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HomeMy WebLinkAboutMiscellaneous - 99 SUGARCANE LANE 4/30/2018r 1 E s r M M cc �O O ;N N N00 N ooXWU to t� N �'~ l'o O U OQ O 'ai�,;�' 0 m -0 m O.aS C C U U ii J a X: -:I N m O O O DHHH a. Q 0 0 0 0 0 J m N L;"" in E E O U — I -I 0 O O ,N Ni N O (a 1 ai :2x Q �.6,c) U 1 U CU CL CU �,a U) O C O O; W U �c O F a W Z �s W aJ Q� a 45 Q r S J W J J Q: JN W W W H c L: o ci Z , oUEm0. Q 'a of U a J O =� cox UL� Z OUQ '0 Q {n M Ir) o i0 N .4 JZ' O O rLLI 07 U a U)o° aU) W O Ym, 0 W N U 'OO6 .f m 'd :U w '2 C a U Q Q O JFO 107 :o � UZ . �o�� O �N Q o 2 d O o J a U o. m O ai ai a o. — c G >C" `o O � f6 f6 f6 f6 �- In c0 fn cn U O J to t� N �'~ l'o O U OQ O 'ai�,;�' 0 m -0 m O.aS C C U U ii J a X: -:I N m O O O DHHH a. Q 0 0 0 0 0 J m N L;"" in E E O U — I -I 0 O O Z O O O Q Ln 00 Nco O O Q o t0Z U. W aJ Q� a O J W J J Q: JN W W � V �� ZO Q J � u U J =� cox UL� Z OUQ '0 Q 3: CL C C J J O Q t, ' O r N 0) m CL 00 00 00 W N - o N N U Ocri C C J J O 3 Y Y LO i N o 0 O O Z (0o i 7� 7 O N N Z� oW - a viJ Q W J J Arim, Ito 2! ° ON Qo Zoo LL Z AM ZO +•N p ti � (O O: - U1 04 J rn0 V 0 0 >mm p y.Bill imill"104 m.m o 0 Z O N d � N O r-� 0 O) O) 00 i W, O CL o 0 U Ha_ F- I- p c p F- _ O ULO d o o 0 000 00 m r �O rLN N aj 3 Qm m'o�m'Cc 0 E°° E za �nininoo a: U) c m UY 0 0---0 QmlLm w�lAyUQQ� A V_vai . Z 00000 co w o n n o O cn C7) W N'ii O rIj tin Q. N N ffTl V Aq OLL cQ cQ c LL C •LL m ai + O O 'v _ c iL Q C7 u+ n W (� c�oacoaf6imo�• GZ):Q :D F- W }(7 Udo R .N e-1 Iwai 0 V-,vm� •��� COO t0 Q �� =LM L6 r4 m mmS E LL ELL:L 7'L M mU) = 000OO m m N N 0 0 m m,�' U� m aco M o �p tea— �mL =Y E EU 1-Omli2 W m2w mm< ri rmn E P H o ai .4i(D CL U = aid: �0c CL v W 0 Nc ma)a>c ctLu2ti iii LL o" IL 0- U) O r N 0) m CL CONDITIONS WATER SUP -PLY: WELL PERMIT, WELL TESTS: COMMENTS: TOWN WELL CHEMICAL DALE APPRUVED RIA I DATE ()PPRUVED BACTERIA rl--, DATE APPROVED l FORM U APPROVALAPPROVAL PPROVAL TO ISS-lu-Z YES NO DATE ISSUED .Y CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES. NO OTHER YES NU ANY VARIANCE NEEDED YES NO GI PD BOARD . " FINALOF HEALTH APPROVAL: DATE:.._oZk BY:..Az Ccmrnonweaith of Massachusetts 01 City/Town of - -- :stem Pumping record NORTH ANDOVER Farrr, 4 e used. but the may b DEP has provided this form for use he same, Boards of Health. Other forms as that provided here. Before using this form, check with your information must be substantiallyhey use. The stem Pumping Record must be submitted to local Board of Health to determine the form o ingtau authority within 14 days from the pumping date in the local Board of Health or other app accordance with 31 o CMR 15.351. A, Facility Information importan°: Z. System Location: When fillinc out r forms on the % % -5 4 d computer, use Address ��l only the tab key fo`iz CCode Zip Code ode to r .ove your _ ,._. State cursor - do not _ C$yROwn' use the return key. �. System Owner: Name �,> Address (if different from loca(ion) - State - Zip Code Cityf-rown e l,17 _ Telephone Number - — --------------- pt, pumping Record f�G - //IZ� �. _._—_ 2, quantity Pumped: Gatrons Date of Pumping pate Tight Tank :Grease Trap Gess ooi s [peptic Tank E]9 Type of system: ❑ p { ) ❑ Other (describe): - — � Yes [C�fift9 if yes, was it cleaned? ❑yes ❑ No 4. Effluent Tee Filter present. ❑ 5. Condition of System: S Forfar �t --� 6. System Pumped By: 40 RECEIVED Bradford, Ma o183r. _ n `��«ey®2 vehicle License Numler Name "978 38 v � i ' 2Q14 Company - TOWN OF NOR T H ANDOVER ' HEALTH DEPARTMENT 7. Location where contents were disposed: Signature of Hauler Signature of Receiving Facility t5orm4.doc• 03106 Date _ . ...--- System Pumping Record • Page 1 of t Sawyer, Susan From: Sawyer, Susan Sent: Wednesday, August 10, 2005 1:49 PM To: 'Bill Marshall' Cc: Hrnuncia'k, Bill; Cyr, John; McKay, Alison; Grant, Michele Subject: Sugarcane Lane Dear Mr. Marshall, I am sorry for the delay in getting !back to you. in regard to the beaver concerns that we have been discussing over the past few months. As was mentioned in regards to the site walk, the purpose was to gain knowledge into identifying the location of the dams as well as to evaluate the potential problems. As you are aware, all those persons listed above excerpt for Jon Cyr attended this extensive site walk. Since that time, I have spoken to Bill and Alison about this matter and we have collectively determined the following. 1) The dam located on Cedar Lane appears to be on private property, therefore any action relating to this particular dam would be addressed to the !homeowner at #66 Cedar Lane and not the Town. This was determined by Mr. Hmurciak's review of the local maps. 2) Discussion and review of the law was completed in regards to the complaint that the dam is causing an lem. ergency and an emergency permit should be required of the homeowner to mitigate the problem. This would be done under the guise of the MA nuisance laws. In reviewing the current condition of the swamp, if such a permit application was submitted by the homeowner, the permit application would be denied 'based upon the Conservation and Health's opinion that it does not meet the definition set forth in the state regulation. In short the expansion of the swamp that has occurred by the beavers reclamation of their territory is not considered a Health Issue at this time. In fad the conservation would be adverse to tampering with this protected resource area and associated ecosystem/wildlife habitat if the impact was not deemed a public health issue. 3) The Health Department will notify the homeowner at #66 Cedar Lane that ,a beaver dam has been located on their property and that it could potentially cause problems for neighbors that could result in an order to correct. It will be requested that the homeowner respond to the Health Office for additional- details on the state and local jurisdictions regarding beaver dams. If the homeowner the to request our assistance in gaining a state permit, we will assist them. However, please be aware that should the homeowner apply for a local permit, the same determination would need to be made as to whether the area would be considered a public health or safety issue. 4) As this office is not inclined to allow an emergency permit for the relief of the current situations, a state permit could be applied for. This office would assist you or any homeowner if this measure was requested- as per the N. Andover town meeting vote regarding beavers. You may want to consider speaking with other potentially impacted homeowners to see if there are those who are interested in either joining in on the cost and/or possibly finding a homeowner with a health situation that could trigger the need for an emergency permit to be ordered. 5) http://www.mass.gov/dfwele/dfwldhvof/dfw trapping_regs.pdf This link takes you to the MA trapping laws. There are times of the year that a trapper can be hired to trap the beavers without coming to the Health and Conservation.. For more information you might want to contact a local trapper. They can assess the swamp and let you know the options such as installing a flow device. Bear in mind that permission from the homeowner would be needed to access their property. A professional in beavers may even have a better idea of how to tackle your concerns. In closing, all the members of the town staff that attended the site walk do understand your concern as a homeowner in regards to the possible expansion of the existing surrounding wetlands, however we are bound to make decisions in accordance with the laws given to us. In this case, there does not appear to be enough compelling evidence of an emergency to trigger this portion of the regulation, therefore without that evidence, it is currently the neighborhood who could address the problem rather than an Order to Correct. We understand that the situation could change and you could end up in an emergency situation that could rause us to take action, but for now it does not meet the criteria. I expect that you all may have comment to this letter and if] spoke for someone incorrectly please let me know and I will retrad the statement if necessary. Thank you, Susan Sawyer, Health Director Alison McKay, Conservation Administrator Page Y of 1 Sawyer, Susan From: Sawyer, Susan Sent: Wednesday, June 01, 200510:20 AM To: Cyr, John; Hmurciak, Bill Cc: McKay, Alison; Grant, Michele Subject: FW: Sugarcane Lane Beaver Problem To all, Please see the attached request by Bill Marshall of 99 Sugarcane Lane, in regards to a potential hazard caused by beavers between Sugarcane Lane and Cedar Lane properties. Both DPW and Health have been involved in the preliminary fact gathering, however, a recent site walk by the complainant found dams and a beaver but behind properties off of Cedar Lane. He informed the health office of the location and subsequent research has identified the assessor's map for the area. This map was shown to him last week. The general area of the dams has been identified by Mr. Marshall. There are a number of owners that may be potentially responsible. According to the town assessors maps, the Town of North Andover is the largest land owner in this area. I will provide all of you with a copy of the assessor's map through interoffice mail. I believe the next step is to figure out who's property the dams are on and whether these dams are causing the need for emergency measures. John, would any of your workers be able to do this or would we engage an outside party? I believe that this should happen before further steps are discussed. Please let me know your thoughts and I will communicate our actions to Mr. Marshall. Thank you Susan -----Original Message ----- From: Bill Marshall [mailto:bmarshall@neoninc.com] Sent: Wednesday, June 01, 2005 8:00 AM To: Sawyer, Susan Subject: Sugarcane Lane Beaver Problem Susan, As we discussed, this e-mail serves as a formal request for your department to investigate and resolve the beaver problem in the wetlands behind Sugarcane Lane in North Andover. Based on the information we reviewed at our meeting last week, it appears as if the beavers and their dams are located on town property. We believe the erosion from the changing water levels and flows has and continues to damage our driveway and could damage the retaining wall around our property. We are also concerned about the mosquito problem the standing water will cause as well as the overall damage the beaver will cause to our property and the wetlands. Although I can't site any specific damage to his property, l have discussed this problem with Bill Cunningham at 102 Sugarcane Lane and he shares my concerns. We would appreciate it if your department and the Town of North Andover could resolve this problem in a timely and effective manner. Please keep us informed. Regards, Bill Marshall 6/1/2005 Pamela DelleChiaie From: Pamela DelleChiaie [/o=North Andover/ou=First Administrative Group/cn=Recipients/cn=pdellech] To: Sawyer Susan (E-mail) Subject: 99 Sugarcane Lane - Bill Marshall Hi Susan, Bill Marshall, homeowner for above called Friday afternoon looking for a follow-up status on the Beaver Issues at this property. Please call him at 978.687.4016. Thank you. The last notation in the file indicates that Bill Hmurciak will check the maps to determine if this is town land. You were going to hold off on other suggestions or recommendations of action until that was determined. 8¢8f R¢gAPds, PQiK►¢0Q D¢BG�¢G�lilwf¢ Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com DelleChiaie, Pamela ' From: DelleChiaie, Pamela Sent: Friday, July 16, 2010 4:19 PM To: 'pamela5100@aol.com' Subject: FW: I.R. - 99 Sugarcane Lane - Scanned Health Dept. File Attachments: 20100716161236490.pdf Dear Pamela, Attached is the scanned copy of the file for 99 Sugarcane Lane. All the septic information that you are looking for should be attached. Enjoy your weekend—Pamela D. Best Regards, Pamela DelleChiaie Administrative Assistant lCommunity Development Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 ph: 978-688-9540 fax: 978-688-8476 "We can never seethe path of our life if we are too busy focusing on the pebbles under our feet." --Anonymous -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Friday, July 16, 2010 4:13 PM To: DelleChiaie, Pamela Subject: I.R. - 99 Sugarcane Lane - Scanned Health Dept. File This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 07.16.2010 16:12:36 (-0400) Queries to: noreplygtownofnorthandover.com �7—.A� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: q9 Sv rt Lv,% F.R . t1. q u.J cC' Owner's Name: M ",.\ .r+\\ Owner's Address: tam- 4�0Q6 Date of Inspection: 4� �'�-U6 TOWN o ORT"©DO\/ER HEALTH DEPARTMENT Name of Inspector: (please print) aoie.,`.. WkAew A Company Name: Mailing Address: SAX O4 v \fie, Telephone Number: boa W9V - G30,V CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: The system inspector shall su t a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: q9 S0aW_u,nt- Ln. Owner: MftC"\\ Date of Inspection- 1A, t) - o Inspection Summary: Check A,B,C,D or E 1 ALWAYS complete all of Section D A. System Passes: _.JL_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y\out n the for the following statements. if "not determined" please explain. The septic tank is metal and oars old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltratration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a comp'c tank as approved by the Board of Health *A metal septic tank will pass inspecis durally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 2d is affable. ND explain: Observation of sewage backuk out or high tatic water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: qq Skt L,n Owner: Vn4cS\,.n\1 Date of Inspection: C. Further Evaluation is Required by the Board of Health: Condition exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect ublic health, safety or the environment. 1. System will pa unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The systeNac ank and soil absorption system (SAS) and lite SAS is within 100 feet of a surface water ry to a surface water supply. The systeank and SAS and the SAS is within a Zone 1 of a public water supply. The systeank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �I°y S Kpc rr-N-^t_ L+ -N Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate `yes" or "no" to each of the following for all inspections: Yes N 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 %s day flow Required pumping more than 4 times in the last year NOT due to clogged or obstnicted pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis; performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 00 (Y o) The system fails. T 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 now of 10,000 gpd to 15,000 You must indicate either `yes" or "no" to each of the following- (Me ollowing(The following criteria apply to large systems in addition to the criteria above) yes no the syste is within 400 feet of a surface drinking water supply _ the system is nN#iin 200 feet of a tributary to a surface drinking water supply _ the system is locate4 a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone H of a public wa 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. Page 5 of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Q9 4, n. ( Qvtc Owner: chA&%n \ Date of Inspection: -11-4 Check if the followina have been done. You must indicate `Yes' or "no" as to each of the followin Ye,S 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? (lf they were not available note as N/A) J 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'' _ 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: Y no Existing information. For example, a plan at theBoard of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page d of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Qi Sum Ca2ne_ Ln M An�OJtc Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): LA Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): '-\4 U Number of current residents: �%-\ Does residence have a garbage grinder (yes or no): ,r\bSZcc cmv\K Is laundry on a separate sewage system (yes or no): n� [ yes separate tion required) Laundry system inspected (yes or no): fla Seasonal use: (yes or io): Curmv.} Water meter readings, if available (last 2 years usage (gpd)): Sump pump (yes or no): ng Last date of occupancy: COMMERCIALRNDUSTRIAL Type of esta lislunent: Design flow on 310 CMR 15.203): gpd Basis of design w (seats/personsl%Aetc.): Grease trap presen or no): Industrial waste hol g tank present (yes or no): Non -sanitary waste dis arged to the Tide 5 system (yes or no): Water meter readings, if vailable: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: o u, tc Was system pumped as part, of the inspection (yes or no): a If yes, volume pumped: _gallons -- How was quantity pumped determined? . Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool —Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information. Were sewage odors detected when arriving at the site (yes or no): no Page I of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S w-cA !�. A.ndl6a4r Owner: MRn41X Date of Inspection: Vl- 0 - 0 (, BUILDING SEWER (locate on site plan) Depth below grade: �1 / Materials of construction: cast iron \/40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): - 9Wk1hA O&AX - ovGC lAn�� ArLAr� ?0%3L \ _u fq, G YY P^tA`�. SEPTIC TANK: _ (locate on site plan) Depth below grade: i� Material of construction: concrete metal _fiberglass polyethylene other(explain) If tank is metal fist age: _ is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: lost LS Sludge depth: Itas ih'%.n t," Distance from top of sludge to bottom of outlet tee or baffle: aS� Scum thickness: less ►1,R,. 1- Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlektee or baffle: �J ` How were dimensions determined; Comments (on pumping recommendations, inief and outlet tee or baffle ebn&tiotL structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): GREASE TRAP: ,_(locate on site plan) Depth below grade: Material of construe • concrete _metal fiberglass __polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of et tee or baffle: Distance from bottom of scum to bolt f outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:. �9 Su�o,c�cnn� Ln Owner: tYl"S Date of Inspection: -*L TIGHT or HOLDING TANK: (tank must be um at time of in 'on p ped speck )(locate on site plan) Depth below gra e: Material of cons tru 'Orr concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: ons Design Flow. Ions/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.); DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _Gj� 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.: t^ ` . � J PUMP CHAMBER: (locate on site plan) Pumps in working order (y r no): Alarms in working order (yes o o): Comments (note condition of pum chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSUR]ptACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: °l9 Sveft-e'ftAt- l.n._ tYIA Owner: M nuc\\ Date of Inspections SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number leaching trenches, number, length: a leaching fields, number, dimensions: overflow cesspool, number: innovativetalternative system Typeiname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and co n\1 fi ration: Depth — top of liqui inlet invert: Depth of solids layer: Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no); Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (l on site plan) Materials of constructio Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: q�( Lr R Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: OR 8tApmFW11L Owner: Mnt�s�\1 Date of Inspection: SITE EXAM, Slope c>-3�a Surfacewater e),,)- been G3ar���t' c04,4,4s o-1 At, CAu3;ns Check cellar ✓ dry �(„�, Shallow wells Estimated depth to ground, water y� feet N-^3 Please indicate (check) all methods, used to determine the -high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SA Checked with local Board of Health-explain: 4%av'4-%jW ,\9�►ti a� :�� Checked with local excavators, installers- (attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water e 1 tion: -~-� O z p Cl) W m 0o Z aNp O _ zoU . W v Z W `.° Zo° or� U w O O w�a ���-' z ale o Q w 4 e1v 0 Z O it ° cw v0 � Lu 2 �Z w a Q LL �.J8zm an �o �W LLJ � � � 6 oz U Z c� �LLz Wod' LL U. o(o) wiz W3: 0U.a0. g wWo z oxo WN N© �o N 0 C14 � OOU O Y2� �.e tip o. x ,sem r ° coZF=XoI]O U ?Qo. F w 0 ko3 IR Summary Record Card generated on 4/19/2006 9:64:32 AM by Elaine Barclay Town of North Andover Tax Map # 210-106.A-0263-0000.0 99 SUGARCANE LANE MARSHALL, WILLIAM 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 Page t Class 101 Single Family Property Typo 1 Residential Size Total 0.97 Acres FY 2006 UB Mailing Index Name/Addrass Type Loan Number Active/Inact. From Until MARSHALL, WILLIAM Payor 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Activelinactive Bldg Id. 17669.0 - 99 SUGARCANE LANE Last Billing Date 4/10/2006 3170339 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 61.02 /1 UB Meter Maintenance - Serial No Status Location Bran Type Size YTD Cons 41849368 a Active ENC F.RT. 7 W Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 3/8/2006 1469 a Actual 18 4/17/2006 -39% 12/21/2005 1451 ' a Actual 17/2006 -64% 9/20/2005 1416 a Actual /14/2005 138% Trouble Code:03 6/27/2005 1326 a Actual 15/2006 138% 3/30/2005 1285 m Manual estimate 6/2005 -27% 12/14/2004 1265 a Actual 14/2006 -65% Trouble Code:03 9/24/2004 1244 a Actual U77 /8/2004 105% 6/11/2004 1167 m Manuel estimate 30/2004 670,E4/16/2004 1147 a Actual 17/2004 0% Trouble Code:03 12/15/2003 14 i9 ENOW Iviefer/15/2003 poy CA All 1 � • f f J07 96'0 vvo Wal .OZ = j *37YOS N r Id ?d -Ji 86_4r Q'OZi WSIVIN ON -09 +V 96olAo V611.1 46 13AVSD 4MV aNVS z ' o1 a' 7-1 �_... ---.._....._.__._..... ___— -- Fri Fri I WC 7 n� NOlLdl8OS3Q #� 2 ON ,Lid IS31 L9/9Z/£ UIVQ I 'ON lid lS3l 1_ Ed /710 d0 N!/N!Y! z :31vw QV ! 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JAN 0 6 2005 rowry of- NO ,('�:iWN VF' NUK'I'I•i ,�t�th!� f1EAL7HDe ANDOVER VA flit I�-���� �Y9nNf PtJM p !N U RFC 0KL 1. ,• MMI• WIM1M .\....,,v.r�. ..QUANTITY pUMpCc�- /J � .�...,......._ .. YtS� Oby111\ 1 ./ 111 +VA4P I'ct11 nt Nn PVKU ON 3LRYit?8t iiVV'l'INa . OOOU CONOi'i`IVN „.. iv J, I'u vo y t.rx L'� i YY 0 8 UA'p't. Sa .,\wr/1 Eytrto4�oCrl��aY!�N%Xot SXQMYg� A $QUPQAKAYq tr1 � j iNA1 f'vrrt�•�d �r w (;^�G'./'/J.{r `/-,y.� ' • 1. M, 1.11 ,\ II♦YI\W ., .\ . UH I'M J v rm)y&gxxbv 1% c� z ro V a Q a d ti W U O cs b GIO v �G 2 c 4 O ti Q 4 1 12 W z ro V a Q d 12 W ro W U O GIO v 4 ti Q 1 4 r., � S s z Z Z 10 f]. H ap C �p Z z z �k LLD U pp N th 12 W Sawyer, .Susan From: Sawyer, Susan Sent: Wednesday, August 10, 20051:49 PM To: 'Bill Marshall' Cc: Hmurclak, Bill; Cyr, John; McKay, Alison; Grant, Michele Subject: Sugarcane Lane Dear Mr. Marshall, I am sorry for the delay In getting back to you. in regard to the beaver concerns that we have been discussing over the past few months. As was mentioned In regards to the site walk, the purpose was to gain knowledge into Identifying the location of the dams as well as to evaluate the potential problems. As you are aware, all those persons listed above except for Jon Cyr attended this extensive site walk. Since that time, I have spoken to Bili and Alison about this matter and we have collectively determined the following. 1) The dam located on Cedar Lane appears to be on private property, therefore any action relating to this particular dam would be addressed to the homeowner at #88 Cedar Lane and not the Town. This was determined by Mr. Hmurclak's review of the local maps. 2) Discussion and review of the law was completed in regards to the complaint that the dam Is causing an emergency and an emergency permit should be required of the homeowner to mitigate the problem. This would be done under the guise of the MA nuisance laws. In reviewing the current condition of the swamp, if such a permit application was submitted by the homeowner, the permit application would be denied based upon the Conservation and Health's opinion that it does not meet the definition set forth in the state regulation. In short the expansion of the swamp that has occurred by the beavers reclamation of their territory is not considered a Health Issue at this time. In fact the conservation would be adverse to tampering with this protected resource area and associated ecosystem/wildlife habitat if the impact was not deemed a public health issue. 3) The Health Department will notify the homeowner at M Cedar Lane that a beaver dam has been located on their property and that it could potentially cause problems for neighbors that could result in an order to correct. it will be requested that the homeowner respond to the Health Office for additional details on the state and local jurisdictions regarding beaver dams. If the homeowner chooses to request our assistance In gaining a state permit, we will assist them. However, please be aware that should the homeowner apply for a local permit, the some determination would need to be made as to whether the area would be considered a public health or safety Issue. 4) As this office is not Inclined to allow an emergency permit for the relief of the current situations, a state permit could be applied for. This office would assist you or any homeowner if this measure was requested as per the N. Andover town meeting vote regarding beavers. You may want to consider speaking with other potentially impacted homeowners to see if there are those who are Interested in either joining in on the cost and/or possibly finding a homeowner with a health situation that could trigger the need for an emergency permit to be ordered. 5) hffp:/Awiw.mass.gov/dfwele/dfwfdfwpdf/dfw_trapping_yegs.pdf This link takes you to the MA trapping laws. There are times of the year that a trapper can be hired to trap the beavers without coming to the Health and Conservation. For more information you might want to contact a local trapper. They can assess the swamp and let you know the options such as Installing a flow device. Bear in mind that permission from the homeowner would be needed to access their property. A professional In beavers may even have a better idea of how to tackle your concerns. In closing, all the members of the town staff that attended the site walk do understand your concern as a homeowner in regards to the possible expansion of the existing surrounding wetlands, however we are bound to make decisions in accordance with the laws given to us. In this case, there does not appear to be enough compelling evidence of an emergency to trigger this portion of the regulation, therefore without that evidence, it is currently the neighborhood who could address the problem rather than an Order to Correct. We understand that the situation could change and you could end up in an emergency situation that could cause us to take action, but for now it does not meet the criteria. I expect that you all may have comment to this letter and if I spoke for someone incorrectly please let me know and I will retract the statement if necessary. Thank you, 2 Pamela DelleChiaie From: Pamela DelleChiaie [/o=North Andover/ou=First Administrative Group/cn= Reciplents/cn=pdellechj To: Sawyer Susan (E-mail) Subject: 99 Sugarcane Lane - Bill Marshall Hi Susan, Bill Marshall, homeowner for above called Friday afternoon looking for a follow-up status on the Beaver Issues at this property. Please call him at 978.587.4016. Thank you. The last notation in the file indicates that Bill Hmurciak will check the maps to determine if this is town land. You were going to hold off on other suggestions or recommendations of action until that was determined. 8aBlRaaafd8, . PayraBA 11aBBaG�Alala Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax http://www.toNvnofnorthandover.com healthdept@townofnorthandover.com i Sawyer, Susan To: Sawyer, Susan; McKay, Alison; Bill marshail (E -mall); Cyr, John; Grant, Michele. Cc: DelleChlale, Pamela Subject: RE: 99 Sugarcane Lane Thanks to everyone who showed up for the beaver walk. It was shall we say.. very interesting... The next step. Bill H will check the maps to determine If this is town land. I will hold off on other suggetions or recommendations of action until that Is determined. I will be in touch. Susan .----Original MlessaW---- sFrom: Sam, Susan Sent: Wednesday, June 29, 2005 7:41 AM To: Sawyer, Susan; Md(ay, Alison; Bill marshals (E-mail); Cyr, John, Grant, Michele Ccs DelleChlale, Pamela Subject RE: 99 Sugarcane Lane Due to scheduling issues, the walk will start at 8:30AM this morning. Sorry, I didn't get this to you all sooner. Susan -----Original Message.... From: Sawyer, Susan Sent: Tuesday, June 28, 200510:40 AM To: May, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Ce:. DelleChlale, Pamela Subject: 99 Sugarcane lane The beaver dam exploration walk for 99 Sugarcane has been scheduled for Tomorrow, Wed. e/29/05, at 9:00AM. For those who are attending, please meet at the above address and we will go in from there. Plan for at least an hour, I would guess. Bill, Alison and Health will definitely be there. We will report to the rest of you on our. findings If you sit this one out. Thanks Susan Page 1 of 1 Sawyer, Susan From: Sawyer, Susan Sent: Wednesday, June 01, 200510:20 AM To: Cyr, John; Hmurclak, Bill Cc: McKay, Alison; Grant, Michele Subject: FW Sugarcane Lane Beaver Problem To all, • Please see the attached request by Bili Marshall of 99 Sugarcane Lane, In regards to a potential hazard caused by beavers between Sugarcane Lane and Cedar Lane properties. Both DPW and Health have been involved in the preliminary fact gathering, however, a recent site walk by the complainant found dams and a beaver but behind properties off of Cedar Lane, He Informed the health office of the location and subsequent research has identified the assessor's map for the area. This map was shown to him last week. The general area of the dams has been identified by Mr. Marshall. There are a number of owners that may be potentially responsible. According to the town assessors maps, the Town of North Andover is the largest landowner In this area. I will provide all of you with a copy of the assessor's map through Interoffice mail. I believe the next step Is to figure out who's property the dams are on and whether these dams are causing the need for emergency measures. John, would any of your workers be able to do this or would we engage an outside party? I believe that this should happen before further steps are discussed. Please let me know your thoughts and i will communicate our actions to Mr. Marshall. - Thank you Susan ---Original Message ----- From: Bill Marshall [mal[to:bmarshall@neoninc.com] Sant: Wednesday, June 01, 2005 5:00 AM To: Sawyer, Susan Subject: Sugarcane Lane Beaver Problem Susan, As we discussed, this e-mail serves as a formal request for your department to investigate and resolve the beaver Problem in the wetlands behind Sugarcane Lane in North Andover, Based on the information we reviewed at our meeting last week, it appears as if the beavers and their dams are located on town property. We believe the erosion from the changing water levels and flows has and continues to damage our driveway and could damage the retaining wall around our property. We are also concerned about the mosquito problems the standing water will cause as well as the overall damage the beaver will cause to our property and the wetlands. Although I can't site any specific damage to his property, I have discussed this problem with Bill Cunningham at 102 Sugarcane Lane and he shares my concerns. We would fppreclate it if your department and the Town of North Andover could resolve this problem in a timely and effective manner. Please keep us Informed. Regards, Bill Marshall 6/1/2005 M NN a o� ti b b 2 a o� DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 29, 200510:36 AM To: Sawye san; M ay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: Del ehlaie, Pamela Subject: 99 Sugarcane Lane Thanks to everyone who s owed up for -•the saver walk. It was shall we say... very interesting... The next step. Bill H will check the maps to determin 'f-thisl"s town land. I will hold off on other suggetions or recommendations of action until that Is determined. I will be In touch, Susan -----Original Message ----- From: Sawyer, Susan Sent: Wednesday, June 29, 2005 7:41 AM To: Sawyer, Susan; McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiale, Pamela Subject: RE: 99 Sugarcane Lane Due to scheduling issues, the walk will start at 8:30AM this morning. Sorry, I didn't get this to you all sooner.. Susan Original Message ----- From: Sawyer, Susan Sent: Tuesday, June 28, 2005 10:40 AM To: McKay, Alison; Bill marshall (E-mail), (yr, John; Grant, Michele Cc: DelleChiale, Pamela Subject: 99 Sugarcane Lane The beaver dam exploration walk for 99 Sugarcane has been scheduled for Tomorrow, Wed. 6129/05, at 9:OOAM. For those who are attending, please meet at the above address and we will go in from there. Plan for at least an hour, I would guess. Bill, Alison and Health will definitely be there. We will report to the rest of you on our findings if you sit this one out. Thanks Susan 1 +ay DelleChiaies i Pamela L= From: Sawyer, Susan Sent: Tuesday, June 28, 200510:40 AM To: McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject: 99 Sugarcane Lane The beaver dam exploration walk for 99 Sugarcane has been scheduled for Tomorrow, Wed. 6/29/05, at 9:OOAM. For those who are attending, please meet at the above address and we will go in from there. Plan for at least an hour, I would guess. Bill, Alison and Health will definitely be there. We will report to the rest of you on our findings if you sit this one out. Thanks Susan e ..Nlag UJ��QQj a C C d Ii1 C.7 C yO L oa O, LU Z o �n a0 Z �ciium vas �3u�i C V o1LU o i �o' o w .tU e z q� OJ o CL �o O0 aao 4)0)4)0 O . MEW Z ts 1 .. . 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Parcel ID: 210/106.A-0263-0000.0 SKETCH Click on Sketch to Enlarge 1 Page 1 of 1 Community: North Andover PHOTO No Picture Available Location: 99L-5/ SUGARCANE LANE Owner Name: MARSHALL, WILLIAM A NANCY J MARSHALL Owner Address: 99 SUGARCANE LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 0.97 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 4568 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 910,200 872,106 Building Value: 710,200 681,600 Land Value. 200,000 190,500 Market Land Value: 200,000 Chapter Land Value: LATEST SALE Sale Price: 165,000 Sale Date: 04/25/1996 Arms Length Sale Code: P -NO -USE- Grantor: COLONIAL CHNGE DEVELOPMENT Cert Doe: 12405 Book: 00095 Page: 0025 lithe•//n.er_ma ire/i�Tan n��PrPi,hAn�./ict�/TTnmp;an9Paap=1ArT A"VTr1=AA?h7d A1,)R/7fN1S North Andover Board of Assessors Public Access North Andover Board of Assessors Public Access Page 1 of 1 h fn://ecr.ms-m/NJgn4nvPrPiihAnr/icn/CavPCParnh ;en Pale 1 of 3 Sawyer, Susan From: Cyr, John sent: Monday, December 13, 2004 2:53 PM To: Sawyer, Susan Subject: RE: 99 Sugarcane Lane - Beaver/Flooding Issue Sensitivity: Confidential We unclogged the culverts at 393 forest st. and on Salem Stat Granville Rd, on Thursday and also this morning, This will lower the water level on Sugarcane IN. we will continue to monitor the water level. Ucyr1 --Original Message----- From: Sawyer, Susan Sent: Wednesday, December 08, 2004 2:31 PM To: pdellechiaie@townofnorthandover.com Cc: Cyr, John Subject: RE: 99 Sugarcane Lane - Beaver/Flooding issue Sensitivity: Confidential I spoke at length with the homeowner. They do not have any emergency that needs permitting, however, they have been noticing a steady increase in beaver related activity; such as trees down and a rising water level. I told her that to take any action there is a process and I would forward her the information. Also, unless it were on town property it would be up to the landowner to take action. So, I guess that is it for now on this one. Susan ----Original Message --•-- From: Pam Dellechiaie[mailto:pdellechiaie@townofnorthandover.com] Sent: Wednesday, December 08, 2004 9:43 AM To: Chir, John Co: Sawyer Susan (*mail) Subject: FW: 99 Sugarcane Lane - Beaver/Flooding issue Importance: High Sensitivity: Confidential Hi John, Do you know if this is in the beaver area that is being monitored? Can 12/27/2004 Page 2 of 3 you call me back today and let me know? Thank you. Pamela 978.688.9540 ----Original Message----- From: Pam Dellechiaie[mailto:pdellechiaie@townofnorthandover.com] On Behalf Of Dellechiaie, Pamela Sent: Thursday, December 02, 2004 9:53 AM To: Sawyer, Susan Cc: Merrill, Pamela Subject: 99 Sugarcane Lane - Beaver/Flooding issue Importance: High Sensitivity: Confidential Hi Susan, I briefly spoke with Pam M. about this call to see if she had any guidelines. Received a call from Nancy Marshall at above address. C: 978.621.6150; H: 978.687.4016 re: beaver problems and gradual creation of a wetland area surrounding her home. The way the caller described her situation is that her home is elevated, and gradually slopes down. It appears as though all Of her lower property area is engulfed in water (looks like a pond) surrounding her home. She is concerned that all the trees on the property will die off (and also they will be unable to use their land) because of the beaver activity which is causing this flooding. At this time, there was no request for a beaver permit. She is looking for guidance, next step, etc. I am not really up to speed on all the beaver updates, so I am referring it to you. 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CC.D2 'in Z `o U V C _ 0,- m= oID "Co, �+ O Mtn o D 0 'a 0.0 C* = cyv a� a O ,= Q CO . C1 *5 M z Q i 0 (� 0 IL � Q S •O J a N LU � x o ° Z •i •� o U d � O LU c Q N o LL Z a I bo c O OV ''' •� Q p N u ►. Q c:CA m Z O O co 3 o u ° o a ° 3 c Q o o p u y th L D bb v r CA N IV 0 IV 0 Q6 06 5 LL � H 3 � Z O 4A LU o CV. O Q p N Z 3 o 0 c\ L0 f Q. z �I a { J �Jz V}t o�SR **� 0 �t 4 0 06 Of, 06 KENNETH R MAHONY Director Town of North Andover. OFFICE OF COMMUNITY DEVELOPMENT.AND SERVICES 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 October 11, 1995 Mr. Phil Christiansen Christiansen & Sergi 160 Summer.Street Haverhill, MA 01830 Re: Lot #5 Seven Oaks Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Less than 4 feet to groundwater. 2) Less than 660 GPD design flow (variance requested). If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BuI DING 688-9545 CONSERVATION 6889530 HEALTH 688-9540 PLANNING 688-9535 Kathleen Bradley Colwell Julie Parriuo D. Robert Nioetta Michael Howard Sandra Starr v1 I1,+011111140 10 V1f ►oct- VI 'v."vr 9v0IV1 01 r+ol':•". r.^.V. S t '• nr ,1:,''1S ",:•:,:•, ooltn OrOrno/ 1A?./;OrrnO r,;Inprfryl r.'11 :. A. fiac111ry InIQrm� IIQn (Ire; r;:,; `• Sj�S;BCI IOCdUOn;' /40- ::l1 NI, '. num-�1�•r • (��'i�I,�•1��tt �rl'•li.. � , ' .. , Qj'1.1 , y 'U .l/+S'!`m1 f'fu1�41�i+�g+�J1,�i��it� •"r. .,. S } tiri iL !{'�/rl'I'�I'1"If',����,I ,dt,l,i�t; .'.., � /\ �• � 11111 tp(n SoNVonj 1~ Cq ' �; •....I/i,{r Y'j�i,l:i:,''YJI,,.1, If'Zi�,�f1\1a'' 1, , _ .. � .' f, Oa1q o! 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I'•1 Q� f'IIr, of n, y / .. ..,, t,:',,„� •,r.f� • �, � Y A I,SW G � 15'1'i.�f'1, •'p., 11 .,' .�„�,,,,, �'9oY/Oer1p�r4la�lapproYa��lblorms,n;m,vins�bc� '` PLAN REVIEW CHECKLIST ADDRESS �Q�''� j ENGINEER GENERAL 3 COPIES STAMP•-/ LOCUSy NORTH ARROW SCALE CONTOURS L� PROFILE L/ SECTIONy� BENCHMARK �� SOIL & PERCS ELEVATIONS WETS..DISCLAIMER WELLS &-WETS WATERSHED? DRIVEWAY 4- (Eley) WATER LINE 41/ FDN DRAIN SCH40 C/ TESTS CURRENT? v SOIL EVAL —DAV ©• (QxWe=TGu SEPTIC TANK MIN 1500G .17 INVERT DROP c.� GARB. GRINDER ,(a (+200% EDF) 25' TO CELLAR v MANHOLE•_Q4e- ELEV GW # COMPS. D -BOX SIZE # LINES `�-' FIRST 2' LEVEL STATEMENT INLET M? -73' - OUTLET /R47 lel _ l 7 (2 11 OR . 17 FT) TEE REQD? A LEACHING MIN 660 GPD?, RESERVE AREA 1,,-/41 FROM PRIMARY? 2a SLOPE- 100' TO WETLANDS 100' TO WELLS Cl4' TO S.H.GW (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS C-----'325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY L•/ MIN 1211 COVER 1 ---FILL? 4- (25' ' �^ if above natural elev; 101if below) BREAKOUT MET? TRENCHES / v SIDEWALL DIST.,�3X I'F. MIN 660 gpd SLOPE (min .005 or 611/1001) W ORD MIN 61)'V RESERVE BETWEEN TRENCHES? &- IN FILL? L,,� MUST BE 10' MIN. � 4" PEA STONE?y VENT?_ __t�v (>3' COVER;.LINES >501) BOT140e) + SIDE ��� X LDNG TOT 1 (L x W x #) (DxLx2x#) (G/ft2) Copyright Q 1995 by S.1.. Staff DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE l)*PERMIT # Z&- DATE RECEIVED Z 5 , /,� APPLICANT �/9U4 T �y �/�� ASSESSORS MAP ADDRESS PARCEL # LOT # STREET ENGINEER ADDRESS p % PLAN DATE ! ��/� REVISION DATE CONDITIONS OF APPROVAL Rlji,� �} 1 i� SIN 4lfY•IirS'Il�r: Tr rt ' 1 - - .. � :1•..ti'•:1f�'•��:fjf•�J•�t ,;�.:•.r , � �f,�1'i.lfrtvr4t'1,V ;rtl} � L A ( L •,,. � rTt"�J � Sj 5 ! - �:.}4 t'f lT�l':i♦r.`f)}' •lE�1 �.� 4� AO Y.Gillt�/ig1�ri'�r .. •1'1'11 P•.y.`)�r;A Y/•'�,ti7fl ''JJ�'�,\\f,;." j ��t +, •r� t ,rr I' r Iw J !';.t!•pJ \' '4 rR. 'r �:.�:•1f:.'., ',t .. irt: n7,l:F.' .'f � ti., •.a.,'' -t �'Il •S''' •r• i , 5.., fill yiy r. •rr. ;° 0 .,. ;i •fi.- :,�;�'�.:.y f11�'�,17db'yf ;�:5.\:•'l'1.\f.iwi: •\\lrg4t'Yr$�.RJ� rk•:.rfi a .t .R t. .T. - . ' •'� '' `1 VY• � �fhtV � ��1 9 i ' i�4: ,t , r �^"�•!w+r+..•,•. 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LO 1: LL H-U)li U� iu O WO 1�5 � F- W ° Z °'►+ �sj Qm Qwz c _� z .. d - Q F -z =U o �s O `° v >- Z F -O o 2c= � F- Nn (A U = F- ~ ~ --i Z U- i LL ZOOU COs, ' X Ix 0 ,X\, ti M 54.58' 1`. l; 4 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 373-0310 FAX: (508) 372-3960 September 26, 1995 B&fit) OF HEALTH North Andover Board of Health SEP 2 8 1995 120 Main Street North Andover, MA 01845 Re: Lot 5 Sugarcane Lane (Seven Oaks Subdivision) Dear Board of Health Members: On behalf of my client, Mr. Paul St. Hillaire, I would like to appear before the Board at your scheduled October meeting to request variances from the Town of North Andover's Minimum Requirements for the Subsurface Disposal of Sanitary Sewage for the above referenced lot. The variances requested are as follows: North Andover Regulation 2.14.4 Minimum Cana The variance requested is to allow for the minimum capacity of the disposal system to be reduced from the required 660 gallons per day to the design flow of 440 gallons per day. 2. North Andover Regulation 2.14 Sewage Flow Estimates The variance requested is to allow for the estimated daily flow per bedroom to be reduced from the North Andover requirement of 165 gallons per day to the Title V requirement of 110 gallons per day. Please notify me when you have scheduled a meeting to consider this request for variances. Very Yo rs Phil rlstiansen FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Co Lo,v,,;W_i/�/� .� oyL . �Q� Phone ILZ -Z 32-y LOCATION: Assessor's Map Number Parcel Subdivision -7 COX.$ Lots) S - Street _T^A i Gov e 4A?t_t St. Number of *******;k****************Official Use Only************************ RECOr44ENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health - zdA le"_� Sep is Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected j Date Approved Date Rejected Received by Building Inspector Date f NORTN O'tt��e ��,•yO ti w F t � ACHUSEt� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant AUG 1�57— /71/CZ,91,e6- Test No. Site Location -D> 6 'SEI/, Reference Plans and Specs— Permission Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee '060• a0 CHAIRMAN, BOARD OF HEALTH Site System Permit No. -� I CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 October 13, 1995 Ms. Sandra Starr North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 5 Sugarcane Lane (Seven Oaks Subdivision) Dear Ms. Starr: (508) 373-0310 FAX: (508) 372-3960 Please find enclosed 3 copies of the revised Septic System Design for Lot 5, Seven Oaks. I have raised the elevations throughout the system by 0.2 ft. as per our previous discussion. Please contact me if you have any other questions about this design. Very Truly Your Daniel J. O'onnell Encl. Ir LU ojz Z< < Iu im"r �- Ij. sc 0 20 LI,., 00 0 0 Zp D F— J o p&� til Ilr- ; �x IM r 2°29'48" W 54.5§I No......................... Fuic............... THE COMMONWEALTH OF MASSACHUSETTS BOARD N.G.HEALTH ...........0 F ........ ,/.V.G ../ .....1Z1..�.(JU ���.................. Appli�afilill for D1!ii1mml RI11r 1w T111115tr ur illll punkt Application is hereby made for a Permit to Construct (L or Repair ( ) an Individual Sewage Disposal System at: ..............5..�`}IAC.!�d`�.....LIN.�[................... 5{R.1....5.....(,.�\SU I .................... or N S Loea(ion • •\dd cess 47T?.... ! : :��..i'..r.11 % :.l.�l..M.�� A .......... � ..... .�........� l %................................ ! O�, ncr Address ................................. ...................................................... I ........ I................................................................................................... Installer Address Type of Buildingyy Size Lot ... 4�Z7L......Sq. feet Dwelling — No. of Redroofns...............`T....................... Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Uttildiub .......... ..... I............. No. of persons............................ Showers ( ) Cafeteria ( ) Otherfixtures.....................................................................................:..................................I............................. Design Flow ................ 5_57 ...................gallons per person per day. Total daily flow ..............:::� ................gallons. Septic 'f;uilc ••— 1_iyuid capacity.�S�Ugalluns Length../.Q'-6... Width...6.:.:4�'. Diameter ..... ..=..... Deptth.5..`-IS... Disposal Trench No. ....... Z.......... Width ..... 4..t......... Total Length.7—Y...`5 !.`•. Total leaching area ...... 0 ®...sq. ft. Seepage Pit No ..................... Diameter.................... Dcpth below inlet.................... Total leaching area .................. sq. ft. Other Distribution box Dosing tank ( ) t Percolation Test Results Performed by.....Gpl4l3.1-MA : 1..�..,�t�Ct:f�11J.N..r........... Date.. 9!����.%L.713471...... -� Test Pit No. I ... L.L...... minut.es per inch Depth of Test Pit......N.°N`Iq........ Depth to ground water../Mr 93 P9S-5' Test Pit No. 2 ... ).>......... minutes per inch Depth of Test Pit .... 14..4 �...... Depth to ground water.... L ............ Q3 —r I , ............................................................................................................................................................. Description of Soil..... .4/...St�'`!y(!?!!►..-1b..FrL!/(k.4................................. .....................................SSM. fz.tLr�k�! ... (?.�19k�..`.................................................................................................................. ........................................................................................................................................................................................................ Nature of Repairs or Alterations — Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The tmdersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LZ 5 of the State, Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,161ped y the b�oar� health. Signed. j .1 .... s . .................................. ... y .. Date ApplicationApproved By.................................................................................................................I......•....•.•.....•.... Date Application Disapproved for the following reasons:............................................................................................................... ............. :.......... .................. .......................... ..................................................... •............................................................... Date PermitNo ......................................................... Issued _........ :.............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............I ........................ I ... I OF.........,........................................................................... C�rr�tifdrttfp lvf Cnni�t�li�lnrp THIS iS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....................................................................I...........................•..................................................................................................: Installer at............................................................................................................................................................................ •.........•............... has hecn installed in acr.ordalic.c Willi tile. provisiopi of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit iv'o.':.:................................... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. IATI..........................................................................I...... Inspector...:................................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ I ....... I.................I... OF ...................................................................................... Dilip-alla1 3V OrllB Tv1Z3tr1Zrltan rmlit Permissionis.hereby.-gr;inted..................................................................•........................................................................... to Construct �o)rlc ;fir ( )� 1' ( ) all individual Sewage Disposal System atNo .....................::..:'-fit ............................................................................................................................................... • Slreet as shown un the applicatiInt fu laispusnl \\'url;s Crntstruction Permit No ..................... Dated.......................................... llonnl of Health DATE................. A ........ I ............. I ................ FORM 1255 H088S & WARn EN. `INC.. PUBLISHERS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1).9 Lo REE7:E Owner'sName: i'1 r�riNn�1\ff Owner's Address: 5�.,..e J2006 Date of Inspection: L\- c)-U(S TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Name of Inspector: (please print) Company Name: -, Mailing Address: S,4X \34^\,,A`c.. (LA Telephone Number: Los WTC - GW _ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: all—Date: 4 40,0(�, The system inspector shall su t a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 Su,WLNnk Ln, n, vQ0Lojtr ri Owner: c`ngcs\„rs\\ Date of Inspection: 0(, Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: VI 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: 614 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. Answer yes, no or not determined (YN ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 2 ears old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or a tration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying sep *c tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is aurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is ailable. ND explain: Observation of sewage backup or breakout or high\static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: qSI& vNt_ ,n Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditi\existwhich require further evaluation by the Board of Health in order to determine if the system is failing to proc health, safety or the environment. 1. Systemunless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system as a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supp or tributary to a surface water supply. The system has a ptic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a sep c tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S%-crkrt:Nhe Ln Owner• M r rSV^ Date of Inspection: - 6 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 ''/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ �✓{ 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 analysisy performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] f\o (Ye o) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the systeh%�Js within 400 feet of a surface drinking water supply _ the system is Mhin 200 feet of a tributary to a surface drinking water supply the system is locatean a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public wat 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. Page 5 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: qcl S Owner: Date of Inspection: Check if the following have been done. You must indicate `yes" or "no" as to each of the following: Yep 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) J _ 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 bales or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum 11 _ 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: YDS no J _ Existing information. For example, a plan at the Board of Health. _ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: q `] Juc pc, CA v L^ Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): L1 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): `�qo Number of current residents: y Does residence have a garbage grinder (yes or no): Asa.Z (�S C'r ow'^t6 Is laundry on a separate sewage system (yes or no): A,,[� yes separate inspection required] Laundry system inspected (yes or no): Seasonal use: (yes or 0: C,urm,,, - Water meter readings, if available (last 2 years usage (gpd)): Ap"AJ Sump pump (yes or no): Last date of occupancy: r use e„nY COMMERCIALANDUSTRIAL Type of estat ishment: Design flow on 310 CMR 15.203): gpd Basis of design w (seats/persons/sgketc.): Grease trap presen\dils r no): Industrial waste honk present (yes or no): Non -sanitary wastrged to the Title 5 system (yes or no): Water meter readi,vailable: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection (yes or no): nc, If yes, volume pumped: _gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM �( Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool —_ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval _ Other (describe): Approximate age of all components, date installed (if known) and source of information: __. Were sewage odors detected when arriving at the site (yes or no): no Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �`� S�"—cp'y\'_! l�. a_'_ AyV'C Owner: Mptc,§ ,,,\ Date of Inspection: y- C) 0(o BUILDING SEWER (locate on site plan) Depth below grade: \–) / Materials of construction: —cast iron •✓ 40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): 1 `' ` ?oss:�ltr -- rr'1� S D P.U�Il`�a� ��AnFS OVu FA�n\�. Ij(�(,Pf' GAV c SEPTIC TANK: _ (locate on site plan) Depth below grade: _k Material of construction: concrete _metal _fiberglass —polyethylene —other(explain) If tank is metal list age: — Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: Ve,ss Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: i e ssy , �'- Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlettee or baffle: 1k How were dimensions determined: qr tc"tmut L ` Comments (on pumping recommendations, irdef and outlet tee or bale on do structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 0.w.e }A n\2 I&L ; jowCl GREASE TRAP: _(locate on site plan) Depth below grade: Material of constructio concrete metal fiberglass —polyethylene _other (explain): — — Dimensions: Scum thickness: Distance from top of scumLtoop oftlet tee or baffle: Distance from bottom of sto bottom f outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: "1)9 Cl, Owner: Date of Inspection: ti-%-) TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construon: concrete metal fiberglass _polyethylene other(explam): Dimensions: Capacity: gallons Design Flow: alIons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: At- ; 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order (ye or no): Alarms in working order (yes o o): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: C" MH Owner: C'S-A Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): V (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: a SLS leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and confi tion: Depth - top of liqui o inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locl on site plan) Materials of constmctio Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: q�( Svc v. L� Owner: V -n - o (o Date of Inspection: Prc`S�rrr�� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. See, A � (� U\V\J % Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: rn�rs\1 Date of Inspection: SITE EXAM o Slope 0-3,o Surface water nod see✓ C Check cellar ,/ Ar-, Shallow wells f\ , \,, Estimated depth to ground water -A'4- Meet NS 0 ,, �,) c 1, U1, � g Please indicate (check) all methods used to determine the high ground water elevation: JObtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SA Checked with local Board of Health -explain: _ rw: ,,0,� Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water Summary Record Card generated on 4/19/2006 9:54:32 AM by Elaine Barclay Town of North Andover Tax Map # 210-106.A-0263-0000.0 99 SUGARCANE LANE MARSHALL, WILLIAM 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Size Total 0.97 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until MARSHALL, WILLIAM Payor 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17669.0 - 99 SUGARCANE LANE Last Billing Date 4/10/2006 3170339 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 61.02 /1 UB Meter Maintenance Serial No Status Location Bran cj Type Size YTD Cons 41849368 a Active ENC F.RT.? w Water 0.63 0.63 0 Date Reading j/ Code Consumption Posted Date Variance 3/8/2006 1469 a Actual 18 4/17/2006 -39% 12/21/2005 1451 a Actual 35 1/17/2006 -64% 9/20/2005 1416 a Actual 91 10/14/2005 138% Trouble Code:03 6/27/2005 1325 a Actual 40 7/15/2005 138% 3/30/2005 1285 m Manual estimate 20 4/5/2005 -27% 12/14/2004 1265 a Actual 21 1/14/2005 -65% Trouble Code:03 9/24/2004 1244 a Actual 77 10/8/2004 105% 6/11/2004 1167 m Manual estimate 20 7/30/2004 57%u 4/16/2004 1147 a Actual 28 5/17/2004 0% Trouble Code:03 12/15/2003 /15/2003 0% JSEN & SERGI INC. AF (1987) �TARR (1993, 1995) UE: 9114195 11:10 D NOT TA/N 12" VG SOAK RATE: <2 A41N/IN ATE: 7131195 C: 12:21 12:37 12:54 1:20 RATE: 12 MIN/1N OF .OIL. TEST PIT NO. 1 x o BENCHMARK: NAIL SET IN 10" OAK ELEV. = 124.96 DATE: 3126187 TEST PIT NO. ?- PLAN SCALE: 1" -^ 2=/' LOT 4 q4 \ r 210.66' j-,.`; DESCRIPTION DESCRIPTION w G I" 1280-_____-! SUIT i x26.0 24 --_-- SAND AND GRAVEL i 123.0 60 % SAP \, GRA NO REFUSAL REFI PLAN SCALE: 1" -^ 2=/' LOT 4 q4 \ r 210.66' j-,.`; r ' � lZ o n Z Oz _0 w m L)o Q Z ow.N� F' O =_ CnLLw o" < co F_ zOP ®� W = cfl �� 0Z� Z� Z Q W r ?—w sw M Q v,) W ui o -S �ZZ ao j U wp O LL Q 0 w CO 0 �0 0 w > U cc Q W /pry p Z Q O LUJO UD =wZ z8 ?Zvi o., WFQzmo�OZQ u~.o= U) ...7 6p A `t = ¢ Y ° via w 'S OR Ez' t— F— < Y= m t=- w z o w O<o F -O0 =� W 0 v cnU- z wz w0M Z .4 LL ��OLL ocn W—z =Q �WO 00 4 F--� wwZ am QcnZ H0 z � O?O LL p: O 1: uj Lu U-)U� F-QO F - (o LU cq U-JLL Z N N 0000 -� N F- a 0 J F- O (9` ry o co o CJ Cn x 0_ c� \ �°`x, `sem co Z aco;rn�vO?� O CA p� w 000rnQ� o 54.58 m MMrM�"� w H nil j n w ZXw O mzI.-Xma U F= U.¢tLOLLw V a OF'Om00 -iOOOO=)Z w w O?O?Ow (n .:�;.' .,,r]:,t,^` y„«'K'''"7�1:�5' yF r/�'y �Nt{'S�F� IJj!'.•ti'rti�; r . -- .,•y, ,`�ip �Jft)±��r�i�,l•••�'�"�hX��L�x" p��nyy� �''+�•�t� .. v �1Y�0 L 5.,�j7'�1�tlr. '�,.71�jjYj•t���t� 11 •b''• y rflEALTH 0 6 2005 TOWN UF' TOWN DE FRTF NORTH NDOVERv.�t'�PtJMP1NV RP_C .. . %'t41POOL,; N YUJ•. HA rvKu ON s�RY►c,��; xvv'rfrr� t hltK�lhtcl OOOb Qoyorriyiv rVU. I'V l,•C7Yrx ►MYY QVXA38 BAY7l85 INF KQQT3.: . excu81Y8 sOl,lpB .".. FLOODED '1frL8�� ,,.•_•.. P1,00D �OLiDC�XAY9ng01rtiER•eXPL,11N Cl Ad � UN 1'frN l'y t}�Nyy�XKbu 11 1 k t k c ( B = � � � p k $ v a Cts c 2 k 0 �� § 2 o Z 2 § a 7 % k F- D J k 2 2 « k c B = ® � � � p k $ v a a k c 2 k 0 � 0 2 � ■ 3 8 \ I k � � B = k p k ) Lo loirCL c cc # 2 E 2 % k F- � LL k � 2 p k k t) f : 7 o /\ 8 \ I § B = k p k ) Lo Lo .j � B w 2 % F- C) LL ° k . ? f : 7 o ac 2 E ■ a § § E \ § 3 Cl) O � COL -0 a .. / ° % 2 7 � t § a 4) § k 2 § u Q Q W Cl) 8 \ I Sawyer, Susan To: Sawyer, Susan; McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject: RE: 99 Sugarcane Lane Thanks to everyone who showed up for the beaver walk. It was shall we say... very interesting... The next step. Bill H will check the maps to determine if this is town land. I will hold off on other suggetions or recommendations of action until that is determined. I will be in touch. Susan --Original Message ----- From: Sawyer, Susan Sent" Wednesday, June 29, 2005 7:41 AM To: Sawyer, Susan; McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject RE: 99 Sugarcane Lane Due to scheduling issues, the walk will start at 8:30AM this morning. Sorry, I didn't get this to you all sooner. Susan -----Original Message ---- From: Sawyer, Susan Sent Tuesday, June 28, 200510:40 AM To: McKay, Alison; Bill marshal) (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject 99 Sugarcane Lane The beaver dam exploration walk for 99 Sugarcane has been scheduled for Tomorrow, Wed. 6/29/05, at 9:OOAM. For those who are attending, please meet at the above address and we will go in from there. Plan for at least an hour, I would guess. Bill, Alison and Health will definitely be there. We will report to the rest of you on our findings if you sit this one out. Thanks Susan -5 O O O O 0 m r zzzz N O bq cC Q C O O ra. N r9r r o x R CD O U Q C 0 0 x R N t` � O N Oa o c N L � o r� N w O v ZM a � N v � U N y m M O .0 C7 � 0 IO 6 CIO O� O L O O 00 00 y o y 0 � � y RS O 0 0 N Q S ON \D 1�0 -� 0 N a z W) cQc CC O a .a 0 m r N O bq cC Q Li. O O ra. r9r r o x R CD O U C 0 x R � O � Oa o c L m w O v ZM Q N y m M O .0 0 6 O L 00 00 y y w Q S �i z W a .a W y W 9 ¢ a c � U G 01 Lam- U Q � C 0 5 0 .0 C z � 10 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 29, 2005 10:36 AM To: Sawyep-Susan M ay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: Del eLhiaie, Pamela Subject: : 99 Sugarcane Lane Thanks to everyone who s owed up f�tie eaver walk. It was shall we say... very interesting... The next step. Bill H will check the maps to determin ' 4 'is'1s town land. I will hold off on other suggetions or recommendations of action until that is determined. I will be in touch. Susan -----Original Message ----- From: Sawyer, Susan Sent: Wednesday, June 29, 2005 7:41 AM To: Sawyer, Susan; McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject: RE: 99 Sugarcane Lane Due to scheduling issues, the walk will start at 8:30AM this morning. Sorry, I didn't get this to you all sooner. Susan -----Original Message ----- From: Sawyer, Susan Sent: Tuesday, June 28, 2005 10:40 AM To: McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject: 99 Sugarcane Lane The beaver dam exploration walk for 99 Sugarcane has been scheduled for Tomorrow, Wed. 6/29/05, at 9:OOAM. For those who are attending, please meet at the above address and we will go in from there. Plan for at least an hour, I would guess. Bill, Alison and Health will definitely be there. We will report to the rest of you on our findings if you sit this one out. Thanks Susan DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, June 28, 2005 10:40 AM To: McKay, Alison; Bill marshall (E-mail); Cyr, John; Grant, Michele Cc: DelleChiaie, Pamela Subject: 99 Sugarcane Lane The beaver dam exploration walk for 99 Sugarcane has been scheduled for Tomorrow, Wed. 6/29/05, at 9:OOAM. For those who are attending, please meet at the above address and we will go in from there. Plan for at least an hour, I would guess. Bill, Alison and Health will definitely be there. We will report to the rest of you on our findings if you sit this one out. Thanks Susan r M M z m m g C -° Q O O W O U N'N @UE= m N N o J � W W a O C7 ooX�U o Q J - 0 —i a� c cu J o0� W 07 � U p (n c4 i6:2 of O_ o 0 N d W w C U U) vcl Q U a0i Wwg; � z a om 0 Cl.Q 0 d 0_ m CD t� N C O tq a ao En0 O�LUUS O F- IL-2 W Q z m m g C -° Q T- W O U Z @UE= m 0 -0U) J � W W a V C7 z0 C-4 0 Q J - in Z —i MInCD J o0� W 07 � U p (n 0 0 N O W U� o 0 N d W w ..0:z 0to0: 20 COdU C vcl Q Q a0i Wwg; � z �U om 0 Cl.Q 0 d o 0 ro..laC) a C 0 d in > _O ao En0 a)a)00 � in in cn O J oIn M Qo ti NCD H le O O 0 ¢ m 0 N ¢ c OUE Cc q x —:. Na)00 O DHF - CD Z o O O F.. O O O 0 J m m E 0 U —I . I0 M Q m m N 0 � 0 Q o ad t LL z Q� Q W Q � W J � W W � V �� z0 C-4 0 Q J - in Z —i a J W =} yV iii:3 CD �- U ..0:z 0to0: 20 Z Q �z CL O ¢ J J LO 0 o N 0 O 0 0 O 0 0 co 0 co 0 0 N 0 75 ns a 0 0 O Ln N N o 0 LO N <- U M J J CC) 3Ci N O) Y Y 00 r00 oIn z Orn } 7 Z N r 0 zr a W z J J 0 r` ON 400 Z oo -gnaw LL N (o Z6-- ' coZ•..N 0.. 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Parcel ID: 210/106.A-0263-0000.0 SKETCH Click on Sketch to Enlarge Community: North Andover PHOTO ,%t0 P'1C$uPa Location: 99L-5/ SUGARCANE LANE Owner Name: MARSHALL, WILLIAM A NANCY J MARSHALL Owner Address: 99 SUGARCANE LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 0.97 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 4568 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 910,200 872,100 Building Value: 710,200 681,600 Land Value: 200,000 190,500 Market Land Value: 200,000 Chapter Land Value: LATESTSALE Sale Price: 165,000 Sale Date: 04/25/1996 Arms Length Sale Code: P -NO -USE- Grantor: COLONIAL CHNGE DEVELOPMENT Cert Doc: 12405 Book: 00095 Page: 0025 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3 &LinkId=467624 Page 1 of I 6/28/2005 North Andover Board of Assessors Public Access Page 1 of 1 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=2&ReeNo=11 6/28/2005 North Andover Board of Assessors Public Access Page 1 of 1 http://csc-ma.us/NandoverPubAcc/j sp/SaveSearch.j sp 6/28/2005 Page 1 of 3 Sawyer, Susan From: Cyr, John Sent: Monday, December 13, 2004 2:53 PM To: Sawyer, Susan Subject: RE: 99 Sugarcane Lane - Beaver/Flooding issue Sensitivity: Confidential We unclogged the culverts at 393 forest st. and on Salem St.at Granville Rd. on Thursday and also this morning. This will lower the water level on Sugarcane LN. we will continue to monitor the water level. Ucyrl -----Original Message From: Sawyer, Susan Sent: Wednesday, December 08, 2004 2:31 PM To: pdellechiaie@townofnorthandover.com Cc: Cyr, John Subject: RE: 99 Sugarcane Lane - Beaver/Flooding issue Sensitivity: Confidential I spoke at length with the homeowner. They do not have any emergency that needs permitting, however, they have been noticing a steady increase in beaver related activity; such as trees down and a rising water level. I told her that to take any action there is a process and I would forward her the information. Also, unless it were on town property it would be up to the landowner to take action. So, I guess that is it for now on this one. Susan -----Original Message From: Pam Dellechiaie[mailto:pdellechiaie@townofnorthandover.com] Sent: Wednesday, December 08, 2004 9:43 AM To: Cyr, John Cc: Sawyer Susan (E-mail) Subject: FW: 99 Sugarcane Lane - Beaver/Flooding issue Importance: High Sensitivity: Confidential IE John, Do you know if this is in the beaver area that is being monitored? Can 12/27/2004 Page 2 of 3 you call me back today and let me know? Thank you. Pamela 978.688,9540 -----Original Message ----- From: Pam Dellechiaie[mailto:pdellechiaie@townofnorthandover.com] On Behalf Of Dellechiaie, Pamela Sent: Thursday, December 02, 2004 9:53 AM To: Sawyer, Susan Cc: Merrill, Pamela Subject: 99 Sugarcane Lane - Beaver/Flooding issue Importance: High Sensitivity: Confidential Hi Susan, I briefly spoke with Pam M. about this call to see if she had any guidelines. Received a call from Nancy Marshall at above address. C: 978.621.6150; H: 978.687.4016 re: beaver problems and gradual creation of a wetland area surrounding her home. The way the caller described her situation is that her home is elevated, and gradually slopes down. It appears as though all of her lower property area is engulfed in water (looks like a pond) surrounding her home. She is concerned that all the trees on the property will die off (and also. they will be unable to use their land) because of the beaver activity which is causing this flooding. At this time, there was no request for a beaver permit. She is looking for guidance, next step, etc. I am not really up to speed on all the beaver updates, so I am referring it to you. 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V_f N\ rQ0 •O 0 CIL. _ b p ro NMpl *r• U4) LL Town of North Andover AORTN f 1 OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street - p��TO KENNETH R. MAHONY North Andover, Massachusetts 01845 9SSACHUSEt Director (508) 688-9533 October 11, 1995 Mr. Phil Christiansen Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Re: Lot #5 Seven Oaks Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Less than 4 feet to groundwater. 2) Less than 660 GPD design flow (variance requested). If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nioetta Michael Howard Sandra Starr Kathleen Bradley Colwell .r.•. r •.ti • • 0 i •� 0' ♦ I� 1IT*; I •!yy, j.� • .+ : �. r�i •.0•i ^ OVi. ♦I,�/r.�� •1•) •.i f••��� L`%��A �.i0''0•i.lf,li•; r+�1;�.t�:�•,1 1 �I#� f ` /��) 'f:� i •+�fi �': • �% �•/.., r /L� (► J I:i• 0. •�i ,� •,��/ f r� • Vill WAY OA v I • • i Oe1e of PumDIA9 •. 01� Oral � ^': ar'.'�/ r•; ; 5'' CO>�9001(�)OD�!c Ten. -- 'IS•"•1 18 - r vi (describe � 77�';�, m�e�) 1vv FI►Ie(p(O.�enr7 [' Yo, n'o ''tt/, ,'��'li.b�1lI�?1'�G'f� r Il,.x��t/il �%�i" iltii!'�'''.,%• r97. n'8) 1: C'Odn00% � T� S m,.,�t,;; — �••'i�,'/il.jl�,11J'i'Jr � 1'.I'(I!1;ViV1V '!�l•":t �. Y. . 'yrS ..l,l; l�l'�Yr,N•, �r ira Irl. r; SY1 Pymped 8y!' ,,.• 1„ ';G, �,'� �VIM i •f I (' `,.. , Yl1'l V�yf , ' �fr�✓ �lj� r�lr, / / r w.1{ . ' • a'•. �,;,�IyL,�'.�,�;����,G,O���IIU,y�Qra dlsDoso/v: ,� ' ,, „.i'. '•I �.Il'; �.y'• 111' 1'1r 1, 1'�r I •.�. I, � �l� ..'nr.masa• 9ovldeplveleiliDD�4Ye��llblo PLAN REVIEW CHECKLIST ADDRESS ,�p�—`g` � / � 0 ENGINEER GENERAL 3 COPIES STAMP �� LOCUS NORTH ARROW l� SCALE CONTOURS PROFILE Z/ SECTION �� BENCHMARK SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? _4/0 DRIVEWAY '� (Elev) WATER LINE C---" FDN DRAINy� SCH40 6,-" TESTS CURRENT? `' SOIL EVAL 'D�nl �CpytJ�UGG SEPTIC TANK MIN 1500G 11� .17 INVERT DROP z/ GARB. GRINDER /tb (+200% EDF) 25' TO CELLAR v MANHOLE/)41" ELEV GW # COMPS. D -BOX SIZE # LINES ` FIRST 2' LEVEL STATEMENT INLET IAA, 73 - OUTLET /R% 7e = 9 % 7 ( 2" OR .17 FT) TEE REQ' D? !yU LEACHING MIN 660 GPD?,/ RESERVE AREAb,/41 FROM PRIMARY? 2% SLOPE 100' TO WETLANDS 1.00' TO WELLS 4' TO S.H.GW A (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS L-,-325' TO SURFACE H2O SUPP L/ 4' PERM. SOIL BELOW FACILITY L- MIN 12" COVER ILL?4---'("25- if (25'if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 d SLOPE min .005 or 611/1001) `� SIDEWALL DIST. 3X F. W OR D (MIN/6' ) RESERVE BETWEEN TRENCHES? L --"--IN FILL? L/ MUST BE 10' MIN.y 4" PEA STONE? 61"'� VENT?(>3' COVER; LINES >501) BOT 400 +' SIDE ��� X LDNG � � = TOT , 0 (L x W x #) (DxLx2x#) (G/ft2) ` Copyright © 1995 by S.L. Starr DATE 14 //T /5 � 5 Sheet BOARD OF HEALTH TOWN OF NORTH ANDOVER of SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # zz DATE RECEIVED Z APPLICANT'PRUL- SL 1 iZA/e'er ASSESSOR'S MAP ADDRESS ENGINEER ADDRESS p %, PLAN DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED PARCEL # LOT # Ur STREET i5,! 6—A Oi9,rr's' REVISION DATE Zy5 hf van+ Qy y�✓ �i" ! rii r % r A k•€l. 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C2 Town of North Alidover Health Depaftfii6nt Date: 400111 Location: Q (Indicate Address, if ResiJKtial, or Name of B sine s) Check #: Type of Permit or License (Circle) Animal Dumpster $ ➢ Food Service - Type. ➢ Funeral Directors $ lf-- ➢ Massage Establishment $ > Massage Practice $ -> Offal (Septic) Hauler $ Y. > Recreational Camp $ > SEPTIC PERMITS: Ej Septic - Soil Testing $ Ey L] Septic - Design Approval $ 0 Septic Disposal Works Construction (DWC) $ Li Septic Disposal Works Installers (DWI) $ > Sun tanning $ i > Swimming Pool $ A > Tobacco $ ➢ Tra.chl`Snlid Wa.qtp Hauler > Well Construction $ )0, OTHER: (Indicate) HXrK Agent Initials 15 9, 6 White - Applicant Yellow - Health Pink - Treasurer i NO _ aNb71 II C 4 Z_ LAS >PE=0.02'/. s N� 0�6 X' . AnJ 2°29148" W 54 U rn Q 0 ch W LO Q SUGARCANE LANE p0 1 I > LLQ > I Inp J a Z I I d 00 0 w J .z � � � Crr) UJ O 00 Z Q I i N c� �- zo 0 0 Z O I ! = o &0 1 >, _j U5 Q Z N ,I W �! CV I LL' In 80 1 LO U). 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"'<'� �-� �7:' �-' . , � I � - J, ,A- --- � .. -'.. - -7�'! - .,-'.,, '!� , . ", " �1 �' �'-.� -- -- 1�Sj III 1. 1 j., yi 1 /9' - (41 v_ _7 , �- .--,. Nv I.. -.--./-!�.""'-..' ---'!-:!'.. x - - �. / r//. ,/ +fir. i '� X / r�.Y'ill Vi t �'� // 11 f l S-'\ Commonwealth of Massachusetts City/Town of a W° System Pumping Record 0 Form.4 JUN e7 4011 DEP has provided this form for use by local Boardsbe used, but the information must be substantially the same as that p vi w4w EWng this form, check with your local Board of Health to determine the form they use. a By'sl9mm7ruMpin ecord must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of hous rich front of house left side of house, right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. City/Town 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) Sta aZip Code �-�-��.s Telephone Number — 2. Quantity Pumped: Gallons eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: �Jo`v-CL,� A d� 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: Of Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 v 5528 �O F: •`.rte -' L9 Town of North Andover ,' HEALTH DEPARTMENT ,SSACHUStt CHECK #: ATE: LOCATION: /i�� , H/O NAME: CONTRACTOR N Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Tithe Inspector $ O -'Title 5 Report $� ❑ Other. (Indicate) $ Health Agent Initials': White - Applicant Yellow - Health Pink- Treasurer. Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - dq not Use the return key. ISI @oineonwealth of Massachusetts Title 5 Official Inspection Fo Subsurface Sewage Disposal System Form - Not for Voluntary) 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover Cityrrown MA 01810 State Zip Code JUN 4.2 ZQ1 I TOWN OF NORTH ANDOVER %I 6/10/2011 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. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover Cityfrown 978-475-4786 Telephone Number B. Certification Ma State S115 License Number 01810 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Fur.0er Evaluation by the Local Approving Authority 6/10/2011 Inspector Sig ature V Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. ML t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System . Page 1 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M yt 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every page. Cityfrown State Zip Code Date of Inspection— B. B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins - 09/08 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 't 99 Sugarcane Lane Property Address Diego Mansilla Owner owner's Name information is required for North Andover MA 01810 6/10/2011 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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? ® ❑ 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. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 6 of 17 Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Commonwealth of Massachusetts ❑ No ❑ Title 5 Official Inspection Form ❑ No ❑ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ❑ No 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 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 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover MA 01810 6/10/2011 City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: State Zip Code Date of Inspection General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: Date Pumped last year, owner 1500 gallons Measured tank Inspect tank, baffle & tee ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 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 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover MA 01810 6/10/2011 Cityrrown State D. System Information (cont.) Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 15 years old, 4/16/1996, as built plan Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron [-140 PVC ❑ other (explain): ❑ Yes ® No 1.5 feet Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC thru wall, 4" & 3" PVC in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal ❑ fiberglass 0.5 feet ❑ polyethylene ❑ other (explain) If tank is metal, list ager years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 4" ❑ Yes ❑ No t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Owner information is required for every page. t5ins • 09/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover MA 01810 6/10/2011 Cityrrown D. System Information (cont.) Septic Tank (cont.) State Zip Code Date of Inspection 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 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 23" 2„ 8" 19" Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Bushes should be relocated off tank. Some roots getting into septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal 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: 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 99 Sugarcane Lane Property Address Diego Mansilla Owner Owners Name information is required for North Andover MA 01810 6/10/2011 every page. CitylTown 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.): a Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Owner information is required for every page. I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01810 6/10/2011 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): D -box level & distriibution. No evidence of leakage. Evidence of carryover, pumped d -box to clean. 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: t5ins - 09/08 Title 5 Official inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (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 t5ins - 09108 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 Mt 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every 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: 2 trenches 50' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. 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 t5ins - 09108 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 13 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 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover MA 01810 6/10/2011 CityrTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every page. Cityfrown State Zip Code 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 L 1111110M SOL "1 w"O—c- Ak k = �`°I AU LA _Va_� IS_ t IJ .t5ins - 09/08 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Owner information is required for every page. 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Sugarcane Lane Property Address Diego Mansilla Owner's Name North Andover MA 01810 6/10/2011 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/21/1995 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts An Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 99 Sugarcane Lane Property Address Diego Mansilla Owner Owner's Name information is required for North Andover MA 01810 6/10/2011 every page. 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 t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 0 Summary Record Card generated on 6/3120112:01:10 PM by Karen Hanlon Town of North Andover Tax Map # 210-106.A-0263-0000.0 Parcel Id 17408 99 SUGARCANE LANE DIEGO MANSILLA 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Size Total 0.97 Acres FY 2011 UB Mailina Index Name/Address DIEGO MANSILLA 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 MARSHALL, WILLIAM 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17669.0 - 99 SUGARCANE LANE 3170339 03 Cycle 03 UB Services Maint. Account No. 3170339 Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Account No. 3170339 Type Loan Number Owner Previous Customer Property Type . Active/Inact. Inactive Occupant Name Last Billing Date 4/6/2011 Page 1 1 Residential From Until 6/30/2006 Active/Inactive Active Rate Charge Multiplier/Users 0.835/8 7.82 1/ 01 ALL METER SIZE 114.85 /1 Serial No Status Location Brand Type Size YTD Cons 33132497 a Active ERT HH b Badger w Water 0.63 0.63 635 Date Reading Code Consumption Posted Date Variance 3/8/2011 851 a Actual 27 4/13/2011 -60% 12/9/2010 824 a Actual 69 1/12/2011 -55% 9/10/2010 755 a Actual 163 10/15/2010 296% 6/7/2010 592 a Actual 39 7/15/2010 -1% 3/9/2010 553 a Actual 40 4/14/2010 -21% 12/8/2009 513 a Actual. 50 1/12/2010 20% 9/9/2009 463 a Actual 43 10/15/2009 3% 6/8/2009 420 a Actual 39 7/20/2009 92% 3/13/2009 381 a Actual 22 4/29/2009 -46% 12/9/2008 359 a Actual 40 1/20/2009 -390/c 9/8/2008 319 a Actual 67 10/10/2008 800/c 6/6/2008 252 a Actual 36 7/16/2008 1290/c 3/7/2008 216 a Actual 15 4/11/2008 -61% 12/11/2007 201 a Actual 43 1/22/2008 -15% 9/5/2007 158 a Actual 41 10/12/2007 99°/r 6/18/2007 117 a Actual 25 7/20/2007 9°k 3/14/2007 92 a Actual 23 4/16/2007 -520/c 12/8/2006 69 a Actual 32 1/19/2007 34°/r 10/5/2006 37 a Actual 37 10/20/2006 -1000/( 6/28/2006 0 n New Meter 0 7/10/2006 -1000/( 6/28/2006 1496 r Replacement 0 7/10/2006 -1000/( 6/28/2006 1496 f Final Bill 27 6/28/2006 30X 3/8/2006 1469 a Actual 18 4/17/2006 -390/( Summary Record Card generated on 6/3/20112:01:11 PM by Karen Hanlon Page Town of North Andover Tax Map # 210-106.A-0263-0000.0 Parcel Id 17408 99 SUGARCANE LANE DIEGO MANSILLA 99 SUGARCANE LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residentia Size Total 0.97 Acres FY 2011 12/21/2005 1451 a Actual 35 1/17/2006 -64% 9/20/2005 1416 a Actual 91 10/14/2005 1380/c Trouble Code:03 6/27/2005 1325 a Actual 40 7/15/2005 138% 3/30/2005 1285 m Manual estimate 20 4/5/2005 -270/c 12/14/2004 1265 a Actual 21 1/14/2005 -65% Trouble Code:03 9/24/2004 1244 a Actual 77 10/8/2004 1050/( 6/11/2004 1167 m Manual estimate 20 7/30/2004 570/c 4/16/2004 1147 a Actual 28 5/17/2004 0°k Trouble Code:03 12/15/2003 1119 n New Meter 0 12/15/2003 00/c � Commonwealth of Massachusetts City/Town of W° System Pumping Record Form 4 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 front of house,( rear of house. riaht rear of house. left >left side of house, right side of house, Left ht rear of building, under deck. q, 47 1x 2 Cityrrown State ' 2. System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): HO -AA <� ua State Telephone Number 61 Date 2• Quantity Pumped: Cesspool(s) Septic Tank Zip Code Zip Code Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [3�lo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: C,::" r-- ('d - Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1