HomeMy WebLinkAboutMiscellaneous - 89 MARIAN DRIVE 4/30/2018 (2)North Andover Board of Assessors Public Access
Parcel ID: 210/107.C-0046-0000.0
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Community: North Andover
PHOTO
Location: 89 MARIAN DRIVE
Owner Name: CONDON, EDWARD A, JR
NANCY A CONDON
Owner Address: 89 MARIAN DRIVE
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 6 - 6 Land Area: 1.2 acres
Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1500 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 335,900 321,000
Building Value: 140,700 135,000
Land Value: 195,200 186,000
Market Land Value: 195,200
Chapter Land Value:
LATESTSALE
Sale Price: 1 Sale Date:
Arms Length Sale Code: N -NO -OTHER Grantor:
Cert Doc: Book: 01108 Page: 0179
Page 1 of 1
http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=468544 8/4/2005
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Owner
information is
required for every
page.
Important: Wher
filling out forms
on the computer.
use only the tab
key to move your
cursor - do not
use the return
key.
Pommonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kenned
Owner's Name
North Andover _
Cityfrown
MA 01845
State Zip Code
6/27/2013
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.
A. Genera! Information
Inspector:
Chad Jablonski
Name of Inspector
CJ Jablonski Septic Inspection & Repair__
Company Name
237 Merrimac St,
Company Address
Newburyport
CityfTown
978-360-9358
Telephone Number
B. Certification
MA
State
4574
License Number
01950
Zip Code
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:
N Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
Date
The system ins ctor shall submit a copy of this inspection report to the Approving Authority (Board
of Health or D ) 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.
t5.ns • 11,10 Title 5 Official Inspection Form: SUbSUdace Sewage Disposal System • Page 1 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kennedy`
Owner's Name
North Andover
City/Town
B. Certification (cont.)
MA _ 01845 6/27/2013
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:
SAS and all components in good working order.
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):
t5ms • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17
Commonwealth of Massachusetts
rw Title 5 Official Inspection Form
1;1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
B. Certification (cont.)
B) System Conditionally Passes (cont.):
01845 6/27/2013
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 - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17
89 Marian Dr.
Property Address
Kennedy -- --
Owner
Owner's Name
information is
North Andover MA
required for every
page.
CitylTown State
B. Certification (cont.)
B) System Conditionally Passes (cont.):
01845 6/27/2013
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 - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kennedy -
Owner's Name
North Andover
Cityrrown
B. Certification (cont.)
MA 01845
State Zip Code
6/27/2013
Date of Inspection
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 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 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
❑
®
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/z day flow
t5ins • 11;10
Title 5 Official Inspecdon Form: Subsurface Sewage Disposal System • Page 4 of 17
,o
Commonwealth of Massachusetts
Title 5
official Inspection Foran
i-'
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
n -
`_J
89 Marian Dr.
— -
Property Address
— --- _
Kennedy__
Owner
Owner's Name
information is
required for every
North Andover
_ Andover-.---
___ _ ___—._ ____ _ MA 01845 6/27/2013
page.
City/Town
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 i 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.
t5;ns - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
01845 6/27/2013
Zip Code Date of Inspection
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?
❑ ® 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?
® ❑
89 Marian Dr.
Property Address
Kennedy
Owner
Owner's Name
information is
required for every
North Andover MA
_
page.
City/Town State
C. Checklist
01845 6/27/2013
Zip Code Date of Inspection
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?
❑ ® 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?
Z ❑
Was the facility owner (and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ®
Existing information. For example, a plan at the Board of Health.
® El
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
;5 ns • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17
Commonwealth of Massachusetts
=- Title 5 Official Inspection Form
l l - J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kennedy - -------
Owner Owner's Name
information is
required for every North Andover MA 01845 6/27/2013
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system? [if yes separate inspection required]
Laundry system inspected?
Seasonal use?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
r�
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
Attached
Sump pump? ❑ Yes ® No
Last date of occupancy: Occupied
Date
Commercial/Industrial Flow Conditions:
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:
t5.ns • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
iwl i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr. _
Property Address
Kennedy __
Owner Owner's Name
information is
required for every North Andover MA 01845
page. City/Town State Zip Code
D. System information (cont.)
Last date of occupancy/use: Date
Other (describe below):
General Information
6/27/2013
Date of Inspection
Pumping Records:
Source of information: Home Owner
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: na
gallons
How was quantity pumped determined? na_�
Reason for pumping: na
Type of System:
1z 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):
,51ns - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17
Commonwealth of Massachusetts
`r 'Title 5 Official inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
_i
89 Marian Dr.
Property Address
Kennedy _
Owner Owner's Name
information is North Andover MA 01845 6/27/2013
required for every —_
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:
Certificate of Compliance dated 6/23/2006
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer (locate on site plan):
Depth below grade: 48" from top of foundation
feet
Material of construction:
® cast iron ❑ 40 PVC ❑ other (explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Watertiqht at foundation
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
® concrete ❑ metal
0
feet
❑ 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: 10.5 x 5.5 x 5.5
Sludge depth:
2
15!ns • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr. _
Property Address
Owner Owner's Name
information is
required for every North Andover
page. City/Town
D. System Information (cont.)
Septic Tank (cont.)
MA 01845
State Zip Code
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
6/27/2013
Date of Inspection
32"
1°
5"
Distance from bottom of scum to bottom of outlet tee or baffle 14"—
How were dimensions determined? measuring tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is structurally sound. Inlet and outlet tee's in good working order. Effluent filter must be cleaned
annually.
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal
Dimensions:
Scum thickness
feet
❑ fiberglass ❑ polyethylene ❑ other (explain):
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:
i51ns • 11/10
Date
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
-l'
89 Marian Dr. _
Property Address
Kennedy
Owner Owner's Name
information is North Andover MA 01845 6/27/2013
required for every
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 Molding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
❑ fiberglass ❑ polyethylene ❑ other (explain):
gallons
gallons per day
❑ Yes ❑ No
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
t51ns • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17
n
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kennedy
Owner's Name
North Andover ` ^_
City/Town
D. System Information (cont.)
MA 01845 6/27/2013
State Zip Code Date of Inspection
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.):
Box is level and distributi
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ms • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17
Commonwealth of Massachusetts
- -� Title 5 official Inspection Foran
j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
x 89 Marian Dr.
Property Address
Kennedy
Owner Owner's Name --- --
information is
required for every North Andover _ _ MA 01845 6/27/2013
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
number, dimensions:
❑ overflow cesspool
number:
® innovative/alternative system
Type/name of technology:
infiltrator system 61' x 37'
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
No sign of_hydraulic failure or ponding.
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
15:ns • 11;10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kennedy
Owner Owner's Name
information is North Andover MA 01845 6/27/2013
required for every
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 • 11110 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 14 of 17
Commonwealth of Massachusetts
u Title 5 official Inspection Form
(� Subsurface Sewage Disposal System f=orm - Not for Voluntary Assessments
", -�i 89 Marian Dr.
Property Address
Kennedy
Owner Owner's Name
information is North Andover _MA 01845
required for every
page. City/Town State Zip Code
6/27/2013
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
507
y
i3 C /T 7
A --3> e3..z
0 - '> z__?
t5ms • 11/10 Tale 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17
Commonwealth of Massachusetts
P _ -0 Title 5 official inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
D. System Information (cont.)
Site Exam:
®
89 Marian Dr. —
®
Property Address
Kennedy _
Owner
Owner's Name
information is
North Andover
required for every
page.
CityfTown
D. System Information (cont.)
Site Exam:
®
Check Slope
®
Surface water
Check cellar
®
Shallow wells
Estimated de th to hi h round water
MA _ 01845 6/27/2013
State Zip Code Date of Inspection
4' below SAS
p g g feet
Please indicate all methods used to determine the high ground water elevation:
►t
'0l
no
Obtained from system design plans on record
If checked, date of design plan reviewed: Plan approved 2/10/2006Date
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:
Soil test performed 8/31/2005 by Bill Dufresne and witnessed by A. McBrearty.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
89 Marian Dr.
Property Address
Kennedy
Owner's Name
North Andover MA 01845 6/27/2013
City/Town
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
r5ms • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17
Summary Recon: Care generatec on 6/2712013 11 58 2.1 AM ny Karen Hanlon
Type
Page 1
Serial No Status
Town of North Andover
Location
16335710 a Active
..
00
Date
Reading
Code
Tax Map # 210-107.C-0046-0000.0
899
a Actual
Parcel Id 18330
881
a Actual
10/23/2012
89 MARIAN DRIVE
a Actual
7/23/2012
839
NATHAN 8r. KATIE KENNEDY
4/23/2012
799
a Actual
89 MARIAN DRIVE
780
a Actual
10/20/2011
NORTH ANDOVER, MA 01845
a Actual
7/20/2011
Class 101 Single Family
a Actual
Property Type
1 Residential
Zoning2 1 Residential
1/25/2011
Zoning3
1 Residential
Size Total 1.2 Acres
689
a Actual
7/22/2010
FY 2013
a Actual
4/22/2010
657
UB Mailing Index
1/22/2010
641
a Actual
Name/Address
Type Loan Number
Active/Inact. From
Until
NATHAN & KATIE KENNEDY
Owner
4/27/2009
570
89 MARIAN DRIVE
1/23/2009
549
a Actual
NORTH ANDOVER, MA 01845
531
a Actual
7/22/2008
CONDON, EDWARD A.
Previous Customer
Inactive 3/27/2007
485
89 MARIAN DRIVE
N. ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/inactive
Bldg Id. 13649.0 - 89 MARIAN DRIVE Last Billing Date 5/8/2013
1090327 01 Cycle 01 Active
UB Services Maint.
Account No. 1090327
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63518 7.82 1/
WTR WATER 01 ALL METER SIZE 68.40 /1
UB Meter Maintenance
Account No. 1090327
Type
b Badger
Serial No Status
Consumption
Location
16335710 a Active
5/20/2013
00
Date
Reading
Code
4/25/2013
899
a Actual
1/24/2013
881
a Actual
10/23/2012
865
a Actual
7/23/2012
839
a Actual
4/23/2012
799
a Actual
1/23/2012
780
a Actual
10/20/2011
762
a Actual
7/20/2011
745
a Actual
4/22/2011
720
a Actual
1/25/2011
705
a Actual
10/21/2010
689
a Actual
7/22/2010
671
a Actual
4/22/2010
657
a Actual
1/22/2010
641
a Actual
10/23/2009
624
a Actual
7/24/2009
599
a Actual
4/27/2009
570
a Actual
1/23/2009
549
a Actual
10/23/2008
531
a Actual
7/22/2008
510
a Actual
4/23/2008
485
a Actual
1/28/2008
470
a Actual
10/24/2007
452
a Actual
7/19/2007
433
a Actual
4/19/2007
413
a Actual
3/23/2007
410
f Finat Bill
Brand
Type
b Badger
w Water
Consumption
Posted Date
18
5/20/2013
16
2/13/2013
26
11/9/2012
40
8/14/2012
19
5/9/2012
18
2/13/2012
17
11/14/2011
25
8/15/2011
15
5/16/2011
16
2/11/2011
18
11/12/2010
14
8/16/2010
16
5/12/2010
17
2/12/2010
25
11/11/2009
29
8/12/2009
21
5/13/2009
18
2/10/2009
21
11/12/2008
25
8/15/2008
15
5/19/2008
18
2/19/2008
19
11/16/2007
20
8/15/2007
3
5/21/2007
8
3/23/2007
Size
0.63 0.63
YTD Cons
439
Variance
15%
-39%
-36%
111%
10%
3%
-34%
63%
3%
-16%
29%
-13%
-5%
-32%
-17%
48%
14%
-13%
-19%
59%
-7%
-4%
-11%
98%
-26%
110/0
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Commonwealth of Massachusetts
Map-Block-Lot
0
f 3? 5' �o� 107.C- 0046 -
I,O a
Board of Health -----
n Permit No
i North Andover
s� a' BHP-2006-0052
--------------------
���ti;^ «�;t P.I. FEE
Ss4cUuse F.I. $250.00
- --- -
Disposal Works Construction Permit
Permission is hereby granted Mike Reilly
to (Repair) an Individual Sewage Disposal System.
at No 89 MARIAN DRIVE
- -
- - - - - - ----------------
as shown on the application for Disposal Works Construction Permit No. BHP-2006-005 Dated February 24, 2006
r. --
Ir
F.
Issued On: Feb-24-2006
- -------------------
--------------------------------------------------------- �o rd o cal.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
VQ
nA
Application for Septic Disposal System
Construction Permit - TOWN OF
Application is hereby made for a permit to:
❑ Co struct a new on-site sewage disposal system*
C epair or replace an existing on-site sewage disposal system*
❑ Repair or replace an existing system component
A. Facility Information
j Q
TODAY'S DATE
$ 250.00 — Full Re a'
ponent
Ckr_t C^
Address or Lot # 1PkGS'e
City/Town
2.- *TYPE OF §ETIC SYSTEM*:
❑ Pump ravity (choose one)
***If pump system, attach copy of electrical permit to application***
❑Co ntional System (pipe and stone system)
nfiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D -Box Present) S.A.S.
2. Owner Information
IE
Name
Address (if different from above)
City/Town State Zip Code
Telephone Number
3. Installer intormation
1z' P R p "�' \ vi AJ�Clc� �_.- o" l/&Lk
Name Name of CompAny
Address
P�0& CG "CX.
City/Town State Tom— Zip Code
Telephone Number (Cell Phone # # possible please)
4. Designer Information t
Name Name of Company
Address
City/Town State Zip Code
q71�_ y'\ls- 555
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
N°Rrk Application for Septic Disposal System
r Construction Permit - TOWN OF
} ��
NORTH ANDOVER, MA 01845
SSEAU,
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: residential Dwelling or ❑Commercial
B. Agreement
TODAY'S DATE
$ 250.00 — Full Repair
$125.00 - Component
The undersigned agrees to ensure the construction and maintenance of the afore -described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certibcate of Compliance has
been issued by this Board of Health.
Names Date
Applicatio proved By: (Roard of Health Representative)
3-1—�L
�Na We Date
�- Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached. Yes
2. Project Manager Obligation Fotm Attached? Yes
3. Pump Sys tem? Ifso, Attach copy ofElectrical Permit Yes
4. Foundation As -Built? (new construction ronly): Yes
(Same scale as approved plan)
5. Floor Plans? (new construction only): Yes_
No
No
No
Not-'
No,. -
Application for Disposal System Construction Permit • Page 2 of 2
01
0
o
ti
OSP_ COCNIC AWK..
PUBLIC HEALTH DEPARTMENT
fommunity Development Division
CVj- - PR7IElCAr.1 -(.7- -7POAF CO9YlIA9VCE
As of:
dune 23, 2006
q'his is to cert that
the ind viduafsudsurface dzsposaCsystem was
Fully repaired
by:
dike Reifly
At:
89 Marian Drive
worth Andover, M q 01845
The Issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
Pu6fc Y-Cealth Inspector
1600 Osgood Street, North Andover, Massachusetts 01845 -
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
TOWN OF NORTH ANDOVER °E M° e' :
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 ��SSACHUg S,
Susan Y. Sawyer, .REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 89 Marian Drive MAP
INSTALLER: Mike Reilly
DESIGNER: Merrimack Engineering
PLAN DATE: 12/27/05 — Last Revision
BOH APPROVAL DATE ON PLAN: 2/10/06
INSPECTIONS
TANK INSPECTION: 3/31/06
DATE OF BED BOTTOM INSPECTION: 3/23/06
DATE OF FINAL CONSTRUCTION INSPECTI 14/5/06
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
LOT:
®Existing septic tank properly abandoned
®Internal plumbing all to one building sewer
❑Topography not appreciably altered
Comments: Could not access basement but it seemed apparent that only one
wastewater system would exist at this site. 4/5/06.
SEPTIC TANK
Q Bottom of tank hole has 6" stone base
Q Weep hole plugged
Q 1500 gallon tank has been installed — 2 Piece
H-10 loading Monolithic construction
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
® Inlet tee installed, centered under access port
® Outlet tee (gas baffle or effluent filter) installed,
centered under access port
❑ 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
® Hydraulic cement around inlet & outlet
S p-ee.j leve is in PIt9-c4ee,
Wastewater System Documentation — Feb 2006 a, i' S 4—r f D V r
Page 1 of 3
e- _q v¢�
TOWN OF NORTH ANDOVER t NORTH
,° ti
Office of COMMUNITY DEVELOPMENT AND SERVICES �? •;a °°p
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 cHus�t
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
Comments: Tank water level was +/- 6" below outlet invert. May be a leak. To be
investigated by installer. Manhole cover to grade needed over effluent filter. 4/5/06.
D -BOX
® Installed on stable stone base
❑ Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
❑ Speed levelers provided (not required)
Comments: Suggested flow equalization devices should be installed though not
required as outlets.
SOIL ABSORPTION SYSTEM
❑
Bottom of SAS excavated down to 6" to C soil
layer, as provided on plan — 25 x 52
®
Size of SAS excavated as per plan
®
Title 5 sand installed, if specified on plan
❑
3/4-1 '/2" double washed stone installed
❑
1/8-1/2" (peastone) double washed stone installed
❑
Laterals installed and ends connected to header
❑
Laterals vented if impervious material above
❑
Orifices @ 5 & 7 o'clock positions
®
Gravel -less disposal systems: type, number and
location as per plan
®
Elevations of laterals installed as on approved plan
®
40 Mil HDPE barrier installed
❑
Retaining wall (boulder / concrete / timber/ block)
❑
Final cover as per plan
Comments:
Bottom of the Bed — 61' x 37'
Number and type of chambers per plan. 4/5/06.
Wastewater System Documentation — Feb 2006
Page 2 of 3
TOWN OF NORTH ANDOVER °t Mo e-r `,ti
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845SACHU
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
SYSTEM ELEVATIONS
INVERT ON DESIGN PLAN FIELD INVERT ELEV.
Building Sewer OUT 93.78
95.28
Septic Tank IN 93.52
95.03
Septic Tank OUT 93.27
94.76
Distribution Box IN 92.77
92.76
Distribution Box OUT 92.60
92.60
Chamber IN 92.57 92.56
Wastewater System Documentation — Feb 2006
Page 3 of 3
Page 1 of 1
DelleChiaie, Pamela
From: Dan Ottenheimer [info@millriverconsulting.com]
Sent: Thursday, April 06, 2006 1:44 PM
To: amcbrearty@millriverconsulting.com; Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters;
DelleChiaie, Pamela; Sawyer, Susan
Subject: 89 Marian Drive
We'll have the form to you shortly, but just so you know the issues we found:
➢ Field built correctly.
➢ D -box set level to within 2 1/100ths — nice work, though we did talk about putting in speed levelers in the
event future settling occurs
➢ Septic had an effluent filter put in at the outlet end so it requires a manhole cover to grade.
➢ Septic tank was not watertight. Water level was about 6" below the outlet invert. Reilly was going to
figure out what was going on and let us know.
Dan
Daniel Ottenheimer, President
Mill River Consulting, Inc.
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting.com
danomillriv_ercon_sultng.com
4/6/2006
'TOWN OF NORTH ANDOVER of 14ORTH 1
41L4C ra h
Office of CO;*VliVIti CITY DEVE LOP�iNIENT ,Q ND SERVICES o? a�
HEALTH DEPARTMEN'rw
17 CHARLES STREET
NORTH ANDOVER_ MASSACHUSETTS 01845 'SSACHUSEK
Susan Y. Sa«•ver, REHSiRS 978.688.9540 — Phone
Public Health Director 978.688.9542 -- FAX
December 27, 2005
Anthony Donato, P.E.
Merrimack Engineering Services, Inc.
66 Park Street
Andover, MA 01810
Re: 89 Marian Drive, Map 107C, Lot 46
Dear Mr. Donato:
The proposed septic system design plans for the above site dated November 18, 2004 and
received on November 28, 2004 has been reviewed. Unfortunately, it cannot be approved until
the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North
Andover regulation that is not met by this design follows each item.
1. Please depict the legal boundaries of the facility. This may be accomplished on.a
separate sheet if desired. — 220
2. Please provide ties or other referenced to fixed objects so the contractor can accurately
locate the soil absorption system area — 220
3. Please clarify the intended loading of the septic tank to be utilized on this site. The
detail indicates it to be H-10 yet provides dimensions associated with an H-20 loading
tank.
4. Please utilize trenches as the dispersal method for the soil absorption system or explain
why they cannot be used — 240
5. Please indicate the bed bottom excavation is to extend 6" into the natural soil — NA
9.02
6. To avoid retaining and possibly mounding the ground waster table, please design the
impermeable barrier so it does not intercept the estimated seasonal high ground water
table.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a septic system that will be in compliance with all regulations and
assure protection of public health and the environment of North Andover.
Sincerely,
1�
san Y. Sawyer, SIRy
public Health Director
cc: Owner
File
WA',
ERRIMACK
'RWGINEERING SERVICES INC.
Engineers • Surveyors • Planners
66 Park Street
ANDOVER, MASSACHUSETTS 01810
(978) 475-3555
Fax (978) 475-1448
TO -- *A
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
HEUVI n @P 4MR�MTTVLffi
DATE
d Ti%(ep
JOB NO.
ATTENTION
RE:
RECEIVEI)
FEB 0 9 2006
TOWN OF NORTH ANDOVEJ
n utrIkN I MENT
the following items:
❑ Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
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E4.4 approval ❑ Approved as submitted ❑ Resubmit
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❑ As requested
❑ Approved as noted
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REMARKS
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4
TOWN OF NORTH ANDOVEROt pORT14 q
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT.
400 OSGOOD STREET
NORTH ANDOVER,. MASSACHUSETTS 01845 �'ssHCHU
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
February 10, 2006
Edward Condon
89 .Marian Drive
North Andover, MA 01845
RE: Septic System Design 89 Marian Drive, North Andover Map 107C Lot 46
Dear Mr. Condon,
The North Andover Board of Health has completed the review of the septic system design plan for the above
referenced property, submitted on your behalf by .Merrimack Engineering Services, Inc. dated, November 18, 2005,
last revision date January 5, 2006.
The design has been approved for use in the construction of an upgrade onsite septic system. The 4 -bedroom (g-
room maximum) design has been approved for use in the construction of a replacement onsite septic system. This
approval is valid for two years from the date of the approval in accordance with current local regulations and during
this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of
Compliance be endorsed by the installer, designer and the Town of North Andover.
This approval is subject to the following conditions:
1. The Health Department was not provided with a plan with an original engineer's stamp and signature. Please
note that the office must be provided with a plan with an original stamp and signature and one additional copy of
the plan prior to the issuance of an installation permit.
2. If site conditions are found in the field to be different from those indicated on the design plan and%or soil
evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the
applicant shall reapply for a new Disposal Systems Construction Permit.
3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or
other representative to ensure that all other state and municipal requirements are met. These may include review
by the Conservation Commission, Zoning Board, .Planning Board, Building Inspector, Plumbing Inspector
and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply
compliance with any of the aforementioned requirement
4. The plan does not call for the installation of a septic tank effluent filter but one is recommended. Please be
advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow
certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected
for use if you choose to install one. .
Your effort to provide a properly functioning septic system for your, dwelling is greatly appreciated. The Health
Department may be reached at 978-688-9540 with any questions you may have.
Sincerely
Susan Y. Sawyer, REHS/RS ./
Public Health Director
Encl: list of licensed septic system installers
Cc: Merrimack Engineering Services, Inc.
Ms. Susan Y. Sawyer
Public Health Director
Health Department
400 Osgood Street
N. Andover, MA 01845
Dear Ms. Sawyer,
February 22, 2006
89 Marian Drive
N. Andover, M A 0185
RECEIVED
FEB 2 3 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
The Board of Health has approved my application to install a new septic system at the
above address. I have plans to put the house or the market this spring and am applying for
a permit for an early installation of the system.,
I have spoken with installer and he understands your concerns about early installations.
He said he would meet all of those concerns.
Thank you for your consideration,
Sincerely,
60ef a -71z, Q417 rL?7
Edward A. Condon Jr.
t r
A17, v-5
40
Ms. Susan Y. Sawyer
Public Health Director
Health Department
400 Osgood Street
N. Andover, MA 01845
Dear Ms. Sawyer,
February 22, 2006
89 Marian Drive
N. Andover, M A 0185
RECEIVED
FEB 2 3 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
The Board of Health has approved my application to install a new septic system at the
above address. I have plans to put the house or the market this spring and am applying for
a permit for an early installation of the system.,
I have spoken with installer and he understands your concerns about early installations.
He said he would meet all of those concerns.
Thank you for your consideration,
Sincerely,
60ef a -71z, Q417 rL?7
Edward A. Condon Jr.
t r
A17, v-5
Town of North Andover
HEALTH DEPARTMENT
27 Charles Street
North Andover, MA 01845
978.688.9540
RECE �E�
Nov %'82005
TOWN OF NORTH ANDOVER
TMENT
HEALTH DEPAR ,..
SEPTIC PLAN SUBMITTAL FORM
l
DATE OF SUBMISSION: I'z�
SITE LOCATION: 101 J:d A&�t) Ml U
ENGINEER: �..L•Le IL�� jJ t''�%r'L 1 hid
NEW PLANS: YES 25.00/Pl n ✓ Check #:
ncludes E and one Re -Review Only)
REVISED PLANS: YES S 75.00/Plan Check #:
SITE EVALUATION FORMS INCLUDED: &I
NO
LOCAL UPGRADE FORM INCLUDED4;) YES NO
Telephone #;�� f'I ��ilr Fu #:�
E-mail: 'F-1 GYWI, C-04 -' A, L
HOMEOWNER NAME: E7171j9 ' eO IJ t94tnJ
OFFICE USE ONLY
When the submission is complete rincluding check):
L, Ltm
stamp plans and letter
S. plete and attach Receipt
3.py File; Forward to Consultant
4. Enter on Log Sheet and Database
I.ncation•
•
.
W_ Owner's Name:
Map/Parcel:
o I;;IG
Address:_ 9q MAy",^j
]installer.
Tel k4ga &5P New MnL gep�r ✓
Date: b-1 L -Cr Wetlands_?=�Zoae II Sod Symbol• Ri4me uxaftriLson
_Soil Qsss
Deep Observation Hole Logs
Depth
Solt Horizon
Solt Texture Son Color SOR MOtdW9 % Gravel, Ston •
Stones, etc.
F�17
'
V , Fwl.l•�
Ioy ole rw
x-122 G
5't' �,/Z .
Parent Atatettal . 'T"i t.t� Depth to Bedne�_Stmdla� �lleuria the Seta_ _Weepin= fe�eat?!t Faa� _g,�BGN fi'.
i -, A;
Parattt Material_ �! tt. Depth to B . .
6tU"g �t Nwift &B Ha -�WKPA9 fn= ft Fan ESBCLY: _
Date11'ercolation Tests
Obsenation Hole d
Depth of Pere
Stut Pre-soik
Time at 12@4t
Time at 9"
Time at 6" .
Time W- 6'7•••.
-Rate Mln&nch . 1 -20)
Performed BWitnessed Br. Ltr . PG �y�
BOARD OF HEALTH
NORTH ANDOVER, MASS. 01845
978-688-9540
APPLICATION FOR SOIL TESTS l�
DATE: 7 ' Z� " `' �' MAP & PARCEL: _11-1 10 7
LOCATION OF SOIL TESTS: AJAR, -IA LO j VC:
OWNER: FbAAJA4W co U WK) TEL. NO.: (q?� .- 36ke
ADDRESS: 0-c_ H,& Ix.1. 1.� 121uu 0
ENGINEER: I I Ci -M t--iAck - Mka W Ei N 6a TEL. NO.: 42; li `2755_7E_
CERTIFIED SOIL EVALUATOR: f'� 11,1-- oLII2%�
Intended use of land: Residential Subdivision ' gljf�l m Commercial
Is This:
Repair testing Undeveloped lot testing Upgrade for addition
In the Lake Cochichewick Watershed? Yes No`s_ -----
N EIVE®
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Land
G 0 2 2005
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests)F NORTH ANDOVER
2. Plot plan TH DEPARTMENT
3. Fee of 425.00 per lot for new construction. This covers the minimum two deep ho percolation tests
required for each disposal area. Fee of $360.00 per lot for repairs or up rg ades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the
location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write w This Line
N.A. Conservation Commission Approval:
Date Received: Check Amount: Check Date:
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BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE Nov. 26, 1966
NAME OF APPLICANT J• -J. Segadelli, Inc.
LOCATION Lot #13, hillside Acres
Address of lot no.
BUILDING: Dwelling X Other
SYSTEM: New X Repair
GENERAL DESCRIPTION OF LAND High
SUBSOIL: Clay X GravelSand
PERCOLATION TEST 8 minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK 1000 gallon capacity.
LEACH FIELD 200 lineal feet of drain pipe.
illiam J. D scoll, Engine r
Board of Hea h
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
—
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1.
NAME J'• .Sey
tj 40/// Xw e.
DATE
2.
ADDRESS C • n Gc-/,e�� f S
LOT NO. -0-0 /? TEL.
3.
NO. OF BEDROOMS
DEN
YES NO
4.
GARBAGE GRINDER
YES NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
Hillside Acres
i
Lot # 13
.r
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
Lot 13, Hillside Acres . I will install this system in ac-
cordance with all the laws of the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of 1000 Gal, in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of 200 lineal (fie) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
tile line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE
gignal=4 a Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
ignature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE
Percolation Test 8 min. Soil; Clay
Garbage Grinder
LAI. JJ
Signature of Inspecting Offi er