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Home My WebLink AboutMiscellaneous - 226 Forest Street (2) 226 FOREST STREET t 210/106.A-0013-0000.0 --- T I w t �sYaTN ML.NSS8.4l,�T QN tISTHE INSTALLER LICENSED? YES NO ,. .,TYPE. OF- CONSTRUCTION: "' - NEW REPAI 'NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW_ YES NO tx CONDITIONS OF..APPROVAL YES NO (FROM FORM U) f: r `.ISSUANCE OF DWC PERMIT YES NO • rDWC PERMIT INSTALLER: BEGIN INSPECTION YES 0: EXCAVATION .INSPECTION: : NEEDED: l - r �<' Y ♦.fit �' 1 7 .• ' •. , � t..- t\.. .. PASSED =tom `•:CONSTRUCTION INSPECTION: NEEDEDt : ,AS BUILT PLAN SATISFACTORY: YES: APPROVAL. TO BACKFILL: DATE: BY !FINAL . GRADING APPROVAL: DATE HY DATE: BY FINAL CONSTRUCTION APPROVAL: i �iu�l�u�Y qF I nlve2Ts �,51C-�1J S1J'IrE N( w-s ►uV,y.r Fvr�i• = 9�,3 I.) exor. %rnv 'rAkm 6i-vL►_6a pHov&o Fact-1 -Y: Pia0 SIT6 ANv 971i PF4%*D nC IN A4 LIrffDVEf7 Lo(A'1104 1jEr-TIG Taal ly �(/.Z2 2.) 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I19,�o rta�' �1ftzE ET • -r"rtiT eE��.r5 L 13 T-I (APeIL� zS, 1.1.14 100 FILL 2. yro�1Y 51,,tY r1 u. �`I_ I.lo U"TEQ, AY ew LcArtev 3s,t DIST. 25cTY _�— � 4reve l.I.FD. �ZZ(o 12''c►�l IZ"cttt,J b'°e-C1ty cF'PFo•5ro,1r. Beucfl�L 1 I P-)ILL „ _ BLV•lon.o —`%"� I �/ Il.•�'ct-I%z r'1'° 56N.4c PJB M. _ I Larl?bt1 1 It17 ---- � IBo1 i �E GT I O rel PL SUBSURFACE DISPOSAL. SYSTEM LOCATED IN t\SGi A61-I Ll'6114, M PREPARED FOR 1?;,0 I-IAaE;SY TOWN OF NORTH ANDOVER DATE: AP>?I IL, Approved SCALE; I".4o 1 Date Signature IQOUJ T9,6 Fcw MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 TEL (all) 475.3553. 573-3721 +„ts "R¢ FORM. U - LOT RELEASE FORM ,- �10)3 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fr Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. "APPLICANT FILLS OUT THIS SECTIO APPLICANT / /G r �j /p,Yd, rj 78 /`CJS-S/O� c�! ff PHONE__ LOCATION: Assessor's Map Number PARCEL � SUBDIVISION LOT(S) STREET ST. NUMBER b OFFICIAL USE ONLY******"***"**** RE NDATIONS O WN AGENTS: CONSERVATION ADMINISTR OR DATE APPROVED DATE REJECTED COMMENTS s} TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC NS CTOR-HEALTH DATE APPROVED D O DATE REJECTED COMMENTSt L(� �� , PUBLIC WORKS-SEWERAVATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm w I �il Nark Diondi hl i l a I \ . "V pO�1{ S f N o S cp.l-r"c„ FpL2G 5 T #Zone A h X outside Dwellirvr, Tone X (hitside TO THE Provident Dank AND Frs(nTLE Nst s ) MORTGAGE INSPECTION PLAN I CERTIFY THAT THE BUILDlIGS sHOWN Do( ) CONFORM TO sETaAcrc REOUIREIIENTs (� � � IN I If (FRONT, SIDE t REAR SETBACK pILY)OF North Andover J M►iQl CONSTRUOTFD, OR ARE EXEMPT FROM VIOIA71pN ENFORCE1fD1T ACTION UNDER MASS GL- ��'7`" TITLE NI, cNAPTER SOA. SECTION 7. UNLESS OTHERM1sE NOTED. .-MASSACHUSETTS I FURTHER CERTIFY THAT THIS PROPERTY IS LOCATED IN THE ESTABLISHED FLOOD HAZARD AREA.COMMUNITY PANEL NO.: 25009° DATE.: h-2-o lm9 3 DEED THS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEOUENT TO THE RECORDED BOOK ALJ ed Iry A1•4•,'. DATE OF THE LATEST DEED OF RECORD. WHENEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTYUNE IT IS ADVISED PAGE UCEETHAT A MORE PRECISE SURVEY BE MADE TO VEWy THESE MEASUREMENTS. CERT..NO TION IS BASED ON LOCATION OF SURVEY MARIMM ENT A PROPERTY SURVEY.TMVERIFICATION OF SURVEY MARKERS OES NOT PIAN BK. PACE MAY BE ACCOYPLJSNED ONLY BY AN ACCURATE, INSTRUMENT SURVEY. AYS . S SHOWN. 33.;51 A ON T%PLAN Eg EPICTED FLAN / DATED THIS CeRTIFICATION TO BE USED FOR MORTGAGE SE NI Y. OFFSETS AS SHOWN ARE NOT TO B BmI0 USED FOR THE ESTABLISHMENT OF PROPER go.9629 SCALE: 1'. � •9L,.a�o�°° BRADFORD \ .; ENGINEERING CO. ~ *:"— `/. P.O. BOX 1244 JAMES W. BOUGIOUKAS' R"#9529 P.O. MA. 01831 TEL (9718)373-2396 �S A1VE2TS M.IL/., a FEx E/r, ,Eric. TAUL 541n1.L9c Px Hnr£D FDOI.1 SIT& AIlD DISPoSGD of Int A".l AnmovFL7 LUAnog FLA 1J OEr.T10 T4L1�IJ 9t,.?2 Z,)n.4 AOCA 10' ALL A¢WND 'r,-12 'pWop ,eD T1c6NG4&, .)EPIC INCI.UppUb-rut F.KI'7rIU6 'LEACH FICLO 4UUL BE DIYr, 9r"fVP OF Su9-5.16,-TI'P601L, AWO bPoILDt6ox1� = 95.17 HATQYIAL ANp QePLA"D IJrrH 9PtuF1e17 FllLJ_ Dr+L ?lace„r :95,(,0 3.) ALL. PIPIPI/n 4Aaw e[ �x.a,to•y"PVG EIJp TQ�.''rC"2. ,}•) All t.J I�i00 F�AL5EPf1C 'rAN� 7FIAL.L �S`. Iw` g5,3o BE I"ISTA LLtD TI.10 (-0 bPr.w10t BYIFet-v -0. ly pre?'M""" elraw 9c IN7(AWaJ vrl y �.') G,)Go*ro4 of tetNc�l C�CGaVATIDrJ SLIAL.L ee ° Bz 5 - No ca.cArE¢ T(JA�•I 3,o F&e7 vecP PeF TNC LISTB0 54rIr1ACY 6F IclViars AND TLlfc Rt5JL1S /62>C, . OF;•lll: Oo11. -m". 1,) 1140 IJVCILT DF 4 ?HE 4 C' I. FOV AT-r-46 Ip ID„I. WALL. �IALI.6E HAIu'rAIQ10(ELV4.AS,3,Arf�.) 97e• e•1 LoN9muclloi,l OF -r0f LEA"+ 1¢eNCNFJ SNati 3e I.L coNcacrurtcE WITH Tl" 'TYPICAL, 5rerq� <�LIe�1J .gid eN 0" W mi TITLG V. ,•rH. yf�rf£ SAi.I MAILS( Coof, LM AYkb (oxo 99:V GOOr GTI$! �7" �1reEE`i' -T r �E�iy L r5 f'I I�(oQ L 13 T-I ([welt. z5 1,1.14) 97.0 Tor— s�LL www 7r NY SI rY T i,L .�4_ IJ0 WnYEZ AT gy�' LTJ. FL.I. G7�•OE 30 Eri4T,Z`fIY r -- Lw.eD {4eeDED u.F D,pZZ(o 12"lA.�+l 12"cWU ( T'P SILL - Y.•r-FU. 4'PuYrol� 9Kx.flLli ELLV.•Ioo.o .. �" ( IL Lq.l%: 'F'ScN.4o Pro 1 DaeLe i J �LImI a iI ( 3 +�-- (. 3,. e TI --- u FO�E.yr S E GT 1 p r.l PLa�I ��I��II �Ic-, �EPAI� of SUBSURFACE DISPOSAL SYSTEM LOCATEDIN I10e.TH AtJDOVEe•. HQS`iACIALlI 'ET(V,. AS PREPARED FOR SY TOWN OF NORTH ANDOVER DATE: AP IL, z5, I q qq Approved SCALE: 1"=z}o1 Date /yg Signature z<.1JA MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET. • ANDOVER,MASSACHUSETTS 01110 TEL(617)475.3555,373-5711 Address Title of File Page of Date File Open: Date t=ale closed: Doc Document/Action Title Date of Refer to other Purpose of Documernt/Action and notes action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department PETER F. REILLY AFFILIATED WITH F.P. REILLY AND SONS, INC. 206 ANDOVER STREET, SUITE 11 ANDOVER, MA 01810 (978) 475-4370 SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION Property Address: 226 Forest Street, North Andover, MA 01845 Name of Owner: Sue Hahesy Address of Owner: same Name of Inspector: Peter F. Reilly (I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: F.P. Reilly & Sons Mailing Address: 206 Andover St., Suite 11, Andover, MA 01810 Telephone Number: (978) 475-1237 / (978) 475-4370 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes N/A Conditionally Passes N/A Needs Further Evaluation By the Local Approving Authority N/A Fails Inspector's Signature: Date: May 8, 1999 Peeer F. Reilly The system inspector shall submit a copy of this inspection report to the approving authority within thirty (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 regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. NOTES AND COMMENTS it TOUI/IVOF NORTH APlDOVER/ BOARD OFHEALTH tEALTH SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 INSPECTION SUMMARY: A. SYSTEM PASSES: Check A, B, C or D ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: System was functioning properly. B. SYSTEM CONDITIONALLY PASSES: N/A 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. Indicate yes, no, or not determined (Y, N, ND). Describe basis of determination in all instances. If "not determined", explain why not) N The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tan was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. N Sewage backup or breakout or static high water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed N/A distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and environment. 1. SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: N/A Cesspool of privy is within 50 feet of a surface water N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh. 2. SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. N/A The system has a septic tank and soil absorption and the SAS is within a Zone I of a public water supply well. N/A The system has a septic tank and soil absorption and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a water well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance N/A (approximation not valid). 3. OTHER N/A 4 SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 D. SYSTEM FAILS: You must indicate "Yes" or "No" to each of the following: N/A I have determined that the system violates one or more of the following failure conditions exist as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. N/A Liquid depth in cesspool <6" below invert or available volume <'/z day flow. No required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: none No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You Must indicate either "Yes" or "No" to each of the following: The following criteria apply to a large system in addition to the criteria above. N/A The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: N/A The system is within 400 feet of a surface drinking water supply N/A The system is within 200 feet of a tributary to a surface drinking water supply N/A The system is located in a nitrogen sensitive area (Interim Wellhead Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B - CHECKLIST Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 Check if the following have been done. You must indicate either "Yes" or "No" as to each of the following: Yes No Yes Pumping information was requested of the owner, occupant and Board of Health. I Yes None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A As built plans have been obtained and examined. Note they are not available with N/A. Yes The facility or dwelling was inspected for signs of sewage backup. Yes The system does not receive non-sanitary or industrial waste flow. Yes The site was inspected for signs of breakout. j i Yes All system components, excluding the SAS, have been located on the site. Yes The septic tank manholes were uncovered, opened and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. Yes Existing information (Example: Plan at BOH). N/A Determined in the field if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable [15.302(3)(b)]. SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 FLOW CONDITIONS RESIDENTIAL: Design Flow: >440 gpd (110 gallons/bedroom/day Number of bedrooms (design): 4 Number of bedrooms (actual): 4 Total Design Flow: not indicated on 1994 design plan Number of Current residents: 1 Garbage grinder (yes or no): no Laundry (separate system) (yes or no): no; if yes, separate inspection required Laundry system inspected (yes or no): N/A Seasonal use (yes or no): no Water meter readings, if available (last two years usage (gpd): private well - no measure of consumption Sump Pump (yes or no): yes Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of Establishment: N/A Design Flow gpd (based on 15.203): N/A Basis of Design Flow: N/A Grease trap present (yes or no): N/A Industrial waste holding tank present (yes or no): N/A Non-sanitary waste discharged to the Title 5 system (yes or no): N/A Water meter readings, if available: N/A Last date of occupancy: N/A OTHER: (Describe) N/A Last date of occupancy: N/A GENERAL INFORMATION PUMPING RECORDS and source of information: last pumping: not pumped since new system installed in 1994 System pumped as part of inspection (yes or no): no (pumped following inspection) if yes, volume pumped: N/A gallons Reason for pumping: N/A TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other (explain) SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/98 APPROXIMATE AGE of all components, date installed (if known) and source of information: System was replaced new in 1994. Sewage odors detected when arriving at the site (yes or no) NO BUILDING SEWER: (locate on site plan) Depth below grade: 14"-16" material of construction: cast iron ✓ 40 PVC other (explain) Distance from private water supply well or suction line N/A Diameter: 4" Comments: Condition of joints, venting, evidence of leakage, etc.) Building sewer was watertight and appeared sound. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain) If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No) Dimensions: rectangular - 1,500 gallons 6"-10" sludge depth 14" distance from top of sludge to bottom of outlet tee or baffle V-6" scum thickness 4" distance from top of scum to top of outlet tee or baffle 14" distance from bottom of scum to bottom of outlet tee or baffle How dimensions were determined: measurement Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc.) Tank was watertight and functioning properly. Pumping was recommended and done following inspection. GREASE TRAP: N/A (locate on site plan) Depth below grade: material of construction: concrete metal FRP other (explain) Dimensions: N/A scum thickness N/A distance from top of scum to top of outlet tee or baffle N/A distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc.) N/A SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to, or at time of inspection) (locate on site plan) Depth below grade: material of construction: concrete metal Fiberglass Polyethylene other (explain) I I Dimensions: N/A Capacity: N/A gallons per day Design Flow: N/A gallons per day Alarm Present: N/A Alarm level: N/A Alarm in working order N/A (Yes or No) Date of Previous Pumping: N/A Date of previous pumping: N/A Comments: (condition of inlet tee, condition of alarm and float switches, etc.) N/A DISTRIBUTION BOX: ✓ (locate on site plan) 0" depth of liquid above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) The d-box was level and functioning properly. Two lines were distributing equally. Little solids carryover evident. PUMP CHAMBER: N/A (locate on site plan) N/A Pumps in working order (Yes or No) N/A Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) N/A SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: not applicable Type leaching pits and number N/A leaching chambers and number N/A leaching galleries and number N/A leaching trenches, number, length two (2) trenches about 60 feet long each (600 s.f. total) leaching fields, number, dimensions N/A overflow cesspool, number N/A alternative system (name of technology) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils over leaching area were good, no evidence of breakout. CESSPOOLS: N/A (locate on site plan) Number and configuration N/A Depth-top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow (cesspool must be pumped as part of inspection) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable PRIVY: N/A (locate on site plan) Materials of construction N/A Dimensions N/A Depth of solids N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: indicate at least two permanent references, landmarks, or benchmarks locate where public water system enters house locate all wells within 100' I'1 la(oQ L I3 I, SAC, p �PProx, We t/ tr �, L u.�o pzzc, I P /ILL I 6-LEV.01oo.o 13 v �Pv 1 _ L ( F ? a til T-1 y6 SEPTIC TANK TIES: A to Inlet (1) 17'0" B to Inlet 2410" A to Center (C) 14'3" B to Center 27'0" A to Outlet (0) 13'0" B to Outlet 30'0" D-BOX TIES: A to Box 2110" B to Box 4013" NOTE: The system is in the front yard. The well is in the rear yard and measured at greater than 100 feet from SAS. w i SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) I Property Address: 226 Forest Street, North Andover, MA Owner's Name: Sue Hahesy Date of Inspection: 5/8/99 NRCS Report Name N/A Soil Type N/A Typical depth to groundwater N/A USGS Date website visited 4/1/99 Observation Wells checked Wilmington Groundwater depth: Shallow Moderate ✓ Deep SITE EXAM Slope level in area of system Surface water none observed Check Cellar dry Shallow wells none observed Estimated Depth to Groundwater > 1' (below bottom of SAS) Indicate all methods used to determine High Groundwater Elevation: Y Obtained from Design Plans on record Y Observation of Site (abutting property, observation hole, basement sump, etc.) Y Determined from local conditions N Check with Local BOH N Check FEMA Maps N Check pumping records Y Check local excavators, installers N Use USGS Data Describe how you established the High Groundwater Elevation.* Per 1994 design plan on file at North Andover BOH. Soils and grade changes in the area appear to confirm adequate groundwater separation. *Inspector's Note: Soil Evaluation is the currently recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified subsurface disposal system inspector. (see attached Disclaimer) DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. i i Peter F. Reilly Inspector May 8, 1999 •Tti^.� '. 7;- . i �' "'All J. . 11 � ,a.•* ` � l• :1� 1\ '�' Wf�N'a � l 3 1ti an g1 v, Rly— Town of North Andover, Massachusetts Form No.3 • t NORTH, BOARD OF HEALTH 1940 � ' •i 7 DISPOSAL WORKS CONSTRUCTION PERMIT SA US Applicant NAME A DRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair (X•}-an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. L J CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. LjurlF-AVY OF In1VEL -4 16--1IJ ZNrTek.(T IMV-,K 3 �t7T1�• 9$.'S-,► I.) FacKrr. %rIf. TA►JL 61-INLA-66 fEHoVIr0 F¢oH LAY' FLA0 SITE ANv v15Pe�5L'rD mF IW A-1 AffeoV E7 Lo"1104 e7r'fLL 'r441!i Ly g2 Z.) 0*4 A ISA Io' aLL AQaJrlo 'fi•!ri 'pii oeW TIa�NG-IG�i I": 150' lj1;PrIG T4nlL�a 95.°11 INc.L'ugq" T" Uyr1L)6 L&AGN PIL':LO 4"L RE 9rTr fPO OF Su4 SIL �-Or 5011., AWL? "la D Dorr, BoveI� : `'15.'1'1 Har"JAL Aao R ftokc90 lJmM 5PE440917 FIL.L'. orrf. PVK,,W q 5.(00 3.) AL.L. ��P L rl�, 411Aw B E 'ejeA4.0 0•qkI ArG EFJp TQ°LTQ"t. 'I.) A Uinta 15o0 E+Rl.• �jEPftC -MarlL. VHwL I_ BE I.4'vrk .LED iF'r%4L E)(V-fG 1•Ar41, 'K LGs4-r0AW Ior�GaL, 5OT-ro" "�¢L;Nc�I q�}.s,o S) Two civ Fc� L.ar+ BY a,pr. w as $Y I F9E-r a ay Prep iLGENG►!6S "ALL, rig, I�IyrALL.or� pge, �B2o.... 10�?H Of 'TZENG� EyCGAVAI 10 1 SiI.,L,t ,6 h � I.LO C,,"ATE¢ TLIArI 3.D FVCr GE'Lt(7 PEF 'fNC LSTfeD SArit—%ey OF INVfgn AND Tl,,& j1@$a6 $ 7) TN0 1NVEr.? of THE *G 1. F{I'F AT "rl4f. FL7tIJ. WAW S41AL4i BE HAW'rAlQ09 (ELev. 18.S�APP.�r.) g.) GON9T�uCT401.1 OF -rvlJ LLA 44 TeENGN�f SNAL.1. g� 1�► GortLo,cr4t1,1c� L.LIrN 'r"C. 'TYPICAL byJnl gel ! ANrJ kl1'T'u rirtL —1 4WA-C �l�nl IYA Ie,Y GO PE. ej,) - VIAL. Alt, 02c,410C-P (POO-51,� J r t'I 10(pA L I3 T 1 (rPe Zs, 1 q4 TTor�� i �ieNoY Yror+Y S1"TY .Tiw WO L1ATER. AY eW —,u �i.l. C�rta,DE 1 35't �nST. zSrtY � — �La.e-ieD_��jLCDED '� 1z''tLO4 I2"cwJ I u't•'DP II.Z� vLt1�Fily 4'PFASToNt BAucf�w �° J I EL �loo.o � 0X4-1%Z i' ScH.'io Pio —J � '� � LISLE ►l.,�lv J 1 Lout?b,,l Wd N 1 rtI sr. 3' -_►�— (i —�►I-- 3' W 3' �E GT 101.1 FLAd -'200iJI Qe-i P-EPAie. of SUBSURFACE DISPOSAL. SYSTEM LOCATED IN �oe-T ANpO�LEQ I''It\c/-7A(14LIQ6TJ AS PREPARED FOR DATE : AP IL, 7,5/ t llgl} TOWN OF NORTH ANDOVER SCALE: 1'•:7 401 Ap ro Cd� 3 64 FM esf ST Date Signature MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 O TEI. (6171 473.3535, 573-3721 TVX s -Joni Ax ��y �, � 7 7 Form No.4 Town of North Andover, Massachusetts r BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired ( ) by INSTALLER at ,.J SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. dated 19 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH ENGINEER v J i r . tJ- CCD co a �9 O N , e � . ''6 0 rk 50, a r N 3G X6-L62 �_Ip cX hO ges [{GD MAW L /74 02 �"a 7:;�R�'/< GE&ti'-+s" -r_ .��; ,ter. ►. . t � -�?-- l� - - :�e ,, -; .��`� f c_:I. 6 L °jG .44 �7. 94 ? 04 (tel tk,,.) a � IN IN I z �. 4 JIL.rte- -------^---------— '- "' � "� - - - � a -�� .,.�q s I+�:•� ; I�•�Y. _ O QUI pi-.•�.. +.�c �✓h L. '•,r,.. I ,A! '"'�:`fix--•�srar�� ` - - - � - ' . 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