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HomeMy WebLinkAboutMiscellaneous - 73 FARNUM STREET 4/30/2018Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. learn Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 11/3/2015 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. A. General Information 1. Inspector: r Neil J. Bateson Name of Inspector Bateson Enterprises Inc. DEC r 2ni� Company Name 7`Q• .,L� ^,r 111 Argilla Road tom. Company Address Andover Cityrrown 978-475-4786 Telephone Number B. Certification MA State S115 License Number 01810 Zip Code 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 Inspector's Signature 11/3/2015 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 11/3/2015 Cityfrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After permit from B.O.H. , install new d -box & outlet yee in septic tank, inspection from B.O.H., septic system now passes Title 5 Inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or 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 of NORrH qti O0 o m 5 ��SSA C IiUS��� PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 11/3/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D -Box and Outlet Tee By: Todd Bateson At: 73 Farnum Street Map 107.A Lot 0055 th Andover, MA 01845 ' of this ce ca e j! hal jot be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 73 Farnum St. INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BQH APPROVAL DATE ON PLAN: MAP: 107.A LOT: 0055 INSPECTIONS I D -Box INSPECTION: 111� DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX Installed on stable stone base H-20 D -Box Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Schedule 40 PVC Pipe Comments: • sw°' Map -Block -Lot Commonwealth of Massa usettS • 107.A0055 ARD OF HEAL ----------------------- rth Andover CE TIFIC T F COM LIA CE THIS TO CER FY,That th Individua Sewage Dispo 1 System epair) by Todd Ba son --------------- ------------------ -- ------------------------------------------- ------------------ ---------------- ------------------- Installer at No 3 FARM S ET has been installed in acc da ce with the provisi ns of ITLE 5 of the Sta Env' nmental Code as de ' ed in the application for Disposal Wo s Construction Pe 'tN 13HP-20157087 to __ October_05,_2015___ ----------------------------------------------------------------- Printed On: Oct -05-2015 BOARD OF HEALTH • ."' Commonwealth of Massachusetts Map -Block -Lot • 107.A0055 BOARD OF HEALTH ----------------------- Pennit No North Andover BHP -2015-0875 ----------------------- FEE $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd B-ateson - - - - ----------------------------------------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. at No 73 FARNUM STREET as shown on the application for Disposal Works Construction Permit No. BHP -2015-087 Dated October 05, 2015 1-1--%, ----------------------------- -------;� F -CO-PY ------------------- Issued On: Oct -05-2015 BOARD OF HEALTH q ! Application for Septic disposal .System TODa S DATE s Construction; Pe l it - TOWN OF $ 250:00 — Full Repair NORTH .ANDOVER, MA 0.1845 $x-25.00—Component Important: Application Is hereby made for a permit to: When filing out ❑ Construct a new on-site'sewage disposal system* forms on the computer, use❑7epair Ir or replace an existing. on-site sewage disposal' system* only move key or replace an existing system component - what? 1p �"�to move your�� yr n I` cursor -.'— - do not J"' use the return A. Facility Information key. �%�� F/; rem Address or Lot# nr,�,- •^� �� � �Qv✓•cam-- �`��t cityrrown OCT 0 5 2015i�J� 2: *TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ravity (choose one) TOH'N OF NORTH TMIENTANDOVER * if pump syste , attach copy of electrical permit to application'** HEALTH DEPARTh;Ef�T ➢ pump System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes Not If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) What is theMakc? What is theModa€s 2. Owner Information Name X13 �>MNli� �• Address (if different from above) Cityrrown State Zip Code T47? 6,T 'z- 7�3 Y Telephone Number 3. Installer Information 1 Name e Name of Corr�pany_ 1iATEDON ENTERPRISES, INC, 111 ARG I lzb� Address4nvf ANDOVER, MA 01810 Cityrrown State Zip Code Telephone Number (Cell Phone # if posslb/e. please) 4. Designerinformation Name Name of Company Address Cityrrown State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 4 �--3,, =A:� TODAYS DATE $.250.00 - Full Repair $125.00.- Component PAGE 2 OF 2 A. Facility. nformation continued.... 5. Type -of Building: 24esidentialDwelling or []Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system In accordance with the provisions of Title 5 of the Env/ronmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system !n operation until a Certificate of Compliance has been Issue y thls Board of Health. 3a -rs� Name _ ^ n Dam Health Representative) Date Ono reasons:.. For Office Use Only: 1 ' . Fee Attacbed? : Yes 2. • ProjectM"ager Oblfgation Form Aaaclieda 'yes 3•: ? Ifso) Atrsch My Permrt`... res 4. Fotrrl4 on wilt- (hew construction •ronly). 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Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _Q ISI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street " " Property Address Salvatore DiMilla v Owners Name North Andover MA 01845 9/12/2015 �I Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the fn R. / ECEIVE® A. General Information SEP 23 2015 ,ft 1. Inspector: TOWN OF NORTH ANDOVER Neil J. Bateson HEALTH DEPFRTMENT Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover Cityfrown 978-475-4786 Telephone Number B. Certification MA State S115 License Number 01810 Zip Code 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ N eds urther valuation by the Local Approving Authority 9/12/2015 Insp ctors Tignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under theconditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 State Zip Code 9/12/2015 Date of Inspection 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 Owner information is. required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner's Name North Andover Cityrrown B. Certification MA 01845 State Zip Code 9/12/2015 Date of Inspection ❑ 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 ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): ❑ 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(4)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Stree Property Address Salvatore DiMilla Owners Name North Andover MA 01845 9/12/2015 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: Outlet tee in septic tank needs to be replaced. 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'/ day flow t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® 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 C, 73 Farnum Street Property Address Salvatore DiMilla Owner information is Owner's Name required for North Andover MA 01845 9/12/2015 every 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Citylrown 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): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 14 N/A t5ins • 3/13 Title 5 Official 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 73 Famum Street D. System Information Description: Number of current residents: 9/12/2015 Date of Inspection Does residence have a garbage grinder? Property Address ® Salvatore DiMilla Owner Owner's Name information is required for North Andover MA 01845 every page. City/Town State Zip Code D. System Information Description: Number of current residents: 9/12/2015 Date of Inspection Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection Z Yes ❑ No information in this report.) Yes ❑ No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Pumped 2014, owner 1000 gallons Measured tank Inspect tank & tees 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 operatorunder contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins - 3113 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts ugTitle 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments73 Farnum Street Owner information is required for every page. Property Address Salvatore DiMilla Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01845 State Zip Code 9/12/2015 Date of Inspection Approximate age of all components, date installed (if known) and source of information: Orginal 4/1/1961, info at B.O.H. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.6 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast Iron through wall, 4" & 2 Cast iron in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 0.6 feet ❑ 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: 6'x 4' Sludge depth: 1" t5ins • 3/13 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal poral System •Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 73 Famum Street Owner information is required for every page. t5ins - 3/13 Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Cityrrown 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 N/A 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 1" N/A= Outlet tee corroded off N/A How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic Tank 2. Pumped septic tank. Outlet tee corroded off, needs to be replaced ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass 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: feet ❑ polyethylene ❑ other (explain): Date Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner information is required for every page. Owner's Name North Andover MA 01845 City/Town 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.): 9/12/2015 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: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner Owner's Name information is required for North Andover MA 01845 9/12/2015 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -Box 2 D -box level & distribution equal. Evidence of carryover, pumped d -box to clean. No evidence of leakage. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "< 73 Farnum Street Property Address Salvatore DiMilla Owner Owner's Name information is North Andover MA 01845 9/12/2015 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leachin chambers b g num er. ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 60' long ❑ 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.): Soil Ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow t5ins • 3113 ❑ Yes ❑ No Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Fonn: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 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 10a feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately 71wvc., � --6% ktA-s tn"'j, -') -"— (mg1ne<- '�. S\V� t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 --�3C'� �I- = X3'8 1 �1 O�a�L C - a t — a Lt'LI 1, V)01 71wvc., � --6% ktA-s tn"'j, -') -"— (mg1ne<- '�. S\V� t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r< 73 Farnum Street Owner information is required for every page. Property Address Salvatore DiMilla Owner's Name North Andover Cityfrown D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells MA 01845 State Zip Code 9/12/2015 Date of Inspection Estimated depth to high ground water: >4feet 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: Date 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) ® Accessed USGS database - explain: Essex County Soil Map. You must describe how you established the high ground water elevation: Essex County Soil Map, Sheet # 36, Canton Soil, Water >6' Deep 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 rt 73 Farnum Street Property Address Salvatore DiMilla Owner information is required for every page. Owner's Name North Andover MA 01845 9/12/2015 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked Z. 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 :&N Commonwealth of Massachusetts City/Town of . System Pumping. Record Form 4 DEP has provided this form for use -.by local Boards of Health. Other forms may be'used, but the information' must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/ Right front of house, Left / rear ofh4ttsl:r Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address citylrown State Zip Code 2. System Owner. Name' Address (if different from location) city/rown B. Pumping state 2p Code 4!�2 e �--7a-, Telephone Number ' 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type -of system: ❑ Cesspool(s) eptic Tank a ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes LJ'No If yes, was it cleaned? ❑ Yes ❑ No '5. Condition of System: II 6. System Pumped By.- Nell. y: Neil. Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Waste Water F5821 Vehicle License Number Date t5form4.dor.- 06/03 1 System Pumping Record • Page 1 of 1 Summary Record Card generated on 9/1/2015 12:53:30 PM by Karen Hanlon Town of North Andover Tax Map # 210-107.A-0055-0000.0 Parcel Id 17881 73 FARNUM STREET DIMILLA, SALVATORE 73 FARNUM STREET N. ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.69 Acres FY 2016 UB Mailina Index Name/Address DIMILLA, SALVATORE 73 FARNUM STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 14231.0 - 73 FARNUM STREET 2100227 02 Cycle 02 UB Services Maint. Account No. 2100227 Service Code MISCFEEADMIN FEE WTR WATER UB Meter Maintenance Type Loan Number Activellnact. From Payor Occupant Name Active/Inactive Last Billing Date 6/4/2015 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/ 01 ALL METER SIZE 34.20 /1 Until Account No. 2100227 Serial No Status Location Brand Type Size YTD Cons 16337217 a Active ERT METE METE w Water 0.63 0.63 364 Date Reading Code Consumption Posted Date Variance 8/4/2015 908 a Actual 9 0% 5/5/2015 899 a Actual 9 6/22/2015 -30% 2/3/2015 890 a Actual 13 3/20/2015 -5% 11/3/2014 877 aActual 14 12/15/2014 9% 8/1/2014 863 aActual 12 9/11/2014 -6% 5/5/2014 851 a Actual 13 6/12/2014 7% 2/4/2014 838 a Actual 13 3/17/2014 -5% 10/31/2013 825 aActual 13 12/20/2013 1% 8/1/2013 812 aActual 13 9/18/2013 -2% 5/1/2013 799 a Actual 12 6/18/2013 11% 2/7/2013 787 a Actual 13 3/13/2013 -12% 10/30/2012 774 a Actual 13 12/13/2012 14% 8/3/2012 761 a Actual 12 9/26/2012 -3% 5/2/2012 749 a Actual 12 6/20/2012 -5% 2/2/2012 737 a Actual 13 3/14/2012 6% 11/1/2011 724 aActual 12 12/15/2011 -7% 8/2/2011 712 a Actual 13 9/14/2011 2% 5/2/2011 699 a Actual 12 6/13/2011 1 % 2/4/2011 687 a Actual 13 3/15/2011 -32% 11/1/2010 674 aActual 18 12/13/2010 15% 8/3/2010 656 a Actual, 16 9/13/2010 32% 5/3/2010 640 a Actual 12 6/9/2010 -8% 2/1/2010 628 aActual 13 3/11/2010 0% 11/2/2009 615 aActual 13 12/11/2009 -3% 8/3/2009 602 a Actual 13 9/11/2009 7% 5/7/2009 589 a Actual 13 6/16/2009 -3% 2/2/2009 576 a Actual 13 3/16/2009 -4% 11/3/2008 563 a Actual 14 12/10/2008 -3% 8/1/2008 549 a Actual 14 9/12/2008 10% Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q t5ins • 3113 Commonwealth of Massachusetts 5 -t -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street. Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: SEP 2 Neil J. Bateson 2015 Name of Inspector its',: -w CF %CRTN Bateson Enterprises Inc. kzu]7;ram �r'A-� Company Name 111 Argilla Road Company Address Andover MA 01810 Citylrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ NeedA Further Evaluation by the Local Approving Authority c ems---- 9/12/2015 Inspector's tignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""*This report only describes conditions at the time.of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 1 of 17 Y Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Cityfrown B. Certification (cont.) State Zip Code Date of Inspection 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 • 3113 Title 6 official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. t5ins • 3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owners Name North Andover Cityrrown B. Certification (cont.) MA 01845 9/12/2015 State Zip Code Date of Inspection ❑ 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 ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): ❑ 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 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Cityrrown 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 -Box needs to be 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'/ day flow t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 4 of 17 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 U Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner Owners Name information is required for North Andover MA 01845 9/12/2015 every page. Cityfrown 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 44 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Owner information is required for every page. Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): N/A t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -N of for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner owner's Name information is required for North Andover MA 01845 9/12/2015 every page. C4rrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Yes 1 No ❑ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ® Yes ❑ No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Sump pump? Last date of occupancy: Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Pumped 2014, owner 1000 gallons Measured tank Inspect tank & tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ 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): l5ins - 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 73 Farnum Street D. System Information (cont.) 9/12/2015 Date of Inspection Approximate age of all components, date installed (if known) and source of information: Orginal 4/1/1961, info at B.O.H. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.6 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast Iron through wall, 4" & 2 Cast iron in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 0.6 feet ❑ 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: 6'x 4' Sludge depth: 1 " t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Property Address Salvatore DiMilla Owner Owner's Name information is required for North Andover MA 01845 every page. CitylTown State Zip Code D. System Information (cont.) 9/12/2015 Date of Inspection Approximate age of all components, date installed (if known) and source of information: Orginal 4/1/1961, info at B.O.H. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.6 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast Iron through wall, 4" & 2 Cast iron in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 0.6 feet ❑ 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: 6'x 4' Sludge depth: 1 " t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °t 73 Farnum Street Property Address Salvatore DiMilla Owner Owners Name information is required for North Andover MA 01845 9/12/2015 every page. Cityrrown 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 Scum thickness 32" 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic Tank 1 Pumped septic tank. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal feet ❑ 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner's Name North Andover Citylrown MA 01845 State Zip Code 9/12/2015 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No "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 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner information is required for every page. Owners Name North Andover MA 01845 9/12/2015 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 -1 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -Box 1 D -box level & distribution equal. Evidence of leakage, liquid below inverts. Has corrosion holes, needs to be replaced. Evidence of carryover, pumped d -box to clean. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins - 3/13 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Owner information is required for every page. t5ins • 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner's Name North Andover City/Town D. System Information (cont.) Type: ❑ leaching pits ❑ leaching chambers ❑ leaching galleries ® leaching trenches ❑ leaching fields ❑ overflow cesspool ❑ innovative/alternative system MA 01845 State Zip Code number: number: 9/12/2015 Date of Inspection number: number, length: number, dimensions: number: 2 trenches 60' long Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil Ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Farnum Street Property Address Salvatore DiMilla Owner's Name North Andover MA 01845 9/12/2015 Citylrown 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments re 73 Farnum Street Property Address Salvatore DiMilla Owner Owner's Name information is required for North Andover MA 01845 9/12/2015 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately 04 11 l"Jl"l3 7���� 2 frt _C� t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 I Is lc -"k a Ll t C I ,, Wa� ID --Gc>r-2l­ l2 t5 if 11 l"Jl"l3 7���� 2 frt _C� t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 73 Famum Street Property Address Salvatore DiMilla Owner's Name North Andover City/Town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells E f t d d th t h' In d t' MA 01845 State Zip Code >4 9/12/2015 Date of Inspection sma a ep o Ig group wa er. 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: Date ❑ 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) ® Accessed USGS database - explain: Essex Countv Soil Map. You must describe how you established the high ground water elevation: Essex County Soil Map, Sheet # 36, Canton Soil, Water >6' Deep. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurfaces Sewage Disposal System - Page 16 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 73 Farnum Street Property Address Salvatore DiMilla Owner Owner's Name information is required for North Andover MA 01845 9/12/2015 every page. Cityrrown 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 • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summary Record Card generated on 9/1/2015 12:53:30 PM by Karen Hanlon Town of North Andover Tax Map # 210-107.A-0055-0000.0 Parcel Id 17881 73 FARNUM STREET DIMILLA, SALVATORE 73 FARNUM STREET N. ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.69 Acres FY 2016 UB Mailina Index Name/Address DIMILLA, SALVATORE 73 FARNUM STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 14231.0 - 73 FARNUM STREET 2100227 02 Cycle 02 UB Services Maint. Account No. 2100227 Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Type Loan Number Active/Inact. From Payor Occupant Name Active/inactive Last Billing Date 6/4/2015 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/ 01 ALL METER SIZE 34.20 /1 Until Account No. 2100227 Serial No Status Location Brand Type Size YTD Cons 16337217 a Active ERT METE METE w Water 0.63 0.63 364 Date Reading Code Consumption Posted Date Variance 8/4/2015 908 a Actual 9 0% 5/5/2015 899 a Actual 9 6/22/2015 -30% 2/3/2015 890 a Actual 13 3/20/2015 -5% 11/3/2014 877 aActual 14 12/15/2014 9% 8/1/2014 863 aActual 12 9/11/2014 -6% 5/5/2014 851 a Actual 13 6/12/2014 7% 2/4/2014 838 a Actual 13 3/17/2014 -5% 10/31/2013 825 a Actual 13 12/20/2013 1 % 8/1/2013 812 aActual 13 9/18/2013 -2% 5/1/2013 799 a Actual 12 6/18/2013 11% 2/7/2013 787 a Actual 13 3/13/2013 -12% 10/30/2012 774 a Actual 13 12/13/2012 14% 8/3/2012 761 a Actual 12 9/26/2012 -3% 5/2/2012 749 a Actual 12 6/20/2012 -5% 2/2/2012 737 a Actual 13 3/14/2012 6% 11/1/2011 724 aActual 12 12/15/2011 -7% 8/2/2011 712 a Actual 13 9/14/2011 2% 5/2/2011 699 a Actual 12 6/13/2011 1 % 2/4/2011 687 a Actual 13 3/15/2011 -32% 11/1/2010 674 aActual 18 12/13/2010 15% 8/3/2010 656 a Actual 16 9/13/2010 32% 5/3/2010 640 a Actual 12 6/9/2010 -8% 2/1/2010 628 aActual 13 3/11/2010 0% 11/2/2009 615 aActual 13 12/11/2009 -3% 8/3/2009 602 aActual 13 9/11/2009 7% 5/7/2009 589 a Actual 13 6/16/2009 -3% 2/2/2009 576 a Actual 13 3/16/2009 -4% 11/3/2008 563 aActual 14 12/10/2008 -3% 8/1/2008 549 a Actual 14 9/12/2008 10% 4N. Commonwealth of Massachusetts City/Town of . System Pumping. Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be'used, but the information, must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left / Right front of house,Righter o ou ,Left /right side of house, Left/ Right side of building, Left / Right front of buil Ing, Left / Right rear of building, Under deck Address'�7-3 Citylrown State Zip Code 2. System Owner. D� Y l� �•� Name' Address Cd different from location) citylrown ' state Zip Code ; Telephone Number a i l•_ -.Jt I.r B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type -of system: ❑ Cesspool(s) ptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yep ©-1Vo If yes, was it cleaned? ❑ Yes ❑ No ' 5. Condition of System: 6.. System Pumped By.- Nell. y: Nell. Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Waste Water F5821 Vehicle Uoense Number Date t5form4.docr 06/03 System Pumping Record • Page 1 of 1 71-31v COMMONWEALTH OF MASSACHUSETTS G <« -� [1,4� -�s ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION vel ?I TITLE 5 zk� OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS Llj X f SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM 54" o'A� PART A CERTIFICATION Property Address: 73 Farnum' Street No. Andover, MA 01845 Owner's Name: Sal DiMilla Owner's Address: 73 Farnum Street No..Andoverl MA 01€14 5 Date of Inspection: June 5, 2007 Name of Inspector: (please print) James Wright_ Company Name: RJ Inspections, TnC, Mailing Address: 270 Lawrence St et Methuen, MA 01844 Telephone Number: (978) 68_R�rg CERTIFICATION STATEMENT RECEIVE® �1PS. JUL 0 2 2007 P TOWN OF �N'ORTH AND HEEALTH DEPARTMENT ER 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: ses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature- Date: The system inspector h su py of this inspection report to the Approving Authority (Board of Health or DEP) within 30 day 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 �i�f�� �� �� �✓ i��� �' L /���`��r Ly vim- 711"-f ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 73 Farnnm St-root- Tt^ nnn n a a R Owner: Date of inspection: June S, 2007 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: 11 Syste .Conditionally Passes: zOne or mores stem components "Conditional 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: +e 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 -abstruction 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: 73—Reim—Stre.Pt -No, Anio��Pr� MA 01 845 Owner: Sa 1 Di Mi 1 la Date of Inspectiow._June 5, 2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of He order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health deterfnines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a mann ..,w4ich will protect public health, safety and the environment: _ Cesspool or privy is pitfiin 50 feet of a surface water Cesspool or pry N 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 environmc�r�t:''"`" _ The system has a septic tank and soil absorption system (SAS) and *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 S sthin a Zone 1 of a public water supply. The system has a septic tank and SASd the SAS is within 50 feet of a private water supply well. _ The system has a septic taand SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply, wejl"#*:Method used to determine distance "This system pdsses 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- Farmim St And erg MA 01845 Owner: Sal DiMi11a Date of Inspection: June 5 ,� 2 0 0 7 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No j — c/ c cup 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 gged SAS or cesspool — _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool quid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number tunes pumped �y portion of the SAS, cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tribut . to a surface water supply. r _ / Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private .water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are �Otriggered. A copy of the analysis must be attached to this form.] (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 t criteria above) yes no the system is within 400 of a surface drinking water supply the system is in 200 feet of a tributary to a surface drinking water supply — i the syst m is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone I f 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 23 Parntrm St- _ n�-r--M A—�-1845 Owner a Sl tai Mi l l a Date of Inspection: j,,,, 5, 20(4! Check if the following have been done. You must indicate "yes" or "no" as to each of the following Ye o ✓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 weekP eriod ? Have 1 ge 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 ? ere 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 depthlof 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: Yesr,,no -V-1' _ Existing information. For example, a plan at the Board of Health. _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.3 02(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7,1 Farnl3m St-rapt- No- Andover, MA�-01845 Owner: Sal DiMilla Date of Inspection: _,lune 5, 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: 12 A / Does residence have a garbage grinder (yes or no): /v Is laundry on a separate sewage system (yes or no): Y (if yes separate inspection required] Laundry system inspected (ye;.,or no): Y Seasonal use: (yes or no): ,/ Water meter readings, if avai le (last 2 years usage (gpd)): Sump pump (yes or no): Last date of occupancy: COMMERCIAL/iNDUSTRIAL Type of establishment: Design flow (based on 310 CMR ,1.5:20): Qnd Basis of design flow (seats�,et9ons/sqf ,ctc.): Grease trap present (yes,or no): Industrial waste hol ' Ig tank present (yes or no): — Non -sanitary w e discharged to the Title 5 system (yes or no):.` Water meter R6adings, if available: _ Last date of occupancy/use: OTHER (describe): Pumping Records GENERAL INFORMATION Source of information: Was system pumped as part of the inspection (yes or no): 0 If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM _!�f 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 kngwn) and source of i Were sewage odors detected, when arriving at the site (yes or 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: 73 Farnum Street No. Andover, MA 01845 ,Owner: Sal DiMilla Date of Inspection: June 5, 2007 BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) Depth below grade: I Material of construction: _trete _metal _fiberglass __polyethylene —other(explain) If tank is metal list age: ` Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: _ ;_ Distance from top of sludge to bottom of outlet tee or baffle: _,'2 4. Scum thickness: / // Distance from to of scum to top of outlet tee or baffle: 7 Distance from bottom of scum to bottom of outlet tee or—baffle: How were dimensions determined: _ /°L pj/t AaMp Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, invert, evidence of leakage, etc.): CT- 7--r GREASE TRAP: _(locate on site plan) 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 o e: Distance from bottom of scum to bottom utlet tee or baffle: Date of last pumping: Comments (on pumping redations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, e ' ence of leakage, etc.): Page 7,of ! 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 73 FarnU reat Nn_ AndnvPr* MA 01845 Owner: Sal DiMi lla Date of Inspection: ju.n ., 2007 BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage,'etc.): SEPTIC TANK: _ (locate on site plan) Depth below grade: I Material of construction: _rete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: ` Is age con firm, e<t'jy a Certificate of Compliance (yes or no): certificate) _ (attach a copy of Dimensions: bel - Sludge depth:6— Distance from to of stud a to b P g gitom of outlet -tee or baffle: A/D Scum thickness: / 6r .v/— _ Distance from top of scum to top of outlet tee or baffle: w m o 7 - Distance from bottom of scum to bottom of outlet tee or baffle: aTz-47— How were dimensions d.-termined: Comments (on pumping recommendations,*, inict anc� outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inve , evidence of leaka2.P.,, etc.): 4-7 GREASE TRAP: _(locate on site plan) Depth below grade: Material of constructic:,: _concrete ,metal _fiberglass _„polyethylene _other (explain): Dimensions: — -- Scum thickness: Distance from top.of scum to to outle, tee'or baffle: Distance from bottom of stu . to bottom of c.i!let tee or baffle: Date of last pumping: Comments (on pump' recommendations, '. ,' t and. or or baffle condition, structural integrity, liquid levels as relatod to outlet invert, evidence of leaLa c etc.)- Page 8 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 73 Farnum Street Nr) Andover MA 01845 Owner• ,,; a 1 D i mi Ila a Date of Inspection: _ June 5, 2007 TIGHT or HOLDING TANK: (tank must be .pumped at time of inspection)(locate on site plan) . Depth below grade: Material of construction: concrete metal berglass polyethylene other(expl'ain): Dimensions: Capacity: Ions Design Flow: Z galIons/day Alarm present (yes or no Alarm level: <Iarm in working order (yes or no): Date of last pumpi Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no)- Alarms in working order (yes o): Comments (note co di of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 73 Farnum Street No. Andover, MA 01845 Owner: Sal DiMilla Date of Inspection: June 5, 2007 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain'why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: ALU q� 3 O % !T/0 ,G/•v 63 `' JJ % 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.): 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 cesspo Materials of cons ction: Indic4tion 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) Materials of construction: Dimensions: Depth of solids: Comments (note condi of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r . Page 10 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 71 Farnnm StrAAt _No_ Anrini�Arl 01845 Owner: Sal Di Mi 1 1 a Date of Inspection: une0 7 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. ib 0C 10 10:53 9786888476 HEALTH PAGE 05/05 .06/04/2007 rY 0 21.0 10 r, N 17 4. Ep 7-7 A rl F,4 00 o7l Z 24 50. t 2. .-Vt c T F- is -A, `14 V lox Nr L5 le 3 0/ P if PH YL On 47'e jq 06/04/2007 10:53 9786888476 HEALTH BOARD M' M=R T M OF NMH ANDD VERp M • PAGE 04/05 '; M• rr ���ii Y NAME VASA T Dl M�yyi4 DATE /n— i • RLJ�•7 • • ♦ • . M ♦ • ♦ • ♦ • • • • Lm N©A� • SPA ,.. Y • rtn • • • • • • • • 3. N0. OF BEDROOM �. . . . DEN YM .x. A NO. 4. GARBAGE GR lm 'YES • N0. �j • . . 5. SHOW DIM, NS IONS OF MOUSE oli 4 ' X ;� AY � 6. SHOW DISTANCM OF HOUSE TO ALL PROPERTY LINES 7. SHOO DIANSIOlz OF LOT S» SHOW LOCATION AND SIZE CF SEPTIC TANK OR CESSPOOL 9, NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHGW LOCATION OF BROOKS, STREAKS, DITCHES, LEME OUTCROP, ETO. 3.1, SHOW DISTANCE OF SEPTIC TANK OR CE aSF00L FROg HOM LOQ2 LOCAL REGULATIONS SHOULD BE READ CAREFULLT • 06/,04/2007 10:53 9786888476 HEALTH PAGE 02/05 Salvatore. Umilla .Lot r' 73 Farnham St. APPLICATION FOR SEWAGE D13POSAL IMALIATION -7 MLTH DEPA NT - NORTH ANDOVER). IUS. I hereby make application for a permit for a sewage disposal installation at 1 'Will ins tali this Sys tem 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 )+ inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. 1 will install a con- crete septic tank of . Q qal.* „in size„ A inanholo (s) permitting easy cleaning will be prodded 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 _p-00..:.� �, lineal (RUM) feet of effective absorption area. The pipes will be laid on a 6 i.noh layer of washed gravel or crushed stone ranging in size from 3/4, to 1-1/2 inches (din,.) 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 inehes of gravel or stone 1/8tt to 1/4.1, Wa.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of A+ to 6 inches/100 feet. No single file line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum, of b feet wall. 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• its tallation 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 lite. I_further _agree not to cover anX_ ortion of this installation until approved b_ e inspe_ tion ofd, as provided below, artd to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DA • , /� / Signa ure of Applicant - I hereby issue the above -permit for the Board of Health of the Town of North Andover$ Massachusetts. DATE y� /9 /0 / �- Si ture of Health Agent I have Inspected the Mcoversd sygteal indicated above and find everything done as described. DATE �. Signature of cting Officer Percolation Test dlmin. �r Soil: Sands -clay Hy. �. Garbage Grinder No Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 73 Parntim StrPAt _No. Andover, MA 01845 Owner: Sal Di Mi Ila Date of Inspection: June 5, 2007 SITE EXAM Slope S er Check cellar Saowwes Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: Jun 28,07 01:24p p.1 summary Record Card generated on 6,2812007 11:47:44 AM by Elaine Barclay Page 1 Town of North Andover Tax Map # 210-107.A-0055-0000.0 73 FARNUM STREET DIMILLA, SALVATORE 73 FARNUM STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.69 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Activellnact. From Until DIMILLA, SALVATORE Payor 73 FARNUM STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 14231.0 - 73 FARNUM STREET Last Billing Date 6/19/2007 2100227 02 Cycle 02 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 37.56 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cans 16337217 a Active ERT METE --METE- ""''--` w Water 0.63 0.63 0 Date Reading Code % Consumption Posted Date Variance 5/4/2007 478 a Actual j 12 6/26/2007 -7% 2/21/2007 466 a Actual 20 3/23/2007 -14% 1111/2006 446 a Actual 19 12/22/2006 -34% 8/1/2006 427 a Actual 28 9/13/2006 91% 5/4/2006 399 a Actual 15 6/20/2006 7% 2/2/2006 384 a Actual 14 3/13/2006 -11 % 11/3/2005 370 a Actual 15 12/14/2005 2% 8/8/2005 355 a Actual 15 9/12/2005 4% 5/11/2005 340 a Actual } 14 6/8/2005 -1% 2/14/2005 326 a Actual 15 3/15/2005 -17% 11/15/2004 311 a Actual 19 12/17/2004 -5% 8/11/2004 292 a Actual 18 9/20/2004 5% 5/17/2004 274 a Actual 18 6/14/2004 14% 2/17/2004 256 a Actual18 4/16/2004 0% 11/6/2003 238 n New Meter 0 11/6/2003 0% ( � C(A--lz- I I I I Page 1 of 3 SUMMARY OF GROUND -WATER LEVELS MAY 2007 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground -Water Data page; OWc, monthly measured value used in high ground -water level estimation report, USGS Open -File Report 80-1205.) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I YEAR IN MONTH IN ONE FROM BELOW LAND - 0 T OF YEAR MONTHLY SURFACE P H RECORD 23 MEDIAN DATUM O 0 0.35 - 0.28 (OWc) 0.16 3.49 23 (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS ACTON 158 * TS 1965 - 0.26 - 0.07 + 2.16 15.62 22 ANDOVER 462 VS 1968 - 0.32 - 0.98 + 0.68 13.71 23 ATTLEBORO 83 VS 1964 - 0.35 - 0.28 + 0.16 3.49 23 BARNSTABLE 230 FS 1957 + 0.73 + 0.83 + 1.21 21.69 30 BARNSTABLE 247 FS 1962 + 1.81 + 0.65 + 1.98 21.72 30 BECKET 12 TS 1986 - 0.42 - 0.90 - 0.03 3.42 22 BLANDFORD 9 VS 1986 ----- - 0.22 + 0.33 1.94 22 BOURNE 198 FS 1962 + 0.48 + 1.36 + 1.28 31.15 29 BREWSTER 21 FS 1962 + 0.23 + 0.16 + 1.65 7.97 22 BREWSTER 22 * FS 1962 + 0.56 + 0.69 + 1.46 28.59 22 CHATHAM 138 FS 1962 + 0.63 + 0.30 + 0.30 22.79 24 CHESHIRE 2 HT 1951 - 2.29 - 1.90 - 1.43 5.00 23 CHICOPEE 95 TS 1984 + 0.44 + 0.32 + 0.45 20.40 21 COLRAIN 8 VS 1965 - 1.40 + 0.44 + 1.08 16.33 23 CONCORD 165 TS 1965 + 1.14 + 1.09 + 2.42 38.39 22 CONCORD 167 TS 1965 + 0.17 + 0.27 + 1.41 5.21 > 22 CUMMINGTON 13 VS 1986 - 2.08 - 0.78 - 0.16 4.60 23 DEDHAM 231 ST 1965 - 0.83 - 0.91 + 0.65 5.21 22 DEERFIELD 44 VS 1965 + 0.04 + 0.05 + 0.36 2.32 23 DOVER 10 TS 1965 + 0.16 + 0.85 + 0.70 31.30 22 DUXBURY 79 * VS 1965 - 0.47 + 0.26 + 0.85 7.27 21 DUXBURY 80 VR 1965 - 0.56 - 0.33 + 1.16 20.56 21 EAST BRIDGEWATER 30 HT 1958 - 1.70 - 0.94 + 0.67 5.85 25 EDGARTOWN 52 VS 1976 + 1.06 + 1.00 + 1.40 15.57 29 FOXBOROUGH 3 TS 1965 - 0.09 + 0.63 + 0.72 17.72 21 FREETOWN 23 TS 1964 - 0.48 + 0.14 + 0.95 12.06 23 GEORGETOWN 168 VS 1965 - 0.42 - 0.99 - 0.18 4.46 23 GRANBY 68 VS 1954 - 0.39 + 0.70 + 0.57 6.19 21 GRANVILLE 5 TS 1965 + 1.30 + 0.33 + 0.77 31.00 22 GRANVILLE 6 'GREAT SS 1965 - 1.89 - 1.61 - 0.60 4.93 22 BARRINGTON 2 VT 1951 - 1.55 - 1.06 + 0.82 9.21 21 ',HANSON 76 VS 1964 - 0.24 - 0.11 + 0.28 4.27 21 HARDWICK 1 'HAVERHILL TS 1965 - 0.99 + 1.79 - 0.44 13.89 22 23 TS 1960 - 1.09 - 1.43 + 1.65 8.78 23 HAWLEY 8 ST 1986 - 0.65 - 0.34 + 0.33 2.84 23 LAKEVILLE 14 * TS 1964 - 1.44 - 0.05 + 2.33 10.79 21 LEXINGTON 104 VS 1965 + 0.29 + 0.21 + 1.18 1.25 22 MASHPEE 29 FS 1976 + 0.00 + 0.54 + 0.63 6.99 29 MIDDLEBOROUGH 82 VT 1965 - 2.89 - 1.03 + 1.35 5.33 21 MONTGOMERY 19 SS 1986 - 1.00 - 0.32 + 0.21 0.70 22 NANTUCKET 228 FS 1976 + 0.86 + 0.82 + 0.55 23.83 30 NEW BEDFORD 116 VS 1964 - 0.09 + 0.03 + 0.35 3.70 23 NEWBURY 27 VT 1965 - 0.78 - 1.00 + 1.80 3.55 23 NORFOLK 27 * VS 1965 - 0.01 + 0.30 + 0.46 5.40 21 NORTHBRIDGE 54 VS 1984 - 0.25 + 0.45 + 0.80 3.13 > 24 NORTON 37 FS 1964 - 1.45 - 1.01 + 1.44 5.80 21 ORANGE 63 TS 1985 - 0.61 - 0.30 - 0.30 6.52 22 OTIS 7 VS 1965 - 2.22 - 0.97 - 0.05 7.98 22 PELHAM 23 * SR 1981 - 0.71 + 0.79 - 2.30 15.03 22 http://ma.water.usgS.gov/current_cond/data/2007_05.txt 6/6/2007 PELHAM 24 SS 1984 - 0.30 + 0.11 + 0.54 3.12 22 PETERSHAM 16 ST 1984 - 3.97 + 0.69 + 0.65 12.50 22 PITTSFIELD 51 * VS 1963 - 0.72 - 0.11 + 0.32 14.24 22 PLYMOUTH 22 TS 1956 + 0.27 + 0.13 + 1.15 21.83 25 PLYMOUTH 494 SS 1985 + 0.16 - 0.08 + 3.21 26.20 24 SANDWICH 252 FS 1962 + 0.16 + 0.14 + 0.40 46.52 29 SANDWICH 253 FS 1962 + 0.25 + 1.03 + 2.36 47.08 29 SEEKONK 275 VS 1964 - 0.15 - 0.13 + 0.67 5.45 23 SHEFFIELD 58 FS 1987 + 0.43 + 0.00 + 1.04 11.18 21 SOUTHBOROUGH 12 HT 1990 + 0.32 + 1.52 + 3.99 1.83 > 22 STERLING 1 ST 1947 - 1.06 - 0.87 - 0.21 3.41 22 STERLING 177 SS 1995 - 1.61 - 1.36 - 0.47 14.65 < 22 SUNDERLAND 7 SS 1957 - 0.08 + 0.71 + 1.86 8.72 23 SUNDERLAND 68 VS 1983 - 0.68 - 0.32 + 0.35 2.40 23 TAUNTON 337 TS 1964 - 0.70 - 0.35 + 0.72 7.80 21 TEMPLETON 3 VS 1957 - 0.45 - 0.25 + 0.13 3.45 22 TOPSFIELD 1 HT 1936 - 1.53 - 1.18 + 1.89 8.96 23 TOWNSEND 13 TS 1965 + 0.04 + 0.20 + 1.75 10.14 22 TRURO 1 TS 1950 - 0.01 - 0.21 + 0.57 10.04 22 TRURO 89 TS 1962 + 0.07 - 0.11 + 0.34 11.42 22 WAKEFIELD 38 * FS 1965 - 0.27 + 0.19 + 1.03 5.36 23 WARE 43 VS 1965 - 0.54 + 0.38 + 2.29 6.44 22 WAREHAM 51 TS 1959 - 0.52 + 0.45 + 0.54 5.95 24 WAYLAND 2 TS 1965 - 0.16 + 0.30 + 0.63 14.73 22 WEBSTER 1 HS 1958 - 0.65 + 3.62 + 1.05 12.10 21 WELLFLEET 17 VS 1962 + 0.43 + 0.51 + 0.24 9.61 22 WENHAM 76 VS 1965 - 0.37 - 0.68 + 0.49 1.83 23 WEST BOYLSTON 26 SS 1995 - 0.78 + 0.25 + 1.99 3.04 > 22 WEST BROOKFIELD 2 TS 1959 + 0.29 + 0.28 + 1.04 17.22 22 WESTHAMPTON 20 SS 1986 + 0.54 + 3.23 + 2.00 5.89 22 WESTFIELD 62 SS 1957 - 1.21 + 0.06 + 0.14 6.25 22 WESTFIELD 152 TS 1986 - 0.35 + 0.01 + 0.89 2.47 22 WESTFORD 160 VS 2001 - 0.44 + 0.10 ----- 10.30 > 21 WEYMOUTH 2 FT 1965 - 1.32 - 0.64 + 1.98 7.04 21 WEYMOUTH 3 VS 1965 - 0.33 - 0.04 + 0.55 4.27 21 WEYMOUTH 4 TS 1965 - 0.44 + 0.01 + 1.00 5.61 21 WILBRAHAM 55 TS 1965 - 0.13 + 4.77 + 1.16 35.19 21 WILMINGTON 78 * FS 1951 - 0.34 - 0.30 + 1.27 6.05 23 WINCHENDON 13 ST 1939 - 0.10 + 0.14 + 0.91 3.43 22 WINCHESTER 14 ST 1940 - 0.06 - 0.09 + 3.01 7.09 > 23 RHODE ISLAND BURRILLVILLE 187 TS 1968 - 0.69 + 0.08 + 0.13 14.29 BURRILLVILLE 395 UT 1992 ----- ----- _____ ----- BURRILLVILLE 396 VT 1992 ----- ----- ----- ----- BURRILLVILLE 397 HT 1992 ----- ----- ----- ----- BURRILLVILLE 398 HT 1992 ----- ----- ----- ----- CHARLESTOWN 18 FS 1946 - 2.19 - 1.25 + 1.26 15.17 CHARLESTOWN 586 VT 1992 ----- ----- ----- _____ CHARLESTOWN 587 ST 1992 ----- _____ ----- ---_- COVENTRY 342 VS 1991 - 2.05 - 1.46 + 0.59 8.13 COVENTRY 411 SS 1961 - 1.10 + 0.05 + 0.74 19.96 COVENTRY 466 VT 1992 ----- ----- ----- _____ CRANSTON CITY 439 ST 1992 ----- ----- ----- -_-_- CUMBERLAND 265 SS 1946 - 1.42 - 1.33 + 0.92 11.51 EXETER 6 VS 1948 - 0.64 + 0.15 + 0.93 4.46 EXETER 158 ST 1991 - 2.08 - 2.13 + 0.83 6.73 EXETER 238 FT 1991 - 0.57 - 0.23 + 0.44 11.45 EXETER 278 HT 1991 - 2.90 - 2.56 + 0.51 9.61 EXETER 475 VS 1981 - 0.66 + 0.90 + 0.86 12.39 EXETER 554 SS 1988 - 0.89 - 0.41 + 0.20 9.37 FOSTER 40 HT 1991 + 0.04 - 0.34 + 1.88 3.41 FOSTER 290 HT 1992 ----- ----- http://ma.water.usgs.gov/current-cond/data/2007-05.txt 22 21 22 22 22 22 22 21 21 22 21 22 Page 2 of 3 6/6/2007 TOPOGRAPHIC (TOPO) SETTING: F=FLAT, G=FLOOD PLAIN, H=HILLTOP, S=HILLSIDE, T=TERRACE, U=UNDULATING, V=VALLEY, W=UPLAND DRAW LITHOLOGY (LITHO): G=GRAVEL, R=ROCK, S=SAND, T=TILL CONTENTS OF MAJOR RESERVOIRS (ESTIMATED END OF MONTH READINGS) (MILLIONS OF CUBIC FEET) MONTH-END PERCENT OF PERCENT RESERVOIR CONTENTS AVERAGE FULL BORDEN BR + COBBLE MTN RES, MA 3110 QUABBIN RESERVOIR, MA 55255 SCITUATE RESERVOIR, RI 5063 101 92 --- 100 106 103 STREAMFLOW FOR SELECTED INDEX STATIONS (CUBIC FEET PER SECOND) MONTH-END PERCENT MAXIMUM DATE MINIMUM DATE STREAM MEAN MEDIAN FOR MONTH FOR MONTH CHARLES RIVER, MA 546 143 877 01 263 16 E. BR. HOUSATONIC RIVER, MA 92.2 68 219 01 40 26 PAWCATUCK RIVER, RI 301 128 462 01 163 31 WARE RIVER, MA 321 147 ----_- --------------------------------------------------------------------- A MONTHLY REPORT PREPARED BY THE U.S. GEOLOGICAL SURVEY MASSACHUSETTS -RHODE ISLAND WATER SCIENCE CENTER 10 BEARFOOT ROAD, NORTHBOROUGH, MA 01532 IN COOPERATION WITH THE MASSACHUSETTS DEPT. OF CONSERVATION AND RECREATION, MASSACHUSETTS DEPT. OF ENVIRONMENTAL PROTECTION, CAPE COD COMMISSION, RHODE ISLAND DEPT. OF ENVIRONMENTAL MANAGEMENT, AND THE PROVIDENCE WATER SUPPLY BOARD http://ma.water.usgs-gov/current_cond/data/2007 05.txt Page 3 of 3 6/6/2007 HOPKINTON 67 ST 1991 -' 3.85 - 2.67 + 1.30 12.82 22 LINCOLN 84• VS 1946 - 0.69 - 0.63 + 1.46 3.34 22 LITTLE COMPTON 142 ST 1992 ----- ----- ----- ----- NEW SHOREHAM 258 UT 1991 ----- ----- ----- ---_- NORTH KINGSTOWN 255 VS 1954 - 1.35 - 1.11 + 0.84 6.64 21 NORTH SMITHFIELD 21 TS 1947 - 1.25 - 0.87 + 0.96 6.53 22 PORTSMOUTH 551 HT 1992 ----- ----- ----- ----- PROVIDENCE 48 TS 1944 - 0.29 + 0.12 + 2.57 3.47 22 RICHMOND 417 VS 1976 - 0.84 - 0.34 + 0.29 6.06 21 RICHMOND 600* TS 1977 - 0.43 - 0.73 + 0.53 32.73 22 RICHMOND 785 FS 1989 + 0.02 + 1.56 + 1.95 20.83 22 SOUTH KINGSTOWN 6 VS 1955 - 1.22 + 0.59 + 0.81 10.66 21 SOUTH KINGSTOWN 1198FS 1988 - 1.38 - 0.23 + 0.41 6.96 21 TIVERTON 274 TT 1990 --=-- ------ _____ ----- WARWICK 59 ST 1991 - 0.14 - 0.31 + 0.66 4.67 22 WESTERLY 522 FS 1969 - 1.00 - 0.33 + 0.39 11.62 21 WEST GREENWICH 181 US 1969 - 2.20 - 1.68 + 0.43 15.31 22 WEST GREENWICH 206 --------------------------------------------------------------- ST 1991 - 0.04 - 0.02 + 0.28 3.74 21 >> SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR PERIOD OF RECORD > SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR END OF MAY << SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR PERIOD OF RECORD < SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR END OF MAY ------ - DATA NOT AVAILABLE TOPOGRAPHIC (TOPO) SETTING: F=FLAT, G=FLOOD PLAIN, H=HILLTOP, S=HILLSIDE, T=TERRACE, U=UNDULATING, V=VALLEY, W=UPLAND DRAW LITHOLOGY (LITHO): G=GRAVEL, R=ROCK, S=SAND, T=TILL CONTENTS OF MAJOR RESERVOIRS (ESTIMATED END OF MONTH READINGS) (MILLIONS OF CUBIC FEET) MONTH-END PERCENT OF PERCENT RESERVOIR CONTENTS AVERAGE FULL BORDEN BR + COBBLE MTN RES, MA 3110 QUABBIN RESERVOIR, MA 55255 SCITUATE RESERVOIR, RI 5063 101 92 --- 100 106 103 STREAMFLOW FOR SELECTED INDEX STATIONS (CUBIC FEET PER SECOND) MONTH-END PERCENT MAXIMUM DATE MINIMUM DATE STREAM MEAN MEDIAN FOR MONTH FOR MONTH CHARLES RIVER, MA 546 143 877 01 263 16 E. BR. HOUSATONIC RIVER, MA 92.2 68 219 01 40 26 PAWCATUCK RIVER, RI 301 128 462 01 163 31 WARE RIVER, MA 321 147 ----_- --------------------------------------------------------------------- A MONTHLY REPORT PREPARED BY THE U.S. GEOLOGICAL SURVEY MASSACHUSETTS -RHODE ISLAND WATER SCIENCE CENTER 10 BEARFOOT ROAD, NORTHBOROUGH, MA 01532 IN COOPERATION WITH THE MASSACHUSETTS DEPT. OF CONSERVATION AND RECREATION, MASSACHUSETTS DEPT. OF ENVIRONMENTAL PROTECTION, CAPE COD COMMISSION, RHODE ISLAND DEPT. OF ENVIRONMENTAL MANAGEMENT, AND THE PROVIDENCE WATER SUPPLY BOARD http://ma.water.usgs-gov/current_cond/data/2007 05.txt Page 3 of 3 6/6/2007 0? Val *(ii 4 Y PUBLIC HEALTH DEPARTMENT (ommunity Development Division C����rCA2� OE C09YPLzAXCE As of.- July f:JuCy 31, 2007 2%iis is to certif that the indi'viduaCsu6surface dzsposafsystem received a SA7ISFAC70RT 15VS(PECI70X of the: Distribution Bol Only Repaired By: ToddBateson At: 73 Earnum Street Map 107.A, .Got SS North Andover, 9WA 01845 The Issuance of this certificate shaff not 6e construed as a guarantee that the system wiff function satisfg1ordy. Sulan 2'. Sawyer Pu6fic Yfeafth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com pORTH fulo 06 1r - y T -C' Oi� [«wKrrtwrr • 1 T PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP OT: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS J-'Z'5�/z TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer Comments: ElTopography not appreciably altered SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Comments: PUMP CHAMBER Comments: DISTRIBUTION -BOX Comments: U, qLAD O urs A- �q txwnu�w�er v 7A _ORATED 1•��,(� PUBLIC HEALTH DEPARTMENT fommunity Development Division ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet ■ ■ ■OAF Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthondover.com K o/ 4O"'4 4ti Commonwealth of Massachusetts Map -Block -Lot ?'•„ CQ 107.A- 0055 - - �? ,t ----------------- o a Board of Health Permit No +BHP -2007-0246 North Andover _- _-----------_-_ P.I.01 FEE 3s4cwu5t4 F.I. $125.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd -Bateson ---------------------------- - --- to (Repair -D -BOX REPLACEMENT ONLY) an Individual Sewage Disposal System. at No 73 FARNUM STREET I as shown on the application for Disposal Works Construction Permit No. BHP-2007.=024-1o--''dtsd Jufly�27, 2007 -------------------- Issued On: Jul -27-2007 Board of Health Commonwealth of Massachusetts Map -Block -Lot .•� '• °a� 107.A- 0055 - Board of Health ----------------------- North -----------------North Andover s....._w�4{� Certificate of Compliance s�CHU THIS IS TO CERTIFY, That the Individual Sewage Disposal System (Repair -D -BOX REPLACEME by Todd Bateson ------------- ---------------------- Installer at No 73 FARNUM STREET - ------------------------------------------------------------ ------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2007-024 Dated July 27, 2007 Printed On: Jul -27-2007 Board of Health Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. It�l Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage dic epair or replace an existing system componen A. Facility Information Address or Lot # City/Town 1_ _'13 TODAY'S TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component ,�,Ll L %16 XV 2.- *TYPE OF §fjMC SYSTEM*: ❑ Pump ravity (choose one) ��✓d/ ***i ump system, attach copy of electrical permit to application*** Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information / 1 j� Name '73 F4 54' Address (if different from above) City/Town 3. Installer Information / Name 4. Address !i"lg Cityrrown State Telephone Number Name Aadover. State q�. Zip Code Telephone Number (Cell Phone # if possible please) Name Name of Company Address --- City/Town — ------------ State — --- Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 0 PAGE 2OF2 TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component A. Facility Information continued.... 5. Type of Building: esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental_ Code, as well as the Local Subsurface Disposal Regulations for the Town of North Ando ve nd not to place the system in operation until a Certificate of Compliance has been issue b this Board of Health. Name Date Applicationf rov By: (Board of Health Representative) - 7 Z39/� Name Date App icaf n Disappro d for the following reasons: r Office Use Only: L Fee Attached? 2. Project Manager Obligation Form Attached? 3. Pump -System? If so, Attach co i of Electrical Permit 4. Foundation As -Built? (new construction ronly): (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes No Yes_ XNo Yes_ _ Yes_ No_ Yea' No A PAGE 2OF2 7 -J -J -f X -_. TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component A. Facility Information continued.... 5. Type of Building: esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andove _ in not to place the system in operation until a Certificate of Compliance has been issue b this Board of Health. Name Date Application rov By: (Board of Health Representative) Name Date App icat' / n Disappro d for the following reasons: r Office Use Only: L Fee Attached? 2. Project Manager Obligation Form Attached? 3. Pump S sy tem? If so, Attach coo f Electrical Permit 4. Foundation As -Built? (new construction ronly): (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes Yes Yes_ � J Yes_ Yep' No No No_ No WE • it SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (.Address of septic system) Relative to the application of to r CSdi✓ (Installer's name) Dated�— J 3 � Q o a` s ate For plans by (Engineer) And dated ngina ate) With revisions dated (Last re-vised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that reauestine an insDection. without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or M company. a. Bottom of Bed — Generally, this is the first (15) inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept a,townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than Pimple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I finrther understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation bas been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation oftanly D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved Dlans. No instructions by the homeowner. Qeneral contractor. or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: e � (Name —Print) 1 e — Signe (Today's Date) ?,_J 3 —.,7 Salvatore Dimilla � APPLICATION FOR SEWAGE DISPOSAL INSTALIATION -7`3 Lot 73 Farnham St, HEALTH DEPARTMENT - NORTH ANDOVER, PASS. I hereby make application for a permit for a sewage disposal installation at 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 2%. I will install a con- crete septic tank of 750 Gal, 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 2QQ lineal ("X%) 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 1/4" (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'' If Signa ure of Applicant I hereby issue the above -permit for the Board of Health of the Town of North Andover, Massachusetts. DATE CA41 -/ 1� /9 6/ U Sig tune of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of I cting Officer Percolation Test 6 min. Soil: Sandy -clay Garbage Grinder No . a April 1, 1961 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Farnum Street building site of Salvatore J. Dimilla. The land in general is high. The subsoil in the area was of sandy clay content and a 6 -minute percolation test was conducted. It is recommended that a 750 gallon concrete septic tank be installed together with 200 lineal feet of drain pipe. Very truly yours, �aiII. Aoi-v'C'�te WJD:hd q! bo ''� jo N2760 S 2 7,'o A waolo w i76, \� a 5S FAR NUM s T. - N 268 a6 0 3/6FlfogTip6a w Ibab / SU 73 F,q R NUM s T x1920 9o4GR'a5 'N25-00 A, 1607 -pi J/ 24S'o,00 0 :ks Q o O FRoa 5'X p 23.7 A` N X478 �1 FAR,NUN1 ST. '14 VF ;�.7.39' 2 ACRES f vrcTo� H, AN ,�,�Rs��,ti Al 2 2,28,00A NO W 1863,57 PHYLLIS NOERSOIN, 2, o y S7. S 5480 33. ; 423",56 w 14 SR;,cg ��z4o9b�� uA i r r� o, a o t FRoxT��,� 1/'�a 4 2.9 A!"REs z - ',o 7 N 2 CU -0 ✓� t H31. 7E +� aD(' Fr'o,�r i�9GF N N tii , fti' 0 L E T '440 rY /'rt - , q' 20 /' �- BOARD OF HEALTH TOWN OF NORTH ANDOVER, 11ASS. 1. NAME $,4 V.4 T�x rr. �� l Al / y�i4 .DATE % �% �1 i%1i /2/.97v ) 5 ate'/%�lPVI�N�w�rT �-—gam �3 x 2. ADDRESS . . . LOT N0. TEL. 3�a5 3,, NO. OF BEDROOMS :3. . . . DEN YES .XC. . , N0, : . . , , 4. GARBAGE GRINDER YES . . . . . N0. . 5. SHOW DI112NSIONS OF HOUSE ki 6 ' X ;�'1 1 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DI IENSIOIZ OF LOT S. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS: STREAKS.. DITCHES., LEDGE OUTCROPt ETC. 11., SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULAT IOAIS SHOULD BE READ CAREFULLY. .P—\ . Commonwealth of Massachusetts City/Town of . System Pumping- Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left / Right front of hous , L ftar of h ,Left/right side of house, LeftRight side of building, Left / Right front of b ng, Lght rear of building, Under deck Address City/Town State Zip Code 2. System Owner. Name Address (if different m location) U City/Town ()\ V\"-�- U'5� ut NU;ttt1 ANVv -- State Zip Code TU�►`►�tNtttP�.ltti�11E:Nf H� t Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): U)-a4Y Date 2. Quantity Pumped: Cesspools) Septic Tanks Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 0 -No If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition o�Jo4v� 6. System Pumped By. Neil Bateson Name Bateson Enterprises Inc Company 7. Locati here contents were disposed: A!LI- b.jY J _ Lowell Waste Water F5821 Vehicle License Number Data 06rm4.doc• 06/03 System Pumping Record • Page 1 of 1 ktdt VED Commonwealth of Massachusetts a City/Town of APR 29 2013 e System Pumping Record T WNOHNO ARM OOVER Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left /Q , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address V1 Z r"" v �"' Cityrrown 2. System Owner. Name Address (if different from location) City/Town State Zip Code Stat^ �, ` `r L O 714 e Telephone Number B. Pumping Record L4 1q- 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 No If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition of System: '��o " C--1 6. System Pumped By: Neil Bateson Name i Bateson Enterprises Inc Company 7. Location where contents were disposed: G.L S. Lowell Waste Water U-9) 12—km-a�� 01 F5821 Vehicle License Number L4 -13 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 1 �` a L A ���x♦�`1�`, � °br i� A +7 ti Irf4f�c Qf.INassachusetts u. �19;00 TOWN OF NORTH ANDOVER FOili14 HEALTH DEP M DEP has provided this form for use by local Boards of Health. The y must be submitted to the local Board of Health or other approving authority. X Facility Information iv, ,� 1, system location: forms on the owwuse o stab key Address to move your autsor • do not use the return �Y ..., 2, system Owner State t - Zip Code Name Address (If different from location) City/TOwn State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 4Da 2. Quantity Pumped: dauons 3. Type of syst®m: ❑ Cesspool(s) �eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of system: If yes, was it cleaned? ❑ Yes ❑ No 6 s P�B�5` Vehicle Uoense Number Y. 7. Location "re contents were disposed:ev httpdAv*w.m8ss.qov/depMrafer/approval&45forms.htm#inspect t5form4.41oa 06103 A. i Date System Pumping Record • Page 1 of 1 DOVER' R- m AC H �"" �A" � 6 ��US E T f 10 OEP.hai PtQY I do cl m14 Do IQ or ctrl Facill — — r 701 o �n� TOWN �F T 5), �HEAOL ri tm',! 141 I Ii I I I !.*!-h',*,.vl .'' I f If I $m'M sm owner, A401 �4 4 (it JVI . W v9ri) I q 17 N ...) . ... �;�,:B,:PIumPl11S Rekord t -Y Pv,mping.: Typo 91 I(om:::. CD 4 E*011( Too, 'F 11(0( P ,(Oonr7 y05 C3 No Pvmp I c4Qn. Wh T9 10moo.- mv I Uv m 8,k4, 90 Y/j 0 6Y, ? $m!c Ton., 7 N N YINVI &'\ Commonwealth of Massachusetts I^ City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record r` Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms the �C.� 17 computer, use only the tab key Address to move your cursor - do not ' use the return City/Town key. 2. System Owner: 4 1 A )�// Name Address (if differe � ECEIVE® City/Town MAY 11 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTnnFnrr Pumping Reco 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Y, State Zip Code State Zip Code Telephone Number 1©6 Da 2. Quantity Pumped. Cesspool(s) Septic Tank JoDo Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: A --9T1 Sys m Pumped By: Name Vehicle License Number C."` 0 �• f � Q Company 7. Location where contents were disposed: W .1�7� Signature Hauler http://www.mass.gov/dep/ ter/approvals/t5forms.htm#inspect Date y t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 �wir`+iSrd •r; r it rd M.� M�t�k� \rJf V ,J i I 1{ yr� , 1 M1rrG,r ,'r i, t r •I f h ti Tb�W OF NORTH �f IJOV R SYSTEM P'UM'PI.NG R4COR.D' �1'�'I'6M U:W�fER &. ADDRESSw SYSTEM LOCATION. 10 f.ron( _ (ez�m�le; �\\c,_ca-f house) . I t U I C OF PUM�'INQ;` 1b3' QUANTITY ('UMPC, D_�J���c; 1 N' 1 Jt1l J'. 7ry� r'� a1 1 r YES -.SEPTIC TANK: NO YES Y N.aTUFtE OFSERVICE; ,'ROUTINE. EMERCEN'CY X111>f°fZY71TI0NS; V ,� .. K.UUQD_'CQNUI'1'ION F'ULL'T0 COYER. ..BAFFLES IN PLACl L FA C H FI C L D R U N U A CK.,, GXCFSSIYE SQLIDS FI�O:O.DED SOLI'M CARIZYOYFR` p i7MFR.f'LA.1N) t� tti (EX_^ � r '1 'jjt .t U Jt 1h d/9�ylTt lrj yY� � t , 1. ♦�i t, rt y: 1 .t . >1'.�'I'lM PUM:PCI�f:RY �,• // � � v�. '' , �:�, . S ,: ;•� ! b` 11.1• � ,, .. - .. . 1 1` � Nsr�►iI��D r�. \ �:f •.:/:..�: ;.Iii <yr�^•. �:1M'•1 :'.t '.. r. o• ..