Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 74 COLONIAL AVENUE 4/30/2018
lok � xti s � ti :. t i ,, `. 1 � .+6�. ,;�.E �'' p ,YY� ,y � j� i�•-by� y, ��' kr r'� :- X K�y'a a `r' r �.. r ..... 1� '' LOT # 'STREET - 6zeAll Ave - Q 4� QV JIEW FEE BEEN PAID? YE5 NO DATE IL: ✓��� � APP. BY lWq6PLAN DA-rE .vRR,\ :LL PERMIT WELL TESTS: COMMENTS: WELL DRILLER ICAL BACTERIA I BACTERIA II DA I E APPROVED DA t E (IPPRUVED bTKE nPPROVED FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO YES NO YES NO YES NO YES NO DATE:. _.._......_..._ ....IIY:._. . ry IS THE ' INSTALLER LICENSED? + ` ��� NO .TYPE OF- CONSTRUCTION: t.. REPAIR NEW CONSTRUCTION:- CERTIFIED PLOT PLAN ,REVIEW NO . 2 s.J s CONDITIONS OF:.APPROVAL YES NO (FROM FORM U) ;•:. ` `'` \` A � i ,:fes y , f .... • _ r NO —ISSUANCE OF DWC PERMIT _ ES DWC PERMIT-- ERMITN0. y'. (6� INSTALLER:CS- , ' ,_ BEGIN .INSPECTION YE NO :EXCAVATION.INSPECTION: NEEDED: • + , �_ •1 -'•^� 1, .. - .1\ i •• . _• � .. \ PASSED : BY ' ....:CONSTRUCTION I_NSPECTIONs NEEDED: AS BUILT PLAN SATISFACTORY- YES: APPROVAL. TO BACKFILL: DATE: BY FINAL.GRADING APPROVAL: DATE A7 Ci BY w "FINAL CONSTRUCTION APPROVAL: DATE: l� BY /1 i ON Commonwealth of Massachusetts City/Town of System Pumping Record I PR 0 7 MA Form 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 i ht front of ho eft /Right rear of house, Left /right side of house, Left / Right side of building, Left / Right rout of building, Left/ Right rear of building, Under deck Address City/Town V ei State 2. System Owner. �vx.-;�k v Name Zip Code Address (i different from location) Citylrown StateZipCCo e Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date 2. Quantity Pumped: Gallons Cesspool(s) ' 9 --Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yeas 3- Ido_ If yes, was it cleaned? ❑ Yes ❑ No 5. Conditio of System: �- 6. System Pumped By. 7. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company contents were disposed: 0orm4.doa 06/03 System Pumping Record • Page 1 of 1 Town of North Andover Health Department Date: �/ .%, Location: Ali h (Indicate Address, if Residential, or Name of Busi ess) Check #• , `J. Type of Permit or License: (Circle) ➢ Animal $ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasIVSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer � Commonwealth of Massachusetts [HEALTH �'�'V�D City/Town of N 0 2 2008 System Pumping Record NORTH ANDOVER�r FOrm 4 DEPARTMENT Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 1�1 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 i 1. System Locatiot) gk A_k Address 1� 4 60 2. System Owner. Name Address (if different from location) City/Town State Zip Code City/Town State /Zip\ ode ((0 9 "7 Telephone Number B. Pumping Record � — 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ ❑ Other (describe): (S� Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [],N -o-- If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. SysteMPBy: � Name l Vehicle License Number Company 7. disposed: Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 PETER F. REILLY 136 ANDOVER STREET ANDOVER, MA 01810 (978) 375-3750 TITLE V OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION Property Address: 74 Colonial Avenue, North Andover, MA 01845 Name of Owner: Lareau Address of Owner: same Name of Inspector: Peter F. Reilly Company Name: same Mailing Address: 136 Andover Street, Andover, MA 01810 Telephone Number: (978) 375-3750 CERTIFICATION STATEMENT APR 0 4 2006 TOWN OF NORTH ANDOVER HEALTH DEPART'M`ENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) The system: ✓ Passes N/A Conditionally Passes N/A Needs Further Evalu N/A Fails Inspector's Signature: F. Reilly By the Local Approving Authority Date: March 25, 2006 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS ****This report only describes conditions a the time of inspection and under 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 (See attached Disclaimer). OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 INSPECTION SUMMARY: A. SYSTEM PASSES: Check A, B, C, D, or E / ALWAYS complete all of Section D ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: The system met the Pass Criteria of Title V. B. SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no, or not determined (Y, N, ND). Describe basis of determination in all instances. If"not determined", explain why not) N The septic tank is metal, and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a 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: N Observation of a sewage backup or breakout or high static water level in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed N/A 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): N/A broken pipe(s) are replaced N/A obstruction is removed OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and environment. 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: N/A Cesspool of privy is within 50 feet of a surface water N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh. 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well. N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well.**Method used to determine distance N/A This system passes if the water well water analysis, performed at a certified DEP 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. A copy of the analysis must be attached to this form. 3. Other N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 D. System Failure Criteria applicable to all systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N/A Liquid depth in cesspool less than 6" below invert or available volume <% day flow. No required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: once No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 ata DEP laboratory, for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen is less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form). N/A The system fails. I have determined that one or more of the above failure criteria exist as defined in 310 CMR 15.303, therefore the system fails. The property owner should contact the Board of Health should be contacted 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 a large system in addition to the criteria above) N/A The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No N/A The system is within 400 feet of a surface drinking water supply N/A The system is within 200 feet of a tributary to a surface drinking water supply N/A The system is located in a nitrogen sensitive area (Interim Wellhead 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 such 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. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B - CHECKLIST Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 Check if the following have been done. You must indicate either "Yes" or "No" as to each of the following: Yes No Yes Pumping information was provided by the owner, occupant, or Board of Health. No Were any of the system components pumped out in the previous two weeks ? Yes Has the system received normal flow in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes Were as built plans of the system obtained and examined ? (If they were available note as N/A) Yes Was the facility or dwelling was inspected for signs of sewage backup ? Yes Was the site was inspected for signs of breakout ? Yes Were all system components, excluding the SAS, located on the site ? Yes Were the septic tank manholes uncovered, opened and the interior of the septic tank inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum? Yes Was the facility owner (and occupants of if different from the owner) provided information on the proper maintenance of subsurface sewerage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No Yes Existing information. For example, a plan at the Board of Health. N/A Determined in the field if any of the failure criteria related to Part C is at issue (approximation of distance is unacceptable) [15.302(3)(b)]. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 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: Does the residence have a garbage grinder (yes or no): Is the laundry on a separate sewerage system (yes or no): Laundry system inspected (yes or no): Seasonal use (yes or no): Water meter readings, if available (last 2 years usage [gpd]): Sump Pump (yes or no): Last date of occupancy: COMM ERCIAL/INDUSTRIAL: Type of Establishment: Design Flow gpd (based on 15.203): Basis of Design Flow (seats/persons/sq.ft., etc): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER: (Describe) PUMPING RECORDS 4 4 440 gallons 5 no no (if yes, separate inspection required) N/A no about 250 gpd no current N/A N/A N/A N/A N/A N/A N/A N/A N/A GENERAL INFORMATION Source of Information: owner (about once each year) Was system pumped as part of inspection (yes or no): no if yes, volume pumped (gallons): N/A How was quantity pumped determined ? N/A Reason for pumping: N/A TYPE OF SYSTEM ✓ Septic tank/distribution box, soil absorption system Single cesspool Overflow cesspool Privy 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 the system owner) Tight Tank Attach a copy of the DEP Approval Other (describe): Approximate age of all components, date installed (if known) and source of information: original system installed in 1997. Were sewerage odors detected when arriving at the site (yes of no): no OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 BUILDING SEWER: (locate on site plan) Depth below grade: about 6" - 8 " Materials of construction: cast iron 40 PVC ✓ other (explain) Distance from private water supply well or suction line N/A Diameter: 4" Comments: Condition of joints, venting, evidence of leakage, etc.) Building sewer was watertight and appeared sound at foundation. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: about 2"- 4" Material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain) If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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 How dimensions were determined: Rectangular - 1,500 gallons (per plan) <1" 28" <11. 8" 16" observation Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) Tank was watertight and appeared to be functioning properly. PVC tees in place. GREASE TRAP: N/A (locate on site plan) Depth below grade: material of construction: concrete metal FRP other (explain) Dimensions: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A Date of Last Pumping: N/A Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: N/A material of construction: concrete metal Dimensions: Capacity: Design Flow: Alarm Present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Fiberglass Polyethylene other (explain) N/A N/A gallons N/A gallons per day N/A N/A N/A N/A Comments: (condition of alarm and float switches, etc.) N/A DISTRIBUTION BOX: ✓ (locate on site plan) 0" depth of liquid above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) D -box was level. Two lines leading to SAS were accepting effluent evenly. No solids carryover evident. The box cover was about 8" - 10" below the surface. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order (yes or no) N/A Alarms in working order (yes or no) N/A Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) not applicable OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required) If SAS not located, explain why: Type ✓ leaching pits, number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number alternative system (name of technology) n/a N/A N/A 2 - 60' long trenches per "As -Built" Plan N/A N/A N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils in area of SAS appeared normal, no signs of breakout. CESSPOOLS: N/A (locate on site plan) Number and configuration N/A Depth -top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow (cesspool must be pumped as part of inspection) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable PRIVY: N/A (locate on site plan) Materials of construction Dimensions Depth of solids N/A N/A N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Lareau Date of Inspection: 3/25/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100'. Locate where public water supply enters the building. I• I -X 4'56H. 90 PERF 2-60' TRENCHES i' 1(i�r5�7 1.161.691 FRONT YARD 1.161 0.8ox -- !V!--ko2.06+N INV 44/.90 our r=16W APP. WATER 4"5(H40 E A 2° 5,110' � � St; b 9 r � / 20 SEPTIC TANK `TDP TANK ELEV. =163,65 c to 9rMIV. TANK INV.=I6Z,36tN_ INV. '1(GZ ROUT B SEPTIC TANK TIES: A to Center (C) 30.0' B to Center 23.5' D -BOX TIES: A to Box 32.0' B to Box 33.0' NOTE: The system is in the front yard. The top of the d -box was about 8"-10" deep. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 74 Colonial Avenue, North Andover Owner's Name: Kesapradist Date of Inspection: 3/25/2006 SITE EXAM Slope flat in area of system Surface water none observed Check cellar dry Shallow wells none observed Estimated Depth to Groundwater >4' (below bottom of SAS) Please indicate (check) all methods used to determine the high ground water elevation: Y Obtained from Design Plans on record - if checked, date of design plan reviewed: 1993 Y Observed site (abutting property, observation hole within 150 feet of SAS) Y Check with Local Board of Health - explain: information on file Y Check local excavators, installers - (attach documentation) N Accessed USGS Database - explain: website too complicated You must describe how you established the high ground water elevation.* 1996 design plan indicates adequate separation. The soils and grade changes in the area indicate no groundwater in the SAS. However, the precise groundwater elevation cannot be determined for certain without a soil evaluation test. *Inspector's Note: Soil Evaluation is the currently recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified subsurface disposal system inspector. (see attached Disclaimer) DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. Peter . Reilly Inspector March 25, 2006 1 130731 Lo�Q� iA L �r .V"C.6,v eCC7'lFY TO T.YE T/rte IWSe-MOW 4VO Tr% rNE OWWA- r.NAr TWe ~,--Z4AW IS ZOG'ATEO ON rile Gor'fs eawwaPA! /Y/TN rW-Z- AV, AN,00419 Q ZZW1.0% ,eE64,zA,rxws ,qWM 01, SETdGII>t'S WOM SMeerf e 40,r e.'AleS. " 'r -&,eye LCCr1,-Y' TifG/T TN/S OM2rLl/.Y6 /S ivOT L044rE0 /AI THE FEAE,�.4G FiCO�oO f/A2A.�0 APE.4. �SyOwN O/V �EM�' COM•y��viTY /�.IitlGL '� 1-51-eldR9 4"Ic G��D 6-2-93 � 97 HOFN ANN #36381 JUN 2 3 61 z i9 ✓E,vvE RL. or PL.4A/ /A:�'. IOVODI/�,�� O.PA#'W FO.P L; Bl�icoE.eS� /.vC 6G �'A.P,E� .s'T•�EET 4�VOOYE.C, �1'4S,T4C.fi//SETT.S O/8/O Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 ib "tiO� -� � 19Gj � 6 t �q o„,•w APPLICATION FOR SITE TESTING/INSPECTION Applicant ai-t.� NAME ADDRESS TELEPHONE Site Location Engineer Test/Inspection Date and Time Fee j CHAIRMAN, BOARD OF HEALTH Test No. 6 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts BOARD OF HEALTH {y i1 APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time F9 CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH OytED /6��0J `' 7 � 1911 r 0 APPLICATION FOR SITE TESTING/INSPECTION Applicant LocationSite • • . L_ . _ "" Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. T cSa S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH k�� m APPLICATION FOR SITE TESTING/INSPECTION 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME. ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No, S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: _ 7/27/n5 SYSTEM OWNER & ADDRESS LAREAU 74 COLONIAL AVE. NORTH ANDOVER, MA 01845 J rAUG U 2 2005 TOWN OF NORTH AND DVER HEALTH DEPARTNC_NT SYSTEM LOCATION (example: left front of house) FRONT DATE OF PUMPING: 7/7/05 QUANTITY PUMPED 1on GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE V EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: RAccs sF.PTT(- SEiRVIf E, INC. COMMENTS: CONTENTS TRANSFERRED TO: WAYLAND - SUDBURY TREATMENT PLANT FORAM 4 • SY SMI PJAWNG.RkORD Commonwealth of Massachusetts NORTH ANDOVER , Massachusetts Estimated Date of Pumping: 4 /16 / 0 4 Quantity Pumped: 1500 gallons Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes 91 RAGGS SEPTIC SERVICE, INC. System Pumped by. d . b . a . E- A. COMEAU SEPTIC License r: Contents transferred to: WAYLAND-SUDBURY Date 5/17/04 Inspector RAGGS SEPTIC SERVICE INC. TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 8/8/02 SYSTEM OWNER & ADDRESS ERICK LAREAU 74 COLONIAL AVE DATE OF PUMPING: 7/17/02 SYSTEM LOCATION (example: left front of house) EST. QUANTITY PUMPED 1500 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES x NATURE OF SERVICE: ROUTINE X EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM 7DUMPED BY: COMMENTS: x FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) RAGGS SEPTIC SERVICE INC CONTENTS TRANSFERRED TO: GREATER LAWRENCE SANITARY DISTRICT AND WAYLAND SUDBURY TREATMENT PLANT TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 11/7/01 SYSTEM OWNER & ADDRESS LAREAU 74 COLONIAL AVE SYSTEM LOCATION (example: left front of house) FRONT est. DATE OF PUMPING: 8/8/01 QUANTITY PUMPED 1500 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES x NATURE OF SERVICE: ROUTINE x EMERGENCY OBSERVATIONS: GOOD CONDITION x FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: RAGGS SEPTIC SERVICE INC r M ~ Q 2001 CONTENTS TRANSFERRED TO: GREATER LAWRENCE SANITARY DISTRICT HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 U� (617) 246-2800 ' g FAX (617) 246-7596 . TOW OOF HF ESOARD R/ FORM 11 - SOIL EVALUATOR FORM 9199;: Page 1 y No. * ..................................... JOB FILE Com nw afth of Massachusetts V0 lo r Popv Massachusetts - If rr •, 7 0'r . i Performed By:.... .................. Witnessed BY:._.. . ................................................... �... Location Address or La R -uf .New Construction E[-"' Repair.. -❑ _ Office Review Date ..... 1. U -71} I—) nt for. On-site Sewaze Disposal Published Soil Survey Available: No ❑ Yes Ea— Year Published Publication Scale Soil Map Unit ....C... Drainage Class :.J:Z�. Soil Limitations .................. .................. ....... .................................... : .......................... ...... Surficial Geologic Report Available: No ❑ Yes El Year Published ............... Publication Scale ........ .......... Geologic Material (Map- Unit).--.. ........................ .............. = ...................... Landform.................. _.............................................................. ........... ..-................. _ .......................... Flood Insurance Rate Map: Above 500 year flood .boundary No ❑ Yes ❑ Within 500 year flood- boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) _.... ... Wetlands Conservancy Program Map (map unit) ......................................... ................................ Current Water Resource Conditions (USGS): Month .......... Range : Above Normal ❑ Normal ❑ Below Normal ❑ Other References Reviewed: , ' .^ ^ FORM 11 —SOEI' EVALUATOR FORM ReviewPage 2 ...... q2f Location(identify onsite plan) ....................................................................................................... Land Uder............ ..................—'--_-'. S|npo.M .................. .'SurfacoStones _ Vegetation..................................................... ........................................ ........................................................ Landform--.---'-_-----_................................. --.............................................................. Position onlandscape (sketch onthe back) ........................................................ ............ - Distances from: - Open Water -................. feet Drainage way ................... feet Possible Wet Area ............ feet propertyLhne ------ feet Drinking VVe1er Well ............ foot ' 'Other '''................... --- Wauthor........... ....... ........................... -DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, 100 77 Parent Material <gou|ogio> ----.------ Depth noBedrock: -Depth to Groundwater: "����� Standin0\-VsLo- inthe Hole: Weeping from Pit Face: ^ � Estimated Seasonal High Ground Water: ��� HAYES ENGINEERING, INC. 603 SALEM STMEET JOB FILE FORM 11 - SOIL EVALUATOR FORIM1 WAKEFIELD, MA 01880 Page 3 (617 246-2800 • FAX (617) 246-7596 ,Detennination for Seasonal Hiyli Water Table Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ................... inches ❑ Depth to soil mottles .................. inches ❑ Ground water adjustment ................ feet Index Well Number ................... Reading Date ................... Index well level .................. Adjustment factor .................. Adjusted ground water level .................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date i -- . �. y "� -. r -... _ � HAYES-ENGINEERING, INC.. 603 SALEM STREET WAKEFIELD, MA 01880 (617) 246-2800 FAX (617) 246-7596 JOB PILE FORh1 12 PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS , Massachusetts Percolation Test Date:.----------------- ------------------ Time:..................................... Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12". Time at 9" Time at 6" Time (9"-6") Rate Min./Inch Site Passed ❑ Site Failed ❑ Performed By: Witnessed By: Comments:...... r HAYES ENGINEERING, INC. 603 SALEM STREET. wAKEF11:LD, MA 01880 FORM 11 - SOIL EVALUATOR FORM (617) 246-2800 FAX (617) 246-7596. tIU L'�J Page 1 6-� -�s . Date ..... ........ ............................. JOB FILE Com onwealth of Massachusetts . o fMassachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed : B .. Y },• :....:.:M.:::..... Witnessed B ..:. ... .,.. ..................................................................................................................................................................................... `........_....- .......... Loaiion Addru: a *s ►�. CYov wt c.a�., La ! Address, and Tckphorc [ � .New Construction 01 Repair_ ❑_...._. . Office Review Published Soil Survey Available: No ❑ Yes ©� Year Published :/./cS/-. Publication Scale Soil Map Unit ....C....-. DrainageClass :. Soil Limitations ._... ............... .._................_....__..................................:.............--................................ Surficial Geologic Report Available: No ❑ Yes ❑ Year Published --- .__ Publication Scale .................. Geologic Material (Map- Unit).-_ ...._ ......: .. Landform................... ...... ......................................................... _ ----- ---- ------------- Flood Insurance Rate Map: Above 500 -year flood boundary No ❑ Yes ❑ Within 500 year flood- boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) - - --- -- ..... Wetlands Conservancy Program Map (map unit) ........................... .... ........................ ....... Current Water Resource Conditions (USGS): Month Range : Above Normal ❑ Normal ❑ Below Normal ❑ Other References Reviewed: o ' . . ' - D"'RA1 11 -SOILEVALUATOR FORM Page 2 On-site Review ' _ �/ Deep Hole Number ������' Date:.-!�..����'� 7lnme:_--'_ Weather '-' Location(identify onsite plan) .................. ................................................................................................................................................................... ^-��� ' �ang ~' .'.S�po(Y6).................. '----.-------------_-_-� Vegetation ___ Landform . --' Position onlandscape (sketch onthe back) ----'------. ......................................................... Distances from: --''�dan��/atorBudy-..�_ fent. Drainage vvay------ fent - Possible Wet Area '----- feet Property Line _.............. feet -DEEP OBSERVATION HOLE LOG Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munse if) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 100 C 4 .Parent K8etehu( (geologic) Depth to Bedrock:Depth to Groundwater: Standing \\Iste' in the Hole: Weeping from Pit Face: '^ � Estimated Seasonal High Ground Water: • - - 3 HAYES,ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 (617�246-2800 FAX (617) 246-7596 JOB FILE FORM 11 - SOIL EVALUATOR FORM Page 3 Detennination fior &6t a� Method Used: ❑ Depth observed standing in observation hole....... inches ❑ Depth weeping from side of observation hole ................... inches El Depth to soil mottles �/ inches ❑ Ground water adjustment ................ feet Index Well Number ................... Reading Date ................... Index well level Adjustment factor .................. Adjusted ground water level --- ......... _...... ......... _.. Depth of Naturally Occurring Pervious Material le Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on W 1 ` %(date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. — / A Signal ate 1611%h Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director October 31, 1996 Mr. Aurele Cormier AC Builders 33 Walker Road North Andover, MA 01845 Re: Lots 27, 28, & 29 Colonial Ave. Dear Aurele: This is to notify you that the septic plans for Lots 27, 28, & 29 Colonial Ave. have been approved. The system for Lot 15 Puritan Ave and Lot 16 Colonial Ave. cannot be approved until waivers from the Planning Board for the 50 foot buffer zone have been granted. Lot 17 Colonial Ave. needs additional soil testing at the south end of the system. Any questions, please do not hesitate to call me at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: Ed Stearns, Hayes Engineering BOARD OF APPEALS 688-9541 BUILDING 688-9543 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FORM U - LOT RELEASE FORK INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: A - C. U U; 1A t r y ! A G Phone 0 5- 8 3 5 0 LOCATION: Assessor's Map Number Subdivision Food 1QAJ ES f a1t$ Street co I D n i a l ha Parcel Lots) a8 St. Number *********************** Official Use only************************ REDATI NS AGENTS: 7Date APP roved //. Conservation Admin'strator Date Rejected Comments ( t "moi .),✓1 C e(i Date Approved 2�9 i"-' Town Planner Date Rejected Comments Food Inspector-HealthSeptic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date GENERAL 3 COPIES �� STAMP 4--- LOCUS - -- NORTH ARROW ✓ SCALE L-� CONTOURS L,-' PROFILE` SECTION V BENCHMARK L�- SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS L� WATERSHED?t/O DRIVEWAY�Elev) WATER LINE;` FDN DRAINJJ/ i SCH40JLZ' TESTS CURRENT? /D S SOIL EVAL SEPTIC TANK MIN 150OGy .17 INVERT DROP, GARB. GRINDERL 2 comps +200) 25' TO FDN DK MANHOLE ✓ ELEV GW ## COMPS. GB ---- D-BOX SIZE ## LINES aQ FIRST 2' LEVEL STATEMENT --J�: INLET- OUTLET = • 16 ( 2" OR .17 FT) TEE REQ' D?,�/o LEACHING MIN 660 GPD?)� RESERVE AREA 1� 4' FROM PRIMARY?_ 2% SLOPE 100' TO WETLANDS X100' TO WELLS/ 4' TO S.H.GW v"." (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS CCK 400' TO SURFACE H2O SUPP L--- 4' PERM. SOIL BELOW FACILITYMIN 12" COVER L--- FILL?,tb (15') BREAKOUT MET? TRENCHES MIN 660 gpd-Z SLOPE (min .005 or 6"/100') Y SIDEWALL DIST. 3X EFF. W OR D (MIN 6') ✓ RESERVE BETWEEN TRENCHES? ✓ IN FILL?:�,p MUST BE 10' MIN. C---- 4" PEA STONE? '—VENT? (/� (>3' COVER; LINES >50-) BOT 66 b + SIDE � 8 � X LDNG � J � = TOT �T��� 6'60 (L x W x ##) (DxLx2x#) (G/f 2) 8 ¢O Copyright 0 1995 by S.L. Starr I �: PLAN REVIEW CHECKLIST ADDRESS_ iC �pCO/V/%36 ENGINEER XIAIV675 GENERAL 3 COPIES �� STAMP 4--- LOCUS - -- NORTH ARROW ✓ SCALE L-� CONTOURS L,-' PROFILE` SECTION V BENCHMARK L�- SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS L� WATERSHED?t/O DRIVEWAY�Elev) WATER LINE;` FDN DRAINJJ/ i SCH40JLZ' TESTS CURRENT? /D S SOIL EVAL SEPTIC TANK MIN 150OGy .17 INVERT DROP, GARB. GRINDERL 2 comps +200) 25' TO FDN DK MANHOLE ✓ ELEV GW ## COMPS. GB ---- D-BOX SIZE ## LINES aQ FIRST 2' LEVEL STATEMENT --J�: INLET- OUTLET = • 16 ( 2" OR .17 FT) TEE REQ' D?,�/o LEACHING MIN 660 GPD?)� RESERVE AREA 1� 4' FROM PRIMARY?_ 2% SLOPE 100' TO WETLANDS X100' TO WELLS/ 4' TO S.H.GW v"." (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS CCK 400' TO SURFACE H2O SUPP L--- 4' PERM. SOIL BELOW FACILITYMIN 12" COVER L--- FILL?,tb (15') BREAKOUT MET? TRENCHES MIN 660 gpd-Z SLOPE (min .005 or 6"/100') Y SIDEWALL DIST. 3X EFF. W OR D (MIN 6') ✓ RESERVE BETWEEN TRENCHES? ✓ IN FILL?:�,p MUST BE 10' MIN. C---- 4" PEA STONE? '—VENT? (/� (>3' COVER; LINES >50-) BOT 66 b + SIDE � 8 � X LDNG � J � = TOT �T��� 6'60 (L x W x ##) (DxLx2x#) (G/f 2) 8 ¢O Copyright 0 1995 by S.L. Starr I �: NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: * 6 PERMIT # 8`Ss DATE RECEIVED 7/a V l9ol APPLICANT, C. U/Gi�C,eS� -Z (UC MAP 1076 PARCEL ADDRESS ENG. 9i9YC5 /�� 5),-&AXCU ENG.ADDRESS LOT # a8 STREET # STREET (2DLD.(/rt9e /t//#// lig- PLAN DATE_ %/1,1-/9 4� REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: l el' 3/6 114Vco, / &- TC57- ,Uo 7- D6Av& 4 " -0 6640 sY67-&71-f. LOCATION: Lo SEPTIC PLAN SUBMITTALS aS b jovial Avt Wood luAc E5"fJw-5 NEW PLANS: YES REVISED PLANS: YES DATE: -112.119 ffi DESIGNENGINEER: haw( Lra+f\lErin -- 75�-%?- 1an (C�aai A. �. $25.00/Plan When the submission is all in place, route to the Health Secretary Town of North Andoverf 40RTij IN OF �� o ,. `. o ° • °0 COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director September 5, 1996 Mr. Ed Stearns Hayes Engineering 603 Salem Street Wakefield, NIA 01880 Re: Lot 28 Colonial Ave. Dear Mr. Stearns: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Reserve not 4 feet from primary. (N.A. 2.23) 2. Wetlands Disclaimer Missing. (N.A. 6.02 O) 3. Site evaluation certification not signed. (3 10 CMR 15.018 (2)) 4. Not 165 flow design or 660 GPD minimum (variance requested). 5. Perc test not done 4 feet below system. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 (617) 246-2800 FAX (617) 246-7596 July 16, 1996 Board of Health Town Hall 120 Main Street North Andover, MA 01845 �0 RE: Variance - Lots 27, 28 & 29 Woodland Estates, North Andover, MA Dear Members: REFER TO FILE #. NOA-0042 l A.UIC 11996 s � f Please accept this letter as an application for a variance from the North Andover Board of Health Regulations for the above-mentioned lots. We are requesting a variance from Section 2.13, which requires a design flow of 165 gallons per bedroom per day, on all three lots. The designs are based on a flow of 110 gallons per bedroom per day, which is the Title 5 requirement. We are also requesting a variance from Section 4.18, which requires a distance of 100 feet between a wetland and the leaching facility or reserve area, on Lot 29. A distance of 78 feet is provided. Please allow time on the agenda at your next available meeting to discuss these issues. Very truly yours, Edward E. Stearns, P.L.S. Firoject Cool di; alul EES/dab Enclosures J Town of North Andover, Massachusetts Form No. 2 BOARD OF HEALTH 3? •fir• _.•..�• °o c _19_cil 41 ;,s •...e.•�� DESIGN APPROVAL FOR s"`""5` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant_' . �1j�� ,c t �-. Test No. Site Location —CA -t' Si n . a . I Reference Plans and Spec - -- Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIR AI:1:1, 1:11 ; RD LTH OF HEALTH Fee � •+ Site System Permit No. � n r -t n CD 71 Ln r Lr) 0 � � C A 0 r S mi m 0 E) fly TUIIIIIIVIIVreal� of 4&f;fjttcJJtJgr tf; Departtarat of JJubfie 0afetg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 . Office Use Permit No. Occupancy d& Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 2:00 (PLEASE PRINT IN INK OR �T�YPE ALL INFORMATION) Date 7 /v City or Town of . 27J - To the Ins ector of Wires: The udersigned applies for a /pe_r[mit to perform the eelectrical work described below. Location (Street & Number) t i 2-S-` � Owner or Tenant )_qz- Owner's Address Is this permit in conjunction with a building permit: Yes (Check Appropriate Box) Purpose of Building IA&S: /a6z%%x ' L Utility Authorization No. --_e?72_ Existing Service Amps —_� Volts Overhead ❑ Undgmd I i No. of kleters New Service PCl Amps 2WVIt, Overhead LJ Undgrnd L'"t No. of fvteters Number of Feeders and Ampacity - — — s r.r, Location and Nature of Proposed Electrical Work i��l /X� '" �LLZ/-S1 OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Ofh:rations Coverage or its substantial equivalent. YES NO =_ 1 have submitted valid proof of same to the Offica. YES rJ NO 1,�: If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE Id BOND C OTHER C (Please Specify) General Liabi 1 ity 12/3 /97 (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Signed under the Penalties of Wiury: FIRM NAME Boissonneault Electric Licensee Rough A/ ,, 4` � Final UC.NO. A 1 1 8 2 3Q Uc. NO. 9 ?�c ( CJ -i (esus. Tel. No. (508) 454-0383 Address 47 Salem Road Dracut, MA 01826 at. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Lic4nsee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. _ .._ PERMIT FEE $ (Signature of Owner or Agent) GIS l �a x-6565 I total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Above In - Swimming Pool grnd. ❑ grnd. ❑ Generators KVA I No. of Emergency Lighting No. of Receptacle Outlets ( No. of Oil Burners Battery Units _---- No. of Switch Outlets No. of Gas Burners FIRE ALARMS ho. of zones No. of Delect,on and I Total No- of Ranges (,to. of Air Cond. tens Initiating Devices No. of Souncmg Devices No. of Se(f Contained No. 01,Dispocats No.ot Heat Total Total Pumps Tons i;Y•I — tto. o: Dishwashers i Space/Area Heating to :r D,,:.ctionlSounding D•_wice; I Local - ❑ fdun,cip3f CJlher Connecuan NO. Of Dryers Heating Devices K'�: No. of No of -- Low Voltage Na. of VJa;er Heaters K' J ( Signs Ba!lascs VIcring --� No. Hydro f.;assage Tubs ( No. of Motors Total f I P OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Ofh:rations Coverage or its substantial equivalent. YES NO =_ 1 have submitted valid proof of same to the Offica. YES rJ NO 1,�: If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE Id BOND C OTHER C (Please Specify) General Liabi 1 ity 12/3 /97 (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Signed under the Penalties of Wiury: FIRM NAME Boissonneault Electric Licensee Rough A/ ,, 4` � Final UC.NO. A 1 1 8 2 3Q Uc. NO. 9 ?�c ( CJ -i (esus. Tel. No. (508) 454-0383 Address 47 Salem Road Dracut, MA 01826 at. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Lic4nsee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. _ .._ PERMIT FEE $ (Signature of Owner or Agent) GIS l �a x-6565 Date ...... 7... gin J1 2. NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 'tSACHUS This certifies that .... ...................................... has permission to perform ................. al.&r . . ......................................... .................... .10 wiring in the building o ............... ........................ at ...... ............. 7..y ............ ................. ...... ............ . North Andover, Mass. Fee..Z'�---- Lic. No ............................................................................. ELECTRICAL INSPECTOR 3�r04/77 6 M-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer G, 4z Lfam lliwafti of -quiiar4ai1f5 Etpariattttt of f ubtic E-deq BOARD OF FIRE PREVENTION REGULATIONS 521 C JR 12:00 Office Use Only �/} Permit No. v 7 Occupancy A Fee Checked 31W (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7 oZ9.79-2 (i)ir or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant A2 • C eulL D F2 S Owner's Address Is this permit in conjunction with a building permit: Yes E (Check Appropriate Box) ��5� ��� ��`{ Purocse of Building Utility Authorization No. Existing Service Amos _J Vcits Overhead _ Unagrnd ( No. of Meters New Ser,ice Amps _1 Voits Cverheac _ Uncgrna r No. of Meters Numoer of Feeders aria Ampacity Lccaticn ano Nature of Prcoosea Elect. -,cal :Vcrx �-Pl r. r • Tti `�? r //y No. or L:gnung Outlets i No. of Hct ':as i No. cTotalt Transtarmers KVA Above.— ,n - No. of Lignnng Fixtures Swimming =.:a'grna. _ grnc. _ Generators KVA I I No. at Emergency Lighting No. of Recectacie Outlets No. ct Cil Burners I Battery units No. of Sw,tcn Outlets No. at Gas =urners I FIRE ALARMS No. of Zones No. of Ranges I No. ct Air Conc. Totai No. at Cetecuon anotons Initiating Oevices No. of Oisbosals No.ct Heat Total Totai Pumcs Tons KW No. ct Souncing Oev.ces No. of Sair Contained No. of Cisnwasners - ! ScaceiArea Hearing KV'J Oq+!ec:canrSounatng Oevices No. at Cryers ` Heaang Oev:ces KW Lccai _ Cannn ecalc:.on ^ Other _ Co No. ct Na. of Low Voltage No. of ',Nater Heaters KVV I Signs Ballasts wiring w No. Hydro Massage Tubs I No. of Motors Tatal HP OTHER: t/Y: TMJ �� /�2 %I INSURANCE CCVERAGE: Pursuant :o the requirements at '.tassac-users ;eneral Laws I have a current Liabiiity Insurance Policy inctuc.ng Ccmc:etec Oceraucns Coverage or as substantial ecuivalent. YES C -'NO = I have suamirtea valid proof at same to the Otfice. YESY f� — If you nave cnecxea `!ES, atease inoicate :he type of coverage Cy cnecx.ng the aoproariate box. INSURANCE 3r-3CNO = OTHER = lP!ease Scec:yf Estimates value of E! tncal ' Qrk 5 i Cl a --fl c�-- (Exb.ratlon Oatel Worx :o Start Z G� Inscecuon Cate Aacues:ac: Rougn Fnai Signea unser the Penay yes at pertury. FIRM NAME 7l/ LIC. NO. �ysC Licensee U y� d S;gnature UC. NO. -�_! lu_/ �A� Bus. :e1. No. Acaress Z? ���L�.t1� S /FIGt��/�/I_1C� - /! Alt. Tel. oto. OWNER'S INSURANCE WAIVER: I am aware that the L:censee coes not nave the insurance coverage or its substantial eauivatent as re- ouirea by Massachusetts General Laws. ano that my signature on :htS .^.ermit aoptication waives tries rectNrement. OwneriAgent (P!ease cnecx anet � r weanone No. PERMIT FEE 5 (Signature at Owner or Agenti t.�gog Of NORTH ,M e O i? �.'„,` ...... • of O P � r Date ......... ..��............. '... TOWN OF NORTH ANDOVER PERMIT FOR WIRING sSACHuSEt L• � This certifies thafF../�—. ... ....: --°.:r':.:? ....................................... has permission to perform ...... .:............ wiring in the building•of ............ .,: = ' ,y .::r................................... at ..........%./ ..... ` ... -L'.. - r.... ,......... , North Andover, Mass. Fet' .r.. ....... Lic. No.- '/V............................................................... ELECTRICAL INSPECTOR 47/31/97 13:11 35.00 RAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer wLru�OA /-- MAP AND PARCEL ADDRESS -7 !' p-,)� , OWNER A,e- , 11.c. / o — SIZE OF LOT IN SQUARE FEET # BEDROOMS_ SEPTIC SYSTEM LOCATION Sr I/i/IwV (For example, FRONT YARD SOUTHEAST CORNER) FINAL GRADING DATE '7 �;L 5 � 4 AS BUILT PLAN IN FILE? A/ b INSTALLER (%" Z;Z—<141tl i DWC PERMIT DATE ;! — % �9 7 CERTIFICATE OF COMPLIANCE DATE ENGINEER ` Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH Sept. 29 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( X) or repaired ( ) by Charles Zaher INSTALLER at Lot 28, 74 Colonial Drive SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 855 dated October 3119 96 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. �—�� BOA OF�HEALTH ENGINEER Town of North Andover, Massachusetts Form No. 3 "ORTM BOARD OF HEALTH OO O � � A 19 `L.L_ DISPOSAL WORKS CONSTRUCTION PERMIT S�CHUSE Applicant (� NAME Site Location_ 12, AD TELEPHOt Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No.__ T CHAIRMAN, BOARD OF HEALTH Fee—Z D.W.C. No. !72 A PLAN OF LAND /N NO. -ANDOVER IVA 55, SCALE.' I, = 40, SEP17.bRfR /6, 1997 /AYES ENG/NEER/NG, INC. ► 60,y S4LEA/ STREET CML ENGINEERS & WAKEFIELD, MASS. 01880 LAND SURPEYORS TEL. (517) ?45-2800 / CFR77FY 7Mr Thi/S HOUSE /S LOCATED ON THE GROUND AS SHOWN, AND 7y4r /T CONFORMS TO THE ZONING BY-LAWS OF 7NE TOWN OF NORTH / FURTHER CERTIFY 7H4 THIS PROPERTY DOES NOT UE WITH/N A fZ000 HAZARD AREA (ZONE A OR V) AS SHOWN ON 17000 INSURANCE R47F MAP COMMUN/TY PANEL NUMBER 250098 0010 B. EFFEC77kE D47F JUNE 15, 1983 047F' _��1Lo]------- PROFESS/ONAL —14N AND SURVEYOR �N OF 'k4Sy� 9 PETER 1 w J. OGREN #33604 ZONE- R.R.D. (R-2) V.R. MN/MUM SETR4CKS.' FRONT = 20' SIVE = 20' (SEE SEC. 8.5.6. 01) REAR = 20' r17•50'�E i 122 46 N86'5123'W LOT 28 Top FND. EUV. =164 18 ►{ 23, 324 S. F. 99.8 R 1 c*\ ' Zx v �.Q m G> P\�5 N 205.41 p N N LOT 27 , ZONE- R.R.D. (R-2) V.R. MN/MUM SETR4CKS.' FRONT = 20' SIVE = 20' (SEE SEC. 8.5.6. 01) REAR = 20' 0 V O z sI h—E I E N :od •hn 0 co O E coL z 0 pF •w C9 o a CO2 Q L CD C CD C O y -nl 3 .a O •L Qi _R ro �� I ° W I+y v/ 0 IM r co 0w ° w W w 1�1 ° CL C A c� CD w c� w" a°' 9B cn cn h—E I E N :od •hn 0 co O E coL z ts co •w C9 o a CO2 Q L CD C CD C O y -nl 3 .a O i _R i O L�dpp co C O CcC CL C A c� CD z CD C O CL H O C C _c Ea CO) cj: o a y E C • o m 0 Q CD E &.S E`i1�E y.o E a, o moi. m 3 r C c y y C O •E m O CD o c : CL( 1p L = Q Of Qf p C C Q t9 d L : m Cot _ m • Z o` ' i o ao c Q ® i O C .` H �O+ y m c/� W C ea L o .. = t w• .Cgs' tvC M Z C.3 co N2CL O� O� y CL4- h—E I E N :od •hn 0 co O E coL z ts co CL CD CM CO2 Q C93 caCD CD C CD -nl 3 .a CD i _R i O L�dpp co C O CcC CD z CD V CL H O C C _c CO) :alpQ rBnoiddy ON SOA �jpng-W uoprpuno3 ON /� SOA 0DWEW aa3 00'9L$ f.IUO asn 9AIJU ISTUT upV r 'IMflg-SV MOLL( KM0J ELDVJ LV aSVarld `NOULDaI.SNOD A1aN jl :N0I.LDII?I.LSAI0O AkaN =Iuvclau :3NO xDaRD #gA offila al VY" :auf . vNIDIS :2Ia'I'Iv,LSIa QaSAIaDIZ :uoLLdooz Iv ZII aci AIOI.LxiiusNoD mom rivsodsia uo3 NouvOI'Iddd -C-\ Commonwealth of Massachusetts City/Town of v a w° 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 side of house, Right side of house, Left front of hou Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address City/Town 2. System Owner: Name Address (if different from location) City/Town State DO,A A � Zip Code State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Imo. No Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: V"- 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L�{5.D /1 /-, Lowell Waste Water �lgrptute of Haul roc- 06/03 Date System Pumping Record • Page 1 of 1 : Commonwealth of Massachusetts City/Town of . System Pumping. Record AH 2 7 2016 Form 4 TOWN OF NORTH ANDOVER V,„ALTH DEPARTMENT 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: Le i t front of hous Left / Right rear of house, Left / right side of house, Left / Right side of building, Left / Right ron of building, Left / Right rear of building, Under deck Address Ci y'rrown State Zip Code 2 System Owner. CID e'er Name* Address (d different from location) Cityfrown B. Pumping 1. Date of Pumping 3. Type -of system: ❑ ❑ Other (describe): L -f _t — 2. Qua Pumped Septic Tank Date State o g �1� 10 -Code Telephone Number Number; Cesspool(s) 4. Effluent Tee Filter present? ❑ Ye i; 5. Condition of System:. 6: System Pumped By - Neil. Bateson Name Bateson Enterprises Inc- Company ncCompany 7. Locgfio�w,here contents were disposed: Waste Water Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No; F5821 Vehicle License Number Date t5form4.doc- 06/03 System Pumping Record • Page 1 of 1