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HomeMy WebLinkAboutMiscellaneous - 1024 TURNPIKE STREET 4/30/2018 (3)MAP # 7'61. LOT # --- �J PARCEL # / STREET - HAS PLAN REVIEW FEE BEEN PAID? 4YE5 NO PLAN APPROVAL: DATE �� / �%� APP. BY__,��7l/v'..__ DESIGNER: PLAN DATE:_ CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT `� DRILLER.`__._____.___.__._..._._..._...__ _._....._.._................ WELL TESTS: CHEMICAL DAZE APPROVED --.___,_.......... _ BAC I DA f E F1F-PRUVED ....... BACTERIA II DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED BY + CONDITIONS: i FINAL APPROVAL:. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO �+ SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU + ANY VARIANCE NEEDED YE NO i FINAL BOARD OF HEALTH APPROVAL: DATE:_.__ .............. ._.DY:._.. y Ar, +.i + �,. : h::9>'. ..t 9 - t'S'P':,. :...,::a st„• moi-- /••a a ; elf 1 1 '7. .. ';t=x IS 7HE • INSTALLER LICENSED? �r + > , YES NO _ `.TYPE. OF'CONSTRUCTION: ; - - NE REPAIR' .i' \ .NEW CONSTRUCTION:_,... CERTIFIED PLOT PLAN `REVIEW. (YES) NO SOF CONDITION ..APPROVAL :f YES NO s+ r (FROM .FORM / "\4ISSUANCE OF DWC PERMIT / " ` YES NO DWC PERMIT NO. INSTALLER:,f..1On BEGIN INSPECTION `/Y N0: ,\ Y _ EXCAVATION .INSPECTION: _ -;NEEDED: -, PASSED hi .HY-7: CONSRUCTION INSPECTION: NEEDED: T " ''' .• ' . ' ....w7.,yrs`•^ - AS BUILT PLAN SATISFACTORY: `: YES. APPROVAL TO BACKFILL. DATE: BY "FINAL.GRADING APPROVAL: DATE-14HY l 1• :t FINAL CONSTRUCTION APPROVAL: DATE:J9�0).BY • i Owner information is required for every page. Important: When filling out firms 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 For Subsurfaces Sewage Disposal -System Form - Not for Voluntary Assessments er a1 �- r-� - / "7 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. X General Information 1. Inspector. Name of Inspector Company Name Comoanv Address LMMU1111111i''m IVA crtyrrown Teleph ne Number EL Certification state —rip Code License Number I certify that 1 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: d Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of Inspection and under the conditions of use at that time. This inspection does not address how the system will perforin in the future under the same or different conditions of use. Tide 5 ORidal Inspection Fonts subsurface Sewage Dlsposel system • Page 1 0117 t5ins • 03l13 5/ I//Y 1/Si 4 •��,��•t r 0 S Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspecti®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �a� Property Address Owner's Name City/Town B. Certification (cont.) State 'Lip Code Date of Inspection Inspection Summary: Check A,B,C,D or E 1 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: &hU a �i >�'P c o `M h1 v� c� �l s vy, 1V I U I +� 0 ti �l (e - 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 replacementdr repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" br "not determined" (Y, N, ND)for following statyements. If "riot determined, " please explain. The septic tank is metal and over 20 years old' or the tic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replace ith a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection ' it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is I s than 20 years old is available. ❑ Y ❑ N ❑ Y6(Explain below): t5ins • 03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System - Page 2 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Citylrown State zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.); ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Wp'lain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ND (Explain below): i ❑ The System required pumping more th 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with aap oval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is remo ed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of health: ❑ Conditions exist which require further evaluation by tl�e Board of Health in order to determine if the system is failing to protect public health, safety the environment. 1. System will pass unless Board of healt etermines in accordance with 310 CMR 15.303(1)(b) that the system is not functi Ing in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy isZ-in feet of a surface water ElCesspool or privy is feet of a bordering vegetated wetland or a salt march t5ins - 03/13 Title 5 Oficial Inspection Form Subsurface Sewage DISposal System • Page 3 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Addre: Owner's Name Cityllbwn e. certification (cont.) State Zip Code Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) deterimes 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) an a SAS is within 100 feet of a surface water supply or tributary to a surface water pply. ❑ The system has a septic tank and SAS and the SAS is within Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is (thin 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the S CS 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 anal is, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presen of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other, ailure 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 ❑ Er 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 `�_ A ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less an % day flow t5ins - 03113 Title 5 Official Inspection Forth 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 Da4 ce Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Ea Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ aAny portion of the SAS, Cesspool or privy is below high ground water elevation. El 2"' Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ EY' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 12r Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 2' 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.] ❑ 2r This system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ El� 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. IE) 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" tq,6ach of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 /of urface drinkiing water supply ❑ ❑ the system is within 290 feet of a tributary to a surface drinking water supply ❑ ❑ the system is lXamapped in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA o Zone II of a public water supply well If you have answered "yes" to y question in Section E the system is condidered a significant threat, or answered "yes" in Sectior 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. (Sins . 09/13 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 Property A dress Owner Information is Owner's Name required for every 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 Z" ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 1� Were any of the system components pumped out in the previous two weeks? V ❑ 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? 2 ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) Er ❑ 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? 19" ❑ 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? a ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? This 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 T Residential Flow Conditions: Number of bedrooms (design): __ Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 6('0 6 Po t5in5 - 03/13 Title 6 Official Inspection Form subsurface Sewage Disposal System • Page 6 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1_y Turn:I�� i - Property Address jwnerrs Name City/Town u. uystem Information Description: State Zip Code Date of Inspection Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes Q No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 12r No Laundry system inspected?A ElYes ❑ No Seasonaluse? ❑ Yes 13 No Water meter readings, if available (last 2 years usage (gpd)): C7WnJ i�kp2Y Detail: Sump pump? ❑ Yes O'No Last date of occupancy: Dan;, , �v Commercial/Industrial Flow Conditions:. te Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (god) Basis of design flow (seats/persons/sq.ft.,e .): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank prese ? ❑ Yes ❑ No Non -sanitary waste discharge to the Title 5 system? ❑ Yes ❑ No Water meter readings, if ailable: t5ins - 03/13 TWe 5 Official Inspection Form Subsurface Sewage Disposal system - Pape 7 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name CityfTown State D. System Information (cont.) Last date of occupancy/use: Other (describe below): Zip Code General Information Date Date of Inspection Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 12'No If yes, volume pumped: gallons How was quantity pumped determined? n Reason for pumping: Type of System: ffSeptic 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): Tllle 5 Official Inspection Form Subsurface Sewage Disposal System • Pape 8 of 17 t5ins .03113 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 Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): Depth below grade: feet Material of construction: LJ cast iron ❑ 40 PVC ❑ other (explain) Distance from private water supply well or suction line: feet --7Z� Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): I� CD `' U16 ,(OL Depth below grade: l 1 -5— Material of construction: feet concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes C] No Dimensions: / -S-C)6 67:-( �/61z Z-/ I, Ll Sludge depth 15ins - 03113 Title 5 Official Inspection Form Subsurface Sewage Disposal System • Pepe 9 of 17 a �w Owner Information is required for every page. Commonwealth of Massachusetts *title 5 Official Inspection F=orm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a a `f �nrl ) Le S� r 1 UtJUJ LY P%UU1 Ubb Owner's Name Cityfrown State Zlp Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle , Scum thickness rL Distance from top of scum to top of outlet tee or baffle S Distance from bottom of scum to bottom of outlet tee or baffle / -I,/ How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 --- Grease Trap (locate on site plan): Depth below grade: _ Material of construction: feet ❑ concrete ❑ metal ❑ fiber ass ❑ polyethylene ❑ other (explain) Dimensions: Scum thickness Distance from top of scum t top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins - 03/13 Date TIUe 5 Of idol InspecUon Form Subsurface Sewage otsposel System • Page 10 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments q TLA Y"1Y1 J2) Jae s+ Propertv Address Owner's Name 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: Design Flow:/d /jgns 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 • 03113 illle 5 Official Inspection Form Subsurface $swage Disposal Systein • Page 11 of 17 SIX R ' Owner Information is required for every page. t5ins - 03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner's Name City/Town u. System deformation (cont.) State Zip Code Distribution Box (if present must be opened) (locate on site plan): Date of Inspection Depth of liquid level above outlet invert 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 /C Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ff Yes ❑ No Ef Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): CL--t �`DAJ 11 ��i✓ r P� �.� n Ir e, �f J i Kip L- I f—1 rt Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: L% T10o 5 Official Inspection Forth Subsurface Sewage Disposal System • Page 12 of W a 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 Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: leaching galleries number: r❑ u leaching trenches number, length: z ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of,technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): , )c%tf� Ct7, { l rnt .lam �-�. 1 1 'moi. ,� o - lI ';� i', r IJ ,- _ nr t -r -e_ i Cesspools (cesspool must be pumped as part of inspection) Number and configuration Depth - top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction on site plan): Indication of groundwater in ow ❑ Yes ❑ No t5ins - 03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System - Page 13 of 17 a r Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments D rn ►1�P Owner's Name CltylTown State Zip Code D. System Information (cont.) Date of Inspection 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 draulic failure, level of ponding, condition of vegetation, etc.): tSins - 03/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System • Page 14 of 17 Owner Information is required for every page: t5ins • 03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Owner's Name CitylTown D. system Information (cont.) State Zip Code Date of Inspection 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: E hand -sketch in the area below ❑ drawing attached separately 7~i Title 5 Oftldal Inspection Forth Subsurface Sewage Disposal System • Pape 15 of 17 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 4 T y-v,TD, lc e �+ Address Owner's CitylTown D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: State Zip Code Date of Inspection feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record If checked, date of design plan reviewed: ae ❑ 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 ISG$ database - explain: You must describe how you established the high ground water elevation: Before filling this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 03/13 Title 5 Official Inspection Form Subsurface sewage Dfsposai System • Flags 16 or 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspecti®n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /(Da4'5rY)t-))� s Name City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 12/Inspection Summary: A, B, C, D, or E checked -� Inspection Summary D (System Failure Criteria Applicable to All Systems) completed System Information - Estimated depth to high groundwater LN Sketch of Sewage' Disposal System either drawn on page 15 or attached in separate file t5ins • 03113 Title 5 Official Inspection Form Subsurface Sewage Disposal System • Page 17 of 17 UB Mailing index Town of North Andover " Tax Mar) # 210-107.0-0007-0000.0 Parcel Id 18273 1024 TURNPIKE STREET YONGJIAN YU Loan Nurnher 1024 TURNPIKE STREET NORTH ANDOVER, MA 01845 --- Class 101 Single Family .—�-�-------'Property 1513® 1 Residentfaf 7-onln92 1 R9=ldenGal zonings 1 R.ealdanllal Size Total 3,31 Acres FY 2017 1024 TURNPIKE STREE' UB Mailing index NamedAddrew; Type Loan Nurnher Activallnact. From Untl! YuNG.iiAN YU Owner 1024 TURNPIKE STREE' NORTH ANI7i7VER, MA 01845 ZHP,C, JPNE Previous Guatcmer Inactive 1212212004 XiN, FRANK 1024 TURNPIKE 5-1REET WORTH ANDOVER, MA 0 345 U13 Account Maint. AGcw4nt• No Cycle Occupant Name Activellnactiva BIS Id. 137W.0 -1024 TURNPIKE STREW' Last Billing 'ata M12017 1050472 01 Cyce 01 Act!v6 0— 1rvic s ffiq LQt, Account NO. 1090472 Servfc� Cade Rate Charge Multi pllerNsem MISC.FEEADMIN FEE 1 1 9.18 11 VVTR WATER D1 ALL MIZI :: SIZE 110,80 h 1,113 Meter Maintenance Acroun. No. 1090472 sed l No Status Locaticn Brand Type Slzo Y70 Cons 13240201 a Active 00 METE METE w Water 1 1 707 Date Raading Code Consumption Potted Date Variance 4/18/20'7 1Do! aActuol 16 1/17/2017 -81A 1119/2017 985 aActual 18 2/16!2017 -1V4i 10119/2015 967 a Aclual 21 11 /10/'010 33% 7/21/2016 946 a Actual 16 8/16/2016 24% 41211201E 930 a AGlual 21, 5/2Ui016 d`/o 112112016 909 a .Actual 20 2/19/2016 10/21/2015 889 a Aokwl 21 11120/2015 9 /o 7122/20/5 868 a Actual 19 6/14/2015 -16`.10 4/2312015 849 a Aclual 23 5/19/2015 5°k 1/22/2015 826 a Actual 22 2/20/2015 1 % 10/2$/2014 804 a Actual 22 11(14/2014 5% 7/23/2014 782 a Actual 21 03/2014 2% 4/22/2014 761 a Aclual 20 5/15/2014 2% 1/23/2014 741 aActual 21 2/14/2014 -4% 10/23/2013 720 a Aclual 22 11118/2013 8`Yo 7122/2013 696 a Aclual 20 8/1612013 -2% 4/22/2013 678 a Aclual 21 5/2012013 13`/�/0 1/18/2013 657 a Aclual 18 2/13/2013 -10'4 10119/2012 639 a Actual 20 11/9/2012 11 % 7/20/2012 619 a Aclual 18 8/1412012 6% 4/20/2012 601 aAclual 17 5/9/2012 -14% 1/20/2012 884 a Aclual 20 2/13/2012 161YQ 10!2012011 564 a Actual 17 11!1412011 13% 7!21/2011 547 aActual 15 8115/2011 -21% 4/21/2011 532 a Actual 18 511612011 -3% North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 1024 Turnpike Street INSTALLER: Rob Diagle DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: MAP: 107.0 LOT: 0007 07/20/2017 — Brian LaGrasse Dbox Replacement, Dbox only passed inspection INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction Comments: PUMP CHAMBER Comments: CONTROLPANEL Comments: DISTRIBUTION -BOX ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank 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 ❑ cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement ® Installed on stable stone base ® H-20 D -Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: Dbox replaced roots cleared out speed levelers used SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 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 ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As -Built Plan BM = HR = HI = SYSTEM ELEVATIONS ROD AS -BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN f M� CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) Z 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 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) Z 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 V",rf'rit� �.MIr /Y//7� JVL•),^iOr1f\ `-/fi��)Ffl a— — 30308 1--345 6677 :rr Salem, NH 603-896.1554dT Andover978-475.4711 Methuen 978-686-2214 Newburyport 978462-4661 E CUSTOMER'S ORDER NO PHONE IEC ANIC I HELPS BILLTO ADDRESS.,. -- r .66-Y WORK CITY' – %� F ❑CONTRACT ❑ EXTRA Jdb NXIVRE AND LOCATION JOB PHONE TERMS: C.O.D. – Because of the nature of the work herein described and of its emergency, we prefer that all payments be made to mechanic on the Job after completion. A FINANCE CHARGE computed at a periodic rate of 11161/6 PER MONTH, which is an ANNUAL PERCENTAGE RATE of 18% will be charged on all accounts remaining unpaid by the 10 of the month following the purchase. If collection proceedings are necessary, all fees, including legal fees, are the responsibility of the customer. THANK YOU. A service charge of 515.00 will apply on all returned checks. Commonwealth of Massachusetts BOARD OF HEALTH North Andover P.I. F.I. Map -Block -Lot 107.00007 ----------------------- Permit No BHP -2017-0499 FEE `11*�y-------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted _ (�S .� ------------------------------------- to -__ __ ____ to (Construct) an Individual Sewage Disposal Syste �.I �,an 7//- at 1at No 1024 TURNPIKE STREET $175.00 --------------- as shown on the application for Disposal Works Construction Permit No. BHP -2017-049 ated Jul 17 --------------------------- ----- Issued On: Ju1-10-2017 BO OF HEALTH -------------------------------------------------------------------------------- �/JA NOPTM 1q, ` I I 4 0 Town of North Andover HEALTH DEPARTMENT ,SSACNUSt� ., CHECK #: 0857 DATE: 7 -/0 •w200 LOCATION: 10d l nDi, �S A H/ O NAME: n Y� 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 Testingb $ ❑ Septic -Design Approval o r$ Septic Disposal Works Construction (DW) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ 978- yU3 - 6933 He'aft* Agent Initials White - Applicant Yellow - Health Pink - Treasurer .. RECEIVED •; •�-� Application for Septic Disposal System 15n 1017 , Construction Permit —TOWN OF 1111 TOD D NORTH ANDOVER, MA 01845 M $1 Womponent Important: Application is hereby made for a permit to: When filling out ❑o struct 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 - What? G cursor - do not use the return A. Facility Information key. I Address or Lot # ` �l � l $ - I�City/Town �ensn 2.- *TYP F 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) --- - - �-- >=F-9-, Pressure Dosed (D=Box-Present) S.A:S:-__._- y ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) What is the Make? 2. Owner Information What is the Modeh Name L 1 Y6 n Address (if different from above) oZq- wt/ nC�i ICS S+ . N• / Email addres A 3. Installer Intormeftl n Name l (�� ��► Address City/Tom 4. Designer Information Name Address City/Town ��✓ h� �l- °l g �ty State Zip Code X78- 331- 9$6I Telephone Number Name of mpany � Stbte Zip Code Telephone Number (Cell Phone #ifpossible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 -y • Application for Septic Disposal System Construction Permit -TOWN OF NORTH ANDOVER, MA 01845 PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: bgResidential Dwelling or ❑Commercial B. Agreement TODAY'S DATE $350.00 - Full Repair $175.00 - Component 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. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. Name Date Applicat' n Approved B - oa0-6J&fiealtk Representative) _ l Name ell Date Application Disappr ed for the following reasons: For Office Use Only: m 1. Fee Attached? Yes No 2. Project Manager Ohligation Form Attached. Yes No 3. Pump S sY tem? If so, Attach copy of Electrical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approvalletter, all paperwork received.? Yes No Missing:' 5. Foundation As -Built? (new construction only): (Same scale as approved plan) Yes No 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 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: ( 0 VA �—L) J ,, � 6 bu P 5�, (Address of septic system) For plans by Iy (Engineer) Relative to the application of J (Installer's ame) And dated N' Dated t �D I � With revisions dated (Original ate NM. (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: healthdept@northandoverma.gov) 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 theinstaller, 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_bv 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 solel_)� responsible for the installation of the system as per the me of this obligation. Undersigned Licensed Septic Installer: ) (Today's Date) G� &V -t kC%A*116 r ame —Print) (Name —Signed) • 79) 4 ' O is �_ • ��,. h �p a Town of North Andover ,;.p HEALTH DEPARTMENT 1SS^CHU5�4 ' CHECK #: L DATE:Z?-,Z( ' LOCATION: 16th>r-���c 574 H/O NAME: CONTRACTOR NAME: w 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 $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ Title 5 Report ❑ Other: (Indicate) $ lth Agent Initials White - Applicant Yellow - Health Pink - Treasurer lky j ZeA/1-0 `fig e e� 4 01 C' , 000� -000 0, 0 � Commonwealth of Massachusetts RECEIVED Title 5 Official Inspection Form. JON 19 207 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments TOWN OF NORTH ANDOVER 1024 Turnpike Street HEALTH DEPARTMENT Property Address Yongjian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered ' y way. Please see completeness checklist at the end of the form. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Jdli A. General Information Inspector: Neil James Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Companv Address Andover Cityrrown 978-475-4786 Telephone Number B. Certification MA 01810 State Zip Code SI -15 License Number 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 ❑ Nee Further Evaluation by the Local Approving Authority A azir I L 6/9/2017 Inspector's '%nature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system 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.doc • rev. 6/16 1 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner's Name North Andover MA 01845 6/9/2017 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.doc - rev. 6116 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 w Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner's Name North Andover Cityrrown B. Certification (cont.) MA. 01845 State Zip Code 6/9/2017 Date of Inspection ❑ 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): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner's Name North Andover MA 01845 6/9/2017 Citylrown 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: Outlet pipe in pump chamber cracked & leaking & d -box needs to be replaced. Trees around d -box needs to be removed to prevent root invasion D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution, box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc • rev. 6116 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 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. Cityrrown 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 Zane 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.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is North Andover required for every page. Citylrown C. Checklist MA 01845 State Zip Code 6/9/2017 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 660 t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage pisposal System • Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? ❑ Yes ❑ No ❑ Yes ❑ No Non-spnitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: 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 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 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: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: Pumped 2016, owner ® Yes ❑ No 1500 for septic tank & 500 for pump tank gallons Measured tank Inspect tank & tees ® 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.doc - rev. 6116 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 18 years old, 8/9/1999, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 2.6 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.): 4" Cast Iron through wall, 3" PVC in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: 1.6feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x5'x4' Sludge depth: 2" t5ins.doc - rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Owner information is required for every page. Colrimonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10241Turnpike Street Property Address Yongian Yu Owners Name Nortli Andover MA 01845 6/9/2017 City/Town State Zip Code Date of Inspection D. System Information (cont.) i Septic Tank (cont.) j 31" Distance from top of sludge to bottom of outlet tee or baffle I Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser 1' deep Grease Trap (locate on site plan): i Depth below grade: feet I Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): I Dimensions: I S6rn 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.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Capacity: Design Flow: Alarm present: Alarm level: — Date of last pumping: ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner's Name North Andover MA 01845 6/9/2017 Citylrown D. System Information (cont.) State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert L Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box cover broken, replaced same. D -box has extensive root invasion. Needs to be replaced. Trees around d -box needs to be removed to prevent root invasion. Roots in pipes needs to be removed. 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.): Pump tank 2 'deep. Pump tank has riser cover over pump & floats 1' deep. Pump tank ok. Pump ok. Alarm ok. Alarm has both audible & visual alarm . Outlet pipe cracked & leaking liquid. Pipe needs to be replaced. * 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.doc - rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 57' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doG • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. Cityrrown 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.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. Cityrrown 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 l5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 A-Av szt l `31 '17 11 _���►-71f Uev-� 0-�� - `" 1 `7 0 ­ TkkeqtiD ff_� pv\.-P. it, 5b4 $ -ep kd N Y�1( Z'�i,� :-- l5ins.doc • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 Turnpike Street Property Address Yongian Yu Owner Owners Name information is required for every North Andover MA 01845 6/9/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells >4 Estimated depth to high ground water: fee, 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 6/11/1993 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per design plan test pit data. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc • rev. 6116 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 1024 Turnpike Street Property Address Yongian Yu Owner Owner's Name information is required for every North Andover MA 01845 6/9/2017 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.dop • rev. 6/16 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 : Commonwealth of Massachusetts _ C4ffown 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.,' heck 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 eft / Right 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 C>- cityrown lJ State - Zp Cotle 2. System Owner. � Name' Address (if different from location) Citylrown State �,[�Zip f L7 �� [ � � Code Telephone Number i B. Pumping 1. Date of Pumping 3. Type -of system: ❑ ther (describe): Date 2. Quantity Pumped: Gallons Cesspool(s) 'is ank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ YesLeo If yes, was it cleaned? ❑ Yes ❑ No, '5. Condition of System. 6: System Pumped By.- Nell. y: Neil. Bateson ' Name Bateson Enterprises Inc Company 7.=�S. a contents -were disposed: _ Lowell Waste Wa F5821 Vehicle License Number G --- Co Date form4.doc- 06/03 System Pumping Record • Page 1 of 1 s,jr Y11Bly Kscdrd Card genir6led on &I4 2017 2:25:57 AM 9Y Win 11161/011 Town of North Andover Tax flap # 210-107.0.0007-0000.0 Parcel Id 18273 1024 TURNPIKE STREET YONGJIAN YU 1024 TURNPIKE STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residentlai Z*ning2 1 Residential Zoning3 1 Residential Size Total 3.31 Acfes FY 2017 — - UB Mailing Index, NamelAddress Type Loan Number Activellnact. From Untl! YONGjIAN YU owner 1024 TURNPIKE STREP=, NORTH ANDOVER, MA 01845 ZHAO. ,LANE Previous Gu31emer Inactive 12/22/2004 XIN, FRANK 1024 TURNPIKE STREET 14ORTH ANDOVER, MA 01845 U® Account Main!, Account No Cycle Occupant Name Activslinactiv© Bldg Id -13796.0 -1024 TURNPIKE STREET Last Billing Late 519/2017 1090472 Ot Cycla Oi ACtivq Us Services Malnt, Account No. 1090472 Service Code Rate Charge Multipller/Users MISCFEEADMIN FEE 11 9.18 11 WTR WATER O1 ALL METER SIZE 80,80 11 US Meter Maintenance Account No, 1090472 Serial No Status Location grand Type Size YTD Cons 13240201 a Active 00 METE METE w Water 11 707 Date Reading Code consumption Posted Date Variance 4/16/2017 1001 a Actual 16 511?!2017 -811/6 1/19/2017 985 a Actual 18 2/16/2017 -16% 10/19/2016 967 a Actual 21 11 N 612010 330/6 7/21/2016 946 a Actual 16 8/16/2016 -24% 4/21/2016 930 a Actual 21 5/25/2018 6% 1/21/2016 909 a Actual 20 2/19/2016 -6% 10121/2015 889 a Actual 21 111/2012015 9% 7/22/2016 868 a Actual 19 6/14/7015 -16% 4/23/2015 849 a Actal 23 5/19/2016 5% 1/22/2015 826 a Actual 22 2120/2015 1% 10/23/2014 804 a Actual 22 11/14/2014 6% 7/23/2014 782 a Actual 21 8/13/2014 2% 4/22/2014 761 a Actual 20 5/1512014 -2% 1/23/2014 741 aActual 21 2/1412014 .4% 10/23/2013 720 a Actual 22 11/18/2013 8% 7/22/2013 696 a Actual 20 8/1512013 -2% 4/22/2013 678 a Actual 21 5/20/2013 13%/� 1/i6/2013 657 a Actual i8 2/13/2013 -1014 1011912012 639 a Actual 20 11/9/2012 1140 7/20/2012 619 a Aotual 18 8/14/2012 6% 4120/2012 601 a Actual 17 5/8/2012 -14% 1/20/2012 664 a Actual 20 2/13/2012 16% 10/2012011 564 a Actual 17 W114/20111 13% 7/21/2011 547 a Actual 15 8115/2011 -21% 4/21/2011 632 a Aotuel 18 5/16/2011 -3% 5APD,-( CiaA u� Fo �- L) -F Z gvILLIJ1G E1•�D TZI%'1 167.7' ZC0.g EVAT O mac. &,pG ZZI,03 _ Ov-T- S,T^ I =ZZo,Ds- Top P C, =ZZ I los' I ki D - Box = Z 3 (Z J 007- D- Bc< = Z 3 5,3s r+l© Tt2.# I =z 3 s. oZ I L, -Z ItZ-Z33, 35 EkJt� 7-e4Z =Z33.10 a `" APPRox28�0 FEET To JO%4QSOfJ 5'iREtl- ( AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN a�r�5_Ri AS PREPARED FOR No316! 6UuyA GoiZPoF-AT(0�-4 ." • DATE: AvUvsT lQ`�9 ` SCALE: i L -©T Z`� �p ��► �� s7 r"(# l ozu TI'`I . I a7- G, Pry e. 7 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 Commonwealth of Massachusetts City/Town of &4 An&>vpA System Pumping Record Facility Information: System Location: RECEIVED '-3 ZU14 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Address N.0(4� &dwm MA- 0IN( City/Town State Zip Code System Owner: Name: Adress (if different from location of pump) City/Town State Zip Code Telephone Number Pumping Record Date of Pumping— / Quantity Pumped /,,, gallons Type of System—.�),_Septic Tank Grease Trap Other (what) System Pumped by: hAl Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843 Location where contents were disposed: lbs Signature of Hauler _ % Q1 1 Date 7� � t5fbrm4.doc• 06103 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 SEP 05 LUQ 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: Left / ght front of house eft / Right 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 Address14 -TU ---- Citylrown State Zip Code 2. System Owner. Name Address (if different from location) l.J City/Town State � 2ip/Code -5— Telephone — 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 No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location w ere contents were disposed: It Waste Water F5821 Vehicle License Number Date System Pumping Recons . Page 1 of 1 � Commonwealth of Massachusetts T City/Town of DECEIVED \ System Pumping Record Form 4 AUG 2010 v WN OF DEP has provided this form for use by local Boards of Health. Other fo UNWHE9T' T information must be, substantially the same as that provided here. Be f ith your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health or-otlae"r approving authority.,,- `° A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hou i ht front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address ' �j City/Town v State 2. System Owner: Name Address (it different from location) City/Town Zip Code Sta72 Code ode Telephone Number B. Pumping Recor 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Other (describe): Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No 5. Con ition f System: � V � 6. System Pumped By.- Neil y:Neil Bateson Name Bateson Enterprises Inc Company 7. Locati contents were disposed: G.L.S.D W 9 LowAVVgaste Water of F5821 Vehicle License Number —�I:--,/ -_l6 Date t5form4.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. OCT - 9 2008 TOWN OF NORTH ANDOVER HEALTH DEPART;,,—NT Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. A. Facility Information 1. System Location: Left front, left rear, left side of hous . Right front, fight rear, right sid of house Address City/Town 2. System Owner: Name Address (if different from location) Cityrrown U State Zip Code Stl� LJ 1 Z*p / Telephone Number B. Pumping Record lj 1. Date of Pumping 2. Quantity Pumped: ` Date Gallons 3. Type of system: Cesspool(s) = eptic Tank Tight Tank 0 Other (describe): 4. Effluent Tee Filter present? 0 Yes 9-140 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: L. Lowell Waste Water of If yes, was it cleaned? 0 Yes 0 No F 5821 Vehicle License Number Date,, -3�v t5form4.doc° 06/03 System Pumping Record • Page 1 of 1 Commonwealth of MassachusettsF�_, O City/Town of 1 System Pumping Record 06 Form 4 CE, ARI ILNT �OVERDEP has provided this form for use by local Boards of Health.: he System Pumping Record must be submitted to the local Board of Health or other approving authority. . . A. Facility Information .Important: When ruing out forms on the 1. System Location: computer, use only the tab key move your cursor do Address - U — � / /✓ U c - not use the return Cityfrown State Zip Code key. 2. System Owner: Name Address (if different from location) Cityf town State iode Telephone Number B. Pumping Record 0-0 1. Date. of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ET Septic Tank ❑ Tight.Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Er No If yes, was it cleaned? El Yes ❑ No 5. Condition of System: r 6. System Pumpe By License Number Name �rc=�/ chicle Company -- . .7. Location ere contents ere osed: r l.� Sign ur f auler Date hftp://www.mass.goyidep/waterlapproval8;/t5forms.htm#inspect t5form4.doc• 06103 System Pumping Record • Page 1 of 1 JUO S, r0WN0FN0RT UA tl �,SYSTEM pUMpl SYSTEM UWNFR ADDRESS yq ZhaoY, load �r�PiK�S1- A), olvw e) ep, M-67 [ANDOvF_p, 0 "CORI) -rF� I(�:txc DATE 0FptjMpjNo: .-.--.....-Q(,JANTTTY PUMPED:- C"ss YES- sop(ic NO NA rURE OF SERVICE: RU 'r F ;MER()hN(,Y C)bSERVA,riom: 000D CONDITJION!�p -ro COVERHEAVY ORWE UCOVER DEC 0 7 2004 BAPFLES IN PLACL "ORTH ANDOVER LBACHFIELD RUNBACK BXCESSIVE SOLIDS DEPARTMENT SOUD CAKRy()V-ER­--- FLOODED ...... OTUER EXPLAIN Pwnpod by :51 h6l, CPO. Z/ 177a. �'UMMENTS. �'uN ItN i's rKANSFtKKBD lb �0,1#1-rx-;- -. - ... 10 . 4 NEW ENGLAND ENGINEERING SERVICES INC August 15, 2002 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 1024 Turnpike Street , North Andover, MA Dear Sirs: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin C. Osgq� 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: /O ;.1( U Rn p' KC :SI ,92012-17Y Ati) Vit' LJE2 AtA Owner's Name: :nY ggwy WDH 1-fti&44::WWAi2.A*A) q Owner's Address: / a a y 7- 2 ✓i Pi a e s71 N'o /LT►d A&j o 6L) E A4 /* Date of Inspection02 Name of Inspector: (please print) , an- Company J 2Company Name: _ N FW Tty&jA1 EL" 2i, 6 - Mailing Address: (oc> )?jz i vC-- ju0ttTly oIRI.15- Telephone Number: q-70 - 6-/ 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: "Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: g— (f ( _ Date:��� c Z The system inspector shall submit a copy of this inspec'{ion report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1024 TURNPIKE STREET NORTH ANDOVER,MA Owner: ��►R-P12RK►�K 1.+41<sH12tl.N�2/1��N� Date of Inspection: 8/15/02 Inspection Summary: CnmK r,,,,,. ,., .,.., , .. . _A of Section D A. System Passes: V 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. SI(stem Conditionally Passes: One more system components as described in the "Conditional Pass" section need to be replaced or repaired. The s em, upon completion of the replacement or repair, as approved by the Board of H , will pass. Answer yes, no or not de ined (Y,N,ND) in the for the following statements. If' of determined" please explain. The septic tank is metal an ver 20 years old* or the septic tank (wh er metal or not) is structurally unsound, exhibits substantial irztrati or exfiltration or tank failure is ' inent. System will pass inspection if the existing tank is replaced with a complyin ptic tank as approved b e Board of Health. *A metal septic tank will pass inspection if i . structurally sour not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old available. ND explain: Observation of sewage backup or br ut or high stth 'c water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, seal or uneven distribut box. System will pass inspection if (with approval of Board of Health): roken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The,jvsftem required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass ins ion if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page! of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1024 TURNPIKE STREET NORTH ANDOVER,MA Owner: T(TI4 F9-0 11 t�► SK M1N I�R�ty/��t// Date of Inspection; 8/15/02 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. stem will pass unless Board of Health determines in accordance with 310 C 303(l)(b) that the em is not functioning in a manner which will protect public health, safetyafid the environment: 1 or privy is within 50 feet of a surface water _ Cessp 1 or privy is within 50 feet of a bordering vegetated wetlan or a salt marsh 2. System will fail unless the rd of Health (and lic Water Supplier, if any) determines that the system is functioning in a manner at protects th ublic health, safety and environment: _ The system has a septic tank an it sorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a s e water supply. — The system has a septic d SAS and a SAS is within a Zone 1 of a public water supply. _ The system has a sept' tank and SAS and the S is within 50 feet of a private water supply well. The system has peptic tank and SAS and the SAS is s than 100 feet but 50 feet or more from a private water sup Dwell**. Method used to determine distan **This Sys passes if the well water analysis, performed at a DE certified laboratory, for coliform bacten d volatile organic compounds indicates that the well is free om pollution from that facility and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to tlu orm. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _ 1024 TURNPIKE STREET NORTH ANDOVER,MA Owner: .moi A'YR P(ZA 1j'AS 1-i L a4llsl livr [ N �42►'+� �^� Date of Inspection: _ 8/15/02 D. System Failure Criteria applicable to all systems: You must indicate ` ves" 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 % day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped V 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. v Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No) 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. Lane Systems: To be co ' ered a large system the system must serve a facility with a design flow of 10 O�pd to 15,000 �• You must indicate ei "yes" or `�o" to each of the following: (The following criteria ap to large systems in addition to the criteriaab6ve) yes no — _ the system is within 400 feet water supply the system is within 200 feet o butary t surface drinking water supply _ the system is 1 m a nitrogen sensitive area (Int Wellhead Protection Area – IWPA) or a mapped Zone II of lic water supply well If you have answered "yes" to any question in Section E the system is consider significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any 1 e system considered a significant threat under Section E or failed under Section D shall upgrade the system in a dance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _ 1024 TURNPIKE STREET NORTH ANDOVER,MA Owner: 0-wy, p fl A V A 5 W 1-+AK-!-� fl.vt tti tl ►tL 6,M viq Date of Inspection: _ 8/15/02 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 ? �l _ 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: Yes ono 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) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _ 1024 TURNPIKE STREET NORTH ANDOVER,MA Owner: TA -j Af (Z 4jJ- + F1 ti�41�•stf M (�v �f 2A�f1i(1�i Date of Inspection: 8/15/02 _._ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): -q— Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): y Number of current residents: Z Does residence have a garbage grinder (yes or no): 1j i D Is laundry on a separate sewage system (yes or no): J [if yes separate inspection required] Laundry system inspected (yes or no): Seasonal use: (yes or no): — Water meter readings, if available (last 2 years usage (gpd)): Sump pump (yes or no): ALIS Last date of occupancy: G a m e AT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): Qnd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): — Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: P Ey EP -- y M t jl Was system pumped as part of the inspection (yes or 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: Were sewage odors detected when arriving at the site (yes or no): _1 0 Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1024 TURNPIKE STREET NORTH ANDOVEF MA Owner: SPrl#4PL-O"HA4(Aj4aALJ)4A) Date of Inspection: 8/15/02 BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: _cast iron V/4 - eO PVC _other (explain): Distance from private water supply well or uction line: Comments (on condition of joints, venting, evidence of leakage, etc.): P ( P9 AJ /I F -w C a ✓1 D )-�j 6✓1 10 805 0 ✓,1 i /t1 l SEPTIC TANK: _ (locate on site plan) Depth below grade: I Z. Material of construction: vconcrete — — metal fiberglass _polyethylene —other(explain) If tank is metal list age: — Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 1.5-o o C, -fl r, t,a t'j S Sludge depth: _ 2j, Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Z "` Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: c i7C. I< Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): AJ G-oo 6c7Y7 b 1-170/) I ,SC 14 L4 L) ►70C TCG l ti �?C7J7 (QfN D1710 \ GREASE TRAP: A(locate on site plan) Depth below grade: — 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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYCTF.M INFORMATION (continued) 1024 TURNPIKE STREET Property Address: _ NORTH ANDOVER,MA .�"�IYA-'PR�I�,tA-sH >.�ksH�u�n�fldt►y'�9ti�q Owner: 8/15/02STRONG Date of Inspection: _ 8/9/02 TIGHT or HOLDING TANK: &A (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/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Qit_ 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.): w f k-.*> MOL7)(')A. F7U10G1-3GF of L-F4ik►4Ge 1 A n/Z ), PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): A e s Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): &ALP A -ND TA -/-,)L , %:)J14, 4Il.. Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 1024 TURNPIKE STREET NORTH ANDOVER,MA Owner: �'Ytf fzi4K14 S R 6 -Al --S kM(1v#(Z/4 j,�N Yt Date of Inspection: ` 8/15/02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: ✓ leaching trenches, number, length: Z `i w E X 18 b E P X S 7' 1- a n G- i r'e'p c hli 5 leaching fields, number, dimensions: overflow cesspool, number: innovativetalternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): iR-2.Er4 bF f—I67 CESSPOOLS: A44 (cesspool must be pumped as part of inspectionXlocate 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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY 'jVj,�- (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.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 1024 TURNPIKE STREET NORTH ANDOVEF MA Owner: �'"!9t%j9TM Kt95ff 4.14KSX1WtN,10?PWfi Date of Inspection:. 8/15/02 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. ST Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ Owner: Date of Inspection: _ SITE EXAM Slope Surface water Check cellar Shallow wells 1024 TURNPIKE STREET NORTH ANDOVER MA ��7►� PIz � � �s K 8/15/02 Estimated depth to ground water tf feet �,KU:sHM irvV1(Ltyiwf� Please indicate (check) all methods used to determine the high ground water elevation: _* Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of 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: 5 ti sl t r+n D £s, Wy E OL} ' f 60,)E C lLZ�,j N P w A --j 12 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508) 475-3555, 373-5721 • FAX (508) 475-1448 May 23, 1995 Ms. Sandy Starr Health Inspector Town of North Andover Town Hall 120 Main Street North Andover, MA 01845 RE: Gunya Corp. Route 114, North Andover Dear Ms. Starr: Enclosed is a copy of the transmittal and easement recorded by Attorney Waldron at the site. Please contact me should you have questions or comments. cd Enclosure G SERVICES � w; M�+`r'-22-1995 13 57 REGISTRY ESSEX NORTH DECLARATION OF EASEMENT P. 02 Cunya Corporation, at Maine corporation hereby declares an easement in the following described premises in North Andover, County of Essex, commonwealth of Massachusetts: Beginning at the southwest corner of lot #2, at the south- east corner of lot #1, at a point on the northerly sideline of Turnpike street, Route 114, at the lot corner between lot #1 and lot #2 running N 46° - 43'-41"W 30,50' along the northerly sideline of Route 114, thence Northeasterly 82.00' across lot #1 to a point, thence Easterly 40.00' across lot #1 to a point on the division line between #1 and 42 thence 5 450 -51'-05"W 105.47 along lot #2 to a point on the northerly sideline of Route 114 said point being the point of beginning. said premises are shown on a plan entitled "Plan of Land in North Andover, Massachusetts for Gunya Corporation", March 1994 by Merrimack Engineering services. Said easement is for the benefit of Lot 2 on said plan and shall consist of the right to place and maintain, fill and to construct and maintain slopes all for the construction of a subsurface disposal system on lot 1 on said plan. Executed as a sealed instrument May % 91995. Gunya Corporation by i s resident an Treasurer . kvdkn B M/ ..`. '95 05/23 10:11 h1HT- ?-1995 13:58 REGISTRY ESSEY NORTH 503377,6746 JAMES F WALDRON 03 P.03 COMMONWEALTH OF MASSACHUSETTS Essex, $a. May 1995 Then personally appeared the above named President and Treasurer and acknowl ged the foregoing instrument to be the free act and deed of to Gunya Corporation, before me, otary Public Y commission pir s: FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant.fills out this section***************** 53�3 -�iiZ APPLICANT: l ,yC zt, Phone S3 Y- � LOCATION: Assessor's Map Number Parcel 7 Subdivision ��1� Lot(s) _Z__ Street -57- St. Number1 ��Z� ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspe/c�toor-Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works --sewerfxaater connections M - driveway permit SSve `i -5 Fire Department Received by Building Inspector Date APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:CURRENT INSTALLER'S LICENSE# r - LOCATION: LICENSED INSTALLER: �_iC� SIGNATURE: c�-/ ��� TELEPHONE# CHE REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No I� Foundation As -Built? Yes�� No Floor Plans? Yes V No Approval Date: TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 12/1/99 This is to certify that the individual subsurface disposal system constructed ( X ) or repaired ( ) by John Carr at 1024 Turnpike Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector BOARD OF HEALTH 146 MAIN STREET TEL. 688-9 540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 14-3 _90 APR; 6 LOCATION OF SOIL TESTS: 1-6 —1-S 7 3 Tuiz.�piK_E Assessor's map & parcel number: OWNER: (ay�_iVA eopP, TEL. NO.: Zo7-q3y-7 22 ADDRESS: l q £3 SA Co AVE - O&D aG•�HA 2D 985FlC.14 ti tE ENGINEER: 1-a5¢¢ HAcE_' E_u6Z, TEL. NO.: CERTIFIED SOIL EVALUATOR: LAL-/,(A1-1 Dyr25'9�jf_:� Intended use of land: residential subdivision, single family home, commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 515F- APPRu✓E RcAWS du EiLe- Of &D -I-1 , 3. Fee of $175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH Q� °y ED o%�%�%L 1� 19 PCZ e L Z� APPLICATION FOR SITE TESTING/INSPECTION Applicant (� U lam' y19 L�6'rP' NAME ADDRESS TELEPHONE Site Location D / 0,e/2f /,eC Engineer_ /"d 1^4C4 - NAME ADDRESS TELEPHONE Test/Inspection Date and Time Ind X 9715 I M 9'.'e � CHAIRMAN, BOARD OF HEALTH Fee�j7� Test No. �� S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD 'OF HEALTH _ L, g T APPLICATION FOR SITE TESTING/INSPECTION Applica Site Location -40J 2 Engineer �ff-1 14CA- NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee /� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover NORTH OFFICE OF i+ 04 , a o e 6 COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9SSAGNUS�� Director April 10, 1997 Mr. King Weinstein Gunya Corporation 32 Saco Ave. Old Orchard Beach, ME 04644 Fax# (207) 934-1566 Dear Mr. Weinstein: This letter concerns Lots 2 & 3 Turnpike Street, North Andover and the recent problems concerning contaminated fill placed on the lots. I have been by these lots and have observed the stockpiles of fill and brush and apparent excavation over various areas of the lots. Much of this activity appears to be in the areas of the proposed septic systems. Because of this, the approvals for proposed septic systems have been suspended until the Design Engineer has located all stockpiles, brushpiles and changes in elevations and submitted them overlaid on septic plans to the Board of Health. Please note that if there has seen sufficient deformation of the site the septic approvals may be withdrawn. Please call the office if you have any questions. Sincerely, Sandra Starr, R.S., Health Administrator S S/cjp cc: Michael Howard, Conservation Admin. Wm. Scott, Director, P&CD BOH File BOARD OF APPEALS 688-9541._ BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover, iviassachusetts BOARD OF HEALTH z -:_DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant "-q Q �Test No. O _rl—) Site Location Z --61' /' Reference Plans and Specs.i/ji�/� ENGINEER DESIGN C DATE Permission is granted for an individual soil absoprtion sewage disposal system to be installed in accordance with regulations of the State and the Board of Health. BOARD OF HEALTH Fee Site System Permit No. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 30 School Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT' Director Merrimack Engineering 66 Park Street Andover, MA 01801 RE: Lots 2 and 3 Turnpike Street Dear Mr. Godin: July 24, 1998 This is to inform you that the proposed plans for the sites referenced above have been disapproved for the reasons below. 1. No deed references are shown on either plan. 15.220(3) 2. Plans do not contain designer's certification statement. 3. Basement floors appear to be less than 1' above groundwater elevation. NA 5.04 4. Bouyancy calcs for septic tanks missing. 15.221(8) 5. No compaction of soil fill under D -boxes specified. 15.221(2) 6. No stone specified beneath D -boxes. 15.221(2) 7. Pipe from D -boxes not specified level for first two feet. 15.232(3) 8. Pump performance curves not provided for pump chambers. 15.220(4)(r) 9. Bouyancy calcs not provided for chambers. 15.221(8)(a) 10. On Lot 3 fill area extends over property line. Slope easement specified but not shown. 15.255(2) Please be aware that all revision submittals must be accompanied with a $45.00 fee. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator CONSERVATION - (978) 688 9530 - HEALTH - (978) 688-9540 - PLANNING - (978) 688-9535 I *BUILDINGOFFICE - (978) 688-9545 0 *ZONING BOARD OF APPEALS - (978) 688-9541 - *146 MAIN STREET Jul -23-98 09:52A Paul D. Tut -bide, PE/PLS 508-465-0313 P.02 • July 23, 1998 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for Lot 2 Turnpike Street Dear Sandra, Enclosed find the "Checklist for North Andover Septic System Plane' for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. General Information • No deed references are shown on the plan. 220(3) • Plan does not contain designer's certification statement. • Basement floor appears to be less than F above groundwater elevation. NA 5.04 Septic Tank • Buoyancy talcs have not been provided. 221(8) Distribution Box • No soil compaction of fill is specified below d -box. 221(2) • No stone is specified beneath the d -box. 221(2) • Sewer is not laid level for first two feet. 232(3) (c) Pump Chamber T• Pump performance curves have not been provided. 220(4)(r) • Buoyancy talcs have not been provided. 221(8)(a) PORT Leaching Faciit I lity ENGINEERING ° No orifice size is specified for the system. 251(8) If you have any questions or comments please feel free to contact us. Civil Engineers & Land Surveyors Sincerely One Harris Street Newburyport, MA 2 01950 (978) 465-8594 Carlton A_ Brown, P LS SEPTIC PLAN SUBMITTALS LOCATION: U!Jl 2 I uy-j'xPI l— 107-L , 71 -Z- NEW NEW PLANS: REVISED PLANS: YES DATE: -7-(-10 $125.00/Plan $ 45.00/Plan DESIGN ENGINEER: P'1�11 M AGIL 1G� G 1 cb=-PBZ) �-c L� S'F(ZyrS DATE TO CONSULTANT: �/� 7 A7 IS When the submission is all in place, route to the Health Secretary 711& L FORM 11 - SOIL EVALUATOR FORNI Page 1 Date .6—.0-10 ... Commonwealth of Massachusetts I.I09rH AkIDOVC2 , Massachusetts I . ..LEs.......6.ab.1.w....................................................... Performed By: . 5...:. 7..-..9.8 ...... Witnessed By Sf1:1,J.�lA'AR.f _. .:.:.::..::.:.....:.:::...::..v .................. :............................................................................................................................... LbMim Addrow or '•°" '.-rV?,KJ P1 Ke STTOr—T' fbeno" or- T• M . K I o`1 -C PAR- *(3 New Construction ($I Repair ❑ Office Review ow—•.'b—' GvuyA COZPWA11 of l Adds:. ad Q Tckphm / NO SACo AWE ftb Oli'C.FFARZ 13EAe.H , HM Published Soil Survey Available: No ❑ Yes � Year Published .x.9..1...... Publication Scale +..l.. �l0 Soil Map Unit ... .. Drainage Class ...4�...... Soil Limitations........3Z.V............................:.........X,I�.i,d.......... Surficial Geologic Report Available: No Yes ❑ Year Published Publication Scale .................. GeologicMaterial (Map Unit) ............................................................................................................................................ Landform..................-........................................................................................................................................................................... Flood Insurance Rate Map: .*� ZSZ)o qJ3 000 0 C' Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ® Yes ❑ Within 100 year flood boundary No © Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ......<? .....!.TE......DU!Tod( ............................ Wetlands Conservancy Program Map (map unit)........ ....................................................................... Current Water Resource Conditions (USGS): Month Range : Above Normal ❑ rmal ® ZA SSuM D) Below Normal ❑ Other References Reviewed: U. !�S. HAn *I FORM i1 - SOEL EVALUATOR FORM Page 2 On-site Review Deep Hole Number ..I..r. ..... Date: =.Z..Z.'4$ Time: .. •. Weatherp........�uAJ.ilt.�r/. Location(identify on site plan) .... ice..... :94f................................................................................................................................... Land Use S'!J.l. .FR.t .,.... ........ Slope M...1...0........ Surface Stones.....1'%.H..uy(.........:......................................:....... Vegetation ..........f2 at ......�l,1.�t.ct� ....fou. 7 �.......... ..1........ . AGi .....GCS. fZ�,..................................................... Landform....bZV.MG.cL1......................................................................................................................................................................................................... Position on landscape (sketch -on the back) ......110-C ................................................................................................................... Distances from: Open Water Body feet Drainage way. -R..... feet Possible Wet Area 1.Q..4. +.. feet Property Line ...1a.t... feet Drinking Water Well UTA...... feet Other ......................................... DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) Ap ?6;'— -70" �( Co• Z.SYSi(, �.5V2s�g Mnsslvt', V,FerH Sri%�%l�3 qe�"- !2Z" eZ c. 2,Sysl6 Iv a 6mv S-Coaas Parent Material (geologic) .... `i. ......�a. .C..�.+( .........T1..4 L .............................. Depth to Bedrock: .I/i............... Depth to Groundwater: Standing Water in the Hole: Weeping Weeping from Pit Face: ..r..t' Estimated Seasonal High Ground Water:��, Sri' • FORM 11 - SOEL EVALUATOR FORM Page 3 Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ................... inches ® Depth to soil mottles 2*-f.-4Zo inches ❑ Ground water adjustment feet Index Well Number ..."" Reading Date ........... Index well level .......-...... Adjustment factor .......... Adjusted ground water level ........... ...:.::...::.:................................ Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 4-340-W3 (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 " � Signature Date 6--8-18 LOT Z FORNZ 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Ko??T AksDo�2.,_1 , Massachusetts Percolation Test Date:... -..7....- r .v Time:....... t.M..,......... Observation Hole # P, Depth of Perc Z(p f7— Start ZStart Pre-soak 1D= 26 End Pre-soak Time at 12"� 1®= S =Time 9" Time at 6" Time �9"-6"1 Rate Min./Inch 1'2 - Site Passed 2Q Site Failed ❑ Performed By: �� �0 L) I � Witnessed By: ?,yA`/ RO-NbL, o Comments:..... ...... PtAm...... az...."i.51"5............ ............ ...................................... MERRII ACK ENGINEERING SERVICES INC. Engineers • Surveyors a Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (508) 475.3555 Fax (508) 475-144; TO --r �'Al_.cD2t� �>a2f -L 90 Il 21) HrA (_114 of= )..f UV 1 4 A )-iL-w\r rrt WE ARE SENDING YOU ❑ Shop drawing ❑ Copy of letter DATE J J I[ DA JOB NO. ATTENTION RE: t J go1( y lJL 14 , � ❑ Attached ❑ Under separate cover via the Ilowi items: s ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DA NO. DESCRIPTION -TSE{ ! J go1( y THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO ,�— SIGNED: _' If enclosures are not as noted, kindly notify us at once. MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (508) 475-3555 Fax (508) 475-1448 TO _QA >LcDrzA &--7+M Soli .f-, Or HerACTN 17 c.?aJ Piz M0M Au00'Ce'2 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ L IEVVIM fil W DATE 6-g3-. g3' it DATE JOB NO. ATTENTIONS ^ RE: (U S-17 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Approved as noted ❑ Submit copies for distribution ❑ Returned for corrections ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: `-'4-- 5, C.�iCi�� If enclosures are not as noted, kindly notify us at once. No........... FORM 11 - SOILI EVALUATOR FORM Page 1 -. .. .R8. Date.. .. Commonwealth of Massachusetts ICOM AkLWVE7iz , Massachusetts PerformedBy: .4451-.S......... ..P... .1.!1........................................................ witnessedBy:... 1.11 .::::..:::: 7?+:i l.::.::..::::::::::.:.::...::,:.::.:.::::.:::.::........�......::..................:::..::............:«: ......................................................................................................................... oniian Addren a OwKr's ' 40#4YA Coeft�Ti o N Nd&=. ow tar 3 SaMPI Kms- sll rem r 19S SAGO AVE . OC,D oecj4AM 131FAc14, t1a. Po you oF' Y:t-a"�io?-e P�Q.'*8 Oiio6q New construction K Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes M Year Published 1q.61 .... Publication Scale .[-A.040 Soil Map nit ......6.. F Drainage Class ...0........ Soil Limitations ... �1�vt<I?.�......................................... ...............R �c :�Q.!�t ....... Surficial Geologic Report Available: No ❑ Yes ❑ Year Published ..~7771 Publication Scale ... '....... GeologicMaterial (Map Unit) .......---.................................................................................................................................... Landform .....-.............................................................................. ....................................................................;....................................... . Flood Insurance Rate Map: 4- ZSiZg6 COOO C Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ® Yes ❑ Within 100 year flood boundary No ® Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ........ ........TZ.4dOu ..4 ................ Wetlands Conservancy Program Map (map unit) ..... ....................................................................... Current Water Resource Conditions (USGS): Month HAY. aS Range : Above Normal ❑ Normal © Below Normal ❑ (ASSvme-D) Other References Reviewed: U-Sz Ci S t -MPS, LcT3 *1 Wz FORM 11 - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number I.4.2..... Oate:'..7.-98 Time: .!'!F r. r Weather 70,..... sv�y. Location(identify on site plan)........T4�.....SL4.�...............................................................................................................................✓.... Land Use .. 111ICa....FAr .,... ....... Slope (%) ....IG....... Surface Stones....MA.)J\/.............::............................................. Vegetation... C -464W .. ......... ...U..X1.01W,,......�o.m.s.T)..............................:..............................:.....................................:..................................... Landform....... WW t- I..44. . ....................................................................................................................................................................................................... Position on landscape (sketch.on the back)..........i..................................................................................................................... Distances from: Open Water Body ....iPPf feet Drainage way.... feet Possible Wet Area ...IOO t feet Property Line ....i'Q..t.. feet Drinking Water Well .u1R..... feet Other ......................................... DEEP OBSERVATION HOLE LOU Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) t7"-12" lul -- �vrFi►c s-r2rPPr~� SAuOy 'Z,sYsly 7-5-'406 nAssM5, F,R!Irl ).-OA h'( SY 41 Z ?oars QF Aja /4r 4Auuy l4Af'1 aG Ill" TS of PIA SkAby LOAM QU-60 -- 'Fi LZ. -- - _ STR u'► E it iGt,Ep iJF-fT>y of 06L VA9 iE'S 7Sya Oil VIAsrkVit S V, FWAOU-- SAUD SY(10( 3 A A� �' 5�� �y�� 1 0 r1A ss ► veM A ac6 , Parent Material (geologic) ......< 4444.# ...... L. ..... ! . ........................... Depth to Bedrock: ut.>Ai.............. Depth to Groundwater: Standing Water in the Hole --K.... Weeping from Pit Face: 'Ko..r... 6C) Estimated Seasonal High Ground Water: C.cT' 3 FORM 11 - SOIL EVALUATOR FORM Page 3 -0 M .0 1M.NW, 411»11111�11���=�� Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ................... inches 56 Depth to soil mottles tZ.4.5Z inches ❑ Ground water adjustment feet Index Well Number ... Reading Date Index well level ................... Adjustment factor ........ Adjusted .ground water level ........................................................ Del2th of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? "IC -5S If not, what is the depth of naturally occurring pervious material? Certification I certify that on 4-30-q6 (dates 1 have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date FORDS 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS NoM Kksoov6Z Massachusetts Percolation Test Date: Time: ........ Observation Hole Depth of Perc Start Pre-soak Z7 End Pre-soak ---------- Time at 12" Time at 9" Time at 6" 14 Time (9,,-611) 1 1 I Rate Min./Inch I 1z MIS. 1ki 1 —1 Site Passed Site Failed ❑ . ..... ......................................................................................................... ....................... Performed By: 65 S 6 ON Witnessed By: Fub\L- Comments: lr�2 FORM 11 - SOIL EVALUATOR Form Page 1 Date...6..-.8.1..5...... Commonwealth of Massachusetts WIZTH AUDoVC(z , Massachusetts PerformedBy:....L .......6.40I.N.................... :.................................. ...5...:. 7-1.5 witnessed By: ....... ..:.::..::...:..:...::::..:..v:.......:.Y:�.:.....��.....:...........:.......::: pim Addmu a �°` r 2 "f'vRN Pt Ke STPOii=T Pbenow of T.M.4101-1d PAR -W$ New construction ® Repair ❑ Office Review Owwra A&kU. W GvuYA coePaexnoi4 r� r 19O SACo AWE . Ol,b 02GµARi, 13EACH . HM Published Soil Survey Available: No ❑ Yes M Year Published .x.9.1 .1...... Publication Scale CI.1.,SL"'O Drainage Class ....C....... Soil Limitations ........UN .......... Surficial Geologic Report Available: No ❑ Yes ❑ Year Published ... Publication Scale Geologic Material (Map Unit) ............................................................... Landform ................. .................. ........................................................................ . Flood Insurance Rate Map: * ?goo Rg oqo P-3 G Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ® Yes t Soil Map Unit ... :b &v ....................... . El Within 100 year flood boundary No © Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ...... Ok4...... !.TE...... ? 1-! Tod,( ............................ Wetlands Conservancy Program Map (map unit) .........- Current Water Resource Conditions (USGS): Month Range : Above Normal ❑rmal ® Below Normal ❑ (A sgum A Other References Reviewed: MAPS t4T'Z r *` FORM 11 - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number ..... Date:.!! 7V -`i8 Time:A.!.� ... Weather 7 .....�QAJ.!lt.�/. Location(identify on site plan) ...... 4° ......I.Tbp ................................................................................................................................... Land Use ZAk4A. FA.H...... :........ Slope M\...1.G...... Surface Stones ..... f%H..u"�/) ..................................................... l .... DGi ..... 2�t...................................................... Vegetation ...W!!.ill?......��1:�cuJ�...v,tc.7:....................�. Landform....QPWM.(..1.�1.......................................................................................................................................................................................................... Position on landscape lsketch.on the back) ..........196 ........................................................................................................ ........... Distances from: Open Water Body JP .:t.. feet Drainage way.. ..*... feet Possible Wet Area l.Q..o.. feet Property Line ...1.t... feet Drinking Water Well 1,Ltli....... feet Other ......................................... DEEP OBSERVATION HOLE LOU Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Strus ona Goullders, Cons tenc i� , Oto 0 Ap ZCo"— °78'' G( C.� � � Z.SYs/G ?.sY2s�g 1•-inssl.�r', vFQ�n 5`r�13 N 2G" 2o'/a D 4 2 L4.Z Ar S�"—(off" Bw F:S,L . foylZyl� Z,sy�� 6Z("- 98" L, 5, Z,S\/Sj(, e- lP" HAsS�vff, F21ASLe- �$` ' ►2Z" eZ �.�C, 2,SYSf 6 Iv/o &Mv. �'tv6Z3s Parent Material (geologic) .... ...... T(.. L.. ................................ Depth to Bedrock:.f A................ Death to Groundwater: Standing Water in the Hole: IZA... 1.2 Weeping from Pit Face: +.. Estimated Seasonal High Ground Water: �.., . Lo -r z FORM 11 - SOIL EVALUATOR FORM Page 3 Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole ................... inches ® Depth to soil mottles inches ❑ Ground water adjustment feet Index Well Number...---. Reading Date ........... Index well level .......-..... Adjustment, factor ......¢:-..... Adjusted ground water level ..............s............................... Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 4 -3a -R3 (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature a�Date FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS W?1V AijDoVr!Z Massachusetts Percolation Test Date:... Time: ...... ............ Observation Hole # Depth of Perc Pre-soak StartPr 10- 26 EStart End Pre-soak Time at 12" Time at 9" Time at 6" 7 Time (9"-6") Rate Min./inch Site Passed Site Failed El , "0' � - , ...... . . .................................................................................... I ................... Performed BY: L-5-5 60b16 0 Witnessed By: ?L)hq I Comments: .1z -M-5.rs .. ... ........... ............. ................ .j.!.j!: . ....... PtA.M a> e .......... SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: $125.00/Plan REVISED PLANS:YES $ 45.00/Plan r G (: SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGINEER: DATE TO CONSULTANT: 71191 When the submission is all in place, route to the Health Secretary e ti Town of North Andover NORTH OFFICE OF Q ., o ti �' * 0 COMMUNITY DEVELOPMENT AND SERVICES 3� p 30 School Street ° North Andover. Massachusetts 018-4 WILLIAM J. SCOTT Director August 3, 1998 Merrimack Engineering 66 Park Street Andover, MA 01801 RE: Lots 2 and 3 Turnpike Street Dear Mr. Godin: This is to inform you that the proposed plans for the sites referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Aug -03-98 08:06A Paul D. Tui -bide, PE/PLS 508-465-0313 P.03 .e •- I August 3, 1998 Sandra Stan: North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for Lot 3 Turnpike Street Dear Sandra, We find that the most recently submitted plans for Lot 3 Turnpike Street by Merrimack Engineering Services have been corrected of the problems outlined in our previously submitted checklist. If you have any questions or comments please feel free to contact us. Sincerely /yam Com" Carlton A. Brown, PE/PLS Civil Engineers & Land Surveyors One Harris Street Newburyport, MIA 01950 (978)465-8594 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET -ANDOVER, MASSACHUSETTS 01810 -TEL (978) 475-3555,373-5721 - FAX (978) 475-1448 - E-MAIL: merreng@aol.com Ms. Sandra Starr Board of Health Town of North Andover 120 Main Street North Andover, MA 01845 RE: Lot 2 Turnpike Street Dear Sandy: July 28, 1998 �' f ?i -7 JUL 2 g In response to the Title V review performed by Port Engineering for the subject septic system design, I enclose three (3) sets of plans revised as follows: • Deed reference (Note #8). • Soil evaluation certification added. • Calculations shown for groundwater elevation and building. Cellar floor elevation adjusted. • Buoyancy calculations are enclosed for septic tank. • Compaction of fill and crushed stone specified beneath D -box. • Note added to profile specifying first two feet of pipes out of D -box to be level. • Pump performance curves are enclosed. • Buoyancy calculations are enclosed for pump chamber. • Orifice size for perforated piping is specified (Note #2). Please process this information and feel free to contact me should you have any questions or comments. Very truly yours, MERRIMACK ENGINEERING SERVICES r Les Godin Project Manager cd LE50=SERIES PUMP The pump(s) shall be model as manufactured by Liberty Pumps, Bergen, NY, or equal. The pump(s) shall have a capacity of GPM at a total dynamic head of feet. Motor size shall be 1/2 horsepower, single phase, 60 hz. and volt operation. ' ►ITI�S%1� The pump motor shall be of the submersible type, oil filled, hermetically sealed and shall be thermally protected. The overload element shall automatically reset when motor cools. Motor windings shall be of the class B insulation rating. The rotor shaft shall be made of 416 stainless steel and shall be supported by lower bronze and upper sleeve bearings. The power cord shall be of the quick -disconnect design allowing replacement of the cord without breaking seals to the motor and/or oil chamber. TECHNICAL SPECIFICATIONS IMPELLER The pump shall have a 2 -vane semi -open impeller capable of passing a minimum 2" spherical solid. SEAL The shaft seal shall be of the carbon/ceramic unitized design, with BONA N elastpmers and stainless housings. EXTERNAL CONSTRUCTION The pump volute, legs and motor housing shall be heavy gray iron castings, class 25 or better. All castings shall be enamel coated before assembly. All fasteners shall be of 300 -series stainless steel or brass. LEVEL CONTROL The pump shall be controlled by an adjustable, mercury -free, wide angle float switch. Float cord shall be equipped with a series plug for manual by-pass operation. DIMENSIONAL DATA: Weight: LE51 M: 39 LBS. Height: 12.75" Major Width: 10.75" (manual models) Maximum fluid temperature 140 degrees F. ZS &Rm G Zz ' TD.H PNIA ca -Certified City of LA certification available rcreee PERFORMANCE CURVE , 28 8 E6 m m 4 x m 12 2 0 24 20 m S 16 m = 12 m Y H 8 4 1725 RPM 0 20 40 60 80 100 120 140 U.S. Gallons Per Minute 0 2.1 4.2 6.3 8.4 Liters Per Second Liberty Pumps • 7307 Lake Rd • Bergen, New York 14416 • Phone (716)..494-1B17 Fax (716) 494-1839 7241-82/93 JL MODELS HP VOLTS PHASE AMPS DISCHARGE AUTOMATIC IMPELLER LE51 M 1/2 115 1 13 2" FNPT NO 2 -VANE SEMI -OPEN,. LE51A 1/2 115 1 13 2" FNPT YES 2 -VANE SEMI -OPEN LE52M 1/2 230 1 6.8 2" FNPT NO 2 -VANE SEMI -OPEN LE52A 1/2 230 1 6.8 2" FNPT YES 2 -VANE SEMI OPEN 10' cord standard on above models. For 20' option, add a "-2" suffix to model pumber. Example: LE51 A-2 DIMENSIONAL DATA: Weight: LE51 M: 39 LBS. Height: 12.75" Major Width: 10.75" (manual models) Maximum fluid temperature 140 degrees F. ZS &Rm G Zz ' TD.H PNIA ca -Certified City of LA certification available rcreee PERFORMANCE CURVE , 28 8 E6 m m 4 x m 12 2 0 24 20 m S 16 m = 12 m Y H 8 4 1725 RPM 0 20 40 60 80 100 120 140 U.S. Gallons Per Minute 0 2.1 4.2 6.3 8.4 Liters Per Second Liberty Pumps • 7307 Lake Rd • Bergen, New York 14416 • Phone (716)..494-1B17 Fax (716) 494-1839 7241-82/93 JL il Tuywp1 A'.r. STTtreor I ?L'o,qAj4c,Y dALeuLAT-iam X02 IS�ev 6AL. Sr' Tie TA wAt�72 W1516 4 T of Tilde— f�tler-( _ Tod' = b.�x wax io' &T- = 0,3 :S';( 4 X t o 91 oes = 0.3 X 14,67 x to' oS = 0.33x 4-67'xS,33 B077= e•{ " Tv P= Co " 4JA L� s = 14 3o c. F. '73 , ti c- F . x 13 0 Fib" = Vo tF TA wKTi5fL llilS X ._... .. _�!�FC w, T" 95L, I-98wAF�t F—Su lG RA M 02I6-4u4L C,ttn.oE 222,0 q,ol 'BoT- '9).c4- _ 0'x10 1ZdC,F SLJONA L� i 'F -ACC- = IZO e_F, x 6z,s pV Px�R.o�,u (eov�� ovIFf2 TNJ V) '� ' � X 6'Y, ID) 60 <5. F o C. F. x 130' le, F = —7 000 1 4- -7 S; -o D"F-(f --------------- WO FAUAS-r WQu�D tK'o'qAuG'-( C4ALCuWT lams F02 L/A PF7& _ &Z , -�- # /C. Com c m = I3f) C F� t.J15 i G 1+ 1 Of T IG f5t--t pT% Top= 6.5 x logx to St Oes = o. q,67 "x to = 0.33�x �t�G7'xS�33� 13077-2 Lf 11 IV 30 c. r. P Z c. F u F. F Wfave TA aLg:-:� �✓� Vit, = I is " .., ._ iw�� .'�x�s-nuG Gft�oc -y8 '' CTH• _qg oR+liu�C. Gnho�. ZN10 _SoT. 1-6mIc cL x10)_ C � ... '�u13TMe"T- d�IEEZB� R o�Ia (COVF-Z 6VrP- TA IL = 1, D x Iii e r" _ gsgq C • F. x 130 4*1,2 F' 7geo* -- 375-0 (* `70oo 4 X184 Z -I - (, \ d gfl LCA S'T �� i 1 'r'! 3 0 1999 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (✓) constructed; ( ) repaired; by I?cty" eco (foh+r-ac -oy'S 4,4 c4 �n!j sneers located at 'Tq rnf'i ke 5)`ree—t was installed in conformance with the North Andover Board of Health approved plan, System DGUC Design Permit # 1075 , dated NAjeCH 30119 9 9 , with an approved design flow of 144 ® 6pp 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. Installer: �L ���� Lic. #: Date: est' ign Engineer:{C���� Date: ""���� 9 q FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION"******"" APPLICANT U'` %� � PHONE 20 aqS o ®ila7 I v! LOCATION: Assessors Map Number �i jc PARCEL C� k SUBDIVISION STREET LOT (S) jC ST. NUMBER/'_)d USE RECOMMENDAT IONS OF TOWN AGENTS:MaoRA4Arwt .- cS 4 ,S �— 4✓ CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED S SPECP&-gtALTIT DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED SY BUILDING !NSPECTO Revised 919,' jm DATE ll� 091 " 1 I • 143 I O O w O O 5 Z CD Q. O CO) D � Co C C -100 g O 'O o U z w W� z� o 0 /eco W cc d � v. w+ i c O \ w° cn L .o W 7$ Co w° a°' U w U W W ° r w°' v cz cG° w A Q w o M cn cn 091 " 1 I • 143 I O O w O O 5 Z CD Q. O CO) D � Co C C -100 g O 'O o ®_ c ,.. o o 0 /eco W cc C y w+ i c O co ,Uz. ca ev L C D9 O •� cc L O ; O CD N E . 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Tv,e.�PieE ST,e�• T �.E�avTE //4� �S NERE�Y CE.cT/fY 7V Tye T/TGE 1A/S6,eOW, vO 71% 77147 T,vE Lw-,rz41.w /S GACATEG O.V Tii/ELOT.�SSift9iri'.Vq.VDTi:G�T?OGIFS CGLt/FAP.�f lY/TH T//E 7osv�/ D/� .r14,VoovE-At Zewlwa eE6vZ.4.rXW-V .(��I.rDicK sETacicrs F�o�/ sT.PEtTs �` tar t/�t.Es S F!/.�TH GE.rT/FY T.V.IT T.Y/s z 2rLLiv6 /s�vd7, LOG4TED /iS/ T.f�E FEAE.rAG /r[Aop 114Z4.PD APE.4• Syaw.t! o/v Ff.�+-t • a'o.�...y�.v�ry p.�.v« '"� 25-0a 7(9 000eC . •(HOFA/,� JJAT6z) 6/2 93 j E /2 9 AIO #36381 ssi L or //V /t�0 . fy.clDO ✓E.eJ �!� S.S O.PA�/V FO,P 2/, 19916 66 f-4•P,� .ST.rEET �4.t/QOYE.� /:�.4S.S:vGf///SE7TS O/8/O ISI y �I I �,voQ N1-eZ'�S oF- £t�►�eSf b� ZN C w� � fiq �r•S ���, � 0 EoeF a� 06LINEAT$D ,3. I ti qA,' ,! 3 /3 7. 90 L or //V /t�0 . fy.clDO ✓E.eJ �!� S.S O.PA�/V FO,P 2/, 19916 66 f-4•P,� .ST.rEET �4.t/QOYE.� /:�.4S.S:vGf///SE7TS O/8/O Town of North Andover, Massachusetts Form No. 3 NORTH BOARD OF HEALTH ' </ 3r e ° 0 19 L F A oo.�"� DISPOSAL WORKS CONSTRUCTION PERMIT CHUSO- Applicant NAME ADDRESS TELEPHONE Site Location Z—W,— Permission is hereby granted to Construct) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. Fee CHAIRMAN, BOARD OF HEALTH D.W.C. No. i&%_s Issued from: Issued to: Date: Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 VIOLATION NOTICE NORTH ANDOVER CONSERVATION COMMISSION GUNYA CORP./KING WEINSTEIN/C.P.MCDONOUGH/ALL SUBTRACTORS FEBRUARY 27, 1997 D.E.P. No. 242-706 Location/Property- LOT 2 TURNPIKE STREET, N.ANDOVER, MA. 01845 /HORTM SS4CHU50 The North Andover Conservation Commission has determined that the activity described below is in violation of the Massachusetts Wetlands Protection Act. (M.G.L. Ch. 131, Sec. 40) and/or the Town of North Andover Wetlands Protection Bylaw. Extent and Type of Activity: REFER TO ENFORCEMENT ORDER If this violation is not immediately addressed as required below, an Enforcement Order will be issued, which may include a stop work order, which may be followed by legal action. Required Action: REFER TO ENFORCEMENT ORDER Questions concerning this violation notice the North Andover Conservation Office, Town Street, orby ling (508) 688-9530. Signature: 10 should be directed to Hall Annex, 146 Main BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover f HORTN , OFFICE OF 3? O COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WII.LIAM J. SCOTT SSACH S Director Dep# 242-706 FEBRUARY 27, 1997 1. Stockpiled, non -indigenous soils have been sampled, and are considered potentially hazardous materials. (Ex. building debris observed in stockpiles, pipes, bricks) A strange odor was also observed on site. 2. The silt fence was installed improperly and inadequately. Haybales are not staked. 3. There is silt washing down into the resource area, where erosion control should be. (westerly side) 4. As asked in a site inspection conducted on February 11, 1997, wetland flags were not re -flagged. 5. As asked in a site inspection conducted on February 11, 1997, failure to remove original silt fence in resource area. 6. Haybales stop at approximately 218.90 elevation. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 issued by NORTH ANDOVER CONSERVATION Cosffiission ompleted Cl Capplication forms and plans as required by the Act and Regulations shall be filed with the NORTH puiDOVER CONSERVATION COMMISSION (date), on or before erformed until a public hearing has been held and no further work shall be p and as Order of Conditions has been vACCeOfficee late said Application forms arssued tgTown Hall Annex e available awork. - t: prevent further C] The property owner shall take every reasonable step to violations of the act. [� other (specify) NO ACTIVITY IS ALLOWED TO TAKE PLACE ON SITE, PENDING A SITE REVIEW BY THE ENTIRE CONSERVATION COMMISSION AND ANALYSIS OF SOILS. Failure to comply with this order may constitute grounds -for legal action, Massachusetts General Laws Chapter 131, section 40 provides: Whoever violates any. provision of this section shall be punished by a fine of not more than twenty-five thousandbotdollars dayor bor imprisonment for not more than two Years portion thereof of continuing violation shall constitute a separate offense. Questions regarding this Enforcement order should be directed to NACC (signature of delivery person or certified mail number) 9-2b 310 CXR 10.99 DFP Fie Nm 242- 706� P o rm 9 (To be pro idod by DEF) chy,rrawn NORTH ANDOVER AppLiaaat GUNYA CORP./KING WEINSTEIN co=Mortvealth C.P.MCDONOUGH/ALL SUBCONTRACTORS of Massachusetts CEASE.AND DESXS� AWD Enforcemen raer Hassachusetts Wetlands Protection Act, G.L. c. 131, $40 AND UNDER THE TOWN OF NORTH ANDOVER BYLAW, CHAPTER 3, SECTION. 3.5 From NORTH ANDOVER CONSERVATION COMMISSION (NACC) issuing Authority To GUNYA CORPORATION/KING WEINSTEIN/C mcnmmnnaw /AT.T. -jTRrnMTPAr'1PQRS Date of Issuance FEBRUARY 27,1997 Property lot/parcel number, address LOT 2 TURNPIKE STREET, N.ANDOVER, MA 01845 Extent and type of activity: REFER TO ATTACHED LIST The NACC has determined that the activity described above is in violation of the Wetlands Protection Act, G.L. C. 131, $40, and the Regulations promulgated pursuant thereto, 310 c ---P.,10.00, because: Q Said activity has been/is being conducted without a valid order of conditions. [ said activity has been/is being conducted iri violation of an order of conditions.. -.issued to GUNYA CORP/MING WEINSTEIN/C.P.MCDONOUG4 dated 2 27 97 File �nuxber 242- 706 t Condition number(s) ( other (specify) SUSPICIOUS SOILS The NORTH ANDOVER CONSERVATION COMM. hereby orders the following: ® The property owner, his agents, permittees and all others shall immediately cease and desist from further activity affecting the wetland portion of this property. C] Wetland alterations 'resulting from said activity shall be corrected and the site returned to its original condition. Effective 11/10/89 9-1 DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE lG PERMIT # DATE RECEIVEDCS��/ APPLICANT at/iJY/-? ASSESSOR'S MAQ 7C75- ADDRESS 32 1�vE 8cff� 'lt�C6-- PARCEL # `7 LOT. ;a - A-4 r TIT Q�. Form No. 2 Town of North Andover, Massachusetts BOARD OF HEALTH I 19 q v ORT"_�-- p�tJo 3: ......,. 0 ,p P DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM ,SSACHU`'E4 ons •TAO Test No. Applicant �! . Site Location Reference Plans and Specs. U CJI u- V ENGINEER bsorption sewage disposal system to be installed Permission is granted for an individual soil a in accordance with regulations of Board of Health. CHAI1Z�A, ARD OF HEALTH N Site System Permit No.—� — Fee —' 0 BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext23 August 9, 1994 Re: Lot #2 Turnpike Street To Whom it May Concern: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Please specify schedule 40 for forcemain. 2) Relocate water main outside of system area. 3) Where is benchmark on site plan? 4) Please supply record of registered easement from Lot #1. 5) System must be vented. 6) Use DB 6 instead of 3 -hole D -Box. 7) Please add thrust blocks at forcemain bends. If you have any questions, please do not hesitate to call the Board of Health Office at the number above. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp PLAN REVIEW CHECKLIST ADDRESS �L pT a 7U.gMpj LG ST, ENGINEER MC,ejZ,M /9-cr GENERAL / n / 3 COPIES C --/STAMPS/ LOCUS(/ NORTH ARROW SCALE CONTOURS &,--" PROFILE_,/� SECTION 2� BENCHMARK, -j- SOIL & PERC INFO ELEVATIONS ✓ WETS. DISCLAIMER r WELLS & WETLANDS a� WATERSHED?/j/0 DRIVEWAY--�(Elev) WATER LINE FDN DRAIN SCH40 '�^ TESTS CURRENT? SEPTIC TANK / MIN 1500G .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR_ L,,:::-- MANHOLE TO GRADE �� ELEV GW / D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET' 53--L - OUTLET _ 117 ( 2" OR .17 FT) TEE REQ' D',' LEACHING MIN 660 GPD? RESERVE AREA V-' 4' FROM PRIMARY? C---'2% SLOPE7 nice 100' TO WETLANDS01"r3100' TO WELLS L,-� 4' TO S.H.GW C,--, 35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H2O SUPP !/ 4' PERM. SOIL BELOW FACILITY MIN 12" COVER v' FILL? if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/1001) -,� >31COVER?-VENT-- SIDEWALL DIST..2X EFF. W OR D (MIN 61) a/ IS RESERVE BETWEEN TRENCHES?(/ IN FILL?MUST BE 10' MIN -L,--'4" PEA STONE?LC BOT 3�D X LDNGE _�+ SID_ X LDNG q&a = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright O 1993 by S.L. Starr PITS MIN 660 LEACHING MIN 1 (131x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W) xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED PERC RATE FASTER THAN 20M/IN GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE .005? >31COVER-VENT SCH 40 MIN 12" COVER RATE LDG X 660 = ft2/G REQ'D (ft2) LXW = TOTAL DOSING TANKS AND PUMPS DIMENSIONS X X = �Qd �'. PUMP CAPACITY gpm C 613 TD /4 L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE L-,"� ALARM SEP. CIRC. e--*"' GW (Min. 1' below inlet) HWLd%718 LWL2,2/(•�8 CHECK VALVE L�/ BLEEDER HOLE c-� MANUAL OP. SWITCH Copyright 0 1993 by S.L. Start Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Site Location ( .D -T— -W Engineer Test/Inspection Date and Time Fee L� CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 N0RBOARD OF HEALTH off 1 SLED i64 tiO C •Y 1 • / ) 19 CO ^o \Ao. Ew,oa APPLICATION FOR SITE TESTING/INSPECTION Applicant:' --[— NAME ADDRESS TELEPHONE Site Location a� i� s r -=�•L'`/� �r Engineer NAME ADDRESS iTELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508) 475-3555, 373-5721 • FAX (508) 475-1448 June 13, 1994 Town of North Andover Board of Health Town Hall 120 Main Street North Andover, MA 01845 RE: Lot 2 - Turnpike Street (Rte. 114) Gunya Corporation Dear Members of the Board: On behalf of our client, we hereby request a Variance to the North Andover Board of Health Regulations, Section 4.18 - Distances, to allow the future expansion area of the septic system to be 92 feet from the wetland, instead of 100', for the proposed leaching trench disposal system, as shown on the plan entitled "Plan of Subsurface Disposal System in North Andover, Massachusetts, as prepared for Gunya Corporation, 32 Saco Avenue, Old Orchard Beach, Maine 04644, signed and stamped, dated June 10, 1994. Please contact me should you have any questions or comments concerning the above request. Very truly yours, MERRIMACK ENGINEERING SERVICES -(15 �,-ar 4 4RoertC. Daley cd Enclosure cc: King Weinstein PITZY-ll -AJ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: /O.3�j'r TU��/�//1✓i� S'" �..�'$-� d; Owner's Name: Z.N i4U NOV `� 3 2go4 Owner's Address: Date of Inspection: 1/ G TOWN OFr2JRTH ANDc cR P HEALTH UEPARTML4T Name of Inspector: (please print) Company Name: Name: X"014-27*457' F.Uy -EA16 Mailing Address: S'T "14 0/17Z3 Telephone Number: 7 / •SSiO$" CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).- The system: 'Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ter-- Date: The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments IeWIO AF112 e,L" 1z ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1-1 . s ' OFFICIAL INSPECTION FORM --NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A� CERTIFICATION (continued) Property Address: Owner• Date of Inspection: - Inspection Summary: Check A,B,C,I) or E / ALWAYS complete all of Section D A. System Passes: L 11� 1 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: 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 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: 2 . Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART A CERTIFICATION (continued) Property Address: !f27— Owner: f2 —Owner• ' 7,IhIG% Date of Inspection: %/ 6 C. Further Evaluation is Required by the Board of Health://J 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. ' r 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner.which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 W OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /D,? y ;1_y1e...yf//*1/G4 Owner: Date of Inspection: // 9 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 w-* Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ /tlk Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow =--Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 1/ 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 I of a public well. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a. private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Y s/No) he system fails. I have determined that one or more of the above failure criteria exist as e�ed 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: /�//h�tem To be considered a large system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the 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 trapped 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. F Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Zw-HA 9 Date of Inspection: O Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No 2,o"' Pumping information was provided by t e owner, ccupant, or Board of Health t/ Were any of the system components pumped out in the previous two weeks ? v Has the system received normal flows in the previous two week period ? k 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 ? f_ Was the site inspected for signs of break out ? Were all system components, excluding the SAS, located on site ? v _ 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: Yes no 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) [3 10 CMR 15.302(3)(b)] 5 Page6ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 100 �t _% 1Ua/L7Tf- �¢�u4J�i�. Owner: 7 0 Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): _ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): ,3 Number of current residents: Z.- / Does residence have a garbage grinder (yes or no): 4 Is laundry on a separate sewage system (yes or no):[if yes separate inspection required] Laundry system inspected (yes or no): 'Y✓ Seasonal use: (yes or no): W Water meter readings, if avail ble (last 2 years usage (gpd)): Sump pump (yes or no): Last date of occupancy: C(l2/1..�►v1� COMMERCIAUINDUS.TRIAL ,�%�, Type of establishment: Design flow (based on 310 CMR 15.203): _ gpd Basis of design flow (seats/persons/sqft,etc.): Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: GU1 OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: ,57`4 L / A -05-2S Was system pumped as part of the inspection (yes or no): If yes, volume pumped: /UDgallons -- How was quantity pumped determined? Reason for pumping: /ii.Jfr/L�v� /.ol���CT 7Us11 TYPE OF SYSTEM _tic 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: �~rrzs Were sewage odors detected when arriving at the site (yes or no): _ 0 Page 7 of 17 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:7J/llllP/ s%`� ,rro . � �e Owner•-,/�>fffl Date of Inspection: /f BUILDING SEWER (locate onsite plan) Depth below grade: /� 1 Materials of construction: `cast iron L-4'OrPVC _other (explain): Distance. from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): G Glaj� SEPTIC TANK: (locate on site plan) r. r Depth below grade: /6 Material of construction: 4--tIoncrete metal fiberglass polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) , S Dimensions: / ro G c Al%aa A// "e b Sludge depth: ia" Distance from top of; ludge to bottom of outlet tee or baffle: Scum thickness: / Distance from top of Scum to top of outlet tee or baffle: j {� Distance from. bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): GREASE TRAP: _(locate on plan) �(%/• Depth below grade: 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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): bl Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /d;k y Owner: Zjf�¢p Date of Inspection.: 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/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX:- (if present must be opened)(locate on siteP lan) Depth of liquid level above outlet invert: 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.): 0�0 C C," /,r 7OAl PUMP CHAMBER: ' (Locate on site plan) Pumps in working order (yes or no): Y Alarms in working order (yes or no):— Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):. 6 oc�/'--, r r, A-0) I'7061 Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: izw-/Iet "ALII� .sem v Owner: t . 114.0 Date of Inspection: d SOIL ABSORPTION SYSTEM (SAS): locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: gt Z. � . � �a/a-1�p /x/24/9 leaching trenches, number, length: -- G0 '`� 5- a �% leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CESSPOOLS: cesspool must be pumped as part of inspection)(locate on site plan) Number and 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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: %V (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION (continued) Property Address: s-7— Owner: %Owner: `Z.Itfv¢P) Date of Inspection: 12 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 publics water/supply enters the building. C �-e a l l� Q 10 Page 11 oil l -- OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /0 22 V ,7'V12 -X AZA! ( 7 ` Owner: �. Date of Inspection: SITE EXAM Slope Surface water 7 yew' Check cellar Shallow wells >7s�--7 Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: 41' Obtained from system design plans on record - If checked, date of design plan reviewed: 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) ,L'AccessedUSGSdatabase-explain: L -S/9'04-- You must describe how you established the high ground water elevation: `z' F:17_ 4,11 1+,c_ 1` :� I s T --t, f63 F b 5 I T S