HomeMy WebLinkAboutMiscellaneous - 62 OLYMPIC LANE 4/30/2018 62 OLYMPIC LANE
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North Andover Board of Assessors Public Access Page 1 of 1
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Parcel ID: 210/106.11-0112-0000.0 Community: North Andover
SKETCH PHOTO
Click on Sketch to Enlarge
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Available
Location: 62 OLYMPIC LANE
Owner Name: FORBES,ALAN J
Owner Address: 62 OLYMPIC LANE
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 7 - 7 Land Area: 1.21 acres
Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2464 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 497,200 464,100
Building Value: 281,000 264,000
Land Value: 216,200 200,100
Market Land Value: 216,200
Chapter Land Value:
LATESTSALE
Sale Price: 0 Sale Date: 12/31/1978
Arms Length Sale Code: N-NO-OTHER Grantor:
Cert Doc: Book: 01374 Page: 0176
http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=808911 8/14/2006
Residential Property Record Card
PARCEL ID:210/107.A-0173-0000.0 MAP:107.A BLOCK:0173 LOT:0000.0 PARCEL ADDRESS:337 SUMMER STREET
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 04959 Road Type: T Inspect Date: 06/20/2002
Tax Class: T Sale Date: 02/08/1998 Page: 0047 Rd Condition: P Meas Date: 06/04/2002
Owner: Tot Fin Area: 3302 Sale Type: P Cert/Doc: Traffic: M Entrance: C
BISSELL FAMILY REALTY TRUST Tot Land Area: 1 Sale Valid: F Water: Collect Id: RRC
J F H&S J BISSELL,TRS Grantor: JOSEPH BISSELL Sewer: Inspect Reas: C
Address:
337 SUMMER STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOBO Indust-B/L% 0/0 Open Sp-B/L% 0/0
NORTH ANDOVER MA 01845
RESIDENCE INFORMATION LAND INFORMATION
Style: CL Tot Rooms: 9 Main Fn Area: 1753 Attic: Y NBHD CODE: 6 NBHD CLASS: 6 ZONE: R2
Story Height: 2.35 Bedrooms: 4 Up Fn Area: 1549 Bsmt Area: 1753 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class
Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 360 1 P 101 S 43561 1 209,964
Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: DETACHED STRUCTURE INFORMATION
Masonry Trim: 40 Ext Bath Fix: Tot Fin Area: 3302
Foundation: CN Bath Qual: M RCNLD: 393966 Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond%Good P/F/E/R Cost Class Kitch Qual: M Eff Yr Built: 1983 Mkt Adj: 1.1 PC S 800 1978 A A /50//42 17,900 1SE S 192 1996 A A /50//48 1,100 1
Heat Type: HW Ext Kitch: Year Built: 1978 Sound Value:
Fuel Type: G Grade: GV Cost Bldg: 433,400 VALUATION INFORMATION
Fireplace: 3 Bsmt Gar Cap: Condition: A Att Str Val 1: Current Total: 662,400 Bldg: 452,400 Land: 210,000 MktLnd: 210,000
Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Prior Total: 620,400 Bldg: 426,100 Land: 194,300 MktLnd: 194,300
Att Gar SF: 648%Good P/F/E/R: /100/100/90
Porch Type Porch Area Porch Grade Factor
P 28
W 458
SKETCH PHOTO
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34 451BAW.
528 Sq.R.
24 24
8 71 22 471 Available
Q"0.5/G
27 648 Sq.R. 15 FU/B/FM
19 1225 Sq.R.
28
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Parcel ID:210/107.A-0173-0000.0 as of 8/14/06 Page 1 of 1
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SOWNOF NORTH AN'DOV E:6. TOWN OF NORTH ANDOVER
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SYSTEM PUMPINt;} Gp} HEALTH DEPARTMENT
'y "M OWN UA & ADE)RESS
SYSTEM LOCtiT10N .....
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DATE OF PVWNQ; -
-. . .._QUANTITY PUMP6t};4 _._.�Q�� . ._.
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
�l STEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: -13-44 QUANTITY PUMPED �GALLU'v
C. 1'SS1)00L; NO J YES SEPTIC TANK: NO YES
".ATURE OF SERVICE: ROUTINE EMERGENCY
c) i.SFRV:\TIONS;
GOOD CONDITION FULL TO COVER
HEAVY CREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER �j�HFR (EXPLAIN)
�l'S"l'LM PUMPED BY:
U UNI .Iyl ENTS;
U TRANSFERRED TO:
Septic System Information
62 OLYMPIC LANE
Printed On:Monday,August 14, 2006
System ID: BHS-2002-1185
General System Information Latest Permit Information
Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench
Design Flow: One Two Capacity: Number:
Design Flow Provided: Minutes per inch: Width: Width:
Total Flow: Depth: Length: Length:
Seasonal: No No Depth to Water: Diameter: Leaching:
i
Grinder: No No Soil Type: Depth:
Laundry: No No
Hauling/Pumping Listin Quantity
Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons)
i
Routine Septic Tank STEWARTS SEPTIC GLSD 06/09/2005 1000
I
Inspections:
Inspected: Expires: Inspector: Status:
08/14/2006 Benjamin C.Osgood,Jr. Passes
Comments: Title 5
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1
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_,�'•�;,;o:: HEALTH DEPARTMENT
CHECK#: / ,4�91"
LOCATION:
H/O NAME: L� c��? itf.lelo
CONTRACTOR NAME: legw G2;
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 $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title Inspector $
A3 Title 5 Report $ `IV
❑ Other. (Indicate) $
1757
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
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NEW ENGLAND ENGINEERING SERVICES INC
1600 Osgood Street Bldg 20 Suite 2-64 AUG 1 1 2006
North Andover,MA 01845
TOWN OF NORTH ANDOVER
T
HEALTH DEPARTMENT
Tel: 978-686-1768
Fax: 978-327-6138
August 10, 2006
Ms. Susan Sawyer
North Andover Board of Health
1600 Osgood Street Bldg 20
North Andover, MA 01845
RE: TITLE V REPORT: 602 Olympic Lane,North Andover,MA
Dear Ms. Sawyer:
Enclosed is the Title 5 Report for the above referenced property. The system PASSES
the inspection.
If there are any questions please call me at my office, 686-1768.
Sincerely,
4
Ben'jarWin C. Osgood, r.
Certified Title 5 Inspector
1ofIf
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Y ~
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Owner's Address: 62 Olympic Lane North Andover,MA 01845
Date of Inspection: July 27,2006
Name of Inspector: (please print) Benjamin C.Osgood,Jr. Certified Title 5 Inspector
Company Name: New England Engineering Services Inc.
Mailing Address: 1600 Osgood Street Building 20 Suite 2-64,North Andover,MA 01845
Telephone Number: 978-686-1768
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,
accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the
proper function and maintenance of the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section
15340 of Title 5 (3 10 CMR 15.000).The system:
1z Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: C% Date: 7 G
72O
The system inspection shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30
days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and
the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system
owner and copies sent to the buyer,if applicable,and the approving authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does
not address how the system will perform in the future under the same or different conditions of use.
}
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A.- System Passes:
V 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:
/V-� One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,
upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits
substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a
complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the
tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):
Broken pipe(s)are replaced
Obstruction is removed
Distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if
(with approval of the Board of Health):
Broken pipe(s)are replaced
Obstruction is removed
ND explain_
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• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
C. Further Evaluation is Required by the Board of Health:
/
/y O Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect
public health,safety or the environment
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is
functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and (SAS)Soil Absorption System and the(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 the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private
water supply well**. Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organize compounds indicates that the well is free from pollution from that facility and the presence of
ammonia nitrogen and nitrate nitrogen is equal to or less than 5ppm,provided that no other failure criteria are
triggered. A copy of the analysis must be attached to this form.
3. Other:
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
D. System 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 overload or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool
vf Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow
i�— 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
coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the
presence of ammonia nitrogen and nitrogen is equal to or less than 5ppm,provided that no other failure criteria are
triggered. A copy of the analysis must be attached to this form.)
, j (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR
15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to
correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
The system is within 400 feet of a surface drinking water supply
The system is within 200 feet of a tributary to a surface drinking water supply
The system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II
of a public water supply well
If you 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.
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
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 an inspection?
Were as built plans of the system obtained and examined? (If they were not available note as N/A)
V Was the facility or dwelling inspected for signs of sewage back up?
+.� Was the site inspected for sign of break out?
Were all system components,excluding the SAS,located on site?
Were all 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 difference from owner)provided with information on the proper
maintenance of the subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
Existing information.For example, a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable) [3 10 CMR 15.302(3)(b)]
6ofIf
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design)Number of bedrooms(actual):
DESIGN flow based in 310 CMR 15.203 (for example: 110 gpd x #of be rooms) l?e o
Number of current residents:_?
Does residence have a garbage grinder(yes or no): N (7
Is laundry on a separate sewage system(yes
�o) yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no): !v(9
Water meter readings,if available(last 2 years usage(gpd):
Sump Pump (yes or no): �6 e--.,._
Last date of occupancy CJ �•rt s1T
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no)
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): A./O
If yes,volume pumped: gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank, distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
Tight tank Attached a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected wen arriving at the site(yes or no): / j
7of1I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
BUILDING SEWER(locate on site plan)
(.
Depth below grade:
Materials of construction:_:�._cast iron 40 PVC_other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
P"int by C,/<s O 1/, .v ,2� s?S C-�✓! e--'7
SEPTIC TANK: (locate on site plan)
Depth below grade: ct
Material of construction: X concrete metal fiberglass polyethylene
Other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate)
Dimensions: a4"C J y
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined: -,-7,7 t=/a-S r. ,U-17 sT7c i�,
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet
invert,evidence of leakage,etc.):
-f-A /w' r'>14. C'cJ,1��r17c.�1, r�,tJ��^t/ �3ifi��i-L c: lti'(l�C-i ,,W- e-,1
l/V5'7- Atl—LtA. C+1-7 .4-C1'e q-0 f1 C jC'rS A-r ;.-4_e,
�G:3
GREASE TRAP:-(locate on site plan)
Depth below grade:
Materials 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 sludge to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition structural integrity,liquid levels as related to outlet
invert,evidence of leakage,etc.
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
TIGHT OR HOLDING TANK: Aje 4 _(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Materials of construction: concrete metal fiberglass polyethylene other
(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: C�
Comments(note if box is level and distribution to outlets equal,any evidnence of solids carryover,any evidence of leakage into or
out of box,etc.):
( U A3>> I .!. N v 0, l-•C-d1 A Azle-77 Iry C
�•>✓i Nti C'V 1/7t'. C h' L�t� L Ot-t 175 C "91211(./ G"l['2 17>/S%jZif3C-',-A5�"'1 L_
PUMP CHAMBER:ZV r4 (locate on sire plan)
Pumps in working order(yes or no)
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required
If SAS not located explain why
TYPE
leaching pits number
leaching chambers, number
leaching galleries number
leaching trenches,number in length
leaching fields,number,dimensions: V'I S i- i? .4
overflow cesspool,number: ���, _, c:��,, r=
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)
P-acA Ui! S4-s %f d,-% 12M lee/C
CESSPOOLS: °L� (cesspool must be pumped as part of inspection) (locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of Construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRM': NIT(locate on site plan)
Material of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil signs of hydraulic failure, level of ponding,condition of vegetation,etc.
r 1
10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate
all wells within 100 feet. Locate where public water supply enters the building.
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 62 Olympic Lane North Andover,MA 01845
Owner's Name: Allen Forbes
Date of Inspection: July 27,2006
SITE EXAM
Slope 2.`��
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record—If checked,date of design plan reviewed:
_ Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health—explain:
Checked with local excavator,installers—(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
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LETTER OF TRANSMITTAL ppRTFt
North Andover Health Department oir IL
o
400 Osgood Street 3? dd`s� Mb'6 �oL
North Andover, MA 01845 0
978.688.9540 - Phone � L •"y
978.688.8476 - Fax coc L 840
'll A�Rwsao ��`y'
healthdent(ii),townofnorthandover.com -E-mail -
www.townofnorthandover.com - Website Page / of 9SSqCNus�i
TO: DATE:
COMPANY: FROM:Pamela DelleChiaie,Health Dept.Assistant
D
Phone:
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We are sending you: OCopyofLetter 5Tfans L7 Other ill in below)
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REMARKS:
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,1
Ir ACTIVITY REPORT
TIME 06109/2005 13:44
NAME HEALTH
FAX 9786888476
TEL 9786888476
SER.# 000B4J120960
NO. DATE TIME FAX NO./NAME DURATION PAGE(S) RESULT COMMENT
06/06 13:04 53 02 OK RX
#378 06/07 09:02 89786889522 39 01 OK TX
#379 06/07 11:13 89786826660 00 00 BUSY TX
#380 06107 11:20 89786826660 00 00 BUSY TX
#381 06107 11:59 815083942895 01:01 03 OK TX ECM
06/08 08:40 978 741 2012 46 02 OK RX ECM
06/08 09:50 19786888058 02:47 05 OK RX ECM
06108 12:50 01:46 03 OK RX
#382 06109 09:38 816172364339 34 02 OK TX ECM
#383 06/09 10:56 89783743437 01:46 03 OK TX
#384 06/09 11:15 89789750456 02:06 03 OK TX ECM
#385 06/09 13:03 819785324686 01:06 02 OK TX ECM
06/09 13:26 58 02 OK RX ECM
#386 06109 13:36 89784750413 57 04 OK TX ECM
BUSY: BUSY MO RESPONSE
NG POOR LINE CONDITION / OUT OF MEMORY
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SUBSURFACE DISPOSAL SYSTEM CHECK LIST
NORTH ANDOVER BOARD OF HEALTH .
APP OVED DATE PROVIDED DISAPPROVED DATE TIME REASON
Title 5
Reg. 2. 5 Fail OK The submitted plan must show as a minumum:
he lot to be served (area,dimensions,lot //,abutters)
(Planning Board files)
location and log of deep observation holes-distance
to ties
location and results of percolation tests-distance
to ties
design calculations & calculations showing required
leaching area
location and dimensions of system (including reserve r
area)
4� existing and proposed contours
location of any wet areas within 100' of the sewage
disposal system or- disclaimer (check wetlands mapping) !
surface and subsurface drains within 100' of sewage
disposal system or disclaimer
location of any drainage easements within 100' of
sewage disposal system or disclaimer (planning board
files)
known sources of water supply within 200' of sewage
disposal system or disclaimer
location of any proposed well to serve the lot (100'
from leaching facility)
location of water lines on property (10' from leaching {
facilities)
m location of benchmark
driveways
garbage disposers
p no PVC is to be used in construction
a profile of the system (elevations of basement , plumbers
pipe septic tank, distribution box inlets and outlets,
distribution field piping and any other elevations)
maximum ground water elevation in area of sewage disposal
system
plan must be prepared by a Professional Engineer or
other professional authorized by law to prepare such
plans
Se t 'c Tanks
Reg. 6 (a Capacities - 150% of flow, water table , tees , de th
of tees , access, pumping,
b) Cleanout
W10' from cellar wall or inground swimming pool
25' from subsurface drains
North And ver Subsurface disposal system check list - Page 2
Fail OK Distribution Boxes
Reg.10.2• ( Slope greater than 0.08
Reg.10.4 b Sump
Leaching Pits
Leaching pits are preferred where the installation is
possible
Reg.11 .2 (a) Calculations of leaching area (minimum 500 S.F. )
Reg.11 .4 (b Spacing
Reg.11 .1 (c Surface drainage 2%
ieg.11 .11 d Cgver material
pt"k p -d
Leaching Fields
Reg.15.1 (a) reater than 20 minutes/inch
Reg.15.1 Area (minimum 900 S.F.)
Reg.15.4 c Construction of field
Reg.15.8 (d) Surface drainage 2%
Reg. 3.7 (e 20' from- cellar wall or inground swimming pool
Leaching Trenches
Reg.14.1 (a Calculations of leaching area (min. 500 S.F.)
Reg.14. 3 (b Spacing (4 ft. min. 6 ft. with reserve between)
Reg.14.4 (c Dimensions
14.5
Reg.14.6 (d) Construction
Reg.14.•7 (e) Stone
Reg.14.1 (f) Surface drainage 2%
Do hill Slope
(a) Slope y/x = (to be shown)
(b) y/x X 150 = (to be shown)
Pum
Reg. 9.1 (a) Approval
Reg. 9.6 (b) Stand-by power
A
a
SOIL PROFILE & PERCOLATION TEST DATA
Town/City Pb . A-F ND . No.&Street Q L�j C L,4t�V Lot No. S
Loc./Subdiv.AfJC., kLLS CQchS(k)GPlan Owner
Investigator �j'.J ,"g Lsy,_ BALL o Observer 'T P., ;[r USkj j ,�C t�tt4
SOIL PROFILES-DATE
( ( BI-77
�- ( g I77 1 g/.7
Elev. 1
1. 1
� Elev. 3' Elev. 4"Elev.
0 '5((g(-77 0 8 18 0 0
Suwbi-
1 1 1 1
2 2 2 2
N'F D�NN
3 3 3 3
4 - 4 — 4 4 --- '�` Ln i
t
co
5 5 Bot•t 5 5 �..
TELL
o�yMPic
6 6 6 6 '--A Jv
7 7 7 7
8 IL 8 8
Y _
9 9 9 9
10 10 10 10
Benchmark Location
Elevation Datum
Percolation Tests-Date S) �$ (-7$
Pit Number 1 2 3 4 5
Start Saturation
Soak-Mins.
Start Test-Time
Drop of 3"-Time
)rop of 6"-Time
Mins.lst 3"Dro
Mins.2nd 3"Dro Z
Notes & Sketches on Back Frank C. Gelinas & Associates, North And.