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Miscellaneous - 57 COLONIAL AVENUE 4/30/2018 (2)
57, Colonial�Drive� 1 0 MAP # LOT # __..____, PARCEL # STREET • �ON.STRUCTI_Q.N_.APPROVAL • HAS PLAN REVIEW FEE .DEEN PAID? YES NO PLAN APPROVAL: DATE /D APP. DESIGNER: / �S PLAN CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DALE APPROVED BACTERIA I UA 1 E (IPPRUVEU BACTERIA II - DA1E ��RPRUVEll COMMENTS: FORM U APPROVAL: 2 APPROVAL TO I5S E YES IVN DATE ISSUED �✓ BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL ES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DAT'E . ._.BY✓ �. • � r sE12TIP Li.LS1:l��LSS�4 VsiF-t c r, > r• ` .c ::i: `ro*i. r<aa �, # •c>iti 7. yrA>: •..+t _ _ 't i*;..M .•,.y .. ,,� •t` t �3',e n',,, r 4-i .. t� �.�ry ,.�.�C:'^"^T •.hiE THE INSTALLER LICENSED? NO ES rr fr 1. ', i ••�y ` u n. .,n. .'-: �.or••" - ,-..,...' r r.1� JQ t. .w S!-• o ..a r t..,tr ` 'TYPE. OF CONSTRUCTION: t NE REPAIR , .,NEW CONSTRUCTION: :.:. CERTIFIED PLOT PLAN REVIEW = YES �u� r„a l t CONDITIONS OF: APPROVAL �: YES NO (FROM .FORM U) ' r ..ISSUANCE_OF DWC PERMIT r ? YES NO DWC PERMIT N0. INSTALLER: - ,,: ,:i -., ";^rte i:. - . '.` .. - .. . ..••ti. � .. uHEGIN INSPECTION YESO: :j EXCAVATION .;INSPECTION: ; NEEDED: SASSED 'n_ BY .-'.:CONSTRUCTION INSPECTIONS NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL.: DATE: BY ; 1 FINAL GRADING APPROVAL: DATE f DATE: BY Y BY O�//lJ 7 ' `.FINAL CONSTRUCTION APPROVAL: • _ - 3 � U O`NORT1 ,� . O 0 9 Town of North Andover �ti'•,,,,,�: �' HEALTH DEPARTMENT ,�/ CHECK#: �/ /�� ATE: / / O� LOCATION: '-�- H/O NAME: /a7X44;.t,-e-G �r�l A CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSystems : ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Spector $ Title 5 Report $ 5 �. ❑ Other:(Indicate) $ ✓/ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Oct _C9q - Commonwealth of Massachusetts Title 5 Official Inspection FormFnts �cElVIED Subsurface Sewage Disposal System Form-Not for Voluntary AssessmPR1 5 �� 2009 57 Colonial Drive Property Address I HEALTH OE TH AMENTEIR Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 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 �T S When filling out C— forms on the computer,use only the tab key 1. Inspector: to move your Benjamin C. Osgood, Jr. cursor-do not Name of Inspector use the return key. Company Name P.0 Box 932 Company Address Newburyport MA 01950 ' City/Town State Zip Code 508-328-4633 870 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 0, G Q 4-7-09 InspectZes Signature VDate 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r� 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4$-09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiitration 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): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 every page. CitylTown 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): ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is North Andover MA 01845 4-6-09 required for 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 El ® 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 every page. CityrFown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 gpd Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No 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)): 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: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 every page. CityfTown 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: 8-6-06 per BOH 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): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 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 1994 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Pipe looks OK in basement " Septic Tank(locate on site plan): Depth below grade: . 8" 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: 1500 Gallons Sludge depth: 2" Commonwealth of Massachusetts ti - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is North Andover MA 01845 4-6-09 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" 2„ Scum thickness 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 16" How were dimensions determined? Measure Stick 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 PVC tees in good condition Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 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 4 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is North Andover MA 01845 4-6-09 required for every page. City/Town 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.): Box in OK condition. No evidence of leakage in or out. No carry over. Distribution equal. Box 24" below Grade. 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: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is North Andover MA 01845 4-6-09 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3-52' long ❑ 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.): Area of leach field looks normal. Probing with a crowbar in to stone reveals that stone is clean and dry. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 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.): 4 Commonwealth of Massachusetts U°�~ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is North Andover MA 01845 4-6-09 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately D15—14 Nc.E$ 3 TZf;N ttdES A-T4tiK 22•5 1'}-D��x 2s•o a -D�Jx �l9.O IS�o 00 0 .,41� 1 c t Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is North Andover MA 01845 4-6-09 required for every page. CityrFown 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: eet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Basement dry with no sump pump. USGS soil maps indicate water> 6.0 feet below ground. Leach field only 2 feet below ground. Test pits done in 1993 indicate water 84" below ground. Before filing this Inspection Report, please see Report Completeness Checklist on next page. M Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 57 Colonial Drive Property Address Dominic Morrow Owner Owner's Name information is required for North Andover MA 01845 4-6-09 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 Commonwealth of Massachusett ai City/Town of NORTH ANDOVER M ACHU US rr - � 'I�' System Pumping Record � Form 4 N JUL 19 2006 DEP has provided this form for use by local Boards of Health. The Sys em Pumping Record mu be submitted to the local Board of Health or other approving authority. TOWN OF HNORTH ANDOVER A. Facility Information -- -- -- Important: p When filling out 1. System Location: C�� r forms on the computer, use only the takey Addressto move your ___ Q . C / 5 ... � ----- --- -'<2Q —- cursor-do not _ use the return City/Town Sta e Zip Code key. 2. System Owner: Name - -------- - —- -- Address(if different from location) - - ity/Town State Zip Code -- Telephone Number B. Pumping Record 1. Date of Pumping Date ---- 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) c�-=e tic Tank El Tight Tank ❑ Other(describe): - - ----- ___ _-- 4. Effluent Tee Filter present? ❑ Yeso If yes, was it cleaned? ❑ Yesf�to 5. Condition of System: 6. Sy em�Pu�mpQe/}d�By: Name —.�..__ Vehicle License Number Company -A-gz� — - 7. Location where contents were disposed: i ature of Haul Date http://www.mass.gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record •Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) c DATE OF PUMPING: QUANTITY PUMPEDy GALLO:.NS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE '—� EMERGENCY 013SERVATIONS: GOOD CONDITION _ FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) .SYSTEM PUMPED B Y: � G C'ONINIENTS: CONTENTS TRANSFERRED TO: - r . T N OF NORTH'ANDOVER . SYSTEM PUkPING RECORD s1•STEM Owls" & ADDRESS ,. SYSTEM LOCATION — (example: left franc orb Ouse) . /�,14ve; UATF OF PUMPING:_ QUANTITY PUMpCD_ 22 C;ALLO�, ESS11OUL: NO , YYES` SEPTIC TANK: NO YESv a NATURE"OF SERVICE; ROUTINEEMERGENCY ullaCRYATl0NS:, s: Goon CONDJTIOX FULL TO COVER HEAVY GREASE -BAFFLES 4N PLACL ROOTS LEACH FIELD 7tUNBAC& EXCESSI-VE SOLIDS FLOODED SOLIDS CARRYOYBR ,P�HER (EXPLAM) i1 STFIIlm PUMPC6 IBV: C'V�'Ilvr FNTS: • c UN7'Is!Y'1'S' TRANSFERRED TO: Add ress S-7 co 4-o A,I t 11-4. G� 0 Title of File Page of Date File Open: -- Date file closed:_ Doc Document/Action Title Date of _ action Refer to other Purpose of Document/Act o,n and notes Document/ document/ IW u m. ---- Action De artment ---------- Board of Appeals — Board of Heal h Plannin Board ; 9. Canseruaflon Commission — Building Departm, e Form No.4 Town.of North Andover, Massachusetts BOARD OF HEALTH J11nP r-- 19_97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X ) or repaired ( ) by Charles Zaher INSTALLER at Lot #6 Colonial Drive, North Andover, MA #5'� SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 746 dated June 22 , 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. "A RO[ HE LTH Town of North Andover, Massachusetts Form wo.z NORT1y BOARD OF HEALTH 19QS F w p DESIGN APPROVAL FOR s�cMus t� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant__ 9SJUIJjAk'� Test No. Site Location CIO 1— —'*-- b Cleo� azVaA_ a Reference Plans and Specs. 16,Z 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. CHAT RMAN,OKAD OF HEALTH tl 4 Fee Site System Permit No. G 0011114 0 Ofover A Y No. - * o . LAKdover, Mass., 19 I '9-COCMICHEWICK tY'�• Z79S OAS TED �G BOARD OF HEALTH RMIT T PE Food/Kitchen Septic System glL&�w—z�j v'" BUILDING INSPECTO THIS CERTIFIES THAT......................................... .......'...�..,...........� ..�..[.. (v.... ....................../__ ......... Foundation has permission to erect................... .................... buildings on ......5...7..................x. . ..�.1.1.9'.... .... A..V tobe occupied as................................................ �N. +� ......... � ..�....... ........................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms the application on file in Final this office, and to the provisions of the Codes and By-Laws-relating;to the Inspection, Alt ration and Construction of Buildings in the Town of North Andover. PLUMBING SPC OR VIOLATION of the Zoningor Building Regulations Voids this Permit. 9 g PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTO UNLESS CONSTRUCTION ST S -- c ................................. ........ ...... . d LDIN�ECTOR Final Occupancy Permit Required to Occupy uilding GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F Rounal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. = 11 Ff lass UNITED STATES POSTAL SERVICE �`irst-CMail Postage&Fees Paid USPS Permit No.G-10 • Print your name, Ad`dr�, and ZIP Code in this box bow�dAnn Board of B'ealth North � r- Andover, Nlq 01845 3oSENDER: I also wish to receive the ■Complete items 1 and/or 2 for additional services. i ■Complete items 3,4a,and 4b. following services(for an h ■Print your name and address on the reverse of this form so that we can return this extra fee): 2 card to you. ai d ■Atttacc Attach form to the front of the mailpiece,or on the back if space does not 1. El Addressee's Address Z m ■ permit. Receipt Requested'on the mallpiece below the article number. 2. ❑ Restricted Delivery « ■The Return Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number m _ P 205 969 507 c CL Aurele Cormier E 4b.Service Type 0 AC Builder:: ❑ Registered ,. ® Certified fr Cn 3 3 T�T,�lker Raac: ❑ Express Ma�F'� ❑ Insured c North Andover, MA 01345 ❑ Retum Receipt for Merchandise ❑ COD c 7.Date of Delivery .° cc 5. eived By: (Print Name) 8.Addressee's Address(Only if requested I and fee is paid) r I— g 6.Sig taus : (Addre eeprAgent) P Form 3811, December 1994 Domestic Return Receipt Town of North Andover f NORTH , OFFICE OF 3a o�`" °0 COMMUNITY DEVELOPMENT AND SERVICES ♦ y 30 School Street North Andover,Massachusetts 01845 4 °-••'y cy WILLIAM J. SCOTT 9SS'4CNusEt Director June 4, 1997 AC Builders 33 Walker Road North Andover, MA 01845 RE: Letter of noncompliance, Lot 6 Colonial Drive Dear Mr. Cormier: Pursuant to our telephone conversation earlier today and in reference to the many discussions we have had concerning the amount of heavy trucking traveling over the septic system at lot 6 Colonial Drive to, among other things, deliver large rocks to the rear of the house for the retaining wall, there is reason to believe that the system has been compromised. Therefore, under 310 CMR 15.232(2) and 310 CMR 15.226(3) you are requested to have your licensed installer contact this office to discuss the amount of excavation and discovery that will be required to determine that the septic system and all its components have not been damaged by this violation of 310 CMR 15.246(2). This investigation shall be performed to the satisfaction of the Board of Health prior to the issuance of a Certificate of Compliance. If you have any questions, please call the Health Department at the number below. Sincerely, Sandra Starr, R.S. Health Administrator Cc: Wm. Scott, Dir CD&S BOH File CONSERVATION 68R-0530 HEALTH 688-9540 PLANNING 688-9535 �,, -%,.P 205 969 507 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Senitp, Builders Street&Number 33 Walker Road Post Office,State,&ZIP Code No. Andover, MA 01845 Postage $ . 32 Certified Fee 1 . 10 Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to 1 . 10 Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ 2 . 52 M Postmark or Date 0 LL a Stick postage stamps to article to cover First-Class postags,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. ao CV) 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. t€ 6. Save this receipt and present it if you make an inquiry. a Town of North Andover, Massachusetts Form No. 3 pt 14pp7H, BOARD OF HEALTH fL �J 1e•hp 'lti/V C� / 3? pL 19 � O � — 1 9 # y �,'°�,•�� ''`� DISPOSAL WORKS CONSTRUCTION PERMIT SS�CHUSE� Applicant ( ,/�`,•g,� �� � X)���� NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct (-41/or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. t t CHAIRMAN, BOARD OF HEALTH Fee ,::�J D.W.C. No. g�U PLAN REVIEW CHECKLIST ADDRESS Z . �, �6�j�f/�RG ENGINEER 1-114,45-5 GENERAL 3 COPIES STAMP LOCUS NORTH ARROW J SCALE —� CONTOURS PROFILE t_� SECTION "�� BENCHMARK SOIL & PERCS ELEVATIONS WETS. DISCLAIMER V WELLS & WETS WATERSHED? /Vu DRIVEWAY (Elev) WATER LINE FDN DRAIN SCH40 t/ TESTS CURRENT? 3 SOIL EVAL SEPTIC TANK / / MIN 1500G t/ . 17 INVERT DROP &- GARB. GRINDER/-b (+200% EDF) 251 TO CELLAR MANHOLE . ELEV GW # COMPS. D-BOX / SIZE # LINES FIRST 2 ' LEVEL STATEMENTy INLET /CJ 9,5/ - OUTLET /.J9•.3Jr (2" OR . 17 FT) TEE REQ'D? LEACHING / / MIN 660 GPD? v RESERVE AREAy 4 ' FROM PRIMARY? y 2% SLOPE 100 ' TO WETLANDS ---'1001 TO WELLS --' 4 ' TO S.H.GW 5 '>2M/IN) � 35 ' TO FND & INTRCPTR DRAINS,/ 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL? L—(25 ' t. if above natural elev; 101if below) BREAKOUT MET? TRENCHES / � � MIN 660 gpol� SLOPE (min . 005 or 6"/100 ' ) ` _ SIDEWALL DIST. 3X EFF. W OR D (MIN 61 ) ✓_ RESERVE BETWEEN TRENCHES?y IN FILL? ''"MUST BE 10 ' MIN.✓ 4't PEA STONE? 1�, VENT? (>3 ' COVER; LINES >501 ) BOT 7 + SIDE 7/i X LDNG_Le�,L = TOT (L x W x #) (DxLx2x#) (G/ft2) ,��9 (�z Copyright© 1995 by S.L.Starr 1 7 c . R TD 2• x ,0 12 ' o 5 »E � N8 0'07 3 0 . . 145. 9 00 ZOT �n �- 35 956 1 .. 8 28 �-- �� 15 W1,OE EX/517NG FOUNQAT/ON SEE Df TA/L \ �` F , w/oE �5 ,r S �S ORA�N Es F V. R. SEE SEC. 8. 5. 6. D. 1) FORK U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: APPLICANT: A • C. 6ul 11(5 Inc, Phone LOCATION: Assessor's Map Number Parcel Subdivision _W00J land ESl Al t5 Lot(s) � lD Street l D IO n i U I St. Number ********.****************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected ���1_,! �!�� Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Town of North Andover f NORTN , OFFICE OF �?o q�`` t COMMUNITY DEVELOPMENT AND SERVICES ° o . ._. A �- 146 Main Street KENNETH R.MAHONY North Andover, Massachusetts 01845 9SSACNUSEt Director (508) 688-9533 August 28, 1995 Hayes Engineering, Inc. 603 Salem Street Wakefield, MA 01880 Re: Lot #6 Colonial Drive To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) No foundation drain. 2) No wetlands disclaimer. 3) Soil tests - groundwater - out of date. 4) Less than 25 feet from foundation to septic tank. 5) Less than 35 feet from foundation to leach area. 6) No elevations for perc tests. 7) No vents on leaching lines. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, 1 Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Perrino D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell • �l HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 NOA-0042 (617) 246-2800 REFER TO FILE# FAX (617) 246-7596 October 3, 1995 Mr. Richard A. Colantuoni Building Inspector Town Hall 146 Main Street North Andover, MA 01845 RE: Woodland Estates - Test Hole Information Dear Mr. Colantuoni: In accordance with our discussions back a couple of months ago, I have conducted the required test holes and inspected the soils on Lots 1, 2, 4, 5 and 6 Colonial Avenue in the Woodland Estates subdivision in North Andover. The procedure used was to excavate a test hole at each end of the proposed dwelling, determine the type of soil, and also estimate the seasonal high groundwater based on soil mottling. In addition, a comparison was made to the highest groundwater elevation of any nearby test hole conducted for the purposes of septic system design. Based on the highest groundwater encountered in the area, I recommended a cellar floor elevation at least two feet above the highest elevation. My conclusion is that underdrains are not necessary under the Mass. Building Code on Lots 1, 2, 4, 5 and 6 Colonial Avenue. I trust this information is suitable for.your purpose, and, by means of this letter, am requesting you to notify Sandy Starr, Health Agent for the Town of North Andover, so that permits may issue on these lots. Ve truly yours, AVOW OMAs� `M Ii F Im J. WREN N Peter J. Ogren, P.E., *33604 President . t�No 9to+0 t „ au PJO/dab Enclosure cc: A.C. Builders, Inc. TEST HOLE INFORMATION WOODLAND ESTATES NORTH ANDOVER, MASSACHUSETTS October 2, 1995 Elev.Top Elev. Bottom ESHWT 2 Highest GW 3 Minimum Proposed Underdrain Lot# Hole#' Soil Type of Hole of Hole or (mottling) at nearby Recommended Elev. Required Water Elev. Title 5 Elev. Test Hole 1 1A(LE) Silty gravel 141.7 130.7 136.3 135.6 138.3 142.5 No 113 (RE) Silty gravel 145.3 132.3 None 2 2A(LE) Silty gravel 143.5 129.5/water 139.5 135.1 141.5 143.0 No 2B (RE) Gravel 142.7 132.7 139.2 3 NOT DONE 4 4A(RE) Silty gravel 144.0 134.0 138.5 140 142 145.5 No 4B (LE) Silty gravel 146.5 137.5 None 5 5A(RE) Gravel 146.5 136.5 138.5 143.9 145.9 151.0 No 5B (LE) Gravel 147.5 132.0 142.0 6 6A(LE) Gravel 154.0 145.0 None 148.8 150.8 154.5 No 6B (RE) Gravel 150.5 142.5 None ' End of House Facing Proposed Dwelling. LE = Left End RE= Right End 2 Estimated Seasonal High Water Table. 3 Actual or Estimated Groundwater Used in Septic Design. r �� 5 NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: Q PERMIT # o DATE RECEIVED Z �� APPLICANT MAP PARCEL ADDRESS 3 �,{JAG,�E,t� �� ✓V LOT # (� ENG. / 50//C9, �i�/ C ST. ADD. PLAN DATE REV.REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: Po wl rCAly® S T w- o0 T O f= G lU Q TOW�OF Np IIT HAL E No...... .......... ........................... THECOMMONWEALTHOF FHEALTH TS 2 2199 BOARD ,JUN ............ 1.........OF..... .. .......A&V 0.IL0.j -----------..... ... Appliration for Diopoottl Works Tonotrurtion Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: ................_....... 0 ,44..A ... '..:...................... ............Lo.m.��--•....... .,......---.....----.................. /'p --p - _. 4r.r....L�7� J Address Y `-- .... � )� A�Id�t .1/.]i .l l ll..Y...,�. Owner Address W ----------------- ------------------- -........ ......r............. .....-.-•--•--------------•-.... .... ^•. .......................................t.................................................. InstalleF Address �� � Q Type of Building Size Lot._ .. . ............Sq.Ab U Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbagq Grinder Ab Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ..........•-•--•-••---•---....... W Design Flow.............15.5.....................gallons per person per day. Total daily flow....... v.......................gallons. WSeptic Tank—Liquid capacity.lSQagallons Length.......:........ Width................ Diameter............_.. D1e th..__._.._..._._. x Disposal Trench—No..._.3........... Width....M-........ Total Length.....1..g-L.- Total leaching area.�_.t. (a.....sq. ft. Seepage Pit No..................... Diameter............._...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosingtank ( �+ Q aPercolation Test Results Performed by _l�_Y' _.,_..ri_NG.--�_1�C.................... Date.....9".1.::!.4........... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--__-__-___-_-_.-_-----. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................................................. ........ ••-- ..... ODescription of Soil-------------------- - - .....••••C�• ---•---- ILA9.-•-----•-•...••••--••-•••......--.._........•-- x U .........•••-•-••-•••----•-••--•••-••••----...•-•......••--•-•-•-•-•....---•---••••....................• ...--•-•-...-•-....._..•.... ---......-----•-----........--------------------.......--•••--- w -------------------------------------------------•-------------------------------------------,--.....--•-------------•------------------------•----------------•---r•-••--......._....._................ V Nature of Repairs or Alterations r-Answer when applicable-----------------------------------............................................................ -.-..................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL� 5 of the State Sanitary Code— undersigned fu e grees not to place the system in operation until a Certificate of Compliance has been is b the b rd of G� Signed....... -•.•-• -- Cp o2GL Date ApplicationApproved By.................................................................................................. ....................--............... Date Application Disapproved for the following reasons:---.-•-•-•--••-•-•--•••--•-...•••••••--•-•-•---•-•--•••-••-•••...•-•---•-••--•-••••-•-••---•--•---........ ----••-•-•-•--••••-•--••--.....•-•••--••-••----•---••----•-----•-•-•-•••-•-••-••••----••••...•••••--•-•----.._..---•-••---•--•••--•••-••-•-•-•-••--•---•-•-------•---•-•••----••-•----•---••••......- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I............................OF..................................................................................... Trr#ifiratt of Tontphanu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------------------------------------•--------------------------------------------- ----------------------•--•----------•------------------------------.----------•----•--•--------- Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions of I-171 ': 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.••••-••----•••--•-••-----••-•--•-••---•--•--••...•---...__...._---•- •-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF.................................................................................... No......................... FEE........................ RaVooa1 Works Tonotrudion rani# Permission is hereby granted.............................................................,.-----••----•-----------•---•------..........---........._--•••.........----•--• to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No-----------_-------- Dated.......................................... ...............•••••._._.._..._....._...••-----•••------------•-•-•-•-•...-••..._..........,.•••--_...._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TOWN C11r) Bojq GF. PLAN OF LAND / q /N I NO, ANDOVER, MAS SCALE- 1" = 80' ✓UNE 4, H4 YES ENG/NEER/NG, INC. ► 60J SALEM S, C/V/L ENGINEERS & WAKEFIELD, MASS. 0 LAND SURVEYORS TEL. (517) 246—. / CER77FY THAT THIS FOUNDARON /S LOCATED ON THE GROUND AS SHOWN, AND THAT /T CONFORMS TO THE ZONING 8Y—LAWS OF THE TOWN OF NORTH AN0012rR. / FURTHER CERT/f THAT THIS PROPERTY DOES NOT LIE W/TH/N A FLOOD HAZARD AREA (ZONE A OR V) AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUN/TY PANEL NUMBER 250098 0010 S. EFFECTIVE" DATE.• JUNE 15, 198,3 DATE.• V V N �' � � � ��tN of i ---- — --- --- � SIONEl PROFESSIONAL ND SURVEYOR C. FIELD, X #15320 Fss� sulr�' 54. 1 N G FOtJNpATION o � EXIST FNS E�E�_2�62.14 2. o TOP O �, 012,0' N 12.8,0 0 12.8' o• 12.4 Df-TAIL SCALE- N80-0 7',3,5 CALEN80-07'35"E 145-98 o N , LOT 6 o 3 .956 S.F. �_v S8,3 p828„ EXIS17NG FOUNDATION SEE DETAIL ?��SF 25 P WIDE,r ►� h• S �S DRAIN ESM �\ <rl ` SNE.• P.R.D. (R-2) VR Q v '4.fUM SETBACKS.• ANT = 20' r = 20' (SEE SEC. 8.5.6.D. 1) R = 20' i TOwN 01 r11111T. 80,4 OF PLAN OF LAND /N NO, ANDOVER, IWASS. SCALE- I" = 80' JUNE 4, 1996 HAYES ENG/NEER/NG, INC. ► 60,E SALEM STREET C/V/L ENGINEERS dr WAKEFIELD, MASS. 01880 LAND SURVEYORS TEL. (617) 246-2800 / CERTTFY THAT THIS FOUND477ON /S LOC47ED ON THE GROUND AS SHOWN, AND THAT /T CONFORMS TO THE ZONING BY-LAWS OF THE TOWN OF NORTH ANDOVER. / FURTHER CERT/FY THAT THIS PROPERTY DOES NOT LIF W/TH/N A FLOOD HAZARD AREA (ZONE A OR V) AS SHOWN ON n000 /1VSUR4N0E RATE MAP COMMUN/7Y PANEL NUMBER 250098 0010 B. EFFECTIVE" DATE- ✓UNE 15, 198,E f C �'N OF SSS _ SIDNEY PROFESS/ONAL Z SURVEYOR C. FIELD, JR. #15320 P� � fSS 1 Y 4, 1 N FOUNDATION o EXISTI FNp E �E�- 162- 14 02- 14 2. o TOP OF N o 12.0 ti N 12 8'0 0 12.8' o 0 12.4 DETAIL SCALE t480-07)35"E 145-98Po o N LOT 6 1114 35,956 S.F. S8�oB28 15' EXISTING FOUNDAT/ON SEE DETAIL ' WIDE 25 ,r h' P S �S DRAIN ESM ZONE P.R.O. R-2 V R. 0 Q l � v MINIMUM SETBACKS.' FRONT = 20' SIDE = 20' (SEE SEC. 8.5.6.D. 1) REAR = 20' TOWN OF NORTH ANEXJVE, SYSTEM PUMPINQ RECOKD UA 1-1151 SYSTEM OWNER ADDRESS SYSTEM L.Ok'A I ION 12�&4� DATE OF PVMMNQ: _QUANTITY PLJMp6D: sopuc 1'"k: Nu YES L' "A ruKi5C)F38RVICE: K0u'rINE,..�EmEg(jb,,,,. R S C FE i v _D UtASUAVA-nom: OOOD CONDITION �005] KRAYY ORBA3B .��LL -ryj COVE.R JUN 0 3 2005 itooTs — BAMBS IN PLACE, T OWN OF(vU.TH AN,'--,OVER Oxcellolvo SOLIDS LBACKRUD KUNBACK HEALTH DEPART�v,E:NT SOVID CAKUAYOYFLc>ODED —_OTHER EXPLAIN 177a, �:uN Vwns rKANsybxjuL) I.(j Trr,r�'V An ra X Sr yN�.�` , �,1 N-nr I .,i ,I ;rf J�j{h {,;I•, !r `, �aya�7 , r' t, I ,, �k Irl-4a g., 4 1 !„ 'r ', • .C�� 7 df+����. �kL{It rt + rte' \�r �4 1°rl�t.4 i+�i.� t i ' 4 i•rI ��•r� ,ij'Fik7� ��aril+ l;Faf .n r.l� t.� f 1 r..' r •- ii ' TOWN OF NORTH ANDOV ,R SYSTEM PUMPING RECORD pq Y r ,a �� 9' �, +iii. '}_.j�13,_ >�..�4 a I�r ,'"I,� � �`t f::l���� �}�l iZAim� fr .�•}• y�. k{• t _ - so*'il+Id• at�Rlt}�QSh� t j a. ,. w • V -TJ a i. AN.. ,. l 1 F r 6/t r�rY,r ji{r SYSTEM O ADDRESS SYSTEM LOCATION Uft•fro►nt of house) r 1 1 ���� j�,i5t��}�1�'"�"7•rti•J•r� ` �;"'1. a:t-:.r �.���� �. ��,,//J>�/� �+ ''ji1k�TP . I.,..ri i J ref x�'(kr.�K�rJJi�`�,. � /'�"t+'W.�•r"'JIB ' N ;.'? ._..�. • 1 r .>♦.lir P Ir � t� +;�''� ,t�- ,`,�1j�,rrN I � 1. . . . t. iWIN, 'QUANTITY PUMPED GALLONS , VIM,, w� C SSPOOI.• YES 411 JS.,, ,> • •\O .�.. r SEPTIC TANK: NO YES . C1n �!�'� b.• { Air.. r r-.l�•!''��h5,, Ti�T OF'S t a.. ,r i r ri t �4it•• N RO V IY r1 / IJ EMERGENCY (1„ �Jtt�r~7«...r,la fli �Aiw •-. , I y t i j U•i rh� S ;Ay.� TIONS:.k C . ; r- y✓ J i r r+ , r _MOD CONDITION' HEAVY GREASE -~."'• FULL'TO COVER by 1l I yds,P , 15f f. ROOTS —, BAFFLES IN PLACE EXCESSIVE SOLIDS LEACHFIELD RUNBACK SOLIDS C -- FLOODED j�fK :l i•r�,:, r,�w',,{ r F , ARRYOVER OTHER(EXPLAIN) we mammms 77 . a I � rf�h. h'9�:/r'.i`'•1+raj}�1t�• �� 41 Yy��lr7��.�r�.;+ r'^�w.� r '�' > �.C�r?}191+ �Jd1+?e.`i°s” •;fi h.cJ j +^j 1.- �. i yI +f`fr,o itca 1 w.i♦ 04/06/1997 15:02 5083736611 STEWART/ANDOVER PAGE 01 lU,or Ajvt.-,bver Q&ti+,- i7 � vrc� N�rt1 A ncay..- STFM , M 01835 u.w w 1 c t Cr-n41� 578-372-7471 MMM cr NMI ADORM e f loo S' 8vt T food nngn or. . t5od o?3-7 Corl kn lane �� 15ao . � e? 22 -r '79) io�oo f�Ap o m ,d /007 fsdp :5-7 CrA/a h tq/ v 15zrp /e. . G Di»rgn OV' t� TAVer r) Ign 11 dd 15 Lon �� �rh 74 Lcrn gnG I I i I t - 11 I ori n , t i I i { e I I I i ' i ii � ljl Ij I I _ Is1l,t.,711 � . . _ o`! ! ' S 410 1 tL < < �i `i. 4z.` wns4 Sri < I . �---. _ !' leiz - 16 -,fit Soro �Y Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3?oy�t�Eo 'b16 d -19 �— O � ty APPLICATION FOR SITE TESTING/INSPECTION �9SSACHus���h ApplicantNAME ADDRESS ADJDRESS_ _ p TELEPHONE Site Location &T -+e�� A-6(� CL�/� Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee� Test No. L$ L4 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 6,6 19 o „•.a' m APPLICATION FOR SITE TESTING/INSPECTION TED �9SSACHUS���� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.