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Home My WebLink AboutTitle V Inspection Report - 171 SUMMER STREET 9/29/2009 Commonwealth of°Massachusetts Official Title 5 e Subsurface Sewage Disposal System Form - Not for Voluntary Assess v s er 1p iO ri ..R I.a)00 R AL i f 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your HAROLD T. LINCOLN, JR. cursor-do not Name of Inspector use the return key. - RAGGS, INC. Company Name � P.O. BOX 1027 Company Address CONCORD MA 01742 City/Town State Zip Code 978-369-1100 4162 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: [ Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i Inspe -or' natur Date The system inspector shall su da copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 d s 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. ROBERTSMARKINSP.DOC-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Co ' o0wealth of Massachusetts Title 5 Off�Nc"BaB Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is NORTH MA 01845 SEPTEPWBER202000 required for �� Z|pCoda outaof|nopommn every page. City/Town � B. Certification (cont.) Inspection Summary: Check A'B'C'Q 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 CyWR 15.303orin 310 CK8R 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 13) System Conditionally Passes: �� [)neur more system components oadescribed 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. N. ND) in the 0 for the following statements. If"not detormined.'' please explain. �� The aepUotank io metal and over 2O years old* or the smpdctank (vvhetharmetal VrnoUia �� structurally unsound, exhibits substantial infiltration or axfi|treUnn or tank failure is imminent. System vvi|| pass inspection if the existing tank ia replaced with a complying septic tank aa approved by the Board of Health. ^ A metal septic tank will pass inspection if it is structurally sound' not leaking and if Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) nr due ho a brohen, settled or uneven distribution box. System will pass inspection if(with approval of Board ofHea|th): El broken pipe(e) are replaced EJ obstruction iaremoved rm°5omm°`/"°p°m/"^r.,m.n"b°"^°�n°°°o°o/"p=°/o'"�m'ran"uwm noosn,ow^nx/wvp000'�mo i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 _.. _... every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ROBERTSMARKINSP.DOC•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form e Not for Voluntary Assessments °b 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® 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. ROBERTSMARKINSP.DOC•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 ` . ' Commonwealth of Massachusetts 5 Official Inspection Form Title Subsurface SexvmQm Disposal System Form - Not for Voluntary Assessments � 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is NORTH ANDOVER &4A 01845 SEPTEMBER 29, 2009 required for State �"*e -- D�e vf/nope�iun every page. City/Town _� B. Certification (cont.) Co System Failure Criteria Applicable hmAll Systems (cont.): Yes No El 0 Any portion of cesspool or privy iewithin a Zone 1 of public well. �l �� Any po�ionofa cesspool or privy iovvithin5O feet nfaphvate water supply �� well. �� Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet -- -- from o private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed mt aDEPcertified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or|mes than 5 ppnm' provided that nm other failure criteria are triggered. A copy of the analysis and chain of custody must be attached tm this fmrmm.] The system ieo cesspool serving a facility with a design flow of2O0Ogpd- [� y� 10'000gpd. The system fails. | have determined that one or more of the above failure criteria exist ---described in 310 CK8R 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: Toha considered a large system the system must serve m facility with m design flow mf1O'00Ogpdtm15,U0Ogpd. 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 El Fl the system is within 400 feet nfo surface drinking water supply El D the system is within 2OO feet ofa tributary to a surface drinking water supply the system ia located inm nitrogen sensitive area (|nterimVVe||headProteodon �l 1:1 Area—\VVPA) ora mapped Zone || ofa public vva'ersupply well If you have mnavvenyd "yes" to any question in Section E the oyoham is considered o significant threet, 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. ROBE prnw^nx/wsp000'vomo Title o Official Inspection Form:Subsurface Sewage Disposal System`Page om`n ` Commonwealth of Massachusetts "�""��N�� u��~�� 0�� N�� Title �� *�N � N��0�wN Inspection 0—��mmuw Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 every page. Qty[Tonn State Zip Code Date ofInspection C. Checklist � Check if the following have been done. You must indicate^veo or"no" as to each of the following: Yes No E El Pumping information was provided by the owner, occupant, or Board of Health Fl Were any of the system components pumped out in the previous two weeks? E F-1 Has the system received normal flows in the previous two week period? Fl �� Have large volumes of water been introduced to the system recently or as part of �� this inspection? �� [l VVereaa built plans of the system obtained and examined? (If they were not �� available note osN6A) | • Fl Was the facility or dwelling inspected for signs of sewage back up? | � • [l Was the site inspected for signs nf break out? | E D 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? �l VVeathe facility ovvner(and occupants if different from ovvner) provided vvith �� 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: �� Fl Existing information. For example, a plan at the Board of Health. [� Fl Determined in the field (if any of the failure criteria related to Part is at issue �� approximation of distance is unacceptable) [31UCyWR 15.302(5)] noosxrsMxnmwnp.uou'vnmo Title x Official Inspection Form:Subsurface Sewage Disposal System'Page om1s Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a, 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS _.. Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 —.. every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 2 --- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No 97.34 AVG GPD Water meter readings, if available (last 2 years usage (gpd)): 6/2/_07-6/3/09 Sump pump? ❑ Yes ® No Last date of occupancy: D eCUPIED Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): - ROBE RTSMARKINSP.DOG-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 171 SUMMER STREET, NORTH ANDOVER, MA 01845 _ Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 - - -- - every page. City/Town State Zip Code Date of Inspection D. System Information (coat.) General Information Pumping Records: Source of information: LAST SERVICED MARCH, 2009 PER OWNER & RECORD Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1,000 gallons How was quantity pumped determined? FIELD ESTIMATE _ Reason for pumping: INSPECTION OF TANK AND TEES Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: CIRCA 1960'S OWNER, BOH RECORD Were sewage odors detected when arriving at the site? ❑ Yes ® No ROBERTSMARKINSP.DOC 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts al Inspection Form W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 — Property Address MARK AND LISA ROBERTS_ —.---..—.— — Owner Owner's Name information is NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 — required for — State Zip Code Date of Inspection every page. City/Town D. System Information (cunt.) Building Sewer(locate on site plan): .7 ---- — Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): ——--- Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): GOOD; OK; NONE — -- - Septic Tank (locate on site plan): .2 — Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------ Dimensions: 3" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 3711 — .--..--.—..--_ 31' 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 14" FIELD ESTIMATE How were dimensions determined? — ROBERTSMARKINSP.DOC-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 ` Commonwealth of Massachusetts =�""��0�� m��J��~��=��N ��~�� N�� m�� 8 ��N �mo��m � K–��pmum Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner'oNamo information is required� NORTH MA 01845 SEPTEMBER 29, 2009 r —��— �---�� every page. City/Town State te Zip Cpd_o Date ofInspection 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 ofleakage, ab:j: RECOMMEND ANNUAL PUMPING; TEES INTACT; APPEARED STRUCTURALLY SOUND AJ TIME OF INSPECTION; LIQUID LEVEL ATOUTLET INVERT; NO EVIDENCE OF LEAKAGE AT TIME OF INSPECTION Grease Trap (locate on site p|an): Depth below grade: feet Material of construction: El concrete El metal El fiberglass [l polyethylene F-1 other(explain): Dimensions: Scum thickness Distance from top of scum ho top of outlet tee orbaffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping renommendadnns, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert' evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): � Depth below grade: Material ofconstruction: El concrete El metal 0 fiberglass El polyethylene [| other(explain): ROSERTSMARKINSP.DOC 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts T"Itle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 ............. ..... Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX APPEARED LEVEL WITH EQUAL DISTRIBUTION; LIGHT CARRYOVER ; NO LEAKAGE OBSERVED ......... Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No ROBERTSMARKINSP,DOC-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts j Tits ffiiai Inspection Form Subsurface Sewage Disposal System Form o Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address ---- — ---- 1 MARK AND LISA ROBERTS Owner Owner's Name information is NORTH ANDOVER MA _ 01845 SEPTEMBER 29, 2009 required for ----- every page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 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: Type: ❑ leaching pits number: - ❑ leaching chambers number: ❑ leaching galleries number: — — ❑ leaching trenches number, length: 28'X 48' ® leaching fields number, dimensions: RECORD ❑ 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.): LOAM, NO SIGNS OF HYDRAULIC FAILURE OR PONDING ABOVE GROUND; DRAY; GRASS ROBERTSMARKINSP.DOC-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts T"MtQe 5 Off"Dc~aN Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREETN()RTHANDOVERMAO1845 MARK AND LISA ROBERTS Owner Owner's Name information is NORTH MA 01845 SEPTEMBER 29, 2009 State required for S �� Zip Code Date ofInspection every page. Cityrrown D. System Information (cont.) 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 nfcesspool Materials ofconstruction No�l� Yea � Indication of groundwater inflow �� `� Comments (note condition of soil, signs of hydraulic failure, level ofpondinQ. condition of vegetation, etc.): Privy (locate on site plan): Materials ofconstruction: Dimensions --�� Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): noenomm�m"��""pmm:o"b��" o°°�"o/�=wn�mm`p�e 1nm10 �oosmow*nmwnp000'o`mv Commonwealth of Massachusetts --- Title 5 Official Inspection Form Subsurface SmxvmgmDisposal SystemmFmrmm - NotforVo|unt�ryAem�esnnen�a � 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is MA 01845 SEPTEMBER 29, 2008 NORTH required for �r � �-- Zip Code Date ufInspection every page. C|ty/Tmwn D. System Information (cont.) 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. ,3 W ]// aq^ --- Title o Official inspection Form:o"u� sewage Disposal system'Page 1*m1s noosnrnMAnxwspuno'vnmu Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER TREETN[)RTHANDOVERK8AO1845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is NORTH ANDOVER MA 01845 SEPTEMBER 29 2000 required for State Zip Code Date o/Inspection every page. City/Town D. System Information (cont.) Site Exam: Z Check Slope Fl Surface water Check cellar �l Shallow wells 7'+ Estimated depth ho high ground water: feet-�� Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on nanovd |f checked, date nf design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) z Checked with local Board nf Health - explain: CHECKED PRIOR INSPECTION REPORT ON FILE Checked with local excavators, installers ' (attach documentation) F� AoceeoedUSGSdababese -exp|ain: You must describe how you established the high ground water elevation: CELLAR DRY- NO SUMP PUMP; RECORD INDICATED THAT NDGROUNDWATER FOUND IN 7' DEEP HOLE (SEE INSPECTION DATED 3/14/02) Title n Official Inspection Form:Subsurface Sewage Disposal System'Page 1smm 1 < M Z �SI� w w m cool m� 1030 OZ 111 V1 IT! 111 rm (A/� ^� `�I ��.. =C :0 n U) �j��j, ,} y� Ci7 O7 i plyy T >9 0mg -6 oz j3 10 m m m N I - ®® o CO Q0 � o 0 X p I< m r °t m -in ?� w o y w I y ? gy m= OD �• :u x m N (n ymC �aa y .« M N N vii gc 90 PM !'p �mrs d o n 0@ �X o o = �? m ® o? t r y ® o ro ={ Z Z I can I�I can r ® D O D ((�I�l m S ® C r. 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SHOW LOCATION AND FSIM OF SEPTIC TANK OR CESSPOOL OF 04' � ab MOTE LOCKTION AND DISTAI CE OF IUPLL FROM S0"Pl!"RAC Z SYSTEM 10. SUM LCCAT IOIN OF BRGOKS s STFEAIvS s DI E'S p LEDGE OUTCROP� 21a SHOW DISTA OZ OF SEPTIC TA Y, OR CESSPOOL FrRO'11I IJOUSE NCIJ'E s LOCAL REGULAT IOM) SHOULD BE READ CA's YTJLLY a November 4, 1061 i' s Pfary Sheridan R. N. health Agent Board of Health. Jorth Andover, Mass. iJ "'t s Sheridan: �r '':?_5� An ES:e:aminfiat ,xon was made as rEUtEs "Fui : Cr ue T' to CeterY'_ Ti the suitability ity o the soil for the sub u.rface Ca'ispoFsa7 o,L' tiKGVjge on the tiroposed K m r Street building site row, 'Wilfred 7 e{ e ult The i_€end in general. is high. T.I:]. ' subsoil in the area was of sa 'd",y 61 Confte7t and a min to percolation '%est %r`1 conducted. it is recommended F:i"?at a 750 gallon concrete septic T::;;nk be installed together % itr 18 : lineal feet of drain F:: .uea Very tr-aly your'ss is)cD j hd Arsanault, Wilfred Summer Ste APPLICATION FOR SEWAGE D.ISPCSAL DSTALIA.TION t HEA LTkS DEPA RTI PVT ® NORTH ANDOU'ER, MASS. I hereby make application for a permit for a sewage disposal installation at lummox 2 , I will install this system in ac- eordance with all the laws of the Commonwealth of Mkssachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 75.0 Gal ., in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open ,jointed pipe and laid in a series of trenches, the bottom of which will pro® vide a minimum of 8O _lineal (4t feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3A to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/$" to 1/4P (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single vile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. T further aZEee not to cover anv portion of this instal ation until ap roved by the_ inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DA f ;r f'. Signature' of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE .� Ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE �' '` Signature of" Inspecting Officer ".., Percolation Test 5 mine Soil® Sandy Clay Garbage Grinder®�e No m U) 0 21 m o K:o 0w JCL O D ro rov c v o, Z a 1 m � 0 °� C)�CD Oro 0 iv S to n tp C7 o ro o -4 D Ir C) 3 Zm D ao Z ° Z m� X r Dww mxmmmmw-1 �m °n co o o r. .. �_ v 00 03 C) 0® r O 0 0 G�G7 ci'(Jp-m o O o U) v scro -n m N 3 A D o �n 00)) x 0 N -1®10 a -bNUI M n Z w Z S o c°o o TOO GM -ICDCK 0 O hb G).0 O N CD =:4 ==:)h==:)h� - RL-0 N 171 I® ZZ N W O O a CD w O -n`n T Z a CO O .a CD .. - v N N@ � X O O N c QO mm S ro x ro o D 3 r--no , 0) m o w DD aA O W ° Z D rn p N C) o v ' x 3DDC)(n w nwD� °o 0 o o n m D 0 ®"' a w (no c a D r � N o < wa,o C G73 r ®C<aC`' a CL CD m O w w w w CD n� CD @mmmn� o � N CD CD CD CD ® O. N N M w n CU n ® m. 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City/Town State Zip Code Date of Inspection D. System Information (coot.) 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. �e t» ,3 V ,�i�Yrt�✓tom:R S� A�c�vi�t��r�3��'�� tit�t '�' e ROBERTSMARKINSP.DOC•03/08 Title 5 Official Inspection Form:Subsurtaee Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts T"Itle 5 Official Inspection' Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 171 SUMMER STREET, NORTH ANDOVER, MA 01845 Property Address MARK AND LISA ROBERTS Owner Owner's Name information is required for NORTH ANDOVER MA 01845 SEPTEMBER 29, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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