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Miscellaneous - 86 WILLOW RIDGE ROAD 4/30/2018 (2)
11 r 1% SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? TYPE OF CONSTRUCTION: or .N 0ES�, NO NEW PAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? YES NO DWC PERMIT NO. cS�'l INSTALLER: 1,0140 SavG�y BEGIN INSPECTION YE�O: EXCAVATION INSPECTION: NEEDED: PASSED CONSTRUCTION INSPECTION: AS BUILT PLAN SATISFACTORY: BY Z A NEEDED: APPROVAL TO BACKFILL: DATE: FINAL GRADING APPROVAL: DATE ���� BY FINAL CONSTRUCTION APPROVAL: DATE:C/G�BY Commonwealth of IVlassachuse s RECEIVED ED _ City1T®wn ®f Norl:h Andover MAY 11 2015 S - stem Pumping Recti TOWN OF NORTH ANDOVER - HFAjFI DEPARTMENT Fora 4 w` 0 _.ma be used but the DEP has provided this form for use by local Boards of Health. OUher orms y same as that provided here. Before Record must.be o check information must be substantially the submitted local Board of Health to determine the form they use. The System Pumping the local Board of Health or other approving authority within 14 days from the pumping, date in accordance with 310 CMR 15.351. City/ own Ma ., 01886 State Zip Code State Telephone Number Zip Code B. Pumping Decor � / Quantity Pumped: Gallons 1. Date of Pumping Date 3. Type of system: E]Cesspool(s) Septic Tank ❑ Tight Tank ❑Crease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. &i'Ste1�i Pumped By: If.yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number t—e rt's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Signature of Receiving Facility Date Date System Pumping Record - Page t5form4.doc- 03/06 A_ Facility Informati®n important, When 511ing out forms System Location: 1. S Y on the computer, use only the tab key to move your Address cursor - do not North Andover use the return City/Town key. 2. System Owner: .&1 c Name MW ��& Address (if different from location) City/ own Ma ., 01886 State Zip Code State Telephone Number Zip Code B. Pumping Decor � / Quantity Pumped: Gallons 1. Date of Pumping Date 3. Type of system: E]Cesspool(s) Septic Tank ❑ Tight Tank ❑Crease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. &i'Ste1�i Pumped By: If.yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number t—e rt's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Signature of Receiving Facility Date Date System Pumping Record - Page t5form4.doc- 03/06 7094 • . Town of North Andover `••o;, o �:,' HEALTH DEPARTMENT cNustt / CHECK #: ��3 DATE:. LOCATION: VZ fOA) H/ O NAME: ,( CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing ❑ Septic - Design Approval ❑ Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ Title 5 Inspector *IKTitle 5 Report ❑ Other. (Indicate) r V Health Agent Initial.- White nitial: White -Applicant Yellow -Health Pink -Treasurer CD N co v rn w w rn r r O O m r m cn 0 0 0 r m z z 0 0 m o o ° m Z m z� 0 O z D =3 o: D- 0 i mo 1 z Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road l Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner's Name North Andover Cityrrown MA 01845 State Zip Code 4/22/2015 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor - do not John DiVincenzo use the return key. Name of Inspector Stewarts Septic Service Company Name 58 South Kimball St. Company Address Bradford City/Town 978-372-7471 Telephone Number MA 01835 State Zip Cde S113386 Cd License Number APR 2 9 2015 B. Certification TOWN OF NORTH ANDOVER HEALTH DEPARTMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority I ector's Signature 4/23/2015 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 1 of 17 €te Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - N Owner's Name North Andover Cityfrown B. Certification (cont.) L. and Brian M. Baker Trustees MA 01845 4/22/2015 State Zip Code Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form m, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - N Owner Owner's Name information is required for every North Andover page. City/Town B. Certification (cont.) L. and Brian M. Baker Trustees B) System Conditionally Passes (cont.): MA 01845 4/22/2015 State Zip Code Date of Inspection ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool E] ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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 under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 09/08 T Ue 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? information The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. CityrFown State Zip Code Date of Inspection D. System Information Description: PumoD used to tranfer wastewater into a standard leachina field. Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sinale residential well in use Sump pump? Last date of occupancy: Commercial/industrial Flow Conditions: ❑ Yes ® No N/A ® Yes ❑ No 4/22/15 Date Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Date Source of information: As -built plan dated 8/13/1996 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? truck volume Reason for pumping: internal inspection Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Septic tank about 30 years, +/-, leaching field 20 years Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): 3.5',+/ - feet Distance from private water supply well or suction line: 87',+/-, septic tank connection -100' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Average. Septic Tank (locate on site plan): Depth below grade: 2'9 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 10'x 6'x 5', Sludge depth: 6 t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 2.2 Scum thickness 2-3 Distance from top of scum to top of outlet tee or baffle 9-101, Distance from bottom of scum to bottom of outlet tee or baffle 17-18" How were dimensions determined? field observed Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend pump septic tank every 18 months. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain).- Dimensions: 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: Date t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts -- w Title 5 Official Inspection Form ^, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Condition looked good, no evidence of solids carryover or surging Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): pump chamber free of floating solids. Trace level (0-1") of sludge in pump chamber. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form m, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields 1, 27'x45' number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of breakout observed. No damp soil at surface or in field. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Na Owner Owner's Name information is North Andover required for every page. Cityrrown L. and Brian M. Baker Trustees MA 01845 State Zip Code 4/22/2015 Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand -sketch in the area below ® drawing attached separately t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form R, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments _ 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Na Owner Owner's Name information is required for every North Andover page. City/Town L. and Brian M. Baker Trustees D. System Information (cont.) MA 01845 State Zip Code 4/22/2015 Date of Inspection Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: T* feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record .1 ■I If checked, date of design plan reviewed: rev. 9/21/1995 Date 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: 3'* = the system has a raised leaching out of ground water. Bottom of field estimated at 101.2' and ave. GW level at 98.2', +/-. Bottom of field is not in ground water but site has hydrology complexities. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Willow Ridge Road Property Address Nancy L. Baker Living Trust - Nancy L. and Brian M. Baker Trustees Owner Owner's Name information is required for every North Andover MA 01845 4/22/2015 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 i0©1 ---O t,)o.�11 M 1p i ELEVATIONS (Invert) Tank Out: 100.15 Pump Chamber In: 99.90 Pump Chamber Out: 100.06 D -Box In: 102.76 D -Bax Out: 102.57 Header # 1: 102.47 2: 102.51 3: 102.45 4: 102.44 5: 102.42 Pipe, Field End #1: 102.26 2: 102.28 3: 102.26 4: 102.23 5: 102.19 t SY Co 4JTARt+� MEASUREMENTS AC - 35' BC - 32' AD - 32' BD - 43' AE - 36' BE - 46' AF - 45' BF - 49.6' CERTIFIED ASBUILT PLAN I hereby certify that I have reviewed the installed septic system and find it to be in reasonable conformance with plans by me dated August 24, 1994, revised September 21, 1995, 4, pages. CARBONE ASSOCIATES 270 Ferry Road Ward Hill, MA 01835 (508) 521-2595 86 Willow Ridge Road North Andover Brian and Nancy Baker Installer: John Soucy Date: August 13, 1996 Commonwealth of Massachusetts _-- City/Town of North Andover Syyst m Pumping Rec®rd Form'4-- ' Q,�J but the DEP has provided this form for use by local Boards of Health."f k r=i I , check with your information must be substantially the same as that provided h_ st be submitted to Record mu local Board of Health to determine the form they use. The System Pumping date in the local Board of Health or other approving authority within 14 days from the pumping accordance with 310 CMR 15.351. A Fgcality Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rzwn System Location: 1� (D Address 01886 North Andover Ma State Zip Code City/Town 2. System Owner: �n1i O i . Name Address (if different from location) State City/f own Telephone Number B. Pumping Record / - - G ` 2. Quantity Pumped: 1. Date of Pumping Date ❑ Ti ht Tank 3. Type of system: ❑ Cesspool(s) ,�j ptic Tank g ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes IC�N0 5. Condition of System: Zip Code Gallons ❑ Grease Trap If.yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped Vehicle License Nu ber Na Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's PDO reatment Plant, 20 So. Mill Bradford, Ma 01835 of Receiving Facility t5form4.doc• 03/06 Date Date a System Pumping Record • Page 1 0 Commonwealth of Massachusetts City/Town of North Andover System Pumping Record Form 4 M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days fromi t�e in accordance with 310 CMR 15.351. ' E, City/Town Ma State State Telephone Number B. Pumping Record P� 1. Date of Pumping in Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 0 OCT 18 ZU1I 4 OF NORTH ANDOVER ��EPAR?'M �N''�:, 01845 Zip Code Zip Code -75-n Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No S stem Pu rnped By: 1 -Vcj l Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: ,Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Sigfniture`oa u- I e'r Date Signature of Receiving Facility Date t5form4.doc° 03/06 System Pumping Record ° Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms the computer, use only the tab key Address to move your No.Andover cursor - do not City/Town use the return key. r� 2. Syst caner: c — Name Address (if different from location) City/Town Ma State State Telephone Number B. Pumping Record P� 1. Date of Pumping in Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 0 OCT 18 ZU1I 4 OF NORTH ANDOVER ��EPAR?'M �N''�:, 01845 Zip Code Zip Code -75-n Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No S stem Pu rnped By: 1 -Vcj l Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: ,Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Sigfniture`oa u- I e'r Date Signature of Receiving Facility Date t5form4.doc° 03/06 System Pumping Record ° Page 1 of 1 1 ao l @`74w;l lowpjge ` o. ELEVATIONS (Invert) Tank Out: 100.15 Pump Chamber In: 99.90 Pump Chamber Out: 100.06 D -Box In: 102.76 D -Box Out: 102.57 Header # 1: 102.47 2: 102.51 3: 102.45 4: 102.44 5: 102.42 Pipe, Field End #1: 102.26 2: 102.28 3: 102.26 4: 102.23 5: 102.19 o��Ep�tN Of'�s o TN0M v CARgp1V,- 9 NO. 1010 �., ./STEREO 1�/ rA a % A Y MEASUREMENTS AC - 35' BC - 32' AD - 32' BD - 43' AE - 36' BE - 46' AF - 45' BF - 49.6' CERTIFIED ASBUILT PLAN I hereby certify that I have reviewed the installed septic system and find it to be in reasonable conformance with plans by me dated August 24, 1994, revised September 21, 1995, 4' pages. CARBONE ASSOCIATES 86 Willow Ridge Road 270 Ferry Road North Andover ; Ward Hill, MA 01835 Brian and Nancy Baker (508) 521-2595 Installer: John Soucy Date: August 13, 1996 Scale • i "= 3,0, 2 ELEVATIONS (Invert Tank Out: 100.15 Pump Chamber In: 99.90 Pump Chamber Out: 100.06 D -Box In: 102.76 D -Box Out: 102.57 Header # 1: 102.47 2: 102.51 3: 102.45 4: 102.44 5: 102.42 Pipe, Field End #1: 102.26 2: 102.28 3: 102.26 4: 102.23 5: 102.19 tH OF c� THOMAS G ti CARBONE w No. 1010 /STea�`� /V/TAR% r. .T MEASUREMENTS AC - 35' BC - 32' AD - 32' BD - 43' AE - 36' BE - 46' AF - 4-5 ' BF - 49.6' CERTIFIED ASBUILT PLAN i I hereby certify that I have reviewed the installed septic system and find it to be in reasonable conformance with plans by me dated August 24, 1994, revised September 21, 1995, 4 pages. i k i CARBONE ASSOCIATES 86 Willow Ridge Road 270 Ferry Road North Andover Ward Hill, MA 01835 Brian and Nancy Baker (508) 521-2595 Installer: John Soucy Date: August 13, 1996 SC -0(0- - r ". 3d v August 30, 2002 Ms. Sandra Starr, R. S. Health Administrator Town of North Andover Office of Community Development Services 30 School Street North Andover, MA 01845 RE: SEPTIC SYSTEM REPAIRS Dear Ms. Starr: As you are aware, the repairs to our septic system at 86 Willow Ridge Road were completed in August, 1996. Per the letter to us dated October 25, 1995 from Sabin M. Lord, Regional Engineer for Resource Protection, Commonwealth of Massachusetts, Department of Environmental Protection, we were directed to have the tank pumped once a year and to have the pumping reported to the North Andover Board of Health. In accordance with the above, per the attached invoice from Soucy's Sewer Service Inc., the tank was pumped this year on July 17, 2002. Very truly yours, Brian M. Baker b 1C% November 23, 2001 Ms. Sandra Starr, R.S. Health Administrator Town of North Andover Office of Community Development Services 146 Main Street North Andover, MA 01845 RE: SEPTIC SYSTEM REPAIRS Dear Ms. Starr: As you are aware, the repairs to our septic system at 86 Willow Ridge Road were completed in August, 1996. Per the letter to us dated October 25, 1995 from Sabin M. Lord, Regional Engineer for Resource Protection, Commonwealth of Massachusetts, Department of Environmental Protection, we were directed to have the tank pumped once a year and to have the pumping reported to the North Andover Board of Health. In accordance with the above, per the attached invoice from Andover Septic, the tank was pumped this year on November 20, 2001. Very truly yours, Brian M. Baker Rp ory %200e / ❑ Reg ANDOVER SEPTIC 20 South Mill Street O N/C (978) 475-2593 Bradford, MA 0 835 Date of Service" PAY FROM THIS BILL ROTO -RAM - (978) 4529622 C Nature of Service. Aeg. Maint. ❑ Emergency Day ❑ Night Customer Name: Septic Tank Pumping and Cleaning Service Location:" ! Phone: "Done the Right Way" Emergency 24 Hour Service - 7 Days a Week Contact: Billing Address: City: 4Z, Zip: Special Instructions Completed ❑ Incomplete Reason: Per: AM/PM Services Rendered r Pumping Observations Drain Cleaning 1V-,acuum t Septic Tank �❑ Drywall Good Condition ❑ Leechfield Runback ❑ Main Line ❑ Toilet Bowl O Leech Pit / Overflow ❑ Riding High ❑ Kitchen Sink ❑ D -Box (liquid level) ❑ Bathtub / Shower ❑ Pump Chamber ❑ Full to Cover ❑ Vanity ❑ Grease Trap O Catch Basin ❑ Portable Toilet ❑ Other G� Ory: Size: O Under 1000 gallons 1:11000 gallons O 1500 gallons ❑ 2000 gallons ❑ 3000 gallons ❑ 4000 gallons O 5000 gallons O other ❑ Excessive Solids Top / Bottom ❑ Use No Powdered Soap a Heavy Grease Roots ❑ Suggest Electric Rooteri ng O Van Called ❑ Other ❑ Floor Drain ❑ Yard Drain El Vent ❑ Sewer Jet ❑ Other Footage: cJ Misc. 1 ❑ Digging Charge / ❑Backhoe ❑ Inspection ❑ Location ❑, Consultation ❑ Certification: P/F ❑ Service Call O Estimate Reason: ❑ Labor ❑ Portable Toilet Rental O Pump Repair ❑ Waiting Time O Baffle ❑ Repair Digging Charge Is Per Driver ❑ Chemical Treatment Discretion O Other Description of Work Recommendations Terms of Payment Parts Vacuum Pumping Drain Cleaning Yr. Month Yr. Month NET 15 DAYS Tax Discount Terms & Conditions ❑ Cash ❑ Check O Credit Total // (( 1. Not responsible for damage beyond curb line. 3. 1.5% per month will be charged to accounts past due. 2. All complaints shall be reported within 48 hours. 4. The purchaser agrees to pay all coat of collection. Customer Signature Serviceman 11 November 17, 2000 Ms. Sandra Starr, R.S. Health Administrator Town of North Andover Office of Community Development Services 146 Main Street North Andover, MA 01845 RE: SEPTIC SYSTEM REPAIRS Dear Ms. Starr: As you are aware, the repairs to our septic system at 86 Willow Ridge Road were completed in August, 1996. Per the letter to us dated October 25, 1995 from Sabin M. Lord, Regional Engineer for Resource Protection, Commonwealth of Massachusetts, Department of Environmental Protection, we were directed to have the tank pumped once a year and to have the pumping reported to the North Andover Board of Health. In accordance with the above, per the attached invoice from Andover Septic, the tank was pumped this year on November 16, 2000. Very truly yours, Brian M. Baker 27 0 Rag ANDOVER SEPTIC D WC (978) 475-2593 Drt`of rvi - 47 Railroad Street ROTO=RAM Bradford, MA 01835 (978) 452-9022' o ' �p'_y Q 'Night PAY FROM THIS BILL Customer Name: ; Service Location: ✓ , Septic Tank Pumping and.' leaning Phone: 11 1 "Done the Right'W-a Emergency Hour Servic = 71Days a Week — Contact: �. Billing Address' City: j / /L .� Zip: Special InstructionsV ❑completed / x ,� • � �1�� . ❑ Incomplete Reason: Per: i AM/PM % Services Rendered a Vacuu umping Observations Drain Cleaning ' Septic Tank ❑ Good Condition ❑ Main Line ❑ Drywall ❑ Leechfield Runback ❑ Toilet Bowl ❑ Leech Pit / Overflow ❑ Riding High ❑ Kitchen Sink . O D -Box (liquid level) ❑ Bathtub / Shower ❑ Pump Chamber ❑ Full to Cover ❑ Vanity ❑ Grease Trap ❑ Excessive Solids ❑ Floor Drain , _ ❑ Catch Basin - Top / Bottom ❑ Use No Powdered Soap ❑ Yard Drain- ❑ Portable Toilet ❑ Other ❑ Heavy Grease ❑ Vent ❑ Sewer Jet _ Oty❑Other ❑ Roots � Size: �/ ❑ Under 1000 gallons 64-1110,00 gallons ❑ 1500 gallons El Suggest Electric Rootering Footage: f ❑ 2000 gallons ❑ 3000 gallons ❑ 4000 gallons ❑ Van Called ❑ 5000 gallons ❑other ❑ Other Misc. cam, ❑ Digging Charge ❑ Backhoe ❑ Inspection ❑ Location ❑ Consultation ❑ Certification: PIF ❑ Service Cal ❑ Estimate Reason: ❑ Labor ❑ Portable Toilet Rental ❑ Pump Repair ❑ Waiting Time ❑ Baffle ❑ Repair Digging Charge Is Per Driver ❑ Chemical Treatment Discretion r ❑ Other ; Description of Work Recommendations Terms of Payment parts' Vacuum Pumping Drain Cleaning NET 15 DAYS Tax Yr. Month Yr. Month Discount • Terms 3 Conditions ❑ Cash ❑ Check 1. Not responsible for damage beyond curb line. ❑ Credit 3. 1.59E per month will be charged to accounts past due., Total 2. All complaints shall be reported within ♦8 hours. 4. The purchaser sprees to pay all cost of collection.. j (/ Customer Signature Serviceman U / LIUL z ' o ElH H 44 AOcii 0 U t z cn W v O Z z a H o 04 0zE' s V a0 E-4 Q a E-4 x A W04 * U ,a •a zA w : a 04 O 04 H ° a. a W v7 irr^^ O z b �1 V) z M H A J IQ a cn . aL4 j .. H . rn N CD W C 4 a North Andover Board of Health 120 Main St. North Andover Ma.01845 Haul Lic. #151 -OOH Install Llc. # 128-0 Date Address 11/1/2000 303 Chester St 11/1/2000 50 Willow Rd 11/1/2000 160 Carelton Ln 11/1/2000 165 Bridal Path 11/4/2000 174 Ingals St 11/4/2000 1062 Salem St 11/6/2000 373 Raligh Tavern Ln 11/6/2000 252 Boxford St 11/6/2000 150 Liberty St 11/6/2000 149 Osgood St 11/7/2000 255 Haymeadow 11/7/2000 850 Winter St 11/8/2000 25 Windsor Ln 11/9/2000 249 Carlton Ln 11/9/2000 767 Johnson St 11/10/2000 56 Academy Rd 11/14/2000 Sugar Cane Ln 11/14/2000 250 Abbott St 11/15/2000 195 Winter St 11/15/2000 187 Winter St' 11/16/2000 85 Laconia Cir 11/16/2000 86 Willow Ridge 11/17/2000 2135 Turnpike St 11/20/2000 203 Grandville Ln 11/20/2000 391 Pleasant St 11/20/2000 124 Tucker Farm Rd 11/22/2000 394 Boston Rd 11/22/2000 728 Forest St 11/22/2000 18 Johnney Cake St 11/24/2000 106 Rockey Brook Rd 11/24/2000 258 Rea St 11/28/2000 1815 Great Pond Rd 11/28/2000 1420 Great Pond Rd 11/29/2000 266 Lacy St 11/29/2000 155 Laconia Cir Andover Septic 47 Railroad St. Bradford Ma. 01835 Gallons Comments 1000 1000 1500 1500 1000 1250 1000 1000 Leachfield Run Back / Ex. Solids 1500 1000 1500 1250 1500 1500 1500 1500 1500 1000 Extra Solids 1500 1500 1500 1000 1500 1000 Flooded 1500 1500 1500 1500 1500 1500 1000 1000 1500 1000 1500 Elm September 5, 1999 Ms. Sandra Starr, R.S. Health Administrator Town of North Andover Office of Community Development Services 146 Main Street North Andover, MA 01845 RE: SEPTIC SYSTEM REPAIRS Dear Ms. Starr: TC. - 1 51999 As you are aware the repairs to our septic system at 86 Willow Ridge Road were completed in August, 1996. Per the letter to us dated October 25, 1995 from Sabin M. Lord, Regional Engineer for Resource Protection, Commonwealth of Massachusetts, Department of Environmental Protection, we were directed to have the tank pumped once a year and to have the pumping reported to the North Andover Board of Health. In accordance with the above, and per the attached invoice from Soucy's Sewer Service, this is to inform you that the tank was pumped this year on August 23, 1999.. Very truly yours, �' oz� Brian M. Baker souc D E OF SERVICE u`rtia �23 /q q4 SEWER SERVICE INC. COMPLETE SEWER -SEPTIC SERVICE INVOICE ? ;c CUSTOMER iDMER NAME N (978) 683-5709 (978) 470-1400 Methuen, MA Andover, MA (978) 937-9889 (978) 851-8839 Dracut, MA Tewksbury, MA (603) 898-9339 (978) 663-6633 Salem, NH Billerica, MA (978) 658-7700 Wilmington, MA BILLING ADVRESS g ti • ,,, ,� -' C TY STATE ZIP PHONE: JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS ADDRESSLDE "44-4h�.� ZIP CRIPTIONOF WORK VACUUM PU P C; -SEPTIC TANK GALS. ❑ CES -- = OVERALL SYSTEM 0 DRYWELL O BASEMENT FAILED SYSTEM COMMENTS TERMS OF PAYMENT TYPE OF SERVICE TAX EXEMPT w 7AX TOTAL CASH 0 RES/COMM ❑ INDUSTRIAL 0 CHECK CHARGE ❑ PLUMBING O $ JOB COMPLETION This is to acknowledge completion of the above described work which has been done to my complete satisfaction. We will assume no responsibyty for any damage made on driveway, curbo walkway. DATE cusJOWER SIGN URE S AVICEMAN'S NAME fi' \ / E ƒ /Ln [ �7 •g c 3 � E J y LnCN \ £ � o / / U. // ) \.\ \ A U o > / f f ° 0 \ \ 2 <f Ln L �§\ \/ U a j ©E_ u w<2 \ 0 o ± $ O L 0 oG ¥ ou < 2/% u W < 2 /- / ± 2 / 3 _ < z .- r-) - t - / \ 0 ® 2 / -C = \ k co / Z 2 IL a m S s 0 ¥ ° ¥ f a w g = g o t/ ©/ Z/ / u / 7 *CL\ < r 2 / 7 � / & ) . / 2 co V) 7 \ ) 0 § z / f r ) 7 u 0 / < / % / Chairperson North Andover Board of Health Town Hall North Andover, MA 01845 Dear Board Members: Brian and Nancy Baker 86 Willow Ridge Road North Andover, MA 01845 September 22, 1994 This letter is addressed to you to ask your consideration in reviewing the proposed septic system for our home at 86 Willow Ridge Road. Our current system is currently in a state of failure, necessitating a prompt repair. The proposal has been designed by Thomas G. Carbone, a Registered Sanitarian in the Commonwealth. We respectfully request that the Board approve waivers of the following regulations and requirements: 1. The bed bottom will be 2 feet above the ground water where 4 feet is required. 2. The edge of the bed will be 44 feet from a drainage easement were 100 feet is required. 3. There is no Reserve Area shown; future repair shall consist of removing contaminated stone and sand and replacing with clean material in place. 4. The edge of the bed will be 60 feet from an area of seasonal standing water where 100 feet is required. The existing septic system was designed by Joseph Barbagallo, R.S., in 1976, prior to the existing working version of Title 5. Prior to 1978, there were times when systems were allowed under the code to be placed as close as 2 feet above the water table. We ask that this be considered while deliberating on our request. We hope that you will see this request in a favorable light, so that we will be able to commence repair work shortly and have the entirq project completed and the area reseeded while the weather conditions are still good. Respectfully submitted, Brian Baker Ma Form No. 3 Town of North Andover, Massachusetts BOARD OF HEALTH HORTN ,1 �.� I.n L/ _1 9 pf i.aa ,e, NO , a 1 a i DISPOSAL WORKS CONSTRUCTION PERMIT SZA SB _ TELEPHONE Applicant AME ADDRESS Site Location Re air (tan Individual Soil Absorption or Permission is hereby granted to Construct ( ) P Sewage Disposal System as shown on the Design Approval S.S. No. f MoRTq ooc 0 P ,SSACNUSEt� Town of North Andover, Massachusetts BOARD OF HEALTH DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Form No. 2 Applicant ���%�Ni9'e�'e Test No. Site Location Of.) l l.(AL ,�fOCc.)�l� DGS Reference Plans and Specs. 20M Cge 801/e r ig,?-r 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. �J C MAN, BOARD OF HEALTH Fee Site System Permit No. 7,59 Carbone Associates 270 Ferry Road - Ward Hill, MA 01835 • (508)521-2595 • fax August 13, 1996 Mr. Sabin M. Lord, Jr. Department of Environmental Protection 10 Commerce Way Woburn, MA 01801 Re: 86 Willow Ridge Road, North Andover DEP Transmittal No. 94811 Dear Mr. Lord: RTH aHpoV�R/ TOw gOAgp of HEA► w� p�G 'L 01996 `, I This letter serves as the certification concerning the septic system repair for the above property. Please see the attached Certified Asbuilt Plan dated August 13, 1996, for system location, measurements, and elevations. In a letter dated October 26, 1995, entitled "Modification to Approval of Variance Request", certain conditions were imposed on the approval; answers to those conditions are as follows: 1. Additional percolation test: unable to be performed due to water table; see letter from Sandra Starr, R.S., Health Administrator for North Andover dated August. 24, 1995, certifying conditions on site. 2. Installation of Monitoring Well: Installed and monitored in Early 1995; see earlier correspondence detailing results and revisions of pians. 3. Liner around existing system: No liner was existing , as evidenced by inspection during system installation. 4. Garbage Disposal: Removal is in progress as of this writing, and will be verified by the Bakers. 5. Naturally occurring material: On August 8, 1996, Sandra Starr, Health Administrator and I witnessed a deep hole test conducted within the system excavation. At that time, the impervious material was removed, to roughly elevation 98.00, and a deep hole was dug to elevation 94.00, revealing 4' of sandy loam below all impervious material. 6. Bed Bottom / Water Table Separation: As the system was installed as designed, there is a 3.2 foot separation. 7. Pump Chamber Effluent Outlet Valve: A valve was installed after the pump to turn the system into a tight tank if needed. 6b €4'Willow Ridge Road North Andover August 13, 1996 Page Sincerely yours, �j k:). Thomas G. Carbone R.S., C.H.O. cc: North Andover Board of Health Mr. & Mrs. Baker John Soucy William F. Weld Governor Trudy S. Coxe Secretary, EOEA David B. Struhs Commissioner Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protects Metro Boston/Northeast Regional Office Brian and Nancy Baker 86 willow Ridge Road North Andover, MA 01845 RE: MODIFICATION TO APPROVAL OF VARIANCE REQUEST Application for BRPWP02 - Title 5 Variance 86 Willow Ridge Road, North Andover DEP Transmittal No. 94811 Dear Mr. and Mrs. Baker: IYN V, OF Hc""---', BOARD 3 1995 i. October 26, 1995 The Metropolitan Boston -Northeast Regional Office of the Department of Environmental Protection recently received additional information as required by its approval of your variance application for the above referenced project. In the approval letter dated, January 9, 1995, four special conditions were imposed upon the . approval. These conditions were as follow: • A percolation. test shall be performed in the area of the proposed system at the time of excavation for the new system. If, at that time, the percolation rate of the soil is found to be slower than 10 minutes per inch, this approval shall be considered null and void and a new application will have to be filed. The percolation test shall be not be performed in frozen soils. The test shall be witnessed by the Board of Health or its administrator. A letter shall then be submitted by the Board of Health or its administrator to the Department documenting the percolation rate found at the site. • A monitoring well shall be installed in the vicinity of the system. Groundwater elevation readings shall be made once every two weeks, using the same datum for elevation determination, during the months of February, March, April May and June. The information shall be submitted monthly to the Board of Health and the Department. In the event that there is found to be less than the approved separation of 3.2 feet, the applicants shall notify the Department and Board of Health in writing within ten (10) days of the elevation reading. The Department will then determine what, if any action, by the Department is warranted. • The plan of the existing system indicates that a liner was installed around the existing system. As much of the liner as possible shall be removed without compromising the integrity of the existing permeable soil beneath the system. • The system is not properly sized to accommodate a garbage disposal. The plans indicate that the house currently has a garbage disposal. As such, the existing disposal shall be removed 10 commerce Way • Woburn, Massachusetts 01801 • FAX (617) 932-7615 • Telephone (617) 932-7600 -r Carbone Associates 270 Ferry Road • Ward Hill, MA 01835 • (508)521-2595 June 19, 1995 Mr. Sabin M. Lord, Jr. Regional Engineer for Resource Protection Department of Environmental Protection 10 Commerce Way Woburn, MA 01801 Re: 86 Willow Ridge Road, North Andover DEP Transmittal No. 94811 Dear Mr. Lord: This report is in response to the Department's approval conditions in a decision dated January 9, 1995, addressed to Brian and Nancy Baker, for variances related to the repair of an existing failed septic system. The following is the report of ground water levels for March and April, 1995. The top of the outer casing is at elevation 104.08, and the top of the 2" pvc is elevation . 103.94 (both assumed). Date Depth below outer casing Elevation 3/4/95 68" 98.41 3/19/95 64" 98.75 4/1/95 69" 98.33 4/15/95 70" 98.25 5/5/95 75" 97.83 5/13/95 76" 97.75 5/31/95 78" 97.58 The applicant has taken the above readings and has reported them to me for interpretation and reporting. Ground water table readings will be taken twice monthly as required, and reported monthly. A percolation test will be conducted in June, once the water table has dropped, and a revised plan reflecting required changes will be submitted for review and approval. 86 Willow Ridge Road North Andover June 19, 1995 Page 2 Respectfully submitted, L C1- Thomas G. Carbone, R.S. cc: Mr. & Mrs. Baker North Andover Board of Health Carbone Associates 270 Ferry Road • Ward Hill, MA 01835 • (508)521-2595 April 4, 1995 Mr. Sabin M. Lord, Jr. Regional Engineer for Resource Protection Department of Environmental Protection 10 Commerce Way Woburn, MA 01801 Re: 86 Willow Ridge Road, North Andover DEP Transmittal No. 94811 Dear Mr. Lord: This report is in response to the Department's approval conditions in a decision dated January 9, 1995, addressed to Brian and Nancy Baker, for variances related to the repair of an existing failed septic system. I apologize for the delay in reporting this information. As shown on the enclosed Well Completion Report, the well was installed on March 2, 1995, by T.J. Ogden Company of Tewksbury. The well was not installed prior to this date due to several reasons, including the seeking of information for proper installation, the seeking of prices, and weather conditions. The top of the outer casing is at elevation 104.08, and the top of the 2" pvc is elevation 103.94 (both assumed). The March water table readings are as follows: Date Depth below outer casing Elevation 3/4/95 68" 98.41 3/19/95 64" 98.75 The applicant has taken the above readings and has reported them to me for interpretation and reporting. Ground water table readings will be taken twice monthly as required, and reported monthly. A percolation test will be conducted in June, once the water table has dropped, and a revised plan reflecting required changes will be submitted for review and approval. Respectfully submitted, Thomas G. Carbone, R.S. cc: Mr. & Mrs. Baker North Andover Board of Health From . Y, OLDEN .,JELL & PUMP I10. PHONE h'k,. . 508 K1 90`'1 Mar. 15 1995 11: 15AM PQ1 .�" `7ivrc1h11 r!i tlVi{1P.t iic.snnrcet • Ur,ltiaru+tent irl C;+vuu+auctttol At:usapntuvntl� +� yVF.t i C OMMPTION REPORT WE! (. Li}C lONi arovinAf i11C ()ESCIMITION r ArdcLr.J 11,y__ fes' t I , Aaa . *'-�1 � �� ;; P dY rPi _ __ _ ... • frfrrN Irlrr/Il � (fn,frir Ultyilowv_ AL (Ir71. NI PMIIriP � ICTr:% !(t we sec it. W/_ fnxlll f3odrd of Huuith permii olaiained: yn nu WELL USa W1 1 1. DATA rumet,ic Q i'c/bi1C �� Inrlu�iric+i "wl�l well riar,rh ivi1Lr1tilr)I'irtg f;ll,al . _ []cplh to IxrJtvck..+�.. ...--- fr• --,,�� F'1 O1Ci'iP(lMfHt�t roti ,c.ru�rtcr.G<dnln..i niGtCfs1 M4111vu+Irjilr• d,t Ucrcriptinn ..... (Jatnrlrilfedt -- CASINO _... Type Cvr5dl ! �_.—It. i'ilalt.i S 1 "' .....fil.__ y1 1=,•om . I enptl, into oudlock. __..__id. Gravel pock vvrll: dla. PUMIctiva Wcii M11: Ulcalt, Otitcr_. _ 81at v�C�'►'(3 !angcll��f._}rotn �•-- to r't PTATit' NAI P -A LraV cL (All W0119) v,[ 131plic? avatar lava; below Istid 6'.,rfnc4 WELL TEST iproduct,on w01191 Drawdown It. Atlor pu,npiga 1,r._, (T+(r1, Mt 4rt11 iiuwaneastueci .,,,„C{srnvory It. mltel,._itr,__... w+b,. LOG cl Pt;ialb;AT"!?i'15 c0-AMCNTR tds+e. arc ; "rh y T3 A AddresS_2...Supen1sing D�dler Reg.# s1 .,,.,•„ - ,:, nrkf,r. •r'O p,P1PPulbd wet � lgb1N Fl+rw o�;�r .r+n Y ST A 3 t C Or 7 BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 Brian & Nancy Baker 86 Willow Ridge Road North Andover, MA 01845 Dear Mr. & Mrs. Baker: TEL. 682-6483 Ext23 December 16,. 1994 This is to confirm that on December 15, 1994 the North Andover Board of Health granted variances to the following regulations for the proposed septic system repair of 86 Willow Ridge Road: 1 - Depth to ground water 3.2' - North Andover regulation 17.02 310 CMR 15.14(2) 2 - Only 3' o` 3 - Distance 4 - Distance 1 5 - No reserv( 310 CMR 15.03(6) only 44' - North Andover 4.18 rth Andover 4.18 �r 17.08 _4(8) 6 - Distance oL septic tank to cellar 15' - North Andover 4.18 7 - 1000 Gallon tank less than 150% of liquid capacity - North Andover 9.01 310 CMR 15.06(1) If you have any questions, please do not hesitate to call the office at the above number. Sincerely, Sandra Starr, R.S. Health Administrator cc: Tom Carbone File �� ' � G G—r.. J �i/lc� �� BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 Brian & Nancy Baker 86 Willow Ridge Road North Andover, MA 01845 Dear Mr. & Mrs. Baker: TEL. 682-6483 Ext23 December 16,. 1994 This is to confirm that on December 15, 1994 the North Andover Boa -rd of Health granted variances to the following regulations for the proposed septic system repair of 86 Willow Ridge Road: 1 - Depth to ground water 3.2' - North Andover regulation 17.02 310 CMR 15.14(2) 2 - Only 3' of parent material - 310 CMR 15.03(6) 3 - Distance to subsurface drain only 44' - North Andover 4.18 4 - Distance to wetlands 60' - North Andover 4.18 5 - No reserve area - North Andover 17.08 310 CMR 15.14(8) 6 - Distance of septic tank to cellar 15' - North Andover 4.18 7 - 1000 Gallon tank less than 150% of liquid capacity - North Andover 9.01 310 CMR 15.06(1) If you have any questions, please do not hesitate to call the office at the above number. Sincerely, ,��:J Sandra Starr, R.S. 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Powers AcU g CommMskmw Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Metro Boston/Northeast Regional Office Brian and Nancy Baker 86 Willow Ridge Road North Andover, MA 01845 RE: APPROVAL OF VARIANCE REQUEST Application for BRPWP02 - Title 5 Variance 86 Willow Ridge Road, North Andover DEP Transmittal No. 94811 Dear Mr. and Mrs. Baker: January 9, 1995 The Metropolitan Boston -Northeast Regional Office of the Department of Environmental Protection has received and reviewed your application for approval of a sanitary sewage variance pursuant to 310 CMR 15.20 with the above transmittal number. The application contained a written notification dated October 3, 1994 and December 16, 1994 stating that the North Andover Board of Health had, on September 29, 1994 and December 15, 1994, respectively, granted variance to the provisions of: Section 15.15 (3): Ground Water; and Section 15.15 (6): Reserve Area of the State Environmental Code. The citations included in the letters incorrectly referred to the portion of the Code dealing with trenches.' The above citations were revised to reflect the applicable requirements in the leaching field portion of the regulations. In addition, variance to 310 CMR 15.06 (1) was not required since 150 percent of the average flow from the facility would be 660 gallons per day and a 1000 gallon septic tank can accommodate that flow. Although continued use of the existing garbage disposal would have triggered this variance, the leaching area cannot . accommodate the flow from the existing disposal and therefore this system is for a flow of 440 gallons per day. 10 Commerce Way a Wobum, Massachusefts oieot • FAX(617)932-7615 a Telephone (617) 832-7600 Brian and Nancy Baker January 9, 1995 Page 2 Accompanying the application were plans consisting of four (4) sheets, titled as follows: Title: Proposed Septic System Repair Location: 86 Willow Ridge Road Municipality: Middleton, MA Applicant: Brian and Nancy Baker P.E. or R.S.: Thomas G. Carbone, R.S. No. 1010 Date (Last Revision): August 24, 1994 (November 15, 1994) Title: Detail Sheet Location: 86 Willow Ridge Road Municipality: Middleton, MA Applicant: Brian and Nancy Baker P.E. or R.S.: Thomas G. Carbone, R.S. No. 1010 Date: November 23, 1994 Title: Scaled Profile & Pump Detail Location: 86 Willow Ridge Road Municipality: Middleton, MA Applicant: Brian and Nancy Baker P.E. or R.S.: Thomas G. Carbone, R.S. No. 1010 Date: November 23, 1994 Title: Pump Detail Location: 86 Willow Ridge Road Municipality: Middleton, MA Applicant: Brian and Nancy Baker P.E. or R.S.: No Stamp Date: No Date An engineer of the Department has reviewed the plans and the accompanying data and it is the opinion of the Department that the plans are in compliance except for the following provision of Title 5: Section 15.15 (3): Ground Water [Existing conditions preclude any greater than a 3.2 foot separation between the bottom -most elevation of the system and groundwater. Special conditions included in this approval will assist in mitigation.]; and Section 15.15 (6): Reserve Area [A reserve area cannot be provided for repair of this existing system because of site constraints.] Brian and Nancy Baker Page 3 January 9, 1995 It is the opinion of the Department that the requirements for the granting of a variance as specified at 310 CMR 15.20 have been satisfied. The enforcement. of the provision of the Code from which a variance is being sought would do manifest injustice and the applicants have proved to the Department's satisfaction that the same degree of environmental protection required under Title 5 can be achieved without strict application of the subject provision. The Department hereby approves the variance as granted by the Board of Health. As part of its approval of these variances to the provisions of Title 5 of the State Environmental Code, the Department will require that the following conditions be complied with or this approval shall be rendered null and void: • A percolation test shall be performed in the area of the proposed system at the time of excavation for the new system. If, at that time, the percolation rate of the soil is found to be slower than 10 minutes per inch, this approval shall be considered null and void and a new application will have to be filed. The percolation test shall be not be performed in frozen soils. The test shall be witnessed by the Board of Health or its administrator. A letter shall then be submitted by the Board of Health or its administrator to the Department documenting the percolation rate found at the site. A monitoring well shall be installed in the vicinity of the system. Groundwater elevation readings shall be made once every two weeks, using the same datum for elevation determination, during the months of February, March, April May and June. The information shall be submitted monthly to the Board of Health and the Department. In the event that there is found to be less than the approved separation of 3.2 feet, the applicant shall notify the Department and Board of Health in writing within ten (10) days of the elevation reading. The Department will then determine what, if any action, by the Department is warranted. • The plan of the existing system indicates that a liner was installed around the existing system. As much of the liner as possible shall be removed without compromising the integrity of the existing permeable soil beneath the system. • The system is not properly sized to accommodate a garbage disposal. The plans indicate that the house currently has a garbage disposal.. As such, the existing disposal shall be removed and no other disposal shall be installed. The plans submitted by the consultant did not adequately depict the profile of the system and should have shown the grading of the proposed fill into the existing grade. The downhill slope calculation appears to be in error although the calculations by the Brian and Nancy Baker January 9, 1995 Page 4 Department conclude that this distance requirement of the Code has been complied with. In addition, all applicable information should be submitted and all applicable variances should be applied for and granted at the local level prior to submittal to the Department. This greatly speeds the review process at the Department level. It is your responsibility to assure that the approved plans are available at the site during construction. If any additional information is required, please contact Ms. Claire A Holland of my staff at (617) 932- 7743. Very truly yo s, Sabin M. Lord, Jr. Regional Engineer for Resource Protection SMI/CAH/ch \1995disk2\t5varian\t5v94811.app Enclosure cc: • Sandra Starr, R.S., Board of Health, 120 Main Street, North Andover, MA 01845 • Thomas G. Carbone, R.S., Carbone Associates, 270 Ferry Road, Ward Hill, MA 01835 • Kevin Mahoney, Permit Administrator v`ttv� la\ 4I" 0) ,a o / 9 � 7d 4Dq.TiD ♦�P`�.CS October 3, 1994 BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 Thomas G. Carbone, R.S. 270 Ferry Road Ward Hill, MA 01835 Dear Mr. Carbone: TEL. 682-6483 Ext23 This letter is to confirm that at their meeting on September 29, 1994 the North Andover Board of Health granted variances to North Andover sewage regulation 4.18, Distances, to allow the repair of a septic system at 86 Willow Ridge Road with the leaching field 60 feet from wetlands and 44 feet from a drainage easement. A variance was also granted to 310 CMR 15.15(3), depth to groundwater. to permit a leaching field repair with the bottom of the system 2 feet groundwater. If you have any questions, please do not hesitate to call the Board of Health office at the above number. Sincerely, Sandra Starr, R.S. Health Administrator cc: Brian & Nancy Baker File Brian and Nancy Baker 86 Willow Ridge Road North Andover, MA 01845 September 22, 1994 Chairperson North Andover Board of Health Town Hall North Andover, MA 01845 Dear Boal -d Members: This letter is addressed to you to ask your consideration in reviewing the proposed septic system for our home at 86 Willow Ridge Road. Our current system is currently in a state of failure, necessitating a prompt repair. The proposal has been designed by Thomas G. Carbone, a Registered Sanitarian in the Commonwealth. We respectfully request that the Board approve waivers of the following regulations and requirements: 1. The bed bottom will be 2 feet above the ground water where 4 feet is required. 2. The edge of the bed will be 44 feet from a drainage easement where 100 feet is required. 3. There is no Reserve Area shown; future repair shall consist of removing contaminated stone and sand and replacing with clean material in place. 4. The edge of the bed will be 60 feet from an area of seasonal standing water where 100 feet is required. The existing septic system was designed by Joseph Barbagallo, R.S., in 1976, prior to the existing working version of Title 5. Prior to 1978, there were times when systems were allowed under the code to be placed as close as 2 feet above the water table. We ask that this be considered while deliberating on our request. We hope that you will see this request in a favorable light, so that we will be able to commence repair work shortly and have the entire project completed and the area reseeded while the weather conditions are still good. Respectfully submitted, Brian Baker Na -Bak sy �y�ry�e -•.+a i. ' • rw � • • / ''Cf yr � ae L� \ { w t w.,vpc• j �%_, vl • ,• .ri �. -,+.y, yea .>t �'c::� iJi A.�rtir�l'(;r/r-moi- iT�7: .. r 1 •4 ; ` wi a t•f r ,• �•. j. ,'1. \ _. ,+ 1`?. ��,\ i R\ •�\ya\ ,{{\ \ ry 4 f •r�Yy �� �.rJJ- �f 1�'e .. ,' ,••C Y 1 � T -5 tr \1{� 1. {fir' • ♦ '�' i' 1*. 4'•.� '`./'f:�,1: y �R' \f ♦ a. j1�yl J� � , 4' i \: � �. ,�r'\r t%rt`�t'<,i\'i.�:C;�lr�.�iY,}.�"a`•�t'x\1'*,\��f�f��♦4't„1�`i �� fi 1s�4y`Mt��}y,i,q�tK,\ �',� t �Yf � i,�� �'{' 1r , .r ,.1 r ,\” ,.•�• � ,l:•F{, ; '�,.}.. � x�K{ ,\, \i�f ���4i SL� ♦ �\,��� it h fj14..4 tt {fit i\�tt \y Ct.:y �.`li�� lt' �1 a(i`�� 1 t\, 1',�;' i}'14,y �y; ♦�\a1 yYti ��`jt1Y\�It 1} •=i. • �*`�' ��1�3 '`II 1'f } k i�RJ�iSi 5i r t4 \�'ti �`'7'i \{ �Xi t fLi l^� �� •�. �a ��}�<.l�-��I .��, i \ �.� -. i1, r � \ .c!• ., '11;� ��.<y...\.t. � � �•� �`,\ h�t.. ••`,1 ..:; ; t � , l '�`'��" c••',,;a�� ti ` i `y, � !.'rY� �. C� �l ;4 iy =1♦fi a\ 1 ?t �.', ' i � \ t \. y j }\'r�; " �. \e y r1 ��`t♦♦1 :�`"� �\ 1�1 �``:�it, i �.. •. �, J. ' },' +f t{C � � � �jt l��M���� A . Y )..t+'r.'i \ ; `\' .� r \ 11' i 13�i \l' 4 'V ' �. � � � fit. , \�, - C- � t\�� 5 t y �,•li:'T,'� ",t��r�yt i t f4. aC , lr �t tt -ii � } wi ,. 1. � y- i\ r+y �. ct \ . �.V' �, ri �'., 9t`� `N`�,rF, L� �re.t• \7 kLA�1 � °p♦'ty .' t t}y.i �� ��''E}a 1i 4 r \*y `.}\T +/' ,\ � rii'{!`5 \S!" k ,b 1,�1e ��� ♦ e\��, �f ,.�,y`�„Sa„�.�2.: t` � � Y.,' 1: r. L v TO: NORTH ANDOVER, MASS �2" 19 77 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at Z-0 7-�Z `Id W P/ GC �� North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated iq 70 eVY- g. Prof. E •ijeer/R.`S �t n SWELL DATABASE ADDRESS: �'�� l,C,(,` r.C�- (�� ✓ 2 ACL OF WELL PERy ALL LCC 710N: iu� U� Da: i OF R � ,,� TSE': OF W=. DR=ZD b. DU Cc. UN -K T,oi -_ TYl'EOFWATEl=ARRNCROCS = _ WA=AYA_LY=DD =- - HIGH �iGA'iESE_ Y N -- EICEIRON Y N O'E=CGI'�' YA-NTS: y �v DAT_A�E ADDRESS: �c •wiJ�- C7' ACE OF WrCLL: WLLL DRILL�� SWELL PEtZ��T,T: WELL LOCATION: DA! =. �. r_ _ . WELL PERL _ _ DEP, r� OF �Tr 11. r TYPE OFW"-LL: �• DRILLED b. DUCTc. LtiKNOWN TYPE OF WATERBEA=G ROCK. WATER ANAj- PSIS DATE: I-EGH -NL NGANESE: Y N I-HGH RON: Y N OT R CONTAILY24ANTS: Y N September 12, 1998 Ms. Sandra Starr, R.S. Health Administrator Town of North Andover Office of Community Development Services 146 Main Street North Andover, MA 01845 RE: SEPTIC SYSTEM REPAIRS Dear Ms. Starr: As you are aware the repairs to our septic system at 86 Willow Ridge Road were completed in August, 1996. Per the letter to us dated October 25, 1995 from Sabin M. Lord, Regional Engineer for Resource Protection, Commonwealth of Massachusetts, Department of Environmental Protection, we were directed to have the tank pumped once a year and to have the pumping reported to the North Andover Board of Health. As indicated in my letter to you dated September 11, 1997 the tank was pumped on September 10, 1997. In accordance with the above, and per the attached invoice from Soucy's Sewer Service, this is to inform you that the tank was pumped this year on September 10, 1998. Very truly yours, �ea /-Z� Brian M. Baker i' �, 30yI DATE OF SERVICE t-' ( rry J ;91 i SEWER SERVICE INC. COMPLETE SEWER -SEPTIC SERVICE INVOICE CUSTOMER NAME (978) 683-5709 (978) 470-1400 Methuen, MA Andover, MA (978) 937-9889 (978) 851-8839 Dracut, MA Tewksbury, MA (603) 898-9339 (978) 663-6633 Salem, NH Billerica, MA (978) 658-7700 Wilmington, MA BILLING ADDRESS I CIN STATE ( 'l A ZIP PRONE: 22 -? JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS ADDRESS STATE ZIP �.. DESCRIPTION OF WORK —VI VACUUM PUMP) SEPTIC TANK GALS. r 0 CESSPOOL L= OVERALL SYSTEM "y ! DRYWELL ❑ BASEMENT E? FAILED SYSTEM COMMENTS r� A 1-7 1' �rn TERMS OF PAYMENT TYPE OF SERVICE TAX EXEMPT N TAX TOTAL CASH 0 RES/COMM O INDUSTRIAL LZ CHECK %� CHARGE �l `PLUMBING D $ �f ✓ -� JOB COMPLETION This is to acknowledge completion of the above described work which has been done to my complete satisfaction. We will assume no. responsibility.fgrany damage made An driveway, #urb ol;walkVy*.;_. DATE COSTO E SWNAT RE �' SERVICEIA N'S NAME TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: Z (, SYSTEM OWNER & ADDRESS SYSTEM LOCATION 64 t (example: left front of house) DATE OF PUMPING: 11-90-01 QUANTITY PUMPED 1W GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: i �L 1 COMMENTS: CONTENTS TRANSFERRED TO: 1, 4 -10 A TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD/3 DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: _ QUANTITY PUMPED =GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES V NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS:, GOOD CONDITION !� HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER- , SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONVENTS TRANSFERRED TO: 6, L . 0, P4 O m E-+ z W O a U x H 0 P4 a 0 z O H z H W H W E-1 AOU) z >+ O N . U 4c H �w .-I v WW U 0z U '` n �1 U � U xA U VD* 02 0 w Ct cT� A n A 0a h a . U 4c H .-I v ,x "J n E-4 'N ti EA U 02 A n A a • N • U . U 4c Commonwealth of Massachusetts _ City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 RFCFNFD DEP has provided this form for use by local Boards of Health. The System Pumping Record r be submitted to the local Board of Health or other approving authoritf. SEP 1 1 2007 A. Facility Information TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: 1. System Loc tion: When filling out forms on the computer, use only the tab key Addres to move your cursor - do not City/T n use the return key. 2. SystOwner: -011 M-1 t a V) (-(� I% Name ' - — -6 Is . 1, 0;A Address (if different from location) Cityrown State Zip Code State JO b, �f & /b ode 9' Telephone Number B. Pumping Record q -l� 1. Date of Pumping Date 2• Quantity Pumped: 3. Type of system: ❑ ❑ Other (describe): 01, -) 0 Gallons Cesspool(s) Xseptic Tank ❑ Tight Tank i 4. Effluent Tee Filter present? ❑ YesNo �x 5. Condition of System: A k- 6. Syste Pumped By: Na <,.. „ A, <'A \n rr Company ( - I " 7. Location vvhherre. content§,were disposed: z R ffi .." Signat, r of Hau http://www.mass.gov/deprwater/approvals/t5forms.htm#inspect If yes, was it cleaned? ❑ Yes ❑ No -76 ,Q6)4-fZ- )J.J� Vehicle License Number t5form4.doc• 06103 System Pumping Record • Page 1 of 1 st M i w.'_' •�? , . a -----�►� RA�EI FO ice/ CP n � -- Q) �I . l r� J Q 11 y e -f R "Ti a lb -% o T cZi n Q. tl f 4 ti Vi ( � r1 i Q J f t 9 a 00 D r co R.1 ) e -� 4 0 v C� r° 1 l r� J Q 11 y e -f R Ic lb T cZi n Q. tl f 4 ti Vi ( � r1 i Q J f t 9 a 00 D r co R.1 ) -� 4 0 v Ic 1 � r1 J f i 9 a 1 -Tf {7'tj rb IMr,. 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