Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 8 OXBOW CIRCLE 4/30/2018 (2)
f ... .C'. - F' .• t ..�'V� '` 1.?:. ,k Y_�z'.YLi:'!-1J � n' • `+ _ � ~ �� �. qen slt7i !i' +• > ✓ � � "�'+, ♦ 'tel. w v 4• -fLE l :!r"- jM,h>.Y.t' cv ' f' nt. . 'r" 4V• 1. .{ zy,,..`��'�' � �t-o.,$ .�• tom. i�; ����~.. ��+,^ Fya .. ,, . { � lr«K,t. �rr- 3•,•i iit ,y. •. %sP il%f +1' l " U °M '!y� E �tt�J .r.�. MAR # {, LOT d PARCEL #STREET "'�JGG,(�/A� �O.NS_T_RUCTIO.IV A.PPROVA.L, HAS PLAN REVIEW FEE.DEEN PAID? ES NO PLAN APPROVAL: DATE lblt3/l46 APP. BY DESIGNER: ft/�Y�/�� �T %���/ PLAN DA-FE---?/Z(� Q6 - CONDITIONS WATER S WELL PERMIT WELL TESTS: y: WELL DRILLER CH L DA1 E AF`PFtUVED BACTERIA I DALE 11PPRUVED BACTERIA II D -;:.E APPROVED COMMENTS: 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 NU YES NO YES NU YES NO DATE - BY - .:r i' ::�. .:.�. :ir-. ... . '1• IA�'' sir•: i. •ER LICENSED? 1 MA i. �E5 N �1IS 'THE' INSTALLER, _ f - - I ±i REP R' - UCTION,. NC •R ST - 0 CON - •YPE F .T NEW CONSTRUCTION:',... CERTIFIED PLOT PLAN REVIEW.LNO CONDITIONS OF:. APPROVAL !:.. YES NO (FROM FORM U) ; - •••. •�E�S NOISSUANCE OFDWCPERMIT - �DWC PERMIT N0.INSTALLER:4�' • •: BEGIN INSPECTION YES 0: - EXCAVATION INSPECTION: :NEEDED: PASSE ~; ..._ .� BY :;'CONSTRUCTION INSPECTION: ;.NEEDED: AS BUILT PLAN SATISFACT0R'1'';.: t: YES % / APPROVAL. TO BACKFILL. DATE. BY " FINAL .GRADING APPROVAL: DATE BY ION APPROVAL: DATE: iZBY FINAL CONSTRUCT ; North Andover Board ffr'-ssessors Public Access , Page 1 of 1 Parcel ID: 210/107.Bi0147-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge— 8 nlarge__8 OXBOW CIRCLE '•'` Location: 8 OXBOW CIRCLE Owner Name: VERANGE, JOSEPH A BETH H ROSENBERG-VERANGE Owner Address: 8 OXBOW CIRCLE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 0.51 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2661 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 612,300 572,400 Building Value: 413,200 388,100 Land Value: 199,100 184,300 Market Land Value: 199,100 Chapter Land Value: LATESTSALE Sale Price: 395,000 Sale Date: 01/07/1998 Arms Length Sale Code: Y -YES -VALID Grantor: A C BUILDERS Cert Doc: Book: 04935 Page: 0280 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=80963 8 2/22/2006 I�L\_ Commonwealth of Massachusetts W City/Town of System Pumping Record Form 4 M 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 kcal Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms 1. System Lotion: on the computer, L�(bD L 1 C I use only the tab key to move your Add ss A �\cursor - do not X) ( ) . CAc \e'use the return City/Town � 1�- key. 2. System Owner t' Name rztan Address (if different from location) Cityfrown B. Pumping Record -e_= F, RECEIVED 1, li i � 0015 1 141,_ State Zip Code State Telephone Number Zip Code (0 21) 0 1. Date of Pumping Dae 2. Quantity Pumped: Galloi 3. Type of system: ❑ Cesspool(s) B --Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes _ No If yes, was it cleaned? ❑ Yes lzr o 5. Condition of System: 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Signature of Receiving Facility Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 PLAN OF LAND /N NO, ANDOVER MASS. SC4LE.• I" = 40' SEPTEMBER 16, 1997 HAVES ENGINEER/NG, INC. \ 6W SALfV STREET CML ENGINEERS & WAKEFIELD, U4 SS. 01880 LAND SURVEYORS 17) (617) 2462800 / CERAFY my THIS HOUSE IS LOC4TED ON THE GROUND AS SHOWN, AND rHAr IT CONFORMS TO THE ZCW/NG BY-LAWS OF TRE TOWN OF NORTH / FURTHER CERTIFY 7mr THIS PROPERTY DOES NOT LIE WITHIN A FLOOD H47ARD AREA (ZONE A OR V) AS SHOWN ON FLOOD INSURANCE RATE U4P COMMUNITY PANEL NUMBER 250098 0010 B. EFFECTIVE DATLF• ✓UNE 15, 1983 a4TE.•-_SF-PT.1G.j1997---- ------- -- - oP �. PROFESSIONAL ND'SURVEYDRSS1 ��RSIO�NEY v E" FIELD, JR. 15320 P �` sR2 5357 ` 20541 N ,Cb Ao LOT 27 22, 003 S. F. 11215 R=30.00 L =39.36 sem\ J) sem• � �� � \ � ,�'� `ro . / •oo :NBo•3~E DRAIN \ 4 500 • EASEMENT ZONE .• P. R. D. (R-2) V R. MIN/MUM SET84CKS.• FRONT = 20' S/DE = 20' (SEE SEC. B. 5.6.D.1) REAR = 20' Commonwealth of Massachusetts City/Town of NORTH ANDOVER MASSACHUSETTS _ System Pumping Record Form 4 M DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the 1. System Location: computer, use only the tab key to move your Address cursor - do not use the return City/Town key. b � 2. System Owner: Name Address different from (if location Cityrrown RECEIVED MAY 11 2006 �0 0 / 2 'umPIMO e-CoTdiANDOVER HEALTH DEPARTMENT )ate of Pumping .ype of system: ❑ Other (describe): Mate State I elephone Number Zip Code Zip Code Date T 2. Quantity Pumped: Gallons Cesspool(s) 0eptic Tank ❑ Tight Tank affluent Tee Filter present? ❑ Yes WNo If yes, was it cleaned? ❑ Yes ❑ No :ondition of System: 6. System Pumped By: 'Name Vehicle License Number Company 7. Location where contents were disposed: d6 S, � �. Si nature of H r Date http://www.mass.gov/dep/wate pprovals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Town of North Andover Health Department Date: Location: 6- a- _Ze,��d a� (Indicate Addressssa in if Re Uential, or Name of Busess) U rl Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment _ $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 436 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 0 4 'Pez, / NEW ENGLAND ENGINEERING SERVICES INC I� t L February 28, 2006 Ms. Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 RECEIVED MAR 0 2 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: TITLE V REPORT: 8 Oxbow Circle, North Andover, MA Dear Ms. Sawyer: Enclosed is the Title 5 Report for the above referenced property. The system PASSES the inspection. If there are any questions please call me at my office, 686-1768. Sincerely, � � (51- Benja in C. Osgood, Jr. Certified Title 5 Inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 . t Iof11 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 PART A CERTIFICATION Property Address: 8 Oxbow Circle, North Andover, MA 01845 MAR 0 2 2006 Owner's Name: Joe Verange Owner's Address: 8 Oxbow Circle, North Andover, MA 01845 TOWN OF % rf ' Date of Inspection: February 24, 2006 HEALTH DEPARTMENT.!k Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector Company Name: New England Engineering Services Inc. Mailing Address: 60 Beechwood Drive 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 l 0 The system inspection shall submit a copy of this inspectidfi report to the Approving Authority ( Board of Health or DEP) within 30 days of completing this inspection If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. .t 2of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 2006 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: .N 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: m 3of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 2006 C. Further Evaluation is Required by the Board of Health: -AID 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: 4of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 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 Jv/ 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 Yz 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. —7 Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. ( this system passes if the well water analysis, performed at a DEP certified laboratory for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and 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.) (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 follow criteria apply to large systems in addition to the criteria above) Yes No The system is7tbin 400 feet of a surface d7oa g w r supply The system is 200 f tri bu rface drinking water supply The system is located in a of a public water supplym area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II If you answered "yes" to anestion in Section E the system is cons ed a significant threat, or answered "yes" in Section D above the large system hasgiled. The owner or operator of any large system co 'dered a significant threat under Section E or failed under Section D shall upgfade the system in accordance with 310 CMR 15.304. Th stem owner should contact the appropriate regional office of the Department W 5of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 2006 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No �C Pumping information was provided by the owner, occupant, or Board of Health V' Were any of the system components pumped out in the previous two weeks_? —1zf VX Yes No _1✓ — 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 ? Were as built plans of the system obtained and examined? (If they were not available note as NIA) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for sign of break out? 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: 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)) I 6of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Yerange Date of Inspection: February 24, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design)_ Number of bedrooms (actual)- DESIGN 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): N Is laundry on a separate sewage system (yes or no): APQ _ [if yes separate inspection required] Laundry system inspected ( yes or no): Seasonal use: (yes or no): N 0 . Water meter readings, if available (last 2 years usage (gpd): ,5�5-0 , -PT2 n X02 Sump Pump (yes or no): til0 . Last date of occupancy e COMIKERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgk 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: u CO e/ G Was system pumped as part of the inspection 6es or no): 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 vJec+,Q f eP-ic;D 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: Sy `-1 e el (Z S F C n i- S FF( T -c- 2 1.4, N Q L-1 L Cl7 i, Were sewage odors detected wen arriving at the site (yes or no): IV 0. 7of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 2006 BUII.DING SEWER (locate on site plan) Depth below grade: C� Materials of construction: cast iron V'40 PVC other (explain) Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): P(Pt-�- t --00t.4-5 cti- 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:!,� c o Gam} ��� N 5 Sludge depth: z " Distance from top of sludge to bottom of outlet tee or baffle: 3 z H Scum thickness: J 11n Distance from top of scum to top of outlet tee or baffle: 7 Distance from bottom of scum to bottom of outlet tee or baffle 1-5-1 How were dimensions determined: rn 2 e 61n�.v Continents (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): LfinJIL I� lra�P. r'JnJ�I�z-N SG/! yJ PJL T�eS !N Ce 0AJI 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. 8of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 2006 TIGHT OR HOLDING TANK:( (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materials of construction: concrete metal fiberglass polyethylene other 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: D Comments ( 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.): -77 012, CG dry OOC,2- r.2 L.cfl-KEG iii 02 0� PUMP CHAMBEIL Al - (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.): 9of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 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: overflow cesspool, number: innovative/alternative system Typetname of technology: Comments ( note condition of soil, signs of hydraulic failure. Level of ponding, damp soil, condition of vegetation, etc) 6001 No 91104L, yv et>>`JP7 t- P� e' DI�G— CESSPOOLS: N (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: 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. 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Oxbow Circle, North Andover, MA 01845 Owner's Name: Joe Verange Date of Inspection: February 24, 2006 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. V N U Town of North Andover, Massachusetts BOARD OF HEALTH Dec 31, 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X) or repaired ( ) by Qhar1Q5,. INSTALLER at Lot SlE LOCATION with Board of Health Regulations as described in the Design has been installed in accordance Approval Site System Permit No. R a dated Oct 31 19 9 7 - The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: � 1� CURRENT INSTALLER'S LICENSE# LOCATION: �cs� I ((5�0 Ili 11'�_ l ►1`y,�f LICENSED INSTALLER: OL,4v SIGNATURE: TELEPHONE# L( fT CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. glo Administrative Use Only $75.00 Fee Attached? Yes �-''� No Foundation_ As -Built? Yesy No -71 Approval Date: 7/, Tg i JUN 2 31997 ti c'oc`tL EowGEE�azF.o.�4pose v TE0 L> X99 'd0 1 1 �A'Sf/ylE•vT �r 11-0MOf' ro ryE ;'-,1rLE /.vsaeoravo 71% rMe 0,4Ao,r rygr TyEOu'ECL./.NG /S LACATEO 97AI ryE,eor.ff-roWAIW AA.10 rwrir 40PACS e9 wlffaeAr jr/ry rNE Tjj..W ' 0,oAr AV AN40&-Ve zuw1wd tE60LArrws ,4*--4f.4AP1AoWi SErQ. 6Cf AZOW -T reee ,f LOT LIMES. 'o r FWMrjr CE.rr/FY 7Wofr 7WIf AA12r IAA W /S A/Or LOG4rE0 /AI rle FEACWr4G azaOO homrwco .4.ew:4. CSYdAV .1 OAI FEM,COMMt/N/Ty P4.4,1G'G '* ?50098 ewee ,A OF DAr''.D 6-2_17.3 ? E Ao'4WaFf A ; A #or SN 1'L O T RL..,ov /A/ afar X10. �.VD O t/2 f ///•OSS, Die,4%✓/V f0iP / •-,4O � c/1Avc' -0e, /497 11,W4A P4PE� STrET/OOI�E� �1.4S.SOGSf�//SE7TS o/8/0 Town of North Andover, Massachusetts Form No. 3 f NORTH BOARD OF HEALTH 1e O ._'o 019 L /0- T ♦ off_ <«�.:'...' ' i y''•.,.o��"'`h DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACNUSEt Applicant NAME ADDRESS TELEPHONE Site Location ��% % �DZ1ozUl,0 �— } Permission is hereby granted to Construct (Repair ( ) an IndividualSoil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. S.3 CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. 11 LETTER OF'rRANSiNIruri\l., North Andover Health Department 400 Osgood Street North Andover, MA 01345 973.638.9540 - Phone 973.688.3476 - Fax healthdet*d'tow nofnorthandover.com - E-mail www.townofnorthandover.com - Website 117 117 Off T►QRTh� .q O �t`E0 O e —C.. SSgC t115A� Page / of TO: , DATE: 01?—AO�O COMPANY: FROM: Pamela DelleChiaie, Health Department Assistant Phone: C1 / / RE:Q1 12 e Fac: / 0 0/• 2C COPY TO: We are sending you: OCopy of Letter OPlans These are transmitted as checked below: OApp Ned as Noted LTU Requested OAsRequired r OForAppivwd OOther ill in below) OForReviewandcomniew y Own* OFor Your Use dist Y OResuhn* copiesfor (Wmv rl copiesfor REMARKS: COPY TO: COPY TO: SIGNED: COPY TO: TRANSMISSION VERIFICATION REPORT TIME 02/22/2006 15:29 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATEJIME 02/22 14:38 FAX NO./NAME 819788373040 DURATION 00:00:49 PAGE{S} 03 RESULT OK MODE STANDARD ECM PLAN OF LAND /N NO. ANDOVER, MASS. SCALE.• 1' = 40, SEPTEA/BER /6, 1997 10 YES ENG✓NiZWING, INC. \ /I, au Sq" S1AEE/ OWL ENGYNEERS & WWiRiW,, M45S. 01880 LAND SVRVFYORS ra. (617) 246-2800 / CERTIFY THAT THIS HOUSE /S LOC47EU GW THE GROUND AS SHOWN, AND rmr /T CONFORMS TO THE IGW/NG BY-LAWS OF THE R7/YN OF NORTH. / FURTHER nMAFY Par TH/S PROPERTY DOES NOT L/E W/TH/N A FLOOD H47ARD AREA (ZONE A AR V) AS SHOWN ON FLOOD /NSUR4NCE RATE' W COMMUNITY PANEL NUMBER 250098 0010 B. EFFEC71YE a47E:• JUNE 15, 1983 D4rF•--SF-PT.1c,t 1997 PRr.1q-SS/O k6 v SURVEYOR fi -V CO \` S82S'357 E 205.41 h P b o " N LOT 27 Q o z 22, 003 S. F. 66 Nw e � 915�5GE�O R=,30.00 �tAos1632 L =39.36 ?a, .�F �o tJ ;N80+�3 DR4/N s+ 51 EASEMENT SIDNEY C. FlELD, JR. /15320 ZONE P.R.D. (R-2) VR. M/N/MUM SET&4CKS.- FRONT = 20" S/DE = 20'(SEE SEC. 8.5.6.0. >) REAR = ?0' ft Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH Dec 31 , 9 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (x) or repaired ( ) by Charles her INSTALLER at Lot 278) Oxhc,x - SI E LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 81;4 dated Oct 31 19 97 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH i TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: ��- SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) p DATE OF PUMPING:—NMI-da'- QUANTITY PUMPED IJZG GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE V 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: CONTENTS TRANSFERRED TO: Town of North Andover, Massachusetts j °:SMO a*. BOARD OF HEALTH Form No. s w ` o.. 9 Qj CNuS <� DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Site Location Test No. Reference Plans and Specs. w • ENGINEER ` Permission is granted for an individual soil absorption se DESIGN DATE in accordance with regulations of Board of Health. ge disposal system to be installed Fee CHArRu .. ' ^��, BOARD OF HEALTH Site System Permit No. C =r p d = O m: t rA y �_ =ami m C7 y C .�iC y z ?-0 y rn tos y CLa Er m id O y CD -400 y p N O =r CD m Z > >-0occo to O - - O' WCJ O H C-3 CO' ?yam a CK ; to o co V)CO C7� n C O O J n CA H m sa '' 3E. m y i%iGo oIPA F mm _ O o Vu =r�. G O m co v� CA '�j- p ►--� 'v o 1- . m maCO2:. I, �o Cn Cn Cw :. O 9 ~ ter] yd P!. G Irl � '� ^17 � �' x � a� O G E. b O Z q � o .. 41. R t", Q� C 0pa) � a < � w p CA CANA CD C7 ZCD y R CL C CL = y .o d 0 CD CL 0 CD CCD . O CCD Q �. CD. - y HFL F tC I 1 CD CO) CSD 0 CD C =r p d = O m: t rA y �_ =ami m C7 y C .�iC y z ?-0 y rn tos y CLa Er m id O y CD -400 y p N O =r CD m Z > >-0occo to O - - O' WCJ O H C-3 CO' ?yam a CK ; to o co V)CO C7� n C O O J n CA H m sa '' 3E. m y i%iGo oIPA F mm _ O o Vu =r�. G O m co v� CA '�j- p ►--� 'v o 1- . m maCO2:. I, �o Cn Cn Cw :. O 9 ~ ter] yd P!. G Irl � '� ^17 � �' x � a� O G E. b O Z q � o .. 41. R t", Q� C 0pa) � a < � CANA N z 0 EJ 0 c FORK U - LOT RETRASE 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. ****************ApplicantInc,ill's(' out this section*****I*a*********** Lijt(5APPLICANT: •(,� Phone X005-8350 LOCATION: Assessor's Map Number Subdivision WOOJ land E5T t$ Street COI D n is i A Je- ************************O icial RECO TIO OF ENTS: Conservation Administrator Comments Parcel Lot (s) =� St. Number Use Only************************ Date Approved Date Rejected 0� (K=IA. A_Q Date Approved Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected L Date Approved O� Date Rejected Received by Building Inspector Date Town of North Andover , NORTH OFFICE OF o o°c COMMUNITY DEVELOPMENT AND SERVICES ° F- 9 146 Main Street North Andover, Massachusetts 01845 A..,o-:%�'�cy� 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 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 TEL.: (617) 246-2800 FAX: (617) 246-7596 TO �1 0y SIAZ V -- N96Ue2. 1V or ( 1# GENTLEMEN: WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter Dat iqu( LIEVVIE ] OIFULr1]G=,\HOIJVl1 'rUAL DATE o -1S- DATE JOB NO. V /� /� ATTENTION // b z7 M660/45 156o5TIe-P ,N/k� -Yb uO-IS� tYH Q�, OO�tr+ Z nr. ► 21 1996 ttached❑ Under separate cover via g Items: Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION // b z7 M660/45 156o5TIe-P ,N/k� -Yb uO-IS� Z LoT f 5 I2---UL5 Q T WISS Cob(CR N 5 W &Z M -e. L-7 Z -A THESE ARE TRANSMITTED as checked below: X For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Foryour•use ❑ Approved as noted ❑ Submitcopies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment. ❑ ❑ FOR BIDS DUE �/�f J 19 / ❑ PRINTS( RETURNED AFTER LOAN TO US REMARKS: P( J & / ` ` �� " C - 0t =�-t ti:ZS COPY TO SIGNED:'j I! enclosures are not as noted, kindly notify us at once. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director September 5, 1996 Mr. Ed Stearns Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot 27 Oxbow Circle Dear Mr. Stearns: 146 Main Street North Andover, Massachusetts 01845 Y This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. No soil tests in system area. (3 10 CMR 15.102 (2) and 15.104 (4) ). N.A. 4.03 & 4.09. 2. Reserve not 4 feet from primary. (N.A. 2.23) 3. Wetlands disclaimer missing. (N.A. 6.02 0) 4. Top of retaining wall shall be no lower than breakout elevation - 161.66 (310 CM215.255 (f)) 5. Certification of site evaluation not signed. (3 10 CMR 15.018 (2)) 6. Note Missing: First 2 feet after D -Box shall be level. (310 CMR 15.232 (3) (c)) 7. Not 165 Design (variance requested) or 660 GPD minimum. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp i • 9 F �Y 09 » BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: �lvb PERMIT # C915¢ DATE RECEIVED____ %/a/ l6 APPLICANT MAP 1,076 PARCEL o�3 ADDRESS 3 3 C(,/�C.�G;e gyp, �. LOT # A i STREET ## ENG. 14ko5'$ e --t1 . �CD Sr�A SJ STREET_ Q l(,66a) ENGADDRESS_ PLAN DATE REV. DATE CONDITIONS OF APPROV APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: ,/UO 56/o 76-5>S ie2)�- � N' A D('3. uJ�-Tz.4�vD5 /s���/n�rE,e X1.5 5 ��vc . G oW , TDP /1/O LDGtI�•e /61 66 (131,o CAIa 167, , 66s(4) C�d . �JoTE 1v1 r s S / 1v �/� S r- /= rcr ��rc,� - BOX —545- (3110 DES JG.t� /UOQ— �� ( V,,q ell�A)e C- ,07 EQvEsrC-� 09 660 0P D /L1 r A/ /lrvM E E b r 0 31 PLAN REVIEW CHECKLIST ADDRESS 1'O7 -a 7 a66a) C4�l.e, ENGINEERel-, GENERAL 3 COPIES STAIMP LOCUS NORTH ARROW ✓ SCALE CONTOURS PROFILE'✓ SECTION -' BENCHMARK ✓ SOIL & PERCS Or;�,`/ SkLLE� IATIONS WETS. DISCLAIMERZ WELLS & WETS I--- WATERSHED?J/O- DRIVEWAY (E1ev) WATER LINE c.i FDN DRAIN -46 SCH40 TESTS CURRENT? X99,6_ SOIL EVAL %ZbGE•e5U 0 SEPTIC TANK MIN 150OG &"" .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR bf- MANHOLEy ELEV GW # COMPS. D -BOX SIZE , LINES FIRST 2' LEVEL STATEMENT INLET_ fg _ OUTLET (2" OR .17 FT) TEE REQ'D?4-0 LEACHING / MIN 660 GPD? RESERVE AREA 4' FROM PRIMARY?X 2% SLOPE 100' TO WETLANDS L� 100' TO WELLS Li 4' TO S.H.GW (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H2O SUPP ✓� 4' PERM. SOIL BELOW FACILITY MIN 12" COVER-----' FILL? (25' if above natural elev; 10'if below) BREAKOUT MET? TRENCHES MIN 660'gpd_ SLOPE (min .005 or 6"/100') ✓ SIDEWALL DIST. 3X EFF. W OR D (MIN 61 C/" RESERVE BETWEEN TRENCHES? (/ IN FILL? MUST BE 10' MIN. ✓ 4" PEA STONE?z VENT? ✓ (>3' COVER; LINES >50') BOT + SIDE X LDNG = TOT (L x W x `) (DXLX2x#) (G/ft2) Copyright '0 1995 by S.L. Swir HAYES ENGINEERING, INC. 603 sALEm STREET - WAKEFIELD, MA 01880 ' U (617) 246-2800 ` FAX (617) 246-7596:. FORM 11 - Son, EVALUATOR FORM Page 1 Date.... /............................. Boa FILE Co monwealth of Massachusetts -Massachusetts ©rJ .. .....0 y:WitPerformed By - Witness ed nessed By: �J:.`...::.::.,::.............::..:...:.:..:::.::...: :....w.::. _w. ................................................................................................................................................................................................................................ Location Address or Owirr's Nasse. Lot R ` Address. and TekpMrc [ ; New Construction u Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Qi Year Published :.. 9/ Publication Scale .L..�SSIYa Drainage Class: ... Soil Limitations ................................................ Surficial Geologic Report Available: No ❑ Yes ❑ Year Published ----------- Publication Scale .................. Geologic Material (Map ,Unit) :..::...:.......... :................. ........ .................. Landform.......... ........ .............................................................. ................................................ Flood Insurance Rate Map: Soil Map Unit ...�. 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 1I -SOIL EVALUATOR FORM .pageZ `. Review Deep Hole 0umbor����—� �Date:. Time: .................. Location (identify onsite plan) _____-_________—__' �d���r^' '`� ` 96 ' Lang ' S�po( >----_' Stones — q,-tpg ................................................................................................................................................. Landform.... ��................................................................. ..... ------_'—'--'_-----_— Pooitionmnkunducapo(okotchonthobacW ---_-------'-----_—.' Distances from: -Open Water Body ............ feet Drainage way .......... feet ' Possible Wet Area .................. foot Property Line .... .... ...... feet Drinking Water Well --.-' feot ''Other'' '---.- ......... .DEEP OBSERVATION HOLE. LOG Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Iq 36 TA Parent Material (geo|ogin) ��"'//�/��u�� ------� --'--- Depth to Bedrock:Dep th to Groundwater: Standing \Yaie� in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: �� HAYES ENGINEERING, INC. 603 SALEM STREET JOS FILE FORM 11 - SOH, EVALUATOR FORM WAKEFIELD, MA 01880 ,� ,� ^ Page 3 (610 246-2800 Iu'-'•+u,`� FAX (61 7) 246-7596 Determination for Seasonal Hili 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 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 r _ �, . � . '' ��. w � r � ., ....... ., r i y- iliAYES ENGINEERING, INC.. 3 SALEM STREET (VAKEF.1ELD,'MA 01880 (617) 246-2800 FAX (617) 246-7596 JOB FILE FW3,'Al 12 - PERCOLATION IMT COMMONWEALTH OF MASSACHUSETTS , Massachusetts Percolation Test Date: ------_-----_- _--------------- Time:.....................---............. Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 87 Time at 6" Time (9"-6") Rate Min./inch Site Passed El Site Failed n ................................... . ................. ....... Performed By: Witnessed By: Comments: _ --- --------- -------- . .... . ........... . .. DATE_ Y-,-2 6 -el' SYSTEM OWNER & ADDRESS TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD SYSTEM LOCATION DATE OF PUMPING a2�- ©y QUANTITY PUMPED CESSPOOL NO YES SEPTIC TANK NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION _'/ HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLID CARRYOVER FULL TO COVER BAFFLES IN LACE LEACHFIELD RUNBACK FLOODED OTHER EXPLAIN SYSTEM PUMPED BY COMMENTS: CONTENTS TRANSFERRED TO w a HAYES ENGINEERING, INC. 603 SALEM STREET. WAKEFIELD, MA 01880 FORM 11 - SOEL EVALUATOR FORM (617) 246-2800 ` FAX (617) 246-7596. Page 1 .Q-l9-SS./ No. ..................................... Date.... ...................--......... JOB FILE Co monwealth of Massachusetts Tl�w -Massachusetts Soil Suitabilitv Assessment -for On-site Sewage Disposal. Performed BY:.. f. �©o`"� ........-........... ���� . ......................................................---... Witnessed By:....:,...:......:......:: .......... ............................................................ ................................................................................................................................................................................... _............ Lonsion Address or 0vt= s Na=. La / Address. and Tckptarc (. G41c. r"'_� -,-..New Construction. ffrl-- _Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes D� Year Published :.�.. �� Publication Scale Soil Map Unit ---C!'... Drainage Class :... 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: V. - FORM 13-SOR� EVALUATOR FO RM ' ` - e 2 � ^| Review . "�� ` � � Deep Ho�0un�bor���v��-�- �Data:. Time: ........ Weather ................... .......................... Location onsite plan) La �6 ^ '`' ' .. Slope,` (96>--'-_'�'-Sur�/oe0tonoo ---.--_-'_--' Vegetation----.-------'----_------'_'------_.----_----'---.___--___--'-----___ Landform---_-'-------'_---'-_-' ------'------_----__---________--'.....-_______ Position on landscape (sketch on the back) ..................................................... ............... ..................... --------.............................. Distances from: - Open Water Body -Yaot Drainage m/ay-'-- fent ' Possible Wet Area .................. foot _property Line -'............. Yaot Drinking VVotor Well -............ foez' ~ 'Other '''................... .......... DEEP OBSERVATION HOLE. LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 30 / ^ Parent K�atoha|(geo|oOio) ��'.'^��c��k! �y���.------.------. - Depth toBedrock: Standing Y�ie- in the Hole: ��� Weeping fromPitFace:Depth to Grou ^ 7� &YL� Estimated Seasonal High Ground Water: ` HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 V� (617) 246-2800 � FAX (617) 246.7596 Method Used: JOS FILE FORM 11 - SOIL EVALUATOR FOM Page 3 rA ❑ Depth observed standing in observation hole...inches ❑ Depth weeping from side of observation hole ................... inches ❑ Depth to soil mottles ....�lJ..... 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 l�ov �`� i (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 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 RECEIVED City/Town of System Pumping Record FEB 0 6 2008 Form 4 TOWN D PARTM TER DEP has provided this form for use by local Boards of Health. Other fo a u , 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. Sys m Location. Address � � W Cityrrown State 2. System Owner: Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Zip Code State Zip Code Telephone Number bate 2. Quantity Pumped: Gallons Cesspool(s) [-tic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 0 6. System Pumped By: Name C Vehicle License Number t Company cam' 7. t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH O 6��LED /646 OL 19�� f r 0 APPLICATION FOR SITE TESTING/INSPECTION ApplicantG NAME ADDRESS TELEPHONE Site Location Engineer NAME 0 ADDRESS TELEPHONE Test/Inspection Date and Time Fee „ CHAIRMAN, BOARD OF HEALTH Test No. -)3q S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts BOARD OF HEALTH 'EO A o '• mM APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 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, Massachusetts Form No. 1 oRrH BOARD OF HEALTH 9 '�—q IQ APPLICATION FOR SITE TESTING/INSPECTION Applicant Site Location �T � - U )0o C4�".A ' �d-�c_to, ei Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee_ l CHAIRMAN, BOARD OF HEALTH Test No. 1 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NaRTM BOARD OF HEALTH J <`e° o ' 19 APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location— Engineer ocation 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.