HomeMy WebLinkAboutMiscellaneous - 645 SHARPNERS POND ROAD 4/30/2018 (2) 645 SHARPNERS POND ROAD d Road
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210/090.B-0009-0000.0
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TOWN OF NORTH ANDOVER NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 184 'SSACHUg�t
978.688.9540—Phone
Susan Y.Sawyer,REHS/RS 978.688.9542—FAX
Public Health Director E-MAIL: healthdept@townofnorthandover.com
WEBSITE: http://www.townofnorthandover.com
April 11, 2005
To all Sharpeners Pond Road Residents:
Please note that it has come to the attention of the Health Department that many residents are
leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time.
Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the
roadway is a health hazard. Please be mindful of this, as the Health Department will conduct
periodic inspections of the area to determine who is in violation, and fines will be issued if
protocol is not followed.
The Board of Health follows the State Sanitary Code regarding Human Habitation,
105.CMR.410, Section 1:
410.600
(A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight-
fitting covers. Said receptacles and covers shall be of metal or other durable, rodent-proof
material. Rubbish shall be stored in receptacles of metal or other durable,rodent-proof material.
Garbage and rubbish shall be put out for collection no earlier than the day of collection.
(B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a
liner in watertight receptacles with tight-fitting covers as required in 105 CMR 410.600(A),
provided that the plastic bags may be put out for collection except in those places where such
practice is prohibited by local rule or ordinance or except in those cases where the Department of
Public Health determines that such practice constitutes a health problem. For purposes of the
preceding sentence in making its determination the Department shall consider, among other
things, evidence of strewn garbage,torn garbage bags, or evidence of rodents.
410.602
(A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for
maintaining such parcel of land in a clean and sanitary condition and free from garbage,rubbish
or other refuse. The owner of such parcel of land shall correct any condition caused by or on
such parcel or its appurtenance which affects the health or safety, and well-being of the
occupants of any dwelling or of the general public.
(D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way
owned or used in common with other dwellings or which the owner or occupants under his
control have the right to use or are in fact using shall be responsible for maintaining in a clean
and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the
passageway or right-of-way which abuts his property and which he or the occupants under his
control have the right to use, or are in fact using, or which he owns.
s '
Residents should know the following:
• The Town has a mandatory paper and cardboard recycling ordinance that requires
residents to separate these items from their household trash. Paper and cardboard are
collected every other week on the same day as the household's normal trash. Residents
can call the DPW at 978.685.0950 to get their recycling schedule.
• Residents are responsible for picking up loose trash left at the curb after collection.
Banned Items and Recycling Requirements:
Please refer to the DPW website for a complete list of all the recycling requirements:
httR:://www.northandoverrecycles.com.
Please contact the Health Department if you have any additional questions. Thank you.
ZSincere
an Y. Sawyer,REHS/RS
Public Health Director
File
. . ,
���°��N�� ���°��K�*~ Laboratories,"���� Inc.�����~~" Works �~~~��~=. =~m~=U U~~°~n U�.~~ �
6OElm Hill Avenue ° P.O.Box 687 ° Leominster,Massachusetts 01453 ° (508)534-1444 ° 1-800LAB-0094
(in Mass)
C 09
Name : Skillings & Sons Inc Sample Location : North Middlesex Const
Address : 269 Proctor Hill Road Lot 6A Sharpners Pd Rd N Andover Ma
City : Hollis Sampled By : Skillings & Sons Inc
State : Nh Zip Code : 03049 Invoice No : 48903-3
Attn : Date : 04/03/89 PO No. : 4-3-3 �
WATER QUALITY TEST RESULTS
[P] Primary Standard
[S] Secondary Standard
TESTS RESULTS LIMITS |
Coliform Bacteria [P] 0/100 4/100 ml
Fecal Bacteria [P] NT 0/100 ml |
Standard Plate Count NT 200/100 ml
Arsenic [P] ND 0-0.05 mg/l
Sodium [G] 5.70 0-250 mg/l
Copper [S] 0.01 0-1 mg/l
Iron [S] 0.01 0-0.30 mg/l
Lead [P] ND 0-0.02 mg/l
'anganese [S] 0.03 0-0.05 mg/l
Magnesium 7.20 0-200 mg/l
Calcium 32.40 0-200 mg/l �
Alkalinity [S] 81 .40 NO LIMIT
�
� Chlorine ND 0-0.05 mg/1
Potassium 1 .10 0-250 mg/l
Chloride 39.00 0-250 mg/l
Hardness 110.70 0-160 mg/l
Nitrate [P] ND 0-10 mg/l
Nitrite ND 0-1 .0 mg/l
Ammonia ND 0-0. 1 mg/l
Sulfate [S] ND 0-250 mg/l
pH [S] 7.60 6. 5-8. 5
Conductivity 219.00 0-550
Color [S] 0.00 0-15 cu
Odor [S] 1 .00 0-3 TON
Turbidity [P] 1 .00 0-5 NTU
Comments :
NT - Not tested ND - Below level of detection for this parameter
For those items tested , this sample meets the following EPA criteria for
drinking water : [ X ] Primary [ X ] Secondary [ ] Neither
Reported By : Eric J . Koslowski Date : 04/04/89
�
WELL DATABASE
II
ADDRESS: / `TS cam`%� �C•z',�✓
AGE OF WELL: 5 WELL DRILLER: -�Lc.�-e-yL�10
WELL,PERMIT T: 7 WELL LOCATION:
u
L
WELL PERIMIT DATE: � �, DEPTH OF WELL:
TYPE OF WELL: �a- nRTT T F b. BUG ,,,r`'c. UN-KNOWN
TYPE OF WATER BEARING ROCK:
WATER ANALYSIS DATE: _ ��� HIGH MANGANESE: Y DIN
HIGH IRON: Y OTHER CONTAIN TANTS: Y N
r "
COMMONWEALTH OF MASSACHUSETTS
EXECL'?TIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
10
ONE WINTER STREET. BOSTON. MA 02108 617-292-5W
4"
WILLIAMF.WELD TRUDY CORE
Governor Secreta;)
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissiorur
PART A
.,..�" �� •---CERTIFICATION
Property Address: 15'�� 's�Q`r �„. Address of Owner:
Date of Inspection: — 0'2 (If different)
Name of Inspector: n k 0 L`�t U! )}CEj-W
I am a DEP approved d system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Aver6 J-r
Mailing Address: atiacad /' Gl•
Telephone Number: C
7_79
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_Aall
r r�
Inspector's SignatureDate:
The System Inspectormit acopy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM ASSES.
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
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.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound; shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(ravisod 04/25/97) Pago 1 of 10
DEP on the World Wide Web: http:1twww.magnet.state.ma.usldep
Printed on Recycied Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
/
CERTIFICATION (continued)
PropertyA!V(,
dres�: ®y'-_ 5&t j P/u e 1--S 1oljQd go( N4 4A( ejoG4 r
Owner: )14e t d $7G401 0, �o sr f:►U e.S
Date of Inspection: 9'v.. �g
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction.R.is.removed
distribution box is levelled orireplaced
C�ysZemfeqtfie6d-pumping more than four times aYear due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
4 broken pipe(s),are i`eplaced
obstruction is removed
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 the
r public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
•, WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT
- THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private.water.supply_well,.unless a well_water ar alysisjor_coliform bacteria and volatile organic compounds indicates that
the wef is free from pollution Gi n That-fkility and`the presence of ammonia nitrogen and nitrate nitrogen is'equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: �'�S Spar P^�'�rs �f3tip1 Ora NatK�r
Owner: 1210L 11cjq p,7"f,d � r
Date of Inspection: ► c'��.5
D) SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No ....::..-
— ALD Backup�of-s#v age into facilityor system component due to an overloaded or clogged SAS or cesspool.
— �QI �isch;ir7je—o—rpcFKdi'hr—ofifflZ6n—t—to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
k
Matic liquid level"in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
J�D 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 _.
&C> Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
— 4LO Any portion of a cesspool or privy is within 100 feet of'a surface water supply or tributary to a.surface' water supply.
t Any portion of a cesspool or privy is within a Zone I of a public well.
t.
Any portion of a cesspool or privyis within 50 feet of a private water supply well.
�D 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organ,c,compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
r The system seryes,a faci,liry with a.design flow of.10,000 gpd or greater (Large System) and the system is a significant threat to
public healih'and'safety and tl—*Avn ironnfient because one`or4more 6f the#ollowing conditions exist: -
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'll of a
public water supply well)
ۥ The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/35/97) Page 3 of 20
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address.+��� . " r+4,j�aaff,-<r'S ot 12 Jv0 JgnvJflcJ 1
Owner: P4UL. �l�'r►�s9'�"ad of .LlJl i HUf'G$
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following:
Yes No
Pumping information was,provided by.the owner, occupant,or Board of Health.
_ done of the system components have been pumped for at least two weeks and the system has been receiving normal
`flow'iates' '— `that period.A Large volumes of water have not been introduced into the system recently or
as part of this inspection.
Ir _ As built plans have been obtained and''examinea. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
x _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition.of
k baffles or tees, material of construction; dimensions, depth of liquid, depth of sludge, depth of scum.
—The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
le Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
(revised 04/25/97) Pago 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
�^/ - SYSTEM INFORMATION
Property Address:69.5— J�1C�(`QI�C-r5 19ati / AV o R/udo,-"r
Owner: Pali L" �C/rtPsTc'Q p/
Date of Inspection: Q a g J
r 3 �,
FLOW CONDITIONS
RESIDENTIAL:
Design flow: p.d./bedroom for S.A.S.
Number of bedroonts.
Number of current residents:1!2
Garbage gnrder (yes or no):A/ p
Laundry connected to system (yes or no)
Seasonal use (yes or no):AJO
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no):
. t _�}
Last date of occupancy:atrw)' ) , $
COMMER C I.AUI N D USTR IAL:
Type of establishment:
Design flow:_gallons/day
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 bate of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)//g!t
If yes, volume pumped: gallons
Reason for pumping �htf Sy ee-r tl�
TYPE 06+'SYSTEM
i� ,Septic,tank/distribution,box/soil, bsorptionrsysterti
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known)and source of information: Y r
Sewage odors detected when arriving at the site: (yes or no)A0
(revised 04/25/97) Paye S of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
// SYSTEM INFORMATION (continued)
Property Address: E;y� �jh[k/ P/VC/`$
Owner: 040 L 14 eP'p SY-eQa -12L /00' -OS
Date Date of Inspection:
F BUILDING SEWER:
(Locate on site plan) ,
Depth below grade; �$
Material of construction: _"to iron —40 PVC_other (explain)
Distance from private water supply well or suction Ime JDD.
Diameter /f
Comments: (condition of joints, venting, evidence of leakage, etc.)
baa �t.�"�a'"'
k
SEPTIC TANK:
(locate on site plan)
x
Depth below grade:r0
Material of construction: oncrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:
., Sludge depth: /'
Distance from top of sludge to bottom of outlet tee or baffle:,5CPK*
Scum thickness:
Distance from top.of scum to top of outlet tee or baffle:
Distance from bottom of scum to bopm of outlet tee or baffler
How dimensions were determined. j 5v►�Q
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in rela'on to outlet inv r� structural
integrity, evidence of leakage, etc.) /VI
G &G,L 4
GREASE TRAP: 4
(locate on site plan)
Depth below grade-.—
Material
rade:Material of construction: _concrete _metal Fiberglass _Polyethylene —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom-of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
• integrity, evidence of leakage, etc.)
t .
(revised 04/75/17) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ 1 SYSTEM INFORMATION (continued)
Property Address: 6'�� Sia r Mr S 100 j d
Owner: P4UG fil�eonilOSTtaC( °` Gcy� vf�►s
Date of Inspection:
TIGHT OR HOLDING TANK: (Tank must,be pumped prior to, or 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/da
Alarm level: Alarm in °'orking7brder`_Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: /
(locate on site plan) 9
Depth of liquid level above outlet invert/t C
r
Comments:
(note if level and distribution is ual, evidence of solids carryover evidence of leakage into or out of box, etc.)
0 � C,7! ' C� Ovx✓ /{/0 1e�kc�
PUMP CHAMBE
(locate on site plan)
I i. s d 1, r• _ .
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.)
(revised 04/15/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: �7 �``a r f� r'� Pa"JQ/ /V0
Owner: e4o,
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If.not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:
leaching galleries, number:
leaching trenches, number length: a'
leaching fields, number, di6ensi ns:'
overflow'cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of po ing, condition of vegetation, etc.
IA460�,VtZr lAtl1AJ
CESSPOOLS:
(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 (cesspool must be pumped as part of inspection)
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.)
• i
(revised 04/75/97) Paye a of 10
P 44, _,.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ f SYSTEM INFORMATION (continued) /
Property Address:v '�s S�`a Pr't#'r "N oIR"' N4c
Owner: CnCiu�
z #emp-sTe4�Date of pection: a-f+
SKETCH OF SEWAGE DISPOSAL SYSTEM: �D
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house) A
l " c
Y
p
A Jf
J;
(zaviaad 04/25/97) Page 9 of 10
r il`
F _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
// SYSTEM INFORMATION (continued) ,f
Property Address: � � ,Sh4 r Nor U e �z{ ke &al vi
Owner: Pq U Z. ti
Date of Inspection: ^�g
Depth to Groundwater Feet
•Ple�ase�indicate all the methods used to determine High Groundwater Elevation:
1/ Obtained"from Design Plans on record
Po Observation of.Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with;local Board of heAh
-
C eck FEMA Maps
{/ Checkum in records
P P g
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
115 N t) ((, T r�- 11 f.' /Ala L Q A,J M O V l^-tr4
y s
(reviaed 04/15/97) Page 10 of 10
Department of Environmental Management/Division of Water Resources
V_F WATER WELL COMPLETION REPORT
Address
SharpnersLYondIONLot bA r(
Andover,, �A w
City/Town
G.S.Quadrangle Map
Grid Location
Owner Conuerva .4 1'iddlesex Construct ion
Address Y U t30x -I)JI 'V Andover., kA (`t
r�Y WELL USE CONSOLIDATED WELL-
Domestic Domestic ' Public ❑ Industrial ❑
Type of Water-bearing Rock r/•�J
Other
Water-bearing Zones
Rotary �� �
Y 1) From To
Method Drilled
2) From—To—
Date
romToDate Drilled 3/21/89 3) From To
4) From To
CASING Depth to Bedrock
Length �5 Diameter 6 11
Type Steel UNCONSOLIDATED WELL
STATIC WA1T5R LEVEL Water-bearing Materials
1 Sand: fine❑ medium❑ coarse❑
Feet below land surfiage�-L
7/ X12 ,'y Gravel: fine medium coarse
• Date measured ❑ ❑ ❑
Screen:
GRAVEL PACK WELL Slot# length from to
Yes ❑ No ❑
Split Screen(or 2nd screen)
WATER QUALITY TESTS MADE Slog length from to
Chemical ❑ Biological ❑ Depth To Bedrock
PUMP TEST
Drawdown feet after pumping days hours at 10 GPM.
How measured. aJ,-r CO-r)'rR, &covery feet after hours.
LOG of FORMATIONS COMMENTS: (On well or Ovate
Materials From To � ��7,7� `
n'
m
ll
®R�,
SkiVRand Sons, o>c .
Firm
Address 2b9 Proctor Hill -t-jo :d
City nollis, :;:f 03049
Registra ion No. 20.
i
�j i Aerators Signature
Please print hrinly BOARD OF HEALTH COPY 25M-10-85-807101
OF
NaI�TN POVEl�, M,4, ' � � �P�, CQti� �✓N�
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cY,rAV4TIo,nJ )A>SI-i^c T Ion U/J"1 � ��� �a5s E] FAIL-
�PFRO JE1) �1�1-1I()RITy
F�J4L APPR(jvaL
v'
o
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o i
LOT 4A
2 � 2p1.5j.
LOT 3 00' LOT 2
246. LOT 1
�9� LOT 6A WELL 391, EXISTING FNDN. �g
73,267 S.F. TF-221.06
'�� � X73 �`• >pB.
see'
EXIS nNG N V'
�� ��9 9 01D TANK o-8 NNX O �O
Oo pGJ
�9 202.42' N F 195.25' 2�
BARRY A. & KAREN E. v
FITZGERALD
�THIS IS TO CERTIFY THAT I HAVE INSPECTED
THE CONSTRUCTION OF THE SAID DISPOSAL
SYSTEM LOCATED AT LOT 6A, LIBERTY ST.,
NORTH-::ANDOVER, MA. THE GRADES ARE AS
SPE( b` D I ,�T�I3I ,PLANS AND SPECIFICATIONS
DATEDY 3 BY ,1yTICHAE J. ROSATI."
GRADES ;° d °•` `�
ELEVATION TO TOP OF PIPE a
DWELLING: -- 7
TANK IN: 215.52
TANK OUT: 215.27 .
D-BOX IN: 214.97
D-BOX OUT: A 214.76
B 214.78 MICHAEL J. ROSATI DATE
C 214.77
D 214.79 AS BUILT SEWAGE DISPOSAL
END OF DISTRIBUTION
LINE: A 214.48 SYSTEM T PLAN
B 214.53
C 214.53 IN NORTH ANDOVER, MA.
D 214.53 AS PREPARED FOR NORTH MIDDLESEX CONSTRUCTION CO.
SCALE 1"=100' DATE MAY 1989
MARCHIONDA & ASSOC., INC.
ENGINEERING AND PLANNING CONSULTANTS
1
80 MAPLE STREET \R.F.D. 16
STONEHAM, MASS. 02180 MANCHESTER, NH 03103
(617) 438-6121 (603) 434-8725
r^"
: I
Commonwealth of Massachusetts
City/Town of
System Pumping Record NORTH ANDOVER
Form 4
DEP has provided this form for use by local Boards of Health, Other forms may be used, but the
information must be substantlalty the same as that provided here.Before using this form,check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351,
A. Facility Information
Important:
When 11Atng out 1, System location:
forms on the �J /
computer.use _._(!".} _— g�� •.—• Q .•- ---°-- --- .._._ .._.....
only the tab key Address �1
to move your /lam �I, �7 40l b ^
cursor.do not
uSe the return City[Town state Zip Cade
key. Z, System Owner:
A Air Name
Address(if different from loca(ion)
CltyrTown State Ip Code
Telephone Number
B. Pumping Record /
1, pate of Pumping —{ rr f 2. Quantity Pumped:
pate Gattons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ T:ght Tank ❑ Grease Trap
❑ Other(describe): -_..-_ -- - — , — —.. ._...__... . — .... .. .
4. Effluent Tee Filter present? d Yes ®''Ko' If yes,was it cleaned? ❑ Yes. No
5. Condition of System: —.._ ....._........---._.... ..�.._ _.. ..—._ .. . .� _
6. System Pumped By:
�yJ t C
Naas Wilde License Number
company w
7. Location where contents were disposed.
—...._�..._..�._...---- -. —..... . ... ........
Signature of Haule
Si5r.........�„...,.. .—•--•--...-- —•–• Date 4
. �.�;�'�. �tS;�-�•-----.—.. .._
Signature of Receiving Facility Hate
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