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Miscellaneous - 102 SPRING HILL ROAD 4/30/2018 (2)
� � �,� �� ' ♦ A .- • � +� n� � , �,� i;i �y ''� ; i i :� a� :i 3 I fu i � i� gal .� i;i *� i7i '„a (N� W a North Andover Board of Assessors Public Access I `; ,k0R7y Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Tura OTISIOWth AVAIO`rer Hlozwd of Assessors. Parcel ID: 210/107.A-0238-0000.0 SKETCH Click on Sketch to Enlarge d Page 1 of 1 Property Record Card Community: North Andover PHOTO Click on Photo to Enlarge Location: 102 SPRING HILL ROAD Owner Name: STERNFELD, DONALD O Owner Address: 102 SPRING HILL ROAD City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.04 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 3340 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 895,200 829,500 Building Value: 658,300 614,100 Land Value: 236,900 215,400 Market Land Value: 236,900 Chapter Land Value: LATEST SALE Sale Price: 442,800 Sale Date: 10/27/1996 Arms Length Sale Code: Y -YES -VALID Grantor: MARQUEZ, JOE Cert Doc: Book: 04619 Page: 0110 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3 &Linkld=993109 7 Commonwealth of Massachusetts _ City/Town of System Pumping- Record Form 4 DEC -15 2014 DEP has provided this form for use -by local Boards of HY aI ,,,, ther forms maybe used, but the information must be substantially the same as that provi ed ;here. Before using.this form, check with your local Board of Health to determine the form they use. Thb,System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left / Right front of house, Le I ht rear of house Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / ig rear of building, Under deck Address Cityrrown =IV State Zip Code 2. System Owner. Name' Address (if different from location) City/Town Telephone Number 1 B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Data 2. Quantity Pumped: — Gallons - Cesspools)Septic Tank❑Tight Tank 4. Effluent Tee Filter present? �'Ye,,s ❑ No If yes, was it cleaned? es ❑ No: 6. System Pumped By: Neil Bateson Name ` Bateson Enterprises Inc Company 7. Locatioa where contents were disposed: O S. Lowell Waste Water F5821 Vehicle License Number Data t5fbrm4.doc• 06/03 System Pumping Record •Page 1 of 1 Commonwealth of Massachusetts City/Town of ° System Pumping Record Form 4 DEP has provided this form for use- by local Boards of Health. Other forms may be'used, but the information must be substantially the same as that provided here. Before using -this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / i�rear of h s Left /right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address r (f k, fie\te4 City/Town State Zip Code 2. System Owner: 11�1/1/ Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Zip Code ` o o s 'is'i Telephone Number 2. uantity Pumped: Date Gallons i Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? 5. Condition of System: 6. System Pumped By: 7. Neil Bateson Name Bateson Enterprises Ina Company i Yes ❑ No If yes, was it cleaned?Yes ❑ No. contents were disposed: F5821 Date License NOV 19 N13 � TOWN OF NOR I Tlj Drp.q- - _" t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVE System Pumping Record FNOV 12 2012 Form 4 ,M SVS TOWN OF NORTH ANb04"�R DEP has provided this form for use by local Boards of Health. Other f�dhth information must be substantially the same as that provided here. Before using this orm, c ec 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. A. Facility Information 1. System Location: Left / Right front of house, Left i rear of hou , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Rig t rear of building, Under deck Address p �•�� nz City/Town l C/ State Zip Code 2. System Owner: Name Address (if different from location) City/Town Stat 3 6 _ may, e Cade Telephone Number B. Pumping Record �(—%- \4 1. Date of Pumping Date 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) �epbck ❑ Other (describe): 4. Effluent Tee Filter present? 2<es ❑ No 5. Condition of m: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. �710; ere contents were disposed: GLS Lowell Waste Water Oil Gallons ❑ Tight Tank If yes, was it cleaned? es ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts -.... u,pCity/Town of RECEIVED System Pumping Record _ 3,011 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Othdr faa` . -' A#;66�he information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left /Right front of house, Left ight rear of house, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address � 62 Cityrrown V vSltate�1 Zip Code 2. System Owner. Name V Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ State ��ode Telephone Number Com\ Date 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present?r'es ❑ No 5. Condition of t�v\r 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio re-egntents were disposed: G. If yes, was it cleaned? es ❑ No Lowell Waste Water F5821 Vehicle License Number Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 IC Y6,'"P\ Commonwealth of Massachusetts �'�� City/Town of 07 '; J Z010 System Pumping Record TOWN OF NORTH ANDOVER Form 4 1 HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use_ The System Pumping Record must be submitted to the local Board of Health oF-oW r approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of hou Ight rear= eft rear of building. Right rear of building. Address C O5)pf� 4A u City/Town 14 State 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): . aiq�\ 3 C Telephone Number ZU-b-(O Date 2. Quantity Pumped. Cesspools)p Ic Tank Zip Code Gallons ❑ Tight Tank 4. Effluent Tee Filter present?es ❑ No If yes, was it cleaned? es ❑ No 5. Conditio of ystem: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location w ntents were disposed: L.S.D a4lA Lowellfflae Water F5821 Vehicle License Number Date Lam- 6-' t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 � Commonwealth of Massachuset City/Town of CEIV�� System Pumping Record SEP 2 8 2009 Form 4 w„ TOWN Ur NOR _H ANDOVER DEP has provided this form for use by local Boards o RT ENTused, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health of -other approving authority. A. Facility Information 1. System Location: Left side of house Right side of house, Left front of house, Right front of house, Left rear of house, rear of house Left rear of building. Right rear of building. Address Citylrown State Zip Code 2. System Owner: Name Address (if different from location) Cityrrown Staten Telephone Number B. Pumping. Record _�?T 1. Date of Pumping q `' p g Date 2- Quantity Pumped 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Other (describe): 4. Effluent Tee Filter present? es ❑ No 5. Condition of System: , _ 1 e 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Lowell Waste Water Signature of Hauler Gallons ❑ Tight Tank If yes, was it cleaned? es No F5821 Vehicle License Number Date t5form4.doc• 06103 System Pumping Record . Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ ISI Commonwealth of Massachusetts.- E City/Town of System Pumping Record SEP 1 6 Zoos Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: 2. System Owner: v Name Address (if different from location) City/TownCode B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Tp Code State�Zi � Telephone Number 9 �5— (! �:) �c Date 2. Quantity Pumped; Cesspool(s) Septic Tank Cs� Gallons ❑ Tight Tank 4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? 8—Ve--s' ❑ No 5. Condition ste� 6. System P � By: Name Vehicle License Number Company 7. gre contents wem di Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of RFCFIVED \\\j System Pumping Record p` Form 4 AUG - 1 2007 DEP has provided this form for use by local Boards of Health. vfort T I ti :�� se?J,�� the information must be substantially the same as that provided her :reslrrg.thrs•fo eck with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _Q VAI A. Facility Information 1. System Lova ion: Address Cityrrown State 2. System Owner: �ACDL-?Z� Zip Code Name Address (if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [-Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Flo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Systerp Pumped B l%4�<--V\- F Name C=x _1 r, _ � Vehicle License Number d� Company 7. Locarr-7�' where contents were disposed: C.. S-� Date t5form4.doc• 06/03 System Pumping Record tt % �'. Commonwealth of Massachusetts a� Ctty/Towntof NORTH ANDOVER,-MASSACHUSETTS\J System' Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. I he Sy st�e�P`i�f^png; Rec rd mu: be submitted to the local Board of Health or other approving au horny. A. Facility Information p Important: When filling out 1.System Location: /4�/EALTH WN OF NORTH ANDOVER forms on the DEPARTMENT computer, use oto move your nly the tab key Address '�- - --- - - --- --- - - cursor - do not City/Town --•---=--L—.---. use the return StateZipCode _--_____-- key. y. 2. System Owner- OVA wner-OA_ -- '`�/lP1 Address (if different from location) - City/Town-_..._------- • Y. -Stat- Telephone Number B. umping Record - 1. Date.of Pumping Date / �- 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cessp001(s) ❑ Septic Tank El Tight Tank ❑ Other (describe): - __�__._.�------•-.----- 4, Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6, kemped By: -- r /t y Q Vehicle License Number.l Company 7. . Location where contents were disposed: J Aw ,�— Si ature of Hau — Date- -----��`- ---- - http://www.mass.gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record • Page t of i 6 1� I/ " DES c/z=/?T .T-�n� ELE�.ITtnJ x,�v v'�✓a.�.� �. rAA+K £38.$7 To p o f &A4 7A<o K 81.,9 � ru✓. 4*'Pvc_ ou-r a r.4,iK 7.v✓, y ' P✓c. 00're b-auu R6 ,zo JA rNF2L"rlli`�7i�N �NantiE� gS, H9 � Fj • � � (tiN K (-e CiL. 4 .moi 32 SCALE I" -a yp " GEED BOOK Y6/7 PAGE //O AREA /s, VZ 7- .rcJ: F ,. PLAN QUO. 9 rf%tel i ..55C--5tVO0,5 4 3 LOT 1.5- Tet lc� M , ,:9s c sA C ,1.)7. SEPTIC .SYSTEM AS BUILT PLAN IN AS DRAWN FOR iC/, AA. -J V &,o -04 g� 2-rl/0r) R.A.M. ENGINEERING 160 MAIN STREET HAVERHILL, MA (976) 372-0949 R.A.M. ENGINEERING ROBERT A. MASYS, P.E. U, 160 MAIN STREET HAVERHILL, MA 01830 TEL: 978-372-0449 FAX: 978-372-7183 August -.28, 2007 SEP 6 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT REC�J,.,,,. 6. MEMO TO: Susan Sawyer Subject: As - Built Septic at 102 Spring Hill Road S Attached, please find the revised plans with the additional information that was requested. I have included two original stamped plans, a couple copies. If you need additional information, please contact me. stp "U'l TOWN OF NORTH ANDOVER HEALTH DEPARTMENT pESuc=�T7.�n� ELE1�,�TZo�1 Sz'LL �/oZ /oa,vo' TOP or X. -JV. W`Pvc. ouT Q rAwK SN✓, y � Ida'c' znl@ D-lSgK � I,3 7' . TN✓, y" 007-@_ b -d al( 86,Ze INV, IvFiLTki4T �N �N.a.,p3e� 8,5,H9/ TaP �n1 � \OODa cr e yr f;; 3Z SCALE I" • yo' DEED BOOK y617 PAGE /I AREA ✓z Z. PLAN ✓ )o, 9`7%7 R-5Se-sa0a'S 2_i 043 LOT /.5' t L c G.7,f r C„ Teti Lam, tAs CA c'^)T SEPTIC SYSTEM AS BUILT PLAN IN / 01 -?7h° 1414 -)Dy V67�A AS DRAWN FOR D o•.),¢ t- �1> S 7` E0le' � 1-e: 66 at 2 -IT/ % R.A.M: ENGINEERING IGO.MAIN STREET HAVERHILL, MA (976) 3TLI-0449 I, 86.3 m c_ 6 6i 1'NS PecGT xaw1 V / 0� � G �C, SEPfit- TgNK iq ".0v c. 1 33 T6n A L.ofi I 2 �1 Waie0- Ger �tiySz iVa/LT1y SCALE I" % yo , DEED BOOK PAGE //O AREA yam, vz z,5, rd, PLAN AJo. 97�� �SSe-S6©a's LOT /,5- ROBERT ALM MAWS NA X74 upfr 0 V L-l`t,yr/1 �L��� SEPTIC SYSTEM AS BUILT PLAN IN AS DRAWN FOR P oAj,4 t- , > 4S 7 Es .v F� �.6 R.A.M. ENGINEERING 150 .MAIN STREET HAVERHILL. MA (978) 372-0449 SILL 0/off. TOP of �SuaGAG 7A�uK �9,$� rti✓, y'P✓G- oVT P r,.v►K $P.S9' T.v✓, y'r?i'o Y,,�@ i�-l34K 8e'.37' Tti✓ `/`.P✓�-our@�-c3wr /36+.Zo' yvv, LvF3:c.r24Txov CHA,"uEe- gS, yq� TaP Fr1 \ooDt, ,jefN,c:x-c,N y- L Clt 3Z 1 33 T6n A L.ofi I 2 �1 Waie0- Ger �tiySz iVa/LT1y SCALE I" % yo , DEED BOOK PAGE //O AREA yam, vz z,5, rd, PLAN AJo. 97�� �SSe-S6©a's LOT /,5- ROBERT ALM MAWS NA X74 upfr 0 V L-l`t,yr/1 �L��� SEPTIC SYSTEM AS BUILT PLAN IN AS DRAWN FOR P oAj,4 t- , > 4S 7 Es .v F� �.6 R.A.M. ENGINEERING 150 .MAIN STREET HAVERHILL. MA (978) 372-0449 I 2656 86.37__ 0 SCALE 1" - 6/0' DEED BOOK PAGE /I AREAif s, w Z. Z. co. . PLAN No- cl V77 i SSS-s60a's LOT 1S P6.5 =�?T7pn� ELEv,In� 66 •�! /Oap.�cj�eay. I C14 M &R-;%�2 � CHgmrtEQ3 (NVQ D r�uK. y60VG auT P rAWK 9. r.Sr/" TN✓, y �vG 2�J@ D-l3WC �,�,3 7 ,INV, �NAmysEi2 gS, yq �aP F,i�j�� 9 co..,c. Sl sEorza TANK 'b c �y"P✓L /d 2- . Ty SCALE 1" - 6/0' DEED BOOK PAGE /I AREAif s, w Z. Z. co. . PLAN No- cl V77 i SSS-s60a's LOT 1S P6.5 =�?T7pn� ELEv,In� SzcC. #/OZ /Oap.�cj�eay. TOP o F so- GAt_ -r.4�tf( r�uK. y60VG auT P rAWK 9. r.Sr/" TN✓, y �vG 2�J@ D-l3WC �,�,3 7 ,INV, �NAmysEi2 gS, yq �aP F,i�j�� IF CW 8�W i 33 33 H C_oR g�,11 Y8 � v 2 �1 aAe. IL_ G a_1- t L c G.TrQ—r Ca Tetalt, M 4.S 6. sad 6' A)-/' L= M 1/7 J E�`' SEPTIC SYSTEM AS BUILT PLAN IN N0 7�q l4lvpo !6�E AS DRAWN FOR dn/�¢ L t' > S T elegy R.A.M. ENGINEERING 160 .MAIN STREET HAVERHILL. MA (978) 372-0449 PUBLIC HEALTH DEPARTMENT Community Development Division CYE 127ITICAqtF off' CoqqpLIANCE As of: September 7, 2007 rfhis is to cert that the individuaCsubsurface diisposaCsystem received a SA ITS`FAC`Z'oR2'IJVS�nMoYof the: ('uffy RepairedSeptic System repaired By: Todd (Bateson 102 Spring YfiCCgZpad gkJap 107.,.; ('arce1238 YorthAndover, 914A 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Sus `Y. Sawyer 1Tu6licYfealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com Ot K01fTl� � '4t4i0 ��• .'.O cWusC� PUBLIC HEALTH DEPARTMENT Community Development Division OCT - 5 2007 TOWN OF NORTH A,\ �;O\ER TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION. The undersigned hereby certify that the Sewage Disposal System 90 constructed; ( } repaired; (Print Name) Located at: 44 it (ins RationAddress) Was in conformance with the North Andover Board of Health approved plan, originally dated J Z Z00-1 and last revised on , with a design flow of �1r'4-p gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of. Bed Inspection Date:_ �Qbetzr- A- vis HsL And — Print Name Final Construction Inspection Date: b And — Print Name En neer R resentativ (ignature) AEngineersentative ignature) i Installer: (Signature) Date: /© And — Print Name Enginer: Signature) Date: %01, to ALAN NY 23 MAM spa No. W74 e o And — Print Name reet, North Andover, Massachusetts 01845 Phone 978.68. Fax 978.688.8476 Web http://www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System X constructed; ( ) repaired; By 0 A-�e-sd ni (Print Name) Located at: 0 2, 5 -p -a- 19 (InstallationAddress) AUG V4-2007 7 ANDOVER a JPAENT Was installed in conformance with the North Andover Board of Health approved plan, originally dated 7_'S� CA_ -j , Z3 u T7 and last revised on , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: E311 I O And - Print Name Final Construction Inspection Date: g� 0 % 41xJ t- , MA Yis And -Print Name Engineer Representative (Si nature) Engineer Representativ (Signature) �---.4Signature) - - Date:— _S / Z;!q int Name gnature) Date: TWIN MAIM Na. 2D"4a And -Print Name �'- ad Street, North Andover, Massachusetts 01845 Phone 9 Fax 978.688.8476 Web http://www.townofnorthandover.com U AS -BUILT CHECKLIST LOT NUlvfBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUD VE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED 72- c— e– c;L L -P r-- c,1ve.r �r� v'ti�ee ,6�•ry00 �y O PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 102 Spring Hill Lane MAP: LOT: 15 INSTALLER: Todd Bateson DESIGNER: Robert Masys RAM Engineering PLAN DATE: 1/2/07 rev. 2/15/07 field revised (to remove wall) 8/2/07 BOH APPROVAL DATE ON PLAN: 8/3/07 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 8/7/07 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (effluent filter) installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthondover. rom NORTH O�tt%A0 3?a'`-' M ° OL O '- 70 09 CMMICwIWK• _ 7' �I PUBLIC HEALTH DEPARTMENT Community Development Division ® 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 Comments: DISTRIBUTION -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: The plan showed two distribution boxes, the first to make a 90 degree bend around the wall. The installer informed me that since the wall was not constructed that he did not need that d -box. SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: The system was raised two feet to eliminate the wall. A barrier was installed on the down slope side for breakout issues. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTty 00-0,1v O t� T O'O COCM LIY WICK _ 1` r PUBLIC HEALTH DEPARTMENT Community Development Division SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber Infiltrator Quick 4 ® Number of chambers per row 10 ® Number of rows (trenches) 4 ❑ Laterals installed and ends connected to header (and 88.61 vented if impervious material above) ® Elevations of laterals and chambers installed as on Distribution Box IN approved plan Comments: Distribution Box OUT SYSTEM ELEVATIONS 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com INVERT IN FIELD PLAN INVERT ELEV. Building Sewer OUT 89.05 Septic Tank IN 87.90 88.61 Septic Tank OUT 87.59 88.36 Distribution Box IN 86.37 84.34 changed to 86.34 Distribution Box OUT 86.17 84.17 changed to 86.17 Lateral 1 INV 86.15 Lateral 1 TOP 86.13 Lateral 2 INV 86.15 Lateral 2 TOP 86.13 Lateral 3 INV 86.15 Lateral 3 TOP 86.13 Lateral 4 INV 86.13 Lateral 4 TOP 86.13 Bottom of Chamber 85.50 83.50 changed to 85.50 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com To: Robert Masys, RAM Eng. From: Susan Sawyer, REHS/RS Re: 102 Spring Hill CC: Fax: 978 372-7183 Date: 8/23/2007 Pages: 2 0 Urgent ® For Review ❑ Please Comment ❑ Please Reply 0 Please Recycle I reviewed the as -built and found some missing items that are required in N. Andover. I have J/ j� attached our checklist for your convenience. The missing items are not checked Please revise and 1 ` resubmit it to our office. J ; Thankyou . . . . . . . . . . . . . . . . . . . . . 0 . A i "O"T" A Commonwealth of Massachusetts Map -Block -Lot apo,•"tO '•,Foot 107.A- 0238 - a Board of Health Permit No • BHP -2007-0234 North Andover --------_------------- P•I• FEE �Ss�tMus�t F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd Bateson ------------------------------------------------------------------ -- -------------------------- to (Repair) an Individual Sewage Disposal System. at No 102 SPRING HILL ROAD as shown on the application for Disposal Works Construction Permit No. BHP -2007-023 Dated July 05, 2007 ----------------------------------------------------- ----------- ----------------------------- Issued On: Jul -05-2007 - So] ----------- --------------------------- ----- ---- Qi y � HORTp Town of North Andover HEALTH DEPARTMENT sSCHU 44 CHECK #: DATE: LOCATION: A H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic, -Design Approval $ ©iSeptic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ 25'1 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer LUJ Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor - do not use the return A. Facility Information key. D—A Address or Lot # ---- NY City/Town TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ravity (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. Name Address (if different from above) Cit [Town State Zip Code %78' -- Telephone Number 3. Installer Information Name NamreAdFaSONENTERPRISES, INC. /// Ar -I 1-1114 P 111 Argilla Read _ _— Address T Andover, MA 01810 Cityrrown State Zip Code 4. Desianer Information Name Address Ckir–r6 n e!8�30 Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code a Telephon umber iffest # to Reach) -- — Application for Disposal System Construction Permit • Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: l6 a -5 -4/1 T�/4/7 (Address of septic system) For plans by ._� ,, n (Engineer) Relative to the application of >D OYY 72>,4-i 2 Spic/ (Installer's name) And dated 0 ry nguia ate Dated 7—S-0 Io ay s ate With revisions dated Ft Q is i L (Last revised date) 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 manager, 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 Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company, a. Bottom of Bed — Generally, this is the first'(V5 inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdel2t@townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a 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. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done 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 ofHealth 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. / 1 - Undersigned Licensed Septic Installer: all ef(Today's Date) (Name —Print)(Name —Signed) DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, August 01, 2007 8:32 AM To: DelleChiaie, Pamela Cc: Dan Ottenheimer (E-mail) Subject: RE: DWC's - 102 Spring Hill Road See message below first. I also told him to call RAM engineering and get their blessing. The tank is in a tough spot and needs to be closer to the porch than we like, but a wall is in the way. So, I told him It can go back into the same spot. Please add this note to the file. Dan, I just wanted you to see this. We had no choice. The existing deck column is approx 2 feet away and the wall is not much more. I think we can trust Todd on this one. Susan -----Original Message ----- From: DelleChiaie, Pamela Sent: Tuesday, July 31, 2007 10:41 AM To: Sawyer, Susan Subject: DWC's - 102 Spring Hill Road Importance: High Hi, Todd called. He has to replace the tank. It is leaking. FYI. He already has a full repair permit for this site. 8asl Ragwzds, A0141004 D0,4440 lWO Health Department Assistant Town of North Andover 1600 Osgood Street Building 2o, Suite 2-36 North Andover, MA 01845 9978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnoithandover.com healthdept@townofnorthandover.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, August 03, 2007 9:02 AM To: Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Cc: Sawyer, Susan Subject: 102 Spring Hill Road - Plan Modification Importance: High This plan has been modified by the engineer (Bob Masys) to remove the wall and leaching area. The installer has stamped, and red -lined the plan, which Todd Bateson will have on site. 1610sf Ragwl-ds, PAiwal�w Da��aL�lfiwia Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 9978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com r, lb - TOWN OF NORTH ANDOVER F NORTI{ Office of COMMUNITY DEVELOPMENT AND SERVICES 3? HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 * i 'fj •�A�To •r�y� NORTH ANDOVER, MASSACHUSETTS 01845 4SS 1CHU5�� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdept@townofnorthandover.com WEBSITE: http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: //j/P4 RECEIVED JAN 0 3 2006 I HEALTH DEPARTMENT TOWN OF NORTH ANDOVER Site Location.: 10 S,p ,2.kN q «k � � p '9'.aS. Engineer: '",e r0s- C S A 5y J P c New Plans? Yes )�,, $225/Plan Check #- (includes I" submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes_ yNo. Local Upgrade Form Included? Yes No X. Telephone #: q -1 $ - 37 Z - 0 9 ztA Fax #: q1$ - 37 L--7 19 5 E-mail: `(L k -fv\ CA -)!r, Q 5 <j�. Aa p\. C o m - Name: OFFICE USE ONLY When the sub mi ion is complete (including check): ➢ �/ Date stamp plans and letter ➢ v/' Complete and attach Receipt ➢ /Copy File; Forward to Consultant ➢ ✓ Enter on Log Sheet and Database U - Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Friday, January 12, 2007 7:49 AM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 102 Spring Hill Road Well, we did our job in a reasonable amount of time to help the home owner on this site, but it is painfully clear that their designer did not do his job. This plan is chuck full of errors and omissions. I believe they just threw something together to get the owner off their backs, and thus foisted the owner's angst from the designer to us. As you will see in the second to last paragraph I tried to make it abundantly clear that the problems here are not ours, but the designers. Feel free to edit as you see fit. Dan Mill River i consuItin Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano@millriverconsulting.com 1/16/2007 NORTH 4 Ott��to ra1N0 i �,SSACHug t� Health Department January 11, 2007 Robert Masys P.E. R.A.M. Engineering 160 Main Street Haverhill, MA 01830 Re: Wastewater Treatment and Dispersal System. Plan for 102 Spring Hill Road, Map 210, Lot 15 Dear Mr. Masys: The proposed wastewater system design plan for the above site dated January 2, 2007 and received on January 3, 2007 has been reviewed. Unfortunately, they cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. l . Please provide a site plan at a scale of 1:20 or greater - 220 2. Please explain the purpose of the landscape retaining wall on the upgradient side of the soil absorption system. It appears the wall will be buried in part or entirety. Please depict the wall on the detail plan of the soil absorption system, and please provide details regarding construction such as materials to be used and methods to be employed during construction .:-1/3.' Please depict all distances between the tank and soil absorption system to the dwelling, the property bounds and also some fixed points such as the dwelling - NA 8.02 Since it is proposed to re -use the existing tank, it is important to assure the tank is watertight to prevent both wastewater exfiltration and water infiltration. It is also important to assure the internal components and access holes are compliant with regulatory standards. Please provide the means and methods for the contractor to assure watertightness and compliance .5. Please provide the log of the percolation test on the design plan - 220 6:" Please provide a benchmark on the plan for use by the contractor. There is an elevation provided on a tank cover which may or may not be intended to be a benchmark. However, that location is subject to movement and dislocation and is not a secure benchmark - 220 `7. Please indicate and depict the requirement for magnetic marking tape over the components and piping - 221 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 8� Please indicate the presence or absence of a foundation drain around the dwelling, and if present, indicate its discharge point(s) - NA 8.02 9._ -Please indicate all piping is to contain watertight joints and are to be laid on a compact, firm base - 222 & NA 11.02 Ldp 10. Please provide the invert elevation at the dwelling to determine if appropriate pipe slope is provided - 222 11. Please explain why the description of the existing primary (septic) tank is for an H-20 loading unit. Is that the status of the current tank? Is that was is proposed for the contractor to assure compliance with? Will the contractor need to replace the current -12. tank if it is not found to meet that loading standard? -12. Please explain why the description of the primary (septic) tank indicates "Install Flexible Boot as Required". Who is to require the flexible boot, and based on what reason? Please clarify this matter 1�1A. Please clarify the detail of the primary (septic) tank which appears to conflict - are the risers to have covers to meet grade or 6" below grade? The image for the two risers is identical but the notes associated with the two are different X14 Please clarify note 6 in the primary (septic) tank detail which does not appear to make any sense in the context of this design plan 15. Please depict a primary (septic) tank which has tees which extend 6" above the flow line, where the inlet tee extends at least 10" below the flow line, where the outlet tee extends 14" below the flow line, and where a gas baffle is present - 227 16. Please provide for a distribution box which has a minimum of a 6" sump, has a notation regarding all outlets being at he same level, has a notation regarding the first 2' of pipe exiting the box to be laid level, indicates the soil beneath the box is to be compacted, indicates a proper compacted stone base beneath the box, and has risers as needed to meet depth requirements below finish grade - 232 & 221 17. Please use trenches as the soil absorption system on this site or explain why they cannot be used - 240 Please indicate the requirements for the excavation of the soil to extend 6" into the C soil horizon - NA 9.02 c,1�9. Please provide the specifications for the sand fill material to be placed beneath and 'around the soil absorption system - 255 20.1?lease specify and provide details for inspection ports in the soil absorption system - �..F 21. Please clarify the field width provided in the detail as it does not appear it is actualy ,'v; v X11'4" as indicated ` 22. Please clarify General Note 1 as it does not appear to apply to this design plan, clarify General Note 3 as it does not clearly indicate what you may be trying to describe, clarify General Note 6 as it is believed you are trying to identify the manufacturer of the gravel -less chambers specified however that is not their name, you may also wish to provide contact information so the installer can reach them to become certified ` '23. Please clarify the details titled "Standard - Infiltrator Chamber" and "Section -Infiltrator Bed" as the Infiltrator company manufacturs units called "standard" and units called "Quick 4", and the design calculation appear to be based on the Quick 4 X24. Please clarify the soil absorption detail to depict the extent of fill removal and sand - placement beneath the soil absorption system �-25. Please remove references to piping of SDR35 dimension and utilize solely schedule 40 PVC material - NA 10.01 2"6. Please clarify the notation regarding 114" sand indicated beneath the soil absorption system in the system detail f!' 7 c-, 64 27. Please clarify the "Design Computations" as they appear to confuse gallons and square feet, and the design flow calculations 28. Please indicate what the notations for "1.0.3"' and "27.2"' are which appear on the site plan The sheer volume of errors and. omissions on this design plan is troubling. Our office would genuinely like to see your firm provide more services to the residents of our community, but pleased be advised that this level of inattention to detail will not be tolerated on future design plans. Our office does not request designers to provide information which is not in the existing state or local regulations or is not prudent with respect to having the designer provide appropriate standards and information for the contractor to be able to correctly build the on-site wastewater system. We are sure you will be able to meet that standard when you revise this design plan and when future projects are submitted to our office. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, ? 6 Susan Y. Sawyer, REHS RS wy Public Health Director cc: Owner File R.A.M. ENGINEERING ROBERT A. MASYS, P.E. 160 MAIN STREET HAVERHILL, MA 01830 TEL: 978-372-0449 FAX: 978-372-7183 January 31, 2007 Susan Y. Sawyer, REHS/RS North Andover Health Department 1600 Osgood Street Building 20; Suite 2 - 36 RECEIVED North Andover, MA. 01845 FEB 0 2 2007 RE: 102 Spring Hill Road, Map 210, Lot 15 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Dear Ms Sawyer, Attached, please find copies of the revise plans for the above site. We have made adjustments as requested, and as described as follows: 1. Site plan has been adjusted to 1" = 20'. 2. Due to the large amout of fill that had been previously placed at the site, the retaining wall was designed to allow for a change in grade to more approximate the original elevations at the site of the proposed SAS. This allows for the system to be place on the original soils. The detail for the wall has been added to the plans. The wall should be built prior to the installation of the SAS. 3. Distances have been added. 4. A note has been added to the plan to address this concern. 5. The percolation information has been added to the plan. 6. The TBM has been added to the plan. 7. A note has been added to the plan to address this concern. 8. A note has been added to the plan to address this concern. 9. A note has been added to the plan to address this concern. 10. The sewer pipe is located under the cellar floor, and unable to get an elevation. Where the existing tank is to remaiin, this pipe will not be disturbed. 11. This note has been removed. 12. This note has been removed. 13. This note has been removed. 14. This note has been removed. 15. This note has been removed. 16. A note has been added to the plan to address this concern. 17. In designing the proposed system, we looked at using trenches for the SAS. Due to the grading, the area that would be required, and the location of the existing system, the submitted design was a better fit for the site. 18. This note has been removed. `.✓rr% 19. This note has been removed. 20. This note has been removed. 21. The field is to be 5 chambers wide, with a total width of 11' 4". The detail has a break line through the detail, which allows for the width as shown. 22. This note has been removed. 23. The details have been revised to reflect the Quick 4 Units. 24. The detail has been revised as requested. 25. The notation has been revised as requested. 26. The 4" sand located beneath the chambers is intended to serve as a leveling layer, to allow for the correct installation of the chambers. 27. The notation has been revised as requested. 28. The notions were the distances from the tank to the system, and from the house to the system. These numbers have been relocated, to be easier to read. I hope that these revisions will be acceptable for the site. I appologize for the delay in this submission, but due to health issues, I have been out of work for a couple weeks. If I can provide any additional information, or answer any questions, please contact me. Ve ly yours, o rtVass, R.A.M. ENGINEERING ROBERT A. MASYS, P.E. 160 MAIN STREET HAVERHILL, MA 01830 TEL: 978-372-0449 FAX: 978-372-7183 February 16, 2007 Susan Y. Sawyer, REHS/RS Public Health Director North Andover Board of Health 1600 Osgood Street North Andover, MA. 01845 RE: Disposal System Plan for 102 Spring Hill Road, Map 210, Lot 15 Dear Ms. Sawyer, Attached, please find the revised plans for the above site. We have made the revisions that were requested. Those revisions are as follows: 1. Revision date has been added. 2. The graphic scale has been changed. 3. The rate has been changed to 110 gallons/day. 4. The wall detail has been revised to maximum of 4 feet in height. 5. The filed will be 4 infiltrators wide, and will have a total width of 12.83 feet. The 11'4" that was shown was the total with of the chambers and did not include the 6" between them. 6. The inspection port detail has been added to the plan. I believe that these changes will bring the plan into conformance with the Town regulations. If you have any questions, or need additional information, please contact me. M it TRANSMISSION VERIFICATION REPORT TIME 02/08/2007 14:05 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 02108 14:03 FAX NO./NAME 89783727183 DURATION 00:02:06 PAGE(S) 03 RESULT OK MODE STANDARD North Ando er Reaith-Ruff—tn-el 1600 Osgood Street Building 20, Suite 2,36 (North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax henithdept0jawn a"ova a • E-mail Website m Phor Fax: we are sanding poor: Letter of Transmittal Fags of ;K�] onrE FROM: Pamela' Dallechii RE 14% ...-+.-& ofleoer ©P/affs 000torPl ie below) These are transmitted as checked helow- COPY ➢ G7,l�oror�da*,Mo� 30- L7ArAbpiW )0. 17fi r zw ➢ OruralinyawAammw A ,, fi rJi wmv Wealth Department Assistant qpand A L7&fmair -.-- "festwAt w� North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdeptCcD-townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter of Transmittal [Page, z of Qf T0: DATE: COMPANY:FROM: Pamela DelleChiaie, Health Department Assistant � rte. Phone: D. �J D RE: Fax: %2 We are sending you: "coy of Letter O Plans O Other I(fi// k he%w) These are transmitted as checked below: ➢ 174pvVedomw ➢ O,�tsslP�qusrled . ➢ O�IslPegcied ➢ L7ror ➢ Orar&4%va 1xnw # ➢ OrarywrL* ➢ ORWbnr-t apksfiir *PV14d ➢ O&" mpisfiar4f REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: - eo ,6'•NO� O4 C"..C.IC PUBLIC HEALTH DEPARTMENT Community Development Division Robert Masys P.E. R.A.M. Engineering 160 Main Street Haverhill, MA 01830 Re: Wastewater Treatment and Dispersal System Plan for 102 Spring Hill Road, Map 210, Lot IS Dear Mr. Masys: The revised wastewater system design plan for the above site dated January, 2007 and received on February 2, 2007 has been reviewed. Unfortunately, they cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. Please note that the reviewer made some assumptions in regards to your detailed letter. Some items stated they had "been removed" when actually they had been added to the plan such as #18 and 19. f1., Please add a revised date on the plan so that each version can be identified properly. i/2 The site plan has been changed to a 1:20 scale, however the detail of the graphic scale has not been revised. UX Under design computations, the use of 150 gallons per day should be 110 gallons per day. 110 was used for the computation, however it still states 150 4. The wall detail shows a height varying to 8 feet. Under 780 CMR 110.1 a building permit application and required engineering plans must be submitted to the Building Department. The engineered plans must be shown on the septic plan. (see attached) The field size still does not appear accurate using details shown. 5 infiltrators at 34 inches wide, with 6 inches between each is not 11 foot 4 inches, rather it is over 16 feet. Please show the computation that supports the 11 foot 4 inch field as accurate. 6. Please add a detail for the inspection ports showing what size piping, type of physical access cover, final elevation etc. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely n Y. Sawyer, REHS/RS Public Health Director cc: Owner File 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS 780 CMR 109.0 APPROVAL 109.1 Approved materials and equipment: All materials, equipment and devices approved by the building official shall be constructed and installed in accordance with such approval. 109.2 Used materials and equipment: Used materials, equipment and devices which meet the minimum requirements of 780 CMR for new materials, equipment and devices shall be permitted; however, the building official may require satisfactory proof that such materials, equipment and devices have been reconditioned, tested, and/or placed in good and proper working condition prior to approval. 109.3 Alternative materials and equipment: 109.3.1 General: The provisions of 780 CMR are not intended to limit the appropriate use or installation of materials, appliances, equipment or methods of design or construction not specifically prescribed by 780 CMR, provided that any such alternative has been approved. Alternative materials, appliances, equipment or methods of design or construction shall be approved when the building official is provided acceptable proof and has determined that said alternative is satisfactory and complies with the intent of the provisions of 780 CMR, and that said alternative is, for the purpose intended, at least the equivalent of that prescribed in 780 CMR in quality, strength, effectiveness, fire resistance, durability and safety. Compliance with specific performance based provisions of 780 CMR, in lieu of a prescriptive requirement shall also be permitted as an alternate. 109.3.2 Evidence submitted: The building official may require that evidence or proof be submitted to substantiate any claims that may be made regarding the proposed alternate. 109.3.3 Tests: Determination of acceptance shall be based on design or test methods or other such standards approved by the BBRS. In the alternative, where the BBRS has not provided specific approvals, the building official may accept, as supporting data to assist in this determination, duly authenticated engineering reports, formal reports from nationally acknowledged testing/ listing laboratories, reports from other accredited sources. The costs of all tests, reports and investigations required under these provisions shall be borne by the applicant. 109.3.4 Approval by the Construction Materials Safety Board: The building official may refer such matters to the Construction Materials Safety Board in accordance with 780 CMR 123.0 for approval. . . 11/27/98 ADMINISTRATION 780 CMR 110A APPLICATION FOR PERMTr 110.1 Permit application: It shall be unlawful to construct, reconstruct, alter, repair, remove or demolish a building or structure; or to change the use or occupancy of a building or structure; or to install or alter any equipment for which provision is made or the installation of which is regulated by 780 CMR without first filing a written application with the building official and obtaining the required permit therefor. 110.2 Temporary Structures: 110.2.1 General: A building permit shall be required for temporary structures, unless exempted by 780 CMR 110.3. Such permits shall be limited as to time of service, but such temporary construction shall not be permitted for more than one year. 110.2.2 Special approval: All temporary construction shall conform to the structural strength, fire safety, means of egress, light, ventilation, energy conservation and sanitary requirements of 780 CMR as necessary to insure the public health, safety and general welfare. 110.2.3 Termination of approval: The building official may terminate such special approval and order the demolition of any such construction at the discretion of the building official. 110.3 Exemptions: A building permit is not required for the following activities, such exemp- tion, however, shall not exempt the activity from any review or permit which may be required pursuant to other laws, by-laws, rules and regulations of other jurisdictions (e.g. zoning, conservation, etc.). 1. One story detached accessory buildings used as tool or storage sheds, playhouses and similar uses, provided the floor area does not exceed 120 square feet. 2. Fences six feet in height or less. 3. Retaining walls which, in the opinion of the building official, are not a threat to the public safety health or welfare and which retain less than four feet of unbalanced fill. 4. Ordinary repairs as defined in 780 CMR 2. Ordinary repairs shall not include the cutting away of any wall, partition or portion thereof, the removal or cutting of any structural beam, column or other loadbearing support, or the removal or change of any required means of egress, or rearrangement of parts of a structure affecting the egress requirements; nor shall ordinary repairs include addition to, alteration of, replacement or relocation of any standpipe, water supply, mechanical system, fire protection system, energy conservation system or other work affecting public health or general safety. Note: Also see 780 CMR 903.1 (Exceptions 1. and 2.). 780 CMR - Sixth Edition 19 pORTy Of �SLLG 16 q�0 OL - 09 cx.�.c�iE.wcw • �• PUBLIC HEALTH DEPARTMENT Community Development Division Donald Sternfeld 102 Spring Will Road North Andover, MA 01845 RE: Re: Subsurface Sewage Disposal System Plan for 102 Spring Hill Road, Map 210, Lot 15 Dear Mr. Sternfeld, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by RAM Engineering, dated January 2007, last revised February 27, 2007. The design has been approved for use in the construction of a replacement onsite septic system for a 4 -bedroom (maximum 9 room) house. Generally plans are good for 3,years however due to the Title V failure, this plan is good for 2 -years from the date of the Title V report, December 11, 2006. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. The Title V inspection report noted that the home has a garbage grinder. This system is not designed for the use with a garbage grinder. Please have the appliance removed or have the proposed system redesigned with a second septic tank, as Title V requires. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 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. 4. This approval proposes the use of the existing septic tank (approx. 20 years old). Prior to construction, the septic installer must determine whether the tank is acceptable. If it is determined that the tank is not in good condition, the tank must be replaced with a new 1500 gallon tank. 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. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director Encl: list of licensed septic system installers cc: Robert Masys P.E., R.A.M. Engineering file 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com DelleChiaie, Pamela From: DelleChiaie, Pamela Iv Sent: Wednesday, July 25, 2007 1:29 PM To: Sawyer, Susan Subject: Phone call Importance: High �' G Please call Mary Iverson, 978.688.1134. Owner/Resident at Heritage Green who is upset about the Empire carpets she had installed that gave off fumes and made her sick. I attempted to explain what the Health Department does and does not do, but she talked over me and was extremely rude. Good luck. 8esf Ragaads, P41y004 AW044040' aie Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 W978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com FW: 102 Spring Hill Road - Plan Modification `- DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Tuesday, August 07, 2007 9:18 AM To: DelleChiaie, Pamela Subject: RE: 102 Spring Hill Road - Plan Modification Page 1 of 2 WELL, HE SAID HE WAS GIVING US A 'HEADS UP' AND I TOLD HIM THAT WE'D HAVE SOMEONE OVER THAT WAY TODAY; THAT'S WHY I ASKED IF YOU KNEW ABOUT IT; BECAUSE IF I HADN'T GOTTEN YOUR APPROVAL, I WOULD'VE CALLED HIM BACK TO SAY 'SORRY, CANNOT DO, HAVEN'T GOTTEN APPROVAL FROM NORTH ANDOVER BOH'. From: DelleChiaie, Pamela [mai Ito: pdellechiaie@townofnorthandover.com] Sent: Tuesday, August 07, 2007 8:53 AM To: Marianne Peters Subject: RE: 102 Spring Hill Road - Plan Modification Importance: High Just a reminder...... these requests need to go through us, so if an installer calls you directly, please refer them back to us. Thanks. -----Original Message ----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Tuesday, August 07, 2007 8:36 AM To: DelleChiaie, Pamela; 'Dan Obrzut (E-mail)'; 'Daniel Ottenheimer (E-mail)' Subject: RE: 102 Spring Hill Road - Plan Modification YES, THIS IS BEING DONE TODAY; TODD CALLED YESTERDAY. THANKS, MARIANNE From: DelleChiaie, Pamela [mai Ito: pdellechiaie@townofnorthandover.com] Sent: Monday, August 06, 2007 2:55 PM To: Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Subject: FW: 102 Spring Hill Road - Plan Modification Please see below, prior notes. Bob Masys just called and stated the site is ready for a Final Construction Inspection. Todd Bateson is the installer: 978.815.2703. Thank you. -----Original Message ----- From: Sawyer, Susan Sent: Friday, August 03, 2007 9:13 AM To: DelleChiaie, Pamela; Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Subject: RE: 102 Spring Hill Road - Plan Modification Just to add my 2 cents, the leaching area was raised 2 feet, not totally removed. Susan -----Original Message ----- From: DelleChiaie, Pamela 8/7/2007 FW: 102 Spring Hill Road - Plan Modification Page 2 of 2 Sent: Friday, August 03, 2007 9:02 AM To: Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Cc: Sawyer, Susan Subject: 102 Spring Hill Road - Plan Modification Importance: High This plan has been modified by the engineer (Bob Masys) to remove the wall and leaching area. The installer has stamped, and red -lined the plan, which Todd Bateson will have on site. Bast Rgwds, PwfteLew DWI&OW4110 Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 $978.688.9540 - Phone P'' 978.688.8476 - Fax httL:o%mofnorthandover.com healthdept@townofnorthandover.com 8/7/2007 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, August 06, 2007 2:55 PM To: Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Subject: FW: 102 Spring Hill Road - Plan Modification Please see below, prior notes. Bob Masys just called and stated the site is ready for a Final Construction Inspection. Todd Bateson is the installer: 978.815.2703. Thank you. -----Original Message ----- From: Sawyer, Susan Sent: Friday, August 03, 2007 9:13 AM To: DelleChiaie, Pamela; Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Subject: RE: 102 Spring Hill Road - Plan Modification Just to add my 2 cents, the leaching area was raised 2 feet, not totally removed. Susan -----Original Message ----- From: DelleChiaie, Pamela Sent: Friday, August 03, 2007 9:02 AM To: Dan Obrzut (E-mail); Daniel Ottenheimer (E-mail); Marianne Peters (E-mail) Cc: Sawyer, Susan Subject: 102 Spring Hill Road - Plan Modification Importance: High This plan has been modified by the engineer (Bob Masys) to remove the wall and leaching area. The installer has stamped, and red -lined the plan, which Todd Bateson will have on site. 81081 R10014ods, Pa�10l�w D10B�10G�liiuia Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 2978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com North Andover Health Department 1600 Osgood Street Letter of Transmittal Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone Page / of 978.688.8476 — Fax healthdept(CD-townofnorthandover.com - E-mail www.townofnorthandover.com - Website y �t1.av �6' W, �� 4� 1' ' 6 Of6 r~ � COC.i1LM TO: DANIEL OTTENHEIMER DATE: COPY TO: Homeowner FW # COMPANY: MILL RIVER CONSULTING FROM: Pamela DelleChiaie, Health Department Assistant Or Re: Phone: 1.800.377.3044 or 978.282.0014 Mailed Fax: 978.282.0012 COPY TO: We are sending you. O Soil rest Application O Plans for Review O Other These are transmitted as checked below: ❑ As Required ❑ As Requested REMARKS: r COPY TO: Homeowner FW # Or Mailed COPY TO: Fax # Or Mailed Fax # COPY TO: Or Mailed TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES ar 4`�;,'- .'.'• ° HEALTH DEPARTMENT ~ ' 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, RENS, RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX healthdept@townofnorthand over.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: / " % ��� MAP & PARCEL: LOCATION OF SOIL TESTS: R Z S ek , ti k4,11 k""6 OWNER: �on +r 1"l ` c, cl Contact #: 1'0P 6 .5..5 APPLICANT:�at) a I3 Q, •,, fit e C r) Q k Contact #: 1. dg- wly, ' eid Fe ` l �5 3 ADDRESS: iD L. e, i s1�'� 1�1 � F._�c. -z)- A- ENGINEER T�/�/ Vi d J P• Contact #: 9��' %G ' dy'�J —7 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11 "Plot plan & Location of Testine (please indicate test nit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of S360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes 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 testing. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agen . Date back to Health Department: (stamp in): Nvjajavxe S w/ivy 100 r' ea.e a LO a A 4 S W so" p r n. ... ' •�... �oe.se' .. � J o ra0 x i r^ Kx 0 l ♦ Nui Q 4141 Vr i J Q r n« r NS z JQ v ti Z z . arsaod� reee `1 i ,L9. 98' P SS< yyq Q u n e � 1f." �'• m i" `b of 0 (. �; � p °0 0 r � �•I d� 8• � J ¢�� �Q ���n M n �� 3 a" ° •' -�anno E'er �,. i H . I- roan �; •. `^.o '"�v �--E�� �' n � ,n /� %j' —ps 9 Ai y r ♦ b�� NNS $ r`' `� LA f v •• oh� . � , < Vis, b• ti o � � J v SrA F V 5 J rJ p�(oj (C h j CUa 41� IJ � 3 (F Q E a . A R.A.M. ENGINEERING +-) ROBERT A. MASYS, P.E. 160 MAIN STREET HAVERHILL, MA 01830 TEL: 978-372-0449 FAX: 978-372-7183 December 14, 2006 North Andover Board of Health 1600 Osgood Street Building 20, Suite 2 - 36 North Andover, MA. 01845 RE: 102 Spring Hill Road Dear Board, I give my permission for Robert A. Masys, P.E., of R. A. M. Engineering, to conduct percolation tests on my property at 102 Spring Hill Road. Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Wednesday, January 03, 2007 9:11 AM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Eva[ - 102 Spring Hill Lane attached Soil evaluation for 102 Spring Hill Lane attached. Mill 1"U'ver consulting Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 N www.miliriverconsulting.com 1/3/2007 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments tUz- 5?CI&.jC. "IL'L Property Address E+�,✓�EL� Owner's Name City/Town State Zip Code Date of Inspectiorf Inspection results must be submitted on this form. Inspection fonds may not be altered in any way. A. General Information Inspector:: C 4ia.N .j'i'CiC_.0: 1 Name of Inspector Company Name 2.o/6 Company Address H- lit 21-1 i L_ t_ City/TownState Zip Code Telephone Number License Number B. Certification 1 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 []—Pails ❑ Needs Further Evaluation by the Local Approving Authority Ins oPs Signature Date The systeminspector shall subM!t a copy of this inspection report to the Approving Authority (Board of Health or P)v& tlh 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. t5insp.doc - 08/05 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page t or 16 Im i Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name CityrFown 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: /t/ la ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp.doc • 08106 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w Property Address Owner Owner's Name information is required for 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: /Y //q 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: l ❑ 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. t5insp.doc • 08/06 Title 5 Official Inspection form: Subsurface Sewage Disposal System • Page 3 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name Cityrrown B. Certification (cont.) State Zip Code Date of Inspection 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: N /� ** 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 ©e ❑ 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 Y 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. ❑ [ge Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp.doc • 08M Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 15 Commmealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' M Property Address Owner Owne's Name information is required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No [] [T'O" Any portion of a cesspool or privy is within a zone 1 of a public well. ❑ 2/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. �-,,/ ❑ L� 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. E ❑ 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 /iii" /41i ❑ ❑ 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 11 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. t5insp.doc •08/06 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Pam 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. CitylTown C. Checklist State Zip Code Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No E ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ l 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? UR ❑ 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: [f"**' ❑ Existing information. For example, a plan at the Board of Health. ci ❑ 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)] t5ins .doc • 08106 P Title 5 Official Inspection Fam: subsurface Sewage Disposal System •Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �r Property Address Owner information is required for every page. Owners Name Cityfrown D. System Information Residential Flow Conditions: State Zip Code Date of Inspection Number of bedrooms (design): H Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? kle Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Sump pump? Last date of occupancy: Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Last date of occupancy/use: Other (describe): []Yes ❑ No ❑ Yes [E�`No ❑ Yes B No ❑ Yes P --No ❑ Yes P-1 No Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Date t5fnsp.doc • 08/05 Title 5 Official Inspection Form: Subsurtace Sewage Disposal System •Page 7 of 16 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name City/Town State Zip Code D. System Information (cont.) General Information Date of Inspection Pumping Records: It/, 1 d5-; I Z A LI/° Source of information: /V.. A Ai bona P— R -0 yi Was system pumped as part of the inspection? ❑ Yes ED -No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 2.0 'q P5 R S- IaV i L -T PL -r,+ -N 75 Were sewage odors detected when arriving at the site? ❑ Yes B --No t5insp.doe • 0SM Tice 5 official Inspection Form: Subsurface Sewage Disposal System •Page 8 of 15 Commbnwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M Property Address Owner Owners Name information is required for every page. Cityrtown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): % Depth below grade: feet Material of construction: 3 /cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Al 1A Comments (on condition of joints, venting, evidence of leakage, etc.): G0 i7 cc c4'41 'J -Ti i:.i Septic Tank (locate on site plan): % I �' Depth below grade: feet Material of construction: �oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: N /(A years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: cel r N f ✓1 A v Chiy far L CAI -r Distance from top of sludge to bottom of outlet tee or baffle Scum thickness /v A>% Distance from top of scum to top of outlet tee or baffle /vfFY Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? t6insp.doc • 08/06 Idle 5 Official Inspection Farm: Subsurface Sewage Disposal System •Page 9 of 15 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. Cityfrown 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.): G LTi C �>�. 1 r n %�t/<= —rVtS Avec V L"-Vc iC'"% L - Grease Trap (locate on site plan): Depth below grade: A iA 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 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): t5insp.doc • 08/06 Title 5 official Inspection Foran: Subsurface Sewage Disposal System •Page 10 of 15 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. Citylrown D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: A/ la Design Flow: Alarm present: Alarm level: Zip Code Date of Inspection gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert L,60,6 L w s , *l –fo, i' o : b ^ R o 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.): 1= t L Ir �- v-► i I -I C F L U i !� r i "ice s7 i -F E's tom: t is D io i ry L CIA G a~ ( G -L h A —"h 1-1 rL L. I C t=» 14- C .j Ak 3 .E v Gb h}- Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp.doc • 08!06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 11 of 15 Comm6nwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M Property Address Owner information is required for every page. Owner's Name Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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 ❑ leaching chambers ❑ leaching galleries Er leaching trenches ❑ leaching fields ❑ overflow cesspool ❑ innovative/alternative system Type/name of technology: number: number: number: number, length: number, dimensions: number: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 7— it lvl `�4, :..'i� ; ry S O f L f..a in V f � � J.s � T �' c� � } I c� C t IS t5insp.doc - 08W Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name City/Town D. System Information (cont.) State Zip Code Date of Inspection 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 IA_) 1419— Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 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 /U Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc • 08M Idle 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Propertv Address Owners Name Citylrown State Zip Code Date of Inspection 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. t5in doc 08/06 � • Trtle 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 14 of 15 Owner information is required for every page. ft Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name Cityfrown D. System Information (cont.) Site Exam: E�J' Check Slope Z- 3 r r [Surface water [Check cellar_ �I>P-'1 [Shallow wells Estimated depth to ground water: State Zip Code Date of Inspection = S 171 feet 9, i 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:+ 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: t5insp.doc • 01106 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Pape 15 of 15 JaS45 to /� 14,Q1 d CA //10 vi- .e /.� / `i =tea ' v a�� a oz.oa A/ y 3 Z.1 A-' 47 .Qt - co 9 dk ago = Sll3S��., Lel f /S /-5 ao GR/A. _ 2 fR_E /V C