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HomeMy WebLinkAboutMiscellaneous - 65 BOSTON STREET 4/30/2018 65 BOSTON STREET 1 / 210!107.6-0057-0000.0 I � 1 I I I i V �a. Yti 1 '4F' ; ��—u'vfr*Zf , t '� ;-.aa _ � t4Q"Y F, t 4 4. �.v•: r �.j4w .� =� .FYt .: - S f f R 4 Y{ '4 �.-.~ T-. , { . y ' f .r6 y i�l}�"'5•i'�'`y •. . ` ;� - °3^�.jf tx� r� ��� f ty nY'ar-..Kk T� '•t � • MAP # _, �$ �' .......... LOT PARCEL # ;. STREET_.. r 5� ONSTRUCTIQ.N`APPR ._-_- HAS PLAN REVIEW FEE .DEEN PAID? YES NO PLAN APPROVAL: DATE /0 APP. BY--'.A-a DESIGNER: PLAN DA,rE. CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DAZE APPROVED BACT RIA I DA I E f)PPROVED BACTERI II DA I'E APPROVED COMMENTS: FORM U APPROVAL: APPROVAL 1*0 ISSUE YES NO DATE ISSUED 1Z / J BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:MAT146 ..-.BY: �� y E(Y `� .i �. :� ..:`, S 1..x};. •.:.1 .: 1....1.`.yi,.'�t'., t A �1 .'M 1 1. j.., 1 � 7. .`.• ._ ,THE INSTALLER LICENSED? YES NO - - '.• ` .TYPE OF CONSTRUCTION: ► - REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN ,REVIEW_ Y NO 1 y` CONDITIONS OF..APPROVAL ES NO (FROM FORM U) \IISSUANCE OF DWC PERMIT NO DWC PERMIT ' N0. ! ^INSTALLER: BEGIN INSPECTION ES 0- ' EXCAVATION . INSPECTION: : NEEDED: SASSEDHY -:`..:CONSTRUCTION INSPECTIONS NEEDED: .= AS BUILT KLAN SATISFACTORY: YES: ARPROVAL' TO BACKFILL: DATE: HY_ . •1. , " >.FINAL . GRADING APPROVAL: DATE �� BY ' • .-FINAL CONSTRUCTION APPROVAL: DATE: D / BY� {11'1,•x' - • , • . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M •''r 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/23/2013 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out RECEIVED forms on the comonly the tab key uter,use 1. Inspector: JUN 17 2014 to move your Neil J. Bateson cursor-do not Name of inspector TOWN OF NORTH ANDOVER use the return HEALTH DEPARTMENT key. Bateson Enterprises Inc. Company Name VQ 111 Argilla Road Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N d Furth Evaluation by the Local Approving Authority 7/23/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 d Commonwealth of Massachusetts u"( Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owners Name information is required for North Andover MA 01845 7/23/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: After installing new inlet&center covers on septic tank, septic system now passes Title 5 Inspection 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 exftltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 RECEIVED s J ComrrPinwealth of Massachusetts �. Title 5 Official Inspection Form JUL z °13 Subsurface Sewage Disposal System Form-Not for Voluntary Assessmen sTOwN of NORTH ANDOVE HEALTH DEPARTMENT M 'r 65 Boston Street Property Address Phillip Starks Owner Owner's Name f information is required for North Andover MA 01845 7/11/2013 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inca Company Name 111 Argilla Road Company Address Andover MA 01810 warn Citylrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ NeedA Further Evaluation by the Local Approving Authority i ` 7/11/2013 Insbe&,oeCSignatuiV Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts " . MEt Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Citylrown 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): I t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 I • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 65 Boston Street Property Address Phillip Starks Owner Owners Name information is required for North Andover MA 01845 7/11/2013 every 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): I ❑ 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 j the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityfrown 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: Covers on the septic tank needs to be replaced. Inlet&center covers broken, outlet cover unable to remove 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 it �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 v ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped November 2010 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&outlet tee 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•3/13 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 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every 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: 18 years old, 11/25/1995, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.3 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall to septic tank. 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below rade. .3 p g 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: 10'x 5'x 4' 4" Sludge depth: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every 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 23" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet cover broken&needs to be replaced. Center cover broken & needs to be replaced. Unable to remove outlet cover. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metalfiber ❑ fiberglass ❑ polyethylene ❑ other(explain) Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. Evidence of carryover, pumped d-box to clean. No evidence of leakage. D-box cover cracked, replaced it. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 64' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number:P ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. 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-3113 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 M 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): II t5ins-3/13 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t • r a3 W2>14-7 a=Lq®'11 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts uw Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �'� 65 Boston Street Property Address Phillip Starks Owner Owners Name information is required for North Andover MA 01845 7/11/2013 every 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: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/1/1995 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Boston Street Property Address Phillip Starks Owner Owner's Name information is required for North Andover MA 01845 7/11/2013 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for us&by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using-this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/ tse? Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Citylrown State Zip Code w` 2. System Owner. Name v�f Address(d different from location) Citylrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) a<eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Ye§ awo_� If yes, was it cleaned? ❑ Yes ❑ No. 5. Conditi n ofSystem:� 6. System Pumped By: i� Cly , Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: GLLS.JP Lowell Waste Water Sigrk&tufe cf Haule Date t5fomu4.doc•06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 6/26/2013 2:51:29 PM by Karen Hanlon Page 1 • Town of North Andover Tax Map # 210-1073-0057-0000.0 Parcel Id 18170 65 BOSTON STREET PHILIP STARKS 65 BOSTON STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zonirl 1 Residential Zoning3 1 Residential Size Total 1.03 Acres FY 2013 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until PHILIP STARKS Owner 65 BOSTON STREET NORTH ANDOVER,NIA 01845 RUDYARD,WAYAN Previous Customer Inactive 1/31/2007 325 SOUTH JUPITER ROAD APT. 137 ALLEN,TX 75002 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13677.0-65 BOSTON STREET Last Billing Date 5/8/2013 1090355 01 Cycle 01 Active UB Services Maint. Account No. 1090355 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 57.00 /1 UB Meter Maintenance Account No. 1090355 Serial No Status Location Brand Type Size YTD Cons 32772459 a Active 00 b Badger w Water 0.63 0.63 528 Date Reading Code Consumption Posted Date Variance 4/24/2013 720 a Actual 15 5/20/2013 -1% 1/25/2013 705 a Actual 16 2/13/2013 -49% 10/23/2012 689 aActual 31 11/9/2012 -23% 7/23/2012 658 a Actual 40 8/14/2012 167% 4/23/2012 618 a Actual 15 5/9/2012 -21% 1/23/2012 603 aActual 19 2/13/2012 -63% 10/24/2011 584 aActual 53 11/14/2011 1% 7/22/2011 531 a Actual 51 8/15/2011 275% 4/22/2011 480 a Actual 13 5/16/2011 -4% 1/25/2011 467 a Actual 15 2/11/2011 -70% 10/21/2010 452 a Actual 47 11/12/2010 24% 7/22/2010 405 a Actual 38 8/16/2010 245% 4/22/2010 367 a Actual 11 5/12/2010 -21% 1/21/2010 356 aActual 14 2/12/2010 -48% 10/22/2009 342 a Actual 27 11/11/2009 67% 7/23/2009 315 a Actual 16 8/12/2009 47% 4/24/2009 299 a Actual 11 5/13/2009 2% 1/23/2009 288 a Actual 11 2/10/2009 -75% 10/22/2008 277 a Actual 44 11/12/2008 5% 7/22/2008 233 a Actual 41 8/15/2008 292% 4/23/2008 192 a Actual 10 5/19/2008 -19% 1/28/2008 182 a Actual 14 2/19/2008 -76% 10/23/2007 168 aActual 57 11/16/2007 191% 7/20/2007 111 a Actual 19 8/15/2007 50% 4/19/2007 92 a Actual 11 5/21/2007 65% Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH November 8, 19 96 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil. Absorption Sewage Disposal System constructed (X) or repaired ( ) by_ Dav` Ms'�LriFird INSTALLER at Fir, Rost-nn Rtrff MA 01845 SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 755 dated August 3-, 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEAL IN ' t P NV f tells CERTIFIt S TIIAT.. N,,,, '" .. ...a Mkc.;. ,•. 0 o .. . ..... ..................... . .... .. ... . ....... �, � has parm-Ossion tof;�e�t �� %" ,.. ``�; �s�'r� buildings on ..... .... .... to lie mc€pied as .l` � ,... �. .� .... ..... '... . ...t'� °...'..... .. . .. .. . . .... ` s .. r I provid=ed that the parson ac::epting this per€t t shall in everyresf;ect c,e€tforin to the terois of tl.,3 1l llpliCditioi! ou filo i.. this offiea, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Custruction (,I Buildings in the Town of forth Andover. I•'LltIAIT FOR Fi)tJINDATION O�ILY � r = t :v , , .: : , .•, �;� VIOLATION of the Zoning or Building Regulations Voids this Permit. 13EG lLrtiED BY VARA. 116.8-' It•�,. ,(.1/r ,, ' �� 'Is �{ I. S 3 ,,'E t e ! i Z�- ,� JR ate.-f� .,� '�...:�° ...:�Y:-:•: .`?� ..�.�,,..,,.�'� �.� ,r�., t I :�-�, ATE wig �t ` LE PAI ._L5-'t F�UILDI :G I r�7S111: ,����1� i - -- - -- -- 1 • . ��'C c' iC�.1 I���� � E'?771f�: � L'(�,111't'l.� 1(3CAS —� I Display in a Conspicuous Place on the Promises — Do Node'-ril e No Lathing or Dry Wall To Be Doino Until Inspected and Approved by the Building Inspck,, to,�o I I i Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH NORTH / 0 19- IO- 9 �, •°,,,;;:.•�� DISPOSAL WORKS CONSTRUCTION PERMIT 7SgACHUSEt Applicant — AME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct (`-�or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. — 44 d4 �FJMRMAN,ITOXIM OF HEALTH 6V Fee D.W.C. No. Town of North Andover o t NORTH -1OFFICE OF 3a �`' 0 COMMUNITY DEVELOPMENT AND SERVICES A 146 Main Street KENNETH R.MAHONY North Andover, Massachusetts 01845 9sSAC1H4Us�t Director (508) 688-9533 September 22 , 1995 Mr. Steve D'Urso 22 Lilly Pond Road Boxford, MA Re: Lot #16 Boston Street This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Please show distance between house , tank and leaching area on site plan. 2) 4 inch pea stone or 2 inch stone and filter fabric required. 3) Please add groundwater elevation to profile. 4) Elevations of perc tests. 5) Vents required for trenches. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr,R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. SEPTIC CERTIFIED 6/17/96 SCALE:1"=40' DATE:11/25/95 :12/28/95 Scott L. Giles, R.P.L.S. 150 p4, 50 Deer Meadow Road North Andover, Mass. T o�83 RD�RT y ANp OF yEALTy�6R/ LOT 16 44,992 S.F. O 0 O p 3196 O O_ SPg1. FOUND ELEVATIONS 0 :107 97 OUT OF HSE.=105.82 46.0- N INTO TANK =105.35 OUT OF TANK=105.08 INTO D.BOX=104.74 ° OUT D.BOX =104.58 END PIPES =104.22 VENT } pN I CERTIFY THAT ,�,� THE OFFSETS FSETS SHOWN ARE FOR THE USE �tN OF OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING LES 0.13972BY LAWS OF gr NORTH ANDOVER, MA. CONFORMITY OR NON-CONFORMITY *1 TEB�� `a WHEN BUILT WHEN CONSTRUCTED. Na Gi� 9.6 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION �.p pDRATED�PP�.�Gj 1SSACHUS� Applicant—l�)� A l �I NAME U ADDRESS TELEPHONE Site Locations 4A- Engineer G ' NAME ADDRESS �i TELEPHONE Test/inspection Date and Time ��/ lelqu CRAIR AN,BOARD OF HEALTH Fee ` JU' Test No. CIE I S.S. Permit No. 7 D.W.C. No. C.C. Date Plbg. Permit No. FORK"II - <LO'r•--RELEASE FORM ' INSTRUCTIONS: This form -is used_�.to:verify that all necessary y approvals/permits. from 'Boards -and �Departments having jurisdiction have been obtained: This does not_relievethe applicant. and/oic _ landowner,from compliance, with.-any,-applicable local or;:state 'law, regulations or requirements. ***************.*Applicant •fills -out this 'section****************.*. APPLICANT: _G,� �(2u�u � Phone �-351( LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) 16 Street M�a5�v� �� St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments .. Date Approved Food Inspector-Health . , Date Rejected n Date Approved Septic Inspector-Health Date Rejected Comments Public Works- sewer/water connections - driveway.permit Fire Department Received by ,Building Inspector r -.Date ` DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEEPERMIT # DATE RECEIVED e/3// 9,1- APPLICANT _ IAU/I/L� �i�}C'U5� ASSESSOR'S MAP ADDRESS PARCEL # LOT # / STREET `B662 o0A} 57;ed-v'7 ENGINEER �5)-f— ADDRESS PLAN DATE / /, REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED ru)E&-A-) o/0 5/>E Vic:/,51iV , 7o 0 �9. �GEv/�r-ia,u� D/= p�,ec TGSrS i 1 t 1 Town of North Andover, Massachusetts Form Mo.2 of Na07N, BOARD OF HEALTH P # s DESIGN APPROVAL FOR . ,SSAC""SEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM i S Applicant «-'vl_ Test No. Site Location _Ln-T— Co Reference Plans and Specs. l�i ENGINEER DESTGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed } in accordance with regulations of Board of Health. CHA MAN,BOARD OF HEALTH 1y� Fee Site System Permit No. PLAN REVIEW CHECKLIST ADDRESS /< NI -T ENGINEER ZZ� GENERAL 3 COPIES STAMP a,� LOCUS C --' SCALE CONTOURS Cf PROFILE f/ SECTION L/ BENCHMARK L"" ELEVATIONS SOIL & PERC INFO ✓ WETS. DISCLAIMER t/ WELLS & WETLANDS WATERSHED DISTRICT DRIVEWAY WATER LINE t/ DRAINS RESERVE AREA_Lff SCH40 SLOPE SEPTIC TANK / �� MIN 1500G. f/ . 17 INVERT DROP GARB. GRINDER .Ai)(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOX # OUTLETS ,�� FIRST 2' LEVEL STATEMENT INLET 71 - OUTLET= -(2" OR .17 FT) LEACHING 100' TO WETLANDS 100' TO WELLS " 325' TO SURFACE H2O SUPP &"- 35' TO FND & INTRCPTR DRAINS , 4' TO S.H.GW !/ 2% SLOPE 4' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL? '-----(t5' if above natural elevation; 101if below) TRENCHES MIN 660 FT2 SLOPE (min . 005 or 6"/1001 ) >3' COVER? - VENT ---- SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) L---- IS RESERVE BETWEEN TRENCHES? l0 IN FILL? L--' MUST BE 10' MIN. �� ��p -- BOT cS/Z X LDNG + SIDE &Y¢ X LDNG 7`I = TOT 63 >4�,r,� (L x W x #) (G/ft2) (DxLx2x#) iT ,, i t+ 1• Y �{ t'��k F�L� i h •x. t � a 41 •f- t A ir,x J a; e �P Cty.� J{ ilxii•�!��{��((r�+�s�aF��{�b4.�-�'e�?#� � �`—" "�..� t � '�� -- �_ , Jr t-... � i. i iii 4i + !l�t�J ➢ (FM+F'.i {�{�d + n Btt H gg f'"wl "',W$ i�.. r � r k a ` Y a ' Id I i � � i I i � l Illi i ! I I j T s r `f ii I � � � � � f I � i i � xi, x�'� �' �: � t �h,,u k s�:,� P�fiY�> � •{r i J/41 I � I 1,:. I I I I i , I i II h�s x '�tz'��ia; T 1 7�1��ai��t�11ii�+�•�,'1 z S ''+ryfrs r ._Y ::.`�-�,..,,..._._...e.r.rt,.ETt..�fs+}«:lY. s � •.�.`'4 j 4 n1' ih..t.� .s...-tir i... \ , .A � -L •� �, � 1.�\ \1 � v`_ \, THE COMMONWEALTH OF MASSACHUSETTS SETTS TOWN 0 F NORTH Ah G O Y E R Based on assessments as oflSCAL Januuary 1, 1993 Your REAL ES ATEEXAo BILL the OFFICE OF THE COLLECTOR OF TAXES 1993 and ending June 30, 1994 on the parcel of REAL ESTATE described below iscas follllows:ginnir 3^D QTR — DUE FEB 11 19S4 MAKE PAYMENTS TC TCYN CF TAX RATE CLASS cLASs 2 CLASS 3 NORTH ANDOVER . D F F I C E H O U R S: ER S100 RESIDENTIgI OPEN SPgCE COMMERCIA IND STRIAL M Q N C A Y T H R U F R I C A Y b:3 0 p M T Q 4:3 0 P K TOT.TAX RATE 3 BILL NUA PROPERTY IDENTIFICATION A 0 M O N EVE TIL 7:3 0 P M. DESC PEAL ESTATE VALUES 1426 . CLAss VALUE SPECIAL ASSESSMENTS A 9 A TOT.TAX 8 SPEC.ASSESS.DUE • y M +A P : _, PRELIMINARY TAX ^^ ': n 1C-73 APRELIMINARY CREDITS ©y 5 ( 0 0 0 00 PRELIMINARY OUTSTANDING8CO • PACK 01065 n^p EXEMPTION C 1 0 0 S 9 3RD QTR.TAX PYMT.DUE FEB 1 01/01/66 TOTAL ALU PEsf J v U U �g4 ExE\:P TOT TAXABLE rAl_UAT[OrJ TOT.SP.ASS SSM TS �• I � CURRENT CREDITS LOCATION TOT.RE V;€ ATE TAX • CURRENT OUTSTANDING S T A` n PAGE/LINE PRELIMTFIgRY TAX 1 lY STREET 3RD QUARTER PAYMENT BALANCE DUE THIS F--m—OVED BY THE COMMISSIONER OF REVENUE � • 4TH QUARTER PAYMENT C L C U G H, DONALD A COLLECTOR OF TAXES • NTEREST VIRGINIA N CLCLGH KEVIN F. MAHCNEY 75 S 0 S T C N STREET Interest at the,rate of 14% will ANDOVER -PA TAXFAYER • SCPY payments from the due date until payment is accrue on ade - - T P, 115 COPYRIGHT 1993 ARLINGTON DATA CORP. 94 01426000 3 0000023E53 4 C�� f 1 t l SOIL TESTING1 /5— --. l) Applicant should pay current fee for each lot ($150. 00) . 2) Plan (Assessors) of parcel to be tested. 3) Make out soil testing permit using next available number. 4) Update cash sheet referencing applicant, lot # & permit number. 5) Make a file with lot # with perc card & plan placed in it. 6) Update soil testing schedule & place folder with files to be tested. 7) Assign test date & notify applicant. 1 $ � � 176 i 0 0 '• C5, 9�i.. n.5coA-S • 29'1 .21 ,,a /47.21 J� 0 � - r < , m n 2G1N1,y �. °Joy T t ✓1 JZ� o1 M M/fl�1�EL J, f� �dRO7{�Y {7 0u64,LTIZ 1 i O Z� In D ? I 0 i Few- a a o T. 5 TREE f �. Y) N of N D I N i1i t.l a .^.i-ri,RL S C. i.� S 0• GNU