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HomeMy WebLinkAboutMiscellaneous - 7 HAY MEADOW ROAD 4/30/2018 (2) 7 HAY MEADOW ROAD - .210/104.6-0113-0000.0 f I 1 � i i V �! � 1 V._.. ' -,;f t::•. C i`i . � 6I�.. 7jf x 'r �A�s-.}. 13'��"�r� 9+.E 4 .. Lt f S S ��k' 1 "�S^Q t F 1r !r' J �'F �l.�i!f' Y-.1. yr4Y.+ �l y; .p /,• MAP # .. .. - ' 1 PARCEL # _.. . .,, STREET _.._ ONSTRUCTION_APPROVAL HAS PLAN REVIEW FEEBEEN PAID? YES NO PLAN APPROVAL: DATE A41 APP. BY� DESIGNER: PLAN DA,f E. CONDITIONS WATE SUPPLY: TOWN ! WELL WELL R MIT DRILLER. WELL TESTS: CHEMICAL DALE APPRUVED TERIA I DAIE (IPPRUVED BACTERIA II DA1'E APPROVED COMMENTS: FORM U APPROVAL: APP OVAL TO ISSUE YES NO DATE ISSUED CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: ' - SL� SY�ZM_�NSSA4T.T QLl 1.• ti J` n> ,� NO IS 'THE' INSTALLER LICENSED? + ` TYPE. OF CONSTRUCTION: i. = NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT -PLAN REVIEWYES NO CONDITIONS OF:.APPROVAL YES NO (FROM FORM U) i ISSUANCE OF DWC PERMIT NO DWC PERMIT N0. INSTAL LER: BEGIN_ INSPECTION �ES : ::EXCAVATION ,,INSPECTION: NEEDED: PTV ASSED `E ' _ . CONSTRUCTION INSPECTIONS NEEDED: AS BUILT PLAN SATISFACTORVI. �YE� .APPROVAL TO BACKFILL: DATE: �� . BY / " tFINAL . GRADING APPROVAL: DATE BY ' FINAL CONSTRUCTION APPROVAL: DATE: BY HAUL LIC # 777 $100 1996 STEWART'S SEPTIC TANK SERVICE INST LIC # 659 $200 1996 47 RAILROAD STREET BRADFORD, MA 01835 I 508-372-7471 May 3, 1996 0.l.R,_ NO ANDOVER BOH �, C�l,y �•�, TOWN HALL ANNEX ,-- 120 MAIN STREET ''` NO ANDOVER, MA 01845 PH# 508-682-6483 --- `� 508-688-9540 FAX 508-688-9556 Dear SIRS: The following is a list of properties that we pumped in your town. In accordance with TITLE V regulations, we are complying by sending you the following on a monthly basis, if need be. If we didn't pump, you will not be notified. PUMP DATE ADDRESS GALLONS 04-01-96 197 ABBOTT STREET 1,500 105 WINTERGREEN DRIVE 11000 04-02-96 A 42 OLYMPIC LANE 11000 04-04-96 A 71 PENNI LANE 11000 04-06-96 492 SHARPNER'S POND ROAD 11000 A 39 HAYMEADOw ROAD 1,500 04-08-96 498 WINTER STREET 11000 187 SOUTH BRADFORD 11000 04-09-96 A 495 REA STREET 11000 04-10-96 A 706 FOSTER STREEET 11000 04-11-96 A 83 CAMPBELL ROAD 11000 04-11-96 A 43 CHRISTIAN LANE(?) 1,500 04-12-96 t1_7 HAYNMEADOW ROAD 11000 1577 SALEM STREET 11000 04-13-96 278 BARKER STREET 1,000 HEAVY 04-16-96 A 130 BRENTWOOD CIRCLE 11000 04-17-96 A 27 COACHMAN'S LANE 11000 04-18-96 369 HIGH PLAIN ROAD 11000 28 CEDAR LANE 11000 A 121 CAMPBELL ROAD 11000 04-19-96 A 160 BRIDALPATH LATE 2,200 04-20-96 A 200 RALEIGH TAVERN LANE 1,500 A 1 GARFIELD LANE 1,800 57 Town of North Andov Health Department Date: lv6 Location: (Indicate Address, if Resid9dial,or Name of Business Check#: 7 Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials 1 .585 White-Applicant Yellow-Health Pink-Treasurer Town of North Andov r D/ Health Department Date: 4V (o Location: (Indicate Address,if Residgoifial,or Name of Business) _ Check Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials 1 .5b5 White-Applicant Yellow-Health Pink-Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS C a d DEPARTMENT OF ENVIRONMENTAL PROTECTION I 04 V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7 Hay Meadow Road North Andover,MA 01845 RECEIVED Owner's Name: Ken&Gail Tomacchio Owner's Address: Same MAY 3 12006 Date of Inspection: 04-10-2006 TOWN OF NORTH DEPARTMENT NT Name of Inspector:(please print)John Soucy Company Name: Soucy Sewer Service,Inc. Mailing Address: 830 Livingston Street Tewksbury,MA 01876 Telephone Number: 978-851-8839 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority I— Fa&-11P Inspector's Signature: Date: q _Np 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. NOTE: This Title 5 is NOT a guarantee/warranty of the future function of the septic system. s A , Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: Y Passes: B. System Conditionally One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: , 'Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _The system has a septic tank and 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 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 than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool )C Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow 7K7—Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. )C Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and 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.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you 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. ' Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 Hay Meadow Road North Andover,MA 01845 i Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x_ _ Pumping information was provided by the owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x _ Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of this inspection? x Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? x _ Were all system components,excluding the SAS,located on site? X_ _ 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? x _ 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: Yes No x _ Existing information.For example,a plan at the Board of Health. x_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] 'Page 6ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 Does residence have a garbage grinder(yes or no):no Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): See Attached. Sump pump(yes or no): no Last date of occupancy:_recent COMMERCIAL/INDUSTRIAL N/A j Type of establishment: ! Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgketc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Home Owner Was system pumped as part of the inspection(yes or no): yes If yes,volume pumped: 1000 gallons--How was quantity pumped determined?Gage on truck Reason for pumping: Inspection and Maintenance. TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 10 Years Were sewage odors detected when arriving at the site(yes or no):No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 BUILDING SEWER(locate on site plan) Depth below grade: 24" Materials of construction: X cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 75' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: x locate on site plan) �( P ) Depth below grade: 18" Material of construction: X concrete metal __polyethylene other —fiberglass (explain) If tank is metal list age:_Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 4'x 8'x 8' Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 36" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 61'--- Distance "Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: Tape&Sludge Tool Comments on pumping recommendations inlet and outlet tee or baffle condition structural integrity,liquid levels . ( P P g l�tY, q as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) N/A Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection)(locate on site plan)N/A Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:dual 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.): Flow Checked Oka PUMP CHAMBER: X (locate on site plan) Pumps in working order(yes or no):_es Alarms in working order(yes or no):_yes Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Components in alarm worked properly. Secondary floats are in workingorder.rder. Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Hay Meadow Road North Andover MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 SOIL ABSORPTION SYSTEM(SAS): X_(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: X leaching fields,number,dimensions: I Field 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 Simi of Hydraulic Failure. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)N/A Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan)N/A Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Hay Meadow Road 2 North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio r 37. 8 Date of Inspection: 04-10-2006 3 o SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. i 5 � ,•fit /t o F�'.�. � � •'�`S. 1 t t r + r �it� 1/fit 17' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Hay Meadow Road North Andover,MA 01845 Owner's Name: Ken&Gail Tomacchio Date of Inspection: 04-10-2006 SITE EXAM Slope Surface water Check cellar x Shallow wells Estimated depth to ground water 6' from SAS location. Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: x Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) j Accessed USGS database-explain: You must describe how you established the high ground water elevation: Dug Hole with auger in low drop off area. D Summary Record Card generated on 4/5/2006 10:35:13 AM by Lisa Warren Page 1 -Town Of North Andover Tax Map # 210-104.B-0113-0000.0 7 HAY MEADOW ROAD TOMACCHIO, KEN & GAIL 7 HAY MEADOW ROAD N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential a Size Total 1 Acres y FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until TOMACCHIO, KEN &GAIL Payor 7 HAY MEADOW ROAD N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 18093.0-7 HAY MEADOW ROAD Last Billing Date 1/10/2006 3180121 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 57.63 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 13242513 a Active ERT HH METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 3/20/2006 154 a Actual 16 10% 12/27/2005 138 aActual 17 1/17/2006 -21% -6/21 j2065 121 a Actual 22 10/14/2005 25% 6/14/2005 99 a Actual 17 7/15/2005 8% 3/10/2005 82 a Actual 14 4/5/2005 -1% 12/15/2004 68 a Actual 13 1/14/2005 3% 9/28/2004 55 a Actual 17 10/8/2004 -14% 6/15/2004 38 a Actual 10 7/30/2004 -22% 4/23/2004 28 a Actual 28 5/17/2004 0% 12/29/2003 0 n New Meter 0 12/29/2003 0% Town of North Andover, Massachusetts Form No.2 NORrM BOARD OF HEALTH o � ' • s DESIGN APPROVAL FOR SSACN°5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant kJw('a✓r j Test No. Site Location Reference Plans and Specs. , �!Y ENGINEER D GN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HTALTH Fee Site System Permit No. 0`71-7 Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTHVORTN r ti ° � 9 �,'•�,,,,;,.� DISPOSAL WORKS CONSTRUCTION PERMIT • ,SSAGMUSES Applicant ADDRESS TELEPHONE` NAME 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. e! 7 CHAIRMAN, BOARD OF HEALTH OF HEALTH Fee ,`5 D.W.C. No. 84 S • S s ;_; ., .: P _ \�� - V S �� :A .•t t V J � ` �y � _ . �_ RR 1\ .. �.: ti 'i `� �` � ;: 4 �Z �. "I k: � � � �` � � t. 1 � � ..,� � - .> �._�€�:. ,tet=��-rc �N� � ` �.�/ � it �� � r �, /e' • � ����TiQIV/M� � 1�/St' g0� � �� L.1/,.4'L� �� �� ,�. r' 1 IV ' �• rel L -� f 1( 1�_r -�'�^� "4A IX ? 2 r 1 � � � I �� � �� � �� � (J°` " t�� Kort t� Form N0. 4 Town of North Andover, Massachusetts BOARD OF HEALTH fit,gu t ,--19__96__ CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired ) byBen Os ood Jr. INSTALLER atsi- 7 Ha �mAadow Road North Andover, MA has been Installed In accordance with Board of Health Regulations as described in the Design Approval Site System Permit No.__ P47 dated__ June 1.9 , 19 96 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH FORM! U - LOT RELEASE FORM INSTRUCTIONS:. This farm is used to verify that all necessary approvals/permits from- Boards and Departments having jurisdiction have been obtained. This does not relieve {} the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FiLLS'�OUT THIS APPLICANT S C,� {'I/r��j PHONE LOCATION: Assessaes Map Number l v PARCE_ SUSDIVISION LOT(S) 4 \ STRE ST. NUMEER \� OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: ,C�X�$ 3 5��5d� dN cD� X- f X CONSERVATION ADMINISTRATOR DATE APPROVED �--- DATE REJECTED COMMENTS - TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED 7/2-,r 4/1 COMMENTS D/ c< PUELIC WORKS -SEWErFJWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING iNSPECTCR � DATE Revised 119;jm FORK! U'- LOT RELEASE FORM INSTRUCTIONS: Tris form is used to verify that all necessary approvals/permits from, Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/er landowner from compliance with any applicable or requirements: * * � ----**—AFFLICANT FILLS OUT THIS SEC TIC APPL!CAN T �Te S dem r Z PHCNE LCCA T ICN: Assesses Mao dumber la ?`,� PARcE_ & !13 SUEDIVISION LOT (S) STRE.T ST. NUMEER OFFICIAL USE ONLY RECOMMENDA T IONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTi_D COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED I SE:- 1C INSPECTOR-HEALTH DATE APPROVED / DATE REJECTED COMMENTS ' ' O ,1JCYJ�y��/p�i f I� / ` - - 11AD 2 7 20n0 i i PUELIC WORKS -SENERlWATER CONNECTIONS G D=F=, .izi. s�^� CRIVENAY PERMIT FIRE DEPARTMENT FE.C'EVED EY EUILDING ii ISPECTCR DATE PLAN REVIEW CHECKLIST ADDRESS 7 //YMU14bot-J '-� ENGINEER GENERAL 3 COPIES STAMPL.� LOCUSy NORTH ARROW SCALE CONTOURS � PROFILE v SECTION "� BENCHMARK SOIL & PERCS L-� ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? DRIVEWAY (Elev) WATER LINE ' FDN DRAIN SCH40 v TESTS CURRENT? SOIL EVAL SEPTIC TANK 001c'— l low) MIN 150OG .17 INVERT DROP GARB. GRINDER (2 comps +200 25 ' TO FDN MANHOLE ELEV GW ## COMPS. GB D-BOX SIZE ## LINES FIRST 2 ' LEVEL STATEMENT INLET - OUTLET //J1, 7� _ * l (2" OR .17 FT) TEE REQ'D?� LEACHING MIN 660 GPD? RESERVE AREA � 4' FROM PRIMARY? 20 SLOPE 100 ' TO WETLANDS '� 100 ' TO WELLS L---- 4 ' TO S.H.GW 4--- (51 >2M/IN) 35 ' TO FND & INTRCPTR DRAINS --- 400 ' TO SURFACE H2O SUPP �- 4 ' PERM. SOIL BELOW FACILITY '� MIN 12" COVER FILL? 15 ' ) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/100 ' ) SIDEWALL DIST. 3X EFF. i W OR D (MIN 61 ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT + SIDE X LDNG = TOT (L x W x ##) (DxLx2x##) (G/ft2) Copyright 0 1995 by S.L. Starr Z n Do PITS MIN 660 LEACHING MIN 1 (13 'x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x ##) (2x(L+W)xD x ##) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x ##) (2 x (L+W)xD x ##) (G/ft2) FIELDS C111Vk 4-SX2D� ¢D-,"�G,3 4 2 XZ? MIN 660 GPDZ 900 ft2 BED_ GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? L--'4" PEA STONE? IST LINE SLOPE .005? >3 'COVER-VENT L----- SCH 40 L--'MIN 12" COVER RATE16-Mf) LDG 1166 X 660 = X TOTAL 449 4�'c C0 G/ft2 REQ'D (ft2) LXW i DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY 9Pm L W D Vol . DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. t-,'" GW (Min. 11 below inlet) HWL LWL CHECK VALVE --- BLEEDER HOLE '------,MANUAL OP. SWITCH �f W , 16 Copyright Q 1995 by S.L. Starr I I �:o�� �; �,N FORM 11 - SOII, EVALUA'T'OR FORM Page 1 of 3 ? 6199 No. K; Date: ommonwealth of Massachusetts Massachusetts Soil Suitability -Assessment s or On-site �'ewage Ois qsq Performed By: .��`e's�4 ... � ...,.,...... Date; ��,,1/ Witnessed By: .��w1�};....�................�. ,...... ....^its 1,��.a�3z/ 4��wT . ,../ Loc r /\10y Owncr'+Mime„L�%J/6�/Y' �`l�lE /r�✓�' r Telcphon6/ New construction ❑ Repair Office Review Published Soil Survey Available: No ElYes gSoil Limitations /,' :, M Unit --�� - Year Published ;',��y'.�, .. Publication Scale �� , 7'.r Drainage Class �c ✓� sl Trr•.5.i, /Soil ni +�:..; Map Surficial Geologic Report Available: No Q Yes Year Published Publication Scale .......... Geoiogic.Material (Map Unit) ................. ................... Landform ...........:..........................................................:. . Flood Insurance Rate Map: Above 500year flood boundary No ❑Yes Q Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ✓�'4 ��ti Wetlands Conservancy Program Map (map unit) 1-/1,9 Current Water Resource Conditions (USG.S): Month Range :Above Normal ❑Normal ❑Below Normal ❑ Other References Reviewed: DEP APPROVED FORM•12/07195 RM 11 SOIL LVALUATOR. FORM Page 3 of 3 Location Address or Lot No. Determination 62r Seasonal High Water Table Method Used: Q Depth observed standing in observation hole inches Depth weeping from side of observation hole - .., . inches © Depth to soil mottles ..777`", inchesEl Ground water adjustment .................. feet Index Well Number .....:. ........ Reading Date Index well level ...... . Adjustment factor .................. Adjusted ground water level . ................................................... Depth of Naturally Occurring.Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? tet, If not, what is the depth of naturally occurring pervious material? Certification I certify that on '� �' (date) I have passed the soil evaluator examination approved by the Depa tment of Environmental Protection and that the above analysis was performed by me consistent,with the required training, expertise and experience described in 310 CMR 15.017. Signatur ' " Date 1 `�6 AEP APPROVED FORM•12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot NO. On-site Review Z Time:.�, .c.y�'� Weather%`//r�' i .. Deep Hole Number Date:... Location (identify on site pian( : .. Land Use : �' '�'ir/� Slope (%1 Surface Stones Vegetation -rzrn Landformu.�.G��� Position on landscape (sketch on the back) Distances from: Open Water Body? feet Drainage way?/,©"� feet Possible Wet Area feet Property Line .5 ..... feet Drinking Water Well ., -".. feet Other .. ..,.,. DEEP OBSERVATION MOLE LOG' Depth from Soil Horizon . Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, % Gravel) 2:5•l���I7.�c�. : yrs✓c7 S yrZ s�8 5� -11'11417�'/Z S 5•'/NC7 Parent Material (geologic) ��f�c i Z- AepthtoSedrock: Qebth tp Groundwater: Standing Water in the Hole; Weeping fr6n Pit Face: 2 �l Estimated Seasonal High Ground Water: ✓. -- VEP APPROVED FORM-12/07/45 FORM 11 - SOIL EVALUATOR NORM Page 2 of 3 Location Addressor Lot No. , On-site Review Deep Hole Number Date:.3/..,' Time:. Weather ��C? Location (identify on site plan) �rTi.Dr.i�/.QG Slope (%) . ?-- Surface Stones . Land Use ..:: ' ... Vegetation Landform '��r?i�./�I .s�� Position on landscape (sketch on the back) . -. Tom Distances from: Open Water Body % /� feet Drainage way ..: feet Possible Wet Ar*✓a .feet Property Line . . . . feet Drinking Water Well feet Other ,. _...:.. DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure, Stones,G avel)rs, Consistency, Z-'5 7YR S� r� <f ael, Z8„ ARED AT EVERY.FROPOSED DISPOSAL AREA N Parent Material (geologic) Crf �.9[. T ' DepthtoBedrock: w � fC' Depth to Grogndwater. Standing Water in the Hole: Weeping from Pit Pace: Eslimated Seasonal High Ground Water: l!� llEP APPROVED FORA1- 12107195 NEW ENGLAND ENGINEERING SERVICES INC Tp �ARb p�ANDp NEq�TM�ER/ May 17, 1996 North Andover Board of Health Town Hall Annex Main Street North Andover,MA 01845 RE: TITLE V REPORT Enclosed is the Title V report for 7 Haymeadow Rd. ,North Andover,MA. The system,did not pass the inspection. If there are any questions please call me at my office,686-1768. Yours truly, Benjamin C. Osgood Jr. J President 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 Commonwecith of Massachusetts Executive Office of Environmental Affairs Department of. Envir®r-smnental Protection Wiliam m F. Weld Trudy Coxe Argon Paul Cellucci .80aw-7 David 8,Struhs U.Ciwemot CvrnmWslonoi SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Addraaa: 1,4 y11V0ea0 w R1) N. ANpoc.' rC Address of Owner. of Inspection: yljZclG (If different) Nnmootlnepootor. B nja zn C. Osgoe-' Jr. Company Name, Address and Telephone Number. New England Engineering Services, Inc. 33 Walker Road, North Andover, Ma 01845 CERTIFICATION STATEMENT Tel. 508-686-1768 Fax. 508-685-1099 1 certify that 1 have personally inspected the sewa;, disposal system at this address and that the information reported below is true,.accurate and complete as of the time of inspection. The in.eaection was performed based on my training and experience in the proper function and maintenance of on-site'sewage disposal systema. ,"he system; Passes Conditionally Passes Needs FurtYer Evaluation: By the Local Approving Authority �„ Fails /� . Inapeotor'a Signatures 6-1 ply p /' /� Date: / 6 The System Inspector shallsubmit a copy of this irspection report to the Approving Authority.withln thirty(30)days of completing this inspection. If the system ie a'shared system or hez a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the-Department of Environmental Protection, The original should be sent to the system owner Lnd copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B;'C, or D: Ar-SYSTEM PASSES: I have not found any inforrxition which Lndicates that the system violates any of the failure criteria as defined in 310 CMR 15.803. Any failure criteria not evail.ated are ince sated below, B), SYSTEM CONDITIONALLY PASSES: . One or more system components need to be replaced or repaired, The system, upon completion of the replacement or repair, passes inspection. Indicate yea;no,or not determined(u, N, or ND).' Describe basis of determination in all instances. If"not determined",explain why not) The septic tank in inet.al, cracked, structurally unsound; shows substantial infiltration or exfiltmtion,-or tank failure is imminent. The rimtem will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved by the'Board of health, (revised 11/03/95) 1 One Winter Street • boaton, Massachusetts 02108 a FAX(617) 558-1049 a Telephone 1(;17) 292-SSW i PnNed on Recycled Piper ♦ 1 :x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinuod) propertyAddye" 1�P.�MtAw >2D. N• ,/{�'0cvc2 A r, dwnez 13,, "s G' Y ntC CZ.tG DQ4&ad laxplaccla= ti y/,?-1! Bl SYSTEM CONDITIONALLY PASSES (continued) i }�acku 'or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) $ems T Sedistribution}box. The system will pass inspection if(with approval of the Board of or due to s broken settled or.uneven Health): : broken pipe($) are replaced obstruction is remgved _ distribution box is levelled or replaced The system required pumping System more than four times a year due to broken or obstructed pips(s)• The will pass inspection if(with approval of the Board of Health): broken pipa(s)are replaced obstruction is removod , Cl FURTHER EVALUATION IS REQUEgED BY THE BOARD OF HEALTH: FU Condition exist which require fu.�ther evaluation by the Board of Health in order.to determine if the system is failing to protect the publicIhealth, safety and the env?;•oament. 1) 'SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THETENvxRoNMEN�oTIOMNG INA ` MANNER WHICH WILL PROTECT THE PUBLIC _ Cesspool or privy is w•tbir 50 feet of a surface water tea wetland or a.salt marsh, _ Cesspool or privy in Kith:n 50 feet of a bordeidng vegeta IF APPROPRIATE) 2) SXSTEM WILL FAIL UNLL*: THE BOARD s FtJNC'TIONING N(AND PUBLIC WATER SUP pMANNER THAT PROTECT F E iJBLIC HEALTH AND DETERMINES THAT THE S);f iE _ SAFETY AND THE ENVIRON;`sr T: m and is within 100 feet to a surface water supply or tributary to a The system hes a sep'•ic tank and soil absorption syste T surface water supply. well; _ The system has a sept: rank and soil absorption system end is within a Zone I of a public water supply within 60 feet of a private wa er suPP1Y well. _ The system has aseptic-u*and soil absorption sygom and is The system has a sept:" t.enk and soil absorption system ane is less than 100 feet but 50 feet or more from a private water supply well;unless a wch water analysis for coliform bacteria and volatile organic,compounds indicates that the well is free fron, pollution from t::u. .acillty and the presence of amnion a nitrogen and nitrate nitrogen b equal to or less than b ppm. 9) OTHER 2 (revised 11/03/95) :1 SUBSURFACE S,7WAGE DISP T A ,ST INgpECTION FORM PAR CERTIFICATION (continued) f property Addresar '71'(? Y•vi�RQ� ,nJ 0. N• A n1 p c v c✓L Owner 0w(G')4r Date of Inspection: 1 i Z 07 ; Dl SYSTEM F,AIL9s I bare determined that the system violates or mora of the following failure criteria as defined in 910 CMR 16.903. 'Phe basis for . identified below. Thu 'yard of Health should be oontaoted to determine what will be neoessary this determination h to correct the failure. Backup of sewage into facility or stem component due-to an m.,erloaded nr.alogged SAS 9.r^gyp-='•, .. und or surface waters due to an overloaded or clogged SAS or Dischnrga+or ponding of effluent the surface of the gro cesspool. Static liquid level in the distribu•:an box above outlet invert due to an overloaded or clogged SAS or cesspool• —' flow, Liquid depth in cesspool is leas 6°below invert or available volume is less than 112 day " in more than 4 ,es in the last year NOT due to clogged or obstructed pipe(s). Paquired Pumping Number of times pumped • is below the high groundwater elevation. Any portion of the Soil Absorpt:`.a System, cesspool or privy pool or pi. is within 100 feet of a surface water supply or tributary Any portion of a cessto a surface water supply. Any portion of a cesspool or pr'; is within a Zone I of a public well. _ AMY portion,of a cesspool or p:'--./is within So feet of a private water supPly well. is less than 100 feet but greater than 50 feet from a private water supply well with no Any portion'of a cesspQo1 or 1 Y if the well has been analyzed to be acceptable, attach copy of well water analysis for acceptable water quality anal, .'. ammonia nitrogen and nitrate nitrogen. coliform bacteria,volatile orgc..�c compounds, E) LARGE SYSTEM FAILS: The following criteria apply to large ay, •=Ls in addition to the criteria above: S m) and the system is a significant throat to public The system serves a facility wi:h a de :. flow of 10,000 gpd or greater(Large Y health and safety and the envi.:-onmeu. .:cause one or more of the following conditions exist: the system is within 400 fee_ _i a surface drinking water supply the system is withi;• 200 fest I a tributary to a surface drinking water supply m is locate_1 in a n!.:igen sensitive area(Interim Wellhead Protection Area(IWPA) or a trapped Zone II of a public the syete r..- water supply well) m eha! :ring the system and facility into full compliance with the groundwater treatment program The owner,or operator of any such sY" onal office of the Department for further information•, xCMR 5.00 and B,G`). PleaE nsjt the local re requirements of 314gi 3 (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .r PART B CHECKLIST Property Address: 7 NhY M rs 19O� fZ 0 �. c,� ft �• A Owner. OwIGm'r ID,a (210 Date of Inspection: Check if the following have been done: .Pumping information was requested of the owner, occupant, and Board of Health. ✓Nose of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection, ✓As built plans have been obtained and examined. Note if they ars not available with N/A. 2The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout, ZAU system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffle or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum, 'zThe size and location of the Soil Absorption System on the site has been determined based on existing information or a proximated by non-intrusive methods. V The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION r Property Address '? MA1'rnFilOv (L D. V. r4 NO'v e/L Owner. D, -, &)77- 0 DAte of Iti"tion: a/sb FLOW CONDITIONS !1 RESIDENTIAL I 0 v io I Cf Design flow:�,�allona / t� Number of bedrooms:, Number of curmut residents:q �{ Garbage grinder(yes or no): `S at'1 ��`I 3 L Laundry oonnected to system(yes or no)>y Seasonal use(yes or no):_ Water meter readings, if available: dot b`s G'• R � O u C(�� � _. Last date of oocupaney: C ^"T COMMERCIAL/INDUSTRIAL.• Type of establishment: Design flow:_galions/day Grease trap present: (yea or no)— Industrial Waste Holding Tank present: (yes or no), Non•aanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:.(Describe) L.aut date of occupancy;_ GENERAL INFORMATION PUMPING RECORDS and source of infonnation: System pum as part of inspection: (yK or no)'k/ F Y"-") If yea, volume pumped: Rallona Reason for pumping: TYPE OF SYSTEM X _ Septic taak/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yea or no) (if yes, attach previous inspection records, if any) Other(explain) APPROICIMATE AGE of all components, date installed(if known)and source of lnforvo,tion: -7 -7 Sewage odors detected when arriving at the nue: (yes or no)Aj (revised 11/03/95) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) n Property Addrem `7 / f) rY►eftOo ,�•� n N O. ANO v e It- 4 ',V t- f ' 'Owrier. D,--t G-)-i r p,o at o Date of Insp'eotion: H �/Z �41b ' SRPTIC TANK:_ (locate on site plan) Depth below grade: 3 Material of construction:_&concrete_metal—FRP_otheeexplaia) Dimensions: �T e> G 6 1,0/V Sludge depth:-- Distance from top of sludge to bottom of outlet tee or battle: Z2•� Scum thiclm :Q , �f Distance from top of scum to top of outlet tee or baffle: Y Distance from bottom of scum to bottom of outlet',tee or baffle: 2 V Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakn.;e, etc.) GREASE TRAP:_ (locate on site pks. Depth below gra4e: Material of construction: _concrete_metal_FRP_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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of lo&ka;o, etc.) (revised 11/03/95) 6 J•(i• SUBSURFACE SEWAGE DISPOSAL SYS'T'EM INSPECTION FORM '- PART C SYSTEM INFORMATION (continued) Property Address , 7 i^fR�1 ..1rRnvw 242, ,�.,. fy,vpo0i✓rL f Owner. >a w (4 T- O c 2 v 1 Date of Inspection: TIGHT OR HOLDING TANK (locate on site plan) __. Depth below grade: Material of construction:,concrete_metal_FRP wother(explain) Dimensions: Capacity:, aullons Design flow; ........gallona/day Alarm.level, Comments: (condition of inlet tee, condition of alarm and f.,at switches, etc.) DISTRIBUTION 80X: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of soUds carryover, evidence of leakage into or out of box, etc.) ) L ✓ N 7-V 6 = .5 Fin O !2 dS i/L/2bN l�Z)X S6� NOT �l^c�n1(j I.v.45 ✓ r' T-0 f" o l^ :421-5'7-R-[a S2 n 0•� P�P£' PUMP CHAMBER (locate on site plan) Pumps in working orden(yes or no) Comments: (note condition of pump chamber,coaditio...of pumps and appurtenances, etc,) (revised 11/03/95) 7 SUBSURFAC i;SEWAGE DISPOSAL SYSTEM INSPECTION FORM " PART C SYSTEM INFORMATION (continued) r' Property Address: 7 H#y , t Fj pc,,,,`, 2 O, N, ff`N 00 2 Owaer,. fl tN, V HT D 10 .7 1 o Dote of Insp ,otion: `1r12(� L SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; esc,,Avation not res lred, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ loachiug chambers, numba;,— leaching galleries, number: leaching trenches, tiumber,length: leaching fields, number, dimensions: Q. J=�n overflow cesspool, number: Comments; (note condition of soil, Cgns of hydrat-.c failure, level of ponding, condition of vegetation etc,) CESSPOOLS:_ (locate on site plan) Humber and configuration: Depth-top of liquid to inlet invert:_ Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydrau'.c failure, level of ponding,condition of vegetation, etc.) PRIVY: (locate on site plan) Materiels of ocns a Dimensions: Depth of scuds• Comments:(note oondition of soil, siyvs of hydras sic failure, level of ponding,condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Propov-ty Addresa: `7 N4tf Y lvt i"O w 2 D. .U. A i✓D a✓ 2 s+n r4 Owner OLv r C-1-q-T'" DSO R O Date a' Inspection: 141/ 2-1-JCS OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent referenosa landmarks or beAchmarks locate all wells within, 100' AUU� ct 4I � j EAc i I I 2SS I � I r DEFTZ TO GROUNDWATER. Depth o) g.•aundwater: , L feet method v f daterml ation or approximation: tz'-/l C M T S% Ri TS I00 t/ r~ (reviser /03/95) 9 !JGR7,H ANDCUTR °RD OF F*-ALTILJ TAST.AJJ,AqI0I! Ch!:CK T, FROVE5V DISAPPPOV-'n EXUVATION OK Dat p Date: Y.-1 " - . Q'7d Reason: T mi 1, 7 "1-- As %ilt Submitted L coca ion, dimensions of system, location in regard to Check: _7 L ot--lo U percolation 'bests, depth of system., i-rater table 2. Distance to VIetland Areas., Drains, Street & House, Drainage Easement and Wells. 3- Water e Location 4. No PVX11pe e� iDPtic Tement-Pipe to Tank-Joints on both side of Tan 6. Distribution Box - No crack�In box or cove all lines w I)ecually from box. 7. Leach Fields - Di ions, StonXee ths, Cappcnds., Clean do -ee<-ished stone 8. Leach Pits Dimensions., Depth of Stone., Splash paacs,tees., Cerilen-t-pipe to tLrik- joints on both sides of tank-, Clean double-cashed stone 9. No Ga e Disposals Gar 10. Final Grading k%arricading of sub-surface system? Jw P ,/ SOIL PROFILE,&. PERCOLATION TEST DATA Town/Ci�yJ" � No.&Street //,, cwtLot No.� Loc./Subdiv. 6(_/ i-) /P" Plan Owner Investigator6�2i-, Q�-�!!> Observer SOIL_PROFILES-DATE Elev�1_ z' Elev.. :_ . 3• EleV. 4• 0 - 0 d Eiev. �. 0 i O\ 2 1 1 1 0 2 2 2 2 3 C 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7 3 8 8 g 9 � 9 9 9 10 10 10 10 Benchmark Location Elevation Datum Percolation Tests-Date Pit Number 1 2 3 4 S j Start Saturation Soak-Mins. 2 v Start Test-Time ` Dro of 3��-Time Dro of P-Time Mins.lst 3"Dro Mins.2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates North And. i S 01� 12/-29" E 217.00' • `' ` x,•„1.2-7.00` ...'7-- " _ y~`-•••--'1• tw I^,J� s.►.•.:.w—.,-.•, ....�.....•..ea..,...—gyp.•...__ .•_ .,..�1 .._ ; r. _ ;i r. � ter.. 4Y � � r i•' �� ' �r 1 J71 7� (49, or • • ' �f �r 3 -f�r f�awa� .t 4.6T. , ui • •r to OD 00 CQ •: "� � # * � ;t' �x,01 _ �._ - 1 � 7g DSa gol Ocf S 124 g . ..,• •_ o-�.�. �:.��- _ :, ,__-S- 00* X40= ss•, pL3y8 L 1 C /1 DST 1-a VAR . y til.i•ri►•••Y•+�rF1i+_+ it..^- w.-•r.r w�.lrr Y•n. ...•.���r_ ...-.. �.i�. �... Ar TJ {• • • •r^� ,H.s..p. w.�'.`.... .:.1..r__r+ 1 .,.w— r+�+.w+^, r - •u� Nrr-•r.4_.r. M }' 'r• � 1 .1 l . i t/ . '.^. vS'.., • • .ii' x' `" �' �,iL, ♦� `.^.11I`,j �fr'J.�11 T e r = SOIL PROFILE & PERCOLATION TEST DATA TGwr�JCitriC�UU�� No.&Street (�.�� � 'lceC Lot No. //A,' / Loc./Subdiv. ;eC� /h � --- / Z Plan Owner. Investigator - //� Observer SOIL 'PROFILES-DATE 1. Elev. 2' Elev._ 3' Elev. !—Elev. 0 - 0 � 37 0 0 2 2 a 2 2 3 3 3 3 3 4 4 �4 4 5 5 R5 5 6 6 6 6 7 7 �7 7 s 8 8 8 \� 9 9 9 F 10 10 10 10 Benchmark- Location Elevation Datum Percolation Tests-Date amt Number 1 2 3 4 S Start Saturation Soak-Mins. Start Test-Time Dr02 of 3"-Time Drov of 6"-Time Mlns.lst 3"Dro Mins<2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates, North And. 1 July 319 1978 Equity ji nagement Group 22$ Lew--- Wharf Boston, '."Lass. Re: Lot L Winter St. Gentlemen.: The as-la-ground plan prepared for -the above-mentioned lot is unsatisfactory. We request that the plan 6., be revised to show the building and the septic system in t1ie proper location and that all elevations be indicated. We have contacted Joseph Barb alto and he ^ , indicated that he requested to be notified VAien the system -,ras ready for final inspection in the spring of 1978. He also wishes to obtain a certified plot plan to correctly shoTa the lWase and system Your cooperation in this matter ,411 enable the building inspector to issue an occupancy permit on this c�re'1.1ing. Very truly yours, Leonard X. Phillips j Inspector i r _— 1 TO: NORTH ANDOVER, MASS 19 -77 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at 6 V1111 %/-�F-�' s North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans ands fications dated COMtij 19 �0�� n oCD NiGF9�� o � � / Reg. bneer/Reg. Itarian s TO: NORTH ANDOVER, MASS `� �3 19 -77 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at 11V1/\/ 7-7C-- r North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 coM�o� Reg. 11 �tncer/1 e S nitarian ` 90 ' 11v alvD 7F �pMM0N a IqR/A/V so-s' A4FADUW r r4 0 IN �.g Ived • �1� �r��sU;���?,r�,w,�s nv ♦ Sill '^ j i oos �o !U H11y - t s � 3noa d �•�o� � � -� _ &0 71..r.yrr, -1 � LAar,Z• ,';�c`oQ�`+`�l N 1 :, %r�1 ?9 �(�1t�y\ - P i s S-Z" L �T`i0 Nib-)d 4-n 1 l 01\ 1 , r 1� Q rt • Q � ,� !T/ oSFE Ph EgLj .�i'fAD//yASS , ' ;r'• CO M MON oaa �F9( O o a ,. w 'r'•r �o re:S E SL.✓E_� _ v a 7 a Z67 //1 TE 5 2 • SVow Cove P, A ?' FxlST/NC— D L,-,- f/,'%� G hPP�0 t gti 4. 411 /tel; ) S 4kF� rr.��/? �ovs•F/� G D__- /000 To D,6_7-F A All"c Vo4 71 Al s i N T F 10� e Commonwealth of Massachusetts F City/Town of _RECEIVED- a W° System Pumping Record Form.4 ,Mss '� 4 `1 Q 11 DEP has provided this form for use by local Boards of Health. Other"N77sRRginformation must be substantially the same as that provided here. Bgge,�j with your 4Jr� local Board of Health to determine the form they use. The System Ptli�7tM miffed to the local Board of Health or other approving authority. A. Facility Information 1. S tion: Left front of house, right front of house, left side of house, right side of hous Le rear of hous fight rear of house, left side of building, right rear of building, under deck. City/Town State Zip Code P .2. System Owner: L� Name Address(if different from location) City/Town State� _ Z�Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 9_1q_0_ If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi n 9t System: OCi 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Locatio contents were disposed: I Lo II ste ter auler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 r i W r � Y Qk JQiG�7vIN/Nd • � - dFiAL L 1 � � \ —SAND L/y/T r' i T7��5 i� T U �.¢�i—/�ry� TNA T �/.c•!1ArZG� •; r•ow r! 4r 1 �c'13, !.io�r� .4�c;�,,o:t��' A-1.9-� S. �.,r :!J✓Fct•, .fit £��dtl7tCr./3 �g � -3•r.�Y��i r,/ r-i.:� .�;4�./ /�.�r+�� 5�/�+;lye •.�'§ ,�,"�i I i r i gi�irfY•ierv• ylls' yYkn'•.,"' - 'AA�111 - i.4uY[... .. +•1.IAIRF4i^'.. +.xOiYgtlr'[. _ ' PROPOS Eo SC/ASU,R-r4CE SEWAC?e b15PaS L cSYSTE*r t ,4Nv Reo Po3ED Lor aje.41b/NG 0 J� � c�'CACE j �• ct 14- " I 's 114 el •� LOCAT/o": Z-OT- y -- Vt1�►vT• r� 'S-r-r� T Also 3 , . .,� hl a . k .� D,'�r�.� � +r4 s S ,000lvw DQES/C A.! OA rA TYPE OF QL/1G4o/A1cT Y J , .. GRRgGE CEGt..�� PLUMBrfVC, FAC/UT/ES ' JIcO - SEWAC76 FW AO ES'T/MATE : (per SEPTIC TAMC 14000 3 �T to ';' 3b �esaea r/oN AREA 0 J W�•�- 'rte,.� '� ' ,� l SZ OPERCOLAT/ON TESTS sf/ r Sµ DArE I$(o TOP EtEVATro V ..,,,, 1 ABS�tPn etre? _. rBOTTO/N EtE✓A T�t! I.�F� �... LS*C4QAT-/DNDROP /N. M/N M/N. M/N. T/ON RATE /' M•v. /v. M. J% /Nim,j/,v Min. /�v t TEsr PITS .moi 403 #4 TOP 6ZEVAT/OAJ Zb Q WE•L L /N,6, a � o " S©/L TYPES w `18 t„o►a .*t AND 7►c� j7 i3 rpt /Ei'F A;' .D ooutom✓ k.D . � Q S TA 0-* o /,S q. o � �,�� � _- S07 OAI &6VAMAIJ Zo TESTS COA14U C 7-6;0 BY 040 - "A �" ' �"•"► ` v/1 =;ZA ,� TE5rs u//7-A.1 564 6Y : y G Ga k LZ oV "Az PLAAl e� OFsr /cl �.eirCer ,�NT A cEE / OF V G w J - _ o ! fie • a • e e _'s.� r --- !�` • ^`o • APPED �!V D- S'_n.. Z b"4 ¢.,�PCRA-AeATE15 1�' ' P/PE -- -- --- ---- -- Coe EQu/YAe-ENT) SART/AL BED E6,zD SEcrlop i SALE �2n-_ Ii �u l s / 4REA 900 S h N �FO.E 5YE4lF/c�Al"/Oit/S - SEE 9EC710A.1 AT LOWEr2 RA�;NT) _ ,�,gTelBUT/DN 8OW _ ¢"Or,45r T,e%.1, s O05 /t— /DOO ,QAL. COntCA6TE SEPT/C TAAIK 45' - — --4`� PELF. A. �i.-, .s• oC�s r1 BSO.e PTIo/V �EL7 OL A�l! - -t3tur /t/07- Tn c-S ALE L ,Q4CK�lLL - �___ ore - --• -- �- _ - � ._ _ �-T— �,266 ��$" W,45 NEQ _ • S1 iT eo • • • . e e -= t ;•,� -t7Q opQ�c Q ,:n � ` .Z• e9r•• , C,2USNE0 ST©�lj� e.•.• �.4 a ••• • • !"a'Rt� f•'/PE DEQ TMJI ` WASHER ` — ` Jam:c./BGE vt/ASNEp / • .4.A S/,/.O -y - ------- ^ R in LOT- - W, CT 4eSv,ePT/O�. fjEv /04AN QNv <5'EC T/p NS <.s'NEE 7 of r, V { AL - _ _