HomeMy WebLinkAboutMiscellaneous - 84 CANDLESTICK ROAD 4/30/20189
0
0
C)
io
T
LOT
MAP #
PARCEL # STREET -
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE APP. BY
DESIGNER: PLA14 DATE:-
COND I T I ONS— 7
vatlFhFb '5 X V
;,-,o 19"vl
Ae,.:*1:-,p SX61-17v. Ic*le- e e -,b --------
WATER SUPPLY: WELL
WELL "PE T
T AlE APPRUVED .... ... . .....
WELL TESTS: CHEMICAL
ACTERIA I D01 E (11"PRUVED
BAr-TER-W I I DRIE (IPPRUVEL)
COMMENTS:
APP ISSUE YES NO
FORM U APPROVAL: ROVAL TO
DATE ISSUED
CONDITIONS:
FINAL APPROVAL:�
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NU
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED
YES NO
FINAL BOARD OF HEALTH APPROVAL: DA*TE:. BY:....
EPTI( L
Nt"N
:IS -THE INSTALLER �_ICENSED?:.-YES
NO
NE
REPAIR
.,.....TYPE. OF- CONSTRUCTION:
NO
C ONSTRUCTION:,., CERTIFIED PLOT.PLAN REVIEW
CONDITIONS OF..APPROVAL YWI
NO
(FROM FORM U)
NO
. .'.,ISSUANCE OF DWC PERMIT
DWC PERMIT NO. to INSTALLER:.
�lz
INSPECTION
i -s BEGIN
:EXCAVATION.INSPECTION: .:NEEDED:
PASSED t py.
.—CONSTRUCTION INSPECTION: NEEDED
As B UILT PLAN SATISFACTORY: YES:
APPROVAL TO BACKFILL: DATE: By.
FINAL.GRADING APPROVAL: DATE BY
F . INAL CONSTRUCTION APPROVAL: DATE: B Y
Commonwealth of Massachusetts
CityfTown of RE
System Pumping Record JUN '10 2013
Form 4
TOMq OF NOR -Th ANDOVER
DEP has provided this form for use -by local Boards of Health-LOthbg$6ft'ig-.M6'�,66�'Used, but the
information must be substantially the same as that provided here. Before using.this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left t0Wh7tfr—ont o7f�ho�us , Left / Right rear of house, Left / right side of house, Left
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Addressk
25-14
Cityrrown State Zip Code
2. System Owner:
Name
Mll�
Address (if different from location)
Cityflrown
B. Pumping Record
1. Date of Pumping
3. Type of system- [:]
Date
Cesspool(s)
Other (describe):
4. Effluent Tee Filter present? Yes
5. Condition of Svstem:
0
6. System Pumped By:
Neil Bateson
Name
Bateson EnterDrises Inc
Company
7. LocatiQ0 here contents were disposed:
7G LL, S.
.,S.,Q Lowell Waste Wi
,state
Zip Code
C)
Telephone Number
- 2-- Quantity vumped�
a-`S�eptic Tank
Gallons
El Tight Tank
If yes, was ft cleaned? [:1 Yes Ej No
F5821
Vehicle License Number
Date
t5form4.doc- 06/03 System Pumping Record - Page 1 of 1
Commonwealth of Massachusetts
CityfTown of RECVIVED
System Pumping Record
Form 4 JUN 'I � 2010
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other fornis rtM'AMMMdVW91W
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to
the local Board of Health ovottor approving authority.
A. Facility Information
1 . System Location: Left side of house, Right side of house, Left front of house',2_;h:t: �fr�tnt o' house
Left rear of house, Right rear of house. Left rear of building. Right rear of building.
A A
Address
Cityrrown State Zip Code
2. . System Owner: A J I -
Name
Address (if different from location)
Cfty/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: . El
0 Other (describe):
6 --3 —1 (D
22. Quantity Pumped
ET—Septic Tank
Date
Cesspool(s)
State _Zin Code
�R �s s-- L4a/ 0
Telephone Number
Gallons
Tight Tank
4. Effluent Tee Filter present? E] Yes En—No If yes, was it cleaned? Yes No
5. Conqition of System:
V� (2Ak_" —Z
6. Systdm Pumpe!�$
r -A
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
G.
were disposed:
Ael Wasta Water
Date
-3-1"
t5form4.doc- 06103 System Pumping Record - Page I of 1
Commonwealth of Massachusetts
Board of Health
North Andover
P.I.
F.I.
Map -Block -Lot
106.A- 0096 -
---------------------
Permit No
BHP -2006-0030
-------- --------------
FEE
$125.00
---------------------
Disposal Works Construction Permit
Permission is hereby granted Todd-B-ateson ---------- ---------------------------------------- --------------------------------
to (Repair -D -BOX & PIPE TO TANK) an Individual Sewage Disposal System.
atNo84 -CANDLESTICK -ROAD ---------------------- ------ -------------------------------------- ---------------------------------------
as shown on the application for Disposal Works Construction Permit No. BHP -2-006-003_ -A Ruary 02, 2006
7J� I - ---------
7--3 L17--1
-- --------------------------
---------------------- ------
Issued On: Feb -02-2006 Board of Health
----------------- — - - - - -------------------- --------------------------------
,40*Yk Commonwealth of Massachusetts Map -Block -Lot
106.A- 0096 -
Board of Health -----------------------
North Andover
Certificate of Compliance
THIS IS TO CERTIFYThat the Individual Sewage.,Disp6��l System (Repair -D -BOX & PIPE TO TA
by Todd Bateson
- ------------------ -- ---------------- __ - - ---------------- --- -- -- ----------------------------------------------
Installer
at No 84 CANDLESTICK-R6X'
7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. -BHP-2-006--003-- Dated --- Febru?kry_O;,_2006__
------ -----------------------------------
Printed On: Feb -02-2006 Board of Health
-- - --------------
L/
Town i of woreh'Andover
Health Department Date:
Location:
(Indicate Address, if Residential, or Name of Business)
Check #:
XVe of Permit or License: (Circle)
)�- Animal
> Dumpster
> Food Service - Type-*,
> Funeral Directors
> Massage Establishment
> Massage Practice
> Offal (Septic) Hauler
> Recreational Camp
> SEP77C PERMITS.
• Septic - Soil Testing
• Septic- esignApproval $
'c
I �epvtic Disposal Works Construction (DWC)
L) Septic Disposal Works Installers (D W[)
> Sun tanning
.> SwimmingPool
> Tobacco
> TrashlSolid Waste Hauler
> Well Construction
> OTHEIL- (Indicate)
378 Health Agent Initials
White -Applicant re-11OW-Health Pink -Treasurer
� 4 / �zo
TODAY'S DATE
$ 250.00 — Full Repair
$125.00 - Component
Important: Application is hereby made for a permit to:
When filling out Ej Construct a new on-site sewage disposal system*
forms on the
computer, use E] Repair or replace an existing on-site sewage disposal
only the tab key
to move your R-R-epair or replace an existing system component
cursor - do not
use the return c7'
key. A. Facility Information
d --h 9 y
Address or Lot #
_Aj 06 '4
City/Town f C) , /+,& _Ao'/ 6111559V
2.- *TYPE OF SEPTIC SYSTEW:
0 Pump El Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
Yoclonventional System (pipe and stone system)
0 Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.
F-1 Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement)
F� Pressure Dosed (D -Box Present) S.A.S.
2. Owner Information
Name
Address (if different from above)
City/Town State Zip Code
Telephone Number
Installer Information
Name /V Name of Company
Address
City/Town State Zip Code
4. Designer Information
Name
Address
City/Town
Telephone Number (Cell Phone # if possible please)
Name of Company
State
Zip Code
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit - Page 1 of 2
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INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
.,IV C
b A
property at 21 rmx- relative to the application
for plans by and
dated
dated — — with revisions dated -e'
I understand the following obligations for management of this project:
As the installer I am obligated to obtain all permits and Board of Health approved plans prior
to performing any work on a site. I must have the approved plans and the permit on site
when any work is being done.
2. As the installer I must call for any and all inspections. If homeowner, contractor, project
manger, or any other person not associated with my company schedules an inspection and the
system is not ready then item three shall be applicable.
3. As the installer I am required to have the necessary work completed prior to theapplicable
inspections as indicated below. I understand that requesting an inspection, without
completion of the items in accordance with Tile 5 and I the Board of Health Regulations may
result in a-$50-00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but dQes not have to be present.
b) Final inspection - Engineer must first do -their inspection for elevations, ties, etc. As -built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. installer must be present for this inspection. With pump system all electrical
work must be ready and able to cause pump to work and alarm to function.
c) Final Grade - Installer must request inspection when all grading is complete. Does not have to be
on site.
4. As the installer I understand that only I may porform the work (other than simple excavation)
n of the system identified in the attached application for
required to complete the installatio
installation. I further understand that work by others unlicensed to install septic systems in
North Andover can constitute reasons for denial of the system, and/or revocation or
suspension of my license to operate in the Town of North Andover; significant fines to all
persons involved are also possible. must be on site during the performance of the following
5. As the Installer I understand that I
construction. steps:
a) Determination that the proper elevation of the excavation has been reached -
b) Inspection of the sand and stone to be used.
c) Final inspection by Board.of Health staff or consultant.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6, As the installer I understand that I am solely responsible for the installation of the system as
per the approved plans. No instructions by the homeowner, general contractor, or any other
persons shall absolve me of this obligation.
U:ndersignZensed Se tic Installer
Date:
isposal Works Construction Permit #
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
System Pumping Record FEB 14 2006
AN
R
Form 4 TOWN OF NORTHANDO\
T Me
HEALTH DEPARTMEN1,
S _
v
DEP has provided this form for use by local Boards of LHealth. The ys
be submitted to the local Board of Health or other approving authority.
A. Facility Information
1. System Location:
(IN 0
Address
Cityrrown
:2. System Owner:
Name
Address (if different from location)
City/Town
CAI�- �j
State
Zip Code
State Zip Cbde
Telephone Number
Record must
.13. Pumping Record
.1. Date. of.Pumping -date 2. Quantity' Pumped:
Gallons
3. Type of system: Cesspool(s) D–IS A6ptic Tank Tight Tank
Other (describe):
4. Effluent Tee Filter present? E] Yes UN-O—� If yes, was it cleaned? E] Yes F1 No
5. Condition of ystem�:�
6. System P d Qyrl-:
Name
Tehicle License �N
umber
Company
7. Location here contents Were disposed:
http://www.mass.
t5form4.doc- 06103
CY —Q -z> -,—C-�A��
system, Pumping Record - Page 1 of I
Page 10 of I I
Property Address: 84 Candlestick Road-
- North Andover -
Owner: -Yates-
SKETCH OF SEWAGE DISPOSAL SYSTEM
A to Tank = 33'7"
A to D -Box = 60'6"
B to Tank = 18'8"
B to D -Box = 311Y1
RECEIVED
FEB 14 2006
TOVV.-�,,.�r n t -
HEALTH DEPtAr�,
'LOWTH
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
S CHO
Penn it NO:
Date Issued:
Date Received:—
IMPORTANT: Applicant must complete all items on this page
LOCATION ffl- L—Q,
PROPERTY OWNER
MAP NO.: i D 6 k,PAReL-.:'
—1— "1111ril "Twd-
Print
Print
ZONING DISTRICT:
UTQ'rnV11C DMTRICT vv.4; n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
L-] Addition
��Alteration
-gOne family
D Two or more fam I ly
No. of units:
E, Industrial
D Repair, replacement
7- Demolition
0 Assessory Bldg
D Commercial
D Moving (relocation)
D, Other
D Others:
D Foundation only
I -
DESCRIPTION
J"0J'*
ONkNER: Name:
6.
4 L- St'810'vW'-dgJ\oC1K'v
Address: 0 L
.Is tqlvw 1z
CONTRACTOR
Address: v v::1k [.'Sp
Supervisor's Construction License: s 0 --1 Exp. Date: I--)
Home Improvement License: It li� Exp. Date: -6 L
�,U.1.1.vq A,,-ado.,a *
U.,1,,,nSU,:) ad,83SPU'Cl '
Isi . TPods plIng uSSaQ -
y -e,4 gZEV-90 (901 Phone:
901S-SL6 (80)
1d'ASJW0(1 SM3
ARCHITECT."E N GIN EER V\JQ r--� Name: Phone:
Address: Reg. No.
FEE SCHEDULE: B ULDING PERMIT.- S10.00 PER $1000.00 OF THE TOTAL ESTIMA TED COST BASED ON
$125. 00 PER S.F.
Total Project Cost 6tQ 0 —xlO.00=FEE:$
Check No.: Receipt No.:-
- 15 3 3 S--
TYPE OF SEWARGE DISPOSAL
.--
Tanning/MassageiBody Art i -I
Swinirnino Pools
Public Sewer i
Tobacco Sales
Food Packa-ing/Sales
Well
Permanent Dumpster on Site
Private (septic tank, etc.
NOTE: Pervons coidracting with unregi.vtered contractom t10 not have acce.vs to the guaraii(jfitnd
Signature of Agent/Owner.
Plans Submitted 1:1
Plans Waived 11
— Signature of Contractor— —
Certified Plot Plan El Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLV
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
F] El
DWater Shed Special Pen -nit
El Site Plan Special Permit
11 Other
DATE REJECTED DATE APPROVED
F1 11
DATE REJECTED DATE APPROVED
.ZHEALT�H-�, V1 , El
COMMENTs'LL'i., J, IL—",., .4", --s
V
Zonini-) Board of A(9,6eals: Variance, Petition No'.
ZoninL, Decisionireccipt submitted yes
Plannin- Board Decision:
Z)
Conservation Decision:
Water &, Sewer connection signature & date
Comm
Temp DUnipster on site yes—no— Fire Department signature/date
Building Permit Approved and Issued by:
Building Setback (ft.)
Front Yard Side Yard
Rear Yard
Required
Provided Required
Provides
Required Provided
'4171�aw K)AO-2 La. 41
V A
m
DIMENSION
Number of Stories:
Total land area, sq. ft.:
No V --,S and — (For department use)
Total square feet of floor area, based on Exterior dimensions.
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Town of North Andover
Community Development and Services Division
Office of the Health Department
400 OSGOOD STREET
North Andover, Massachusetts 01845
Su.5an Y. 1,`,avN yer, REHS/ RS
Public Health Director
(978) 688-9540 - Pho,ne
(978) 688-9542 - Fax
Date:
Address., North Andover, MA 01845
Re: Application for:
Dear:
Your application fbr-4� I
0&n &,e_5iAas been reviewed by the Health
Department. The application w& denied on, Q C)bto IM for the following reasons:
1. 9"" Missing information
2. 1?"' Passing Title 5 inspection of septic system required
OCK 011 0 Su UCEU 110L a"vyLau v
4. 0 Undersized septic system
To address the vroblem(s):
If #1 Is ch tgked, please supply:
77) Floor plan of existing and proposed addition — all rooms
b. Certified plot plan showing house, septic system and proposed project in scale
If #2 is c k
,Yg� ed:
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,
Reviewer
Cc: Building Department
File
M)""RO ()I APPIAI ,� ')88-0�,41 '011.01-M; FIO\
M 'N ( 161: (;88-95 0 15
TOWN OF NORTH ANDOVER -rot
AW Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT 41 qplqmw--
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 1845 CHU
Susan Y Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 6u,\ t5�4'GV MAP: LOT:
INSTALLER: 6� �56v\
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
INSPE . CTIONS Asp
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
Comments:
SEPTIC TANK
DExisting septic tank properly abandoned
DInternal plumbing all to one building sewer
[]Topograohy not appreciably altered
F� Bottom of tank hole has 6" stone base
E] Weep hole plugged
F-1 1500 gallon tank has been installed
H-10loading Monolithic construction
E] Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
F-1 Inlet tee installed, centered under access port
El Outlet tee (gas baffle or effluent filter) installed,
centered under access port
F-1 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
E] Hydraulic cement around inlet & outlet
Wastewater System Documentation — Feb 2006
Page 1 of 6
TOWN OF NORTH ANDOVER Tst
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT 41
400 OSGOOD STREET K.
NORTH ANDOVER, MASSAC14USETTS 0 1845 &S 4roo
CHU
Susan Y. Sawyer, REHSIRS 978.688.9540 -Phone
Public Health Director 978.688.8476 - FAX
Comments:
PUMP CHAMBER
Bottom of tank hole has 6" stone base
Weep hole plugged
Combo Tank installed. Size:
F-1 1000 gallon Pump Chamber installed
H-10 loading
Monolithic construction)
E] Inlet tee installed, centered under access port
[:1 Pump(s) installed on stable base
F� Alarm float working
E] Pump On/Off floats working
F Separate on/off floats
F-1 Drain hole in pressure line
El 24" inch cover to within 6" of final grade installed over
pump access port
E] Water tightness of tank has been achieved
Visual testing
Hydraulic cement around inlet & outlet
Comments:
ADVANCEDTREATMENTTECHNOLOGY
F-1 Type of treatment device:
Comments:
Installed per manufacturers requirements
All components working in accordance with
manufacturer's requirements
Wastewater System Documentation — Feb 2006
Page 2 of 6
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 1845 CHU
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
D -BOX Installed on stable stone base
Inlet tee (if pumped or >0.08'/foot)
Hydraulic cement around inlet & outlets
Observed even distribution
Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM
F]
Bottom of SAS excavated down to soil layer, as
provided on plan
El
Size of SAS excavated as per plan
F1
Title 5 sand installed, if specified on plan
M
3/4-1 Y2" double washed stone installed
E]
1/8-1/2" (peastone) double washed stone installed
Laterals installed and ends connected to header
Laterals vented if impervious material above
Orifices @ 5 & 7 o'clock positions
El
Gravel -less disposal systems: type, number and
location as per plan
M
Elevations of laterals installed as on approved plan
F-1
40 Mil HDPE barrier installed
0
Retaining wall (boulder / concrete / timber/ block)
F-1
Final cover as per plan
Comments:
Wastewater System Documentation — Feb 2006
Page 3 of 6
TOWN OF NORTH ANDOVER 1 -ft
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 1845 C .. U
Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone
Public Health Director 978.688.8476 - FAX
PRESSURE DISTRIBUTION
F-1
El
Comments:
CONTROLPANEL
Comments:
0
-- inch manifold
laterals installed with end sweeps
size:
material:
Squirt test ft in height
Equal distribution to all laterals
orifice size inch as per plan
F-1 Alarm & Pump are on separate circuits
F-1 Alarm sounds when float is tripped
F-1 Location of control panel:
R Rated for exterior if placed outside
Wastewater System Documentation — Feb 2006
Page 4 of 6
TOWN OF NORTH ANDOVER T#j
Office of COMMUNITY DEVELOPMENT AND SERVICES
0
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 1845 .7 c1lu
Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone
Public Health Director 978.688.8476 - FAX
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland
bylaws
Wastewater System Documentation — Feb 2006
Page 5 of 6
Tank
SAS Sewer
El
Property line
10
10
F�
Cellar wall
.10
20
El
Inground pool
10
20
El
Slab foundation
10
10
F�
Deck, on footings, etc
5
10 - --
F�
Waterline
10
10 101
E-1
Private drinking well
75
1002 50
El
Irrigation well
75
100
El
Surface Water
25
50
El
Bordering Vegetated Wetland
Salt Marsh, Inland / Coastal Bank3
75
106
El
Wetlands bordering surface
water supply or trib. (in Watershed)
150
150
0
Trib. to surface water supply
325
325
F-1
Public well
400
400
F-1
Interim Wellhead Prot. Area
El
Reservoirs
400
400
F
Drains (wat. supply/trib.)
50
100
F�
Drains (intercept g.w.)
25
50
Fj
Drains (Other) Foundation
10(5)
20(10)
F-1
Drywells
20
25
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland
bylaws
Wastewater System Documentation — Feb 2006
Page 5 of 6
TOWN OF NORTH ANDOVER
A
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 1845 C
Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone
Public Health Director 978.688.8476 - FAX
SYSTEM ELEVATIONS
Building Sewer OUT
Septic Tank IN
Septic Tank OUT
Pump Chamber IN
Pump Chamber OUT
Distribution Box IN
Distribution Box OUT
Lateral 1 HIGH
Lateral 1 LOW
Lateral 2 HIGH
Lateral 2 LOW
Lateral 3 HIGH
Lateral 3 LOW
Lateral 4 HIGH
Lateral 4 LOW
Lateral 5 HIGH
Lateral 5 LOW
INVERT ON DESIGN PLAN FIELD INVERT ELEV.
Wastewater System Documentation — Feb 2006
Page 6 of 6
0
COMMONWEALTH OF MASSACHUSEWS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENvIRONMENTAL PROTECTION
TITLE 5
RECEIVED
DEC 12 2005
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 84 Candlestick Road
North Andover—
Owner's Name: -Douglas Yates_
Owner's Address: 84 Candlestick Road —
North Andover, Ma 01845_
Date of Inspection: 12/3/2005
Name of Inspector: — Neil J. Bateson —
Company Name: Batesou Enterprises Inc._
Mailing Address: —111 Argilla Road —
— Andover, Ma. 01810_
Telephone Number: _( 978 ) 475-4786_
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 fimetion and maintenance of 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:
Passes
X Conditionally Passes
Needs FAffier Evaluation by the Local Approving Authority
M- .4A,. 4-n--;--
11ne ad-*nr9e qi nattirp- ate: 12/3/2005
F ft I V F U
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.
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.
Page 2 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 84 Candlestick Road_
— North Andover—
Owner: Yates
Date of &spection: _12/3/2005
Inspection Summary: Check �LXXM 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 3 10 CNM 15.303 or in 3 10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
X 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 (YNND) in the for the following statements. If "not
determined" please explain . Pipe to d -box pitched to tank & pipes to trenches pitched to d -box.
N 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:
Y 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:
N The system required pumping more than 4 times a year due to broken or
obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: — 84 Candlestick Road
– North Andover–
Owner: Yates
Date of fn-specti–on: 12/3/2005
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(l)(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 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 I 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:
Page 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 84 Candlestick Road
- North Andover -
Owner: Yates
Date of &spection- 12/3/2005
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
-No - Backup of sewage into facility or system component due to overloaded or-plogged SAS or cesspool
_No�_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
-No- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
- No Liquid depth in cesspool is less than 6" below invert or available volume is 1/2 day flow.
-No- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
No 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.
-No- Any portion of a cesspool or privy is within a Zone I of a public well.
-No- Any portion of a cesspool or privy is within 50 feet of a private water supply well.
-No- 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.]
_�No�_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described
in 3 10 CNW 15.303, therefore the system fails. The system owner should contact the Board of Health to
determine what will be necessary to correct the failure
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either "yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat tmder Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Page 5 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 84 Candlestick Road
North Andover
Owner: Yates
Date of inspecti-on: _12/3/2005
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
-Yes- — Pumping information was provided by the owner, occupant� or Board of Health
— -No- Were any of the system components pumped out in the previous two weeks ?
-Yes- — Has the system received normal flows in the previous two week period ?
-No- Have large volumes of water been introduced to the system recently or as part of this inspection ?
-Yes- — Were as built plans of the system obtained and examined?
-Yes- — Was the facility or dwelling inspected for signs of sewage back up ?
-Yes- — Was the site inspected for signs of break out ?
-Yes- — Were all system components, excluding the SAS, located on site ?
-Yes - — Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the th
conditio� of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and dep of
scum ?
-Yes- — 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:
Yes no
-Yes- —Existing information.
-Yes - — Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable) [3 10 CNM 15.302(3)(b)]
Page 6 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 84 Candlestick Road-
- North Andover–
Owner: Yates
Date of inspection: 12/3/2005
FL4C)W CONDITIONS
RESIDENTIAL
Number of bedrooms (design): –4– Number of bedrooms (actual): –3–
DESIGN flow based on 3 10 CMR 15.203 660
Number of current residents:
Does residence have a garbage grinder (yes or no): – Yes –
Is laundry on a separate sewage system (yes or no): –No–
Laundry system inspected (yes or no):
Seasonal use: (yes or no): –No–
Water meter reading: –Yes–
Sump pump (yes or no): –No–
Last date of occupancy: –Current–
CON01ERCLAIANDUSTRIAL
Type of establishment: _
Design flow (based on 3 10 CMR 15.203): ___gpd
Basis of design flow (seats/persons/sqft,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: –Pumped two years, owner
Was system pumped as part of the inspection (yes or no): –Yes_
If yes, volume pumped: _1500 gallons -- How was quantity pumped determined? –Measured tank–
Reason for pumping: –Inspect tank & tees_
TYPE OF SYSTEM
_3�_ 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: –9 years old, 2/5/1996, as
built plan_
Were sewage odors detected when arriving at the site (yes or no): –No–
Page 7 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 84 Candlestick Road–
North Andover
Owner: Yates–
Date of Inspection: 12/312005
BUIULDING SEWER – X – (locate on site plan)
Depth below grade: _16"
Materials of construction: — cast iron X 40 PVC —other
Distance from private water supply well or suction line:
Comments (on condition ofjoints, venting, evidence of leakage, etc.) J" PVC thru wall. 3" PVC in house, no
leaks visible
SEPTIC TANKS:
Depth below grade: –4"
Material of construction: –X 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: 101 x 51 x 4'–
Sludge depth: – 3"–
Distance from top of sludge to bottom of outlet tee or baffle: –24"—
Scum thickness: –2"–
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee Wbalffe-: –19"—
How were dimensions determined: –Tape Measure _
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc. _ Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of
liquid at outlet invert. No evidence of leakage._
GREASE TRAP: _(locate on site plan)
Depth below grade: _
Material of construction: concrete metal —fiberglass __polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (contimied)
Property Address: 84 Candlestick Road-
- North Andover—
Owner: Yates
Date of Inspection: 1213/2005
TIGHT or HOLDING TANK: _ (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: _
Material of construction: concrete metal fiberglass __polyethylene other(explain):
Dimensions:
Capacity: --___gallons
Design Flow: ___gallons/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 BOXES: —X—
Depth of liquid level above outlet invert: —17—
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): — D -box level & distribution equal. No evidence of leakage. Evidence of
carryover, pumped d -box to clean. Found outlet pipes to trenches pitched back to d -box, causing liquid level
in d -box to be 1" above inverts—
PUMW CHAMBER: (locate on site plan)
Pump in working order (yes or no):
Alarm in working order (yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 84 Candlestick Road—
North Andover
Owner: Yates
Date of &speci-on: 12/3/2005
SOIL ABSj)RpTI6N_ SySTER (SAS): _X_ (locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
_X_ leaching trenches, number, length: — 2 trenches 811 long_
leaching field, number, dimensions:
overflow cesspool, number:
innovativetalternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): —Soil ok. Vegetation ok. No sign of ponding to surface —
CESSPOOLS:
Number and configuration: _ _
Depth — top of liquid to inlet invert:
Depth of sludge layer:
Depth of scurn 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)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Page 10 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 84 Candlestick Road_
— North Andover—
Owner: Yates
Date of inspection: 12/3/2005
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.
Page I I of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 84 Candlestick Road
— North Andover—
Owner: — Yates—
Date of Inspection: 12/3/2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estirnated depth to ground water — 4.51
Please indicate (check) all methods used to determine the high ground water elevation:
_X_ Obtained from system design plans on record - If checked, date of design plan reviewed: —6/7/1"5—
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: —As per design plan _
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTE"FJSES� INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
I 11 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 84 Candlestick Road, North Andover
Owner: Yates
Date of Inspection: 12/03/2005
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system.
Neil J. Bateson
Bateson Enterprises, Inc.
TOWN OF N -
SYSTEM PUMPING RECORD
DATE: q
SYSTEM OWNER & ADDRESS
I
SYSTEM LOCATION
(example: left front of house)
+
U S�F
DATE OF PUMPING. R D- G '03 QUANTITY PUMPED:
IS -02 ---GALLONS
CESSPOOL: NO SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE "---�EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HE"Y GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED To: G.L.S.13 Lowell Waste
TOMIN OF �J, C VD
SYSTEM PUMPING REC "C
DATE:
O�NO'FJH
PIN00V
.TH0
-v0\0 V6t"PR�
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: �f :��9UANTIW PUMWED:
U-1�
CESSPOOL: NO YES.
NATURE OF SERVICE: ROUTINE
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SEPTIC TANK: NO
EMERGENCY
�' (S GALLONS
YES
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
CONMNTS:
CONTENTS TRANSFERMED To: G.L.S.D Lowell Waste
Town of North Andover, Massachusetts Form No. 2
,A0*T#j BOARD OF HEALTH
X DESIGN APPROVAL FOR
CHU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant 2ZL—�-�c k Test No
Site Location n' -A __Q , J,,==;,
Reference Plans and Specs. t� A JL J\ A-'(--�
'--rNGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CHAIRMAN, BOARD OFWEALTH
Fee Site System Permit No. Qk-
�RD OV H51.1TH
Andov 'Niass-
all
0 - . � 6T F�Zaxl A �5� -1
DISPOSAL DESIGN CHECK LIST
SS )j -S
LOT
_A_PPRWE� j\DATF111r- 4?- DISAPPROV DATE
W
Providedt 7, Reasonsi
t: -I, Oye
t: - fg�, � VIOT
0 tS
"S L
6 (0 70 T �,ev` & rr-19 vt" 12'-C) C)F
-t bNo )� 0� b --
I TI1e_vT_W'5 - 2
I ilel M)� TMH 6 HIROa U_r
'-ftj VJ� ')� CWJ47 k) JA/ 4 6f.)j I ,CC<_o? �O�e Te5
-Tkv:�i Ad' _ Z�6 /F OV�S VJVI�CA-) 0-�,e V)07 .940 W�1, S:0 I) _V11C.
Title V FAM ICK TU d4CI Itj 7-k 15
Reg 2.5 The submitted plan must show as a minirhm:
a) the lot to be served-areat dimensions lot #.,abutters
b location and lo5uleep observation Mes-distance to ties
location and re ts percolation tests -distance to ties
ci AR."im calculations & calculations showing required leaching area
Rm-including reserve area
Reg 10. 2
Reg 10.4
d) 2.51 from subsurface drains --�7 — 7 _C?,- )
Distribution Boxes
a) slope gre—a—t—eFIRE 0.08
b) suzop '
10 -1 1 �) -FC,-O 57T4,=-Ep I '
AJO C-A�� QPI�)�
Tk it, ),:5_1
5,a_ -)O IV)
,j 17,
V2�7- d
/ , 5 T
ItA, 1-F 00 __
Alr_ 4 V I of sewage disposal system or
Ca-AIOV,� OA15- Theq2- rig
f 'thin '00' of sewage disposal
:Z;-5 within 3.001 of sevage disposal
5PITI ro, F. -rz,57,5 ard files
ithin 2001 of sewage, disposal
serve lot -1001 from leaching facility
orty-101 from leaching facility
on
basement,, plumb., pipe.. septic tank,,
_Lletst, distribution field piping and
f3ther'elevations
(r) maximam ground water elevation in area sewage disposal system
(s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6
Septic Tanks
,(a) capacitieB-150$ of flow., water table., tees,, depth of tees.,
access 2 pumping
(b) cleanout,
(c) lot from cellar wall or inground svimning'pool
Reg 10. 2
Reg 10.4
d) 2.51 from subsurface drains --�7 — 7 _C?,- )
Distribution Boxes
a) slope gre—a—t—eFIRE 0.08
b) suzop '
10 -1 1 �) -FC,-O 57T4,=-Ep I '
AJO C-A�� QPI�)�
Tk it, ),:5_1
5,a_ -)O IV)
,j 17,
V2�7- d
/ , 5 T
ItA, 1-F 00 __
No ................ . ..... . Ficz,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
roWn ............... _OF ....... //Kory) ....... . ..................
Appliration for Disposal Works Tonstrurtion rnmit
Application is hereby made for a Permit to Construct ( uKor Repair an Individual Sewage Disposal
System at: I
.............. . . .... 0
ion. ess or t 3V t
...................... . bLAW.'LL . KI . I ..I , (:�
......................
.... ... 2.7 .... M ... 11 .... R .. ox:. 6.161 Ittuecr.m
Owner Address
.................................................................................................. ..................................................................................................
Installer Address
Type of Building Size Lot .... YY --- 72.7..Sq. feet
Dwelling —No. of Bedrooms ................ q -----------_--------- Expansion Attic ( ) GarVage Grinder
Other—Type of Building ............................ No. of persons ............................ Showers ( ) — Cafeteria
Otherfixtures ...................................................... ...............................................................................................
Design Flow .............. fAZO .... j.,5.C2- _gallons per person per day. Total daily flow .......... Jb(:,a .................... gallons.
Septic Tank—Liquid capacity..6 gallons Length ... AL6.". Width.525./.. Diameter.15.�5."'.. Depth ...
Disposal Trench — No . .................... Width .................... Total Length .................... Total leaching area .................... sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. f t.
Other Distribution box Dosing tank Crt3 Fr'q. gp_rt). 14-a-e9sr 49-7-195
Percolation Test Results Performed by ------------ Wn .... 0. ... ..................
:�Qnrlf . ................. Date ........
Test Pit No. I ...... 7 ...... minutes per inch Depth of Test Pit ........ Depth to ground water ... 1V,2..AqZD_--
Test Pit No. 2 ................ minutes per inch Depth of Test Pit ........ Depth to ground water..."Lb.A.2-0...
Description of .. 1:Zal. /"7jw.
......... Q . . ....... .
....................................... ...............................................................................................................................................
Nature of Repairs or Alterations — Answer when applicable ............................................................................ _
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT LE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed.....................
Application Approved By
Date
-- I ..............
Date
Application Disapproved for the following reasons: ................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo ......................................................... IssuedL .......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ T�OW..jn ........... OF ....... Aor-M .... AfAntlee . ................
Trrftfiratr of Tompliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by---------------
...........
Installer
at......................................................................................................................................................................................................
has been instqllf�d in accordance with the provisions of TITLEP 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ........... ............................. dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA&L-rH
No......................... ........ 7 ............. OF ...... .................... FEE ........................
Disposal Works Tonstrurtion"prrmit
Permissionis hereby granted ............ ........ ............................................................... ..................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo ...............................................................................................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No ..................... Dated ..........................................
Board of Health
DATE............ ............................
FORM 1255 A. M. SULKIN, BOSTON
4
MICHAEL JAMES GORHAM
Attorney admitted to practice in Mass. and N.H.
September 27, 1985
Mike Graff
Health Inspector
Town of North Andover
Town Hall
North Andover, Massachusetts 01845
RE: JRQ Realty Trust
Lot 6, Candlestick, North Andover
Dear Mr. Graff,
Take notice that this office represents J. Russell Quartarone,
Trustee of the JRQ Realty Trust, who advises that you have
repeatedly rejected a septic disposal system submitted by Cyr
Engineering on behalf of,,JRQ Realty Trust concerning Lot 6,
Candlestick, without providing any adequate explanation as to
your rejection. k \Ig'
We are informed that the plan, as designed, complies with all
local and state requirements.
Apparently it is your position that there is some deficiency in
the design which allows you to deny approval.
I call upon you, in fact demand, that you respond to me within
five (5) days with specifications as to the exact regulation,
statute or rule which the design failsto meet.
Do not answer by saying that it oesn't comply with Title V or
some such general stat t Xt(1 /J O/T
em t is our belief that if the plan
h:n'% a 1
fails to meet any of t ee /r� ations it should be easy for you,
'te i
as the inspector, to det 1Z which of the regulations--ari---not
met.
Further take noti that should you rE�fuse to respond to this
request and we fi d it necessa t(J"seek judicial intervention
ry
you will be hel personally responsible for the actual damages
I
mrn y ient w
suffArAd by hich include, interest cost, legal fees,
t
engi'�4ing tsiaend other damages.
y tfuWyours,
Michael James Gorham 5iqYiATLAe— To
MJG/p -5e,-L1, L dic) ,orr 'S c)615,
cc. J. Russell Quartarone
Cyr Engineering
N.H. Office: I Main Street 0 Hampstead,N.H. e (603)329-6000
(603) 893-9345
Mailing address: P.O. Box 168 e Hampstead, N.H. 03841
r-_,
Town of North Andover, Massachusetts Form No. I
,%ORTF1 BOARD OF HEALTH
,,�E . D 6 �0 19
APPLICATION FOR SITE TEST I NG/I NSPECTI ON
Applicant
V W -r -f& G
Site Location
Engineer
Test/l nspection Date and Time
Fee
2MVIRWIM,
CHAIRMAN, BOARD OF HEALTH
Test No. 519
S.S. Permit No.-D.W.C. No.-C.C. Date-Plbg. Permit No.
T
'ED
Town of North Andover, Massachusetts
BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
Form No.1
19
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer K,
NAME ADDRESS TELEPHONE
Test/I nspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No.
S.S. Permit No.-D.W.C. No.-C.C. Date-Plbg. Permit No.
R.A.M. ENGINEERI IF N RTH ANDOVER7
0
ROBERT A. MASYS, P.E. "%00ARD0 F HEALTH
160 MAIN STREET
HAVERHILL, MA 0 1830 VAR 2 0 1995
PHONE: (508) 372-0449
March 20, 1995
Ms. Sandy Starr
North Andover Board of Health
Town Hall
North Andover, MA.
RE: Lot # 6, Candlestick Road, David Milot
Dear Ms. Starr,
Attached, please find three copies of the revised septic
design plan, with the changes that you had requested. The
revisions are as follows:
1. Perc rate set at 8 min./inch.
2. Foundation drain shown. (We will be requesting a waiver
from your Board for the setback distances.)
3. Soils information was provided by owner, if the
identification is different, I would like to meet with you to
obtain the information on record with your office.
4. All pipe has been labeled as sch. 40.
S. Septic tank is 18' from foundation, we will be requesting
a waiver from your Board.
6. The expansion area is 25' from the foundation, we will be
requesting a waiver from your Board.
7. This note has been added.
8. Reserve area is 4' from the primary area.
9. We have changed the trenches so that they are not next to
each other.
10. Slope shown in y/x format.
11. Existing grade shown on profile.
12. Detail has been adjusted to show 4" of peastone.
13. Leach area has been expanded to 660 G.P.D.
14. Slope of distribution lines has been set at .005.
would like at a future date to discuss the requirement of having
the distribution lines with a slope.)
15.Invert is shown at the end of the distribution lines.
If I can provide any further information, or if you have any
questions, please contact me.
truly yours,
Robert A. Masys, P.E.
-0- R.A.M. ENGINEERING
ROBERT A. MASYS, P.E.
160 MAIN STREET
HAVERHILL, MA 0 1830
PHONE: (508) 372-0449
March -2D..
North Andover Board of Health
n
Town Hall r;T,"2
North Andover, MA. I
RE: Lot # 6, Candlestick Road, David Milot
Dear Board Members,
on behalf of my client, I would respectfully request a
waiver of the Board's Regulation 4.18, distance from the
foundation drain to the septic system. The regulations call for a
setback of 35' for the leaching facility, we are proposing a
setback of 25'. The regulations also call for a setback of 25'
for the septic tank, we are proposing 18'. The reasons for this
requests are due to the slope of the land, and the Town's
regulation that no building be within 50' of a wetlands. I have
attached plans for the site for your review and consideration. If
I can answer any questions, or provide any further information,
please contact me.
-V-e_ry tru14L-Y-Q-urs,
ob"ertA. syXs, P.r
14ORTN
411
HUS
Town of North Andover, Massachusetts
BOARD OF HEALTH
Form No. 2
%7.� kWATMg-W-AM—�11 =
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No,
Site Location C J,' ,
Reference Plans and Specs.
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
$- 1111)
Fee bc) ,
CHAIRMAN, BOARD OF HEALTH
Site System Permit No. k 0
I
9
a
5Z2
", O"VI
-7 0."-, 77
12
4, In 2
7 Cr
5 Cil
Parent ,cil
9
a
S. RUSSELL SYLVA
Commissioner
935-2160
Jxel rc�t'
5
0&�'
CYR Engineering Services, Inc.
234 Essex Street
Lawrence, MA 01840
Gentlemen:
a
September 16, 1985
RE: NORTH ANDOVER- Interpretation
Slopes- Title 5 - State
Envirom-ental Code - Lot 6 -
Candlestick Road
The Metropolitan Boston/Northeast Regional Offi ' ce, Division of Water Pollution
Control, of the Department of Environmental Quality Engineering is in receipt of
your letter of transmittal requesting an interpretation of Title 5 of the State
Environmental Code for the subject site.
The accompanying plans consist of two sheets, the first of which is titled-,
Proposed Site Plan
Subsurface Sewage Disposal Plan
Subdivision Lot No 6
Candlestick Road
North Andover, MA
Owner: J.R.Q Realty Trust
Designer: CYR Eng. Services, Inc.
Scale: As Noted
An engineer of the Department has reviewed the plans relative to the slope
requirements of Regulation 15.14: Figure 1. (Illustration B) of Title 5.
It is the opinion of the Department that the plans are in compliance with
Title 5 as they relate to leachirk-, trenches 1,2,3 and 4. However, the slope requirements
for the reserve trench, adjacent to leaching trench #1 are not in conpliance with Title
5 of the State Environmental Code.
If additional information is required, contact Tom F. Clougherty at the above
address at 935-2160.
Very truly yours
William A. Kxol., P.E.
Deputy Regional Environmental
Engineer
WAK/TFC/bc
cc: No. Andover, Board of Health, Town Building
,, North Andover, lih 01845
S. RUSSELL SYLVA
Commissioner
935-2160
CYR Engineering Services, Inc.
234 Essex Street
Lawrence, MA 01840
Gentlemen:
0/ enwe� 6 0 nw z en la 7
October 15, 1985
RE: NORTH ANDOVER- Interpretation
Slopes - Title 5- State
Envirornnental Code- Lot 6
Candlestick Road
By letter dated September 16, 1985, the Department of Environmental Quality
Engineering notified CYR Engineering Services, Inc. that, at their request, an
engineer had reviewed a set of plans for a proposed subsurface sewage disposal systern
to service the subject site and determined that the plans were not in compliance with
regulation 15.14: Figure 1 (Illustration B) of Title 5 of the State Environmental Code.
Subsequently, the Department is in receipt of a set of revised plans for the
disposal system for the subject site. The plans are similarily titled as previously
submitted and were revised on September 26, 1985.
An engineer of the Department has reviewed the revised plans and it is the opinion
of the Departmmt that these plans are in compliance with Regulation 15.14: Figure 1
(Illustration B) of Title 5.
If additional information is required, contact Tom F. Clougherty at the above
address or at 935-2160.
Very truly yours,
William, A. Krol, P.E.
Deputy Regional Environmental Engineer
WAK/TFC/bc
cc: North Andover Board of Health
Town Building
North Andover, MA 01845
AIC -
9 -4-1 Z6 /9"),/ c
-7-&r6r�5 C-5. -&)/-7 A) -�E&6,�-setA5 AC6'19-,
7--6 e -0,P"
R.A.M. ENGINEERING
ROBERT A. MASYS, P.E.
160 MAIN STREET
HAVERHILL, MA 0 1830
PHONE: (508) 372-0449
PROPOSED WAIVERS FOR LOT #6 - CANDLESTICK ROAD, NORTH ANDOVER
SEPTIC TANK SETBACK
STATE REQUIREMENT 10'
NORTH ANDOVER REQUIREMENT 25'
REQUESTED WAIVER 12'
LEACHING AREA SETBACK
STATE REQUIREMENT 20'
NORTH ANDOVER REQUIREMENT 35'
REQUESTED WAIVER 21'
DISTANCE BETWEEN LEACH TRENCHES
STATE REQUIREMENT 6'
NORTH ANDOVER REQUIREMENT 10'
REQUESTED WAIVER 8v
1R.A.M. ENGINEERING
ROBERT A. MASYS, P.E.
160 MAIN STREET
HAVERHILL. MA 0 1830
f-r-lkjllir-: kbual -1/4-0449
NORTH ANDOVER
PROPOSED WAIVERS FOR LOT #6 - CANDLESTICK ROAD,
SEPTIC TANK SETBACK
STATE REQUIREMENT 10'
NORTH ANDOVER REQUIREMENT 25'
REQUESTED WAIVER 12'
LEACHING AREA SETBACK
STATE REQUIREMENT 20'
NORTH ANDOVER REQUIREMENT 35'
REQUESTED WAIVER 21'
DISTANCE BETWEEN LEACH TRENCHES
STATE REQUIREMENT 6'
NORTH ANDOVER REQUIREMENT 10'
REQUESTED WAIVER 8f
4".
loop
to "t
-Ae
T% I
-%I V" &A~.
R.A.M. Engineering
160 Main Street
Haverhill, MA 01830
Dear Mr. Masys:
March 31, 1995
. This letter is to notify you that the revised plan dated March
15, 1995 for the proposed septic system located on Lot 6
Candlestick Road has been disapproved for the following reasons:
1. Trenches are wider than the 4 foot maximum allowed by
North Andover regulation 17.04.
2. Deep hole testing done April 1994 showed fill and old top
and subsoil down to 5411 near pit #4 and fill down to 12011 in the
deep hole dug approximately in the center of the reserve area.
There are, therefore, no acceptable soil tests in the reserve area
since we did not, of course, perc this area and this plan shows no
additional tests.
3. Breakout grading remains a problem and variance requests
are on hold until after a Board of Health site visit.
Should you have any questions, you may call the office at 508-
688-9540.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Ken Mahoney, Dir. CD & S
David Milot
BOH
File
120 MAIN ST?=
NORTH ANDOVER, MASS. 01845
March 31, 1995
R.A.M. Engineering
160 Main Street
Haverhill, MA 01830
Dear Mr. Masys:
TEL. �682-6483
Ext23
, This letter is to notify you that the revised plan dated March
15, 1995 for the proposed septic system located on Lot 6
Candlestick Road has been disapproved for the following reasons:
1. Trenches are wider than the 4 foot maximum allowed by
North Andover regulation 17.04.
2. Deep hole testing done April 1994 showed fill and old top
and subsoil down to 5411 near pit #4 and fill down to 12011 in the
deep hole dug approximately in the center of the reserve area.
There are, therefore, no acceptable soil tests in the reserve area
since we did not, of course, perc this area and this plan shows no
additional tests.
3. Breakout grading remains a problem and variance requests
are on hold until after a Board of Health site visit.
Should you have any questions, you may call the office at 508-
688-9540.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Ken Mahoney, Dir. CD & S
David Milot
BOH
File
y"
-4
'A. W,
ORTI,
A`
3P*
U
--r.-'�.BOARD:OP'HEALTH'�'�
120 MAIN ST?=
NORTH ANDOVER, MASS. 01845
March 31, 1995
R.A.M. Engineering
160 Main Street
Haverhill, MA 01830
Dear Mr. Masys:
TEL. �682-6483
Ext23
, This letter is to notify you that the revised plan dated March
15, 1995 for the proposed septic system located on Lot 6
Candlestick Road has been disapproved for the following reasons:
1. Trenches are wider than the 4 foot maximum allowed by
North Andover regulation 17.04.
2. Deep hole testing done April 1994 showed fill and old top
and subsoil down to 5411 near pit #4 and fill down to 12011 in the
deep hole dug approximately in the center of the reserve area.
There are, therefore, no acceptable soil tests in the reserve area
since we did not, of course, perc this area and this plan shows no
additional tests.
3. Breakout grading remains a problem and variance requests
are on hold until after a Board of Health site visit.
Should you have any questions, you may call the office at 508-
688-9540.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Ken Mahoney, Dir. CD & S
David Milot
BOH
File
Al
BOA RUDF,,�.
40 L-
120 N4A1N STREET TEL. 682-6483
CHU NORTH ANDOVER, MASS. 01845 Ext23
March 31, 1995
R.A.M. Engineering
160 Main Street
Haverhill, MA 01830
Dear Mr. Masys:
This letter is to notify you that the revised plan dated March
15, 1995 for the proposed septic system located on Lot 6
Candlestick Road has been disapproved for the following reasons:
1 . Trenches are wider than the 4 foot maximum allowed by
North Andover regulation 17.04.
2. Deep hole testing done April 1994 showed fill and old top
and subsoil down to 5411 near pit #4 and fill down to 12011 in the
deep hole dug approximately in the center of the reserve area.
There are, therefore, no acceptable soil tests in the reserve area
since we did not, of course, perc this area and this plan shows no
additional tests.
3. Breakout grading remains a problem and variance requests
are on hold until after a Board of Health site visit. ,
Should you have any questions, you may call the office at 508-
688-9540.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Ken Mahoney, Dir. CD & S
David Milot
BOH
File
6 IS
BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Ext23
March 31, 1995
R.A.M. Engineering
160 Main Street
Haverhill, MA 01830
Dear Mr. Masys:
This letter is to notify you that the revised plan dated March
15, 1995 for the proposed septic system located on Lot 6
Candlestick Road has been disapproved for the following reasons:
1. Trenches are wider than the 4 foot maximum allowed by
North Andover regulation 17.04.
2. Deep hole testing done April 1994 showed fill and old top
and subsoil down to 5411 near pit #4 and fill down to 12011 in the
deep hole dug approximately in the center of the reserve area.
There are, therefore, no acceptable soil tests in the reserve area
since we did not, of course, perc this area and this plan shows no
additional tests.
3. Breakout grading remains a problem and variance requests
are on hold until after a Board of Health site visit.
Should you have any questions, you may call the office at 508-
688-9540.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Ken Mahoney, Dir. CD & S
David Milot
BOH
File
DATE / L,-�, 8/"
Sheet / - of c1p,
BOARD OF HFALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
F E z 04 � � (D PERMIT # %106 DATE RECEIVED 11�1�q
7 7 1 C.'�� lb Mll!�07- ASSESSOR'S MAP
IT v
PARCEL #
LOT #
STREET q ,v b z 6r
7 71
16 6 /'VQl A) 5,;' #,q V6C171le- C -
p � D'� -=7 0 hl --:) — REVISION DATE
C::;:=---C:,'S OF APPROVAL:
A -7 -Z -70v=
D 1 P Pl� 0 V
7516 A,)
7-1-0 IV or-
CA-) A -;o
A 0, 1�4)1)
0 IV
,gZL -;r,11,0,6- UlUbI47 /V, /Bj
7-1,9Ng .4118)
ApAC/, oge&-19 V�7- 615-' --'11210AI ;,::-6 OAIb A 7-46Aj (N..,Q
7;3 C ,9. A-) 0 77��- 7-WI�12 7— :!5;-X 0— /9 L/
5L /9,7-
5 7 C-- A),
OK6, V<f--
N. /9, 0, a-z3j
�"/7— 1V11U110U" 4"- 1-;e6m' 77�e//W/9-4�/v
REVIEW CONTINUED
SHEET OF
ob q,
<!�;-XI571- Al 6 b 67 0 k)
14
Mt) 5T
�� j Z-)
19 7 1 A/ V --P- 7 �7
/- / A-) 15- ,
PLAN REVIEW CHECKLIST
ADDRESS ENGINEER'T /q
GENERAL
3 COPIES STAMP -,-----"LOCUS NORTH ARROW SCALE
CONTOURS_LZ-' PROFILE L�-- SECTION BE NCHMARK L"-� SOIL &
No g foi,4 rlok
IPA�'IRC INFOYIPF6 ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS WATERSHED? /t/0 DRIVEWAY�.,� (Elev) WATER LINE
FDN DRAIN_,)5� SCH40Z TESTS CURRENT? I Ll--- —
SEPTIC TANK
MIN 150OG `� .17 INVERT DROP GARB. GRINDERjL(+200% EDF)
25' TO CELLARX MANHOLE TO GRADE--'-' ELEV -- GW "
D -BOX
SIZE # LINES FIRST 21 LEVEL STATEMENT
INLET/,66, - OUTLET 161,,71 17 (211 OR .17 FT) TEE REQ!D?
,&a
LEACHING
MIN 660 GPD? -X RESERVE AREA4-"�41 FROM PRIMARY?,,,z 2% SLOPE
100' TO WETLANDS &,-' 100- TO WELLS 4-,� 4- TO S.H.GW
35' TO FND & INTRCPTR DRAINS_,y 325- TO SURFACE H20 SUPP
4' PERM. SOIL BELOW FACILITY -"' MIN 12" COVER L,�FILL?-::�o
if above natural elev; 101if below) BREAKOUT MET?
TRENCHES
MIN 660 gpd.k,"/ SLOPE (min .005 or 611/1001) >31COVER?-VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 6-)-� IS RESERVE BETWEEN
TRENCHES? L-`� IN FILL? MUST BE 101 MIN.z 411'' PEA STONE?, -,-C,*"
BOT 3,-A,�- X LDNG 90"+ SIDE 3A4- X LDNG1z= TOT
(L x W x #) (G/ft2) (DxLx2x#) (G/ft2)
Copyright C 1993 by S.L. Starr
K
0
\ I
R.A.M. ENGINEERING
ROBERT A. MASYS, P.E.
160 MAIN STREET
HAVERHILL. MA 0 1830
PHONE: (508) 372-0449
PROPOSED WAIVERS FOR LOT #6 - CANDLESTICK ROAD, NORTH ANDOVER
SEPTIC TANK SETBACK
STATE REQUIREMENT 10'
NORTH ANDOVER REQUIREMENT 25'
REQUESTED WAIVER 12'
LEACHING AREA SETBACK
STATE REQUIREMENT 20'
NORTH ANDOVER REQUIREMENT 35'
REQUESTED WAIVER 21'
DISTANCE BETWEEN LEACH TRENCHES
STATE REQUIREMENT 6'
NORTH ANDOVER REQUIREMENT 10'
REQUESTED WAIVER 81
�?-1 I I i::-�F
NNE
9,A 1 9, ic-
I
Page 4
Minutes: May 25, 1995
2) A reduction in the offset distance to a cellar wall
from a required distance of 35 feet to a distance
of 20 feet. This variance is a variance to the
North Andover Regulations.
3) A reduction in separation to the water table f rom
the required four feet to three and one half feet.
This is required to meet the slope requirements
which can not be varied. This request is a variance
to Title V but is allowed under sections 15.404 and
15.405.
on a motion by Dr. MacMillan, seconded by Dr. Rizza, the Board
voted unanimously to grant the variances as requested.
At this time Mr. Osgood rejoined the other Board Member as
Chairman.
LOT #6 CANDLESTICK - STEVE DOHERTY:
Steve Doherty was present along with his Attorney Garen M.
Bresnick. Mr. Doherty requested to come before the Board to
discuss the status of Lot #6 Candlestick Road.
Ms. Starr mentioned that she went through the file and found two
plans; 1) a disapproved plan, and 2) a plan that apparently was
approved but not stamped and the design was based on an 18 min/inch
perc rate that was done in the area of the system now. Mrs. Starr
stated that this system is a lot smaller because it was designed on
8 min/inch. Ms. Starr stated that there are sections in Title V
which states that the slowest perc rate shall govern the size of
the leaching field. Ms. Starr stated that this was the main reason
why it was rejected.
Ms. Starr stated that she sent a letter to DEP requesting a written
clarification of that section of Title V.
Ms. Starr mentioned that if a faster rate is used then the leaching
area will be too small. Ms. Starr stated that there have been six
failures on that side of the road within two years after the
systems were put in. Ms. Starr stated that she is really concerned
about the size of the system.
Mr. Doherty stated that his engineer designed a system according to
Ms. Starr's letter on January 28th which stated to design the
system under a 8 minute rate, and now Ms. Starr is telling me to
design -it under 18 minute rate - there is too much inconsistency
and an awful lot of time has passed.
Mr. Osgood asked Mr. Doherty if he could build the system according
to the 18 minute perc rate. Mr. Doherty stated that he would have
r
Page 5
Minutes: May 25, 1995
to look into it. Mr. Doherty is contemplating changing engineers.
Ms. Starr mentioned that she was talking with Mr. Doherty about an
alternative system, i.e. elgin indrain. Ms. Starr stated that she
would like to get more information on this and if it is cost
effective, it may be worth it. Dr. MacMillan asked if it was a
sand filter. Ms. Starr responded,"no" - it is like a fabric that
is doublebacking itself, you would get more leaching out of a
smaller area.
Mr. Doherty stated that he spoke with three different engineering
f irms and not one of them agreed with how to use a ten year old
perc. Mr. Doherty stated that he is willing to bet that the Board
of Health has never gone back ten years in any folder to design a
system on a ten year old perc.
Mr. Osgood suggested to go out and dig a perc in the same area as
the 18 minute rate and see if it is really 18 minutes.
Dr. Rizza mentioned that he would like the Board to entertain some
sort of guarantee upon the designer and/or builder that the system
will work at least 5 years. Mr. Doherty stated that if some of
these new experimental suggestions are implemented, he would not
guarantee it.
Attorney Bresnick mentioned that it is possible to kill a system
through abuse in a short period of time and the issue of why it
failed becomes a critical one where you are talking a major
guarantee. Attorney Bresnick stated that what he is hopeful to do
is to design a traditional system that fits within the lot and is
.properly sized. At the 8 minutes perc rate it is certainly easier
and it becomes an issue of having a lot more room around it, at the
18 minute it will be little tighter.
Ms. Starr stated that another concern of hers is that this was
designed back when they were designing all,those along the street
and that there have been six failures. Ms. Starr questioned - why
did they f ail? ... was it the soils? .... was it the size of the
system? .... was it the garbage disposal?
The Board Members and Ms. Starr agreed that a plan be submitted
prior to the Board of Health Meeting on June 22nd for Ms. Starr to
review and to schedule a tentative date for a perc test on June 6,
1995 at 1:00 P.M.
Dr. Rizza suggested that an engineer be with Mr. Doherty the next
time they meet with the Board of Health.
APPROVAL OF MINUTES - 3/23195:
On a motion by Dr. Rizza, seconded by Dr. MacMillan, the Board
voted unanimously to approve the minutes of 3/23/95 as written.
0 11 74
BOARD OF HEALTH
MINUTES
APRIL 27, 1995
The meeting was called to order at 7:10 P.M.
MEMBERS PRESENT:
Gayton Osgood, Chairman, Francis P. MacMillan, M.D., Member, John
S. Rizza, D.M.D., Member, and Sandy Starr, Health Administrator.
7:00 P.M. - SWIM SAFE PROGRAM - CHIEF DOLAN:
Chief Dolan was present and mentioned that the purpose of the Swim
Safe Program is to keep kids safe around pools. Chief Dolan
realized that the Board of Health inspects swimming pools. Mr.
Osgood mentioned that the Board of Health inspects semi-public and
public pools, not private. Chief Dolan stated that this was a good
opportunity for the Board of Health and the Fire Department to work
together and create a Swim Safe Program.
Chief Dolan stated that he wants to advertise on the Cable TV
station and to let people know there is a video available. Mr.
Osgood stated that it is a good idea to get the Building Inspector
involved because he is the one who regulates the size of the fences
and to let people know their responsibilities.
Chief Dolan wanted to know how the Board of Health felt about this
and then go ahead and get others involved and see how they want to
set it up.
The Board Members gave Chief Dolan their approval and they all
agreed that this was a great idea.
LOT 6 CANDLESTICK ROAD:
Ms. Starr stated that she would like to discuss Lot #6 Candlestick
but she would like to have Dr. MacMillan here because he was on the
site visit.
A brief discussion ensued in reference to Lot #6 Candlestick Road.
Ms. Starr mentioned that she does not have a plan that can be
approved because of the soil tests. Ms. Starr stated that the last
plan was rejected because they had positioned the system over an
area where there was ten (10) ten feet of fill along with other
things but that was one of the major things.
Ms. Starr mentioned to Dr. Rizza that she believed that he wanted
the whole area tested.
Mr. Steve Doherty was present and spoke on his behalf. He stated
that the walk through was quite unsightful to him and his engineer.
Mr. Doherty mentioned that the notes his engineer had for the perc
tests were difficult to read and he could not decipher
Page 2
Minutes: April 27, 1995
where the location of the percs but Mr. Doherty mentioned that his
engineer was able to see physically where they were located at the
site walk. Mr. Doherty stated that his engineer would design a new
system that would not go over the area where there was fill. Mr.
Doherty mentioned that he has a new design of a system on the other
area where there was good material. Mr. Doherty mentioned that Dr.
Rizza and Dr. MacMillan recommended that he do this. Mr. Doherty
stated that he has done that but still has the set backs from the
wetlands and also from the house to the front.
Mr. Doherty stated that they talked about if a plan could not be
designed to fit in that good area and if they had to go into the
filled area they would bring in a machine and dig around and see
what was there. Mr. Doherty believes they have overcome that
problem.
Mr. Osgood pointed out that the waiver for 50 feet from the
wetlands is a State regulation. Ms. Starr mentioned that this is
not the septic system, this is the no build area for Conservation
and it is a State regulation but this would be for the house.
Mr. Doherty stated that he's been hanging onto plans for over a
week now. Ms. Starr stated that that was too bad because she had
told Bob Masys to get the plan into her a week before the meeting
so she could take a look at them.
The Board Members took a look at the plans.
The variances requested are as follows:
1) N.A. Regulations - setback - house to septic tank is 25 feet,
his plan indicates 12 feet.
2) Leaching area setback - N.A. regulation is 35 feet, State is 20
feet, and his plan indicates 21 feet.
3) The distances between tH-e— trenches - N.A. regulation is 10
feet, the State is 6 feet, and his plan indicates 8 feet.
Mr. Doherty agreed that this is a tight lot but a workable lot.
Mr. Osgood asked if the house was a four (4) bedroom. Mr. Doherty
responded, "yes, the house is 3,182 square feet".
Mr. Osgood stated that these are not unreasonable variance requests
but the question is - is the system going to work?
Mr. Doherty wanted to see if the Board would work on the variances
and then the design.
Ms. Starr stated that she was concerned because she got six (6)
failures on that side of the street which were within a few years
of when they moved in. Mrs. Starr wants to check the f ile for more
information.
Page 3
Minutes: April 27, 1995
Mr. Osgood stated that his feeling is that Ms. Starr has to look at
this plan. He also stated that he does not have a problem with
these three variances but the Board doesn't know if this is all
that will be required. Mr. Osgood stated that he does not think
the Board Members are at a point where they can say "yes" we'll
give you these variances because they do not know enough about the
system.
Dr. MacMillan asked if Conservation has approved this lot. Mr.
Doherty stated, "yes". Ms. Starr did not know. Dr. MacMillan
wanted Mr. Doherty to give Ms. Starr a chance to look the plans
over and maybe the Board Members could give Ms. Starr a verbal
approval and does not believe that Mr. Doherty has to wait thirty
(30) days. Ms. Starr stated that it is something the Board Members
have to vary. Dr. MacMillan stated that he does not mind if Ms.
Starr called him and said, "yes, it will work, or "no" it will not
work. Ms. Starr stated that legally the Board Members can not do
this - if it is a variance the Board needs to get together.
Mr. Osgood stated that the Board can grant these variances at this
point provided that this plan stays as it is.
On a motion by Dr. Rizza, seconded by Mr. Osgood, the Board voted
unanimously to grant the variances as mentioned above and to have
the plan reviewed by Ms. Starr.
7:30 P.M. - VARIANCE REOUEST - PATRICK GARNER - LOTS ALONG ROUTE
114 AND BERRY STREET:
Mr. Patrick Garner was present and appeared before the Board for
the following variances:
Lot #1: (a) Distance- from leaching area to wetlands. Instead of
100 feet, the leaching trenches at their closest point
lie 74 feet from BVW.
(b) Minimum gallons per day requirement. Instead of 660
GPD, the system provides 589.5 GPD. this results from
shrinking the system size to maximize the distance to the
wetlands.
Lot #2: (a) Distance from leaching area to wetlands. Instead of
100 feet, the leaching trenches at their closest point
lie 70 feet from BVW.
(b) Minimum gallons per day requirement. Instead of 660
GPD, the system provides 589.5 GPD. This results from
shrinking the system size to maximize the distance to the
wetlands.
Lot #4: (a) distance from leaching area to wetlands. Instead of
100 feet, the leaching trenches at their closest point
'90 1 --N. '%&
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
July 7, 1995
TEL. 682-6483
Ext23
Mr. Steve D'Urso
22 Lilly Pond Road
Boxford, MA 01921
Re: Lot #6 Candlestick Road
Dear Steve:
This is to inform you that the proposed plans for the site
referenced above have been approved with the following conditions:
1) Please show distances from the foundation to the
septic tank and leaching area on the site plan (N.A.
6.03). Also distance to wetlands.
2) Requested waiver for distance between leach trenches
8 feet. However, cross section shows 7 feet. Which
is it?
3) Please locate all applicable test holes.
If you have any questions, please do not hesitate to call the
Board of Health Office at the number above.
Sincerely,
Sandra Starr, R.S.
Health Administrator
SS/cjp
DATE JL)A)6 ��?-7, Sheet_� Of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE
DISPOSAL DESIGN REVIEW
F E PEPMIT
# DATE
RECEIVED (��Ix5A,-
7 Z-: - 7?
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ASSESSOR'S MAP
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PLAN REVIEW CHECKLIST
ADDRESS ENGINEER
GENERAL
3 COPIES STAMP LOCUS 6,1" NORTH ARROW S CALE
CONTOURSI,:,� PROFILE SECTION BENCHMARK SOIL &
PERC INFO -,�/ ELEVATIONS WETS. DISCLAIMER L-'� WELLS &
WETLANDS L,--' WATERSHED?_,�/O DRIVEWAY WATER LINE
(E 1 ev)
FDN DRAIN SCH40 L�TESTS CURRENT?
SEPTIC TANK
MIN 150OG .17 INVERT DROP 11� GARB. GRINDER24/(D(+200% EDF)
25' TO CELLAR MANHOLE TO GRADE
ELEV GW
D -BOX
SIZE # LINESIA FIRST 2' LEVEL STATEMENT
INLET164, - OUTLET 16t, -',y= 17 (2" OR .17 FT) TEE REQ'D? All)
LEACHING
MIN 660 GPD-� RESERVE AREA CZ41 FROM PRIMARY?_,y- 2% SLOPE
100' TO WETLANDS. 100' TO WELLS 4---- 41 TO S.H.GW-.��
35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H20 SUPP
4' PERM. SOIL BELOW FACIL MIN 12" COVER
if above natural ele ; 10'if below) BREAKOUT MET?
TRENCHES
MIN 660 gpd_ SLOPE (min .005 or 6"/100')1L1---� >3'COVER?-VENT/N-
SIDEWALL DIST. 2X EFF. W OR D (MIN 61) t-,� IS RESERVE BETWEEN
TRENCHES?LZ' IN FILL? L, -MUST BE 10 MIN. 4 11 PEA STONE?
BOT X LDNG + SIDE qlel" X LDNG �W= TOT 61� Z �7'40
(L --'x W x (G/ft2) (-ITxLx2x#) (G/ft2)
COPYright @ 1993 by S.L. Starr
C2,
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�5 7;17�e
Town of North Andover
. OMCE OF
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Strea
KENNETH P_ MAHO
Director
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Julie Parrino D. R —Nicetta
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of stone and
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S-9540
Michael tiowara -tarr
PLANNING 688-9535
KnUeen Bradley Colwell
PLAN REVIEW CHECKLIST
ADDRESS- —ENGINEER
GENERAL
3 COPIES
STAMP c--' LOCUS �-� NORTH ARROW L—'
SCALE �-'
CONTOURS
PROFILE Z-�
SECTION BENCHMARK
SOIL &
PERC INFO
ELEVATIONS
WETS. DISCLAIMER
WELLS &
WETLANDS b,-'
WATERSHED? A/
DRIVEWAY &----(-Elev) WATER LINE
FDN DRAIN
SCH40
TESTS CURRENT?
7_11�--VC74aS
SEPTIC TANK
MIN 150OG L"" .17 INVERT DROP GARB. GRINDER /t/O(+200% EDF)
25' TO CELLARVR41AIJ�
__"L7_11q1' MANHOLE TO GRADE ELEV GW
.,�k
D -BOX
SIZE # LINES FIRST 2' LEVEL STATEMENT
INLET OUTLET Q 17 (211 OR .17 FT) TEE REQ I D? 1�16
_L
LEACHING
MIN 660 GPD?--<' RESERVE AREA 4-,-41 FROM PRIMARY?X/ 2% SLOPE
1001 TO WETLANDS L"" 100' TO WELLS L--- 4' TO S.H.GW
JP9.1
351 TO FND & INTRCPTR DRAINS, 419 325' TO SURFACE H20 SUPP
41 PERM. SOIL BELOW FACILITY MIN 12" COVER --"*' FILL?
if above natural elev; 101if below) BREAKOUT MET?
TRENCHES
MIN 660 gpd,,y SLOPE (min .005 or 611/1001) L'�<3'COVER?-VENT OIL
SIDEWALL DIST. 2X EFF. W OR D (MIN 61) IS RES-ERVE BETWEEN
1PI $4�5
TRENCHES? IN FILL? L--' MUST BE 101 MIN.0410"i 411 PEA STONE? X
BOT a'� 70 X LDNG + SIDE X LDNG ZZ,5- = TOT w11,1
(L x W x (G/ft2) (DxLx2x#) (G/ft2)
Copyright @ 1993 by S.L. Starr
BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Ext23
May 25, 1995
Ms. Claire Holland
Dept. of Environmental Protection
5 Commonwealth Ave.
Woburn, MA 01801
Re: Clarification of 310 CMR 15.03 (4)(e) & 15.104(5)
Dear Claire:
I would like a clarification of the above sections of Title V
which state that the slowest percolation rate obtained shall govern
the size of the leaching area.
This office has always interpreted this section as referring
to any official (i.e. done according to regulations in force at the
time and witnessed by a Board of Health representative)
percolation test done at any time. This seems imminently
reasonable since perc test results are "Deemed valid for an
indefinite period." We have a number of sites in town that have
been affected by this regulation.
There is currently one site in particular for which a
clarification is needed, Lot #6 Candlestick Road.
The lot is difficult in that there is a narrow strip of land
near the street that drops off precipitously to wetlands at the
rear of the property. The lot has been filled in various places
with a loamy fill which in some areas goes down to 120 inches.
Apparently the lot had an approved design of sorts back in 1985.
The design rate was 18 minutes per inch based on the slowest rate
obtained. The lot was re -tested in 1994, with 3 deep holes and 2
percs by Christiansen and Sergi. The perc rates were both 7
minutes per inch in those areas tested. No septic design was
submitted since, I believe the engineers recommended their client
not to purchase the lot. In January of 1995 a design was submitted
by Robert Masys of R.A.M. Engineering using a design rate of 8
minutes per inch. When checking the old design, I noted that the
18 minute perc test is located in the area of the proposed system
and rejected the plans as having an improper design rate and
Page 2
DEP - Claire Holland
May 25, 1995
insufficient leaching area as well as for other reasons. The perc
rate used is one of the most critical items.
I have enclosed copies of both old and new designs with notes
for your perusal. I would appreciate a reply as soon as possible.
If you have any questions, please call me at 508-688-9540.
Thank you.
Sincerely,
Sandra Starr, R.S.
Health Administrator
SS/cjp
Enclosure
cc: Ken Mahony, Dir., Comm. Dev. & Services
BOH
,,X -i 1 e
Town of North Andover Of tkORTH AV
OFFICE OF 4 ��10 '6
0
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
KENNETH R. MAHONY North Andover, Massachusetts 0 1845 SACHU
Director (508) 688-9533
May 18, 1995
Ram Engineering
160 Main Street
Haverhill, MA 01830
Re: Lot #6 Candlestick Road
To Whom it May Concern:
This is to inform you that the proposed plans for site
referenced above have been disapproved for the following reasons:
1) Insufficient leach area. Size to be based on slowest
perc rate obtained (310 CMR 15.03e), and the North
Andover Regulation 4.14. This is 18 minutes per inch as
shown on approved plan dated 0/26/95. (Design on 20
minutes per inch).
2) Note that all pipe in system, including trenches must be
SCH 40 (N.A. Regulation 17.17).
3) Reserve area.must be 4 feet from primary (N.A. Regulation
2.23).
4) Pea stone depth must be 4 inches or 2 inches of stone and
filter fabric (N.A. Regulation 17.07).
5) Please locate all known deep holes and perc tests on site
plan (N.A. Regulation 6.02).
Sincerely,
Sandra Starr, R.S.
Health Administrator
SS/cjp
cc: Steve Doherty
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Town of North Andover, Massachusetts Form No.3
BOARD OF HEALTH
N
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DISPOSAL WORKS CONSTRUCTION PERMIT
ADDR
Permission is hereby granted to Construct (4,<O—r Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No. 71��-
CHAIRMAN, BUAK�UW- HEALTH
F e e D.W.C. No. —EQ -,a_
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: I I I& -&7�
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING:U -6 7?��QUANTITY PUMPED GALLONS
CESSPOOL: NO e,'-�YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE --�E�ERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY: (3
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO: S 0.
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R.A.M. ENGINEERING
160 MAIN STREET
HAVERHILL, MA.
508-372-0449
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Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
January 10, 19 96
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( X) or repaired
by - Tim Melvin IN�TALLER
at Lot #6 Candlestick -Lane
SITE LOCAT1111
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. 742 -dated August 2, 19 95
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
BOARD OF NtAL I H
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: Z) r, Phone 7,,,,� V
LOCATION: Assessor's Map Number
Subdivision
C,qtq bl 7 -&-
Street ee�
Parcel
Lot (s)
St. Number
************************Official Use Only************************
RECOMIENDATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved
Date Re3ected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved ghz�:5—
Date Rejected
Received by Building Inspector Date
? i t 141
S t a -r t
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Dr2p
6 � yj)
)mber-
-.)UUU-L V.—
Pi an Owner
4Y Z -
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Observe r ("J
—2
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SOIL PROFILES -DATE
lilev.
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Elev., A-Elev.
0
01
0
0
)nd 3"Duro
Lt,ICJ-,q 'Rate
Ties to Test Pitj
2
2
2
2
3
3
3
3
4
4
4
5
5
5 1
6
6
6
7
7
7
8
8-
8
8
9
9
9
9
,0
10
10
10
B -nch
L mark
Location
evation
Datum
Percolation
Tests -Date
? i t 141
S t a -r t
�01: -1
t -a j L
Dr2p
6 � yj)
)mber-
1
4
-Saturation
—2
n S
To S
)f "—Time
ri me
)nd 3"Duro
Lt,ICJ-,q 'Rate
il
Benchmark
Location-
ElevatIon
Datum
Percolation Tesks-Dat
e__
Pit Number -
SOIL
PROFILE
& PERCOLA TION TEST
DATA.
E4
04%1��r
Soak- F-li-ns-
,��tart
North Andz)v er, 1.,,a 8 s.
No.&Street
Lot No. 6
Loc.-/Subdiv.
P I an'
Owner
Owner
Investi.gator
Observer.
-
SOIL
PROFILES -DATE
1�3_ev.
2
Elev.
3.
Elev.
4
-:--7-Elev.
0
0
0
0
Pe -eol_ation Rate
2
2
Ties to Test Pitt
2
3
3
3
3
4
4
4
4
j
5
5.
6
6
6
7
7
8'
8
8
9
9
9
10
1
10
- 1
*10
-1 n
Benchmark
Location-
ElevatIon
Datum
Percolation Tesks-Dat
e__
Pit Number -
3
5
Start Saturation
E4
Soak- F-li-ns-
,��tart
* Test -Time.--_
Dr�� of 311-1��ime_
Drop of 6" -Time
Mins - I st. 3"Drop -.
Mihs. 2nd 3"Drop
Pe -eol_ation Rate
—z- x X -e
7o-�� r /5
6008W.Ot-0 (q3S--.216,O)
A -AID I Z;ll 1.1le-eel
'41-501 "81 '*n 0 v V� 7% e
vaca -60'? -,41 "7 aj e ek
V7
/11" ge -/
�.04 — q�
-, /,, -r i & ( , C 0 4 C/ /e 5 -/ I C, - k N. A
��-4ck,
fl -)-318 sr
Syslipm Ownet
Ykte's
commonweafth of Massachusells
'A-d/eyamassacht-iset(s
��z
aysteffl pp!Wlqg Re ord
Syslem Localioll
1—�r " .-
Dale of Pullipilig: Quawity Iltimped: gallons
Cesspool. NO- yes Sepiic Tank: No yese��-
Syslem Pumped by: Farede're License
cl),11pliisumisremedlo: gleater LAwtence sanitary pis Itic I --
Date., Inspector.
Commonwealth of Massachusetts
City/Town of RECEIVED
RECE
System Pumping Record
0
Form 4 N 2
NOV 25 2008
DEP has provided this form for use by.local Boards of q.qthgrR*,wsuuayFb used, but the
information must be substantially the same as that pro id -t 90 6ff U s form, check with your
vst Pumping Record must be submitted to
local Board of Health to determine the form they use. he System P
the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out I . System Locatio left rear, left sio-b-f �hous . Right front, right rear, right side of house.
forms on the I ------
computer, use
only the tab key Address
to move your Ca_A—A�P—� Cj� P,
cursor - do not Cityrrown State Zip Code
use the return
key. 2. System Owner:
h
CA
Name
Address (if different from location)
City/Town stf�� Z* Code
Telephone Number
B. Pumping Record
1 . Date of Pumping Date Quantity Pumped: Gallons
3. Type of system: Ll Cesspool(s) Ga-g-e-ptiic Tank Tight Tank
0 Other (describe):
4. Effluent Tee Filter present? El Yes If yes, was it cleaned? El Yes 0 No
5. Condition of System:
f 't'�
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. LocatjqD-wh_ere contents were disposed:
Lowell Waste Water
F 5821
Vehicle License Number
of Harutbr Date
t5form4.doc- 06/03 System Pumping Record - Page 1 of 1