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Building Permit #Exception - 240 OLD CART WAY 5/29/2015 (3)
l� f NORT" q BUILDING PERMIT 3�°�`` ' 10 TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION =it NO: Date Received ite Issued: �9SSACHUS IMPORTANT:Applicant must complete all items on this page CATION_ Print ROPERTY OWNER Pr Jwl Aq 77f Print 1AP NO: PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes o 'PE OF IMPROVEMENT PROPOSED USE Resiciential Non- Residential I N w Building One family dition ❑ Two or more family 11Industrial 'Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: 7 QpMolition ❑ Other eptic El Well ❑ Floodplain ❑Wetlands ❑ Watershed District i ' fl Water/Sewer I + l i s ecs Su 4"OA #60A-*a4 A A5rilVA, 1.34 A 2 cap►Q� jl rT1 I Al 3T,4I/ M5w '.SaMpa ' t4AJ ir�1 Sly► arm - AL P/&"v S) Identification Please Type or Print Clearly}_ ER: Name: Phone�\��-��'1-����3 !ss: 2,q D a c WA 11 A), ©a V61Z, *TRACTOR Name: j� 781 Phone:- 2 S$- S/31 dress: 19 fl sa f� E M14- ervisor s Construction License: Exp. Date: 1 i i me Improvement License: 5 Exp. Date:I _ ./Y- t� 2HITECT/ENGINEER j�1JCa Phone:_ (0/7� wG/- 7/ MI!i dress: A1AL rsrti _( j; ANA Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. F tall Project Cost: $ � �, 001D, FEE: $ I eck No.: Receipt No.: f' ITE: Persons contracting with unregistered contractors do not have access to the guaranty fund (nature of Agent/Owner ature of contractor I , t 1 � � AC, s 3 - -- - DD - -pV 3L li � GN 7D � G G 3 Harty Porch & Renovation 240 OId.CartWay,N.Andover,Ma 01845 -19-2015 1/8"=1'0"or noted Existing Plans Mark Wagner-Architect 5 Malcolm Road Cambridge,MA 02138 617-661-7175 markwagnerarchilect@gmail.com F )l" 4� a • In F o s . i i ; ; i 3 r fi � Z � r � a I e ( � V Harty Porch & Renovation \ 1t 240 Old Cart Way,N.Andover,Ma 01845 i -M-2015 1/8"=1'0"or noted - Existing Plans Mark Wagner-Architect 5 Malcolm Road Cambridge,MA 02138 617-661-7175 markwagnerarchitect@gmail.com f i I � � I I , it II I II II I u Ir ,I 11 I, II - 11 II 11 II r ❑ II I g c v I, ❑ z Z I, ❑ [ • ; it Tff - I 1 m I I❑ O 11 r I� I I �� II ;I it II I Harty Porch & Renovation 240 Old Cart Way,N.Andover,Ma 01845 ® 1-13-2015 1/8"=1'0"or noted Existing Plans Mark Wagner-Architect 5 Malcolm Road Cambridge,MA 02138 617-66J-7175 marlcwagnerarchited@gmail.com y Ix m 1 c� N I X i Ez Sp \ ' i I � � I fel 10 Vi' ;3ar.dorsrs 8 Z o I � 3 9 0 i � 1 r _n L % N I . O ' L Harty Porch & Renovation 240 Old Cart Way,N.Andover,Me 01845 ` 1-1!)-2015 1!8"=1'0"or noted Existing Plans Mark Wagner-Architect 5 Malcolm Road Cambridge,MA 02138 617-661-7175 markw�gnemrchilect@gmail.com .r E -- IItI I E ' yro RPCoE t�. � o+ - - I V I I (juMP GEt-La(L INIOF- I � Lv I I: I � II I A YxTERtoR. f' �o co 0 EW -- - -- ------- --- - ---- - - - ---- -- - - - - - - - - �' to OO O -- - - - - - - --- -- -- -- '- ---- -- -- -=� ------ ------ �: t�+W�IEEwNG �a �ooTtNG SI2ES � � E B�F"n t tpt:IJn�J St2GS gy ENGIr•1EL-2 V G �, 'IVkL Gb 3 8 O � 3Xby E efJTERTaiN�IENt AR's 8 5l8"Gwg Eh IDE woov LOO2IJG oa FOAM VnFofz F,&Rs-IaL 2x6 Savo r.*us Tyr wI(�oKJI.yD�Nn IrtS�wtto*� IJE�U f3Eaon ;� O O � d zX4 STVD wnu s CI P'f ISVTT°rr PLATE T`(P. 3 EXISjIIJG �ASEMErRT - I '� IMSUL I O�dc SIA-KEUP GLS r c R FL O o p 2 3 4 �; m >n yP v3Nv V S.Epn� hTofZaGE 1'EPK E 3-rp-y C r— �ASF,MF.NT PLA - ;I a a � FIFL.oc-ATE MD ADP SpRfOJ -LGRs AS,REQUtf?f�V O _ 10 i � E a Ud 28n6a � ' W 4 4'01 411" hx4 unu5 A m Zbxbe 2x68 24tba sTltJG LIVIrJG WM � za „ o d W M.Geos M. "aT .._ � NEW DoOR� �� ._S° SEE BLEVwrjo NS 3 �`� Z"° SEGTI•N 0 ! I 8 C � &ff i f0 Lo 5v”, _� tia ,yam Vrr'r w To 08) m LSL FL�.vNb OPnoP . h. 111 I° a 91h r -0,R- C -o - o a New sUtJ M c'o v 11 Om:= c ttLF-D WOOD r-LOofL ++p c= {pmo4. i f� SPRJ�K LE{LS As rzeza R---p O�o p. m >u .I5T F L-ODF- PLAN _ _ s N L?N O 1 16•h I W o 8 1 =N vovo,;P��SooCahn Commonwealth of Massachusetts n • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments , 1 ) c�M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 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. Please see completeness checklist at the end of the form. Important:When RECEIVED filling out forms A. General Information on the computer, use only the tab1• MAY 2015 key to move your Inspector: cursor-do not TOWN OF NORTH ANDOVER Chad Jablonski use the return Name of Inspector HEALTH nGpRTMFNTSI)EP key. C.J. Jablonski Septic Inspection and Repair Company Name 237 Merrimac St. Company Address Newburyport MA 01950 City/Town State Zip Code 978-360-9358 4574 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 urther E aluation by the Local Approving Authority In gna re Date The syste 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ° 240 Old Cart Way 'M Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 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•3/13 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 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): Distribution box needs to be replaced. ❑ 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: F1 Cesspool privy is within 50 feet of a surface water Pool or P vY ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D System Failure Criteria Applicable to All Systems: Y pp Y 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 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 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•3/13 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 ;M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts z Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Attached 9 ( Y 9 (gp ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Occupied Date CommercialAndustrial 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: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: Home Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: na gallons How was quantity pumped determined? na Reason for pumping: na Type of System: ® 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Soils test performed 10/13/1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 40" below top foundation feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Watertight at foundation Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: na years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5 x 5.5 x 5.5 Sludge depth: 5" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measuring tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was structurally sound. Outlet baffle needs to be replaced. Liquid level was 0" above the outlet. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is corroded and needs to be replaced. 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.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments wM 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 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: 3-70' ❑ 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.): No sign of hydraulic failure or ponding. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. CitylTown 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 ❑ 9 P Y U T�; C ,o t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 page. CitylTown 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: eet 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. 10/13/1986 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Soils test performed 8/13/1986 by R.Masys and witnessed by M. Gray. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 240 Old Cart Way Property Address Harty Owner Owner's Name information is required for every N. Andover MA 01845 5/18/2015 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 groundwater ® System Information— Estimated depth to high Y P 9 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generated on 5/19/2015 3:25:02 PM by Maureen McAuley Page 1 Town of North Andover Tax Map # 210-107.6-0117-0000.0 Parcel Id 18227 240 OLD CART WAY HARTY, PAUL 240 OLD CART WAY NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.08 Acres FY 2015 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until HARTY, PAUL Payor 240 OLD CART WAY NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13762.0-240 OLD CART WAY Last Billing Date 5/8/2015 1090439 01 Cycle 01 Active UB Services Maint. Account No. 1090439 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 53.20 /1 UB Meter Maintenance Account No. 1090439 Serial No Status Location Brand Type Size YTD Cons 32772770 a Active 00 b Badger w Water 0.63 0.63 769 Date Reading Code Consumption Posted Date Variance 4/27/2015 1090 a Actual 14 5/19/2015 -42% 1/30/2015 1076 aActual 27 2/20/2015 -50% 10/24/2014 1049 aActual 50 11/14/2014 20% 7/25/2014 999 a Actual 42 8/13/2014 165% 4/24/2014 957 a Actual 15 5/15/2014 -13% 1/27/2014 942 a Actual 19 2/14/2014 21% 10/23/2013 923 aActual 15 11/18/2013 -2% 7/23/2013 908 a Actual 15 8/15/2013 -1% 4/24/2013 893 a Actual 15 5/20/2013 -12% 1/25/2013 878 aActual 18 2/13/2013 -65% 10/23/2012 860 aActual 51 11/9/2012 -14% 7/23/2012 809 a Actual 59 8/14/2012 168% 4/23/2012 750 a Actual 22 5/9/2012 29% 1/23/2012 728 aActual 17 2/13/2012 -57% 10/24/2011 711 aActual 41 11/14/2011 133% 7/22/2011 670 a Actual 17 8/15/2011 -4% 4/22/2011 653 a Actual 17 5/16/2011 -6% 1/25/2011 636 aActual 20 2/11/2011 -74% 10/21/2010 616 aActual 73 11/12/2010 121% 7/22/2010 543 a Actual 33 8/16/2010 83% 4/22/2010 510 a Actual 18 5/12/2010 -10% 1/21/2010 492 aActual 20 2/12/2010 -34% 10/22/2009 472 aActual 30 11/11/2009 90% 7/24/2009 442 a Actual 16 8/12/2009 -11% 4/24/2009 426 a Actual 18 5/13/2009 -3% 1/23/2009 408 aActual 19 2/10/2009 -25% 10/22/2008 389 aActual 25 11/12/2008 -43% 7/22/2008 364 a Actual 43 8/15/2008 128% 4/23/2008 321 a Actual 18 5/19/2008 0% i --� -., �� p � � --� � , � � J � � � --� �, � c, � � � � � � a � S { TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES .HEALTH DEPARTMENT � p t 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��sS�CNtl9�� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: �;n ©�1 Cz M� LOT: INSTALLER' DESIGNER: d— PLAN DATE: / BOH APPROVAL DATE ON PLAN: Z ! Y 1 ,S V r INSPECTIONS TANK INSPECTION: z�--L...��,_� DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION' SITE CONDITIONS g septic tank properly abandoned Int mal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page I of 6 TOWN OF NORTH ANDOVER a NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES a ° '* � °� :,.,,, HEALTH DEPARTMENT y 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��ss�C us s4' Susan Y. Sawyer, REHS/RS 978.688.940—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved. Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER °f No o7H Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'ss�caust� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided.(not required) Comments: SOIL ABSORPTION SYSTEM / Bottom of SAS excavated down to(--965l layer, as []�Srovided on plan ize of SAS excavated as per plan a---Title 5 sand installed, if specified on plan [ /4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed 9--Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: I Wastewater System Documentation—Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER NaRTM Office of COMMUNITY DEVELOPMENT AND SERVICES o?��nf� �`' U HEALTH DEPARTMENT 400 OSGOOD STREET ", . .>'+' NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold laterals installed with end sweeps . size: material: Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 4 of 6 TOWN OF NORTH ANDOVER Office of COIVMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p Y j ► 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss�cNusetah Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck,on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVER f MIRTH .Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'SS';C U Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6 TOWN OF NORTH ANDOVER f N�RTM 1 Office of COMMUNITY DEVELOPMENT AND SERVICES o?•' ` � °°R HEALTH DEPARTMENT 400 OSGOOD STREET :o NORTH ANDOVER, MASSACHUSETTS 01845M C U 1y Nuset Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX December 8,2005 Paul&Sarah Harty 240 Old Cart Way North Andover,MA 01845 Re: 240 Old Cart Way—Proposed Septic System Expansion Dear Mr.&Mrs.Harty: The North Andover Board of Health received your plan titled;"Proposed Septic System Expansion for Property at 240 Old Cart Way,North Andover,MA"dated December 5,2005,and received by this office on the same. The design has been approved for a five(5)-bedroom,maximum 11-room home and is to be used in the construction of an upgrade onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please note that the septic installation season closed on November 30,2005. Per your agreement to complete and update all of the changes necessary to the current septic system as a condition of your permit for this year,and notarized here in our office on December 7,2005,you understand that a licensed and registered contractor will do the work as quickly as the law and weather permit in the spring of 2006. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. SincerelZY.:Sawyer, Su REHS/RS� Public Health Director Encl: List of licensed septic system installers cc: R.A.M. Engineering, 160 Main Street, Haverhill, MA 01830;978.372.0449 Lid J �• INSI<ALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at ZyU � GAzr bvA`1 relative to the application '& and r'f dated for plans by �. of�,� H� . Cr �r�pi dated 12-- O with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersignd Licensed Sept' staller Date: - 1-244W _ I {TI! i 4p ♦► tj I i �' i I I I 1 j ` o L -h �f ;aDklh Ati Applicata n for Septic Disposal System ° -`•`v TODAY'S DA p Cons�tructlon Permit - TOV N OF NORTH ANDOVER, MA 01845 ?50.00—Full Repair- 4SSACNUSE�1 $125.00 omponent Important: Application is hereby made for a permit to: When filling out * forms on the ❑ Construct a new on-site sewage disposal system computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your A Repair or replace an existing system component cursor-do not / t use the return A. Facili Informationj'��'IC'�/j key. Xty v rah Address or Lot# /V, p,7 o✓CIt— ---- -- — - - - P/tlf City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑ Gravity (choose one) ***If pump system,attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information L L t Sa�� ��� T 1 Name a2�a 11 L"o C,4 ,it tl-- �.✓� Address(if different f m above) City/Town State Zip Code Telephone Number 3. Installer Information Kr A/ ftlellell arwi,4,-A Name Name of Company Address City/T6wn State Zip Code Telephone Number(Cell one#if possible please) 4. Designer Information ,q , >vl �1 Eel�n�c'yC��j Name Name of Company _/t b__ r - Address y�R---------r�l- - ---- ---- � --- �v CitwnState Zi .d��a----- - Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Nok, , Application for Septic Disposal System � Z 6S n 9Construction Permit - TOWN OF TODAY DAT NORTH ANDOVER, MA 01845 $_;50,,00-Full Repair sr. 12 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: n�esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been is ed by this Board of alth. J/-Z Nat Date Applica i Approved B oard of Health Representative) a Date Application Disapproved for the following reasons: - For Office Use Only: / L Fee Attacbed? Yes ✓ No 2. Project'ect Mana er Obligation Form Attacbed? Yes� No g 3. Pump S, sem? If so,Attacb copy of flectrical Permit Yes_ �./L. No i 4. Foundation As-Built?(new construction ronly): Yes_ ---No_ (Same scale as approved plan) S. Floor Plans?(new construction only): Yes_ No Application for Disposal System Construction Permit-Page 2 of 2 Application for Septic Disposal System TO__ 6 DAY' DAT -Construction Permit - TOWN OF k ,. . t. ' NORTH 00 ANDOVER, MA 01845 $ -Full Repair 125"-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: mesidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been is ed by this Board of alth. Na -7 Date Applica " Approved B oard of Health Representative) _ a Date Application Disapproved for the following reasons: ...................._...................._..................._.................................................................................................................................. ..........._..........._............_...__.......__.........................-..............._..............._......_............_........._..._.............................._......... For Office Use Only: 1. Fee Attacbed? Yes No 2. Project Manager Obligation Form Attacbed? Yes No 3. Pump S, sy tem? If so,Attacb cop, o(Electrical Permit Yes_ A No 'j 4. Foundation As-Built?(new construction ronly): Yes_ —=No (Same scale as approved plan) i f 5. Floor Plans?(new construction only): Yes_ No Application for Disposal System Construction Permit•Page 2 of 2 Massachusetts Department of Environmental Protection Zoo o C.aA Ar (,3 S�_y . Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information 1. Facility Information Owner ei-- I ,c w/ 4- ��-ie.�r�Gt/�i Map/Lot�+SZ. Street Address Z, q oy Cf,-a. t,.y AA- 4--city Wo ( state Zip Code B. Site Informatlan 1. (Check one) New Construction ❑ Upgrade [8 Repair ❑ 2. Published Soil Survey available? Yes ❑ No If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil limitations D D �' m 3. Suficial Geological Report available? Yes ❑ No ® If yes: m z Year Published Publication Scale Map Unit _ z C=) Geologic Material Landform MO C=) -i< 4. Flood Rate Insurance Map: M Above the 500 year flood boundary? Yes [L No ❑ Within the 100 year flood boundary? Yes ❑ No ❑ Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No ❑ 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑ Month/Year I I 7. Other references reviewed: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Wage 1 of 7 Massachusetts Department of Environmental Protection d k ? Bureau of Resource Protection -Wastewater Permitting Program Site Address or MaplLot Number i Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole A: IYP J- L9 Z v"' 9 " 00AP Date Time weather 1. Deep Observation Hole Logs Deep Hole Number 1 Q Ground Elevation at Surface of Hole '2— �• L Location(Identify on Plan) 2. Land Use: rJ �S �� Z- — 5' '7, (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones slope(°i6) vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body _ Drainage Way N Possible Wet Area feet feet � � feet Property Line Z-8` Drinking Water Well t 1A- Other feet feet 4. Parent-Material: (� `l." — e-3�'�- Unsuitable Materials Present: Yes❑ No If Yes: Disturbed Soil❑ Fill Material[] Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No El If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: Z'" inches elevation IDEP Form 1111 Soil Suitability Assessment for On-Site Sewage Disposal•Page 2 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map&ot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. ❑ Depth weeping from side of observation hole A.inches B. inches Inches, inches ❑ Depth to soil redoximorphic features (mottles) A. a Z B. � ❑ Groundwater adjustment(USGS methodology) A.Inches inchesB. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes IR No❑ b. If yes,at what depth was it observed? Upper boundary: Lower boundary: inches inches F. Certification certify t passed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis a by me sistent with the required training,expertise and experience described in 310 CMR 15.017. i re of Soil valuator Date Typed or Printed Name of Soil EvaluatoV *Date of Soil Evaluator Exam I Name of Board of He Ith Witness Board of Health Note:This form must be submitted to the approving authority with Percolation Fest Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 6 of 7 Massachusetts Department of Environmental Protection (3 . r ` Bureau of Resource Protection —Wastewater Permitting Program site Address or Map/Lot number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Deep Hole Number: 1 R Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other (in-) Layer (Munsell) (USDA) (Moist) . Depth Color Percent Gravel Cobbles &Stones ,� q � 2 � se— 5�,t w 5.� e 36-l�z �- °y�- �� q z L-� Additional Notes 4s DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 5 of 7 r0 11/17/2005 11'47 97868884 76t--'� HEALTH PAGE 31!01 TOWN OF NORTH ANIDOVER 140" Office of OO~l't�1C14�TJN•I TX D.IEVELOPIIMRN ' AND SJER dCES ��. HEALTH DEPARTMENT 4oO OSGOOD STREET ► �, " NORTT4 ANDOVER, MASSACHUSETTS 01845 Susan Y.Sawyer,RE-HS,TIS 97$.689.9540—Phone Oulbli+c Health Director 978.688.8476 ;.:FkX heals�g=ofriorthandover corn www.towrtofh rthandovcr.com APKICATION FOR SOIL VESTS DATE: 11/17/05 MAP&PARCEL: 107E-27: VJfc.4.T op;or, son,'I rum, 240 Old Cart Way O ,, °..._Paul&Sarah Harty, contact : 978-372-0449 APPLICANT., Paul&Sarah Harty Contacr,.4: 978-3t-0449 �nD.Rss: 240 Old Cart Way ENGT1'TF.F-,R: Robert A. Masys, P.E. Contact* 978-372-0449 CERTIFIED S•OTL EVALUATOR, Robert A. Masys, P.E. Intended Use of Land; Residential Subdivision Single Family Horn c Commercial T��t Repmir Testing,-_ Undeveloped Lot Testing, Upgrade for Additio-A., . In the Lake Cochichewick Watershed? 'yes "qo x THE IYOLLOWTN.G!MUST RR INCLUDJ�ID WI 'kI TI�[I9�'OaEt14D > Proof of landownership(Tax bill,or letter from owner permitting test) > &5-"x H,,P1nt»lair&Locaitorr et"Tasl>h fi"letrse Indicate zm nlr site+ion the plan) > Fee of S-426____O-0 per lot for nM eofl,ttructian. 11t9s covers the minimum tv�ro deep boles andtaro perobladon tests required for each disposal area, Fac of 60.00 per lot for" airs c,r ungra�des. GENERAL TNFORMA,TION ➢ Only rertiftad Soil Evaluators may perform deep!tole inspvet M. C411y Mass.Registered Sanitarians and Professional Engineers can design.septic plans, A At least two deep holes and two pereotatiot pests are required For each septic system disposal arca Repairs require at Idast two deep bolas and at least one percolation test, at the discretion of the BOH representative, > Full payment will be required for all additional tests within two weeks Of UWting. ➢ .Within 45 days of testing,a scaled plan (no smaller than V-100')shall be submitted to the Board of Health slto*ng the location of all tem(including aborted tests). > Within 60 days of tilting soil evaluation forms shall be submitted. Please Do Not'Wrtte Below' htl Line N.A. Conseruadon CjMm&$iar Approval•Rate• Sirrarttire Of Comensaden Agent. Data back to Health Department; (stamp in) INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from \. Boards and Departments having jurisdiction have been obtained. This cess not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT C-<-',lyll - �� PHONE LOCATION: Assessor's Map Number 1 L`-- C?, PARCEL Q SUBDIVISION LOT(S) STREETST. NUMBER OFFICIAL USE ONL RECOM TI SOF •Q N AGEN ONSE ATION ADMIN TRA R DATE APPROVED K. DATE REJECTED. COMMENTSl � TOWN PLANNER DATE APPROVED t� f, DATE REJECtED COMMENTS F00 INS ECTOR-REACT DATE APPROVED DATE REJECTED ! OPTIC INSPE06k- T DATE APPROVED Z- ' DATE REJECTED' COMMENTSI�-,--,e Z-7 Zr PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT �f,S•f =!�'� •/ ��- .�� FIRE DEPARTMENT 'ECEIVE0 BY BUILDING INSPECTOR /1/0 .���'/� ? Y��~� r Rev[sod 9197 Jm To the Health Department and Building Department of North Andover, I, Paul Harty owner and resident of 240 Old Cart Way, North Andover MA 01845 certify that I will complete and update all of the changes necessary to the current.septic.system as a condition of my permit for building the addition as submitted on November 1, 2005. I have been advised by a certified Title V engineer and am -.aware of the=changes-necessary-to have-rny-residence in compliance with the law. A licensed and registered contractor will do the work as quickly as the law and weather permit in the spring of 2001. 6q Paul Harty 240 Old`Cart-Way North Andover Ma 01845 DONNA K WEDGE NOTARY PMUC COMMiONWMTH OF MASSACHUSETTS hq Comm,Expkw Aug.7,2009 1 31Z 2 Lor 17 lk �� •� G. C1� . IJ.S IR u[}1C r " i L J " 9- SALELZJ6ig Ss� d ��. /9 -sc o SEPTic SYSTF-m " MMT PLM W C*A%* Fool scALF r • L� �' neva eooK race o/_„I �,�e ,�� C.Y AREA PLAN 4apy 7, CC,ASSESSOR MAP GLOW R.A,NL ENG QRWG LOT /g 160 5 MEET 1 v J.L. WAR D CONSTRUCTION1 DESIGN&REMODELING SOLUTIONS 50 Vft*'r r Iu 01915 Tz 97&�,2�52 ��3��a1.�580 aaar.i��ncardca�stNuct�acc�m ; 129222 f UQ G&MIL Town of North Andover November 17, 2005 Board of Health Department 400 Osgood Street North Andover, Ma Phone: (978) 688-9540 Fax: (978) 688-8476 Re: Harty Residence 240 Old Cart Way To Whom it May Concern, I would like to provide your office with the necessary documentation you requested to move forward with the permitting process for the above residence: I, Jeffrey L. Ward president of J. L. WARD CONSTRUTION INC; acting as the duly appointed agent / representative for Paul and Sarah Harty of 240 Old Cart Way North Andover Ma have retained the services of Robert A. Masys, P.E. of RAM Engineering, 160 Main Street Haverhill, MA. 01830. Mr. Masys has been retained to perform the necessary requirements associated with the Septic expansion/upgrade, which is required as part of the permitting process for the proposed addition. Tha k Lard nd be /t rye iards, WJe — President J. L. Ward Construction, Inc. Design and Remodeling Solution Enclosures: Proposal # 100605 Construction Agreement November 17, 2005 To whom it may concern: I give permission to Robert Masys of Ram Engineering to perform a septic consult at 240 Old Cart Way in North Andover Massachusetts. If you have any questions please cal me at 978-794-1106. Sinc e y Sarah Harty r'. �..I4 1, q ,,y y j (is Il M S�JM6 c C—LIJ, 7 IL 1 K4 IKy i _-FILL r 11M�yf ' "lye S _TccL Dr-<'71(a f L t..; .. .. .. i. `•! ;�'�'"?��i.!nL!', : .��?.. rAL ��': 7?�±tih�% '3q: ,;n;j`e��•••J.}t"+y�,�i�'C"?��:t '+.'tywnyrQq•y.t t •.1'. �' •` t.1tlV fn t.\l fJ \ ``� fit♦ ��'_. �L`•1 `•,.�`.. .. - J.` 1'p• :,� i� �,,,•'�•a ��t^...Ai.• 'L'l��i",�:� �-w,;:,�, rt t:- 1:�1•.'i: TL:•�+-ro' 'q t y 0 +1 r' Town of North Andover, Massachusetts Form No.3 e HORTM BOARD OF HEALTH o ,a s:? ; oL 19_ 9C4 Eth` DISPOSAL WORKS CONSTRUCTION PERMIT SACMUS Applicant NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct (>�,—pr Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH & Fee D.W.C. No. �!�, gORTq Ott. ° '1�0 3rw�] � BOARD OF HEALTH Mn� A t Mil ; 120 MAIN STREET TEL. 682-6483 'SSACHUsf NORTH ANDOVER, MASS. 01845 Ext. 32 JAN 2 .- i:3.;J �. January 22 , 1993 Les Godin 1.,yu s BAN Merrimack Engineering Services, Inc. 66 Park Street Andover, MA 01810 Dear Les: This is to confirm that at the Board of Health meeting held on January 21, 1993 , the Board granted variances to North Andover regulations: 2. 14-4, minimum design flow for single family dwellings, for Lots 1 and 18 Old Cart Way; 17 . 03 , spacing between leach trenches for Lots 8, 10, 11, and 14 Old Cart Way; 4 . 18 distance to a catch basin for Lot 5 Old Cart Way; 4 . 14 to allow a twenty minute design rate. With these variances, all current lots on Old Cart Way have been approved, specifically, Lots 1, 2, 4 , 5, 6, 7, 8, 9, 10, 11, 12 , 13 , 14, 15, 16, 17, 18, 19, 20 and 21. If you have any questions, please do not hesitate to call. Sincerely, v Sandy Starr Commonwealth of Massachusetts . City/Town of � E!L�' �1 System Pumping Record NORTH AND VER Form 4 �v - G DEP has provided this form for use by local Boards of Health. Other oFn�ty, t�31 information must be substantially the same as that provided here. B QW]WARTMEnck ith 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 within 14 days from the pumping date in accordance with 310 CMR 15.351, A. Facility information Important: When filling out 1. System Location: forms on the computer.use — -0 —0 only the tab key Address /� 1 / to move your Ncx�� t 1T1 ov-c-\ -- —.. -- cursor-do not — --- — -- State Zip Code use the return City/Town key. 2. System Owner: ._..n GUN Name �-------- - - - Address(if different from location) ------- ------ ---- --------- - --- ------ City/Town State Zip Code 1)-76- -794 110 6 --- Telephone Number B. Pumping Record 1�3-) 1. Date of Pumping Date y G2. Quantity Pumped: �/ allons 3. Type of system: ❑ Cesspool(s) tY1 Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): -- ---- --- --- .. -- -- ----- ------- 4. Effluent Tee Filter present? ❑ Yes [vrNo If yes, was it cleaned? ❑ Yes [0'*'No 5. Condition ,ofSystem: 6. System Pumped By: -7 k 7 _ -- -- Name Vehicle License Number vvin��iy�;(�nYicQnrm n�0;,�-- Company 7. Location where contents were disposed: Signature of Hauler Y1 r'i i` r + Date Signature of Receiving Facility Date t5form4.doc•03106 System Pumping Record•Page 1 of 1 . i Z w E -looZ$ s �i� � I 1 6' 2' 7.5' / PROPOSED SUNROOM U - 'x18' `3 �• ADDITION 16 o I EXISTING a HOUSE is• N J 41 1240 90, O SEDT F DECK � ION O TO BE REMOVED ` EXIST.DECK Z / Alt 137.20' ,.W .r I CERTIFIED PLOT PLAN OF LAND AT #240 OLD CART WAY NO.ANDOVER,MA SCALE: 1" = 40' DEED BOOK 9.832 PAGE 190 JEFFREY AS DRAWN FOR: AREA 47,142 SQ. F1', f S. PAUL&SARAH HAF(TY HOF-MANN #240 OLD CART WAY PLAN 10 #36381 NO.ANDOVK MAOpEg 0* . ASSESSOR MAP 101 (j u MAY 6,2015 BLOCK �Ow•s t.ot 17 ILA,M, ENGINEERING LOT 18 :srce tt Hsve�u'll,Maaeaaitueetta'01830 Tn'(478)372.0!49 FAX 372-7183 I 3�Z, LOF 17 �/ � `� fez,� •� �'� p `Ci o \ \ ase \ S,LL ELvB.Zg X93 � �1,9Z • , ^ ti0 s� All SEPTIC SYSTEM AS BUILT PLAIN AS DRAWN FOR SCALE w DEED BOOK PAGE AREA Q PLAN "Gt ASSESSOR MAr ALAN , BLOCK ,4sv,74 R.A.M. ENGINEERING 1-07 -160 MAIN STREET 4 HAVERHILL, I{i�MA.