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HomeMy WebLinkAboutMiscellaneous - 78 LACY STREET 4/30/2018 (2)IN NEW ENGLAND ENGINEERING SERVICES lk INC January 19, 2005 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 78 Lacy Street, North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Ben'ai� C. Os ood If. P.E. J g Certified Title 5 inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 611512000. Inspection forms may not be altered in any way. A. Certification 1. Property Information: `78 L-AC!A s kZ Ef V ? /27,7Y iNDo ) e it - Property Address :3-h A-) HQ RT81� Owner's Name -70 t-ytc-Y 5 -1 -C 7 - Owner's Owner's Address AV O 12"1'1( ,- N D dy !1. City/Town Date of Inspection: 2. Inspector �a State Date f91/UiY1S Zip Code bE-NanM,ry C Uj Name of Inspector A)ewy 9�xI (r1--An//7 it Company Name - Company Address /yy27-/_ A/,Jj:> 61jcE—t2-- -Y-t✓i P/ ads City/Town State Zip Code �z 6e 6--17&5 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: APasses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspec s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 7a 4A6N i 2EC Property Address 7---- — ---- J0oIz-ry lfN Door A MA pl84c City/Town State Zip Code sA�jIr - 14U P --M ti 111a10� Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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: Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments �M Subsurface Sewage Disposal System Form A. Certification (cont.) -78 t_ R -C �, JT (Z- F 1 Property Address— ,Vo (2 71-1 ddress,Vo(2T1-1 AN V DOE (Z 41/4 121,9 'Y City/Town State Zip Code JAN F- HYR12::, Iv 1/19/o — Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M A. Certification (cont.) -7 & c-0C_N r— REC Property Address -N0R-7H �]�> o.),✓ 2 City/Town �J-Fhk)E H4..; Owner's Name State Zip Code Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 7,03 4 RC U e— Property Address-' Nth10%k ikN v oUC 0— 0/8Ys City/Town State ZipCode �l ANc /-1(j r2-1z)1Q Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 9 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ �1 Liquid depth in cesspool is less than 6" below invert or available volume is less '/z than day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E� 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. ❑ C� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ n �P Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ❑ CX 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. Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5 of 16 \ Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 7R "Gj s—t 2FE Property Address PO9-frt /-\-ND ODc ddb�jS City/Town State Zip Code --j- tlt4 Owner's Name Date of Inspection Large Systems: To be considered a large system the system must serve a facility with a de'!5in flow of 10,000 gpd to 15,000 gpd. For larg stems, you must indicate either "yes" or "no" to each of the following, i dition to the questions inSection D. YES NO \ E] E] the s m is within 400 feet of a s ce drinking water supply ❑ ❑ the system is i in 200 of a tributary to a surface drinking water supply ❑ ❑ the system is lo c d I nitrogen sensitive area (Interim Wellhead Protection Area — IWP or a mapped a II of a public water supply well If you have answered " to any question in Section E th stem is considered a significant threat, or answered "yes" ection D above the large system has faile a owner or operator of any large system consi ed a significant threat under Section E or failed under tion D shall upgrade the systema ccordance with 310 CMR 15.304. The system owner should cont-aQ the appropriate regional office of the Department. Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M B. Checklist -70 Property Address 4wo14 —1 H �N D c),�, r 12 �A Dif3 y� City/Town State Zip Code Owner's Name Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: YES NO ED"- ❑ 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? 91" ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? M-11, ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) 2` ❑ Was the facility or dwelling inspected for signs of sewage back up? 21- ❑ Was the site inspected for signs of break out? ❑ H' Were all system components, excluding the SAS, located on site? [� ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: [� ❑ Existing information. For example, a plan at the Board of Health. �- ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 79 _ A 46 Q STA%c Property Address Alb 11-1-H City/Town State Zip Code H J R 7?2!"% 411 C/& - Owner's Name Date Inspection Residential Flow Conditions: 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 residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes © No Laundry system inspected? ❑ Yes [2 No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): k`"'' LL Sump pump? ❑ Yes ® No Last date of occupancy: v Date Commerciallindustrial Flow Conditions: Typ Establishment: Design flow (basest or►_\ CMR 15.203): Gallons per day (gpd) Basis of design flow (seatslp re /sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the- itle 5 system? ❑Yes ❑ No \\ Water meter readings of vailable: Last d occupancy/use: Other (describe): Title 5 Inspection Form.doc • 11/2004 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) -7�,- /-6C-V sTR E Property Address /v/LTR A/tJpex)C- y,—,1 City/Town State Zip Code 7W,4j Ny,�—)-Z) /�l �l os Owner's Name Date of spection General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: .� i � n1 � �y � �G iz O�.•vNC � gallons ❑ Yes 54 No (� Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: —e�-Cl%fiLLE0 /q77 �� &5- /3L,,1L71— Were 1 Were sewage odors detected when arriving at the site? ❑ Yes �d No Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) Property Address ,4/0 a=-ge NNp (-?,.)c 2 b 62,(1�)9S City/Town State Zip Code O-i9-Nc 1.1-4 J 2 �//// q cam Owner's Name Date of Inspection Building Sewer (locate on site plan): I Depth below grade: Material of construction: D9 cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: e feet r 2 e5 _ feet Comments (on condition of joints, venting, evidence of leakage, etc.): t A-) l�AsE� ��• "i Septic Tank (locate on site plan): Depth below grade: feet Material of construction: 0 concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: i years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) 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 were dimensions determined? ❑ Yes 2 No /c7�o &-A,-Wiy 5 L 2 it ZC, iYl 64S u X s—/ 7 i4 Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) Property Address City/Town State Zip Code 4NE .H,) 2 _)_vN f I -/ /oS Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): N fl Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle feet ❑ polyethylene ❑ other (explain): Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form N C. System Information (cont.) ? 43 4_44-J 4Gy STr2 Property Address Naa-iN A AJ u Odc 2- City/Town State Zip Code j AAI i4o 271X) N / j 1 q/03 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 134.,;, A k=&2cA--/.6--z_> U,��EA Bi2tciA, WALK co e.--> 67 �5—r �az6 wAL_y- A) C-_ Ay f -514=44D Pump Chamber (locate on site plan): A) Pumps in working order: Alarms in working order: Title 5 Inspection Form.doc • 11/2004 ❑ Yes ❑ No ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 7 F, 1--f}-Gy si �z Ec Property Address )oo&T'f f7N� ©JC /L /yJft Ol9yS City/Town State Zip Code ,9_4ti/�F Hv�2'i?�N Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits ❑ leaching chambers ❑ leaching galleries ❑ leaching trenches leaching fields ❑ overflow cesspool ❑ innovative/alternative system Type/name of technology: number: number: number: number, length: number, dimensions: number: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ,E(C Ak.J 09 l Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'M C. System Information (cont.) 7S4-146cf Sj 2E� Property Addres A/pez, N Oyc 2 Mr4- City/Town State Zip Code UW A) F H US 1 ,11 j! l y/ Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): k)A Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Alp# � I Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) '72 J-& c -47-0- c Property Address City/Town �f3tic' KvrZ1DN Owner's Name State / / t o,oS Dat of le sno Date 0.1 S �s Zip Code Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 4l1 a Lt— Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 a Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �N C. System Information (cont.) Property Address P,> 2TN E (2-- City/Town ..TR N c H 0 ,Z TL) AJ Owner's Name Site Exam: Slope I JKI Surface water Zoo` Check cellar 0o Shallow wells No ,je Estimated depth to ground water: il State Zip Code 1 -7/"y - Date of Inspection Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date B[. Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-- explain: You must describe how you established the high ground water elevation: fo N p L IFF; L_ 1i Tz? , _ r c, c 8 Etc 0 �L — FL—e,j&IJZ37? L ,Susi L AA (`L(LA.) +S K l cJ �Tl< r5+y E2�i 4_6 & �- L -V 722 f3 G E Title 5 Inspection Form.doc • 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 Town of North Andover Community Development and Services Division o Office of the Health Department *� 400 OSGOOD STREET " North Andover, Massachusetts 01845 Susan Y. Sawyer, REHS/RS (978) 688-9540 - Phone Public Health Director (978) 688-9542 - Fax Date: Ja.Vl �G.( H 0 Address: `7g �i l/� �j`t'� , North Andover, MA 01945 Re: Application for: ?"I Ta -n P--- Ours o n Dear: 13-0 I Your application for 4V G&3� tM at ' W ) W L,� 5T, has been reviewed by the Ukakh Department. The application was denied on, 1, j 4� , ?005` 2004 for the following reasons: 1. 1 Missing information 2. d Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If #1 is checked, please supply: a. Floor plan of existing and proposed addition — all rooms b. Certified plot plan showing house, septic system and proposed project in scale It #2 isc( hge►ced: ate. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 Is checked: a. Relocate the project If #4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, �f evi wer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONS17RVATION 688-9510 NURSV: 688-9543 PLANNING 688-95.35 --"? 85:21 NATIONAL SALEM . r n..rrw c ca _nein.. tun6Mi�m�l�gm1l1t4°�IuAt4nM�{iNii�ai ��+++ �I rtu�uofA00YPY1tYM�tt�mtNWtYio'tpHOo'su»YFutp�ataKD 1 liwu �ocA�M1'P�14'srolfmW=AC uMD �t UM pYgn+at q.�„:i,:ti•vt�i-''. ate. W 90ulAaD Wllw�rv��� t180'IM18 t�LL '� 64RI^a Y MMgiaOWW�A�upopm an saw"* I, 1$o WwDMa awg1 A01MoNhAMW MDIbb �'st'�"''w N� A aek�aa°w�6? ! A 4+rt',d�11� P.02/03 ,o�t5a1,0 9A119ri1� 'N "g iS lan I I ./R •+www•N'S c 1101110 3a' � � �♦� � y it �7 N • NATIONAL SALEM 7ffAi4i N=z'W+oia Kun EulW�AaPIN4 fWAHP�N►1Wi1 RYi sMD tawf3 f(fQ RuauelueAepu+oVPNupDw'W+f{pa'*+u�RutC+f�AV .�pYtrll�il00�iC►1o035 RWPOAeW-Pao'!{cp�piEt11f10AYNWfp111pA09f nf•rapW'M'•yyRiflOL 4�PNIR�Nt�l80'tlfl8 °D�E�CMtV ►t0�tf0 ftgL gpafOm�Ml Ulf W iNe b41P'r0 MI ► p uaPfif aW W � e u R1afw t»t�d � �N*fO •MYl Ir Q 0 LL 4 0 z= U P.03/03 t t t tat i t s R U13! a s Ee3 g�tj all � 14� �lid �m H 9� TOTAL P.03 • �'�,uesoYn�e.a�eoMa.wts�awanv,m.:�a�w .un no sse�oo »IODlagppA siwwo''sPsiae'MwY�nP�p • •►y��V3� ROW �1q'p�jq IWOJNY tiM �Nlgo%M w+mn••oNOYMOIRoI sWesYt'�ia•�q sq nw+W v>w.m�.a�ees M�snawww�«• p �gpNaVNaI� c O!`OIRV P��stM ��� NWl lmoffee�eeee�e rAll 1P111 ��wlvl,�,YooU1SY�4 v11•+aAovwN�Canu •�o�ao i PIE ' f lit d. La Anr�`a�a8 ! A U � O M R lmoffee�eeee�e rAll 1P111 ��wlvl,�,YooU1SY�4 v11•+aAovwN�Canu •�o�ao i PIE ' f lit lrReuttawa+�+na«nauw.w�rsL�xwa�eu� Q q ,� , Rw�efULlgO�gqPl�wlppwiiuwM'�A1Rp'o��rLO sn�MnNl1 p11i�CN7t95 � 6 "' ...7t�i4+3'�i� Fru�p�nvwivtiLeLfi�ILM4�L y�wbOW'N'ss+�Lt01 � Mw.aaw�wi��savne•aa�euoNw rtn►►ro � � "a �P7�wL�LpLn�y�+vaaLOsee�Ni�e�NMD�{fL• _._ Pw4wWtWwl�tN�pvpw�dwwwHt! si E � E b fit 'III's 5 U. 4 ztl :.� Ul L } } v! a s! 3�Sys b Y r a71 F mr-, I e M* NORTH ANDOVER SUBSURFACE DISPOSAL SYSTEM CHECK LIST I. General Information w"V� 2,ti'11 Reg. 2.5 The submitted submitted plan must show as a minimum: UCl the lot to be served (b 4 -location and dimensions of the system (including reserve area) design calculations L-- alculations showing required leaching area (e 0'existing and proposed contours (f)69 -location and log of deep observation holes - distance to ties (9)01�-location and results of percolation tests - _ distance to ties ocation of any wet areas 4Q,01 of the sewage disposal system orsclaime= - surface and subsurface dr ns 00' of the sewage disposal system or isclaim ocation of any drainage easem hi 100' of the sewage disposal system or isclaim t (k)o(known sources of water supply within o ` the sewage disposal system or disclaimer location of any proposed well to serve the lot M4 -location of water lines on the property _fin) maximum ground water elevation in the area of the sewage disposal system (o) a profile of the system +j►(p) ho PVC is to be used in construction (q b location of benchmark --.'>r) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans. II.oi/ Garbage Disposers III. Septic Tanks Reg. 6.1 (a) Reg. 6.7 b) Reg. 6.8 (c) Reg. 6.(d) 60 (e) Reg. .1 Reg. 6.18 ( f ) ( g) IV. Pumps Capacities 4= 150% of flow Water table Tees Depth of tees Access Pumping Cleanout Reg. 9.1 (a) Approval Reg. 9.6 (b) Stand-by power i1 44 i V. Distribution Boxes Reg. 10.2 (a) Slope greater than 0.08 09' Reg. 10.4 (b) Sump ax• VI. Leaching Pits Leaching pits are preferred where the installation is possible. Reg. 11.2 (a) Calculations of leaching area (minimum 500 S.F.) Reg. 11.4 (b) Spacing Reg. 11.10 (c) Surface drainage 2% Reg. 11.11 (d) Cover material VII. Leachinq Fields Reg. 15.1 (a) Greater than 20 minutes/inch O i• Reg. 15.1 (b) Area (minimum 900 S.F.) Ole, Reg. 15.4 (c) Construction of field Reg. 15.8 (d) Surface drainage 2% C)� . IX. Downhill Slope (a) Slope y/x = (to be shown) (b) y/x X 150 = (to be shown) ©(Z- h'1 Jy' INC W k3WQQ� o Q w a j QW .,elz h�QW4� ° Q �. 0 h 44 0 �0 J 3 1 o � WLU J Lu 1�z oati h � � w �whvr� R I 11 o 4 � • � o V w O � ti � NY/ z '4► Q cJ Irl o� W 7 W hW 4 � Ot ti W Q I . �. � •, o N • ' e" Q e I 11 0 O 4 � • � o V w O � ti � NY/ z '4► Q cJ W 7 W hW 4 � Ot ti W Q � 0 Q v 0 Q y Q �a � _7' 0 1. � V i IQ W Q w ------------------- 0 O 4 � • � o V w O � ti � NY/ z '4► Q cJ W 7 W hW 4 � Ot ti Q � 0 Q Q �a � 0 0 i IQ W Q nn0,, o � � o V w O � NY/ LZ Q � 0 Q Q Q � 0 0 IQ W Q /%/Y/ V NY/ LZ I /%/Y/ TO: NORTH ANDOVER, MASS '7 19 7J' BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at ZG %` Z 4 C/ <-7 North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 n �a • R EA Jb /A/C-, ,a 5 5 `� .161.7 7 L F V/9 �r�V •�!/fl� r � 3 •2 9► /ooh CSI /, Se O71 e-- ThjVA' 9 G S",47" &25 — -- - -mss•--- Z�,2 y 5 T- NORTH ANDOVER BOARD OF HEALTH INSTALLATION CHECK LIST APPROVED DATE DISAPPROVED DATE 7 _�/-�� EXCAVATION OK MASONS: G -6- 7 V41� t� -1�(�r- - --- FAIL— FAIL I OK 1. Dista e To: etlands Drains Well 2., -Water Line Location '.,�No PVC Pipe 4. Septic,_Ta s nt Pipe to Tan. - On Both Sides of Tank 5. D. tion Box Box - No Cracks All Lines Flowing Equal Amounts No Back Flow 6. each Field or Trench Dimensions Stone Depth Capped Ends Clean Double Washed Stone 7. Leach Pits Dimensions Stone Depth Splash Pads Tees Cement Pipe to Pit - Both Sides Clean Double Washed Stone --a. No Garbage Disposal ��nalGrading Inspection C, N, 10. a�Edi, ng Covered Syste 11. As - Built Submitted Lot Location Dimensions of System Location with Regard to Pere Test Elevations Water Table M 0 k T 6 A 6 E INSPECTION PLAN City/Tovn:)4p ED yq__q�y stat!:-- M A------------- Date=��4+_'�E-y-j-`�__-_---��------ Owner: ----------------- D:iyer I __}A_v_� RZS? �--- Deed Ref._ 3 Q1Q 4_-__-- Plan Drawn per City/Town of \__ C>"C S NN u► JOSEPH A. ESPOSITO, in. H No. i8M !r� 0 -\ C Y ST REQ=—r TotA t , P--- ---- N i-�-- --------------------------- ------ I hereby certify that the abov! Mortgage Inspection Plan vas prepared for m in connection with a nev Mortgage and is not intended or represented to be a property line or land survey. It cannot bt used for tstablishing fest!, hedge , valls or building lines. No responsibility is extended herein to the land owner or occupant. The location of the original bvilding(s) as shown herein vas in c095liance with the local applicable toning bylaws in tfftet vhth constructed, with tupect to horizontal dimensional requirements, to lot lines or is #leapt frog violation enforcement action under Nast I.L. Title Ytl, Chap. 40A, Sec. 7, unless otherwise shown herein. Subject building(s) lies in a flood tone designated lonet�C slid shown on FIRM sap Cossunity-Panel gZ c�c� = P c�c L Dated:_. 9 g. Job No._.q'3t - -3 JCD, INCORPORATED, LAND USE 1 DEVELOPMENT CONSULTANTS 4 AUTUMN LANE, NETMOl NA 01044 508-603-9132 - a NORTH ANDOVER SUBSURFACE DISPOSAL SYSTEM CHECK LIST General Information Reg. 2.5 The submitted plan must show as a minimum: (a)OP-the lot to be served (b)1 location and dimensions of the system (including reserve area) (c)t�_design calculations (d) calculations showing required leaching area (e)4 existing and proposed contours (f V location and log of deep observation holes - distance to ties (g)d/location and results of percolation tests - distance to ties (h)Ylocation of any wet areas within 100' of the sewage disposal system or disclaimer (i),''surface and subsurface drains within 100' of the sewage disposal system or disclaimer c � Q) location of any drainage easements within 100' of the sewage disposal system or disclaimer W rtr known sources of water supply within 2d6`' of the sewage disposal system or disclaimer (1).'=location of any proposed well to serve the lot (m) -location of water lines on the property maximum ground water elevation in the area of the sewage disposal system o) _a profile of the system (p)-/ no PVC is to be used in construction (q)6/ -,location of benchmark (r) plan must be prepared by a Professional Engineer 6�or other professional authorized by law to prepare such plans. II. Garbage Disposerso,, IV. Pumps Reg. 9.1 (a) Approval Reg. 9.6 (b) Stand-by power III. Septic Tanks Reg. 6.1 (a) alCapacities - 150% of flow Reg. 6.7 (b)' -'Water table Reg. 6.8 (c)`r-Tees Reg. 6.9 ( d ) ,' Depth of tees Reg. 6.12 (e)jt, Access Reg. 6.18 ( f) fT- Pumping (g) y, Cleanout IV. Pumps Reg. 9.1 (a) Approval Reg. 9.6 (b) Stand-by power Q 41 V. Reg. 10.2 Reg. 10.4 VI. Reg. 11.2 Reg. 11.4 Reg. 11.10 Reg. 11.11 4 Distribution Boxes (a) Slope greater than 0.08 61- (b) Sump Leachinq Pits Leaching pits are preferred where the installation is possible. (a) Calculations of leaching area (minimum 500 S.F.) (b) Spacing (c) Surface drainage 2% (d) Cover material VII. Leachinq Fields Reg. 15.1 (a)f—Greater than 20 minutes/inch Reg. 15.1 (b)oeArea (minimum 900 S.F.) Reg. 15.4 (c)04 Construction of field Reg. 15.8 (d )6-L Surface drainage 2% IX. Downhill Slope (a) Slope y/x = (to be shown) (b) y/x X 150 = (to be shown) 61 SOIL PROFILE & PERCOLATION TEST DATA Town/City _ "_Uva No.&Street �G'c Lot No.y Loc./Subdiv. Plan Owner s/ Gp 2t r� InvestigatorAo_'_' Ia_// Observer 42//JL SOIL PROFILES -DATE 11 1' Elev....... 2. Elev. Elev. 4'Elev. 0 0 0, 1 1 1 Benchmark Elevation 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 2' 31 4 5 6 7 8 9 --� 10 --� 10 1--------� Location Datum Percol tion Tests -Date ,7977/7,7&7, Pit Number 1 2 3 4 5 Start Saturation Soak -Mins° Start Test -Time Drop of 3 "-Time Drop of 6" -Time Mins.lst "Dro ,.; Mins.2nd 3"Dro , ••�I. on bacx Frank C. Gelinas & Associates, North And. LOT �\� •ir - �. ..l,....,... �� •..�_, `BSc`'• VN r4r P, z --'._ . C� QI- '' � . �_.. _ ••. L-. ' \ ,. .. ,. X70.0. �apot �� l n 1 (�j O O p� T'io 1.' . O O ,. .. _ •` },1_,-,� _,t�'�y..Jam- b,'� L(N-_ LT 5 07� ( _ ' . o REA Q�.�- /1.0.5 k 7D 71 30 _ Ei 0 L ,V � I OU'Z / = 1�Y0110P v 'z 77= wAl j ro a q W 0 v 4 � a , W _ W W N W o J R V V Q 0 L ,V � I OU'Z / = 1�Y0110P 00' L Z / _ MY/ OU'Z / = 1�Y0110P v 'z 77= wAl Lo atijftp .=�y � � M I R � W QVi� ij ko , oo�W�� QV� oW WO pi�. �. j l 2a F ? LU' o -__ ) L •;1 OF • y GJ ate. in 0 �- i N on 0 ��-. - .�,• � tri 310 /7," 1 s '/l/V/ a kc: 4 W � C c Qj 4 v 4 ate. in 0 �- i N on 0 ��-. - .�,• � tri 310 /7," 1 s '/l/V/ 310 /7," 1 s '/l/V/ 0 9 �� Ll J Q Tj P zt Q W .,QW���� 4th WwQ)LIU 41 �����3Qe� [J m m 4j 0 e� v o � � m [J m 0 o � � V [J tq Y M E-1 E-4 W a o o w � � a � z � w H a H oEA a Z H � i 0 v� U z H w AOEa U L. P4 ti Z W z ww _ PN oz� U E-1 � o �a oU) U zo oaa 6 491, w � O z fiE1L" ®• I ' m 5d TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: n$1 SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING:_--) Ot 10 i QUANTITY PUMPED '�-DQ GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE ✓ EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: i ti runs OF NORTH ANDOV--R/ BOARD OF HEALTH CONTENTS TRANSFERRED TO: J 4 2001 10 V�/VJl 1JJ( VV. JV JV VJl JV V11 M,6(4h ANL)6vr Q -,c 4. lib Main St. Na A ►1t�evPr 0 -moi Liz- iG1-n& 4 n IC4-n. 1I Liz- # /,-,v -D b v N r cwr-• I . r / "I ruu v cn. MMI;ART' S SEPTIC TANK SFjtVICE 47 RMT-RQAD STREEr BWFORD, M 01835 978-372-7471 MORPH OF �, i l ��•_ 1 MMiLY REPORT FOR TOWN OF Commonwealth of Massachusetts Q. City/Town of NORTH ANDOVER, MASSACHUSETTS W System Pumping Record Form 4 RECEIVED DEP has provided this form for use by local Boards of Health. The System PumpingRecord must be submitted to the local Board of Health or other approving authfflLtyt 7 2008 A. Facility Information TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: When filling out 1. System Location: forms on theF computer, use only the tab key Address /%� - t i' to move your �' ; �(-i'r Pr �.✓ cursor - do not City/Town State Zip Code use the return key. 2. System O ner: Name imm Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record R-�(j0 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) (Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes e No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. tem Pumpedy: ��eVehicle License Number 0 V &Q ��l ,i'' R fir' V L-"' Company 7. location where contents were disposed: http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 /a-4-03 - Date System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts City/Town of North Andover System Pumping Record Form 4 RECEIVED FE8 15 2013 TOWN OF NORTH ANDOVER 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information 1. System Location: Address North Andover City/Town 2. System Owner: Name Address (if different from location) City/Town +ree+- Ma State State Telephone Number 01845 Zip Code Zip Code B. Pumping Record 0 1. Date of Pumping Date 11':!) 2. Quantity Pumped: Gallons �� 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. --System Pumped By: ame Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: rt's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Sure of H ler ' Signature of eceiving Facility Date /3 Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1