HomeMy WebLinkAboutMiscellaneous - 75 FOSTER STREET 4/30/2018}}}t2
V
L T
V 0
o m
twn X
b �
o m
o m
o "'
0
Ll
North Andover Board of Assessors Public Access
� e
Page 1 of 1
r
[Parcel ID: 210/104.D-0053-0000.0 Community: North Andover
SKETCH
Click on Sketch to Enlarge
PHOTO
Location: 75 FOSTER STREET
Owner Name: BAIRD, THOMAS D, JR
JOAN V BAIRD
Owner Address: 75 FOSTER STREET
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 5 - 5 Land Area: 1.01 acres
Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1904 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 396,500 369,300
Building Value: 214,400 200,700
Land Value: 182,100 168,600
Market Land Value: 182,100
Chapter Land Value:
LATESTSALE
Sale Price: 0 Sale Date: 12/31/1968
Arms Length Sale Code: N -NO -OTHER Grantor:
Cert Doc: Book: 01127 Page: 0245
http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=808156 9/21/2006
Commonwealth of Massachusetts
= City/Town of
System Pumping Record
Form 4
AUU '19 20 13
TOWN OF NORTH ANDOVER
11 HEALTH DEPARTMENT
DEP has provided this form for uset 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 e Ri �!ronnt�oueft / Right rear of house, ,Left / right side of house, Left /
Right side of build4n Leftdin Left / Ri hf rear of buildin Und9 9�g, 9 g, Under deck
Addre s"75-
75 Q _
Cityrrown Fo nV f State
2. System Owner.
Name
Address (if different from location)
Zip Code
City/Town State
&25a --6TH
Telephone Number
B. Pumping Record
I. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Date
Cesspool(s)
— Z. Quantity Pumped
eptic Tank
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes Ld'No If yes, was it cleaned? ❑ Yes ❑ No.
5. Conditio of System: 1
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locatio wh re contents were disposed:
L,S. _ Lowell Waste Water
-�3
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
0
aI
Q)
fu
0 -
QJ
_o
a)
tEE
2
1%
LL
Q)
4-J
z
1�
C
Q)
CL
Q)
0
v
C
'II
Cn
I
C:
0
N
E
E
0
u
c
0
:a
L
a,
c.
0
U
I
0
m
C
c
fII
CL
i
L
fII
Q)
C
{
8 I
C
f0
G
_a
Q
�.r
v
a
v
w
0
m
0
c.
L
a.
L
)
40-21
9 'LT 0
.id
o � C
0 Q
Q)
I
T.+
F
C
O
Q
U
O
D
C
[O;oj
f- I
C
Q)
CL
Q)
0
v
C
'II
Cn
I
C:
0
N
E
E
0
u
c
0
:a
L
a,
c.
0
U
I
0
m
C
c
fII
CL
i
L
fII
Q)
Commonwealth of Massachusett RF j\J03
City/Town of
System Pumping Record
NppVER
Form 4 TOWN pr NpEPARTMENT
VAEALTH
DEP has provided this form for use;by local Boards of . 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*,eft
ig nt of house, eft / Right rear of house, Left / right side of house, Left /
Right side of buil /Rig fron o uildirig, Left / Right rear of building, Under deck
9 9�
Address
City/Town state
2. System Owner.
Name
Zip Code
Address (i different from location)
City/Town ' State�)_ ^, ode
(cam
Telephone Number
B. Pumping Record 1-4 Y
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 o If yes, was it cleaned? ❑ Yes ❑ No;
5. Conditioofstem:
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Locatiwkwhere contents were disposed:
L.�lc' AIWA. - _ - _ -
�'AA!iMWII1W0
t5form4.doc• 06/03
F5821
Vehicle License Number
Lf ,
Date
System Pumping Record • Page 1 of 1
0 0
�
•,r C o 0
N
G O
d
t
n
�
G
�p
p�
v Ln
a
N
O
2
J
J
O o 0
C
O
a
a
G
i
a
w
�
a
C
d
y
d
o 0
U
J
O
O
y
O C7
W
_
Cl)
G
y
w
Q
ai
O
r/�
_/y
O
O
co(L
Q
42
Q�
m c c
Cl)
a w w
d c c
`
o .o
d
m m
0
a m m
N
h
O
J
Z
Z
Z
d
U
w c
3
a
y
G1
aci
m
Y Y
c c
cc m
�.
yd U U
Oy
LD a a
y
Z
Z
Z
m m
v y to In
LO
OD
o
f
3
t�
k
W
,0
o
'O
J
N
C)
C)
=
LL
G
;�
N
L3)
.
Q
e
d
N
E
m
y
Gyi
a`
C C
a
c5
G1 N
0
O
3
3
5 -�
w
�.
a)
o o
q
v
141
o
V
d
LL
Ll
O
ip
w It
d
-S
H
cCt
`
ani
a'oa
a�
a�
tqC9
V
D
D
12
Cl)
C9
....:dp
of
Town of North Andover
HEALTH DEPARTMENT
€£,s S�CHust
<< CHECK
LOCATION:
r H/O NAME: '�700,o72
CONTRACTOR NAME:
Y'
Type
of Permit or License: (Check box)
❑
Animal
$
±
❑
Body Art Establishment
$
❑
Body Art Practitioner
$
❑
Dumpster
$
❑
Food Service - Type:
$
❑
Funeral Directors
$
❑
Massage Establishment
$
❑
Massage Practice
$
❑
Offal (Septic) Hauler
$
❑
Recreational Camp
$
❑
Sun tanning
$
❑
Swimming Pool
$
❑
Tobacco
$
I.:
❑
Trash/Solid Waste Hauler
$
❑
Well Construction
$
'f.
SEPTIC Systems:
❑
Septic.- Soil Testing
$
't.
❑
Septic - Design Approval
$
❑
Septic Disposal Works Construction (DWC)
$
❑
Septic Disposal Works Installers (DWI)
$
4 „ ❑ Title 5 Inspector $
A" w
❑ -T-itl 5Report er $
❑ Other: (Indicate) $
I
4�
1 809
Health Agent Initials
i
j`, White - Applicant Yellow - Health Pink -Treasurer,
I of 11
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
1,6�
Property Address: A Foster Street, No
Owner's Name:/ Tom Baird
Owner's Address: qjZ -WO Foster Street, No
Date of Inspection: // September 7, 2006
PART A
CERTIFICATION
Andover, MA 01845
Andover, MA 01845
RECEIVE]
SEP 2 1 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector
Company Name: New England Engineering Services Inc.
Mailing Address: 1600 Osgood Street Building 20 Suite 2-64, North Andover, MA 01845
Telephone Number: 978-686-1768
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,
accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the
proper function and maintenance of the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section
15340 of Title 5 (310 CMR 15.000). The system:
Inspector's Signature:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
ate: -1/f Z d
The system inspection shall submit a copy of this inspection report to the Approving Authority ( Board of Health or DEP) within 30
days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and
the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system
owner and copies sent to the buyer, if applicable, and the approving authority.
Notes and Conunents
****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.
2of11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 70 Foster Street, No. Andover. MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
Inspection Summary: Check A, B, C, D or E/ALWAYS complete all of Section D
A. System Passes:
"3E$ 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:
A/0 One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,
upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits
substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a
complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the
tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health):
Broken pipe(s) are replaced
Obstruction is removed
Distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if
(with approval of the Board of Health):
Broken pipe(s) are replaced
Obstruction is removed
ND explain:
3of11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 70 Foster Street, No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
C. Further Evaluation is Required by the Board of Health:
AJO 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
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 (SAS) Soil Absorption System and the (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 the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private
water supply well**. Method used to determine distance
** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and
volatile organize 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 5ppm, provided that no other failure criteria are
triggered. A copy of the analysis must be attached to this form.
3. Other:
4 of i ,
OFFICIAL INSPECTION FORNI — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 70 Foster Street. No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
D. System 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 overload or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool
Liquid 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 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.
i- 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 nitrogen is equal to or less than 5ppm, provided that no other failure criteria are
triggered. A copy of the analysis must be attached to this form.)
IV 0 (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 critiya apply to large systems in addition to the criteria above)
Yes No
The system is wit%200
of a surface drinking water sup
The system is wiof a tributary to r ace drinking water supply
The system is located in a nitroge sitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II
of a public water supply w
If you answered "yes" to any�n in Section E the system is co idered a significant threat, or answered "yes" in Section D above
the large system has failed. e owner or operator of any large system nsidered a significant threat under Section E or failed under
Section D shall upgrade the system in accordance with 310 CMR 15.304. e system owner should contact the appropriate regional
office of the Department.
5of11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 70 Foster Street, No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
i/ 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 an inspection ?
P44I 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 sign of break out?
1/ Were all system components, excluding the SAS, located on site?
Were all 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 difference from owner) provided with information on the proper
maintenance of the subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes No
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 15.302(3)(b)]
n
6of11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 70 Foster Street, No. Andover. MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design) Number of bedrooms (actual):
DESIGN flow based in 310 CMR 15.203 ( for example: 110 gpd x # of bedrooms)
Number of current residents: Z_
Does residence have a garbage grinder (yes or no): 410
Is laundry on a separate sewage system (yes or no):/t/O [if yes separate inspection required]
Laundry system inspected ( yes or no):
Seasonal use: (yes or no): /t/0
Water meter readings, if available (last 2 years usage (gpd): AJD i & M&419C,0 Pc X.
Sump Pump (yes or no): IVO
Last date of occupancy Gv re-e_^-C-
COMMERCIAL/INDUS TRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): gpd
Basis of design flow (seats/persons/sgft, 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):
GENERAL INFORMATION
Pumping Records
Source of information: Ft: A&PEI> &5'C' 'FA L- PUP- ®viN R(L
Was system pumped as part of the inspection (yes or no): AVO
If yes, volume pumped: gallons — How was quantity pumped determined?
Reason for pumping:
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)
Tight tank Attached a copy of the DEP approval
Other (describe):
Approximate age of all components, date installed (if known) and source of information:
j G-CAC4�( 't -I eir LD 1Z_jc7-E® 1-t-7 tRGz i>r✓L
Were sewage odors detected wen arriving at the site (yes or no): ill
7ofIL
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 70 Foster Street, No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
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:
Material of construction:concrete 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: 1®ate C"Atrc.on.4.S
Sludge depth: 4 Z
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 4.1
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined:—A4 eoeavl,e $77®14
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet
invert, evidence of leakage, etc.):
4ZO 4701DCot Q(- 'n �.lc1�Df6�C�" dN vim 6�
GREASE TRAP: (locate on site plan)
Depth below grade:
Materials of construction: concrete metal fiberglass polyethylene other
(explain]
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of sludge to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition structural integrity, liquid levels as related to outlet
invert, evidence of leakage, etc.
a I `
8ofI�
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 70 Foster Street, No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
TIGHT OR HOLDING TANK: N `f+ (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade
Materials of construction: concrete metal fiberglass polyethylene other
(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Continents ( note if box is level and distribution to outlets equal, any evidnence of solids carryover, any evidence of leakage into or
out of box, etc.): n
$�tC 1d1 cll?am/ cy.��•�®n ���'if •�� t�lOn c �2✓�(.. .�Jc� ��.�e9��ace
C> Sb L., PV c .k Oslfic Olt. Lacof-Am9Gzt/-j O2
PUMP CHAMBER: Al 6 (locate on sire plan)
Pumps in working order (yes or no)
Alarms in working order (yes or no)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
4 �
9of11,
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 70 Foster Street, No. Andover, MA 01845
O,vvner's Dame: Tom Baird
Date of Inspection: September 7, 2006
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 in length
leaching fields, number, dimensions: 1 dF [.1> Z-�' k + —
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)
?::�i6'c-D 4-0 %D Arr /4Jodvm 46. Aikn 4r DeAcc dP f'o JJ.
I7A PA P sz> I L' Q a2 0 - 6—
CESSPOOLS:
CESSPOOLS: N j R (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 or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY:A4,A= (locate on site plan)
Material of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc.
10ofN
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 70 Foster Street, No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benclunarks. Locate
all wells within 100 feet. Locate where public water supply enters the building.
F- 2 ST
� f
11 of ? 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 70 Foster Street, No. Andover, MA 01845
Owner's Name: Tom Baird
Date of Inspection: September 7, 2006
SITE EXAM
Slope
Surface water
Check cellar No
Shallow wells nr�NC
Estimated depth to ground water S_ 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 excavator, installers — (attach documentation)
Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
v✓GS uAPS tN�{c� �c�4 c..�-r"� is ? �•�� ►��c�w
c'V— A -a Fr -ox
gFZE r !s olZy.
TOWN OF
SYSTEM PUMPING RECORD
DATE: q,"-6 --o<
SYSTEM OWNER & ADDRESS
S
(a
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: QUANTITY PUMPED :
CESSPOOL: NO YES
_ SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE 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: Bateson Enterprises, Inc.
COMMENTS:
c/
��
CONTENTS TRANSFERRED TO: GI.S.D Lowell Waste
GALLONS
�L\ Commonwealth of Massachusetts
93) City/Town of LREIVED�
System Pumping Record
Form 4
09
NDOVcRDEP has provided this form for use by local Boards of T b used, but the
information must be substantially the same as that prousing 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 hou Left front of house ight front of house,
Left rear of house, Right rear of house.
Address
City/Town StateiD111�
2. System Owner:
Name
Address (if different from location)
City/Town
Zip Code
Stat Zip Code
r'
Telephone Number r
B. Pumping Record �C
1. Date of Pumping q . Quantity Pum
p g Date ped' Gallons
3. Type of system: ❑ Cesspool(s) - Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes D, o
5. ConditioSystem
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
L. .D Lowell Waste Water
If yes, was it cleaned? ❑ Yes ❑ No
Vehicle License Number F5821
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
R
APPLICATION FOR SEWAGE DISPOSAL I16TALIATION
HEALTH DEPARTWNT - NORTH ANDOVER, MASS.
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 ./"v I in size. A manhole (s) permitting easy cleaning
will be provided with removalgle 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 9-ey lineal (*he ) 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 fromanydwelling 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
/
T _
Vgn ture of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE dam .9 U 4 /� 6 /
gnature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described. �/
DATE_ "7 I V � l
Y
Signature of I pecting Officer
Percolation Test
Garbage Grinder `}
n _ BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
7
More
" v
t
T � �
i
�j
1
luno GAL GoNc, Trci'Rnae �' r►d.
i 30 . / 3 Ot .-D. is'n $
I
. . . . . DATEaoc-
j'. S �l . ",► <."2 r LOT NO. TEL
.
2 . ADDRESS ,.� . �:. �° v
3. NO. OF BEDROOP"S ; j . . DEN C= . . . . . .
k. GARBAGE GRINDER -dD> . . . . .
5. SHOW DI12NSTONS OF HOUSE k y
6. SHM DISTANCES OF HOUSE TO ALL PROPERTY LINES
7, SHOW DIPQENSIOM OF LOS
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEhI No we,(/
10. SHOt^l LOCATION OF BROOKS STREX-S DITCHES, LEDGE OUTCROP, ETC.
U, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROPI HOUSE
NOTE: LOCAL REGULATIOiS SHOULD EE READ CAREFULLY.
t
March 18, 1961
Miss Mary Sheridan Re 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 Foster Street building site of James Dean.
The land in general is high.
The subsoil in the area was of sandy clay content and a 5 -minute --
percolation test was conducted.
It is recommended that a 1,000 gallon concrete septic tank be
installed together with 200 lineal feet of drain pipe.
WJD: hd
Very truly yours,
� LJ
William J. Dri toll
TOWN OF
SYSTEM
DATE: 9.^ ( 3- 6
SYSTEM OWNER & ADDRESS
P rd
SEP 1.4 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SYSTEM LOCATION
(example: left front of house)
14— �- 0 mk 5-e
DATE OF PUMPING: S QUANTITY PUMPED: ( Bt) O GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN) r
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D ✓ Lowell Waste
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: " 0 l
STEM O NER & DDRESS SYSTEM LOCATION
b.cki ( (example: left front of house)
5 1:6s�c- -6 � ` k,� -flock-It-Dp- 6's-ic-
DATE
OF PUMPING: 'Ol QUANTITY PUMPED 1'66L) GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES -
NATURE OF SERVICE: ROUTINE ZIEMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO:
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
YQ
ISI
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
RECEiVEt?
SEP 2 7 2001
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Oftr fdif, 'art N, but t to
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 Locati
Address
City/Town
2. System Owner. �
Name
Address (if different from location)
Citylrown
Zip Code
St'tg a — 69� Code
Telephone Number
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes leo If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. Systeu il 43y:
Name .�� Vehicle License Number
Company
7.
t5fonn4.doc• 0603 System Pumping Record • Page 1 of 1
B. Pumping Record
! 1(_7
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 leo If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. Systeu il 43y:
Name .�� Vehicle License Number
Company
7.
t5fonn4.doc• 0603 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town. of
W° System Pumping Record
Form 4
^M SVOy`e
aL P 2 U zoll
TOWN OF NORTH ANDOVER
HEALTH 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 Locatio ront o1
rear of house. rip rear o c
right front of house, left side of house, right side of house, Left
side of building, right rear of building, under deck.
'-7 sf
City/Town
2. System Owner:
Name
Address (if different from location)
City/Town
State
Zip Code
Stat/ /'1 � b _& � ?ode
Telephone Number "�
B. Pumping Record
1. Date of Pumping Date 2. Quanti Pumped'
3. Type of system: ❑ Cesspool(s) eptic Tank
❑ Other (describe):
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes [T No If yes, was it cleaned? ❑ Yes ❑ No
5. Conditiorl sof oy - �� �
4--L�c-
6. System Pumped By:
Neil J. Bateson
Name
Bateson Enterprises Inc.
Company
7. Lopati*4-woere contents were disposed:
L.S.
Signature of
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1