No preview available
HomeMy WebLinkAboutMiscellaneous - 66 MARIAN DRIVE 4/30/2018 (2) 66 MARIAN DRIVE 210/107.C-0056-0000.0 414, a L 6 T MAP # LOT # PARCEL # STREET • • CONSTRUCTION APPR HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE �. APP. BY DESIGNER: A-Ae PLAN DATE CONDITIONS WAFER SUPPLY: WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DATE APPROVED BACTERIA I DATE APPROVED BACTERIA II DATE APPROVED PLUMBING SIGNOFF y WIRING SIGNOFF COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO j DATE ISSUED BY CONDITIONS : FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL ES NO OTHER YES NO ANY VARIANCE NEEDED YES NO To ?le?I S FINAL BOARD OF HEALTH APPROVAL: DATE: BY: SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? ES NO TYPE OF CONSTRUCTION: NEW �PAI NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES -19:) CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? YES NO DWC PERMIT NO. 'O INSTALLER: Ge7T M0170 BEGIN INSPECTION ✓ S NO: EX;AVATION INSPECTION: NEEDED: j.. sr. PASSED BY CONSTRUCTION INSPECTION: -NEE ED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: r BY 1 FINAL GRADING APPROVAL: DATE 7 FINAL CONSTRUCTION APPROVAL: DATE: Z 1�T BY UILL,)I ES UHHA Y o V 62'r5 PVN- OlffrlCrAok 156 27� E G 3' EAlfilwlem- 95.00 q' (ol' 101.Ol(z" ztc G' I o .(07 ' ' o I a " M 4 00.04 M ' ' Oa X70.0 57 7, GT 7,7 Z 0-j 114011 dE I Tee w L 0 I 1 N 0 lA D. F pput To 0rnNv- row - -e Lo 333,20 . I E 2 AS BUI LT PLAN - -- -- OF SUBSURFACE DISPOSAL SYSTEM LOCATED 1N - ,�p�TG..� ,Or 1�1 G�V'1r12- , HG``35. � �/� MAf✓tA I e bIZ. AS PREPARED FOR DATE: SCALE: l 4o' 'IrM 10-76, �e � 3 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET ANDOVER. MASSACHUSETTS 01610 TEL (617) 473-3553, 373-5721 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 66 Marion drive Property Address MArk Menery Owner Owner's Name information is required for every North Andover MA 01886 MAy 7,2014 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John DiVincenzo use the return Name of Inspector key. Stewarts Septic Serive OkA Company Name 58 South Kimball street Company Address Bradford MA 01835 City/Town State Zip Code 978-372-7471 S113386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority /V �/4�v — �G V /�,r � Iq Insp ctor's Signature Date Th system inspecto 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 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 66 Marion drive Property Address MArk Menery Owner Owner's Name information is required for every North Andover MA 01886 MAy 7,2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAy 7,2014 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 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 M 66 Marion drive Property Address MArk Menery Owner Owner's Name information is required for every North Andover MA 01886 MAy 7,2014 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: 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 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,a' 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAY 7,2014 required for every y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is required for every North Andover MA 01886 MAY 7,2014 page. City(rown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAY 7 2014 required for every y page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Occupied 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 a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAy 7,2014 required for 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: Stewarts Source of information: Was system pumped as part of the inspection? ® Yes ❑ No 1500 gallons If yes, volume pumped: gallons How was quantity pumped determined? Site guage on truck Reason for pumping: Inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•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 M 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAY 7 2014 required for every y 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: 16 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 36"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.): Septic Tank(locate on site plan): Depth below grade: 30"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: P t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 j� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M •''p 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAy 7,2014 required for 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 30" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure&sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, evidence of leakage, etc.): liquid levels as related to outlet inverte , q 9 ) Both baffles in good shape, no leakage, liquid levels good. Grease Trap(locate on site plan):: Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 u� Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAY 7 2014 required for every y page. City(rown 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 a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAY 7 2014 required for every , page. Cityrrown 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.): Dist Box equal, no ponding, no solids carry over, no leakeage. 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.): Ran pumps manually, pump in working order at this time. Alarm sounding when float is raised. * 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 Form:Subsurface Sewage Disposal System•Page 12 of 17 -� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Notlor Voluntary, Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MA 7 2014 required for every y 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: 7-36"V1/X38'L ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology:,. Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp Soil, condition of vegetation, etc.): No signs of hydraulic failure, no ponding, no damp soils. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MA 7 2014 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts u - Title e 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01810 MA 7,2014 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: dhand-sketch in the area below ❑J drawing attached separately ap�,1 J°q1`6) qe(AL c p` y Cl M,u leer - dl - 7 •s vena ° Fr �-L 60' 7 �� -- c 21 7 t5ins•3113 Title 5 Official Inspection Farm suosurrace oevrdgv ,,, em•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 66 Marion drive Property Address MArk Menery Owner Owner's Name information is required for every North Andover MA 01886 MAy 7,2014 page. City/Town 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: 30"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: 8/8/97Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Pulled file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Bottom of lowest trench raised 4'above water table. Taken from design plans by Merrimac Eng. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 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 ,M 66 Marion drive Property Address MArk Menery Owner Owner's Name information is North Andover MA 01886 MAY 7 2014 required for every Y 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 Form:Subsurface Sewage Disposal System-Page 17 of 17 RECEIV -D Commonwealth of Massachusetts . _ City/Town of No Andover �'wi',� � r"14 System Pumping Record TC��,I,: �ac�,<< ., o Form 4 ufi W DEP has provided this form for use by local Boards of Health. Other norms 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 Pimping Record must be submitted to the local Board of Health or other approving authority within 14 dayz from the pumping date in accordance with 313 GMR 15.351. A. Facility Information _ Important:When fining out forms 1. System Location: on the computer, use only the tab 66 Marrion Prive key to move your Address cursor-do not No Andnvi-_r PO - use the return --_ _—..._ _. _�..,-.,^.. _ key City/Town T-- . -- — State-- —.--_ —_� Zip Code 2, System Owner: k Menerv, Mark Flame 14- Address (if different from location) City/Town ,State dip GodeA..�- Telephone Number B. Purnping kecord ') 1. Date of Pumping 72. Quantity Pmped.- e� —aiio sU 3. Type of system: ( Cesspool(s) M Septic Tank Tight Tank ❑ Grease Trap Other(describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? ❑ Yes No 5. Condition of System: 6. System Pu.rnped By- Name Vehicle Ucense dumber Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre--treatment Plan', 20 So. kiiiii Bradford, Ma f:1535 Signature of Hauler gate -----__ :tea:--T_-,�—.T -------•--��_—_�._.—.--- . Signature of l� ceiving Facility [3ate _ t5forrrAdoc?03106 $y tern Pumping Re,; rd=Page 1 of 9 Commonwealth cf Massachusetts • Executive Office of Environmental Affairs Department of EnAronmen al Protection Metro Boston/Ncrtheast Regional Office WSllam F. Weld 3oNmor - nMy z Cote p s.�.aSy.em i�r I .2 2 rr77 David&Stmhs SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTInCATION P=p=tFAdd,,. 66 Marian Drive AddmsofOwner Dass of b peetibm: N.Andover, MA WN Nat 5/13/97 Cif,w � Cams w=Y Name,AAQi &iile u7 � Jr. R:J. Inspections 508 )681 -8759 1 Osgood St. , Methuen MA 01 C 844 CMZ ATIox sT AT.t�rr I sad coed completethat I have personally inspected the sewage disposal system at this address and that the information reported bel6w is true, acc-crate tify d of ea-the time sof taspec�.san. The inspection was peud'orsued based on my training and experience in the proper function and maintenance ge disposal systems. The System; • Passes ._ Coaditicnany Passes eeds Further Evaluation By the Local Approving Authorit; Y ailsIh�` Date: The Svstzl P hm>s submit copy of this inspection repay to the Approving Authority within thirty(30)days of completing this "o If system or has a design flow of 10,000 or report to the appropriate regional office of the Department of &�Tz' the=-sPec..ar and the system owner shall submit the The original should be seat to the system owner and Environmental?-otec�an.copies sent to the buyer,if applicable and the approving authority. TNSPEC•'1'ION SUMKARY: Cheek A B,C,or D- A] SYSTEM PASSES: I have not found any,:a5ormatfoa which iadirates.that the system violates any of the failure=itera as defined in 310 Cie 15.303. Any fauZcre Criteria not evaluated are indicated below. B] SYb`iMM CONDITIONALLY PASSES: One or Z e system eomponezts need to be replaced or repaired. The system,coon eon pletioa of the replacement or repair, passes Indicate yes,na,or not determined(Y.N,or ND). Desmile basis of determination is an instances. If-aft The_ The septic tank is lain metal,Backed,attvctcrsIIy==1=d,shows snt���t;ss detaminer,� m"""'A"+ The system will pass iaspeeaon if the septic cn°! , or facie failure is by the Board of ..,,,Lmstiag tank is replaced with a conforming sept;!tank as approved (revised 8/15/95) 1 10 Commerce Way • Woburn,Massachu3sft 01801 . FAX Telephone ` Sewage backup or breakout or bigh static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven dist eution box. The m Board of Health): "M Pam inspection if(with approval of the broken pipe(s) are replaced obstruction is removed i distribution box is levelled or replaced (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM RMPECT'ION FORM PART A CERTIFICATION(camtmoed) P12-F—tyAdds+e.s: 66 Marian Drive, N. Andover, MA Owe Joseph L. & Gertrude A. Iannazzi Dawat Insyecd= 5/13/97 Al SYSTEM CONDITIONALLY PASSES(continued) The system required pumping more than four times a year due to brokin or obstructed pipe(s). The system Pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Cl FURTHER EVALUATION 13 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 faring to protect the public health,safety,and the environment. . 1) SYSTEM WIM PASS UNLESS BOARD OF HEALTH DETERMDM THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WUL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVMONMENT: 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)DMMO&M THAT THE SYSTEM is FUNCTIONING IN A MANNER THAT PRO'T'ECT THE PUBLIC HE ENVIRONMENT- AT„TH AND SAFETY AND THE , _ The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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 nitrate nitrogen is equal to or less tban 5 ppm. Dl S=have . ermined 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. SBackup of sewage into facility or system component due to as 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- �3tatic liquid level in the distribution box above outlet invert due to an ovarioaded or clogged SAS or L _. Liquid depth in cesspool is less than 6"below invert or available volume is less than L day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructedi p•pe(s). (revised 8/15/95) 3 Number of times pgmped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public welL d (revised 8/15/95) 4 SUBSUEFACE SEWAGE DISPOSAL SYSTEM RMECTION FORM PART A CF:BTIFICATION(continued) mpertvAddrewc 66 Marian Drive, N. Andover, MA wner. Joseph L. & Gertrude A. Iannazzi Its of 1=2256' 5/13/97 ] SYSTEM FAILS(cmatimed. Any portion ofa I or privy is within 50 feet of a private water supply well. Any po f or privy is less than 100 feet but greater than 50 feet from.a private water supply well with no accept ib analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform Iatile organic compounds,ammonia nitrogen and nitrate nitrogen- .1 LARGE SYSTEM FAILS: y ` The following criteria apply to large systems in addition to the criteria above: The design Clow of system is 10,000 gpd or greater(Large System)and the system is a significant threat to public Lealth and safety and the environment because one or more of the following conditions eeost: — the system is 4 f a surface drinking water supply the system is 2 eet of a tributary to a surface drinking water supply — the system is in a nitrogen sensitive area(Interim Wellhead Protection Area-(IWPA)or a mapped Zone LI of a public water supply well) Phe owner or operator of any such system shall bring the system and Lwility into full compliance with the graundyvater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information PART B CHECKLIST Check if the folllowmg have been done: Pumping information was requested of the owner,occupant,and Board of Health. l/None of the components have been for at — system pones pumped r least two weeks and the system has been receiving normal flow rates that volumes during period. of water have not been introduced into �� the system recently or as part of this. inxpectim � plans have been obtained and ezammec Note if they are not available with N/A �f�ty or dwelling was inspected for signs of sewage back-up. `�TILe system does not zeceive non-sanitary or industrial waste flow Fin was inspected for signs of breakout. com the Sosil Abso Ssystem components,escFndiag Absorption yatem,have been located on the site. (revised 8/15/95) 5 i, septic tank manholes'were uncovered, Opened,and the mtenor of the septic tank was inspected for =edition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge, depth of scum. _The size and Ixation of the Sail Absorption System as the site has been determined based as information or approximated by non-intrusive methods. existing �e facility o'v'er(and oc=pants,if different from owner)were providea'vith information on the proper maintenance of Sub-Surfe Disposal s� (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOES[ PAST C SYSTEM MFORMATION ?"per'-7Addrem. 66 Marian Drive. N.Andover, MA OwnwDate ofInspecdc=T Joseph L. & Gertrude A. Iannazzi 5/13/97 FLOW CON=ONS Design ffc-,r____gallo 1 Number of bedrooms: Number of current _ Garbage grinder(yes or no)-Z0 Laundry connected to system(yes or no):,!V Seasonal use(yes or no): ti d Water meter readings,if available: Last date of occupancy: Type of establishment: Design flow:_gallonslday Grease trap present:(yes ormo) Indust-ial Waste Eo 8 present: (9es or no)— Non-sanitary Title 5 system: (yes or ao)_ Water meter if Last date ofcc,-u Last data of ocaupanc- GENE, kL RUOR.%=ON PUAmN6 RECOEDS.,V-d source of' ormaticn S.vstem pumped as part of inspect"on:(yes or no'_ If yes,volume pumped: gallons Reason for pumping: TY?y OF SYSTME ✓Septic tan.Wdis on bozlsoil absorption system Single cesspool Over+guw cesscool PZvy Shared system(yes or ho) (if yes, attach previous inspection records,if any) Other(exp'Ldn) APPRO�Z AGE of all components, data installed(if Inown) and source of information: SenaBe odcas detected when arriving at the site:(yes or no (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM DISPECTION FORM PAST C SYMMM INFORMATION(coutianed) lhopertyAddmw 66 Marian Drive. N.Andover, MA O"zmw: Joseph 'L. & Gertrude A. Iannazzi Dame°f Iaspeedom: 5/13 9 7 SEPTIC TANS (ate on site plea) s Depth below.srade:,L�' Material of construction,Kroncrete metal FRP cther(e=plain) Dimensions: — Sludge depth:-_L2 Distance from top of stodge to bottom of outlet tee or bai'Ibe: % (' Scum thic3mess: _ Distance from top of scum to top of outlet tee or+l�Ole: -S Distance from bottom of scum to bottom.of outlet tee or baffle: if � Comme a: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid leve? evidence of ge,etc.) in relation to outlet invert,st�zcturai integrity, —rte— �^ = GREASE TRAP: (locate on site plan) Depth below grade: Material of construction c=mvte metal FRP_otber(e=plain) Dimensions: Scum thiclmess: Distance from of p of outlet tee or baffle: Distance firm o to bottom of outlet tee or baffle: Comments: ( n for pumpin& condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural in ty,, evidence of leakage,etc.) (revised 8/15/95) 8 3URSURFACE SEWAGE DIBPOSAL SYSTEM RMECTION FORM PART C SYSTEM INFORMATION( PlaimtY.Addraw 66 Marian Drive. N. Andover, MA Owl Joseph L. & Gertrude A. Iannazzi Date of Inspection: TIGHT OR HOLDING TANK_ (locate an site plan) Depth below grade: Material of conshlux— concrete metal FRP—other(explain) Dimensions: �pacdr- Design flow: . Alarm level• Comments: ` (condition of inlet condition of alarm and float switches,etc.) DISTRIBUTION BOX- ( (locate on site plan) Depth of liquid level above outlet mvert:��_ Comments: (note"level and distrs'butiOn is equal,evidence of solids r, evidence of leakage int or out of b(ix, etc.) PUMP Gocate on sits plan) Pumps in working order:(w or no) Comments: (note condition P of pumps and appurtenances, etc.) (revised 8/15/95) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAST C SYSTEM INFORMATION(cnntinned) Pi.pe:tyedd:essr 66 Marian Drive, N. Andover, MA Owner. Joseph L. & Gertrude A. Iannazzi D8s Of bR eco: ' 5/13/9 7 • SOIL ABSORPTION SYSTEM CUM:_ Qoeate on,site plea,if posssble,excavation not required,but may be approximated by non-intrusive methods) If not determined to bs # per,ezp]sin: Type= leaching pits,number:_ leaching chambers,number:_ lesebin8 galleries,number. IeachinB trenches,number,length lembing fields,number,dimensions:_ + overflow cesspool,number. Comments condition of soil,signs of hydraulic failure,leyel of nding,condition of ve G t getation,etc.) 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 Materials of constxvcdoit Indication,of ground inflow( must be Pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic&&re,.level ofI?ondin8,condition of vegetation,etc.) PRIVY:_ (locate on site plan) C�],� Materials of construction. Duaens�on� Depth of solid Comments: (nate of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 8/15/95) 10 i • 3.m` FACE SEWAGE DISPOSAL SYSTEM nmECPION FORM • PART C ` SYSTEM INFORMATION( IP:opwtyaddrew 66 Marian Drive, N. Andover, MA O"nw. Joseph L. & Gertrude A. Iannazzi Deis ofI=Pwd - 5/13/97 SKETCH OF.SEWAGE DISPOSAL.SYSTEML iaelnde ties to at least two.Permanent references landmarks or benchmarks I kxm to all wells within 100' S/, i3 �X (revised 8/15/95) 11 I i DEPTH TO GROUNDWAMM Depth to groundwater. i method of determinadl= appradmation: !1. s. (revised 8/15/95) 12 Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH October 29 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X) by-_ Arthur Hutton INSTALLER at 66 MAria n St r SITE LOCATION has been installed in accordance with Board of. Health Regulations as described in the Design Approval Site System Permit No. 959 dated August 8 19 97 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH Town of North Andover, Massachusetts Form No.3 < AORTkt BOARD OF HEALTH o IO L 9 19 CHUSEt DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair (can Individu I Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No._ �/c CH IRMAN, BOARD OF HEALTH Fee Z= D.W.C. No. 7. _ _ APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 9 - 71- � 7 CURRENT INSTALLER'S LICENSE# LOCATION: (o /i��,�-a S✓ LICENSED INSTALL fi V/l I d n J � SIGNAT HONE# SD 3 -G CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUMT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-built? Yes No Floor plans on file? Yes No Approval Date: f� I MAP AND PARCEL /0 ADDRESS LZ WgnA222a OWNER r, � SIZE OF LOT IN SQUARE FEET �J #BEDROOMS SEPTIC SYSTEM LOCATION &44,;�( (For example,FRONT YARD SOUTHEAST CORNER) J FINAL GRADING DATE " 'G AS BUILT PLAN IN FILE? INSTALLER_ ILJj 1`Y DWC PERMIT DATE 1 / CERTIFICATE OF COMPLIANCE DATE D -a 9 c7 ENGINEER Town of North Andover, Massachusetts Form No.z BOARD OF HEALTH 19q a s . • -=-� DESIGN APPROVAL FOR • SSACHUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant est o ` Site Location Reference Plans andS Specs. p ENGINEER DESIGN D T } r Permission is granted for an individual soil absorption sewage disposal system to be installed U07 in accordance with regulations of Board of Health. CHICIRMAN,BOARD OF HEALTH Fee Site System Permit No. f ��- I/ PLAN REVIEW CHECKLIST ADDRESS b1L -ENGINEER---S , -D GENERAL 3 COPIES STAMP Z-� LOCUS `� NORTH ARROW SCALE CONTOURS [/ PROFILE `--- (Sc) SECTION L--' BENCHMARK SOIL & PERCS ✓ ELEVATIONS Ole WETS. DISCLAIMER 1-� WELLS & WETS WATERSHED? //� DRIVEWAY WATER LINE �� FDN DRAIN— M&P SCH40 `� TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 150OG ei- . 17 INVERT DROP L--"� GARB. GRINDER (2 comps +200) 10 ' TO FDN MANHOLE t,- ELEV GW # COMPS. GB D-BOX SIZE # LINES_Z_ FIRST 2 ' LEVEL STATEMENT INLET - OUTLET /&/A6 = (2" OR .17 FT) TEE REQ'D? 7MIN EV)-v-Ig,vGc �� ��� 3 .cr �O 6 440 GP D SERVE AREA � 4 ' FROM PRIMARY? 6/-1'- 20 SLOPE �'0 WETLANDS `� 100 ' TO WELLS �✓ 4 ' TO S.H.GW (5 ' >2M/IN) 20 ' TO FND & INTRCPTR DRAINS L--- f400 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL?�15 ' ) BREAKOUT MET? TRENCHES (�:MIN 4409p LOPE (min .005 or 6"/100 ' ) SIDEWALL DIST. 3X EFF. W OR D (MI RESERVE BETWEEN TRENCHES? L- --fN FILL? 1 ' MUST BE 10 ' MIN. 4" PEA STONE? (/ VENT? �„ (>3 ' COVER; LINES >50 ' ) BOT $ 7 + SIDE lJ-3A = Q 3 O X LDNG ' 33 = TOT 4V2�*o (L x W x #) (DxLx2x#) (G/ft2) Copyright C 1996 by S.L. Starr // 4- PITS MIN 440 LEACHING MIN '1' `( 13'x16 ' )' PIT "' MANHOLE/PIT 'GW MIN 4' BELOW- BOTTOM EXC •2x., EFF W OR D 12"',-48."'` STONE BOT: +' SIDEx: LOAD '= TOTAL (L x w x •.#) (2x(L+W)xa x. #). (G/ft2:) CHAMBERS MI'N 440 'LEACHING GW• MIN 4" BELOW COVER s>3 FT: VENT -MANHOLES:- a. 12"'-4$" "STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed -mix: 60 ' X 6.0' ) MIN 13 ;X16 ' PIT BOT LOAD _ TOTAL (L x W x #); (2 x (;L+W)xD x #) fGJft2) FIELDS tMIN , 440 GPD `: 90.0 f BED' ' ` GW MLN 4 ' BELOf�1 BOTTOM OF FIELD PIPE ENDS. JOINED 4" PEA STONE?' Y -CDIST _LINE SLOPE .005? >3''COVER-VENT , SCH 40' MIN .72COVER • •,t " RATE (... X. 3j` �;: X - :.TOTAL L W LDG ; Y 1 DOSING TANKS AND PUMPS - `DIMENSJONS' X •`' X PUMP` OPACITY'. gpm'- L. WD. Vol:-_ 71, :.DISCHARGE SIZE s ' DISCHARGE .RATE DISCHARGE ,TIME 9Pm MANHOLES, TO GRADE ALARM SEP. . C.IRC. GW Min.. 1 below ry inlet) .HWLLWL� CHECK VALVE -BLEEDER HOLEL' MANUAL OI': SWITCH C ENUF STORAGE? 7'� '-.Copyright 1996 by Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ,.... * r._. APPLICATION FOR SITE TESTING/INSPECTION C2 SACHUSE�� Applicant NA 66-- ADDRESS TELEPHONE Site Location f alb Engineer �� NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH PA Fe I Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 11 n11111111111111n 1 1 d � m111111111n1111 1 111111111111111111111 1 r '10�111111111�1111 11 . •!!! 1:�� i!1 �s 111 � . i ��� G� 111 •���il ! X31 L�CliI 1 1 lig :�11111111i11111�1 hlSO Ell 111111�lcall . 11 1,11_ 1 11 1111111111111 1 �' 11111111111111111111 1� HIM 111 ., , 111111111111 t n r • 1 '�11 1 ��11'LIIh, -1 • �� Illr1 IL' 1 1 11 1 C�- �IIIILI:211:111 Ilinll ��� ►� all ' 111111 111 �aZ�ll�llllllll a da. s t ; ti' rt y.4:. 'r' t+{ � ..Y e ems. d: �, ::,• ?,"�^^,�� ' 4'• n, , ; " ark3 ka;�,`�k� �`}t � s , 7" dr .'`' °.f'- _"' I Wim• r. .,,. ! 1 I K 4 lrs i Ta t��� •� � � � �� � � � � �... 1 NII t moi. I F»s7 k• t�idtN�r'j "2 � t.c. I� I ! I I � �j•. in r I � �-. � � I r Y�f� rEd�a< �J{ k � '�� � I �� ��yli'E`p�, Om zy AT t,t 7.�Ers r7rffff+t1TY'+ £tom 13°I�nit' .' 'Ar3JS ;aj T`tLa+R.gi ! a rY ,( f 7x�✓Y•�i3A�" � f 3 Y Sir? i ifi xa ss} �a"£ .T•, li ttj rit .. , A !a C�1xt i. ! �a tt i ~i i -.,i:. "_ 'fp'c�Yr iw E s �i "'irk,{ ' r••ttc +It t•.N '{}Jp�' }•6 "-i t tytt }ry.lr tl• 1 Y�t° _ 'i 1J�{'�`.t`rMar-.sE F] tpt 9ta:: .',4. { ;si'`#", t g; Hf;., �'tT.j.t, ... . ':' ;t,�.. �:'. p;,.i:-1 t'7C'r.F�. �T��„�?,riF „�#s•��•� '�"�.,.,gyp' » ..44�1r` 1 rpt tf j4 dA rF{ -i 1tr•2 r7sr 1. t 't 1t i ;�, ,F ice. }r9...lFi Md't' �r rt r : int y �P �3 d !a f r .. rl,-, • Y ..»�. t >. r 3 ...,..-e..� ,Ti a a.. .i.Yr t,_:�• •t+,t;: `ik,...i7+� -� a t - 4N•i r ti ?3_ ,p. Y, ;t: d.,t-, . - '^3 .i+• --.5. 'FY».- :1= .:e .4r '�.. )' ,t !:. y _ l tft i ,) 1.. C 1 w ..C y� •_Yl }Vii' 4 3' . r" .3 sr'C, ..�; t,.. a.. �' r._t..s. .[, sr .f Sr'a.» •r d. ,� _ "'{. �1:�' :sr'_'..t,#. � 3°it° t eZ ,tc.. ...' ,.« ,..�•'ru ,.:, .- ,s, a^ Y'F 1 V. x: r t. .t 1"• d' . .. '2 -i. h.a.�. ,. ,, ... ,.t?X .. ,.., . .•,. .,,...:a:'d':x• «� 'F'_'rt: is^'�.:f+?55?` •.z .t -s•.,{� ...z: : tS,'`I, t r6.:,.�+ .,� �. 7 . . t. .z7a' _ .ta•,- .l.,i. s 1-' {,r. !t .,.a•, .«t: .•,... t, t.t. ,. ..tt r,43:., ...0 .� ... .sk•... rt,,, t. t. ,,. ,-, ,r °+•. .pi.•.. Y-" . .33. i�f- d. ",r' !aI `• a. �, ,...t:l , �..t..i , :s „s l4..s{,..1. .^7' ,,.t�• {.., � .. „i{I .r.;-. fir: i•,...-r_ 4 d., + Y d1. .21M ! i.,,, .: -.::r ,,.a. k !, ,,. {`4 . t 1tE. ,. a. .,, t'fit. .:et '•3 ,,.. ..,,, '.:- -�}.. ..t. .:..•.�# 'i& t r ,r,..w-'`! '�',sy'� .. ?C..t'..ti.'it z` f,•i,r. ..p}o-s., :..,. .- t/{,. ti' -r n"-a,...zi•;L. -• +.+, r....7C`t>:...r rl., ... •-hft:...;t• .:..s•.t.:yY, "^�. ,x"w ta': �•z• ;3 ,rMal " t{l'+t. . x» .r,.r. . . _.a. . :. _ _ . , t: .. : r.:a : .i. s.: {, d ..r... cl. it ::Sri....trts '+ ._a .,•rL,fl : � -� '{ie.rsx: •;, r :C. :''t 7 3r • 'Ry $:..}.. ,i4 ::r ! ! .t- .,-zLl rik:�; .in -r .,.,ra f• c :rH •.,2 . : -. .' �, {"` � � r; ' 4 .j� pp'' Y, -,:: eL1. .,. •r,,. >s ,t3�.i Pt• -t _"�':'p'! f•' •f �'• .q� c �prl�.i•t t.,. rr :•r:..:, nh a{: $. ^$fir . .r ,.5--�:.. y :7 �' ::+5 1. !�, ` '1+} L t:l. -7: e• a .r_.: ....�.. ..-....t :> ., ...+ , .-,.,.:, t.. '....-.,.• ...... ... ?;.: `=;:.:,.:. x tr .° '�-.: tea:-��..tt� r.,.S+ Frl:.. ,�r^ �.:, 8� ! �r .n,� pp r t:T r. . ,.a.,,,1».. Fr.. ,... id. .. .... . .. :a• ... .....a ,•{-t q'3.. .. E- r. :. ?:? .. .._. «� '2"i?�`z- "i; nr'.c•Z,`t•. r aa�J44...t -a,Y{ ,.rY '':!• s' :+. - _,s .> 3... ". ,tr;t .,{. .,13, f. _� •:r 't t T rkr 5,... ,t._ _:+i:.r>-.s _£ .•t" .tom. ! >iY F ... '.,i .. .. ..�.,, ..::^:.•':,-, .{ •{r,._ ..,:ii a.;_e.'i YS" S'�i.r, s_..•a::rt.I`�.. �.. ':ir.# .�? Lk: .. .... 5 ..Y,.,s..,._. } . , ... ". ...... ... {� r.. ? is. �a. t ,t ri..rr.-t t. ..{:. i a fS,�, t>,t '.dam.R;F .:..b�. -'it t.. z Fl._rt��}��...at._ •-Y •T ..�,_ t ,t, :y7 �A' t!a _.1;. rflK i�.S �: T•�1:4- .:{f •i. .li,.Y F' �i �. Y .t. .-'�. .t :�.,...-lT:x y $,f' .:4.4... � .+T py, A° L- �ratf:. I. �. 1:' i ••T- i,;.. ,+ ..i:::1" F ...'t'*' kC �.1 '•..y.. _.0"jj .a,'r.i: t �. I •4.� 7�� 'Y1Y� 1.' •1{-� 2..:... .t7.. .3$ : :( [ .:i" ':tX:[ i•s':�. ••1::.Ll:�='. � tt' T: t� L., �:. ..z r ..-�--� t YT:,...:::: 1.bE•.•'.).^:•:r. ..._.u, t i;G�. .:i: ."x... ...�: .:::.. .: ,.._F; ), #§x a. �;., ,w,..:�•.9 :......... ..:...t r. ,.y.,..3.. .t. � _ �x.="4c• _ ? � r rl,...�, li t - .t r F� .:i.� k._ E T:� :7 ,r.,..x:Yii.F%=r,- •:Y's.t.. .•p..-v:..+' ;i. `+ :;; i.. ,ij}i� ' -: r+r! „i�.J'. ' -';t•' r:. � •t.>,w .. Y•-y, ,:"!.. r... ;,;:t;.:' ,;.,..r' r:E+°.t� �: ,.z. •,,t= 'j;:, ;=w.., ! '�d.4 11. E' ��L� �� k i• ,.. .... _5.} ,�w. ,. rt ��. ._. .......{il' ..x._...:.••..;.,...•. .,.i• ...r• _ :.+: 'Tr t[• tY •:T::S[ � L;. itw' # t• y;- _sq .�.,_"ry. r.. ......� •. x..n. �,Yfl'. #- ....:, .... ..,.o-.,�...,n. �r+1r .},• ��.. � .4:.0 .'il '�• •�-• :;?"is., n 7 L• ff` ...is�+ • ..-... .7 a, ,.. .r.LT{..�. .,_....., t.,,,_.ws r ._.:^� tt - .i st, r :'L;,,. �}= r .� •�+'.u�;i'f. f;t ,' .a. t.jt:•'�, t :#.a: .1, t. r £j•T.i 5 µam`" a._ .f a: t7iziii: "r �' ice, r• . ;L y^ .r. s ':3.....: 3ec.1"` AsF i< 'l:. •a'-..::: ... t a { 5 'i y . r.t...r,. .. i,:: .f ,..z ..4.. ....:,.r: ,,t..:i' + 7:�::'�'Y i ri sa - X:•t -._^'f _.:i'C... ..i.1:a' !: �...1Y�a�yq^, ,t.''a'7 t:.,• :t. l.•. tiy"t„' :y�x. Yf YT f'. tt:d.'7�{t7':. N,r,. .{L '.�L..;. .!i': K...i..%!.' :1.• :,-•iii .{. .° :'c: %: =S.if.� .�'•Y a.,r� L �i1,7'i t K .r1Y.• f. .f 7 +r r. i r 1. ��. _�r ,tt•-iT+: .'� -�•. IC ,Y t ,,}ij J_ }•`:.'-" i.Gari �'{' ..': . _:: . . ...:.. .::• `,• ..... .... ....•;»t. ,fir ,d:: i. .1._„7«:_•. J .yt•� ,.;" .-.::.: •! l: ,t. :t.,u: .:.ti�i "r,. .�:•� •1 i'+•.. 6= ��1• i �r t .� ry, .,z.. x. :ir. .,L^:i .i:• -r c•. .� l fir,-•'• .� •7. J..,i �,�• .E',4,;..r='� •�-. • :'. �E. �.., .......::::::. •:•::....: �E::• 'fir:F[::-u•5' - vs ,ti._^_..a� ,r.. o is s. •.,..,..�...._.._Y. . . 74y.:- _.s. •:zt 's t. - ,�, eu d.•�?.ki �s Y •L1.a Y - - w 7'v t it- �3� 761". wa". 7. -t� ,_.i ,xT '•r y�! -.t�:, "t.. •�. `.z.,..::' #�`'�.,�-+-•: f,.,�i_p'•,'�`•�:� ! .T:r � :::ITS» "a ,i.. -t. �F ,.ii: cYa s -r. ::rc`.• :i .1 :'j <.. ..t.' .�. � •.ri: ': :t'i•ik:s{} - Jr.. ..,is. •�. r. �t'�:'t y t-a_ k•-•.--!fid'..• S �'" .:.. • 'r..�.. ?s,'rir* pv'.r• ..,: ,' .t: -a.. .�:. u . ::r.3i?^:aetiE.. :t. Y �. ,a.:'e;.2...rr_..Txf t•i , , r_•�t.x. rt rer!�r: .- t4tr 1 't-r % z::'s{....,_, ak...,:.z,sar:{zzac:::, .. � •. ,-. ,+ ., .. ..,. ;. •;t:'...- . :•.R. ._. .- .,, _ _ .-. .,... ... P'. r..�i::_._ _. _:. . _ •nn,rs, t...ar: - UNIFIED SOILx CLASSIFICATION COBBLES GRAVEL SAND SILT OR CLAY COARSE I FINE CFINE U.S. SIEVE SIZE IN INCHES U.S. STANDARD SIEVE No. HYDROMETER 9. 3/4 3/8 4 10 20 40 80 140 200 100 0 80 20 E- Ey x 60 40 A c7 w z z H � w Q a a z 40 60 w w z U U a a w a a i 20 80 100 0 109 102 10 1 161 1�2 1T3 GRAIN SIZE IN MILITERS SAMP SYMBOL NUMBER DATE DESCRIPTION O 1341C (Sp) REVIEWED BY: EY K. WETHERBEE 111, D.E. Source C. HI7BBARDSTON PTT ACTIVE FACE Project No.9370 PITCHERVII,T.F SAND AND GRAVEL U T S of GRAIN SIZE DISTRIBUTION Figure No. 1 Massachusetts a -j &_�_/ ` Hillside Acres APPLICA ION FOR SEWAGE DISPOSAL INSTALLATION Lot # 3 HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot # 3, Hillside Acres I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 29o. I will install a con- crete septic tank of 1000 gale in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of P00 lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/41' (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 .to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE / _ �� — 6, G 4 G 1� Si e f Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Si�gnature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE 17 7 kaz_A�= Signatur f Inspecting 0 ficer Percolation Test 88 mine Soil. Clay C Garbage Grinder 7/ J M BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 0 Lor 1-$4 es ►os rQ ° T7 I,it $ -� ViD 1. NAME a. X,.e, DATE 2. ADDRESS �ec�{(+�, elf is LOT NO. TEL. 16 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS V SEWAGE DISPOSAL DATE TTn tr_ 26, 6 i. NAME OF APPLICANT J. J. -Segadel1 ;f _-�, LOCATION Lot 4,, Hillside e Aeres Address of lot no. BUILDING: Dwelling X Other SYSTEM: New x Repair GENERAL DESCRIPTION OF LANDHi2h SUBSOIL: Clay_ GravelSand PERCOLATION TEST S minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. A1j,4':'. -\— e ,jj illiam J. D sco 1 , Engine r Board of Heal h