HomeMy WebLinkAboutMiscellaneous - 594 BOXFORD STREET 4/30/2018 (2) 594 80XFORD STREET t J�
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Lot & Street U0_ro�.9 x k Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: NO Permit#
Plan Approval: Date: l//C % Approved by:
Designer: ��� `� �Jl��i.��l t'1��� Plan Date: -
Conditions:
Water Supply-
Well Permit: Driller:
Well Tests: Chemical Date Approved _- �`" '' ��-
Bacteria I Date-Approved Ia 11_x/.
Bacteria lI Date Approved
Plumbing,Sign-Off: Wiring Sign-Off
Comments:
Form"U'' Approval. Approval to-Issue: NO
Date Issued Z By: -
Conditions: Oji illAo ZXL
Final Approval:
.All Permits Paid? NO
Well Construction Approval? NO
Septic System Construction Approval? NO
Certification? y Y
-< YES NO
Other YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY: / r
r -
•
r � .
SEPTIC SYSTEM LNSTALLATION
Is the installer licensed? No
Type of Construction: NEWS REPAIR
New Construction: . Plot Plan Review -...
.__ �s� No
-Floor Plan Review YES NO
— - Conditions of Approval from Form U YES No
-Issuance of DWC permit: - YES NO
_DWC Permit Paid? —_ YES NO .
--DWC_Permit# = Installer: 2 s y f
- BegfiLInspection:_ _ YES NO ---
_Excavation Inspection:
-Needed-
Passed: / By:
-...-Construction Inspection:
Needed:
As.Buil Ian Satisfactory:
YES:
_=_A proval of Backfill: Date: By:
--Final Grading Approval: Date: q By: Ultl�
Final Construction Approval: Dater By:
v
Certificate of Compliance: Approval: of �/� Date:
� � v
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
" 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
ii
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may nota altered in any
way. Please see completeness checklist at the end of the form. AIV
i G�
Important:When
filling out forms A. General Information
on the computer, P p
use only the tab 1. Inspector: FNO� 0ZME
key to move your 000Ee
cursor-do not John DiVincenzo �oy
use the return Name of Inspector
key.
J Ad S Development Corp/Stewarts Septic Service
ISI Company Name
58 South Kimball St
Company Address
R Bradford MA 01835
Cityfrown State p e
978-372-7471 s113386 of.R,
Telephone Number License Number
B. Certification
1 certify that I have personally inspected the sewage disposal system at this dress 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
Inspect 's Signature Date
The ystem inspector shall submit a copy of this inspection report to the Approving Authority(Board
of ealth or DEP)within 30 days of completing this inspection. If the system has a design flow of
10, 00 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
° M 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
wM 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. City/town 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
wM 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover _ Ma 01845 7-6-17
page. Cityrrown state Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 1/day flow
t5ins.doc•rev.6/16 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
594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is North Andover Ma 01845 7-6-17
required for every
page. City[Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
E] ® 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.
l5ins.doc rev.6/16 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
s•''� 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. Cityfrown 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): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440_
t5ins.doc•rev.6/16 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
,M 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder? ❑ Yes o
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
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: occupiedDate
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.doc•rev.6/16 The 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
^M 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. CitylTown 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: Stewart's Septic
Was system pumped as part of the inspection? ® Yes ❑ No
If yes,volume pumped: 1500 gallons
gallons
How was quantity pumped determined? Site guage on truck
Reason for pumping: To inspect the tank
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.doc-rev.6116 Title 5 Official Inspection Form: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
�.M 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. City[Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed(if known)and source of information:
1999
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 14"feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 117'
feet
Comments(on condition of joints,venting, evidence of leakage, etc.):
r
Septic Tank(locate on site plan):
Depth below grade: 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:
Sludge depth:
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. City/Town 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 30"
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? Tape measure sludge judge
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Both tees are good, no leakage and liquid level is good.
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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is North Andover Ma 01845 7-6-17
required for every _
page. Cityfrown 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
l5ins.doc•rev.6/16 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
,M 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
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.):
Equal distribution, no leakage and no solids carry over.
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.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
® leaching trenches number, length: 3-42'
❑ 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.):
No hydraulic failure, no ponding and no damp soils.
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.doc•rev.6116 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
594 Boxford Street
�M
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. City/rown 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.doc rev.6/16 Title 5 Official Inspection Fcnn:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
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
i
I
i
I
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
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SWING TIES j
COMPONENT ' COR E COR F j
SEPTIC TANK 22.9' 24.3' (CENTER)
D—BOX 47.2' 30.7' (CENTER) j 1 2 0'
END PIPE: A 63.3' 68.3'
END PIPE: B 74.4' 74.1'
END PIPE: C 86.2' 81.6'
END PIPE: D 75.1' 55.3' j
1 1
1 75 � 00 '
-------------
B OXFORD S TREE T
( PUBLIC - 1936 ESSEX COUNTY LAYOUT)
ELEVATIONS TAKEN AT TOP OF PIPE
TOP OF FOUNDATION: SEE PLAN .ms
PIPE ® DWELLING: 136.75 P ZNOFNj
TANK IN: 136.42
S N
TANK OUT: 136.09 RR 4„
D—BOX IN: 135.93 civi011
a
D—BOX OUT: 135.77 (ALL) : p 9:-
END
NOTE: THERE ARE NO WELLS GI ERS �•.
END PIPE — A: 135.36 WITHIN 100' OF `res/ONp�EN���°
END PIPE — B: 135.31 THE SEPTIC SYSTEM ''�•�°�
END PIPE — C: 135.34 ASSESSORS MAP 105C LOT 0022
AS-BUILT SEWAGE DISPOSAL SYSTEM PLAN
LOT 2A BOXFORD STREET MARCHIONDA & ASSOC. , L. P .
NORTH ANDOVER, MASS. ENGINEERING AND PLANNING CONSULTANTS
PREPARED FOR
JOYCE BRADSHAW 62 MONTVALE AVE. SUITE I
BOXFORD STREET STONEHAM, MA. 02180
NORTH ANDOVER, MASSACHUSETTS (617) 438-6121
cr,4 i �• 1 "—zn' n n TC. d. /1 G2 /oo
LOT 2 A.
87310 S . F .
2 . 00 A .,1 _ ®I
132. 7'
SW TRENCHES
42'
43' CONC. �)
RC I1"_ 0-BOX
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2e.s'
1500 AL.
S IC TANK lo.e' T�jST
F F FSU
7 0. 8
N '
G 0
0�
100' WELL
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o�A�oN r r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Foran-Not for Voluntary Assessments
w '5 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
page. Cityfrown 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: 32"to 36"
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: 9/9/98
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health-explain:
Pulled the file
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Taken from plans on file at the BOH.S.H.W.T at elevation 130.00 Bottom of the bed at elevation
134.0
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Ttle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 594 Boxford Street
Property Address
Bryan Hanssen
Owner Owner's Name
information is
required for every North Andover Ma 01845 7-6-17
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
7960 �
33� �4, ,D�•1 0
Town of North Andover
HEALTH DEPARTMENT
CNUS��
CHECK#: 16 3 R� DATE: - jrI
LOCATION: 5 "i^ ,4
H/O NAME:
CONTRACTOR NAME: i zi-arp-
lype 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 $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
�❑[ Title 5 Inspector 55 $
ptJ Title 5 Report 4a, $S�
I � P
❑ Other:(Indicate) $
Hea Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
J AND S DEVELOPMENT CORPORATION
16389
Town of North Andover 8/10/17
i
50.00
\ l
1
i 1
50.00
Haverhill Bank 9613
LOT 2A
87310 &
2 00 AG
t, �. r=✓ 1929
l �
132. 7'
3'W TRENCHES
U
42• �-
C
as �G „"
CONC.
-- D-BOX
Q '
G-
29.6'
1500 AL.
S IC TANK ,o.e' X�S
F F Foo
No I� 70. 8
8' E �3g TioN
N °3
��o w GO
100 o,�
A>�
' LOCAIION r r
I r
r r
I 1
SWING TIES I
COMPONENT COR E COR F I
SEPTIC TANK 22.9' 24.3' (CENTER) If
D-BOX 47.2' 30.7' (CENTER) 12�. 0'
END PIPE: A 63.3' 68.3' r r
END PIPE: B 74.4' 74.1'
END PIPE: C 86.2' 81.6' r I
END PIPE: DI 75.1' 1 55.3' I I
1 I I
I I
i I
1 r r
I r
1 75 . 00 '
BOXFORD S
( PUBLIC — 1936 ESSEX COUNTY LAYOUT)
ELEVATIONS TAKEN AT TOP OF PIPE
TOP OF FOUNDATION: SEE PLAN p.s
PIPE ® DWELLING: 136.75 ���p (H OF M a c
TANK IN: 136.42 moo`'
N
TANK OUT: 136.09 RR
D-BOX IN: 135.93 I '9 �p
D-BOX OUT: 135.77 (ALL) NOTE: THERE ARE NO WELLS p F Gj
END PIPE - A: 135.36 WITHIN 100' OF ►S�ONAL EN i a
END PIPE - B: 135.31 THE SEPTIC SYSTEM
END PIPE - C: 135.34 ASSESSORS MAP 105C LOT 0022
AS-BUILT SEWAGE DISPOSAL SYSTEM PLAN
LOT 2A BOXFORD STREETMARCHIONDA 8c ASSOC. , L. P .
NORTH ANDOVER, MASS. ENGINEERING AND PLANNING CONSULTANTS
PREPARED FOR
JOYCE BRADSHAW 62 MONTVALE AVE. SUITE I
BOXFORD STREET STONEHAM, MA. 02180
NORTH ANDOVER, MASSACHUSETTS (617) 438-6121
SCALE: I "=30' DATE: 4/16/99
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
04/28/99
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by
Raymond Fraser
at
594 Boxford Street (Lot 2A)
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit#1042 dated November 20, 1998.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
ORT
Town of isAndover
0 - L
No. M
-: � / O� 198
- dower, Mass.,
o i LAKE � �� �-
'9�_COCHIC HE W ICK
S BOARD OF HEALTH
C
PERMIT T Food/Kitchen
Septic System,.• /11W
7
�) BUILDING INSPECTOR
THIS CERTIFIES THAT... ...... .... ....... ........... ......A.�. .......................... ............... Foundation 1,41`6s . /,t 60
has permission to erect..............i....................... buildin s on .....�....T.:�........, Q ....Td!.. ................ Roug,/l9,¢]
IN rQ o? ,to be occupied as....�........ l y Chimney.. . ............. . .............. ...................... ....................... ........... . ... . .........................
provided that the person acce ing this permit shall in every respect conform to the terms of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Finale eC
Buildings in the Town of North Andover. SPL,' BIN�P/INSP
F,QTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. G ` 9 l�``�
Y — 9S
PERMIT EXPIRES IN 6 MON S ELECTRICAL SPEC
UNLESS CONSTRUCTI ST T e Roug � �3
� I _ 01
BUILDING INSPECTOR , -
(/� 1 <Fin
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough F f
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FI EPARTMENT
Burner
Street No.
Smoke Det. 6(,G
9-08-199S 0-SSAM FROM P. 2
0d/i7/�n i4:o� 6O6�7n®lam _.ltfv= rnM�Cre OOMi�ONv PMSE 02
9-07—7995 5:_p4N FROM P. 1
aPR-�z-y9 Tub s2s41
TOWN Of NORTH ANDOvElt
SWAGE DISPOSAL SY$TLM
LNSTALLATIO14 CIiRTMcAnoN
Thr imditPedh0by m*64 sw4cD4pvW S,stcm to eoasaaed:
WAID
lomu-.d at s
wu installed m eodamam with the North Andover hoard of Health Vp vved pit%System
Pt�samit a��i ! d I f �P auit as approvw dtsip Qow Of
SO=Pa 4W Tia'mat MWA ltsad were is con b mm WDA tAeeo 9ca W oa the ipyrp
Ph&the"m was tastww to with the pmvisias oe3 i o cmx 15.000,Titk S Sud
10W regutatioas,Md dte fide{Stadittg Apm subgantiaHr,rid,Abe approved Om Au woj is
ac wAftly*armed ort the AMuilt w"l=Wp abmftd tv the Bard of Hcatrh
Bed irnspecdon date: (� _
ALI&# SOC laspccau
And wpecdm&CC.
IttStallerMKI C941 Lu.9:
;tgp Z3 6.
i
�C'A
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAIv]E
r/ ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES &DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
r ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
/ TANK & D-BOX
STAMP & SIGNATURE
�-� IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK{ USED
LOCUS PLAN
TOWN OF NORTH ANDOVER/
BOARD of HEALTH � NO R TM
O E o '9
EAPR 1999 6
6 O
gg {
0 LAKE -'
�j QA COCMICMEWICK 1'
"•913 ATE D PP�\���
-TACHUS
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS/LOCATION OF PROPERTY: _�j �� C , 16 17.
DATE REQUEST FILED/READY FOR INSPECTION: `` 1I ILI 3
CLOSING DATE ON PROPERTY: y
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUIRED
ALL WORK AND SIGN—OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME.
A RE—INSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF
THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGNED: e
C_m 1-4 Co
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIONo 6 N0 oT b;'tio
a. , oL
O A
Permit NO: Date Received l b y,2" v io
Date Issued:
s
SgCHUs��
IMPORTANT: Applicant must complete all items on this page
LOCATION -511� &XIECO 5:7—
P *
:7-
P
PROPERTY OWNER &[Ar,)
Print
MAP NO.:• 05,L PARCEL: -7q ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building Ane family
❑ Addition ❑Two or more family ❑ Industrial
!Alteration No.of units:
❑ Repair, replacement ❑Assessory Bldg ❑Commercial
❑ Demolition
❑ Moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
IniiSN 8AS�I�t�i�'7 (us�nj� �yrn1S r Ii FN;bf`��.(�' S�/7 Si 7�• 1'�/
D/)-v/' 0=-�IU,u6 H-;,AJ/-W h>`r 7 `4( Lt).fn 7V Uscra) 195 /1 r—nwi Ly 401-%
Identification Please Type or Print Clearly)
OWNER: Name: _ 1,476 /4&rJ5r& Phone: 97k 337-71ZJ
Address: S�/ k�eo Si , &LW6r-
CONTRACTOR Name: e SIS 64NIA & 'r"" S, Phone: W-R/-L
Address: Jro BICE 3r eQoL1 lid 72L 5- V,2
Supervisor's Construction License: U Exp. Date:
Home Improvement License: 13 7q1 Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.-S12.00�$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :S ZgS3 3, FEES
Check No.: Receipt No.:
Page I of 4
TYPE OF SEWERAGE DISPOSAL Swimming Pools
Tanning/Massage/Body Art ❑
Public Sewer ❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
^/ Permanent Dumpster on Site ❑
Private(septic tank,etc. L Electric Meter location to
project
NOTE: Persons eontractin ith nregistered contractors do not have access to the gi an fund
Signature of ge wrier Signature of contract r
Plans Submitted ❑� Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
j; HEALTH F1 ❑ joA
L✓`
COMMENTS �y ��c i ;r �r ���d �-' � 01*1
�'Z->fig--•- fi`�+ l ��d e'�^
t r
FIRE DEPARTMENT Temp Dumps e on site yes no
Fire Department signature/date
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection/Signature& Date Driveway Permit
l
f
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro,
Boards and Departments having jurisdiction have been obtained. This does not reliev
the applicant and/or landowner from compliance with any applicable or requirements.
************** **********""APPLICANT FILLS OUT THIS SECTION*********************i
APPLICANT Aa/ y V AeVWAI �/7r✓Ssz 1V PHONE f%
LOCATION: Assessor's Map Number zUg C PARCEL DD
SUBDIVISION L LOT(S)
STREET,5q� �,Pa/ shceef ST.NUMBER
** ***** *, ** ►** * *** ***OFFICIAL USE QNLY* ►**** * ** *** **
REC0,#I14ENDATIONS 9F TqYVN AGENTS:
/Co
NSERVATION ADMI ISTRAT DATE APPROVED t3
DATE REJECTED
si
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
' DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
' DATE-REJECTED
COMMENTS
PUBLIC WORKS-SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 im
I i
�a 'T U E 1 S : S S p - 01
Ay q i
LOT 3A q
i N
LOT 2A
87310 S.F.
2.00 Ac.
' 132.7'
cd
i 8 .8 J�p3
N/F
N GORTON
A>.
i
y1�N DF Algs�� i.
oa 128.0'
STEPHEN M.
MEIESCIUC
No. 39048
I • �AO'�fSS�paCp�
� %SUP�Eyt •
175.00
BOXFORD STREET
WE HEREBY CERTIFY THAT WE HAVE EXAMINED
THE PREMISES AND THAT ALL APPARENT
EASEMENTS AND ENCROACHMENTS ARE LOCATED
THIS PLAN IS INTENDED FOR ZONING ! AS SHOWN. THE STRUCTURE SHOWN CONFORMS
PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY
FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO. ACCORDING TO THE
WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.O. FLOOD INSURANCE RATE MAP,
BY AN INSTRUMENT SURVEY. THIS PLAN j COMMUNITY PANEL NO. 250098 0009 C
SHOULD NOT BE USED FOR PROPERTY DATED 6/2/93, THE STRUCTURE IS NOT LOCATED
LINE DETERMINATION. 1 IN AN ESTABLISHED, 100 YR. FLOOD HAZARD ZONE.
CERTIFIED PLOT PLAN
WT 2A BOXFORD STREET I MARCHIONDA & ASSOC.,L.P.
NORTH ANDOVER, MA ENGINEERINC AND PLANNING CONSULTANTS
PREPARED FOR - — ---
62 MONTVALE AVE. SUITE I
KERRY & BRYAN HANSSEN STONEHAM, MA. 02180
a @24BOXFORD ST (617) 436-6121
NORTH ANDOVER_MASS. SCALE:1"=50' DATE: 12/23/98
i
Town of North Andover, Massachusetts Form No,3
Of NORTH, BOARD OF HEALTH
.ti0 i
F? , ___„�___19
49 t i
°0- DISPOSAL WORKS CONSTRUCTION PERMIT
4A US
Applicant_ Aa-
NAME ,1 ADDRESS TELEPHONE
Site Location �:7` ''4 z22< '�"j 2 1
Permission is hereby granted to Construct (}Q or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No,
CHAIRMAN,BOARD OF HEALTH
I•'
Fee / D.W.C. No. d
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: J'��f CURRENT INSTALLER'S LICENSE#_
LOCATION: 624 RoA FOl-?D 5T)��.6r
LICENSED INSTALLER: f719 yWkld T. FRA SE J1
SIGNATURE: TELEPHONE# q7g-rI14'8140
CHECK ONE:
REPAIR: NEW CONSTRUCTION: i
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes ✓ No
Foundation As-Built? Yes ✓ No
Floor Plans? Yes No
Approval Date:
TOWN
TEEM U UGaSK T UAAI7O
F� RF
&Associates, , _,[E
EAPRAP6.Engineerimand
.W f � planning Consultants oATE
t' ,oe No.
MM
(617)438-6121
Fax(617)438-9654 --`
AT T'i0A
TO v___=�� RE:
o x --=
WE ARE SENDING YOU ❑Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑Prints ❑ Plans ❑ Samples ED Specifications
❑Copy of letter ❑ Change order
GATE I I DESCRIPTION
COPIES NO.
THESE ARE TRANSMITTED as checked below: I
❑For approval 0 Approved as submitted ❑ Resubmit copies for approval
IK/For your use ❑ Approved as noted ❑Submit copies for distribution
❑As requested ❑ Returned for corrections ❑ Return . corrected prints
❑ For review and comment ❑
❑FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY•TO w SIGNED:
It...I....... ...not ss noted.kindly notify us st nate.
fL-Associates,L.P.
q .Engineerinwand ;
0. Plannin-,Consultants DATE? Joe NO.
Fax(617)438-9654? �. ATTENTION
TO TO y"D v, 01ear RE:
Uor SA
M A
r
WE ARE SENDING YOU Attached E. U. =e eparate cover via. the following items:
❑Shop drawings G Prints ❑ Plans ❑Samples D Specifications
D Copy of letter ❑ Change order
DATE
COPIES
NO. I - DESCRIPTION
I
tel.
I
i
THESE ARE TRANSMITTED as checked below:
For approval D Approved as submitted ❑ Resubmit copies for approval
XFor
your use ❑ Approved as noted [ISubmit copies for distribution
DAs requested D Returned for corrections ❑Return corrected prints
C) For review and comment ❑
O FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS p T 1 0QC--06 S �I� AO'EA
t
_rd . j.I. c = &.0O6(> ►WF012.HtArtoN
QC aA•T To 1?a%-T IC,oN a Ar4o%JT
COPY TO SIGNED:
M� F
If enclosures are not at noted,kindly notify us at once.
Oct-29-98 08:39A Paul D. Turhide, PE/PLS 508-465-0323 P.02
I
October 28, 1998
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover,MA 01845
RE: Title V review for Lot 2a Boxford Street(Map IOSC Lot 22)
Dear Sandra,
Enclosed find the"Checklist for North Andover Septic System Plans"for the above-
mentioned site. Generally I did not find any major problems after reviewing the plan
with the checklist but I do have some minor concerns.
SOUTHERLY RESERVE TRENCH PLACEMENT
The southerly reserve trench should be moved to the northerly side of the leaching
trenches for two reasons:
1. ESHW is generally at 34"below the ground surface. The high point of the leaching
bed is at the northerly reserve trench with a ground surface elevation of about
133.5'. This would mean that ESHW for the high point of the northerly reserve
trench would be about 130.7 ,which is 0.7' above the design ESWH of 130.0'.
2. The elevation of the finished grade 15' off the leaching bed is designed as 135.5' at
which point the 3:1 slope drops off to existing grade. As shown on the plan,this
135.5' point is 15' off the most northerly trench,but is only about 8'ofFthe most
northerly reserve trench.
Thus either the whole system has to be raised about 0.7'and the 3:1 slope must move 7'
more northerly,or the most northerly reserve trench must be moved to the southerly
side of the leaching bed.
MINOR CONCERN
One minor concern is whether the placement of the system will create ponding on the
southeast comer("upper left")of the lot. If the grades are such that runoff from Lot 3A
if running between the 132 contours onto locus,then the placement of the system will
cause ponding. However,if the system is being built on a"saddle", and runoff is
flowing from the system area southeast off the lot onto Lot 3A,then there will be no
PJDqJ ponding. There is not information on the plan of contour or spot elevations to know
0 R1 which way runoff is flowing,but it should be checked.
ENGINEERINGif you have any questions or comments please feel free to contact us.
Civil Engineers& Sincerely
Land Surveyors
One Hartis Street
Newburyport.MA Carlton A.Brown,PETLS
01950
(978)465-8594
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and^0;0artments having jurisdiction have been obtained. This does not relieve.
the applicant andlor landowner from compliance with any applicable or requirements,
APPLICANT FILLS OUT THIS SECTION
APPLICANT Or i(Arj t kef lol 1141%)S a,✓ PHONE178-X22--//j Z S�
LOCATION: Assessors Map Number /OS h— PARCEL
SUBDIVISION LOT(S)_a_4
STREET F o X (-ocz � ✓tee.¢
ST. NUMBER
_00 '*'"OFFICIAL USE ONLY
RECO M ND TION OF TOWN AGENTS:
CONSERVATIO INISTRATOR DATE APPROVED
r-� DATE REJ TED
COMMENTS – O V 't'l Oct flS
TOWN PLANNER DATEAPPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED o�?Q
DATE REJECTED
COMMENTS
k[o E
PUBLIC WORKS -SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Town of North Andover NORTH
OFFICE OF �ao,�' °1
COMMUNITY DEVELOPMENT AND SERVICES A
27 Charles Street ►
North Andover,Massachusetts 01845 SgeMus t�5
WILLIAM J.SCOTT
Director
(978)688-9531 Fax(978)688-9542
November 20, 1998
Kerry&Bryan Hanssen
C/o Joyce Bradshaw
624 Boxford Street
Worth Andover,MA 01845
Dear Mr.&Mrs.Hanssen:
This letter is to inform you that the most recent plan for the proposed septic system to be installed
at Lot 2A Boxford Street has been approved.
If you have any questions,please call the Health Department office at the number below.
Sincerely,
Sandra Starr,R.S.
Health Administrator
Cc: M.Rosati
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Nov-19-98 01 :24P Paul D_ Turbide, PE/PLS 508-465-0313 P.02
November 19, 1998
Sandra Starr
North Andover)Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover,MA 01845
RE: Title V review of revision for Lot 2a Boxford Street(Map 105C Lot 22)
Dear Sandra,
I find that the cogs raised in my letter dated October 28, 1998 have been
satisfactorily addressed and therefore have no other problems with the system design.
If you have any questions or comments please feel free to contact us.
Sincerely
Carlton A. Brown,PFRLS
PORT
ENGINgING,
Civil Engineers&
Land Surveyors
One Hams Street
Newburyport,MA
01950
(928)465-8594
SEPTIC PLAN SUBMITTAL FORM
LOCATION: F �
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES . $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES NO
DATE: I°1';4 9�
DESIGN ENGINEER: 1111A/1 eJ41, /NdzI
DATE TO CONSULTANT: 16Lv-6,1m
When the submission is all in place, route to the Health Secretary.
Town of North Andover, Massachusetts Form No.2
MORTry BOARD OF HEALTH p Q
c19
OL- IIA
DESIGN APPROVAL FOR
as�CINU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant — Test No.
Site Location ,�* Z
Reference Plans and Specs.
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 HEALTH
Fee 61 Site System Permit No. b L
I Town of North Andover, Massachusetts Form No. 1
NoerH BOARD OF HEALTH
6gtioL -� 3 19
o ,n
APPLICATION FOR SITE TESTING/INSPECTION
ED
��SSgCHUSE��y
Applicant 1' e �'� � ����At� C1ckm !sse- N-
NAME j f ADDRESS TELEPHONE
Site Location x 41t"
Engineer
/{ !1k, 619/7/,TAee/Y/, wkv
NAME ADDRESS TELEPHONE
4
Test/Inspection Date and Time
P) CHAIRMAN,BOARD OF HEALTH
Fee c4,0 Test No.
t
t'
S.S. Permit No. D.W.C. No. C.C. Date Plbg°Permit No.
SOIL EVALUATOR FORM
FORM 11 Page I
No. . ............... Date.....
r Massachusetts
11------.00-COM-Monwealth of Massachusetts.
Soil suitabilia Assess X
Lew
—eMsposal
.........................
Performed By: ..... . .. . . ......... .......... ...........
Witnessed By: .:...:..:..: ...........
......................-....................................................................... .........................................................
......................................................11......................... ------
Landon Adds=Or a_0 .5T Address.ud
Telephone# &Z4
New construction Repair ❑
Office Review
V'STO r4 y
No El Yes F.S.L ,
Published Soil Survey Available: .......... soil Map Unit ...
Year Published 1W... Publication scale 1'1(1,000
Drainage Class Soil Limitations .........................................................................................................................
❑
Surficial Geologic Report Available: No Yes
Year Published ................... Publication Scale ................. ............
Geologic. Material (Map Unit) ......... ..................................................................................................................
Landform ...................................
Flood Insurance Rate Map: ❑
Above 500 year flood boundary No F7 Yes
Within 5.00 Year flood boundary No ❑ Yes
❑
Within 100 year flood boundary No ❑ Yes
Wetland Area:
...............................................................................................
National Wetland Inventory Map (map unit) .................
Wetlands Conservancy Program Map (map unit) ...................:!7n.......................................................................
Month
Current Water Resource Conditions (USGS): Below Normal
Range Above Normal ❑ Normal J
Other References Reviewed:
FORM 11 - SO&EVALUATOR FORM
Page 2
On-site Review
Dee�Hole Number ........ Date:.9.1 11� Time:... Weather R%k7---------------.......
Location (identify on site plan) .......111 ----:....Tb G2.4.........PkZ. X'F! 4 0 V.......................
Land Use ....................... Slope M Surface Stones ...........*................................................
Vegetation ...... It. ...............- .........................
? A(N.� .............................................................................................................................................
Landform S)YT t
.................................................................................. ............................................................................................
Position on landscape Isketch on the back) ....... =vc..T.. 1.(.......1 ......................................
Distances from:.
Open Water Body feef Drainage way �iifeet
Possible Wet Area73PP.. feet Property Line ... feet
Drinking Water Well �%71 feet Other ....... ...........
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(inches) (USDA) (Munsell (Structure,Stones,Boulders,
Consistency, %Gravel"r
12'- 24"
J.
C>\IrL f
ysl 00W C-Aj
................... - Depth to Bedrock: ....................
Parent Material (geologic) ...................G-S4—c) NvN
................................
Depth to Groundwater: Standing Water in the Hole: Ot E. Weeping from Pit Face:
Estimated.Seasonal High Ground Water:
FORM 11 - SOIL EVALUATOR FORM
Page 3
Determination for Seasonal High Water Table
Method Used:
Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole................... inches
Depth to soil mottles inches
❑ Ground water adjustment feet
Index Well Number................... Reading Date ................... Index well level ...................
Adjustment factor .................. Adjusted ground water level ........................................................
Depth of Naturally Occurring Pervious Material - -
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? �J E S
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on 1444 (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature Date
i
v FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
�d L�tJ�Csv�►2_, Massachusetts
Percolation Test
2: +
Date: _... ...
. ... .. Time: ........................moo.........PK
Observation Hole # pt�,
Depth of Perc (00%1
Start Pre-soak - -
End Pre-soak 0S
Time at 12"
Time at 9"
Time at 6"
\� 33
Time (9"-6") 1
Rate Min./Inch
Site Passed Site Failed ❑
...............................................................................................................................................................
Performed By: 1 kkLA�*e�, 5 3ai
Witnessed By:
Comments: .................................................................................................................................. .........................................................................................
FORM 11 SOIL EVALUATOR FORM
r Page 1
qq qC}
Commonwealth of Massachusetts
4 , Massachusetts
Soil Suitability Assessment for On-site Sewage D snosal
Performed By: .......................................................................AYL `..S.........
Witnessed B :.....:.,...........................:..
y
................................................................................ ...............
�=0120 ST Ow-WI Name. Wj%k 1 A K
.
Laaom Address a' Address. id
a
Lal Telephom I "'e•`t �� � s�
New Construction Repair ❑
Office Review
V STo�y
Published Soil Survey Available: No ❑ Yes
�..a�Tv*� F•5.L .
Year Published
19�� Publication Scale .�..-..K0,000 Soil Map Unit ...C�$—L
DrainageClass W.D. ... Soil Limitations ..........................................................................................................................
Surficial Geologic Report Available: No fK Yes ❑
Year Published Publication Scale
GeologicMaterial (Map Unit) ...:................:...................................................................................................................... ...........
ogc-W4;;0 'p1a�
..................................................................................
Landform .................... .............................
.........................................
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑ Yes ❑
Within 500 year flood boundary No ❑ Yes ❑
Within 100 year flood boundary No ❑ Yes �.
Wetland Area:
National Wetland Inventory Map (map unit) .........................................................................................................
Wetlands Conservancy Program Map (map unit)....................--.......................................................................
Current Water Resource Conditions (USGS): Month
Range Above Normal ❑ Normal' ❑ Below Normal
Other References Reviewed:
FORM 11 -SOW EVALUATOR FORM
Page 2
On-situ Review
Dean Hole Number ..._.�.......... Date:. .� .� � Time:... �:_0 �n Weather ...... .............................
E`
Location (identify on site plan) ..... 34C.:....T�........fa_4........ ....�.. ........-...UT.......ZA......................
�f3C'� ........... Slope 3-5°
. Land-Use ...........................5,............ pe (%) ��------------1Q Surface Stones ...-....�.�.lrJ....-•----.................................................
Vegetation ..... ...5........................................................................:............................................................................................................................
LandformTIPY!4
Position on landscape (sketch on the back) .......` ...-....1UP ?. TAP �.(....-...1 4.` ......................................
Distances from:
Open Water Body 7. .. feet Drainage way..:..... ......... feet
Possible Wet Area73.. ... feet Property Line ...4 ..._. feet
Drinking Water Well feet Other........................................
DEEP. OBSERVATION HOLE LOG
-Depth from Surface Soil Horizon Soil Texture Soil Color Soil Matting Other
(Inches) _ (USDA) (Munsell - (Structure,Stones;Boulders,
Consistency, %_Gravel)'—
O— vL`'
12 CZ � Yo Vlrl41(0 5ck-•E FaH '50*c
_i2- C 3 �. 51,. 'Z&Y sr e v
Parent Material (geologic) ............ `N`.y....... -fl.........................._- .__ Depth to Bedrock': ......V30 V.
Death to Groundwater: Standing Water in the Hole: Weeping from PirFace: ..1E
u
Estimated Seasonal High-Ground Water:- ..3 .
l FORM 11 - SOEL EVALUATOR.FORM
Page 3
Determination for Seasonal High Water Table
4
Method Used:
❑ Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole................... inches
Depth to soil mottles inches
❑ Ground water adjustment feet
Index Well Number................... Reading Date ................... Index well level ..................
Adjustment factor .................. Adjusted ground water level ................................................:.......
Death of Naturally Occurrina Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? �JE S
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on ti1e�i 19�� (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
o
Signature Date
w- FORM 12 -PERCOLATION TEST
` COMMONWEALTH OF MASSACHUSETTS
�Oovc�L, Massachusetts
Percolation Test
2-.JO'}
Date: .. ............ ` Time: ...... . ....................Pn
Observation Hole # a
Depth of Perc
Start Pre-soak
End Pre-soak ; aG
Time at 12" 00
Time at 9"
Time at 6 'Z Co
Time (9"-6")
Rate Min./Inch
Site Passed Site Failed ❑
..................................................................................................................................................... .......
Performed By V�CAtle�
Witnessed By:
j
...................................................................................................... �3
fiq
. I
FORM 11 - SOIL EVALUATOR FORM
Page 1
qc� Q
�-- Date....�:. :....1....l.v
{ No._...\��..
Commonwealth of Massachusetts
Massachusetts
Soil Suitability Assessment for On-site Sewage Ih'snosal
t�tct�cfl.
;Y. I..................
PerformedBy: ................................................................................................................
Wimessed B Tcl?-T...:::: .��.:: Y2p. -: ........... :.::.....:.... ::..w::":::...N:..: A::.::::::::::::::: .: .
...........................................................................................I...............................
LoWon Address.a . �.��i� Owner's Nsme. W 0k 1&.K- 6 o2Tr'0 t .)
Ld/' 1111'"' Address.And 5,71`
Telephrn Y `-"'�
C►I—� �,jb. AS��o0���2 r KA
New Construction Repair ❑
Office Review.
V STo�y
Published Soil Survey Available: No ❑ Yes r-�
I 'I�,oc�o C B—L
Year Published .`98� Publication Scale Soil Map Unit ........
DrainageClass 4.0,.... Soil Limitations ..............................................................................................................................
Surficial Geologic Report Available: No Yes ❑
Year Published ................... Publication Scale ...
GeologicMaterial (Map Unit) ........... .....:........................................................................................................................... ......
Landform ...p.47 A§A .................. ..........................................................................................................................
Flood. Insurance Rate Map:
• Above 500 year flood boundary No ❑ Yes ❑
Within 500 year flood boundary No ❑ Yes ❑
Within 100 year flood boundary No ❑ Yes �►
Wetland Area:
National Wetland Inventory Map (map unit) ..................................... ....................................
Wetlands Conservancy Program Map (map unit).............................................:...............................................
Current Water Resource Conditions (USGS): Month ........`........uST
Range : Above Normal ❑ Normal ❑ Below Normal
Other References: Reviewed:
FORM n -SOW EVALUATOR FORM
Page Z
On-site Review
Dee ,Hole Number..........:.. Date:-9- lica
Time:...�'.�b �n Weather .......G42r.......-
Location(identify on site pian) .......�<C..........m......fai4........ A .tl .....Cr.T �..._..............
r 0 .......... Slope (%) 3.'S.�D Surface Stones ..... .ttJ...........................................................
Land Use ...........................5....._.__..
Vegetation .....� E.�....................................................................................................................................................................................................
Landform .........T F !!4...........
....................................................................................................................................................
Position on landscape (sketch on the back) ....... ..... .......1 4. ......................................
Distances from:
Open Water Body 7.'-'OD.. feet Drainage way - feet
Possible WetAreaZ .. feet Property Line ... ...... feet
Drinking Water Well �.�71......... feet Other.........................................
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(Inches) _ (USDA) (Munsell) - (Structure,Stones;Boulders,
Consistency, Gravel'—
L
z �o>
s "t.o ko Yv 124
C'?_ F. L. 5 . M rL 4(o Q_SO�E
Parent Material (geologic) ............... ........................................................ ...... Depth to Bedrock: ........... .. ... .....
Death to Groundwater: Standing Water in the Hole:�`r�r�... Weeping from Pit Face: ...
.......?!...
�l
Estimated Seasonal High Ground Water: ...
i
FORM 11 SOIL.EVALUATOR FORM
Page 3
Determinadon for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole................... inches
Depth to soil mottles ..... inches
❑ Ground water adjustment................. feet
Index Well Number................... Reading Date ................... Index well level ...................
Adjustment factor .................. Adjusted ground water level ........................................................
- Depth of Naturally Occurring Pervious Material-
- -
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? VE S
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on NOy► n94 (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature Date �O Z3 9rf
�r FORM 12-PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
k*Jm Massachusetts
Percolation Test
Date:
q`� Time: ......2. Jo }PK
Observation Hole # �
Depth of Perc wo
Start Pre-soak
End Pre-soak
Time at 12" \,Z1
Time \' No
Time at 6" : Z�
Time (9„-6„)
Rate. Min./Inch
Site Passed Site Failed ❑
...............................................
.........................................._..............
Performed By: < <.
Witnessed. By:
Comments: ..............................................................._...............
............................................................._....
is
:.y
,i
i
NORTH ANDOVER BOARD OF HEALTH
AUTHORIZATION FOR SOIL TESTS
LOCATION ENGINEER TEL# PAID DATE TO PORT
Boxford Street Mike Rosati/Marchionda 781-438-6121 Yes Faxed 8/31/98
NOTE: This is additional testing for this lot. Already tested unsuccessfully with Port. Please schedule as soon as possible.
Thanks.
i
I
I
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NUMBER FEE
THE COMMONWEALTH OF MASSACHUSETTS
198
_ rZ.W.A f /Qr04r,Y.. V, 2Ll.....................
-� This is to Certify that ......................� 1.l'�.C����: --. 1_.:
`i
NAME
AM
— -.
1 ADDRESS
1
} IS HEREBY GRANTED A LICENSE :
, ny
G .For l!U ----•- -------.•-......GG..... ..............................................
., *� _.... .. ........-•------•....................•-•----...-----........__..._..--------•--................----•-•----.._........------------------....-----..._........---••--•----•---
�
::- - . .
This license is granted in cont rmity with the Statutes and ordinances relating thereto, and
, a
expires-_ ....�',_4..,._�q�j__ ______________________unless sooner suspended or revoked.
-
_,_____ .....
_ ... __________________________7 ..._.
--------------�__ ......
p (W
- FORM 433 HQcW HOBBS&WARREN -
.' M t r
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`a � � '.� 'G .,h .• '� Y �S+ ,1 H } ry1 y 3 �-S y �-d. �•4
..�.. '. .
S-31-199S 7:54AM FROM P. 2
ZOS-1999 10:57AM rROM P_ i
! MAO 06:50 FAY 0783528434 VIMU WELL. CO
tool
Zoe.
DMO or MUTH
WORTH ANWVU, MASS.
APPLICA -EM JEWS AND T
mit � ,..... gate
A permit is requested tug drill m well L� install a puny
IACATZON:.M�Z ew&3952� gv_ Lot ..a
Owner Q?�.5.._ l►ddtes48 b2`iti T.�w�kms' - Tal L: :7 2-m ao
well CMtrctr
VMP CMCxetrl��iq[��' l� �••� Add. sT� Tel,�y'esrS�9//l
s�,t���,�s,rts�►rsrsr+rrr+s�Rssrtsss�,uses*+r*ss�►sswa*#sss�►+.►ssres�►s,�sssie��r#t
WELLS (To be aamtple= at time of pump test.)
Type at well use
Diameter of well Sire of casiag_jg_:: ^
Depth Of bed 1'dCl[ _jbaL�OepthCess 121tO bedltock Z&L_ 7�0 0-7A -
rwr
Seal been tested? . Yes ( X) Ido (_j Date of test
of Voll__ hater-bearing rock_
Depth to watev 2,� — D4iVM-5__jZ2_ OM for
Orawdown Peet altertaw 1org j`—
pumping'. ours atAALI am
Date of coaopiotian_/ -$� ,,iM
ll Contractor
ae►a►ai,ra,s*ss+�to;sA�:stwssr•atstsssrisi fi*ssr►oti*esyes*ssssoses��rs+►s+
POS M (To bo filled in Wore instal ti est.)
Fame r1r sit* of
Size of tank p delivers Ste_ CPR
PIPs used ift wells cast iron (_) Galvanized (_) plastic OL,
Slurs used to protect pipe? Yestom) we (VI Type well seal ► k. �.�
Date /2/2 5/_rl
S tore oP to e
t•sl,t•sisaws,tew.l:sss#,t*sks:sew,►*+►ss�wsr�►,es+r►r:ss.►r�,►ssrtsaossesssoss,e�►s
Date water analysis report submitted to Board of Health
5'1 pector fng I,nap*etor
Board of H[sa th
S-31-1995 7:5SAM FROM P. 3
Departmeni otlErnlrt tmental ManagamenVOlvigion of Water Resources
t
WELL COMPLETION REPORT
WELL LOCATION //�� p / GEOGRAPHIC DESCRIPTION
Address�g d n Y��,t?'�. iC[► �
CityiTown W of
Well owner r'.rJ ,-.,� - f �
Address: -
N' S W at i
/ .f •y .,
Board o1 Health Permit Obtained:: yeb ���P •. irtr6rsea;w/�+'C1NCA/1l "
wELL lJ x WELL DATA
Domestic;,19 Public❑ Industrial❑ Total well depth
Monitorir ig❑ Other
Depth to ttadrock ft.
Water-beaking rock/unoon5o►idated material: : ;
Method Chilled
! Description /�Yn L4
Date dila( tt
CASING
Waterbearing zones:
Type�1 ? 1)From
2)From —�To—_,� �#
Length,;�u ft.i Ofa(1.0.)�In. 3)From--.To
Length
*:.• '
Length inito bedroCkt� n. C,ravei Pack well• dia.
Protective well Beal:
Grout Screen: dia.
�� Other Sloth length from_to _._.
STATIC:WATER LEVEL(alt wells)
1
t�
Static YAW level below land auif�ce ' ft WELL:TEST�(pro�d-action wells)'
DrdwdownsV J 1L after
pumping _L hr, min.at` ,gpm
How msiasured a, l� i �r
R+ -20p.G.h, after hr. , Qrrtin
LOG of FORMATIONS COMMENT$
Mater lale From TO
AIA'9 Ji/ _ Ori�ler /
Address
Crow
u ervlsing er Reg
.x^,
•:.� Slnnatrnolau0enti�Ra endwetla!!!or
__ .. ARD OF HEALTH copy,
8-18-1995 6:44AM FROM P. 2
I
66 LITTLETON ROAD,WESTFORD,MA 01886 (978)692-8395 FAX(978)692.0023 1-800.649-TEST
Report Number: C-wps-35556 Report Date: December 15,1998
Client: Samp2e taken at.
Wilmington Pump Supply Inc. Lot 2A,594 Boxford Street
P.O.Box 517 N.Andover,MA
Wilmington MA 01887
Sample taken by:Client On: 12/10/98
Certificate of Analwe
I
I
TEST PARAMETER EPA MAX RESULTS UNITS
Total Coliform(P) 0 * 0P er loom)
Iron(S) 0.3 # 2.3 mg/1,
Manganese(S) 0.05 0.04 mg/L
Sodium "28 237.5 mg/L
Chloride(S) 250 # 305 mg/L
Hardness No Limit 47 mg/L
Nitrates(as N)(P) 10 <0.01 mg/L
Nitrites(as N)(P) 1 <0.01 mg/L
PH(S) 6.5-8.5 7.4 SU
NT--Not tested,#=Value Exceeds EPA STD,TNTC=Too Numerous To Count
*=Background Bacteria Noted,"=EPA Advisory Limit,'=,Exceeds Advisory Limit
(P)=Primary EPA Standard,(S)=Secondary EPA Standard(may affect aesthetics
of Drinking Water,Le.taste,cotor,etc.) '.=E.coli present.
This water sample,as submitted,is considered Safe to drink according to EPA
guidelines.However,one or more parameters exceeds EPA secondary standard
as denoted by the#sign.
Massachusetts State Certified
eicalarlsoC�fo
Testing Laboratory#MA048 Thorstensen Laboratory Inc.
9-07-1999 2:09AM FROM P. 2
0412711999 e8:43 918-6e8-9575 N anuDvER DWTP FUCE M
P AW Fax Note 7672
a7•yp
i CN
TOWN OF NORTH ANDOVER/
BOARD OF HEALTH
Fat
yes T ,
Ej IM 27 Im
Hath Mda�
Watcr Tmaonem Plarrt
4"tit Pond ROW
Nos*AW*m,MA 01845
April 21,)499
CUM With M Bairctt Horses
1049 TLsnpike Street
NOZ'ttl Andover,.Ma 01945
The f0U0"'*a�e the resuks of the tests perfol=d on your wafer sample:
Testa)Pc7fornted:
Cmamage ML
. D T
4126!99 A39,16 . ' . 594 Boxford Sttoet(wrp) Q
North A,adowr, Ivb
If you have my fumo gwgions pig me Ca!!118 at 6WO$74,
Siucerd ,
Y
Kdly Lmtc
Senior Water Analyst
Norsk ArAom W&W Titatment flan!
Mass, Cert.#for Bacteria MA21054
S-03-1995 1 :44AM FROM P. 2
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66 UTTLETOW ROAD,wEST;ORD,MA01886 (978)692.8395 FAX(978)692-DO23 1.800.60-PEST
Report Number: C-wps•3555S Repast Date: December 15,1998
CkiCnt:
Saute taker:at:
Wil>uiAgft FAMF Supply lnc. Lot ZA,594 Boxford Street
P.O-Box 517 N.Andover,MA
Wilmington MA 01887
Sample taken by:Client tJn: 17)10/98
CArfiGM * t - 1
TBSTPARAMETER EPA MAX RESULTS UMTS
Total Coliform(P) 0 ` 0 per 100=1
Iron(S) 0.3 d 2.3 MVI
MaBum(S) o.os 0.04 Met
Sodium 1128 237.5 mg/L
Chloride(S) 250 it 305 mg/L
Hardaess No l jmh 47 (
Nitrates(es N)(P). 10
Nitrites(as N)(P) 1 <0.01 mSn-
PH(S) 6.5-8.5 7.4 SU
NT-Not testod,#--Valuc Excmds EPA STD,TNTC=Too Numerous To.Cow
•=Baftrvand Bacteria Noted,"=EPA Advisory Lireiy'-Exece&Advisory Limit
(P)-larmwy EPA Standard,(S)=Secondary EPA Standard(may affect aesthetics
of Drinking Water,i.e.tam color ac_) '=E.coli preseat.
This water sale,as Submitted,is considered Safc to dtiak according to EPA
$uidctiacs.Howcvrr,one or inose parameters exceeds EPA secoadwry staAdud
as denoted by tht*sign.
Masachues State Ctxafied Ac���for
Testing Lboratcry#MA04g 2khorstensen Laboratory Inc.
i
LOT
2A
87310 S . F .
2 . 00 Ac .
oljol
132. 7'
Tzg
,�TN
3'W TRENCHES
42'
' p,P
rn
' — CONC. w
D—BOX I�
Q4` — d-
G -
29.6* F
1500 AL.
S IC TANK
E �E� No 7 0. 8
`�➢� 03
�o ► ,
N
100' 7!0 1 G 0
-` � p5—BUIIT WeLL 1 r
�ocA�ON 1 I
I r
I 1
I 1
SWING TIES I
COMPONENT COR E COR IF I
SEPTIC TANK 22.9' 24.3' (CENTER)
D-BOX 47.2' 30.7 (CENTER) j 12 . 0'
END PIPE: A 63.3' 68.3'
END PIPE: B 74.4' 74.1' 1 1
END PIPE: C 86.2' 81.6' I
END PIPE: D 75.1' 55.3' I I
I I
I I
I I
I 1
1 1
75 . 00 ' 1 I -11
BOXFORD S TREE T
( PUBLIC — 1936 ESSEX COUNTY LAYOUT)
ELEVATIONS TAKEN AT TOP OF PIPE
TOP OF FOUNDATION: SEE PLAN �s
PIPE ® DWELLING: 136.75 HOFM ®°
TANK IN: 136.42 � N
TANK OUT: 136.09
D-BOX IN: 135.93 v I
D-BOX OUT: 135.77 (ALL) NOTE: THERE ARE NO WELLS )
END PIPE - A. 135.36 WITHIN 100' OF a res/ONAL
END PIPE - B: 135.31 THE SEPTIC SYSTEM `'•••�°°
END PIPE - C: 135.34 ASSESSORS MAP 105C LOT 0022
AS-BUILT SEWAGE DISPOSAL SYSTEM PLAN
LOT 2A BOXFORD STREET MARCHIONDA & ASSOC, , L. P .
NORTH ANDOVER, MASS. ENGINEERING AND PLANNING CONSULTANTS
PREPARED FOR
JOYCE BRADSHAW 62 MONTVALE AVE. SUITE I
BOXFORD STREET STONEHAM, MA. 02180
NORTH ANDOVER, MASSACHUSETTS (617) 438-6121
SCALE: 1 "=30' DATE: 4/16/99
i
LOT 2A
87310 S . F ,
2 , 00 Ac .
132. 7'
3'W TRENCHES
42' C -
�� 1 0
43• J CONC. 00
D—BOX
Q '
G —
29:6'
1500 AL.
S IC TANK ,o.a' X/S,
F E fo
70. 8
. 8' E 139 T/ON
o w G 0
100 �� 1
AS—BUILT WELL I I
c LOOpnON I I
1 I
I I
I I
SWING TIES
COMPONENT COR E COR F I
SEPTIC TANK 22.9' 24.3' (CENTER)
D—BOX 47.2' 30.7' (CENTER) 12 .0'
END PIPE: A 63.3' 68.3' I I
END PIPE: B 74.4' 74.1'
END PIPE: C 86.2' 81.6' I I
END PIPE: D 75.1' 55.3' I I
1 I I
I I
f
f 1
' 1 I
175 , 00 '
E30XFORD S
( PUBLIC - 1936 ESSEX COUNTY LAYOUT)
ELEVATIONS TAKEN AT TOP OF PIPE
TOP OF FOUNDATION: SEE PLAN ►°
p \A OF
PIPE ® DWELLING: 136.75 ! ��
0
TANK IN: 136.42 I 6661 o� �d� °`a N v
TANK OUT: 136.09 RR
....._
D—BOX IN: 135.93 Hl17VEH 10 auvog
D—BOX OUT: 135.77 (ALL) /EMOCrm li.i230N�J
NOTE: THERE ARE NO WELLS L
END PIPE — A: 135.36 WITHIN 100' OF ►�S�ONAL EN�a�°
END PIPE - B: 135.31 THE SEPTIC SYSTEM •O'°
END PIPE - C: 135.34 ASSESSORS MAP 105C LOT 0022
AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN
LOT 2A BOXEORD STREET MARCHIONDA & ASSOC. , L. P .
NORTH ANDOVER, MASS. ENGINEERING AND PLANNING CONSULTANTS
PREPARED FOR
JOYCE BRADSHAW 62 MONTVALE AVE. SUITE I
BOXFORD STREET STONEHAM, MA. 02180
NORTH ANDOVER, MASSACHUSETTS (617) 438-6121
SCALE: 1"=30' DATE: 4/16/99
LOT 2A
87310 S . F .
2 . 00 Ac .
132. 7'
N �---
00
d-
TF/ST
F
87. 8' 7 0. 8'
�3s o/�N
N
GC
�J
AS-BUILT Y'��U �
LOCATION
128. 0'
►X°AA��
N OVII14
�o yGs
�U STEPHEN M.
MELESCIUC On
No. 39049
0 ESSIO��Q
1717 Q 8
`, .� 175 . 00 '
BOXFORD
STREET
WE HEREBY CERTIFY THAT WE HAVE EXAMINED
THE PREMISES AND THAT ALL APPARENT
EASEMENTS AND ENCROACHMENTS ARE LOCATED
THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS
PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY
FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE
WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP,
BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANNEL NO. 250098 0009 C
SHOULD NOT BE USED FOR PROPERTY DATED 6/2/93 , THE STRUCTURE IS NOT LOCATED
LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE.
CERTIFIED PLOT PLAN
LOT 2A BOXFORD STREET MARCHIONDA & ASSOC. , L. P .
NORTH ANDOVER, MASS. ENGINEERING AND PLANNING CONSULTANTS
PREPARED FOR
KERRY & BRYAN HANSSE.N 62 MONTVA
LE AVE. SUITE I
624 BOXFORD STREET STONEHAM, MA. 02180
NORTH ANDOVER, MASSACHUSETTS (617) 438-6121
SCALE: 1"=30' DATE:12/23/98
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