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Home My WebLink AboutMiscellaneous - 105 SULLIVAN STREET 4/30/2018 (3) f n Commonwealth of Massachusetts _ City/Town of North Andover System Pumping Record Form.4 with your �y DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before nusing Record must be submitted o local Board of Health to determine the form they use.The Systemp date in the local Board of Health or other approving authority within 14 days from the pumping accordance with 310 CMR 15.351. A. Facility information important When 1. System Location: filling out forms Y on'he computer, use only the tab key to move your Address Ma 01886 cursor-do not North Andover State Zip Code use the return Cry/Town key. 2. System Owner:ou C-nwan 'n �tie --- Name Address(if different from location) State Zip Code CKYTTowh Telephone Number B. Pumping Record /1' '/ 2. Quantity Pumped: Gallons 1. Date of Pumping Date Tight Tank E] Grease Trap 3. Type of system: ❑ Cesspool(s) p Setic Tank ❑ Ti9 ❑ Other(describe): 4. Effluent Tee Filter present. ❑ Yes ❑ No . ifyes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sys tem ed By: "\ — Stewart' Vehicle License , mber ,�_ms Septic Service Company DEC 112014 7- Location where contents were disposed: Stew s Pre-treatment Plant, 20 Mill Bradford, Ma 01835 Date Si r of Hauler ignature of Receiving Facility Date System Pumping Record•Page t5form4.doc•03/06 I Commonwealth of Massachusetts W City/Town of North Andover -° System Pumping Record n r Y p 9 r 2094 Form 4 TOWN Ur ,.n,h ti dDOVER DEP has provided this form for use by local Boards of Health. Other forms may used,'but the +'T information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location. on the computer, { use only the tab I� 50 lyoo51 key to move your Address cursor-do not North ANDOVER Ma use the return key. City/Town State Zip Code 05�1 2. System Owner: Name ienm Address(if different from location) City/Town State Zip Code ` Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Ga ons 3. Type of system: ❑ Cesspool(s) ,L'Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: �9 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 ignature of Ha Date na ure of Facifity Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 .� ! I ,,fit;.,::• .,,i,;;.. .i.'��' '41��'�WI• n��,e, .w/'in, '',. +;' :vt.' ',ip:il��•;i'�'I,j i.;. ' ,{ ti' + ORT -AIDOVER� MAS •,;'�;. � ,� , " t.11, r,�.p , �. ,� ,. SA(-'HUSETTS �1e o Q rd'Vs ; .t� ;,1t J' t. ,� •r,tom^r.�r. S. ,{y/�. „ .}�;��i'vf,>,.hij•w• 1 { t4: � r;M }':;4•N'Vf':I�fry�'.',f� .�' �'�'..• DEP•,has provided Is form for •t. . use by local Boards of H ea I t h , T h a System m Pumping Recorc mbe':ubm• Ited to the of Health or other aPProvIn9 authority, .' A; Faclllty .lnfarritlon , .yvher,'(drip out .1;. System Location' ony the tab key to move your:, ,•��,/�� ,,%��Q, oanor,r Oo nQt ., ,` u�e'therotum:y '.;;. ; CItY/Town State U `":,l•1` '',',Y::{:.L){rA;'v :''i,.'/��': L•..,'�,.ib�' :rl ,,�fri2r ;.SY!stem Owner, , • •�'• 'c L' :$ J..�rt�'.;,i;):Y;'' t .:t r' 4:i h�gilt�;1••� ;•'Name' t+,;a+' I-•,;'J.,,L' t(r... ,..:,�..., , • •t'�•~.: , .1 ,.•IJII:'I�+rF�,lr..r'41r iY�r��Y�:yAr: 'l: �//J��"�./�,Q •Address Qf Morent from bcatlon) CltyRown, State' W 7rS7 e) Code Telephone Number 1.4 "Rum.ping ... `��. }' .1iP•.';: ! ,i:y7il.!1i11!.�,,Ir L(1� �� .y7 rp',�: •; ��.. ...i..(t•J:�d.tt,;"Y:!d/'",,'Jt.:.j1,1:+t•", i:'4'r'f••;'1,�,,:� v/ pin9, pale 2, Quandty Pumped: 'r ''% :,3. '�;''�� •°`��``" % `;•'� ,� ,.. Gallons lType pf system; ❑ cesspool($) Septic Tank CD Tight Tank Other(d � ' ��;�}rad`•:ii'*;;:r4;;; .8SC1'it).8�:';'� . 4•'„ E(�ue�t Tee Fllta(�pre Yes.❑ No If yes s It cleaned?,ea ? ❑ Yes ❑ No j , sent? wa l.'r;-�'r n'•�i};y(;i,4'1t{,Y�{[ �''r{j•!r "� t 6,1" . .. ,�ip••,,1 A�.::;; cr � ,� ,��'yi, i'yfil. t(uvr,r�•,':."�,,. 1 i :.,� .y,A'.•v^,�7�i`° ,.)'I+tr. �l'ii�r/I,J 7� ird..Vit. ) N r•1.p,, i t�;l r .i a v,t�` )I,rY'•,f: d tr'`,y,4 �� .�:, . . (/��j O `''//')�l I J. Yl',,'Jtt�:.y7' r,%,'•i!y� '(}'r I 'r•,."''' —"f Od l."�/�?�V l•L ' [V " N'•i' -,' J:��h�J,J{f;''l}i!fir Id` ,,4 .,-I..\t'i�t i \v .._. •%•�.''' '''i•`,;:y'' '.lP'1 Y.'�v\rJ'!•4t>;'H1{:I{'i;ii/la i,1,L;,;, AJ :1•i, i .i�,,.,,1j�.,`�.�;.�1.i+i�•, ame'1\"�?!,i�tl�!'i, 'i};1':'�,1+ , '1��;:'�'i. 1. Ucen+e Number • J'.. •J'i'. >i... ws l;r. V. Y��((�u�ly/� �'1'f) Srrt:.a�, �,.) .. .••>-, „,•• •:% Pj i4 �'l. �J}} J�� (/"�4/!,`,:};I i 1'y;.`° / '1 •:r:,?;; ,�.t�.F,:;;:,.,�-.,:7:;1'•.l.'oCa on.wti�ere contents' a ,��" ,'). �' i',ii/:. :;:•(,i.,il::;<',�f::;;:1� ..al ti' ,W. re:di;3posed: .'•. :i:'.•'S`'�i 'i, ,:1•.{i11,. '.�r•,yll,r;:.�+�„', ,I:i'tyi'4'' i.” l:' :I• � {'I p; C ' Hk t1i•• ,rr�,� t 1 tH: 1 'l'4.I },. ':;�4�:. .,.�i5)..;:..: �,?:Mit.d,y.fj+•1t'i;'t!•«t:,•1.,>`..r 'l yl: r'.7•. r ' `,,;'; '%'1�,:�::,i,°�';;:.%rJ`;(�`^r '•:';; ;Sipnahueo(Hauie(;Y�`�)rY'�.,',..:,.It. pa ' htt�/ti�tivrvrmaas•'9ov/deavrafe�/apprCva)s/t6forms,htm#Inspect to t5form4,doa�08/Q3 r .:' `, ':1' ��•,. :, " Sytlem Pumpinp Record Pa e I -j FEET LONG 18 STANDARD CHAMBERS of LEACH BED NOTES 1, SAFETY MEASURES. DAY-TO-DAY CONTRPL OF THE WORK AND w �v G�RGL _ - 70 CONSTRUCTION METHODS SHALL BE THE RESPONSIBILITY P p5 RE THE CONTRACTOR. EPSP SITE cn 2, UNLESS SPECIFIED OTHERWISE HEREON, SYSTEM CONSTRUCTION PO z SHALL CONFORM TO TITLE 5 OF THE STATE ENVIRONMENTAL CODE o ?'0 m AND LOCAL BOARD OF HEALTH CODE. ° m 0 3• ANY INTENDED REVISION OF PROPOSED ELEVATIONS AND / OR HORIZONTAL LOCATIONS AS SHOWN HEREON SHALL BE APPROVED BY THE ENGINEER AND THE LOCAL BOARD GF HEALTH PRIOR TO IMPLEMENTATION. B 36 4, THIS PLAN IS FOR DESIGN AND CONSTRUCTION OF THE SEPTIC � SYSTEM ONLY. PROPERTY LINES SHOWN HEREON ARE APPROXIMATE. 5, ALL WORK ON LINES, GRADES AND DETAILS SHOWN IS TO BE DONE y LOCUS N TS ---70 BY A LICENSED "DISPOSAL WORKS INSTALLERO. THE CONTRACTOR SHALL NOTIFY THE PROPER INSPECTORS AND ALLOW SUCH TIME AS PROPOSED SUBSURFACE IS REQUIRED FOR INSPECTIONS. 7, 6, ALL ERRORS, OMISSIONS AND CHANGE OF CONDITIONS AT THE SITE SEWAGE DISPOSAL SYSTEM 72 SHALL BE BROUGHT TO THE ATTENTION OF THE ENGINEER PRIOR TO UPGRADE EPTIC NK AS-" PERFORMING THE RELATED WORK. SBA DONED E 310 CMR 15.35 7, NO WELL OR WETLANDS ARE LOCATED UWIR]IN 100 FEET OF THE PROFILES & DETAILS - 74 LEACHING FACILITY. FOR : BEVERLY SHEA g, THE SEPTIC TANK SHALL BE INSPECTED ANNUALLY AND PUMPED -76 AS REQUIRED. AT: 105 SULLIVAN ROAD MAP 1078 LOT 10 NORTH . ANDOVER, MASSACHUSETTS g, WATER SAVER TOILETS AND SHOWER HEADS SHOULD BE USED WITH — 78 THE SYSTEM. DATE: AUGUST 28, 2003 SCALE: AS SHOWN 10. THIS SYSTEM HAS BEEN DESIGNED FROM JDATA REVIEWED AND DWG: GCS CHKD: CAM ACKNOWLEDGED BY THE LOCAL BOARD, OF HEALTH. .. 11. THE ISSUANCE OF A CONSTRUCTION PERMIT AND/OR A CERTIFICATE ENGINEERING & SURVEYING SERVICES \ .. OF COMPLIANCE SHALL NOT IMPLY ASA puARANTEE THAT THE SUBSURFACE SEWAGE DISPOSAL SYSTEM WILL FUNCTION SATIS— 70 BAILEY CT HAVERHILL, MA. 01832 \ OF HEALTH. of 978-815-7835 12. CONSTRUCTION OF LEACHING FACILITIES IN CLEAN GRANULAR °. on A.° 978-689-0839 FAX. FlLL: CLEAN GRANULAR FILL SHALL BE AS DEFINED IN THE 21.70' _ STATE ENVIRONMENTAL CODE, TITLE 5, REGULATION 15.255 & 9 SHALL CONFORM TO THE GRADATION SPECIFIED IN 15.255(3). A t � - 13. NO PUBLIC WATER SUPPLE WITHIN 400' .CF LEACHING FACIUTIES. F �oN 14. ALL JOINTS MUST BE MADE WATER TIGHT SHEET 1 OF 1 X15, THE CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UTIUTIES ' 4D BY CONTACTING DIG-SAFE AND MUNICIPAUTILITIES°�� N0. DATE REVISION BY PRIOR TO THE START OF EXCAVATION 111 9-22-03 LETTER FROM BRIAN LaGrasse GCS » > 16, SEPTIC SYSTEM IS NOT TO BE BACK FILLED WITHOUT INSPECTION BY 2 10-14-03 TRENCH SYSTEM, VENT & 6" STONE GCS AN 1 I ` 20THE BOARD OF HEALTH AND PERMISSION OBTAINED BY THE B-.O.H. 17, THE DOSING CHAMBER AND PUMPS MUST COMPLIE WITH. TITi:B� AND 3 10-30-03 add 1000 gallon pump chamber GCS NORTH ANDOVERS CODE SECTION 12.00. 1 NOTES. o EPs p[\Z> SITE 1. SAFETY MEASURES, DAY—TODAY CONTROL OF THE WORK AND ~ I CONSTRUCTION METHODS SHALL BE THE RESPONSIBILITY m !aN RO P� THE CONTRACTOR. SO 2. SHA NLESS SPECIFIED OTHERWISE HEREON, SYSTEM CONSTRUC LL CONFORM TO TITLE 5 OF THE STATE ENVIRONMENTAL CODE '/15/03 AND LOCAL BOARD OF HEALTH CODE. -� )N RATE: 10 MPI 3. ANY INTENDED REVISION OF PROPOSED ELEVATIONS AND / OR �� HORIZONTAL LOCATIONS AS SHOWN HEREON SHALL BE APPROVED BY �� THE ENGINEER AND THE LOCAL BOARD OF HEALTH PRIOR TO { :P HOLE 2 IMPLEMENTATION. y 4. IS PLAN IS FOR DESIGN AND CONSTRUCTION OF THE SEPTIC SYSTEM ONLY.- PROPERTY LINES SHOWN HEREON ARE APPROXIMATE. Ap 77.80' S. LOCUS NTS SANDY LOAM BY A LICENSED u DISPOSAL GRADES RKS INSTND ALLER*SHOWN IS TO BE DONE ALLER . THE CONTRACTOR PROPOSED SUBSURFACE �'R 3/2 SHALL NOTIFY THE PROPER INSPECTORS AND ALLOW SUCH TIME AS 77.30' IS REQUIRED FOR INSPECTIONS. SEWAGE DISPOSAL Bw1 S YS TE N1 SANDY LOAM 6. ALL ERRORS, OMISSIONS AND CHANGE OF CONDITIONS AT THE SITE UPGRADE �'R 4/4 SHALL BE BROUGHT TO THE ATTENTION OF THE ENGINEER PRIOR TO 76.05' PERFORMING THE RELATED WORK. Bw2 SANDY LOAM 7. No WELL OR WETLANDS ARE LOCATED WITHIN 100 FEET PROFILES & DETAILS OF THE R 6/6 LEACHING FACILITY. FOR : BEVERLY SHEA TrLEs AT: 105 SULLIVAN ROAD MAP 107B LOT 10 . . �,. . 75.13' 8. THE SEPTIC TANK SHALL BE INSPECTED ANNUALLY AND PUMPED 2 - AS REQUIRED. NORTH ANDOVER, MASSACHUSETTS /8 � SETTS Cl SL 9. WAS SAVER TOILETS AND SHOWER HEADS SHOULD BE USED WITH DATE: AUGUST 18, 2003 SCALE: AS SHO .5Y 5/6 THE SYSTEM. AVN DWG: GCS CHKD: CAM GAAMY SAND 72.80' 10. THIS SYSTEM HAS BEEN DESIGNED FROM DATA REVIEWED AND ' ACKNOWLEDGED BY THE LOCAL BOARD OF HEALTH. 4/6 ENGINEERING & SURVEYING SERVICES 70.38' 11' THE ISSUANCE OF A CONSTRUCTION PERMIT AND/OR A CERTIFICATE 70 BAILEY CT H OF COMPLIANCE SHALL NOT IMPLY AS A GUARANTEE THAT AVERHILL, MA. 01832 WA SUBSURFACE SEWAGE DISPOSAL SYSTEM WILL;FUNCTION SATTS— WATER NO OF HEALTH. ��N of 978-815--7835 12. CONSTRUCTION OF LEACHING FACILITIES IN CLEAN GRANULAR 0 �� 978-689-0839 FAX. FILL: CLEAN GRANULAR FILL SHALL BE AS DEFINED IN THE s STATE ENVIRONMENTAL CODE, TITLE 5. REGULATION 15.255 &THE iv�� SHALL CONFORM To THE GRADATION SPECIFIED IN 15.255(3). SS/0 L EN�� 13. NO PUBLIC WATER SUPPLE WITHIN 400' OF LEACHING FACILITIES. _XAMINATION APPROVED BY 14. ALL JOINTS MUST BE MADE WATER TIGHT SHEET 1 OF 1 f THE ABOVE ANALYSIS 15. THE CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UTIUTIES NO ATE REVISION D, EXPERTISE BY BY CONTACTING DIG—SAFE AND MUNICIPAL UTILITIES PRIOR TO THE START OF EXCAVATION 16. SEPTIC SYSTEM ISNOT TO BE BACK FILLED WITHOUT INSPECTION BY THE BOARD OF HEALTH AND PERMISSION OBTAINED BY THE BOR.. CROSS SECTION VIEW iD'- " X 5'-8 1500 GALLON DESIGN CRITERIA 15 TION NOTE: STANDARD 20' DIAN. MANHOI-M (SHEA CONCRETE PRODUCTS 1. BUILDING TYPE: DWELLING OR EQUIVALENT) .L REMOVE ALL UNSUITABLE 4' DIA MASTIC PIPE SEAL 2. NO. OF BEDROOMS: 4 + =ET AROUND PROPOSED 4" TOP (6" H-20 4' DIA PLASTIC PIPE SEAL I REPLACE WITH CLEAN 3. DESIGN FLOW: 4 x 110 GAL/BDRM/DAY = 440 GAL/DAY 3' 'ILL IN COMPLIANCE WITH °LITLEr 6' _ 3 13 T INLET 4. FIELD PERCOLATION RATE: 10 M.P.I. (3) — (6) TO ELEVATION 14. 5. GARBAGE DISPOSAL YES NO X DPOSED LEACH BED SCH 40 PVC GAS BAFFLE =41IRT BEAMS 5,8, 6. EFFLUENT LOADING RATE: 0.60 GAL/DAY/SF 4'-4• SOIL CLASS: II DESIGN PERCOLATION RATE: 10 MIN/INCH 4,7' j 7. TOTAL LEACH AREA REQUIRED: HEA LOCAL CODE: 734 SQ. FT. TITLE 5 734 SQ. FT. PROVIDED: 800 SQ. FT. z BOTTOM: 800. SQ. FT. x 0.60 GAL/SQ. FT. = 480 GAL/DAY 4' 4' SECWN VIEW SEPTIC TANK SHALL CONFORM IN ALL RESPECTS SIDE: SQ. FT. x GAL/SF = GAL/DAY TO THE REQUIREMENTS OF TITLE 5, SECTIONS 15.223, 15.226, 15.227 AND 15.228 6" CRUSHED TONE BASE TOTAL: 800 SQ. FT. OR 480 GAL/DAY • 8. LEACH AREA: 20 FOOT WIDE BY 40 FOOT LONG LEACH BED DETAIL — DISTRIBUTION BOX not to scale 'OUR 00 137 oo' 4" ^ = l r � I I (8) 4" DIA OUTLETS c� tp tv 9E I PLASTIC PIPE SEAL O �►�. _o 10" 8,. ' CV I �- 2'-5" , hh PLAN VIEW NOTES: H-10 LOADING 6" CRUSHED STONE BASE 1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS. SECTION VIEW 2, DESIGN CONFORMS WITH 310 CMR 15.000, DEP 3. OUTLET PIPES MUST BE LIAR LEVEL FOR 2'. th TITLE 5 REGS, FOR DISTRIBUTION BOXES. hry Ary SECTION — LEACH AREA not to scaleo^° SLOPE FINISH SURFACE TO DRAI ) A rvvvqmu SEED 26048-' $�0 121.70' 6" Z .coVC. 3/4 -1 1/2" WASHED STONE 2'-6" 5'_0" 5-0" 5'-0" LOT PLAN 1 2'-6" "-= 100' SITE PLAN V` 20 ' SOIL TE TESTS BY: GREG SAAB WITNESS: SANDRA STAI DEEP HOLE # 1 TOP OF 'OUNDATION = 80' 0" Ap 73.70' i FINE SANDY LOAM a 10YR 2/2 04 6" 73.20' n MANHOLES Bw TO GRADE pFINE SANDY LOAM ROpOSEO G 10YR 4/4 RADE 26" 71.53' _ EXISTING GRADE 38„ MOTTLES _ 70.53' 5-0.02 3 2.5Y 6/2 69. z SC S=0.01 TOP OF STONE=75.53' 15' 1 7.5YR 5/8 PEI H 40 I Cl FSL SCH 40 S = 0.005 66�� 10YR 5/6 S\ 40 68.20' I N BED BOTTOM=74.53' ,Mo / DBOX C2 1,500 to M �, n GR LOAMY SAND GAL Ui Ui p II 2.5Y 5/6 TANK r- rl� F- f II II � � Z X-HATCH AREA SEE SPECIAL CONSTRUCTION NOTE 63.70' o n �� 120" r tri Z _ ESH WT ® 38" 70.53' II it OBSERVED WATER 90" PERCOLATION RATE: 10 MPI WATER TABLE=70.53' SOAK - 11:26 12" - 11:41 z z _ 9" 12:07 6" - 12:37 PROFILE SEPTIC SYSTEM I GREG SAAB CERTIFY THAT ON 6/9E THE DEPARTMENT OF ENVIRONMENTAL HAS BEEN PERFOMED BY ME CONSIS' 1 " 2 0 ' H O R I Z . 1 22 � ' VE R T� AND EXPERIENCE DESCRIBED IN 310 � i AREA -= 99, 425 S. F. %2 /80 80 ---- 78 TP#2 77.80 / M 76 I _-- - 72 76 / . 20 70 !.' <_ -i W � EXISTING INGROUND POOL ry U o D 25.4 ^ { D-BOX ' 5 7p s4 - _ BM = BOTTOM SIDING 80.00, 72 EXISTING FEEING/ 10,, #105 1,500 GA LON TA K -74 76 �Yq 78 78 m v • TOTAL CYCLE TIME 11 440.GALLONS/60GPM = 7.3 MINUTES STORAGE ABOVE ALARM ON (7.33)(4.5)(1.50) = 59.37 CF -76 (59.37CF)(7.46 GAL/CF) = 444 GALLONS r r TOTAL STORAGE CAPACITY � (444 GAL)/(440 GAL/DAY)(24HRS/DAY) = 24 HOURS Ory DOSING CYCLES PER DAY A)� EXISTING INGROUND TOTAL DAILY FLOW = 440 GALLONS POOL \ VOLUME PER DOSE = 440 GALLONS CYCLES PER DAY = 440/440 = 1 CYCLES/DAY NO FOUNDATION DRAT \ 20 25.4 � 0 w 15 ERFp MAN cp- LL_ ve z • BM = BOTTOM SIDING = 80.00' Off` p 10 iiiiiiii O,y. LQ EXfSTING DWELLING 10 ►� _ s #105 1 1,5( 5 O 0 10 20 30 40 50 60 70 80 90 100 r CAPACITY GALLONS PER MINUTE '8 D PUMP NOTES: 1) THE PUMP SHALL BE A MYERS SRM4 (OR APPROVED EQUAL), 0.4 H.P., 115 VOLT, SINGLE PHASE, HEAVY, 80 DUTY, HIGH CAPACITY, SUBMERSIBLE PUMP CONSTRUCTED OF CORROSION RESISTANT STAINLESS STEEL. IT SHALL ALSO BE CORROSION RESISTANT, OIL FILLED BALL BEARING MOTOR, WITH HEAVY DUTY MOTOR COVER AND PUMP CASE, AND A NON—CLOG IMPELLER. IT SHALL HAVE A 2" DISCHARGE PIPE, HAVE A QUICK DISCONNECT 260,48 0 ASSEMBLY, AND HAVE THE ABILITY TO PUMP TO 9 FEET OF TOTAL DYNAMIC HEAD (TDH) ® 60 GPM. 28� 2) THE CONTROLLER SHALL BE MANUFACTURED TO WORK WITH THE PUMP ABOVE AND SHALL HAVE N/F BREEDEN 82 MERCURY FLOAT SWITCHES FOR ON, OFF AND HIGH WATER ALARM FUNCTIONS. IT SHALL INCLUDE A RED 82 ALARM LIGHT, AND BUZZER ALARM FOR THE HIGH WATER FUNCTION. THE CONTROLLER SHALL BE MOUNTED T r T r rT IN THE BASEMENT, IN AN AREA DESIGNATED BY THE OWNER. S T T. �/ 3) PUMP WIRES FROM THE CONTROLLER TO THE PUMP STATION SHALL BE PLACED IN SMOOTH WALL PVC I CONDUIT — TYPE DB-120 CONFORMING TO ASTM F 512. 4) THE PUMP SEQUENCE AND INSTALLATION SHALL COMPLY WITH REGULATION 9 OF TITLE V. TESTS BY: GREG SAAB DATE: 7/15/03 < WITNESS: SANDRA STAR PERCOLATION RATE: 10 MPI N/F GAUTHIER DEEP HOLE 1 1 DEEP HOLE # 2 < N/F MARCEAU 0" AID 73.70' O„ A 77.80' _ FINE SANDY LOAM P f FINE SANDY LOAM 70010 ( 10YR 2/2 10YR 3/2 ` 6" Bw 73.20' 6" 77.30' TOP OF Bw1 FINE SANDY LOAM FINE SANDY LOAM j FOUNDATION 10YR 4/410YR 4/4 80' 26" 71.53' 2192 Bw2 76.05' MOTTLES 70F.53' , 38 — -�* FINE SANDY LOAM p 2.5Y 6/2 - 69.12 10YR 6/6 ^� 7.5YR 5/8 PERC Cl FSL 32„ MOTTLES -� 75.13' ' 66" 10YR 5/6 68.20' 2.5Y 6/2 ANHOLES TO PROPOSED 7.5YR 5/8 • WITH*, 6" OF GRADE SOLID PIPE SCH40 G RADE C2 2C5YS5/6 1�/F GENTILE 4" F.M. CH40 LAST 3' GR LOAMY SAND 2.5Y 5/6 60" 72'80' II INFILTRTOR TOP=75.53' C2 w GR LOAMY SAND M 10YR 4/6 rj, o 120" 1 1 63.70 890$ 70,38' \NFILTRTOR BOTTOM=74.52 ESH WT @ 38" 70.53' ESH WT 32 � z OBSERVED WATER NO O o OBSERVED WATER 90 S'0.02 1,500 n PERCOLATION RATE: 10 MPI GAL SOAK - 11:26 S 40 TANK 12" - 11:41 1eAL0 9' - 12:07 o PUMP DBOX 6" — 12:37 /� p TANK M o0 L Z COMPACT FIRM BASE II ori to I GREG SAAB CERTIFY THAT ON 6/96 1 HAVE PASSED THE EXAMINATION APPROVED BY V) THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE ANALYSIS b o II II HAS BEEN PERFOMED BY ME CONSISTENT WITH THE REQUIRED, EXPERTISE co N = F- f- WATER TABLE=70.5 AND EXPERIENCE DESCRIBED IN 310 CMR 15.018(2). ci ^ U ir Of N cv II � � z II II II of PROFILE — SEPTIC `. z z z z 1 "=20' H OR I Z. 1 PUMP CHARACTERISTICS Z — BOTTOM OF TANK= 68.30' Vo tiuE PER DOS h� (7.33')(4,5')(1.78') = 58.82 CIF tp�`• (58.82 CF)(7•46GAL/CF)= 440 GALLONS PER DOSE FAN HFe� [20'(PIPE)+15'(ELBOWS)+15'(CHECK VALVES)]*(4.84/100) = 2.5' J� 99, 425 425 S• F. AREA s2 CROSS SECTION VIEW SEPTIC TANKS SHALL. BE MADE FULLY WATERTIGHT DESIGN CRITERIA 10'-6` X 5'-8' IN ACCORDANCE WITH TITLE 5 15.221 (1) (a) AND (b) 1500 GALLON :(IAL CONSTRUCTION NOTE: STANDARD H-10 LOADING 1. BUILDING TYPE: DWELLING (SHEA CONCRETE PRODUCTS �� DIAMI MANHOLE OR EQUIVALENT) 2. NO. OF BEDROOMS: 4 24' NHOLE COVER �ITRACTOR SHALL REMOVE ALL UNSUITABLE 3. DESIGN FLOW: 4 x 110 GAL/BDRM/DAY = 440 GAL/DAY LS IN AND 5 FEET AROUND PROPOSED r7=0171 , � .4• DIA PLASTIC PI 4" 7'�P 4' DIA PLASTIC JINLEr 4. FIELD PERCOLATION RATE: 10 M.P.I. BCH AREA AND REPLACE WITH CLEAN ;tj73- kNULAR SAND FILL IN COMPLIANCE WITH 0 6 3 5. GARBAGE DISPOSAL : YES NO x 'ULATION 15.255 (3) — (6) TO ELEVATION —� 6. EFFLUENT LOADING RATE: 0.60 GAL/DAY/SF BOTTOM OF PROPOSED LEACH BED sCH 40 PVC L1Q� LEVEL 10' SOIL CLASS: II DESIGN PERCOLATION RATE: 10 MIN/INCH SUPPORT (BEAK GAS BAFFLE 518' 7. TOTAL LEACH AREA REQUIRED: 4'-4' 4`7' LOCAL CODE: 734 SQ. FT. TITLE 5 734 SQ. FT. 1 .1 PROVIDED: 734 SQ. FT. SHEA STANDARD CHAMBER: 37.5' X 3 X 6.53SF/LF = 734 SQ. FT. ENT II 734 SQ. FT. x 0.60 GAL/SQ. FT. = 440 GAL/DAY 4' 4' J SECTON MEW I I TOTAL: 734 SQ. FT. OR 440 GAL/DAY SEPTIC TANK SHALL CONFORM IN ALL RESPECTS COMPACT TO THE REQUIREMENTS OF TITLE 5, SECTIONS 6" CRUSHED $' LEACH AREA: 18 UNITS - 3 TRENCHES 34 WIDE BY 37.5' L 15.223, 15.226, 15.227 AND 15.228 TONE BASE STANDARD CHAMBER TRENCH SYSTEM VENTED { EX SUNG GRADE VELOCITY REDUCING TEE DETAIL — DISTRIBU11ON BOXVELocITY REDUCING TEE PUMP TANKS SHALL BE MADE FULLY WATERTIGHT not to kale ` ! IN ACCORDANCE WITH TITLE 5 15.221 (1) (a ) AND cV 4" 3 :.. / I (8) 4" DIA OUTLETS PLASTIC PIPE SEAL1,000 GALLON PUMP TANK 1 40mi1 HDPE BARRIER I 9 '- TOP = 75.75 e BOTTOM MIN 1' INTO EXISTING GRADE 10 _ FINISHED 2'-5" GRADE FRAME do GRATE (T' CQMPACT BRICK (iYP) PLAN VIEW 6° CRUSHED 24' MANHOLE COVER NOTES: H-10 LOADING STONE BASE 1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS. SECTION VIEW 3. OUTLET;PIPES MUST BE UAD LEVEL FOR 2'. 1/4 WEEP HOLE X—HATCH AREA SEE SPECIAL CONSTRUCTION NOTE z, DESIGN CONFORMS WITH 310 CMR 15,000, DEP FROM 1,_1. CHECK VALVE TITLE 5 REGS, FOR DISTRIBUTION BOXES. SEPTIC TANK ♦ •' VARIES 4'-7' T PUMP STORAGE ABOVE ALARM =a 70.75' PUMP ALARM= 444 STANDARD INFILTRATOR CHAMBER ON ® 70.58' = OFF = 68.80' 1sT/F BO UCHER 12° 6INVERT $o •6' crushed stone c L 15' ;TEM 75' I —7 BOTTOM=68.30' LELEND (EFFECTIVE VERT. LENGTH) 84 — — EXISTING CONTOUR VENT DETAIL / CLEANOUT WITH PLUG F841 34' ----�, NTS nananatIn rL)ens+ �n0 pf No,Tti 11, ' 5541 Town of North Andover ' '••;;;o:. ,' HEALTH DEPARTMENT ,SSACNUStt , CHECK#: DATE: LOCATION: H/O NAME: CONTRACTOR NAME- Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrasWSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 55IInspector $ I 0 �i•t eT 5 Report $0(J ❑ Other. (Indicate) $ // Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer IN Commonwealth of Massachusetts � ��0 ao Title 5 Offidal Inspection Form ° Subsurface Sewage Disposal System Form-Not for Volunta �� 105 Sullivan Street Property Address JUN Beverly Shea Owner Owner's Name TOWN OF NORTH ANDOVER information is North Andover MA 018 HEALTH NT required for every -.- page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Neil J. Bateson use the return Name of Inspector key. Bateson Enterprises Inc. 111 Argilla Road Company Address Andover Ma 01810 City/Town State Zip Code 978-4754786 S 11 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Nee s Further Evaluation by the Local Approving Authority 6/16/2011 Inspector's Signatu 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. �I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 II • Commonwealth of Massachusetts Title 5 Official Inspection Form J Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ® N ® ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owners Name information is required for every North Andover MA 01845 6/16/2011 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ® N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND(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): brokenpipe(s)are re laced Y N ND(Explain below): ❑ P ❑ ® ❑ ( P ) ❑ obstruction is removed ❑ Y ® N ❑ ND(Explain beiow): I 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-09/08 We 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. 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 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: Inlet tee, center riser cover, cement outlet pipe in combo septic tank, outlet pipe to pump tank, d-box &junction box for pump needs to be replaced. Rubber couplings on pump discharge needs to be changed to solid pipe couplings 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 El ® 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•09108 Title 5 Official Inspection Forth:Subsurface Sawage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Cityrrown 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 oiere 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: ® ElExisting 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 09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes E] N o Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 Years usage(gPd )) Yes Detail: Sump pump? ® Yes ❑ No* Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? m ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 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 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped last year, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees 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•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 \ Commonwealth of Massachusetts D. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address . Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 7 years old, 1/10/2004, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: Leet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"cast iron thru floor, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' x 5'x 4' Sludge depth: 1" t5ins•09/08 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 M 105 Sullivan Street Property Address Beverly Shea Owner Owners Name information is required for every North Andover MA 01845 6/16/2011 page. Cityfrown 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 24" Scum thickness 1" 819 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 20" 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.): Pumped septic tank. No Inlet tee. Center riser cover not the correct size. Outlet tee not cemented in tank. Outlet pipe higher than inlet pipe causing septic tank to be flooded. 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: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. 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.): I I I Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fibergi ass ❑ polyethylene ❑other(explain): I 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•09/08 Title 6 Official Inspection Farm:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. 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.): Plastic d-box is broken, needs to be replaced with H-20 box. D-box level &distribution equal. No evidence of leakage. No evidence of carryover. 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.): Rubber coupling on pump discharge needs to be replaced. Junction box for pump&alarm wires has water in it& needs to be replaced. Pump ok.Alarm is both audible&visual Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3 trenches with 18 infiltrators ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Trenches has six infiltrators per trench 9 9 p 9 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•09/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal Svstem•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .y SV.yy 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. City(rown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Cityr town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3 L4 a. o1 0 a= 1B 11 3 4 ao Cw TG^^k t5ins•09/08 Title 5 Official-inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. City/Town 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: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 7/15/2 If checked, date of design plan reviewed: Date 003 D ❑ Observed site(abutting property/observation hole within 150 feet of SAS) lain:� 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 filling this Inspection Report,please see Report Completeness Checklist on next page. t5ins•09108 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 Form-Not for Voluntary Assessments 105 Sullivan Street Property Address Beverly Shea Owner Owner's Name information is required for every North Andover MA 01845 6/16/2011 page. Citylrown 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•09108 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Sumpnary Record Card generated on 6/15/2011 1:55:13 PM by Karen Hanlon Page Town of North Andover Tax Map # 210-1073-0010-0000.0 Parcel Id 18124 105 SULLIVAN STREET SHEA, BEVERLY A. 105 SULLIVAN STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residentia Size Total 2.28 Acres FY 2011 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Unti SHEA,BEVERLY A. Payor 105 SULLIVAN STREET N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13786.0-105 SULLIVAN STREET Last Billing Date 5/3/2011 1090463 01 Cycle 01 Active Bldg Id.13787.0-105 SULLIVAN STREET Last Billing Date 5/3/2011 1090464 01 Cycle 01 Active UB Services Maint. Account No.1090463 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 41.80 /1 Account No. 1090464 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 15.20 /1 UB Meter Maintenance Account No.1090463 Serial No Status Location Brand Type Size YTD Cons 16336693 a Active 00 METE METE w Water 0.63 0.63 211 Date Reading Code Consumption Posted Date Variance 4/22/2011 854 a Actual 11 5/16/2011 -7% 1/25/2011 843 a Actual 13 2/11/2011 12% 10/21/2010 830 a Actual 11 11/12/2010 -35% 7/22/2010 819 a Actual 17 8/16/2010 21% 4/22/2010 802 a Actual 14 5/12/2010 -7% 1/21/2010 788 a Actual 15 2/12/2010 -13% 10/22/2009 773 a Actual 17 11/11/2009 -18% 7/24/2009 756 a Actual 21 8/12/2009 1% 4/24/2009 735 a Actual 21 5/13/2009 -9% 1/22/2009 714 a Actual 23 2/10/2009 0% 10/22/2008 691 a Actual 23 11/12/2008 -10% 7/22/2008 668 a Actual 25 8/15/2008 19% 4/23/2008 643 a Actual 20 5/19/2008 6%, 1/28/2008 623 a Actual 21 2/19/2008 -22% 10/24/2007 602 a Actual 27 11/16/2007 -25%0 7/20/2007 575 a Actual 34 8/15/2007 59%o 4/20/2007 541 a Actual 19 5/21/2007 7% 1/29/2007 522 a Actual 21 2/20/2007 -30% Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of house, right front of house, left side of house,Q'u'rn—i E�o Left rear of house, right rear of house, left side of building, right rear of building, Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) CitylTown State �� UZip Code Telephone Number B. Pumping Record �— 1. Date of Pumping 2. Quantity Pumped: � Date Gallons 3. Type of system: ❑ Cesspool(s) a<eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? Yes ❑ No 5. Condition of System: 6. System PumpePBy: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: S.0. owqjWaste/JVatpwj Signature H ler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Septic System Information 105 SULLIVAN STREET Printed On:Monday, November 14, 2011 System ID: BHS-2003-0059 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity. Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Hauling/Pumping Listing Quantity Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Septic Tank STEWARTS SEPTIC 20 So. Mill Street, Bradford 10/25/2005 1500 Comments: riding high Routine Septic Tank Andover Septic 20 So.Mill Street, Bradford 11/30/2006 1500 Comments: xx solids top&bottom Routine Septic Tank Andover Septic 20 So.Mill Street, Bradford 12/05/2007 1500 Comments: good condition Routine Septic Tank Andover Septic 20 So.Mill Street, Bradford 11/19/2008 1500 Comments: good Routine Septic Tank Andover Septic 20 So.Mill Street, Bradford 11/27/2009 1500 Comments: good Routine Septic Tank Bateson Ent GLSD 06/16/2011 1500 Comments: tank flooded found outlet pipe higher than inlet Structures Structure Type Status Address OPEN 105 SULLIVAN STREET Inspections: Inspected: Expires: Inspector: Status: 06/16/2011 Neil J. Bateson Conditionally Passes Comments: Title 5-Inlet tee,center riser cover,cement poutlet pipe in combo septic tank,outlet pipe to pump tank,d-box&junction box for pump n eeds to be replaced. Rubber couplings on pump discharge needs to be changed to solid pipe couplings. GeoTMS®2011 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Of HO RTI/,� 5592 . O Town of North Andover ,,.. HEALTH DEPARTMENT CNUSk4 CHECK#: ,N DAT / LOCATION: Z7 H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑�ZW5 uspector $ eport $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer 5 59 Town of North Andover HEALTH DEPARTMENT ,SSACNUSfS f CHECK#: �// DAT f LOCATION: l H/0 NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSystems : ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5-Inspector $ ftle 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer, Dean Dynan 2 Suntaug Street Lynnfield, MA 01940 REQ 508-726-9935 AUG 2M11 TOWN OF NM ANDOVER HEALTH DEPARTMENT 8/15/11 N. Andover Health Dept. To whom it may concern, Enclosed is a check for the Title 5 report you have in hand. Sorry for the inconvenience. Call with any question. ^ Dean Dynan Certified Title 5 Inspector -TOWNO,�Nps ANDOVER N License# SI 12837 I � Dean R..Dynan �. 2 3untaug St M;•, Lynnffeld,:MA 0"1940 1421' 1 Ido su/fie a-36 N6 ,mss~,, d I�=.:.i.w°.•'"s'=' a.'«."'�%.°; iHill 111111fflfill#itithill��#llffl!!il!!/!t!!1!�l�lf7lEii� Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Ass smel�t�o Vli lV/ 105 Sullivan St F NORTH ANDOVItR Property Address HEALTH DEPA Beverly Shea Owner Owner's Name information is required for North Andover every page. City/Town i Inspection results must I: way. Please see complett Important: A. General Inform When filling out forms on the �C1//��✓ �-` computer,use 1. Inspector: only the tab key to move your Dean Dynan cursor-do not Name of Inspector use the return kgey. �I Company Name . 2 Suntaug St Company Address Lynnfield 01940 run City(rown State Zip Code 508-726-9935 S112837 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. i ****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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Ass smeIN t Ei ` 011 1 M 105 Sullivan St F NORTH ANDOVER Property Address HEALTH dEhA . Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Dean Dynan cursor-do not Name of Inspector use the return key. Company Name r� 2 Suntaug St Company Address Lynnfield Ma 01940 reran City/Town State Zip Code 508-726-9935 S112837 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �)V-,C�--,-\ 61 - Irrs'pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: system in working order 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 s tents. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank ether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltratio or tank failure is imminent. System will pass inspection if the existing tank is replaced with a co lying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is s cturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less th 20 years old is available. ❑ Y ❑ N ❑ ND (E ain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or u_neven 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 replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The sy em required pumping more than 4 times a year due to broken or obstructed pipe(s). The syst will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Expl ' -below): ❑ obstruction is removed El [IN F1 (Explain below): C) Further Evaluation is/edba Board of Health: ❑ Conditions exist whichr evaluation by the Board of Health in order to determine if the system is failing tohealth, safety or the environment. 1. System will pass of Health determines in accordance with 310 CMR 15.303(1)(b)that thefunctioning in a manner which will protect public health, safety and the envi nment: ❑ Cesspo or privy is within 50 feet of a surface water ❑ C spool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I w 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. 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 p health, safety and environment: ❑ The system has a septic tank and soil absorption system (S ) and the SAS is within 100 feet of a surface water supply or tributary to a surface water upply. ❑ The system has a septic tank and SAS and the SA within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and th AS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system X9b ter analysis, performed at a DEP certified laboratory, for fecal coliform bacterand the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than at no other failure criteria are triggered. A copy of the analysis must be attached to 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town 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 followin ' ddition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a s ce drinking water supply ❑ ❑ the system is within 200 fe of a tributary to a surface drinking water supply El El Area system is locate i a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or apped Zone II of a public water supply well If you have answered "yes"to an uestion in Section E the system is considered a significant threat, or answered "yes" in Section above the large system has failed. The owner or operator of any large system considered a sign' ' ant threat under Section E or failed under Section D shall upgrade the system in accordance h 310 CMR 15.304. The system owner should contact the appropriate regional office of th epartment. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. Cityrrown 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 ® El 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. ® El approximation 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•11/10 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 M •''r 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): S C Detail: Sump pump? ® Yes ❑ No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons y(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank prese ❑ Yes ❑ No Non-sanitary waste disc ged to the Title 5 system? ❑ Yes ❑ No Water meter r ings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: homeowner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 7 years old as per plan 1/2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: about 3' feet Material of construction: ® cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): cast iron converted to sch 40 pvc no signs of leakage Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon two compartment concrete tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'-6"X 5'-8"X 5'-8" Sludge depth: 0-3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 0-1" 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 16" How were dimensions determined? in field measure stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should beeve um ed 2-3 ears or as needed p p every Y Media filter in tank should be extracted and cleaned annually or as needed to avoid clog and possible back up into house/filter cover located at grade for service access inlet and outlet PVC tee liquid at bottom of outlet pipe with separation/no evidence of leakage into or out of tank/ center cover at grade for service access Grease Trap(locate on site plan): Depth below grade: feet Material of construction: El concrete El metal El fiberglass Elpol ylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top outlet tee or baffle Distance from bottom of m to bottom of outlet tee or baffle Date of last pum Date t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal El fiberglass ❑ polye lene El other(explain): Dimensions: — z Capacity: Zigallons ns Design Flow: per day Alarm present: Yes ❑ No Alarm level: Alarm in working order: E] Yes E] No Date of last pXndition Date Comments rm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is North Andover Ma 01845 8/2/2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert liquid at bottom of outlet pipe 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.): PVC 6 outlet D box with 4 inch pvc inlet and diffuser T for forced main/ 3 pvc outlet lines/ box is level no signs of solids carryover/ no signs of leakage into or out of box / box is located 3" below grade 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.): 1000 gallon concrete pump chamber with cast iron cover to grade / 4" pvc inlet 2" pvc forced main outlet / pump&alarm in working order Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3 @ 36' ❑ 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 in good condition/no signs of hydraulic failure, no ponding , sas located in green lawn area with slight slope not to hold rain water sas is infiltrators 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 ces of Mated f construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locatesite plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic fail evel of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �60 W � 0 0 a f< c�.a� j� _ �� P C Al U` r vf- o -D aC �6 t5ins•11/10 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 M , 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 every page. City/Town 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: 4 feet 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: 7/2003 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: plans on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: plans on file with BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official-inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 105 Sullivan St Property Address Beverly Shea Owner Owner's Name information is required for North Andover Ma 01845 8/2/2011 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Summary Record Card generated on 8/5/2011 10:35:36 AM by Karen Hanlon Page 1 • Town of North Andover Tax Map # 210-107.B-0010-0000.0 Parcel Id 18124 105 SULLIVAN STREET SHEA, BEVERLY A. 105 SULLIVAN STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 2.28 Acres FY 2011 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until SHEA, BEVERLY A. Payor 105 SULLIVAN STREET N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13786.0-105 SULLIVAN STREET Last Billing Date 8/4/2011 1090463 01 Cycle 01 Active Bldg Id. 13787.0-105 SULLIVAN STREET Last Billing Date 8/4/2011 1090464 01 Cycle 01 Active UB Services Maint. Account No. 1090463 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 92.65 /1 Account No. 1090464 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 19.00 /1 UB Meter Maintenance Account No. 1090463 Serial No Status Location Brand Type Size YTD Cons 16336693 a Active 00 METE METE w Water 0.63 0.63 234 'Date Reading Code Consumption Posted Date Variance 7/22/2011 877 a Actual 23 8/15/2011 100% 4/22/2011 854 a Actual 11 5/16/2011 -7% 1/25/2011 843 a Actual 13 2/11/2011 12% 10/21/2010 830 a Actual 11 11/12/2010 -35% 7/22/2010 819 a Actual 17 8/16/2010 21% 4/22/2010 802 a Actual 14 5/12/2010 -7% 1/21/2010 788 a Actual 15 2/12/2010 -13% 10/22/2009 773 a Actual 17 11/11/2009 -18% 7/24/2009 756 a Actual 21 8/12/2009 1% 4/24/2009 735 a Actual 21 5/13/2009 -9% 1/22/2009 714 a Actual 23 2/10/2009 0% 10/22/2008 691 a Actual 23 11/12/2008 -10% 7/22/2008 668 a Actual 25 8/15/2008 19% 4/23/2008 643 a Actual 20 5/19/2008 6% 1/28/2008 623 a Actual 21 2/19/2008 -22% 10/24/2007 602 aActual 27 11/16/2007 -25% 7/20/2007 575 a Actual 34 8/15/2007 59% 4/20/2007 541 a Actual 19 5/21/2007 7% I Summary Record Card generated on 8/5/2011 10:35:36 AM by Karen Hanlon Page 2 • Town of North Andover L Tax Map # 210-107.B-0010-0000.0 Parcel Id 18124 105 SULLIVAN STREET SHEA, BEVERLY A. 105 SULLIVAN STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 2.28 Acres FY 2011 1/29/2007 522 a Actual 21 2/20/2007 -30% 10/25/2006 501 aActual 28 11/16/2006 -12% 7/28/2006 473 a Actual 31 8/18/2006 64% 5/2/2006 442 a Actual 20 5/16/2006 -6% 1/30/2006 422 a Actual 22 2/13/2006 -12% 10/27/2005 400 a Actual 26 11/9/2005 -9% 7/20/2005 374 a Actual 26 8/10/2005 52% 4/21/2005 348 a Actual 15 5/13/2005 -10% 2/1/2005 333 a Actual 21 2/15/2005 10% 10/25/2004 312 a Actual 16 11/15/2004 -55% 8/3/2004 296 a Actual 38 8/25/2004 .101% 5/7/2004 258 a Actual 20 6/8/2004 1% 2/4/2004 238 a Actual 21 2/24/2004 0% 10/28/2003 217 n New Meter I 0 10/28/2003 0% Account No. 1090464 1 11 'f Serial No Status LocaYon Brand Type Size YTD Cons 99885615 a Active 00 METE METE w Water 0.63 0.63 56 Date Reading Code Consumption Posted Date Variance 7/22/2011 250 a Actual 5 8/15/2011 20% 4/22/2011 245 a Actual 4 5/16/2011 10% 1/25/2011 241 a Actual 4 2/11/2011 -5% 10/21/2010 237 a Actual 4 11/12/2010 -20% 7/22/2010 233 a Actual 5 8/16/2010 0% 4/22/2010 228 a Actual 5 5/12/2010 25% 1/21/2010 223 aActual 4 2/12/2010 -1% 10/22/2009 219 a Actual 4 11/11/2009 -19% 7/24/2009 215 a Actual 5 8/12/2009 68% 4/24/2009 210 a Actual 3 5/13/2009 -40% 1/22/2009 207 a Actual 5 2/10/2009 25% 10/22/2008 202 a Actual 4 11/12/2008 -2% 7/22/2008 198 a Actual 4 8/15/2008 -4% 4/23/2008 194 a Actual 4 5/19/2008 12% 1/28/2008 190 a Actual 4 2/19/2008 -20% 10/24/2007 186 a Actual 5 11/16/2007 58% 7/20/2007 181 a Actual 3 8/15/2007 -11% 4/20/2007 178 a Actual 3 5/21/2007 -29% 1/29/2007 175 a Actual 5 2/20/2007 55% 10/25/2006 170 a Actual 3 11/16/2006 -27% 7/28/2006 167 a Actual 4 8/18/2006 6% 5/2/2006 163 a Actual 4 5/16/2006 38% 1/30/2006 159 a Actual 3 2/13/2006 -22% 10/27/2005 156 a Actual 4 11/9/2005 -9% 7/20/2005 152 a Actual 4 8/10/2005 -30% 4/21/2005 148 a Actual 5 5/13/2005 25% 2/1/2005 143 a Actual 5 2/15/2005 5% 10/25/2004 138 a Actual 4 11/15/2004 -29% 8/3/2004 134 a Actual 6 8/25/2004 -9% 5/7/2004 128 a Actual 7 6/8/2004 6% 2/4/2004 121 a Actual 7 2/24/2004 0% 10/28/2003 114 n New Meter 0 10/28/2003 0% I i I N D TE SEPTIC SYSTEM AS-BUILT THE PUMP USED IS DIFFERENT ,''r',AN PROPOSED BUT IS AN APPROVED EQUAL TO THE PROPOSED BEVERLY SHEA PUMP. LOCATION: 105 SULLIVAN ROAD NORTH ANDOVER ,MA. DATE: f-10-01Y 3, 34 3 SCALE: 1" = 20' " 3"1 _Y- >_) ' A TO D = 26.2' (D= DBOX) A TO C = 22.3' (C = SEPTIC TANK) A TO E = 28.2.' (F = PUMP TANK) � . 'J c,<r ; A B TO C = 15.1' C v cry m B TO D = 39.4 E,�'lST1.NG 1N(�i'( UND (D o 01 �U B TOE = 21' POOL o INVERT FOUNDATION = 74.20' r Q_ o INVERT TANK IN = 73.86' Q; INVERT TANK OUT = 73.61' INVERT PUMP TANK IN = 73.50' C' INVERT PUMP TANK OUT = 73.25' INVERT D-BOX IN = 75.35' Ci_ INVERT D-BOX OUT 75.18' A INVERT LINE BEGIN =75.08' INVERT LINE END = 75.08' I CERTIFY THAT THE SEPTIC SYSTEM COMPLIES WITH GTITLE 5, LOCAL CODE AND DESIGN PLAN. BM -= BOTTOM II)ING 80.00' C 1,000 ( AI,. PUMP TANK EXISTING DW--.LL_INLw �zH a 10 `>lf) ( "�I 10 N TA�1t,: �.�° Clayton A_ ' o Morin f � !y I #30969 a PROFESSIOAL GINEER )ATE: i ND TE: SEPTIC SYSTEM AS-BUILT THE PUMP USED IS DIFFERENT ; ;AN PROPOSED BUT IS AN APPROVED EQUAL TO THE PROPOSED BEVERLY SHEA PUMP. LOCATION: 105 SULLIVAN ROAD NORTH ANDOVER ,MA. DATE: 4•-10-0'-/ 3, 3 SCALE: 1" = 20' 34" 34' --� TO 10' ; A TO D = 26.2' (D= DBOX) A TO C = 22.3' (C = SEPTIC TANK) A TO E = 28.2' (E = PUMP TANK) B TO C = 15.1' I._.� o ,� �j, m I B TO D = 39.4 EXISTING IN(3ROUND � o a o� � B ?"O E = 21' POOL o , INVs=RT FOUNDATION = 74.20' o ! INVERT TANK IN = 73.86' !N\CERT TANK OUT = 73.61' INVERT PUMP TANK IN = 73.50' INVERT PUMP TANK OUT = 73.25' -moi c INVEZRT D-BOX IN = 75.35' INVERT D-BOX OUT =75.18' A IIS\P._RT LINE BEGIN =75.08' INVERT LINE END = 75.08' CERTIFY THAT THE SEPTIC SYSTEM COMPLIES WTH BOTTOM WING s BN, �O.C)0' E 1 000 (.,,'AI.. PUMP TANK TITLE 5, LOCAL CODE AND DESIGN PLAN. == •-� EXISTING DWELLING i 4105 _. -- ��p�TH OF (;Al I ()N TANKCl oma' ayton A" Gam, Morin #30969 �y; PROFESSIO AL GINEER DATF_: rlJ. ' , v. 1 ;:y,' �r '44 I �f. 'li':•'iZ�'+vt .:..},ry f,' ., r I�Y�''r )•'11'1'''{11�'r'I''' d.{� of. lv.,,bI mlI�lloodr{.11odf0 dJl111loc+lir „ t72009 nOprinpl OI CIIa A1 0 HEA OF NOfiTH ANDOVER �ccaUon;. �''! "�1`,J Ir'r !, , .. .rYi�r#!'.'ri ,a`•p', Sill ,,;/ ' ,,:; 1 ,t�1';�tti'Y �•r �'ali.ril gr"1.r,,�', �;� ' : . . ' ,.r'',.1,,V1'��,,,NI�''yl�r'IG�d�A4/Y�f'I,v• � . ''I �I`•�'(III'�r+;I�'.1,.�f,lh��'��,I�rn;r Y'f,l�'�i�"�i;"� .y�� 7o+n 1 `'a.l q7fs _ 19�911 ' ��%6�:Pura ��• n'V I I'. ofif1'P'{ x11;11,'; . • �'' Z� OY t vm9lnp,�' ,l 1:`,,,,1• '1'1"1„1^ $optic ren, I� , elm o) it YO 8) 1; C'OdnO'J1 f'1 • .. . :':, 1,,;r,,.,,sll�'oQr�d� 9n�o 5 ''m/}�r t.,, , ,.,, r. ; — • " ,,1;�! 1 Y1✓rrr(/t��/r w A�,Yl1 I'+'S' {' — . • , ';YM'''�rIY 11�1,/tlll4 ir'i 1ri1 •YI I'4 �I.��Ir Q' SY Py Ir 11 d 8�� .. '. t lir,}j'IN I r C, ' 1 r {)� 'rl I•i;'; t/ J, , 1 illl1 cJl Jc4n1I n'',T;,Ir rr . ,I.(•.1' ,��'j;rl','` 'tl f�h�r��4��11�! I'�+iy111�t1,�;��;'' � It NOW 9io dl�D • • � � ,� ','•'4'I'1'i��/I�Yr'1 wril Y 'porldip'>YrlgiliPPrlOYq/a�lblorms,r;m�in '� � �rll ��ch,��.e t�r • Rif' AY der �u C H USE1�� • ,�I\.,..•,-.,,,.�_ �6 ..,.,,r.,,:5,.�;,:,:.;..•,,:,�r�,.,::, DEC 2008 OEP.hei provldod ;hI4 iorrn for eo ' C 00 I(Iod IQ the IOC�I 8^arc: r ►� ocar 8oarci or Oj,morOlnor p;ln �V Sy7;d.n r A, F C I I I. , TOINu 4 OF NON�WANDOVEk-t n p r 1 ry a ty—Inf7lr-r lon T,��,� "' _ nr4•'�n; Sys;Qm LQUQ n: y �••• O ' .;� ,i,'r.,.:',2,�;S slam wn s r • 'I. 'r�ri''Nvi11 'y,,� l• ,Y•.1, , —� ►•�� (II OVf�rYnl rpm buVcn) Tr eDn.nr n,mp„ ',:P.umpinl Re'q.ord Oe,s o! Pumping to �3• rYPa 9r sy3lom; Ca99�001(9) $9D!!C Tens 4, Emon39!11? ,J Too Flll9(Pf9.. C' Yo9 II Y05 n8) 1: C'oanov7 77 Ye 11':Coiidl�Jori'P(:9yj;�m''.s' :. . LM C)! U(:4 ' �.;1,.'!''✓ Icy Y'' ;� ' IV,? ' �'• �Vrn'(y�y �� 1:Y1 rr lotson.WhAijra''c or)lanU' ars dl p 1,.. �w :.;^ .ma�3.por/dsF.�welsi/epproYaJaJlbrormi.r:naln9�eC1 �Y Commonwealth• of Massachusetts City/Townrof'NORTH ANDOVER MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Healte P Wiping cord mu; be submitted to the local Board of Health or other approving auth ryr,�CV�4�i� A. Facility information DEC 6 2006 Important: When filling out 1. System Location: TOWN OF NORTH ANDOVER .forms on the ALTH DEPARTMENTcomputer, use . only the tab key Address '---"--- to move your cursor-do not City/Town 7Town use the return Y Stake -- -- key. Zip Code 2. System Owner: non —__... Addresa(if different from location) City/Town _ '--- St�ephone _--------- Zip Code - Teer ----- - g4. Pumping Record _- .Date.of Pumping Date 2• Quantity Pumped: xv /15� Gallons Type of system: ❑ cesspool(s) Septic Tank CD Tight Tank ,,�/- �✓ _ ��C -L Qther(describe):Effluent Tee Filter present? EYes ❑ No If yes, was it cleaned? Yes ❑ No condition of System: 6, Asyem Pumped By: L'_ - --• - Vehicle License Number — -- - Company `5ta �. / 7. Location where contents were disposed: J Aw Si ature of Hsu Date ! http://www.ma'ss..govi/d.ep/water/ i t5form4.doc-06/03 System Pumping Record-Page t of i i ;r�� '+� � . + �;,.v°tl,, �t��' c�J�'t. i a;_r+a 3 c ,ix l�x•��'%%y., 9f134 ky,.s> d..+Az< A •aSl.,f1.ff ,}, z@ x„tf tki,Y�i a 't"�R4 s,au �.r ti:'r rr : £ i+' �1.r' i I.r W,��^aaA•.2 �tf ., i:. 62 �:.':. 1 1 " 'f'OWN j[ NOR'N j N({ y {.OV /fin SYSTEA•1 PUMPIN is ss r a r a r-+. �r R h s r, NO 5t+ J >� f �-- � if N ^•5 f Its Wry.M ...vr... ....QUANTITY fTY pU f r wauc i �uxV)feig i :1 UA VA"nU?43 t�OGDzQo T1UN v" ry Ltt?CAAXY GR EXPLAIN is i•��n�� ..ni... I{.1.�"�`(.a;,�.J, .i,,..+�aJ �4 .�.. :� �•&a s..r�A fs 7 r �,."�M xf�t�'"9,{1•�� T°��"� 3 -.� rs , .� '. "1 S..y��.,-�y�1,. it • : �s "� si5^zs9 5 fi 1Y .,. a rL t �,r c-...rt w sxs4f,#fjfi 1�"fi^*t F' 1,�,•ro v e -- ' 105 SULLIVAN STREET JS-2003-000712 Proiect Detail Report Printed On: Wed Jun 15,2011 Project Name: GIS#: 7607 Project No: JS-2003-000712 Owner of Record SHEA,BEVERLY Map: 107.13 Date Submitted: May-30-2003 105 SULLIVAN STREET Block: 0010 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Septic System Work Location: 105 SULLIVAN STREET Zoning: Proposed Use: Residential District: 'Ss��wu�t�i`' land Use: 101. Proposed Use Detail Single Family Home Subdivision Description Septic System Comments. of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-000041 8/26/04-Al Halfrey stopped by today for this and for 114 Marian Drive. Stated that 105 Sullivan has a fully established lawn now. Site needs a final grade inspection and we need the certification paperwork. A]took the paperwork with him.--p.d. 6/9/04-Greg Saab stopped by to drop off a check for another property,and I asked him to sign the certificate. He cannot sign,as Jon Whyman should have loamed and seeded--not hydroseeded. Greg Saab will speak to John about this. COC from North Andover will not be issued until we the engineer certification form is signed.--p.d. 6/4/04-Manhole changed to 24'as requested. The Final Grade: Top grade,hydroseeded over marginal soil. Sparse grass growing. Manholes left at grade. Called Greg Saab for okay on this. 6/3/04-Jon Whyman called for a Final Grade Inspection. Please call him at:781.334.2323.-- p.d. 5/17/04-Received a call from Beverly Shea. She is looking for a COC. Told Ms.Shea we are still waiting for sign-off from engineer on certification form. We also need to verify Susan's concerns from 4/8/04. Then a final grade inspection needs to be done. 4/8/04-Susan Called Greg Saab,designer. He will call John with concerns. 1.-Tank manhole increase size to 24" 2.-Loam&Seed 3.-Check boundary wall and final grade accuracy. 4.-Clay Morin,Engineer,needs to sign Certificate form(in file). 5. -Needs a Final Grade Inspection. 3/31/04-This address needs a system final as well as a final grade. 3/31/04-Sent copy of As Built to Jon Whyman of Whyman Construction per Al's request when he dropped off 114 Marian Drive. Phone:781.334.2323. Address: Whyman Construction GeoTMS®2011 Des Landers Municipal Solutions,Inc. Page 1 of 3 105 SULLIVAN STREET JS-2003-000712 Proied Detail Report Printed On: Wed Jun 15,2011 Attn: Jon Whyman 451 Broadway Lynnfield,MA 01940 12/16/03-Received a call from AI Helfrey re:fact that J.Whyman thought he overpaid. Did not. 5/28/03-Ck#10477,Soil Test-$200;9/26/03-Ck#10738-Design-$250;10/22/03- Ck#10879-Design Re-Review for$50; 10/23/03-$250 pd.For DWC permit. Called Whyman. He is all set. 11/4/03-Received revised plan dated 10/30/03 adding 1000 gal.Pump chamber. Left message to send$75 for 3rd Revision. Sent to Consultant. 10/31/03-See Document link letter 10/22/03-John Wyman called--he will be coming in tomorrow to fill out application for DWC permit. 10/22/03-Plan Approved by Consultant and 3rd review payment received minus$25 overpaid from before. 10/20/03-Spoke with Engineer-they will send check. 10/15/03-New plans found on desk(hand del?)no letter,no fee. Called and left message with Eng.&Serveying Services at 978.815.7835 re:no fee. Sent plans to Consultant on 10/15. 10/9/03-Septic Plan denial letter sent. 10/3/03-E-mail sent by Consultant to H/O explaining process 10/2/03-Mrs.Shea sent a fax stating her frustration at the septic approval process. Copy forwarded to Heidi Griffin.--p.d. 9/30/03-Revised plans dropped off this afternoon. Sent to Consultant for review. Sent e-mail requesting priority review,as Mrs.Shea called again this a.m.Asking if plans could be reviewed and approved asap due to extenuating personal circumstances and cost of pumping. 9/23/03-Beverly Shea,h/o called re:status of plans. Told her that letter went out to designer and her. Mrs.Shea states that she did not receive letter. I called engineering co:Engineering &Survey Services of Haverhill,and spoke with Greg Saab. I told him that h/o has called re: status. They received letter and will work on revised plan. I advised h/o to call the engineer to check on when they would be submitting revised plans to us.--p.d. 9/15/03-Letter sent re:plans. Revised plans requested. 8/29/03-Design Plan submitted by J.Whyman Const.781.334.2323 7/7/03-Soil Test scheduled for 7/15/03. 6/19/03-h/o:Beverly Shea called to find out status of soil tests for 105 Sullivan Street. 6/3/03-Received back sign-off from Conservation. 5/28/03-Received check and application for soil testing. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2003-0340 Oct-23-2003 SIGNED OFF JS-2003-000712 Repair-Complete Plan Review BHP-2003-0354 NEEDS REVIEW JS-2003-000712 Plan review-REV 3 Plan Review BHP-2003-0270 DENIED JS-2003-000712 Plan Review Plan Review BHP-2003-0299 DENIED JS-2003-000712 Plan Review Plan Review BHP-2003-0332 Oct-22-2003 SIGNED OFF JS-2003-000712 Plan Review Soil Testing-Repair BHP-2003-0247 Jun-04-2003 SIGNED OFF JS-2003-000712 Soil Testing GeoTMS®2011 Des Lauriers Municipal Solutions,Inc. Page 2 of 3 105 SULLIVAN STREET JS-2003-000712 Proiect Detail Report Printed On: Wed Jun 15,2011 Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Inspection DWC-System Repair BHP-2003-0340 Nov-17-2003 FULL COMPLY Dan Ottenheimer JS-2003-000712 Pump information needed. Received on 2/18/04. Bottom of Bed Inspection DWC-System Repair BHP-2003-0340 Oct-31-2003 VIOLATION Dan Ottenheimer JS-2003-000712 Pending a revised plan. See document link. GeoTMS®2011 Des Lauriers Municipal Solutions,Inc. Page 3 of 3 BOARD OF HEALTH MINUTES MARCH 28,2002 The meeting was called to order at 7:09 by Dr. Frank MacMillan. MEMBERS PRESENT Present were Francis P. MacMillan, Acting Chairman; John Rizza, Clerk; Sandra Starr, Director; Brian Lagrasse, Inspector; Public Health Nurse, Deb Rillahan. BOARD OF HEALTH VACANCIES Town Manager, Mark Rees, appeared to discuss the process of filling the upcoming vacancies on the Board. He reported that ads have been placed in the local newspapers asking for volunteers and a selectmen subcommittee made up of Rosemary Smedile and Susan Haltmeier has been formed to assist in the process. JON WHYMAN—INSTALLER VIOLATIONS Dr. MacMillan read the chronology of the installation of both systems. There were many problems with each of them because of the practices of the installer, Jon Whyman. • At 7 Sullivan St. the first bottom of bed inspection failed because of large rocks left in the area and the bottom was not level. • The first system final inspection on 10/03/01 failed due to the D-box not being level and not constructed of concrete as specified; building sewer not as specified on the plan; dirty stone. • The first final grade inspection also failed and to date there has been no as-built, no certification statement nor deed restriction filed with the department. Dr. MacMillan asked if the job was complete now. Mr. Whyman responded in the affirmative. • At 27 Bradford St.—The paperwork was filled out properly but the bottom of the bed was excavated before a permit was issued. The septic consultant also found that it was dug in the wrong place. Multiple inspections because of inspection failures were required at this site as well, and Mr. Whyman was required to pay additional fees because of them. Mr. Whyman spoke at length about his company, pvc d-boxes in general, and his surprise at North Andover's strict septic installation process. Dr. MacMillan presented three action options for Mr. Whyman's violations that are available to the Board: 1. Withdraw license to operate in North Andover 2. Fines 3. Probation Dr. MacMillan recommended probation for 30 days. Mr. Whyman should be closely watched; any further problems and his license to operate would be revoked. Page 2 Board of Health minutes March 28,2002 John Rizza made a motion that Jon Whyman be put on probation for 30 days during which time he will be closely monitored for regulation compliance. Any additional violations shall result in a revocation of his license to operate in North Andover. Dr. MacMillan seconded and the motion was passed. NON-ESSENTIAL WELL MORATORIUM Town Manager Mark Rees stated that his office receives daily questions on wells. He brought up a particular resident in the watershed who said he had all other permits needed to drill an irrigation well except from the Board of Health. (Because the site is in the watershed, a special permit is required from the Planning Board.) Ms. Starr noted that she had a memo from the Planning office that this particular individual had never filed, and consequently never secured a special permit for a well. Dr. MacMillan brought up the current drought conditions and the low levels of the Lake and ground water. He explained and then stated that he feels there should be no irrigation wells in the watershed. He reassured Mr. Rees that the issue will be revisited at future Board meetings. He pointed out that the ban on outdoor water usage for the town begins tomorrow. Brian Lagrasse explained the information in the Board's packets and defined the drought watch recently issued by the state as the third level of drought alert. TOBACCO REGULATIONS Director of the Healthy Communities Tobacco Program, Diane Pickles, brought a draft regulation that includes all work sites. A ban is proposed in health care facilities, restaurants,private clubs, hotels, motels and all worksites. A bar is defined as having an 80/20 split, relative to profits from alcohol and food,respectively. No children under the age of 18 would be allowed in bars/smoking areas. Ms. Pickles stated that they receive many complaints from North Andover people about smoking in work places—employee health. Laws relating to private clubs must be observed for any loosening of regulations. Dr. Rizza would like all types of facilities included as smoke-free worksites. Ms. Pickles explained the legal problems relating to private clubs. Diane is to get a list of towns that have banned smoking in worksites. The Board will also be talking to the Board of Selectmen about the new regulations. There must be a hearing to adopt new regulations. Diane is going to gather data on which towns have done what with what regulations. Some regulations provide for fines to a smoker-customer in srestaurant. Dr. MacMillan asked about state budget cuts. Ms Pickles stated that the program has already lost$4000, but is OK so far. Page 3 Board of Health minutes March 28,2002 REVOLVING FUND WARRANT VOTE Sandra Starr explained the purpose of reauthorization vote—that it is done annually before town meeting because a town vote is required to reauthorize the fund. She also briefly touched upon the problems with next year's budget and the percentage of cuts required by the Town Manager's office. John Rizza made a motion to place a warrant article on the town meeting agenda requesting a vote to reauthorize the MRI/Wheelabrator revolving account. Dr. MacMillan seconded and the motion passed. CORRESPONDENCE Ms. Starr brought the Board's attention to the new DEP policy on the design of retaining walls and impermeable barriers. Ms. Rillahan spoke about the Department of Environmental Protection's request to Boards of Health to assist them in reducing the amount of mercury in the waste stream. They are asking that local Boards of Health promulgate regulations requiring contractors and others to recycle thermostats and other mercury-containing products ADJOURNMENT The meeting was adjourned at 8:30 in response to John Rizza's motion to do so. MEETING RE-OPENED The meeting was re-opened by Dr. MacMillan at 8:40 to discuss the April meeting date. John Rizza will be away on the regular meeting date. The meeting will be changed to April 23`d, a Tuesday; the location will be arranged. Frank MacMillan noted that Dr. Rizza should not be released on June 30th at the end of his term because he will be needed to help train new members. He then went on to state that the probation period set for John Whyman should not be limited to 30 days, but should be for an indeterminatean eriod. If he makes further errors the Board should p Y withdraw his license and/or heavily fine him. Page 4 Board of Health minutes March 28,2002 On a motion by John Rizza, seconded by Frank MacMillan,Dr. Rizza's previous motion is amended to read as: Jon Whyman is to be put on probation for an indeterminate time. Throughout this time he and his work will be closely monitored for regulatory compliance. Any additional errors or violations shall result in a revocation of his license to operate in North Andover and/or a heavy fine. FINAL ADJOURNMENT On a motion made by Dr. Rizza and seconded by Dr. MacMillan the meeting was adjourned at 8:45 P.M. Respectively submitted, i John S. Rizza, DMD, Clerk BOARD OF HEALTH AGENDA Thursday-JUNE 19,2003 7:00 p.m. DPW 384 OSGOOD STREET North Andover,MA 01845 DRAFT VERSION AS OF 6/20/03: New Business Meeting Minutes Approval—April and May 2003 Meeting minutes were unanimously approved. 70 Oaks Drive-Order letter issued on June 10,2003,regarding removal of garbage disposal to Thomas and Debra Ann Witt. Mr.LaGrasse has not had a response from the homeowners to date. Mr.LaGrasse has a tank inspection scheduled for Friday at 10:00 a.m.Once the tank passes inspection,Title V should change from Conditionally Passes to Passes. At issue remains the removal of the garbage disposal. Mr.LaGrasse will follow up and report at next scheduled meeting. Lot 9 Windkist Farm Road—request for extension of soil tests. To be presented by John Hargreaves. File was brought with the Lot information,however,Mr.Hargreaves was not present at the meeting to make a presentation. Lots 2&3 Forest Street Extension -presented by Hancock Engineering—(Charlie Ogden)request for an extension of deep observation holes performed an additional two years. No one from Hancock appeared to present this request. According to Mr.Markey,more testing creates soft spots in bed bottom. Ms. Starr was asked to inspect the site to determine if the topology has been changed since the testing was performed. If the site is undisturbed,an extension may be granted. 32 Olympic Lane—Mr.Bernie Kavanaugh appeared to request a variance for the distance from a leach area to i the foundation. Letter and paperwork was presented at the meeting by Mr.Kavanaugh. A site plan was also presented at the meeting outlining the plans. Mr.Markey recommended obtaining a Title 5 inspection before anything else is pursued. Once the Title 5 inspection is complete and the results are received,Ms. Starr will determine whether the variance can be granted. 458 Johnson Street—Letter received June 18,2003 requesting a hearing about the order letter received re: sewer tie-in. Update presented by Brian LaGrasse. Acting on a tenant complaint Brian Lagrasse visited the site and determined that there were problems with the septic system. Review of the file showed that a letter was sent out in year of 2000 ordering the owner,Mr.John Eaton,to tie-in to municipal sewer. Mr.Eaton stated then as now that the cost for him to tie-in to sewer is prohibitive.It was suggested that the Board of Health members could write a letter to the Board of Selectman requesting that they waive the tie-in fee. The Board agreed to this course of action and requested that Ms. Starr prepare a letter for Dr.MacMillan to sign and present at the next Board of Selectmen meeting. Northside Carting-request for a Permitting Fee Variance for the trash hauling regulations—presented by Mr. Jeffrey Thomson. The company's central office is located in North Andover. The company has a total of 35 trucks,and the cost would be prohibitive for them to permit and placard each truck. The cost would be$100 per truck in addition to the$500 application fee for a total cost of$4,000. They would like a variance to either not pay at all,or settle on a flat fee. In addition,it would be very difficult and time consuming for them to swap placards from vehicle to vehicle,as they are based in North Andover,and come and go frequently. Board Members:Francis MacMillan,Jonathan Markey,Cheryl Barczak I BOH Staff: Sandra Starr,Director,Brian Lagrasse,Health Inspector,Deb Rillahan, Public Health Nurse, Pamela DelleChiaie, BOH Secretary C:\SSawyerl205O8mydocsbackup\Minutes\Minutes 2003\6.19.03-Minutes revised.doc Page 1 of 3 Mr.Markey moved to allow a flat fee of$1,500 if the regulations allow for it. Ms.Barczak seconded the motion,which passed unanimously. Mr.LaGrasse will check the regulations to be sure that this is acceptable. Mr.LaGrasse will notify Mr. Thomson of his findings. Old Business Updates on 383 Abbott Street—presented by Brian LaGrasse Mr.Averka has not been in touch with Attorney Hyatt in a few days. Bob Cachins is going to manage the demolition project. It will cost around$50,000 for the demolition. Mr.Averka wants to get a prefabricated house to put on the lot. Ms. Starr recommended that a letter go out,saying that the Board wants to see a building permit to demolish within two weeks time. Mr.Markey made a motion to issue an order letter that states if the following conditions are not met in the time allotted,the Board of Health reserves the right to fully enforce the original Order Letters and also the right to condemn the dwelling in accordance with 105 CMR 410.831(E). Ms.Barczak seconded the motion. The Board unanimously voted to issue an order letter with the following conditions: 1. The property owners must obtain a demolition permit from the Building Department to demolish the dwelling at 383 Abbott Street by no later than July 4,2003. A copy of this permit must be submitted to the Health Department. 2. The property owners must have the demolition completed by no later than July 17,2003. Discussion Probation for installer The circumstances pertaining to the probation of installer,Jon Whyman,in 2002 were reviewed. The fact that the installer did no further work in North Andover after being placed on probation by the Board was ascertained. Ms. Starr reported that three new requests for soil testing have been received from Mr.Whyman. A lengthy discussion ensued after which on a motion by Jonathan Markey,seconded by Cheryl Barczak the Board voted unanimously to extend the probation throughout the 2003 septic season. American Red Cross Blood Drive Results—presented by Deb Rillahan There was a good turnout. The goal was 50 pints,and 59 pints were taken but only 43 pints were accepted. Sixteen(16)pints were rejected. The American Red Cross does testing for SARS on anyone who has traveled to or from target areas as well as hemocrit tests,Hepatitis,Aids,CJD and West Nile virus. Out of the 43 pints accepted,more will be rejected after additional testing. The Board of Health usually sponsors two(2)blood drives per year. Charging for future vaccines—presented by Deb Rillahan A meningitis clinic was held,and all 30 doses were used. Vaccine recipients were charged$75.00,pre-paid, and the Board of Health made$25 per dose,which will help with future clinics. Ms.Rillahan suggested that we should have a nominal charge of$5.00 for administration for other types of vaccines. Most of the vaccines that Ms.Rillahan gives are for Hepatitis B for college. There is often a$10 co-pay when one sees a private physician for these types of shots. The state cut local Boards of Health off for free Mantoux tests(usually needed for substitute teachers and cafeteria workers). Ms Rillahan suggested that we offer this test at a charge of$10 per patient in order to purchase this vaccine ahead of time. All members voted in favor of this proposal. Dr.Ansel—presented by Deb Rillahan Last month,there was a varicella(chickenpox)outbreak in Andover which was compounded by Dr.Ansel of Childrens Medical Center. He refuses to vaccinate for chickenpox. Dr.Ansel was responsible for two of the Board Members:Francis MacMillan,Jonathan Markey,Cheryl Barczak BOH Staff. Sandra Starr,Director,Brian Lograsse,Health Inspector,Deb Rillahan,Public Health Nurse, Pamela DelleChiaie,BOH Secretary C:\SSawyerl205O8mydocsbackup\Minutes\Minutes 2003\6.19.03-Minutes revised.doc Page 2 of 3 children who contracted the chicken pox,and they passed it on to other children. Based on new state regulations,the affected daycare center had to close down for 11 days,and teachers had to be on paid leave for all 11 days. All parents that worked,did not have childcare. A question was posed as to whether the daycare requires this immunization. This physician puts other people at risk. He also does not believe in the MMR vaccine,nor does he report any communicable diseases,even TB,which is against the law. Dr.MacMillan thinks the state should reprimand Dr.Ansel,and that he should be reported to the Board of Registration. Dr. MacMillan recommends sending a letter to the DPH and a report to the Board of Registration. The Town should not have the onus of policing Dr.Ansel. Ms.Rillahan will follow up with this. k Updates of Trash Truck Permitting—presented by Brian LaGrasse Starting July 1St,trash trucks will be fined$1,000 if they are not licensed. A legal notice was published in the paper on June 13,2003. Copies of Request for Response for Title 5 was published in the paper as a Legal Notice. Ms Starr would like to award the contract by July 1,2003,but realizes that the time allotted for responses may have to be extended. Meeting Change: The Board unanimously agreed to hold their next meeting on Thursday,July 17th,as Dr. MacMillan will be away on the 24th. Corresaondence Letter dated May 28,2003 from the Massachusetts Department of Public Health,to Richard Hogan of the Greater Lawrence Sanitary District(GLSD)re: Approval of Suitability Letter reviewed by the Board Meeting Adjournment The June 19,2003 Board of Health meeting was adjourned at 8:06 p.m. Cheryl Barczak,Clerk North Andover Board of Health i I I Board Members:Francis MacMillan,Jonathan Markey,Cheryl Barczak BOH Staff: Sandra Starr,Director,Brian Lagrasse,Health Inspector, Deb Rillahan,Public Health Nurse, Pamela DelleChiaie,BOH Secretary C:\SSawyerl20508mydocsbackup\Minutes\Minutes 2003\6.19.03-Minutes revised.doc Page 3 of 3 NORTH O�ttLeo ,°q�0 O O coc«ii«ewa« 1' ��SSAC HUs��y PUBLIC HEALTH DEPARTMENT Community Development Division April 25,2008 Jon Whyman Whyman Construction 451 Broadway Lynnfield, MA 01940 Re: Septic System Installer's Permit Dear Mr. Whyman, This letter is in response to the recent concerns over the septic installation in progress at 755 Winter Street,North Andover. The concern stems from your approach concerning the importance or lack there of regarding the following of the approved septic plans. In 2002 you were placed on probation for the entire season for noncompliance to the basic rules of septic installation and were warned that any further problems could result in the revocation of your license to work in North Andover. Since that time you have only sporadically worked in the community,however each instance seems to result in conflict. Currently you have an installation permit to install a system at 755 Winter Street. On Monday, April 21, 2008,the Health Department was requested to conduct a Bottom of Bed inspection for that address. An inspector responded on that day. The inspector's account of the inspection and observations and subsequent necessary actions noted below that are the reason for this correspondence. Upon arrival at the site,the inspector observed that the excavation of the leach bed was not in the location found on the approved plan. It was approximately 20 feet from the approved location. This fact was then discussed with you and you indicated that the engineer, Joe Serwatka, gave you directions on locating the system as you stated there was ledge in the rear of the property. In addition,the inspector reported that your intention was to relocate the proposed 1500 gallon septic tank. These changes are not the prevue of a septic system installer. It is the obligation of the installer to inform the engineer of adverse conditions as is stated in all North Andover approval /setters. "If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit". 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Sincerely, Susan Sawyer, REHS/RS Public Health Director Cc: Joseph Serwatka, P.E. Jon Whyman a 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVERcf NORTH 9 Office of COMMUNITY DEVELOPMENT AND SERVICES �O HEALTH DEPARTMENT 400 OSGOOD STREET a oe NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthdept@townofnorthandover.com ,townofnorthandover.com www.townoftiorthandover.com Scott Talbot 70 Oakes Drive North Andover,MA 01845 December 27,2004 Dear Mr.Talbot, This letter is in regards to your written December Wh request,to the Health Department,for a Certificate of Compliance for the septic system that was recently installed at 70 Oakes Drive by Mr.Jon Whyman and engineered by Mr.Ben Osgood.As I stated in our previous phone conversation regarding your request,I had not yet reviewed the as-built that had been submitted by Mr. Osgood and therefore withheld my comments until such time. Since that time,I have reviewed your file and have unfortunately found two items of concern.These items were noted on Mr.Osgood's as-built,as well as on notes from previous inspections.First is the pump that Mr.Whyman has chosen for your system rather than installing the pump that was specified on the plan.Though the plan indicates that an equivalent may be used,the determination of whether it is truly equal,is made by the engineer.Enclosed is a copy of the as-built plan.Please review the pump note in the left corner.It is important that as the homeowner you are aware of this.The health department allows this replacement,but the customer must be informed. Second,and not so easily solved,is the elevations noted on the plan for the inlet and the outlet on the septic tank. The MA DEP Title V regulations call for a 3-inch drop from the point that the raw sewage enters the tank to the level that the effluent exits the tank.According to inspection notes,the installer was made aware of this problem,however, the as built shows that your tank was left with a drop of.08 or @ 3/4 of an inch.Considering that there is margin for tolerance it would be acceptable to have a drop of not less than 1 'h inch. This problem should be addressed prior to the approval of the occupancy.Mr.Whyman should contact Mr.Osgood for corrective measures.Measures should be made immediately while the frost level is not prohibitive.Once corrected,the engineer must submit a second as built with the changes.Assuming this is taken care of,the health department will then consider signing the building permit for the property,approving occupancy.The actual final Certificate of Compliance will be issued once the final loam and seed are in place in the spring. If you have any questions,please contact the health department. Sincerely, Susan Sawyer,RS/REHS Public Health Director Cc: Jon Whyman,Installer Ben Osgood Jr.,New England Engineering TOWN OF NORTH ANDOVER HORTy Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ~ - 04 ` 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 "SSAtM�s t� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthdept@townoffiorthandover.com www.townoffiorthandover.com Scott Talbot 70 Oakes Drive North Andover,MA 01845 January 6,2005 Dear Mr.Talbot, This letter is in regards to your ongoing septic installation.The Health Department received documentation from your installer and your engineer indicating that all concerns previously noted have been addressed. The Health Department will now be able to sign off on the building permit.Please bring the building card into the Health Department during office hours or make an appointment with the office to do so.The Building Department will issue a certificate of occupancy when all other departments have signed off on the construction and the Building Inspector has completed his final inspection. A Certificate of Compliance will be issued after the following is completed. 1) Once completed by the installer,the final grade inspection should be requested in the spring to verify the final grade,loam and seed over the septic system and components. 2) The installer must sign the installation certification once the job is complete If you have any questions regarding this correspondence,please contact the health department. Sincerely, Susan Sawyer,RS/REHS Public Health Director Cc: Jon Whyman,Installer Ben Osgood Jr.,New England Engineering TOWN OF NORTH ANDOVER t a°R*M Office of COMMUNITY DEVELOPMENT AND SERVICES oa HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �9SSACHUS S� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthdeptgtownofnorthandover.com www.townofnorthandover.com June 11,2004 Jon Whyman Re: 105 Sullivan Street Dear Mr. Whyman, This correspondence is in regards to the property listed above and the recent septic system installation.On June 3rd you requested a final grade inspection from the health department. An inspection was conducted per your request. As you may recall you had a couple of outstanding items that needed to be addressed prior to sign off by the health office.Some items were initially discussed on site with you and our consultant,Dan Ottenheimer last November 17, 2003.Then you and I had a phone discussion about the some of the same items on April 8,2004. As indicated by you,the manhole has been changed to 24 inches as per plan.However,the property has been hydro seeded prior to proper spreading of a minimum of three inches of loam as also required per plan. The"top soil" present is not of sufficient quality needed to establish proper vegetation and is not acceptable by title V standards.The engineering firm on this project,represented by Greg Saab,has also observed the site and is in agreement in this case. As the permit holder it is your responsibility to see that the final project meets the plan. For this reason,the health department is not able to sign the certificate of compliance at this time. Please contact this office at such time the property is ready for it's final inspection. Any subsequent inspections needed for this property will be assessed the$50 fine as listed in the signed agreement(see attached) In addition,after reviewing the file,it was found that you signed the installation certification stating that the system had been installed in accordance with the plan on 10/23/03.This statement was accurate,since the permit to begin the project was dated that same day. A blank for is again being provided to you for your signature and the engineer's signature. Please return this form properly filled out. If you have any questions regarding these issues,please contact the health Office. Thank you for your anticipated cooperation in this matter. Sincerely, � i Susan Sawyer,REHS/RS Public Health Director Beverly Shea,105 Sullivan Clayton Morin,Engineer I i i Board of Health Meeting June 24,2008 Director Recommendations Jon Whyman—Septic Installer—Consideration of revocation of Septic Installer's License in the Town of North Andover. Mr. Whyman was warned by the Board of Health in 2002 that future problems could result in license revocation. Since that time he has installed 3 systems including the ongoing installation. (Relevant details are on attached document) NA Regulation 3.02 License Revocation: (Reasons) 1. violation of any section of requirement of these regulations or Title V of the Environmental Code 2. Deliberate errors or omissions during installations or attempts to mislead 3. other actions or omissions which result in a substantial adverse effect on public safety or health The Director finds that Mr. Whyman has violated item 1 and 2 above numerous times during the installation of the septic system at 755 Winter Street. In addition, Mr. Whyman was previously warned by the BOH that reoccurrence of violations would result in the permanent revocation of his license. In accordance with local regulation section 3.02, may revoke the Septic Installers License of Mr. Jon Whyman or take other action it deems fit. As the installation at Winter St. is not complete, the director would recommend it to be effective after the issuance of the Certificate of Compliance issuance for 755 Winter Street. This Certification will not be issued until all conditions set forth by the director are completed. In addition, future applications will not be accepted. I. NEW BUSINESS A. 69 Oakes Drive— 1. Local Health Bylaw Variance Request— ➢ NA section 5.02 -to reduce the offset distance between the leach area and a wetland from 100 feet to 53 feet. ➢ NA section 5.02 -to reduce the offset distance between the pump chamber and a wetlands from 75 feet to 48 feet ➢ NA section 7.05 -to allow the use of test pits conducted more than 2 years from plan submission date 2. Title V Variance ➢ Title V, section 15.227(5) -to allow septic tank to be designed with inverts located below the estimated seasonal high ground water elevation. In light of new wetland line issues, the applicant is asking ONLY for the Title V variance and the local regulation to allow the use of test pits more than 2 years old. The applicant will return to the BOH at a later date with other requests in addition to these. The Director has no issue with the approval of the above 2 issues. The Department of Environmental Protection must approve the Title Variance as well and the test pit variance is in line with previous proposals. B. 502 Winter Street- Lot 3A—new construction of single family home—Local Health Bylaw variance request 1. Section 5.02 to reduce the distance between a wetland and the leaching facility from 100 feet to 71 feet 2. Section 9.01 to reduce the required 900 sq. ft. minimum leaching bed size to 513 sq ft The Director has no issue with the approval of the local bylaw variances as written. The applicant has offered a proposal that meets the DEP minimums and will offer equal protection to the public health. NORT#f TOWN OF NORTH ANDOVER °.4• :"� 3� ° OL HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 SACHU`�E Sandra Starr Telephone (978) 688- Public Health Director 9540 FAX (978) 688-9542 March 20, 2002 J. Whyman Construction John Whyman 451 Broadway Lynnfield, MA 01940 Re: 27 Bradford St.N. Andover Dear Mr. Whyman: The North Andover Board of Health requests your presence at their next meeting on March 28, 2002 to discuss your participation in the septic repair installation project at 27 Bradford Street,the alleged violations, and why the Board should not revoke your license to operate in North Andover. Please be present at 7:15 PM at 384 Osgood Street,North Andover at the Department of Public Works. Failure to appear may result in an automatic revocation of your Disposal Works Installer's License to operate. If this time is not convenient for you,please call the Health Department at 978-688-9540 to place you earlier or later on the agenda. If you have questions,please call the Health Department. Yours truly, (for the Board) Sandra Starr, R.S., C.H.O. Public Health Director Cc: BOH File North Andover Board of Assessors Public Access Page 1 of 1 NORT11 North Andover Board of Asses �9SSACHUS t ropert3 Click Sea]To Return Parcel ID :210/107.B-0010-0000.0 FY:2011 Community : r SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to AM Search for Parcels Search for Sales Summary X11 Residence ° Detached Structure Condo 105 SULLIVAN STREET Commercial Location: 105 SULLIVAN STREET Owner Name: SHEA,BEVERLY Owner Address: 105 SULLIVAN STREET City: NORTH ANDOVER State: MA Zir Neighborhood: 5 -5 Land Area: 2. Use Code: 101-SNGL-FAM-RES Total Finished Area: 2! ASSESSMENTS CURRENT YEAR PREVIO Total Value: 433,700 441) Building Value: 226,600 24C Land Value: 207,100 201 Market Land Value: 207,100 Chapter Land Value: LATESTSALE Sale Price: 0 Sale Date: 12/31/1976 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book: 01310 P� http://csc-ma.us/PROPAPP/display.do?linkld=1708652&town=NandoverPubAcc 6/17/2011 Commonwealth of Massachusetts City/Town of RECEIVB System Pumping Record V A';i1 14 M1 Form 4 TOWN OF NORTH ANDOVER HE TH DEPAR MENT DEP has provided this form for use by local Boards of Health. , but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information XAMIt en filling out 1. System Location: ns on the e t the tab key 'Address' nove your North Andover ma 01886 sor-do not City/town State Zi Code the return D '2: System Owner: Name Address(if different from location) Cityrrown state Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Q-1epuc Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. S stem Pump By: rj Name Vehicle License Number I Stewart Septic Service Company 7. Location where contents were disposed: w fts Pre tr"tment Plant 20 So. Mill St Bradford Ma 0183 ( Lnd Ta '4 � . . /2&// ature of Hauer Date Signature of Receiving Facility Date 3=4•doa 03M System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts -- w City/Town of No.Andover R CEI , System Pumping Record F , ,� ,i U 4011 Form 4 �' ^M 5 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Otheer fd 'st'bwse � the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms the Q V .� -�� computeto a�,r,use � C ., „ only the tab key Address to move your No.Andover t Ma 01845 cursor- not City/Town State Zi Code use the return P urn - .� _ .< key. 2. System Owner: VQ Name x"07 Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 0 �/--Cl / p g Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s)- 0---S eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes yes, was it cleaned? ❑ Yes 5. Condition of System: 6. System Pumped By: Name Vehicle License Number y Stewart's Septic Service Company 7. Location where contents were disposed: tewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 ignata uler Date f�`) l/�� Signat 7T iving Facility Da��— t5form4.doc•03/06 System Pumping Record•Page 1 of 1