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Home My WebLink AboutMiscellaneous - 1030 JOHNSON STREET 4/30/2018 (2)i ti o b 0 =yf�, 2 o z cn z o M. o m (D fi /Page 1 of 1 North Andover Board of Assessors Public Access ,. Parcel ID: 210/107.A-0065-0000.0 SKETCH Click on Sketch to Enlarge Community: North Andover PHOTO No Picture Available Location: 1030L -A JOHNSON STREET Owner Name: MANNING, NEIL C. MANNING, JANET MARIE Owner Address: 1030 JOHNSON STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.02 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2470 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 572,300 535,600 Building Value: 357,000 336,400 Land Value: 215,300 199,200 Market Land Value: 215,300 Chapter Land Value: LATESTSALE Sale Price: 540,000 Sale Date: 05/22/2003 Arms Length Sale Code: Y -YES -VALID Grantor: PEARSON, DONALD A. Cert Doc: Book: 7825 Page: 286 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&LinkId=809283 11/20/2006 Lot & Street Map/Parcel 11) % CONSTRUCTION APPROVAL Has plan review fee been paid: ES NO Plan Approval: Date: /Z Designer:_ A) Conditions: Water Supply:, Town Well Well Permit: Driller: Permit# Approved by: Plan Date: ll A Well Tests: Chemical 'Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign -Off: Comments: Form "U" Approval Date Issued Conditions: Final Approval: Wiring Sign -off: Approval to Issue By:_ YES NO All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? (::_- LSD NO Type of Construction: New Construction: Certified Plot Plan Review NEW YES EPAIR 0 Floor Plan Review YES NO Conditions of Approval from Form U Issuance of DWC permit: YES YES NO NO DWC Permit Paid? YES NO DWC Permit # Installer: Begin Inspection: YES NO Excavation In ection- _ Needed: - L Passed: By:� Construction Inspection: Needed: As Built Plan Satisfactory: YES: D Approval of Backfill: Date: By: Final Grading Approval: Date: << By: Final Construction Approval: Date: � By: L Certificate of Compliance: Approval: 14 L 1 12 Date: Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ICS IG�I Commonwealth of Massachusetts GO f b Gr (n dt Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner's Name North Andover City/Town MA 01845 State Zip Code 1/12/2015 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. A. General Information 1. Inspector: Neil J. Bateson JAN 14 2015 Name of Inspector r ` Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 Citylrown state Zip Code 978-475-4786 S115 Telephone Number B. Certification 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 ❑ NeedA Further Evaluation by the Local Approving Authority c 1/12/2015 ins6ector's signatur 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 perform in the future under the same or different conditions of use. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17 n Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner's Name North Andover MA 01845 1/12/2015 Citylrown 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: ® 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System. Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner's Name North Andover Cityrrown B. Certification (cont.) MA n1 RAS; JLGIC LIIJ %,uuC 1/12/2015 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 • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form V, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner information is. required for every page. Owner's Name No Andover MA 01845 1/12/2015 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2, System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: 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 '/ day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner Owners Name information is required for North Andover MA 01845 1/12/2015 every 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 Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o V, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 1/12/2015 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 ® ❑ 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): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 1/12/2015 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ® Yes ❑ No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No Yes ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3113 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 '< 1030 Johnson Street Last date of occupancy/use: Date Other (describe below): General Information 1/12/2015 Date of Inspection Pumping Records: Source of information: Pumped Nov 2014, owner Was system pumped as part of the inspection? 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Property Address Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 every page. CitylTown State Zip Code D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information 1/12/2015 Date of Inspection Pumping Records: Source of information: Pumped Nov 2014, owner Was system pumped as part of the inspection? 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..'< 1030 Johnson Street Owner information is required for every page. Property Address Adrian Luz Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 1/12/2015 State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 9 Years old. 11/6/2006, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.6 feet Material of construction: Z 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, 4" PVC & 3" Cast iron in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal .6 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x5'x4' Sludge depth: 0" ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner Owners Name information is required for North Andover MA 01845 1/12/2015 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 0" 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 15" 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. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins • 3113 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal 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 1030 Johnson Street Property Address Adrian Luz Owner's Name North Andover MA 01845 1/12/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3113 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 1030 Johnson Street Property Address Adrian Luz Owner's Name North Andover MA 01845 1/12/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & distribution equal. Evidence of light carryover. No evidence of leakage. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 12 of 17 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 sigh 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 • 3113 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 1030 Johnson Street Property Address Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 1/12/2015 every page. Citylrown 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 60' 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 sigh 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 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 1030 Johnson Street Property Address Adrian Luz Owner's Name North Andover MA 01845 1/12/2015 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street 1/12/2015 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 f-111) t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Property Address Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 every page. Cityrrown State Zip Code 1/12/2015 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 f-111) t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts Title.5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner Owner's Name information is required for North Andover MA 01845 1/12/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4feet 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: 11/2/2002Date ❑ 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam - Not for Voluntary Assessments 1030 Johnson Street Property Address Adrian Luz Owner Owners Name information is required for North Andover MA 01845 1/12/2015 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 Summary Record Card generated on 1/12/2015 10:10:10 AM by Karen Hanlon Town of North Andover Tax Map # 210-107.A-0065-0000.0 Parcel Id 17890 1030 JOHNSON STREET ADRIAN & JENNIFER LUZ 1030 JOHNSON STREET NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zonin92 1 Residential Zoning3 1 Reside'tial Size Total 1.02 Acres FY 2015 UMaiIib4trn`dex NamelAddr6 ADRIAN & JENNIFER LUZ 1030 JOHNSONSTREET NORTH ANDOVER; MA 01845 MANNING, JANETMARIE & NEIL 1030 JOHNSON ST NORTH ANDOVER, MA 01845 U,B AGC66hfMaint. Account No Cycle Bldg Id. 13301.0. 1.030 JOHNSON STREE 2100312 02.Cycle 02 U'B $er.4k 3"Maint. Account No, 2100312 Service Code MISCFEE.ADMIN. FEE WTR WATER Type Loan Number Active/inact. From Until Owner Previous Customer Inactive 3/22/2007 Occupant Name Active/Inactive T Last Billing Date 12/3/2014 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/ 01 ALL METER SIZE 192.55 /1 UB Meter Maintenance Type Account No. 2100312 . w Water Consumption Serial No Status 41 Location 13242X51 a Act�uel` .9/11/2014 ERT HH Date Reading Code 11/3/2014 1595 aActl`" 8/4/21014 .' 1554 a Actual 5/712014 1485'=; a Actual 274/2014 1462 a Actual 10/31/2013 - 1438 aActual 8/2/2013. 1416 a Actual 5/1%2013 1391 aActual 2%5/2013 1372. a Actual 10/31%20.12 1350 aActual. 8/7/2012 1326 a Actual'. 5/3/2012 1294_ . a Actual 2/2/2012 1275 a Actual 11/1/2011..: 1250 a Actual 8/2/2011: 1223 a Actual 5/4/2011 _ 1195 a Actual 2/7/2011 1176 a Actual 11/1/2010 1152 aActual 8/3/2010 1129 a Actual 5/4/2010 1102 a Actual 2/2%2010 1081 a Actual 11/2/2009 1059 aActual 8/5/2009 1036 a Actual 5/4/2009 982 a Actual 2/5/2009 897 m Manual estimate ERT N/R ' 11/5/2008 879 aActual Brand Type METE METE w Water Consumption Posted Date 41 12/15/2014 69 .9/11/2014 23 6/12/2014 24 3/17/2014 22 12/20/2013 25 9/18/2013 19 6/18/2013 22 3/13/2013 24 12/13/2012 32 9/26/2012 19 6/20/2012 25 3/14/2012 27 12/15/2011 28 9/14/2011 19 6/13/2011 24 3/15/2011 23 12/13/2010 27 9/13/2010 21 6/9/2010 22 3/11/2010 23 12/1112009 54 9/11/2009 85 6/16/2009 18 3/16/2009 18 12/10/2008 Size 0.63 0.63 YTD Cons 760 Variance -42% 210% 0% 2% -9% 20% -1% -20% -15% 60% -22% -9% -5% 41% -10% -4% -14% 29% -3% -7% -55% -40% 394% 1% -30% 1 of 11• COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENT 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 the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (3 10 CMR 15.000). The system: _'Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails J Inspector's Signature: :. " ate: �3 The system inspection 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 ****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. SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning NOV — 7 2006 Owner's Address: 1030 Johnson Street No. Andover, MA 01845 Date of Inspection: November 6, 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector Company Name: New England Engineering Services Inc. Mailing Address: 1600 Osgood Street Building 20 Suite 2-64, North Andover, MA 01845 Telephone Number: 978-686-1768 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 the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (3 10 CMR 15.000). The system: _'Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails J Inspector's Signature: :. " ate: �3 The system inspection 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 ****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. 2of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 Inspection Summary: Check A, B, C, D or E/ALWAYS complete all of Section D A. System Passes: i S I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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: 3of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 C. Further Evaluation is Required by the Board of Health: ffO Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health ( and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and (SAS) Soil Absorption System and the (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 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 organize 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 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 4of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 D. System Criteria applicable to all systems: You must indicate "yes or No" to each of the following for all inspections: Yes No --11 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 overload or clogged SAS or cesspool. ✓ Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ./ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 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 _k�/ 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 nitrogen is equal to or less than 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) A/0 (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. 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. You alust indicate either "yes" or "no" to each of the following: (The fol�ng criteria apply to large systems in addition to the criteria above) Yes No The system is wlfthiu400 feet of a surface drinking water supply The system is within 200 feet a tributary to a surfac inking water supply The system is located in a nitrogen sen area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you answered "yes" to any ques ' in Section E the system is considere nificant threat, or answered "yes" in Section D above the large system has failed e owner or operator of any large system considere nificant threat under Section E or failed under Section D shall up the system in accordance with 310 CMR 15.304. The system o should contact the appropriate regional office of th enartment. 5ofIt OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 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-? 'f 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 an 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 sign of break out? !r Were all system components, excluding the SAS, located on site? _ Were all 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 difference from owner) provided with information on the proper maintenance of the 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)] 6ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design) Number of bedrooms (actual): DESIGN flow based in 310 CM 15.203 ( for example: 110 gpd x # of bedrooms) Number of current residents: _ Does residence have a garbage grinder (yes or no): y S Is laundry on a separate sewage system (yes or no): AIz� [if yes separate inspection required] Laundry system inspected ( yes or no): Seasonal use: (yes or no): A/-& Water meter readings, if available (last 2 years usage (gpd):& !I Sump Pump (yes or no):IVO Last date of occupancy C -v " C e ., i " COMMERCIAL/INDUS 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: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Sy ,vim e2 c, e= z 0o D G,2 ctil,c>c (� Was system pumped as part of the inspection (yes or no): /,.fes If yes, volume pumped: gallons — How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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 Attached a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: moF_ aA 4 Were sewage odors detected wen arriving at the site (yes or no): iVr✓ 7 of 11, OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 BUILDING SEWER (locate on site plan) Depth below grader Materials of construction: cast iron 40 PVC_other (explain) Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): P/W /— &ye3p `/l/ ;1454?1V C.4 / SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction:concrete 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: 1,9i26 6-14L[.,3>ti S Sludge depth: t:::1 H Distance from top of sludge to bottom of outlet tee or baffle: i;b' Scum thickness: P- Distance from top of scum to top of outlet tee or baffle: Via` Distance from bottom of scum to bottom of outlet tee or baffle /Z" How were dimensions determined: m S7LC,Je. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): -7WAIA e w 6-c>y,� c., .J,� ;�� ,i: scry 'et v � C ✓ C. 1,),4 GREASE TRAP: ,V/4 (locate on site plan) Depth below grade: Materials 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 sludge 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. 8 of 11 - OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 TIGHT OR HOLDING TANK: A/ d (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materials of construction: concrete metal fiberglass polyethylene other (exnlainl 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: 0 Comments ( note if box is level and distribution to outlets equal, any evidnence of solids carryover, any evidence of leakage into or outtof box, etc.): illi 7 / " &-y017 ! J^��7. i i U!�' s✓✓ � �/ ON.� CC r3ic l G'iil�s�C � �, tJ ,-)/Z o,I Ali -�;; il t / OS �.. �1y tic/ �: ibis i /21x3 v �"7�•✓ i:�cc�J+��_ PUMP CHAMBER :�1 (locate on sire plan) Pumps in working order (yes or no) Alarms in working order (yes or no) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 9of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 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 X1leaching trenches, number in length Z — d: ,49 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: ,il.� , (locate on site plan) Material of construction: Dimensions: Depth of solids: Comments (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc. 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 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 Dublic water sunnly enters the buildine. DES'r {�NCLS 2 —'T -I 05 TIR 11 of 1'1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1030 Johnson Street No. Andover, MA 01845 Owner's Name: Neill Manning Date of Inspection: November 6, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _feet 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 excavator, installers — (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: 5c/S i�rt G'c2r�Si 12.i c �Tp /z c c- NEw ENGL ND ENGINE EMG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01843 "Pel: (978) 686-1768 • Fax: (978) 327-6138 Benjamin C. Osgood, Jr., P.E. President November 7 2006 Susan Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 RECEIVED NOV 17 2006 Re: 1030 Johnson Street, North Andover TOWN OF NORTH ANDOVER Revised As Built plans I HEALTH DEPARTMENT Dear Susan: Enclosed are three copies of revised septic system as built plans for the above referenced property. During a title 5 inspection being performed by this inspector a typographical error was found in the system ties. This typographical error has been corrected on the enclosed plans. If you have any questions, or need additional information, please do not hesitate to contact this office. Sincerely, BLnjn C. OsgoOr�,;(P. E. President Town of North Andover a� �ORTN Office of the Health Department o� •' ` ° Community Development and Services Division * i 27 Charles Street - North Andover, Massachusetts 01845 sswcMus� Sandra Starr Public Health Director TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 04/11%03 This is to certify that . the individual subsurface disposal system constructed () or repaired (X) by Peter Breen at 1030 Johnson Street Telephone (978) 688-9540 Fax (978) 688-9542 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. Brian J. Grasse Health Inspector ?eCe-� `"" BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688 __- _ _ _ _ T � .. Niiuv%s 688-9535 .sem_ n`%=ti•- _ -`:`" 4�E�� :;:;`o-�_�:a`': %�2:�=�`�$.E--;% . � t f TOWN- OIC iNOR,rfH AiNBOVER Sr?�V:%kCrr DISPOS I. S),-tEi1-i I\STALL ATIOIN CERTIEICATION 4 The uncersismed here * --y ceriiv that the Sewage Disposal Systenn i ! consu,ici;Cd-. (, ) repaired: y by FFTz 9 _. located at 1030. so H N.SO was installed in cbnfumance with the L o. th Andover Board of He -with a-5proved plan, Svstem Desien Permdt , dated: With an accroved desion flow of gallons per day The mate:a:s;used were in conformance :�it`t those specified oil the app'rovea plan; the syste*7 was installed in' accordar:ce ,,.ith the prevision= of ? 10 CNM 15.000, Title 5 and local AML-ulatiors, and the final sradica agrees substantially with the approved plan. Ail Lori; is accurateiv represented c)r the As -built :which has been submitted to the Board cz Health. Bed inspection 'late: l Zip a Z c �..- Eneineer RI:m_-sz:::auve Final inspect -on date:`—J— L-nciretr Representat:�.�e Of M lnstalier: k ASS �:C.T: rDDate: - K - - ��/ ARD Cesit'r. Engineer- ! _ _ - Date: /Z /o Z=_ _ U TA FSS/ANAL Q�� I r INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO I ti s A. Bottom of Bed / 1. Excavation to proper depthy 2. With trenches, sides of excavation are beneath B horizony 3. Edge of excavation specified distance from foundation, etc. C/ Comments: B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10' to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8" per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90° change 10. 10' minimum offset to water line Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20" manholes 7. Inlet tee minimum 12" under invert 8. Outlet tee minimum 14" under invert 9. Outlet line cemented 10. Air space 3" above tees 11. 2" - 3" drop from inlet to outlet 12. Pipe set 13. Compact base with 6" of/<" crushed stone under tank 14. Tank is watertight Comments: r Yes NO E. Pump Chamber 1. If separate from tank, compact base with 6" of 1/4" stone underneath 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D -box level 2. Minimum 0.1T' (2") drop from inlet to outlet 3. Minimum 6" sump 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double -washed -'/d"- 1 '/z" - pea stone _ Bucket test done? 2. Minimum 2" of pea stone above distribution lines _ 3. Minimum 6" stone beneath pipe _ 4. Distribution lines capped or connected together _ 5. Grading meets 3:1 slope _ 6. Minimum of 9" of fill graded over system 7. Toe of slope stops minimum 5' from edge of property; if not, then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan - Minimum 2'; maximum - 4'. 4. Vent present if <50 feet or specified 5. Distance between trenches minimum 4' and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6" per 100' �- 8. Depth of trenches below outlet invert minimum of 6". �` 9. Pipes set on stable base. Comments: 1. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipe 6' maximum 4. Pipes connected at end 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade I. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond Yes NO Town of North Andover, Massachusetts Form No. s �f "ooTO, BOARD OF HEALTH ro 41 DESIGN APPROVAL FOR �SsAcMustt� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant.A �.�`t��/ Test No. l �y Site Location Reference Pla Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, 0ARD OF HEALTH Site System Permit No. /) NORTH Ott��a° ye 14, • "s 77.° f SACHUSE� Town of North Andover, Massachusetts BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT Form No. 3 ApplicantdN`;1� Q o I)oyyN l ` NAME ADDRESS TELEPHONE Site Location \ S6A(-, 0'o QA C-(- T- t't,44/ Permission is hereby granted to Construct ( ) or Repair (( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 0 Fee CHAIRMAN, BOARD OF HEALTH D.W.C. No. 1146 t INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 1/0,30 it) �� 5 � � ��relative to the application of kkf ?"eW dated 0 Z _for plans by 44--,?4aiYd dated (0 `6 ( d z— with revisions dated dt(O-z' I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the - system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Disposal Works Construction Permit # � .246' BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:—a/'/ I /O:Z— LOCATION: ((),30 CURRENT INSTALLER'S LICENSE# LICENSED INSTALLER:�L (f r &ne , SIGNATURE: � �TELEPHONE#_ CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 160.00 Fee Attached? Project Manager Ob. Foundation As -Built? Floor Plans? Administrative Use Only Yes 1_1� No Yes—,--' No Ye No Yes No Approval Date:/� NEW ENGLAND ENGNIc EERING SERVICES November 1, 2002 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 1030 Johnson Street, North Andover, Septic system design Dear Sandra: Enclosed are revised septic system design plans for the above reference property. The following changes have been made. Each item below is numbered to correspond to the item number in the letter from John Noonan dated October 25, 2002. 1. The trenches have been labeled on the plan view. 2. The 95 contour has been added. Side slope protection is provided for trench 1 using the barrier. 3. The 89 contour has not been added to the plans, however the bottom of the barrier has been revised to elevation 86 to provide the proper bottom elevation of the barrier. 4. The soil logs have not been revised. The Board of health reviewed the soil notes at the time of soil testing and it was determined that our notes were adequate. 5. There are no wetlands within 150 feet of the septic system. General note # 6 has been revised to indicate this fact. 6. The size, slope, inverts, and material of the building sewer have been added. 7. The 9" minimum and 36" maximum cover have been added to the plans. 8. The profile has been modified to indicate the first two feet of pipe from the d box are to be set level. 9. The actual slope of the pipe from the d box to the tank has been indicated on the plans. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, �f -- Benjar L C. Osgood, r., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 OF t. OKH f'.. SEPTIC PLAN SUBMITTAL FORM 12002 3 LOCATION: 110 3 O %- NEW PLANS: YES $160.00/Plan REVISED PLANS: CYES? $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE:_�� , Z DESIGN ENGINEER: r-, DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. NEW ENGLAND ENGINEERING SERVICES INC November 1, 2002 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 1030 Johnson Street, North Andover, Septic system design Dear Sandra: Enclosed are revised septic system design plans for the above reference property. The following changes have been made. Each item below is numbered to correspond to the item number in the letter from John Noonan dated October 25, 2002. The trenches have been labeled on the plan view. E / The 95 contour has been added. Side slope protection is provided for trench 1 using the barrier. The 89 contour has not been added to the plans, however the bottom of the barrier has been revised to elevation 86 to provide the proper bottom elevation of the barrier. t/4. The soil logs have not been revised. The Board of health reviewed the soil notes at the time of soil testing and it was determined that our notes were adequate. v5. There are no wetlands within 150 feet of the septic system. General note # 6 has been revised to indicate this fact. vK� The size, slope, inverts, and material of the building sewer have been added. i7. The 9" minimum and 36" maximum cover have been added to the plans. 8ZThe profile has been modified to indicate the first two feet of pipe from the d box are to be set level. �9. The actual slope of the pipe from the d box to the tank has been indicated on the plans. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, (1-4 - Benjar L C. Osgood, r., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax'(978) 671-9565 Email: mnkconversent.net October 25, 2002 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770A/015 1030 Johnson Street Assessors Map 107A, Lot 65 Dear Members of the Board, !?Q�RD OF HF ,LTH OCT 31 2002 Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated October 8, 2002, By: New England Engineering Services, Inc. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: 1- Label trench 1 & 2 on plan view. 2- Add 95 contour to demonstrate side slope protection for trench 1. 3- Add 89 contour to demonstrate that impervious barrier extends 1 foot minimum into naturally occurring pervious material (ie C horizon) 4- Soil logs and perc test logs don't match Board of Health records. 5- Identify wetlands within 150 feet of system NA 8.02 6- Provide type of pipe, slope, size and beginning and ending inverts of building sewer 222 (3) 7- Identify 9 inch minimum cover over septic tank and 36 inch maximum, 228(1). 8- Identify on profile that pipes out of "D" Box are level for first two feet 232(3). 9- Provide actual slope of pipe from septic tank to "D" Box. Respectfully, John L. Noonan, P.L.S.-P.E. F: office/BOH/ 1770A-015 Land Surveyors Civil Engineers Environmental Planners NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm@netway.com Date v Z 5 0z— Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770 D Assessors Map /07,+�-, Lot _f L Dear Members of the Board, Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated Oc %• S fL®d '7— by Zby .iV�'z�ci-�v� G�-�✓��J��,ly s�7�y<G-5 /ft/C It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: y 37 7-0 v. c %' ,��r`�'n�✓ 5 j fir T� ?>l�J� /iv rQ �✓�? 7 c Q c— /' -via L,-5- 7' ,ST -// 7' Respectfully, 1•N� �' John L. Noonan, P.L.S.-P.E. G: office/forms/tonarev 7) 9 .7 vim- v vie— rcT'cf T/ L Ca ,a! 1 Land Surveyors Civil Engineers Environmental Planners 1 �� s`� �� `c ?� � �� '/ �� n� V CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS N & M Job 1770/x. O/ 5� The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: R""9� "' 67 /�L rL Naiiiie*besigner: All) jdE- � S Plan Date: /o Aza -z— Revision Date: Date of Review: O 6'� Property Address: /42 3 P ,Inn y� sd'�/ S % Map: 14771f- Lot: V' BOH BOH Reviewer: c1 4-- 0U Type of Plan (new or pgrad Ir�oQi ../4' Number of Bedrooms in Assessor—ss Records: 159t gpd) Garbage Disposal Allowed: General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot - 220(4)(u) Maximum scale of 1 "=40' for plot plan - 220(4) ✓� Maximum scale of 1 "=20' for profile and component details - 220(4) Legal boundaries of the facility being served - 220(4)(a) Names of abutters from recent tax map - NA 8.02j ✓� Number of bedrooms, design calcs., - NA 8.021 Name & address of record owner & applicant - NA 8.02k Name & address of designer - NA 8.021 Holder and location of all easements - 220(4)(b) A�2Date plan drawn & any revision date - NA 8.02m All dwellings and buildings, existing and proposed - 220(4)(c) Location of all existing or proposed impervious areas - 220(4)(d) All distances on site plan — NA 8.03a -c Elevation of proposed driveway - NA 8.02t Location and elevation of foundation drain - NA 8.02y V Location and dimensions of the system incl. reserve new const.) - 220(4)(e) Limits of excavation of leach area on site plan - NA 8.02z ✓' Locus plan - 220(4)(t) (Not to scale) North arrow - 220(4)(g) Existing and proposed contours - 220(4)(g) Locations and logs of deep holes - 220(4)(h) Locations and logs of percolation tests - 220(4)(i) Date(s) of soil testing - 220(4)(h) & (i) Existing grade elevation of each deep hole - 220(4)(h) f Elevation of percolation tests — N.A. 8.02n !l Name of approving authority representative - 220(4)(h) & (i) l ��! Name of soil evaluator - 220(4)0) J--=_ Soil logs and perc test logs match BOH records / Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n) Complete profile of the system to scale - 220(4)(o), NA 8.02c Cross section of leaching facility - NA 8.02w (Not to scale) Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) Note listing all variance requests with proper citations - 220(4)(p) <7-- Local upgrade approval request form submitted - 403(1) !! y Original R.S./P.E. stamp, signature & date - 220(1) & (2) G� If P.E., discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w/in 150') - 220(4)( Location of watercourses, wetlands, wells, etc. Win 150' of system — NA 8.02r Wetland disclaimer — NA 8.02s RLS plan reference & certification required (prop line setbacks) - 220(3) lay=c-er�insdesigrr�r�e r •�ca ' - - --- Use approvals / standards checked for UA system - DEP docs., Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3) Perc rate > 60 MPI - must use modified tight tank or I/A technology - 245(4) Proposed system qualifies as "shared" system - 002 (definitions) Flow is over 2,000 gpd - No R.S. allowed - 220(1) Design flow was set in accordance with code - 203 Existing system location and note on proper abandonment - 354 Leaching facility at least 1' above Base Flood elevation — NA 9.05 All piping Sch 40 minimum — NA 10.01 Basement floor minimum 1' above groundwater elevation — NA 5.04 Foundation drain present with elevation — NA 8.02y On-site Soil and Groundwater Review OK Problem N/A �-- Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests — NA 8.02n Soil evaluation forms submitted within 60 days of field work - 018(2) Proper percolation test log - 220(4)(i) Ample deep observation holes in primary disposal area (minimum 2) - 102(2) +-� Ample deep observation holes in secondary disposal area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) Deep hole testing conducted within two years — NA 7.05 Hole Identification Numbers: ground elevation el. 4 ---- acceptable acceptable soil el. e/ - Leach facilitv invert el. (/ ground water el. _ refusal el. bottom of leach facility el. thickness of acceptable soil before & after soil R&R separation to groundwater separation to refusal ti soil class perc rate loading rate septic tank below g.w. table (yes or no) pump tank below g.w. table (yes or no) IS in fill � -255(l) Setback Distances (Given in feet) 15.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02 OK Problem N/A Septic Tank Leach Facility l� Property line 10 10 Cellar wall 10 20 A 2 v 2 Q w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) t„ r, Pipe cast iron or Sch 40 PVC – NA 11.02 Watertight joints specified - 222(3) & (4) Pipe laid on compact, fin base - 222(5) Pipe laid on continuous grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) v 10' offset to private well or suction line - 222(2) 3 3 Inground pool 10 20 _ Slab foundation 10 10 Deck, on footings, etc. 5 10 Waterline 10 10 C.—_ Private drinking well 75 100 Lam. Irrigation well 75 100 �^ Wetlands 75 100 �i Public well 400 Wetlands bordering surface 400 150 water Supply or trib. (in Waters _ Trib. To Surface Water supply 325 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains (wat. supply/trib.) 50 100 Drains (intercept g.w.) 25 50 Foundation drains 10 20 Drains (Other) 5 10 Drywells 20 25 Downhill slope 15' to 3:1 slope w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) t„ r, Pipe cast iron or Sch 40 PVC – NA 11.02 Watertight joints specified - 222(3) & (4) Pipe laid on compact, fin base - 222(5) Pipe laid on continuous grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) v 10' offset to private well or suction line - 222(2) 3 3 Septic Tank OK Problem N/A v tl' Tank is accessible - 228(3) No structures above tank — (228(3) Tank can accommodate both primary & reserve — NA 9.04 200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a) 2-3" drop from inlet to outlet - 227(5) Minimum of 4' liquid depth - 223(2) 3" air space above tees/baffles (minimum) - 227(4) 9"air space above flow line (minimum) - 227(4) Tees are not to be replaced by baffles - 227(1) Tees extend 6" above flow line - 227(l) Inlet tee extends 10" below flow line (minimum) - 227(6) Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6) Gas baffle installed on outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compart) 228(2) 3-20" manholes - 228(2) 1 childproof, 24" riser/manhole Win 6" of final grade if <1000gpd- 228(2) Inlet and outlet tees on center line - 227(1) Soil compaction below tank specified (if soil is non-native) - 221(2) 6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(1) If > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. - 223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c) Buoyancy calcs. required if tank at or below water table - 221(8) Tank is watertight - 221 (1) 9" of cover over tank (minimum) - 228(1) H- 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) All pumping to tank (if applies) in accordance with - 229 Tank is set to keep old system in service during install if possible Distribution Box (Check here if not present: OK Problem N/A �^ Inlet elevation: Outlet elevation: 0.17' drop from inlet to outlet (minimum) - 232(3)(b) 6" sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) Outlet pipes laid level for first 2 ft. - 232(3)(c) Pipe Sch 40 - NA 10.01 �G Number of outlets: Number of laterals: c� Size of outlets: Inlet baffle/tee min. 1" over outlet invert for all d -boxes - 232(3)(a), Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of stone beneath distribution box specified - 221(2) Box is watertight - 221 (1) Top of box <=36" below grade - 221(7) Buoyancy calculations required if box is at or below water table - 221(8) Pump Chamber (Check here if not present: OK Problem Volume speci wl. I 220(4)(r) M o ev p ation- 220(4)(r) Pu elevation: 220(4)(r) arm on a eva ion: 220(4)(r) Number of cycles per day - 220(4)(r) (also 254(l)(d) if gravity from d -box) Minimum 2" delivery line to d -box if gravity - 254(1)( c) 4 P 4 Pressure dosed l.f. if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a) Cycles per day is consistent with chamber volume - 23 1 Volume calculations include flowback volume - 2') 1(2) 24 hour storage capacity above pump on elevation - 231(2) Number of pumps: 2 if system serves >2 dwelling units - 231(6) Capacity of pump(s) - gpm @ ' TDH - 220(4)(r) Pump can pass 1 1/4 "solids (minimum) - 231(7) Pump controls specified - 220(4)(r) Alarm equipment specified - 231(2) arm is in building and powered on separate cir ' om pump - 2') 1(9) Pu sequence correct (off -lead on -la an -n on) - 231(8) Pump pekormance curves inclu - 220(4)(r) Manual oper ' switc 12.01 Check valve, ble ole - NA 12.01 �lchrldpkT4" riser ole to final grade - 2'31(5), ction beneath p chamber specified (if soil is non-native) - 221(2) "stone beneath climb . ecified - 221(2) & 228(1), Buoyancy calculations if chamber is r below water table - 221(8)@ 9" of cover over chamber (minimum) - 2 H- 10 loading (min.) - H-20 if traffic - 226(')), Chamber is watertight - 221 (1) Top of chamber <=36" below grade - 221(7) Leaching Facility (general - complete for all designs) OK Problem N/A 50% larger if garbage disposal - 240(4) Trenches to be used whenever possible - 240(6) No vehicle or imperv. area above 11 unless unavoidable - 240(7); NA 13.02 Vented if under impervious cover - 241 (1) t� Vented through same pipes as distribution system - 241 (1)(a) Vent protected from precipitation/animal entry - 241 (1)(b) Vent is placed beyond traffic or impervious area - 24 1 (1)(c) V' All lines connected to vent if bed or trenches - 241(1)(d) 9" cover over peastone - 240(9) `--, Reserve area provided (new construction) - 248(1) —"—"' Reserve 4' from primary leach area — NA 9.04 +� 4' (5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b) 4' (down to 2' with variance or UA - upgrades only) of natural soil under l.f. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 - 251(9) Require 5' removal and replacement if in fill - 255(5) Top of leach facility <= 36" below grade - 221(7) Final grade over 11. minimum 0.02 ft/ft -240(10) Surface & subsurface drainage away from 11. - 240(1 1) & 245(5) Minimum design flow 440 gpd without deed restriction — NA 13.01 3:1 slope where grading required - 255(2) Toe of fill slope stops T from property line or swale installed - 255(2) —�" Impermeable barrier if < 3:1 slope or < 15 feet to—3:lslope - 255(2) r� Impermeable barrier/retaining wall poured concrete — NA 9.02 Retaining wall stamped by P.E. - 255(2)(b) v Top of retaining wall >= top of peastone elevation - 255(2)(f) 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) Perc test(s) done in most restrictive layer -104(2) Perc test 4' below leaching elevation — NA 7.06 Design flow listed and required/provided leach area given - 220(4)(f) Leach pipes SCH40 PVC — NA 10.01 Leach pipes minimum 4" diameter except for dosed system — NA 14.04 Leach lines capped, vented, or connected together - 251(9) Pressure dosing guidance followed if pressure distribution - 254(2)(c ), Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1) Leaching Trenches (Check here if not present: ) OK Problem N/A -2^ t� Number of trenches: Minimum of 2 trenches - NA 9.01(2) Depth of trenches (max eff. 2'): -247(l) Width of trenches (2' min., 4' max.): - 251 (1)(b) Length of trenches (100' max.): - 25 1 (1)(a) Trenches are vented (when > 50') - 251 (11) Trenches follow contour lines - 251(2) Trench spacing 3 times effective width or depth minimum- 251 (1)(d) -(LOTZserve between trenches, 10' miA!NA 14.01& 14.03 Available leach area given (Min. 500 s.f.) - NA 9.01(2) Z� Bottom =L x x# – �� Sidewall = L x D x# x 2= Effective leach area given Loading factor: ✓� Effective area = total area s.f. x LTAR – F� Effective area is >= design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.- 247(2) Trench depth of 3/4" to 1 1/2" double washed stone - 247(1) Leach Fields (Check here if not present: ) OK Problem N/A Number of fields: (need dosing chamber if > 1, 231 (1)) Length (100' max.): - 252a(b) Width: Total area: L x– s. f. s.f. s. f. g/day Minimum 900 squn— feet - NA 9.01(1) Distribution ' s connected with solid pipe — NA 15.01 Effecti each area given ading factor: Effective area =total area s.f AR = g/dav Effective area is >= design flow of ity being served Minimum of two distribution ' s - 252(2)(a) 6' line separation (max.) 2(2)(d) 4' maximum sepaza ' n from edge of field to line - 252(2)(e) 10' minimum aration between adjacent leach fields (2)(f) Between and 12" of 3/4 - 1 1/2" stone b field - 252(2)(g) & 247(2) 2"of 1 8"-1/2" 2x washed peastone.- 247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feet/foot – 240(10) Grading shall divert drainage away from leach area – 240(l 1) -t� Grading slopes away from dwelling 5/24/01 f:/office/forms/tonackitr.doc 6 + rel Project Request Record Town of North Andover Date: O Z i 4 Client Id: ToNA Card Id: ToNA CliendCompany Nam : Board of Health Card Type -Client Contact Name: Ms. Sandra Starr Phone: 978-688-9540 Title_ Director Fax: 978-688-9542 . Address: 27 Charles Street Email: sstarr@townofnorthandover.com Notes.. Town: North Andover State: MA Zip Code: 01845 Other contacts if applicable: 'e ;ngZineeLrInstaHer Name: 6V z✓ Phone: 92 9�- S-6 I Z� Title: Fax: _Address: Email: Notes: Town: State: Zip Code: Proiect: Project Id: 1770 *A Project Title: Town of North Andover. Board of Health (JOB NO) (PROJECT NAME & STREET ADDRESS) Manager: NOW Billing Group: Billing CA: Fixed — Contract Info. Project Description for each billing group BGG Applicant no...l if -c, p e4-' Assessors Map /0 7A Lot Street ,la 3 v ,ToAy-%f sp,y i 7– Type of service s z TQ �- 7� �►,�,/ z �--t� Officelforms/jbrqutona SEPTIC PLAN SUBMITTAL FORM LOCATION: 10 30 ac.'WiSoh 5T NEW PLANS: CYEp $160.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: 1 a 0 2 DESIGN ENGINEER: ew,-ee !Lt .. DATE TO CONSULTANT:~z— When the submission is all in place, route to the Health Secretary. DCT 9_'�� NEW ENGLAND ENGINEERING SERVICES INC Sandra Starr, Administrator North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 1030 Johnson Street, Septic system design Dear Sandra: October 8, 2002 `FE i CF KOR1 H AND: / i ECARD OF HD'111:19H MFog 9 2002 ; Enclosed you will find the following documents pertaining to the above referenced property. 1. 5 sets of septic system design plans. 2. Application for approval. 3. Draft Soil evaluator sheets. 4. Check to cover the fee for approval. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Ben�at n C. Osgoo Jr., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 d BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: --q I l ,l z MAP & PARCEL: '3VN OF NORTH ASD® "b w OF HEAL SEP 2 A 20oz LOCATION OF SOIL TESTS:-- i 030 JS0 t t m 5 C) ✓1 OWNER: 2EA fLS �> A TEL. NO.: ADDRESS: ENGINEER: ) e i,_, �,,,E, t TEL.NO.: 7 �- u tG -- 176 B CERTIFIED SOIL EVALUATOR: c /\ 0 Intended Use of Land: Residential Subdivision Uo—V D,ci< 1 Single Family Home Commercial Is This: Repair Testing: S Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $200.00 per lot for repairs or up ades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION I. 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 disposal area. 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. Please Do Not Write Below This Line 91 N.A. Conservation Commission Approval: %� Q r s Date Received: Check Amount: OXO - Check Date: '-117'/ i `1 -� 5 7 I •. MOR MAGE INSPEC RON PLAN AT /030 JOHNSON S TREE T NORTH ANDOVEP, MA. IVO.ESSEX REGIS TRY OF DEEDS.' BK .3 !8B PG. /8; PL/A-" ' N0.5080 CERTIFIED TO" NORTHMARK BANK SCAL E.' / "= 60' DA TE.' NOVEMBE.: R 06, 1997 30'- RF.OUIRED Oaf - EXI-!MNG WORD SHED Oti• ?� 9 EE] CONC. PAD LOT' 4 4,190 :3F, x 1 esu NOTES.' °� } I) THIS 1S NOT A PROPER 7- Y SURVEY, DO NOT USE THIS PLAN TO, ESTABLISH PROPERTY LINES OR TO ERECT ANY STRUCTURE. 2) PROPERTY LINES ARE DETERMINED FROM COMPILED INFORMATION TO BE USED FOR MORTGAGE PURPOSES ONLY ` 3) DWELLING CONFORMS, WOOD SHED DOESNT.' CERTIFICATIONS' BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF, I HEREB Y CERTIFY THA T THE PERMANENT STRUC TURES INDICA TED ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND ARE (SEE NOTE 3) CONFORMING TO THE ZONING SETBACK REQUIREMENTS OF THE APPLICABLE MUNICIPALITY WHEN CONS TRUC TED OR MAYBE EXEMP i PER MASSACHUSE 7 -TS GENERAL LAW CHAPTER 4OA, SECTION 7, AND THAT THE STRUCTURE SHOWN IS NOT LOCATED IN A FL DOD HAZARD ZONE PER FEDERAL L-VEFrGENCY MANAGEMENTAGEAK YMAP' COMMUNITY NO. 250098 EFFECTIVE DATE,' L 6- 02-93 ZONE.' X JOHN ABAGIS B ASSOCIATES, PROFESSIONAL LAND SURVEYORS 137 CHANDLER ROAD, ANDOVER, MA. (.508) 688-48.919 APPLICANT.'PEARSON NO. 3273 i t✓ L O C rn^. i ION SO.H, IN TN E'S S. �. SO1 1171ti! '_1 C. I O TiME OF SC -JA .. /0 � nIF-VT [sinuiuff,,57 i ilrViE E ;Ivi= .^. i 1,2 T N I E i FROM : R. C. TANGARD r t uv i . �. auue J. J7r1.1 r .-) FHONF= N0. : 781 334 0115 FORM 11 - S011. EVALUATOR FORM Page 2 of 3 Location Address or Lot rip- �� On-site Review Deep Hole Number `. Date: -/f- *1 Time: Location !identify on site p?an).14 Land Use ! .... Slope (%I Surface Stones Vegetation Landform .......,........... Position on landscape (sketch on the back) Dis'ances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Wel(: feet Other .. U Werther7&4 DEEP OBSERVATION HOLE LOG' —1 Depth from Surface (Inches) Soil Horizon I Soil Texture (USDA) Soil Collor (Munsell) Soil I Mcitline f IIII Other (Sirucuire, Stones, Boulders, Consistency, % Gravel) i` I i 21-& �50 -3 Pop ' MINIMUM Uh 1 MULES hhI1U1hI;U Al tVtH7 r'!iU!'U7itU UISYUSALAMEA Parent Material (geologic) DapnttoBedrock:_ Depth to Groundwater: Slanding Water in the Ha'e! _ WeeDrn.g from Pit Face: _= Estimated Seasonal High Ground Water: [)EPAPPROVED FOitAI - 1:%07145 * FROM : R.C. TAHGARU L.V 1 . J• GIJCIG J• JJI 11 i Y PHONE N . : 781 334 0115 FORM 11 - S011, 11-INALUATOR FORM Page , of 3 :.: xation .Address or Lot i�o, �%� -' � '57/y��K 1pcj4 0& -- Qn_site Review Deep Ho'e Number Date: /61/11 a Z Time; /e 5 _ Weather 7a b Location (identify on site plan) and Use /r�ySlope ;%1 jii!!!P Surface Stones Vegetation Landform �Q Position cn landscape {sketch on the back! Distances from: b.qen Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other !z,21 V,5�' 1,/6Gr %JL7%7LT\YM I IVIV "%JLG L%JU (Structure, Stones, Boulders, Ccr,sistoncy, Y Parent Material i9eclogic) bepthtoGedrock: Qe th to Groundwater. Standin8 Water in the Hole: _ � Weeping from Pit Face: �+d Estimated Seasonal High Ground Water: 0 fl IIEP APPRCVED FONNI • 1:ro7/95 i Form No. 1 Town of North Andover, Massachusetts f BOARD OF HEALTH I NORTFf 320ytt`ED' 6.6 oCi I4 OL * c APPLICATION FOR SITE TESTING/INSPECTION D iA qq <oc.cwic P 7 �AATED PP •�y SAC U5 i {, Applicant AME ADDRES� TELEPHONE f Site Location ` Engineer ADDRESS TELEPHONE � NAME Test/Inspection Date and Time �— CHAI AN, BOARD OF HEALTH f Test No. Fee ' S.S. Permit No.1/3LD•W.C. No. C.C. Date _Plbg. Permit No._— y Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director March 15, 2001 Don Pearson 1030 Johnson Street North Andover, MA 01845 Dear Mr. Pearson, Telephone (978) 688-9540 Fax (978)688-9542 This correspondence is in regards to your application for a building permit for an addition above your existing garage at the address above. As I indicated in our conversation on March 14, 2001 the Health Department cannot approve the building application because the existing septic system does not meet the requirements of the current Title V that was revised in 1995. According to the Health Department records, your septic system is over thirty-three years old and was originally designed for a three-bedroom house. In 1992 the Board of Health voted on and allowed you to add an addition to your home without increasing the size of the septic system. Your recent application indicates that your home is now eight rooms and you want to add one room. Title V states that to calculate the number of rooms, you divide the total number of rooms by two. To accommodate the addition, your septic system would need to be sized for a four-bedroom house. Exact calculations of your system capacity cannot be made without additional information, which would normally be obtained through requiring a Title V inspection and soils testing, but it is clear that since you have already increased the homes size, your system is not adequate by today's standards. For these reasons the Health Department has disapproved your application. If you do decide to move forward with your addition plans and choose to have your system upgraded, I have enclosed a pamphlet, "My Septic System Has Failed" for your convenience. Although your system has not failed a title V, the procedure for upgrading your septic is basically identical. If you have any additional questions please call the Health Department Monday — Friday, 8:30-4:30. 7usanFo rd, S. Health Inspector BOARD OF APPEALS 688-9541 BLTILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 �6 FORM — U — LOT RELEASE FORM 41d4tc� A(,J �a . INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ............................. ..... Room ........... monsoon Mason .. was ..........■ APPLICANT �n :��t . �sc�y° PHONE ASSESSORS MAP NUMBER P9 LOTNUMBER SUBDIVISION NUMBER STREET / 0.9 0 0 4.1 <r11L,- STREET NUMBER /0,C;-, ion* a a a OWN a 4-00 M -M a ON a as OFFICIAL USE ONLY ........................................................................... RECOND ENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR tv"Mm"I MMM COMIvIEENTS DATE APPROVED TOWN PLANNER COMMENTS FOOD INSPECTOR SEPT CTOR - HEALTH PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR . DATE E C 0 NAfl T 2001 BUILDING DEPT. K -N ins Qs \or\. eD I -M 7- c- December 20, 1991 Donald A. & Charlene Pearson 1030 Johnson Street North Andover, Mass. 01845 To the Town of North Andover Board of Health, It is our intent to remove the roof on our existing three bedroom ranch house. The plan is to put the three bedrooms upstairs, to open up the downstairs for more living space, kitchen, living room, den, and office. The fact that we are not increasing the number of bedrooms, we hope you will allow us to do this project without modifying the septic system. Sincerely, FOM U TOWN OF NORTH ANDOVER LOT RELEASE FORM ;UBDIVISION / _SSESSORS MAP 10.7 UBDIVISION LOT(S) o PERMANENT ADDRESS (ASSIGNED BY D.P.W. ;TREET • /0 �3o 1,nSo .PPLICANT / /o n a /�� 'SG PHONE )ATE OF APPLICATION /2 'LANN TOW TOWN USE BELOW THIS LINE ;,ONSERVATION COtIHISSION� CONSERVATION ADMIN. BOARD OF HEnLTH%,�,� Z , DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED -��. DATE APPROVED li ANITAitIAN DATE REJECTED r--�l 17' /.�A'y rL�Q OF DC-; U ,r pec DEPARTMENT OF PUBLIC WORKS DRIVEWAY . PERtiIT SEWER/WATER CONNECTIONS FIRE DEPT :-�G�f� /iU�2 d r� �eT��d1��:�T J �//i,� 1 /� RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and health Boards, the Conservation Commission prior to the issuance of any building permit for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. 4. Don Pearson - 1030 Johnson Street - Homeowner is requesting approval of building plans from the BOH. Potential for an increase in the number of bedrooms. However, seems unlikely given the size of the house. Agents recommendations: Approve request to sign building permit as renovations will not result in any additional bedrooms (3 max), unless a plan, upgrading the septic system is submitted. 1 SAWYER, John Lot A, Johnson St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot A0 Johnson St. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1/ until 10 feet pre- ceding the septic tank, where the grade shall not exceed 290. I will install a con- crete septic tank of 1000 gal, in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 180 lineal (me_) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/41, (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Signature of App icant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE i Cvv� Sig,4ature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature otinspecting Office Percolation Test 4 min. Soil: Sandy -clay Garbage Grinder No BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. tO.S r..4 (A) 5. SHOW DIMENSIONS OF HOUSE b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. J 1. NAME A�✓� �•`i{ . `%"- DATE q 2. ADDRESS % t LOT NO. TEL.)h'W 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO i---' 5. SHOW DIMENSIONS OF HOUSE b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. ,A- . BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE April 1. 1967 NAME OF APPLICANT John SaToiyer LOCATION Lot #A. aohnson Street Address of lot no. BUILDING: Dwelling Other SYSTEM: New x Repair GENERAL DESCRIPTION OF LAND ip;h �T�T7, ///�� eee�� g SUBSOIL: Clay GravelSand PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. William J. Dr'scoll, Engi eer Board of Hea th n f'� d 44, N 25�f 'Igo ED — N pG —Sir o, ----- pvs 0�1 s1f�T 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 out this section***************** APPLICANT: 0 .1a/rt L'4 /is Phone LOCATION: Assessor's Map Number Parcel Subdivision ll Lot(s) Street % (2 3 v J o`i h Svn St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Date Approved Date Rejected Date Approved 3 Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Date Approved Date Rejected Date Approved Date Rejected Comments 1))ZES2-2 SETd1-K,C%) 55bo Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date