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Miscellaneous - 87 SUGARCANE LANE 4/30/2018 (2)
6) iI C) 00 -4 C) w 0 CD > z 0 > Sl c:) rn Z - 6) f _ _ _ - a ! 4. I F '`Yµ, ;;�,�� � � t�#i( i 1n� M` t �r� �` _N}}�� �'r•�,E,y i t � * .E31� . v� •� � ` ,�,o�� 4 `�`l��'It i^ t 3: i� A y' ! F �frT 'A ' I. • ,. MAP # PARCEL # STREET QONSTRUCTIQN_A.PPROVAL, HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE APP. BY _ DESIGNER: 6610PLAN DAME. CONDITIONS WATER SUPPLY: WELL PERMIT WELL TESTS: COMMENTS: WN WELL DRILLER CHEMICAL DATE APPROVED BACTERIA I Ufa i E f1PNRUVED bPr,TERIA II DATE APPROVED _ FORM U APPROVAL: APPROVAL TO ISSUE YES NU DATE ISSUED l11,3'/BY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO YES NU YES NO YES NU YES NO DATE• BY: Commonwealth of Massachusetts P-M=Owm-a City/Town of System Pumping. Record Form 4 RECEIVED OCT 2- 7 2014 TOWN Ur NUR i H ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Rffrear of house, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town 2. System Owner. State Trp Code Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping date ,�i �2uantity Pumped: �0Gallons 3. Type of system: ❑ Cesspool(s) c Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6. System Pumped By.- Nell y: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio contents were disposed: Ca.L� Lowell Waste Wi No If yes, was it cleaned? ❑ Yes ❑ No: F5821 Vehicle License Number Date t5form4.doc- 06103 System Pumping Record • Page 1 of 1 RECEIVED Commonwealth of Massachusetts ulCity/Town of JUL *1'12013 . •System Pumping Record TOWN OF NORTH ANDOVER Form 4, HEALTH DEPARTMENT DEP has provided this form for use; by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Leftigh rear of hNous Left / right side of house, Left / Right side of building, Left / Right front of building, a Ig t rear of building, Under deck Address arC e L',- '� - d0-'W� Cityr town State 2. System Owner: Name Address (if different from location) Zip Code City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Datet (� (3 Quantity Pumped: (�� Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: No If yes, was it cleaned? ❑ Yes ❑ No NJ 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company 7. Location _ ere contents were disposed: Cll, Q. _ Lowell Waste Water F5821 Vehicle License Number :7-I- 13 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVE® City /Town of System Pumping Record JUN " 5 ZU12 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may a used, u e 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 / Right front of house, Left Ri t rear of ho, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Righ rear of building, Under deck Address _ J City(Town State 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) Zip Code State, Zip Code Telephone Number —2. /Quantity Pumped; Q Septic Tank S�-2« Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 0'9 ^ If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: /� tN CX0-/U k),k � V\ 6. System Pumped By: Neil Bateson 7. Name Bateson Enterprises Inc Company G. were disposed: Lowell Waste Water F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record •Page 1 of 1 Rl LOT 4 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. SCALE: 111= 20' DATE: 10/30/96 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. 13 b= 63 04' SUGARC 'SNE LOT3� 23,03`4\S. F. V 0 T0.VwVv' z:137 9 3 EX/STING FpUNDATIo N LANE 33.16, S 154 0� 2.98, -j". �_� ri�/ .. 111) �. �.�} �'� �.. i' ii. IJ C ---f LOT 4 AS -BUILT SEPTIC SYSTEM LOCATED IN NORTH ANDOVER, MA. SCALE: 1 "= 20' DATE: 11/5/96 Scott L. Giles R.P.L.S. Frank S. Giles 50 Deer Meadow Road North Andover, Mass.. LOT 3 23,034 S.F. 00 w J ° P. oo � TABLE OF ELEVATIONS DIST.BOX INV. OUT HSE.=136.58 1 INV. IN TANK =134.23 " OUT TANK= 133.88 1 " IN D. BOX =132.66 OUT D.BOX=132.47/ 2 PIPES END PIPE#1=132.07 " END PIPE#2=132.02 1 I ,I T.O.W. = 137.93, EX/STI NG BU/LD/NG .4' 33.1 L= 63 p4, SVGq s 1 ° RCgN 5 sp�53„ w E SAN 42.98,. E S1 cz o oo� LOT 2 11/5/96 Town of North Andover, Massachusetts Form No. 3 HORiF{ BOARD OF HEALTH or ; tom, cA _ 19 L_ r- a DISPOSAL WORKS CONSTRUCTION PERMIT SA[HUSb Applicant !a„)�. NAME ADDRESS TELEPHONE Site Location _ •3(a ?�-fit r _ Permission is hereby granted to Construct (k,�`®r Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. -21(t-3-- 4 Fee —76 _ C' D.W.C. No, J I . Commonwealth of Massachusetts REC En City/Town of APR 15 2009 System Pumping Record OF NORTH Form 4 TGHEAL H DEPARTMENTEH 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. B.. Pumping Record 1. Date of Pumping 3. Type of system: El 2 Quanti P d' Date ty Umpe . Gallons Cesspool(s)Septic TankEj Tight Tank Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Condition of System: �� � � �►.n��: � �._,(�� � ice_ � ���� 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ere contents were disposed: L.S.D Lowell Waste Water igna ure of H u r Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out forms 1. System Location: Left front, left rear, left side of house. Right frog right rea? rights a of ouse. on the computer, use only the tab key to move Address your cursor - do not use the return City/Town State Zip Code key. _ 2 System Owner: �9 Name Address (if different from location) Cityrrown State Zipp oddee Telephone Number B.. Pumping Record 1. Date of Pumping 3. Type of system: El 2 Quanti P d' Date ty Umpe . Gallons Cesspool(s)Septic TankEj Tight Tank Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Condition of System: �� � � �►.n��: � �._,(�� � ice_ � ���� 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ere contents were disposed: L.S.D Lowell Waste Water igna ure of H u r Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record g` Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key vl� ISI DEP has provided this form for use by local Boards of Health. Other forn is maQQte information must be substantially the same as that provided here. Before using this form, check witt i your local Board of Health to determine the form they use. The System Pump ng R%%Y rout lr, bmi ed to the local Board of Health or other approving authority. U [U A. Facility Information 1. System Location: 1 Address I- Citylroum 2. System Owner: Name HEALTHOEPARTMENT 4-ra1. Uc � Address (if different from location) City/Town State Zip Code State � q �Zip Code Telephone Number N' -umber B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes L--}-i®o If yes, was it cleaned? ❑ Yes ❑ No 5. Condit oSystem: 6. System Pt�vtp�ed,:By: Name lv� Vehicle License Number Company 7. Location where contents weretdivosed: ES t5form4.doc^ 06/03 System Pumping Record . Page 1 of 1 TOWN OF41A-A**C�� SYSTEM PUMPING RECO7HEALTM RECEIVED DATE: U--3--os NOV - 9 2005 DEPARTMT ANDOVER SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) (A DATE OF PUMPING: (y 3 QUANTITY PUMPED: GALLONS CESSPOOL: NO U,— YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED To: G.L.S.D L/ Lowell Waste TOWN OF A I'. " SYSTEM PUMPING RECORD., DATE: 5 L003 SYSTEM OWNER & ADDRESS �-t S�f CQA,(— SYSTEM LOCATIONI (example: left front of house) DATE OF PUMPING: !) QUANTITY PUMPED: (� G ONS JCESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: gt n t SYSTEM OWNER & ADDRESS lFrukt �1 Suga� Gvkc �J SYSTEM LOCATION (example: left front of house) DATE OF PUMPING:!g-3) QUANTITY PUMPED 1'50-?) GALLONS U CESSPOOL: NO YYES SEPTIC TANK: NO YES -Z 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) CONTENTS TRANSFERRED TO: L • S• fes. �1 'omi onwealth of Massachusetts Massachusetts System Pumping Record System Owner Lu&O— Date of Pumping: Cesspool: No Yes System Location �'7 �o Quantity Pumped: fiWC-luallons Septic Tank: No Yes «� System Pumped by: t5cteedart Sit&"�wwd License # Contents transferrred to : Greater Lawrence Sanitary Dtstrlct Date: Inspector: MAR 1T% --i la or ON 7-4 s t!' "IT uml O z cci _ w % _ •" V' ' Cc �v cc LU C, m CD ... O- � N Nom :_ O O CIO N CD C7f m N O CO) = O w O C G m �r , c( C/) Q1 � N m o cJ =o o> fF•T�•.1d 79 S .5; m C, O cc •�Z O C d O = Q ` L m _ O 3 = m m o o N t— o o.oH m N Cc m �+ � •= Z W V tm V C p.— CDF C Q. y W.— O :a 2 C3y O O v O 0 Lell ti ell 0 -0 co M x E O i O � O Z v O CL O D CO) � O i � O D O O O d x ca C •C O Z O 0 CL �..� y C w O w w o o acz c E ° .0 C a m ° C W °a° C to C c o f 1- w° U w cn� cn t-� t!' "IT uml O z cci _ w % _ •" V' ' Cc �v cc LU C, m CD ... O- � N Nom :_ O O CIO N CD C7f m N O CO) = O w O C G m �r , c( C/) Q1 � N m o cJ =o o> fF•T�•.1d 79 S .5; m C, O cc •�Z O C d O = Q ` L m _ O 3 = m m o o N t— o o.oH m N Cc m �+ � •= Z W V tm V C p.— CDF C Q. y W.— O :a 2 C3y O O v O 0 Lell I cm ell 0 -0 co M C E O i O � O Z v O CL O D CO) � I cm 0 -0 co M C E m m co CD w fr O i � O D O O O d 0- -ycc ca C •C O Z O 0 CL �..� y C •C C y W .C\. ;.d, COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretw ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM MISPECTION FOW PART A CERT*=TION Property Address: 87 Sugarcane Lane, North Andover Name of Owner: Phil Luecht Address of Owner: 87 Sugarcane Lane, North Andover, MA. 01845 Date of Inspection: 2129/2000 Name of Inspector: Neil J. Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Bateson 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _X Passes Conditionally Passes Needs F rther Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 2129/2000 The System Inspector shall u it copy oft i inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a sh ed 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM PASSES: X 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or move 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. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/2912000 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 the public health, safety and the environment. 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 frau a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS - 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: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _x Pumping information was provided by the owner, occupant, or Board of Health. _x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _x_ As built plans have been obtained and examined. Note if they are not available with NIA. _x The facility or dwelling was inspected for signs of sewage back-up. _x The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _x Existing information. For example, Plan at B.O.H. x_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [I 5.302(3)(b)] x The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 FLOW CONDITIONS RESIDENTIAL: Design flow::_165_ .g.p.d./bedroom. Number of bedrooms (design): -4— Number of bedrooms (actual - 4 -Total DESIGN flow __WO Number of current residents: _5_ Garbage grinder (yes or no): _Yes_ Laundry (separate system) (yes or no):_No_ If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):_No_ Water meter readings 97 to 99 = 73000 fe x 7.5 = 547500 Gallons/ 730 Days = 750 gallons / Day * Has sprinkler system. Sump Pump (yes or no): _No Last date of occupancy: Current_ COMM ERCIALIINDUSTRIAL: Type of establishment: Design flow: gpdd ( Based on 15.203) Basis of design flow 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: OTHER: (Describe) _ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped Aug. 98, Owner System pumped as part of inspection: (yes or no)_Yes_ If yes, volume pumped: _I500_allons Reason for pumping: Inspect Tank & tees. TYPE OF SYSTEM _X_ 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 4 years old. 11/5/96 As built plan. Sewage odors detected when arriving at the site: (yes or no)_No_ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2!2912000 BUILDING SEWER: X (Locate on site plan) Depth below grade: 4' Material of construction: cast iron _X 40 PVC _ other (explain) Distance from private water supply well or suction line: Diameter: 4" Comments: $" PVC thru wall. 3" PVC in house. SEPTIC TANK: X (locate on site plan) Depth below grade: 2' Material of construction: _X_ concrete metal _Fiberglass _Polyethylene other (explain) If tank is metal, list age _Is age confirmed by Certificate of Compliance _ (Yes/No) Dimensions: 10' x 5'x 4' x 7.5 = 1500 gallons. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How dimensions were determined: Subtract scum & sludge depths to tee length. Comments: Pumped septic tank, inlet & outlet tees ok. Depth of liquid at outlet invert. No evidence of leakage. GREASE TRAP: None (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: revised .9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 TIGHT OR HOLDING TANK: _None (Tank must be pumped prior to, or 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 Alarm level: Alarm in working order: Yes _ Nc Date of previous pumping: Comments: DISTRIBUTION BOX.:_X_ (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: D -box level & distribution equal. No evidence of leakage. Evidence of solid carryover, pumped D -box to clean. PUMP CHAMBER: _None, gravity system_ (locate on site plan) Pumps in working order. (Yes or No) Alarms in working order (Yes or No) Comments: Revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued)) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: 2 Trenches 88' long. leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: Soil ok. Vegetation ok. No sign of ponding to surface. CESSPOOLS: None (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 (cesspool must be pumped as part of inspection) Comments: PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2129/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent refer locate all wells within 100' (Locate where A to 1 = 46'4" •to2=50' A to D -box = 68' B to 1 = 38'3" Bto2=40' B to D -box = 48'10" 88' revised 9/2/98 Page 10 of 11 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 4 Feet Please indicate all the methods used to determine High Groundwater Elevation: _X Obtained from Design Plans on record _X Observed Site (Abutting property, observation hole, basement sump etc.) —X—Determined from local conditions —X—Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. Must be completed) As per design plan. revised 912198 Page 11 of 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 87 Sugarcane Lane, North Andover Owner: Luecht Date of Inspection: 2/29/2000 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. Veil. Bateson Bateson Enterprises, Inc. CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. SCALE: 1 "= 40' DATE: 7/22/96 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. IkOT 4 TO THE STONEHAM SAVINGS BANK: \ I HEREBY CE'12TIFY THAT THE 'FOUNDATION SHOWN DOES NOT FALL WITHIN,AFLOOD HAZARD ZONE AS PER FLOOD INSURANCE RATE FOR THE TOWN OF NORTH ANDOVER COMMUNITY: PANEL NO' 500 I HEREBY CERTIFY THAT THE FOUNDATION SHOWN CONFORMS TO THE ZONING REGULATIONS (DIMENSIONAL SETBACK REOUTABIVIENTS) FOR THI5,TOWN OF p NORTH%NDOVER. I CERTIFY7HAT THS OFFSETS SHOWN COMPLY WITH THE ZONING ,BY LAWS OF NORTH ANDOVER, WHEN BUILT LOT 3 23,034 S.F. co T.O. W. = 137..93' ow EXISTING FOUNDATION 7r, coo -33.10' L= 63.04' SUGARCANE LANE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING ANSPECTOR ONLY AND SUCH USEI OR PiE DETERMINATIO F ZONING' CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED., 7/2 LOT 2 FORM U - LOT R LEASE FORK INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any. applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Vf&,tJ& �Q.v L CC7a Phone �b'Z —2326) LOCATION: Assessor's Map Number !o a l9 Parcel / y Subdivision '7 S Lots) 3 Street S'USA�2G9-�y� L -4 -Al e- St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspectoor-Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date f NOR7q ,o, w p t ; �j, b•�nn 'A",Cj ssACMUSEt Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 WA,a - 0 s1 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM ApplicantTest No. Site Location- Reference ocation Reference Plans and S EN 4 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee i -CHAIRMAN, BOARD OF HEALTH Site System Permit No. PLAN REVIEW CHECKLIST / S vEN 0,9,C-5ADDRESS Tc<0)9,eCA41& ENGINEER GENERAL 3 COPIESy STAMP L-""- LOCUS C-' NORTH ARROW '--'� SCALE CONTOURS 6--` PROFILEy� TION BENCHMARK SOIL & PERCS ELEVATIONS WETS. DISCLAIMER � WELLS & WETS WATERSHED?111D DRIVEWAY � (Elev) WATER LINE FDN DRAIN SCH40 TESTS CURRENT? 016 SOIL EVAL T, SEPTIC TANK / �% MIN 1500G v/ .17 INVERT DROP �/ GARB. GRINDER/"O(+200o EDF) 25' TO CELLAR L`� MANHOLE ELEV GW # COMPS. D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET OUTLET 133, 76% ( 2" OR .17 FT) TEE REQ' D? /iO LEACHING / MIN 660 GPD? & RESERVE AREA 1,/ 4' FROM PRIMARY?"/ 20 SLOPEy/ 100' TO WETLANDS `/100' TO WELLS "� 4' TO S.H.GW (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS / 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY "" MIN 12" COVER�-� FILL? (25' if above natural elev; 10'if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/100') " SIDEWALL DIST. 3X EFF. W OR D (MIN 6') ✓ RESERVE BETWEEN TRENCHES?vo IN FILL? t/�_MUST BE 10' MIN.LC-' 4" PEA STONE?6/ VENT? (/' (>3' COVER; LINES >50') BOT + SIDE lo Q X LDNG TOT (o io& �lo�oZ� (L x W x #) (DxLx2x##) (G/ft2) Copyright © 1995 by S.L. Starr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. OF .... AO.XT1.1.... t9.&XVF1f................:. Appliration for Bio.lto.9al Worko Tottotrur#io Application is hereby made for a Permit to Construct ( Lof or Repair ( ) an i System at: P Co4A�--...LV %3 a .: 0 45 Location - Address or Lot No. ...................... uC Si �:t c4� Ala.t......-----•----•--•--......•... i^�G..1..��- �,..N..Q ?l� ivaoU �t9�4 Owner Address W a --• ..................... ........ .................... ........---------- .............. ...................... .......... Installer Address Type of Building - Size Lot .... Z3k+PZ4..... Sq. feet Dwelling — No. of Bedrooms ............. 4:. ......................... E.,Zpansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures....................•--•----............--•---.................................................................---•--................................ W Design Flow ............... ez t.s.._.._......_...gallons per person petr dAy. Total daily �ow................. Gkao................ gqons�� WSeptic Tank — Liquid capacity) O.gallons Length../D.-.6... Width.a2 '4..... Diameter .... -........ x Disposal Trench — No....i.. z-......_.. Width....3.t ........... Total Length..T.i.all.'. Total leaching area..../1910 ..... sq. ft. 3 Seepage Pit No ..................... Diameter.................... Depth below inlet..................... Total leaching area .................. sq. ft. Z Other Distribution box (X, Dosing tank a Percolation Test Results' Performed by...CNltIS77!QNWC Date..gl.� l 'I6.tllg t�f yf/q� q3-3 Test Pit No. I ..... ) Z. minutes per inch Deptl-lof Test Pit ...... 64.`!..... Depth to ground water.N.!t! .............. V -3 Gr. q1,5-4- Test Pit No. 2 ...... 3 ...... minutes per inch Depth of Test Pit ...... 11 ........ Depth to ground water.!!N!I!!C............ 9.3'4 a...................................•------•-•........------......................---------------------....:..-----................---..................... O Description of Soil ..... TroN SJ LI'1.... St`PAQ:..!t!!._go. ......../.b...4 . ......................... x W UNature of Repairs or Alterations — Answer when applicable............................................................................................... ...................... „T............................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 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............................•----.................---•--........................--.................................... Date Application Approved By ........................... Application Disapproved for the following reasons: ............................ ; ........... ................................ .................... Date •-••.............................•-••-•.........----•-......--••••-••-•....•--••--••--...............-•------•---....-•-............--••....._........-----• •••............ • •---•--•-•--. Date PermitNo ......................................................... Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... .......................... I...... OF Trrtifirate of Toutphattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed by............................................................................................................................................................. ' Installer ) or Repaired ( ) at..............................................•-•-----••-•••--•....................------..._........ _ ............. has been installed in accordance with the provisions of TITLE 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 HEALTH ......................................... OF ..................................................................................... FEE........................ l9inVosal Worlto Totto#r urnott Famif Permissionis hereby granted..:......................................................................................................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. Street as shown on the application for Disposal Works Construction Permit No ..................... Dated .......................................... DATE............................................................................... FORM 1255 H09139 & WARR5N. INC.. PUBLISHERS ------•---•-•--••-----•--------------•--.......--••---------------•-••••••-••-•• ............ ........... Board of health Contmonwealtlt or Nlassacinisetts �- 4tA4&, M issactttisetts stem 1"utnpirig Record System Owner Date of Pumping: F• -a 6r' �� Cesspool: No Yes �..� System Location �7 6o. Quantity Ptiitiped: /,<� gallon§ Sep is Imik: No U Yes L`_' System Pumped by- aredda see ,&aa Licetise 0 Contents transfertred tti : Greater i..�tt+vrence §anitary l�iafrlct Date: __ ItisliMor: TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: `.0-o . 7F(-qk��ck- -ciq5�<Ca�-e CVCTFM UnCATMN r (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED-4Znj:�j_ GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES 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) CONTENTS TRANSFERRED TO: �'� Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 �M jUN � 2010 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other forml mhRWldWdMLT 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 of other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of hous , igt rear of house Left rear of building. Right rear of building. Address Citylrown U State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) State d i^ Zip Code Telephone Number 2. Quantity Pumped' eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes O If yes, was it cleaned? ❑ Yes ❑ No 5. Cond'tl ior�System- 6. yst� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location ere contents were disposed: L. J Lovy `�aste,Water F5821 Vehicle License Number Date —r -1v t5form4.doc• 06103 System Pumping Record • Page 1 of 1