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HomeMy WebLinkAboutMiscellaneous - 107 GRAY STREET 4/30/2018 (2) i / 107 GRAY STREET i 21.0/10.7..D,0026-0000.0 r I it � 1 G y I m Commonwealth of Massachusetts RECEIVED Title 5 Official Inspection Form MAY 24 2017 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments TOWN OF NORTH ANDOVER 107 Gray Street IjEALTH DEPARTMENT Property Address Charles Hart Owner Owner's Name required fo is North Andover MA 01845 5/13/2017 required for 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 an way. Please see completeness checklist at the end of the form. Immo out forms A General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Neil Bateson use the return Name of Inspector key. Bateson Enterprises Inc. �a Company Name 111 Argilla Road Company Address �—� Andover MA 01810 Cityrrown State Zip Code 978-475-4786 SI-15 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 5/13/2017 Inspectors ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 S � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owner's Name information is required for eveNorth Andover MA 01845 5/13/2017 ry 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.doc-rev.6/116l Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owner's Name information is MA 01845 5/13/2017 required for every North Andover page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owner's Name information is required for every North Andover MA 01845 5/13/2017 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins.doc•rev.6/16 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 t 107 Gray Street Property Address Charles Hart Owner Owner's Name information is North Andover MA 01845 5/13/2017 required for every page. Cityfrown 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.doc•rev.6/16 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 ' 107 Gray Street Property Address Charles Hart Owner owner's Name information is North Andover MA 01845 5/13/2017 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no-'as to each of the following: Yes No ® ❑ 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? I ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual). 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner owner's Name information is i required for every North Andover MA 01845 5/13/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: I Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No I Water meter readings, if available: t5ins.dog•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owner's Name information is North Andover MA 01845 5/13/2017 require4 for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Pumped 2016, owner Source of information: 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) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J° 107 Gray Street Property Address Charles Hart Owner owner's Name information is North Andover MA 01845 5/13/2017 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 13 Years old, 5/10/2004, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ®. No Building Sewer(locate on site plan): Depth below grade: 3.2feet 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.): Unable to see piping ,finished cellar.4" PVC to septic tank Septic Tank(locate on site plan): Depth below grade: 2.3 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 10'x 5'x 4' Dimensions: Sludge depth: 2.1 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 5•' 107 Gray Street Property Address Charles Hart Owner Owners Name information is required for eveNorth Andover MA 01845 5/13/2017 ry page. Cityrrown 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 31" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8.1 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Outlet filter ok. Depth of liquid at outlet invert. No evidence of leakage. Both inlet&outlet covers have risers to grade. Pumped septic tank. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owner's Name information is North Andover MA 01845 5/13/2017 required for every 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 Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.dor•rev.6116 Title 5 Official Inspection Form: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 I 107 Gray Street Property Address Charles Hart Owner Owner's Name information is required for every North Andover MA 01845 5/13/2017 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.): D-box level &distribution equal. No evidence of carryover. No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owner's Name information is required for every North Andover MA 01845 5/13/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 72' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑. Yes ❑ No t5ins.doc•rev.6116. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner Owners Name information is North Andover MA 01845 5/13/2017 required for 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(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.do6•rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 107 Gray Street Property Address Charles Hart Owner owner's Name information is required for every North Andover MA 01845 5/13/2017 page. Citylrown 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 t t5ins.doc•rev.6/16 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 107 Gray Street Property Address Charles Hart Owner Owner's Name information North Andover MA 01845 5/13/2017 required for 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: 6/26/2003 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan test pit data. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doo-rev.6/16 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 107 Gray Street Property Address Charles Hart Owner Owners Name information is I required for every North Andover MA 01845 5/13/2017 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.do�•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts City/Town of . System Pumping-Record Form 4 DEP has provided this forrri for us&by local Boards of Health. Other forms may •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 forrh they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. -A Facility. Information :1. System Location: Left/Right front of House, Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building,Left/Right rear of building, Under deck Address 1,69 CD, Cnyrrown State - Zip Code 2 System Owner. Name' �— Address(if different from location) Citylrown State• ZipCOGS j �l �3 Telephone Numbers .B. Pumping record 1. Date of Pumping date 2. Quantity Pumped: Gallons }—? .3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(descnbe): 4.1 Effluent Tee Filter present? es ❑ No If yes, was it cleaned? es ❑ Na 5: Condition of System: 6.' System Pumped By: Neil Batesbn ' F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. : Locatio where contents•were disposed: AGI S: Lowell Waste Water Sign a Hhui Date ` t6formCdoc-06/03 System Pumping Record•Page i of 1 ' Summary Record Card generated on 5/16/2017 2:40:34 PM by Tara Hurley Page 1 Town of North Andover Tax Map # 210-107.D-0026-0000.0 Parcel Id 18646 107 GRAY STREET HART, CHARLES Since Jan 2003 107 GRAY STREET NORTH ANDOVER, MA 01846 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until HART,CHARLES Payor 107 GRAY STREET. NORTH ANDOVER,MA 01845 UB'Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13715.0-107 GRAY STREET Last Billing Date 5/9/2017 1090393 01 Cycle 01 Active UB ServicesMaint. Account No.1090393 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 49.40 /1 UB Meter'Maintenance Account No.1090391 Serial No. . . Status Location Brand Type Size YTD Cons 19409699 a Active 00 b Badger w Water 1 1 1303 Date Reading Code Consumption Posted Date Variance 4/19/2017 1670 a Actual 13 5/17/2017 -17% 1/19/2017 1657 aActual 16 2/16/2017 -14% 10/19/2016. 1641 a Actual 18 11/16/2016 -16% 7/22/2016 1623 a Actual 22 8/16/2016 83% 4/22/2016 1601 a Actual 12 5/25/2016 -7% 1/22/2016 1589 aActual 13 2/19/2016 -42% 10/22/2015 1576 aActual 22 11/20/2015 -33% 7/24/2015 1554 a Actual 32 8/14/2015 98% 4/27/2015 1522 a Actual 16 5/19/2015 6% 1/30/2015 1506 aActual 17 2/20/2015 -1% 10/24/2014 1489 a Actual 16 11/14/2014 1% 7/25/2014: 1473 a Actual 16 8/13/2014 -16% 4/24/2014 1457 a Actual 18 5/15/2014 -14% 1/27/2014 1439 aActual 23 2/14/2014 -57% 10/23/2013 1416 a Actual 51 11/18/2013 -43% 7/23/2013 1365 a Actual 87 8/15/2013 310% 4/24/2013 1278 a Actual 21 5/20/2013 -11% 1/25/2013 1257 aActual 25 2/13/2013 -77% 10/23/2012 1232 aActual 106 11/9/2012 -2% 7/23/2012 1126 a Actual 107 8/14/2012 257% 4/23/2012 1019 a Actual 30 5/9/2012 15% 1/23/2012 989 aActual 26 2/13/2012 -56% 10/24/2011 963 a Actual 61 11/14/2011 -26% 7/22/2011 902 a Actual 80 8/15/2011 410% 4/22/2011 822 a Actual 15 5/16/2011 -21% 1/25/2011 807 aActual 21 2/11/2011 -80% 10/21/2010 . 1 786 aActual 101 11/12/2010 -7% 7/22/2010 685 a Actual 109 8/16/2010 679% 4/22/2010 576 a Actual 14 5/12/2010 -12% it f"ORT", 7878 Town of North Andover HEALTH DEPARTMENT ,SSACN115�t CHECK#: /3 6 7 DATE: 5 shy 0/7 LOCATION: S E H/O NAME: WCUn y� CONTRACTOR NAME: le-son r t Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ t ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ e ❑ 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) $ x ❑ Title 5 Inspector $ Title 5 Report PC.5 5 s5()- 0 so--❑ Other:(Indicate) $ Hea)MAgent Initials White-Applicant Yellow-Health Pink-Treasurer i Town of North Andovera,No RT►1 , Office of the Health Department ;� F Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 C„�s�t If 978.688.9540-Phone Susan Y.Sawyer, REHS/RS . ' Public Health Director 978.688.9542-Fax i CEXTIEI CA TLOE OE CONI" T.10NCE As of. ,duly 20, 2004 This is to cert that the individuafsu6surface disposal system repaired (-X " by Peter Breen at 107 Gray Street North Andover, 5W,4 01845 has been instaffed in accordance with the provisions of Title v of the State Sanitary Code and with the North Andover Board of,7fealth regulations. The issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. S an T. Sawyer, 1RE3fS1gU Tublu;9fealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Commonwemlth of Massachusetts Map-Block-Lot Board Of Health107.D-0026- ----------------------- Peimit No P I North Andover BHP-200.3-Q331 ----------------------- F.I. FEE $250.00 Disposal Works Construction Permit Permission is hereby granted Peter Breen ------------- - gsposal System to(Construct)an Individual Sewage Di ----------------------------------------------------------- . at No 107 GRAY STREET ----------------------- - - -------------------------------------------------------- - as shown on the application for Disposal Works Construction Permit No._BHP-2003-033 ____________ Dated-__October2 003 Issued On:Oct-21-2003 --- -------------- ---- --------------------------------------- Board Of Health ....... ........ ........................................ APPLICATION FOR DISPOSAL WORKS CONSTRUCTION WR7VIIQT DATE: jU` CURRENT INSTALLER'S LICEN # LOCATION: �� LICENSED INSTALLER: SIGNATURE: ��i YLn TELEPHONE# 2'9 67 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. /D Administrative Use Only J $ .00 Fee Attached? Yes No Foundation As-built? Yes No Floor plans on file? Yes No Approval Date: i 107 GRAY STREET JS-2003-0701 Proiect Detail Report • Printed On:Thu Jun 05,2003 GIS#: '7903 Project No.; JS-2003,0701 Owner of,Record HART;CHARLES Map: 107.D ,l)gWSubmitted 'r Apr-18-2003': 107 GRAYSTREET Block-' 0026 Statu`sr Qpen NORTH ANDOVER,MA 01845 Lot'. . Work-Category ' Work Location 107 GRAY STREET ' Zoriiri Pro used ITses p 'Distrit t: Iand Use: 101 1proposed Use Detail Subdivision Des'criptioa Septic Design Plans d Work Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0035 Thurs.-6/4/03-Brian said that Al Gala(engineer)would like to setup additional soil testing. Fi placed in Sandy's Septic Design inbox.--p.d. - Thurs-5/22/03-Received folder back on desk this a.m.With letter to be sent to engineer,Al Ga and to homeowner. Letters were mailed stating that there were technical deficiencies that must t addressed before approval can be given.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Project No: Description of Work: Design Approval-Plans 1216 May-22-2003 OPEN JS-2003-0701 Septic Design Plans GeoTMS®2003 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 107 GRAY STREET a JS-2003-0701 Proiect Detail Report Printed On:Wed Jun 18,2003 GTS#: 7903 Project No: JS-2003-0701 Owner of Record HART,CHARLES Map: 1,07.D Date Submitted: Apr-18-2003 107 GRAY STREET Block: 0026 Status: Open; NORTH ANDOVER,MA 0.18A5, Lot:, Work Category: Work Location: 107 GRAY STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Septic Design Plans of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0035 Wed.6/18/03-Chuck Hart,h/o called looking for status update on property. Please call him at 617-413-3163.--p.d. Thurs.-6/4/03-Brian said that Al Gala(engineer)would like to setup additional soil testing. H placed in Sandy's Septic Design inbox.--p.d. Thurs.-6/4/03-A1 Gala called regarding list of items Sandy had an issue with regarding the list of 27 items. He has questions on a couple of the items-#26 and#11. The file is in the active files Please call him at 781-932-7890. If you need to defer to Sandy,please let me know,and I will a to tell him that. Thanks. Thurs-5/22/03-Received folder back on desk this a.m.With letter to be sent to engineer,Al Ga and to homeowner. Letters were mailed stating that there were technical deficiencies that must h addressed before approval can be given.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Project No: Description of Work: Design Approval-Plans 1216 May-22-2003 OPEN JS-2003-0701 Septic Design Plans GeoTMS a 2003 Des Landers Municipal Solutions,Inc. Page I of 1 107 GRAY STREET JS-2003-0701 Proiect Detail Report Printed On:Thu Jun 19,2003 — GIS#: 7903 -- Project No: JS-2003--0701: Owner of Record HART,CHARLES - - --- - Map: 107.D Date Submitted: Apr-18-2003 107 GRAY STREET Block: 0026 Status: Open NORTH ANDOVER,MA 0.1845 Lot: Work Category, Work Location: 1,07 GRAY STREET Zoning: Proposed Use: District: land Use: 1.01 Proposed Use Detail Subdivision Description jSeptic Design Plans of Work: j Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0035 Thurs.6/19/03-File was in Sandy's outbox this a.m.With note of 6/26/03 @ 1:00 p.m. (Additional Soil Testing).--p.d. © � No additional applications were received for soil testing. Sandy had been speaking directly with 11: 1 10) Gala,so I do not know what the conclusion of their conversation was. See report for lognotes. P-Original Message----- From:Brian Lagrasse[mailto:blagrass@townofnorthandover.com] Sent:Wednesday,June 18,2003 1:53 PM To:Pamela DelleChiaie' Cc:Griffin,Heidi Subject:RE: 107 Gray Street-Status Update talked to chuck and we are supposed to be doing additional soil testing so the engineer can finist the design. is anything scheduled? did they submitt a soil testing app for additional tests? -----Original Message----- From:Pamela DelleChiaie[mailto:pdellechiaie@townofnorthandover.com] Sent:Wednesday,June 18,2003 12:44 PM To:Sandra Starr Cc:Pamela DelleChiaie;Heidi Griffin;Brian LaGrasse Subject: 107 Gray Street-Status Update Call h/o asap with status update. See attached report for details. Wed.6/18/03-Chuck Hart,h/o called looking for status update on property. Please call him at 617-413-3163.--p.d. Thurs.-6/4/03-Brian said that Al Gala(engineer)would like to setup additional soil testing. Fi placed in Sandy's Septic Design inbox.--p.d. Thurs.-6/4/03-A1 Gala called regarding list of items Sandy had an issue with regarding the list of 27 items. He has questions on a couple of the items-#26 and#11. The file is in the active files Please call him at 781-932-7890. If you need to defer to Sandy,please let me know,and I will a to tell him that. Thanks. Thurs-5/22/03-Received folder back on desk this a.m.With letter to be sent to engineer,Al Ga and to homeowner. Letters were mailed stating that there were technical deficiencies that must h addressed before approval can be given.--p.d. GeoTMS a 2003 Des Lauriers Municipal Solutions,Inc. Page 1 of 2 107 GRAY STREET JS-2003-0701 Proiect Detail Report Printed On:Wed Jul 09,2003 GIS#: 7903 Project No: JS-2003-0701' Owner of Record HART,CHARLES Map: 107:D Date Submitted: Apr_18'-2003 ' 107 GRAY STREET Block: 0026 Status: Open NORTH ANDOVER,-MA 01845 Work Category: Work Location: " 107 GRAY STREET " w; zoning,,, Proposed Use: District:' land Use: 101 Proposed Use Detail Subdivision Description Septic Design.Plans of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: r Board of Health GREEN FLAG BHJ-2003-0035 7/8/03-Tues.-Charles Hart came in to drop off revised Design Plans dated 7/2/03,included as part of the first review fee. Plans will be put with file and placed in Sandy's Design inbox for review.--p.d. Thurs.6/19/03-File was in Sandy's outbox this a.m.With note of 6/26/03 @ 1:00 p.m. (Additional Soil Testing).--p.d. No additional applications were received for soil testing. Sandy had been speaking directly with Gala,so I do not know what the conclusion of their conversation was. See report for lognotes. --P -----Original Message----- From:Brian Lagrasse[mailto:blagrass@townofnorthandover.com] Sent:Wednesday,June 18,2003 1:53 PM To:'Pamela DelleChiaie' Cc:Griffin,Heidi Subject:RE: 107 Gray Street-Status Update talked to chuck and we are supposed to be doing additional soil testing so the engineer can finist the design. is anything scheduled? did they submitt a soil testing app for additional tests? -----Original Message----- From:Pamela DelleChiaie[mailto:pdellechiaie@townofnorthandover.com] Sent:Wednesday,June 18,2003 12:44 PM To:Sandra Starr Cc:Pamela DelleChiaie;Heidi Griffin;Brian LaGrasse Subject: 107 Gray Street-Status Update Call h/o asap with status update. See attached report for details. Wed.6/18/03-Chuck Hart,h/o called looking for status update on property. Please call him at 617-413-3163.--p.d. Thurs.-6/4/03-Brian said that Al Gala(engineer)would like to setup additional soil testing. R placed in Sandy's Septic Design inbox.--p.d. Thurs.-6/4/03-A1 Gala called regarding list of items Sandy had an issue with regarding the list of 27 items. He has questions on a couple of the items-#26 and#11. The file is in the active files - Please call him at 781-932-7890. If you need to defer to Sandy,please let me know,and I will c: to tell him that. Thanks. GeoTMS a 2003 Des Lauriers Municipal Solutions,Inc. Page I of 2 07 GRAY STREET JS-2003-0701 Proiect Detail Report Printed On:Wed Jul 09,2003 Thurs-5/22/03-Received folder back on desk this a.m.With letter to be sent to engineer,Al Ga and to homeowner. Letters were mailed stating that there were technical deficiencies that must 1; addressed before approval can be given.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Project No: Description of Work: Design Approval-Plans 1216 May-22-2003 OPEN JS-2003-0701 Septic Design Plans GeoTMS a 2003 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 i .107 GRAY STREET . �n JS-2003-0701 Project Detail Re Printed On:Fri Jul 18,2003 GIS#: 7903 Project No: JS-2003-0701 Owner of Record:HART,CHARLES Map: 107';D Date Submitted: Apr-18-2003 107 GRAY STREET Block: 0026 Status: Open NORTH ANDOVER,MA :01845 I Lot: Work1 Category Wtrk Location: : 107:.,GRAY STREET' Zoning. Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Septic Design Plans of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0035 7/8/03-Tues.-Charles Hart came in to drop off revised Design Plans dated 7/2/03,included as part of the first review fee. Plans will be put with file and placed in Sandy's Design inbox for review.--p.d. Thurs.6/19/03-File was in Sandy's outbox this a.m.With note of 6/26/03 @ 1:00 p.m. (Additional Soil Testing).--p.d. No additional applications were received for soil testing. Sandy had been speaking directly with Gala,so I do not know what the conclusion of their conversation was. See report for lognotes. --P -----Original Message----- From:Brian Lagrasse[mailto:blagrass@townofnorthandover.com] Sent:Wednesday,June 18,2003 1:53 PM To:'Pamela DelleChiaie' Cc:Griffin,Heidi Subject:RE:107 Gray Street-Status Update talked to chuck and we are supposed to be doing additional soil testing so the engineer can finisl the design. is anything scheduled? did they submitt a soil testing app for additional tests? -----Original Message----- From:Pamela DelleChiaie[mailto:pdellechiaie@townofnorthandover.com] Sent:Wednesday,June 18,2003 12:44 PM To:Sandra Starr Cc:Pamela DelleChiaie;Heidi Griffin;Brian LaGrasse Subject: 107 Gray Street-Status Update Call h/o asap with status update. See attached report for details. Wed.6/18/03-Chuck Hart,h/o called looking for status update on property. Please call him at 617-413-3163.--p.d. Thurs.-6/4/03-Brian said that Al Gala(engineer)would like to setup additional soil testing. Fi placed in Sandy's Septic Design inbox.--p.d. Thurs.-6/4/03-A1 Gala called regarding list of items Sandy had an issue with regarding the list of 27 items. He has questions on a couple of the items-#26 and#11. The file is in the active files Please call him at 781-932-7890. If you need to defer to Sandy,please let me know,and I will c; to tell him that. Thanks. GeoTMS 12 2003 Des Landers Municipal Solutions,Ina Page 1 of 2 107 GRAY STREET JS-2003-0701 Pro * ct Detail Report It Printed On:Fri Jul 18,2003 Thurs-A'22/03-Received folder back on desk this a.m.With letter to be sent to engineer,Al Ga and to homeowner. Letters were mailed stating that there were technical deficiencies that must t addressed before approval can be given.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Project No: Description of Work: Design Approval-Plans 1216 May-22-2003 OPEN JS-2003-0701 Septic Design Plans GeoTMSO 2003 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 107 GRAYSTREET JS-2003-0701 Prosect Detail Report Printed On:Thu Aug 12,2004 Project Name: GIS#: 7903 Project No: IJS-2003-0701 Owner of Record HART,CHARLES Map: 107.D Date Submitted: tApr-18-2003 107 GRAY STREET Block: 0026 Status: OpenNORTH ANDOVER, MA 01845 Lot: Work Category: Work Location: 107 GRAY STREET I Zoning: Proposed Use: District: - land Use: 101 Proposed Use Detail j - Subdivision Description iSeptic Design Plans Comments of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0035 7/20/04-As Built dropped off by Chuck Hart(H/O)done by GEO Consulting Engineers(Al r Gala). Susan checked file,and all looks okay. File. 10/21/03-DWC permit issued. 10/17/03-Fri-DWC application received from Peter Breen y 8/11/03-Notified H/o(Chuck Hart)of design permit approval via phone&fax. Could not get through to engineer,so H/o will forward the fax to him(A]Gala).--p.d. 8/8/03-Plans approved 7/8/03-H/O came in to drop off revised Design Plans dated 7/2/03 6/26/03-Soil tests done. 6/19/03- 6/26/03 @ 1:00 p.m.(Additional Soil Testing). 6/18/03-h/o called looking for status update on property. 6/4/03-engineer would like to setup additional soil testing. 5/22/03-letter to be sent to engineer,Al Gala,and to homeowner stating that there were technical deficiencies that must be addressed before approval can be given. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Design Approval-Plans BHP-2003-0090 May-22-2003 SIGNED OFF JS-2003-0701 Septic Design Plans DWC-System Constructio BHP-2003-0331 Oct-21-2003 SIGNED OFF JS-2003-0701 Form U Signoff-construct BHP-2003-0233 Aug-08-2003 SIGNED OFF JS-2003-0701 Upgrade septic system for addition Soil Test-Undeveloped Lo BHP-2003-0251 SIGNED OFF JS-2003-0701 Soil Testing GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 ♦ NORTy TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER MASSACHUSETTS 01845 SSwCH Sandra Starr,R.S., C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 . August 11, 2003 Mr. Alberto M. Gala GEO Consulting Engineers, Inc. P.O. box 473 Winchester, MA 01890 Dear Mr. Gala: The Health Department has reviewed the revised plans dated July 2, 2003 for the proposed repair of the septic system at 107 Gray Street,North Andover. The plans are now approved. Please'call me at the above number if you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. - Health Director /pfd CC: Homeowner: Mr. Charles Hart, 107 Gray Street,North Andover, MA 01845 Fax: 978-685-9729 (Homeowner will forward to engineer) File: Address Chrono Building .ti HP Fax Ki220xi Log for NORTH ANDOVER 9786889542 Aug 112003 11:17am Last Transaction Date Time Twe Identification Duration Pages Result Aug 11 11 c 17am Fax Sent 89786859729 0:19 1 OK A Town of North Andover N°RTif V tEo tiq�vo Office of the Health Department ay`' 6=° °p Community Development and Services Division 27 Charles Street I p�giTEA ¢,` North Andover, Massachusetts 01.845 "S'ACH Sandra Starr Telephone(978)688-9540 Public Health Director Fax(978)688-9542 May 17,2003 Alberto M. Gala GEO Consulting Engineers,'neers Inc. P.O. Box 473 Winchester,MA 01890 Re: 107 Gray St.,North Andover Dear Mr. Gala: The proposed septic plans dated April 17, 2003 for the upgrade of the septic system at 107 Gray Street,North Andover,MA have been reviewed and been found to have technical deficiencies that must be addressed before approval can be given. They are as follows: 1. Missing assessor's map and lot number. (3 10 CMR 15.220(4)(u)) 2. Missing names of abutters. (NA 8.02j) 3. Name of design engineer. (NA 8.02(1) 4. Distances missing on site plan. (NA 8.03a-c) • SAS to poly barrier + SAS to stone wall SAS to tank&pump chamber • Vent to property line 5. Location and elevation of foundation drain for new construction (NA 8.02y) 6. Missing reserve area(required for new addition construction)(310 CMR 15.220(4)(e)) 7. No elevations for percolation tests. (NA 8.02n) 8. Name and certification statement of site evaluator missing 3 10 CMR 15.220(4)(o)) 9. Missing waterline. (310 CMR 15.220(4)(m)) 10. Statement saying that there are no private wells within 150 feet of the proposed system (or information locating any such wells)missing. (3 10 CMR 15.220(4)&(NA 8.02r) 11. Insufficient deep holes in disposal area-southern end(3 10 CMR 15.102(2)) 12. Please indicate on profile that design meets breakout. (310 CMR 15.21(1) 13. Missing note indicating that building sewer is to be laid on compact,firm base. (3 10 CMR 15.222(5)) 14. Septic tank specification on profile disagrees w/site plan & design data. 15. Missing specification on stone under septic tank,pump chamber&D-box. (3 10 CMR 15.221(2), 228(l)) 'I30APD()1'APP,1 AI"8 68849541 BUILDING 688=9515 C C)�15131�VA'1'1t).lr�f 8$9 3u ]iE A 111688.9 40 {?]ANi'd1Ni.i 018.95 35 16. Missing buoyancy calculations for tank& chamber if at or below water table. (3 10 CMR 15.221(8)) 17. Tops of tank and pump chamber must be less than or equal to maximum of 36" below grade. (3 10 CMR 15.221(7)) 18. Outlet pipes from D-box must be laid level for first 2 feet. (310 CMR 15.232(3)(b)) 19. Size/volume of pump chamber not specified. (3 10 CMR 15.220(4)(r) 20. Missing specification on solids size that pump can pass. (3 10 CMR 15.231(7)) 21. No pump performance curves included. (3 10 CMR 15.220(4)(r)) 22. Missing manual operating switch. (NA 12.01) 23. Vent not protected from precipitation/animal entry. (3 10 CMR 15.241(1)(b)) 24. Groundwater separation not adjusted to highest existing grade. 25. Trenches in fill or w/reserve in between must be 10 feet minimum. (NA 14.01 & 14.03) 26. All previous leach area from wetland buffer towards higher elevation should be removed. 27. This design, if approved, is sized for a dwelling with a maximum of 9 rooms, including a finished basement, 3-season room, and expansion attic and no garbage grinder. Floor plans for the existing dwelling and the proposed addition are required before approval can be given. (Plans need not be to scale—can be reduced in size.) Please call the office at 978-688-9540 should you have any questions. Sincerely, Sandra Starr Health Director Cc: Homeowner File Y 1 CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant:G /�C 5 Name of Designer:A&-r}D C��'r_' y Plan Date: U 1 3 Revision Date: Date of Review: L1 Zq b Property Address: 0� �G� S� Map: V Lot: ?i BOH Reviewer: �j Type of Plan(new or upgrade): Number of Bedrooms: `'+�'� gpd) Garbage Disposal Allowed: �V General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK/"�Problem N/A 14 Street number and map/lot-220 4 u t Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20' for profile and component details-220(4) 1/ Legal boundaries of the facility being served-220(4)(a) �.� Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.021 ✓� Name&address of record owner&applicant- NA 8.02k Name&address of designer-NA 8.021 0ti11 0 o StAr'p Holder and location of all easements-220(4)(b) Date plan drawn&any revision date- NA 8.02m V All dwellings and buildings,existing and proposed-220(4)(c) ✓ Location of all existing or proposed impervious ares-220(4)(d) All distances on site plan—NA 8.03 a-c W t taw S Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y y Location and dimensions of the system incl.reserve(new const.)-220(4)(e) Limits of excavation of leach area on site plan-NA 8.02z 4.•�''_' Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) Existing and proposed contours-220(4)(g) ✓ Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) �✓ Date(s)of soil testing-220(4)(h)&(i) Existing grade elevation of each deep hole-220(4)(h) Elevation of percolation tests—N.A. 8.02n Hc\s AeF+ln 40 6,t..a�' Name of approving authority representative-220(4)(h)&(i) Name of soil evaluator-220(4)0) a E. ? Q,o-� Nt 6K C !_. Soil logs and perc test logs match BOH records — s+a.c A:�, 11- 1A �..� y c� 1! �_ Locations of waterlines,drains,and subsurface utilities-220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system-220(4)(n) Complete profile of the system to scale-220(4)(o),NA 8.02c Cross section of leaching facility-NA 8.02w (Not to scale) !/—'✓ Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) 2 «' f ✓ Original R.S./P.E. stamp,signature&date-220(1)&(2) P.E.,discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies(w/in 400'),pub. wells(w/in 250'),pvt. wells(w/in 150')-220(4)( ./ Location of watercourses,wr I ds,wells,etc.w/in 150'of system—NA 8.02r Wetland disclaimer—NA 8.02s RLS plan reference&certification required(prop line setbacks)-220(3) Plan contains designer's certification statement Use approvals/standards checked for I/A system-DEP docs., ..1� Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) Pere rate> 60 MPI-must use modified tight tank or UA technology-245(4) Proposed system qualifies as"shared"system-002(definitions) _ Flow is over 2,000 gpd-No RS.allowed-220(l) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment-354 Leaching facility at least 1'above Base Flood elevation—NA 9.05 All piping Sch 40 minimum—NA 10.01 -� Basement floor minimum 1'above groundwater elevation—NA 5.04 !f �L Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown, including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(i) _ Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) LeL Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: j, . ground elevation el. 0 CA cp 93 J� 1(0, =, acceptable soil el. �7 ' (N r Z 91B.. Leach facilitv invert el. 1- ground water el. ' ' V refusal el. bottom of leach facility el. - ,, 9`�3 /L(,-3 ��<�-✓ �j thickness of acceptable soil �(j, [�8 �./ !�y . 7, before&after soil R&R separation to groundwater l separation to refusal 1 �JJ Id.3 soil class 2 3 perc rate Z4, loading rate ,.-�Z septic tank below g.w.table or no) pump tank below g.w. table ye or no) IS in fill Setback Distances(Given in feet) 15.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility Property line 10 10 Cellar wall 10 20 / Inground pool 10 20 Slab foundation , 10 10 Deck,on footings,etc. 5 10 V Waterline 10 10 At 01 Private drinkingmell 75 100 - Irrigation well 75 100 Wetlands 75 100 Nvfe uti P(�� 1� Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib. To Surface Water supply 325 325 l /9 J T`✓'' , Reservoirs 400 400 Tributaries to reservoirs 200 200 i;o;�r�Drains(wat. supply/trib.) 50 100 Drains(intercept g.w.) 25 50 Foundation drains 10 20 & Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope 3 4 w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC—NA 11.02 ✓/, Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) Pipe laid on continuous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) 1/ Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment change;.222(8) ! Invert elevation at building:A ' Invert elevation at septic tank:tA A,i) ! % 1 Length of run: 13 /0 ,9- g, Slope:0, V Z (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank OK Problem N/A Tank is accessible-228(3) No structures above tank—(228(3) Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) r� 2-3"drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) 1/ 3"air space above tees/baffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6"above flow line-227(1) Inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 compart) 228(2) 3-20"manholes-228(2) 1 childproof,24"riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) / Soil compaction below tank specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath tank specified-221(2)&22 8(1) If> 1,000 gpd AND not a single fam. dwell.must be 2 tks or 2 comp.-223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart.tank-223(1)(c) Buoyancy talcs.required if tank at or below water table-221(8) Tank is watertight-221 (1) 9"of cover over tank(minimum)-228(1) H- 1 0 loading(min.)-H-20 if traffic-226(3)f1J®T 5�u�4 Top of tank<=36"below grade-221(7) [ooZc t;v t 56{ +u All pumping to tank(if applies)in accordance with-229 i Tank is set to keep old system in service during install if possible 4 4 v 5 Tight Tank(Check here if not present: ) OK Problem N/A 500%of design flow or 2000 gallons provided–260(2)(a) 3-20"manholes–228(2) Soil compaction below tank specified(if soil non-native)–221(2), 6"of<=3/4"stone beneath tank specified–221(2)&228(1) Buoyancy calcs.Required if tank at or below water table–221(8) Tank is watertight–221(1) 9"of cover over tank specified(minimum)–228(1) H-10 loading(min.)–H-20 if traffic–226(3) Top of tank<=36"below grade'221(7) All pumping to tank(if applies)in accordance with–229 AN alarm set at 3/5 tank capacity–260(2)(c) Min. 1-24"frame w/cover at finished grade–228(2)(f) Year round access for pumping–228(2)(g) Distribution Boz(Check here if not present: , O oblem N/A C� , ? r Inlet elevation: 0 S-<�b �a Outlet elevation: q 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6" sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b) —� Outlet pipes laid level for first 2 ft. -232(3)(c) Pipe Sch 40-NA 10.01 l Number of outlets:_� Number of laterals: Size of outlets: Inlet baffle/tee mm. 1"over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6"of stone beneath distribution box specified-221(2) _ Box is watertight-221 (1) Top of box<=36"below grade-221(7) '1rBuoyancy calculations required if box is at or below water table-221(8) Pump Chamber(Check here if not present: OK Prob1 W N/A Volume specified: 220(4)(r) Pump on elevation- 012.b 1 220(4)(r) ,,_, Pump off elevation: C1 0 - %l 220(4)(r) larm on elevation: Ci Z.Llo 220(4)(r) Number.of cycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box) Minimum 2`delivery line to d-box if gravity-254(1)(c) Pressure dosed l.f. if flow>=2,000 gpd-254(1)(a)&254(2)(a) Cycles per day is consistent with-chamber volume-23 1 O Volume calculations include flowback-volume,:2') 1(2) 5 � C/ ism Iti 6 . 24 hour storage capacity above pump on elevation-23 1(2) Number of pumps: 1 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- +S� gpm @ t 'TDH-220(4)(r) Pump can pass 1 1/4"soli (minimum)-231(7) Pump controls specified-220(4)(r) Alarm'equipment specified-231(2) Alarm is in,building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r)-- �� Manual operating switch NA 12.01 J Check valve,bleeder hole-NA 12:01, a 1 childproof,24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr.specified-221(2),&228(1), Buoyancy calculations if chamber is at or below wat r table-221(8)@ 9"of cover over chamber(minimum)-228(1) H 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) _ _ Top of chamber<=36"below grade-221(7) 3f( ' tD Leaching Facility(general-complete for all designs) OK Problem N/ 50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) No vehicle or imperv.area above l.f unless unavoidable-240(7);NA 13.02 Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) �— Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9"cover over peastone-240(9) Reserve area provided(new construction)-248(1) _ Reserve�' from primary leach area–NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a)&(b) 4'(down to 2'with variance or I/A-upgrades only)of natural soil under 11 GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-251(9) Require 5'removal and replacement if in fill-255(5) Top of leach facility<=36"below grade-221(7) Final grade over 11 minimum 0.02 fUft-240(10) Surface&subsurface drainage away from l.f. -240(1 1)&245(5) w�� Minimum design flow 440 gpd without deed restriction–NA 13.01 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) _ Impermeable barrier if<3:1 slope or< 15 feet to–3:1slope-255(2) f - Impermeable barrier/retaining wall poured concrete–NA 9.02 Retaining wall stamped by P.E. -255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(0 r _ 10'offset from edge of leach facility to edge of ret.wall-255(2)(g) 17 Perc test(s)done in most restrictive layer- 104(2) Perc test 4' below leaching elevation–NA 7.06 q 0.0 Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC–NA 10.01 Leach pipes minimum 4"diameter except for dosed system–NA 14.04 6 i 7 I � Leach lines capped,vented,or connected together-251(9) Pressure dosing guidance followed if pressure distribution-254(2)(c), Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) Leaching Trenches(Check here if not present: ) OK Problem N/A Number of trenches: Minimum of 2 trenches- 9AN 01(2) Depth of trenches(max eff.2'): -247(1) ✓� �' Width of trenches(2'min.,4'max.): Z' -251 (1)(b) Length of trenches(100'max.): ' -25 1 (1)(a) 17.. Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) / In fill or reserve between trenches, 10' min.-NA 14.01& 14.03 Available leach area given(Min. 500 s.f)-NA,9:01(2) (� Bottom=L x W Z' e`z# ,�: __ LAU s.f. Sidewall=L �-p �'x D �-4 'x#�x 2= s. f. K�t1/ l�2 V7 Effective leach area given 'S"Y 0 Loading factor: Effective area=total area b s.f.x LTAR 7� g/day tj 25 Effective area is>=design flow of facility being served 2"of 1/8"- 1/2"2x washed peastone.-247(2) Trench depth of 3/4"to 1 1/2"double washed stone-247(1) Leaching Pits(Check here if not present: e OK Problem N/A #ofpitstpit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit or system:L W D Depth of pits(max eff.2'): -253(1)(a) Available leach area given Bottom=L x W x#of systems= s.f. Sidewall=L+W x D x 2 x#of systems= s.f. Total area=bottom +sidewall = s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR Effective area is>=design flow of facility being served Minimum of 2 pits at least 13'X16'—NA 9.01(3) Distribution for galleries/chmbrs. in trench config.-pipe every 20'-253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1/2"2x washed peastone.-247(2) 3/4"to 1 1/2"double washed stone-247(1) Each pit has at least one 20"access cover.24"Cl to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between l'(min.)and 4'(max.)-253(1)(b) Vents,if necessary,exten der covers of pit(s)-241 (e) Leach Fields(Check here if not present: OK Problem N/A Number of fields: (need dosing chamber if> 1,231 (1)) 7 I r 8 ` Length(100'max.): -252(2)(b) Width: Total area:L x W = s. f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: Effective area=total area s.f x LTAR = g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(0 Between 6"and 12"of 3/4- 1 1/2"stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2"2x washed peastone.-247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feet/foot—240(10) Grading shall divert drainage away from leach area—240(11) Grading slopes away from dwelling 5/24/01 8 t Town of North Andover, Massachusetts Form No.2 poRTM BOARD OF HEALTH o c �' • Ja L DESIGN APPROVAL FOR ` Ss,C""5`t SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM f Applicant Test No. Site Location 7— Reference Plans and Specs. GlNEER DESIGN GN ATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. F jj CHAIRMAN,BOARD OF HEALTH Fee I' Site System Permit No. t SEPTIC PLAN SUBMITTALS I � l LOCATION: - Map &Parcel/4-1—D NEW PLANS: $225.00/Plan+ Check#: �9 REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO DATE:—A DATE TO CONSULTANT: DESIGN ENGINEER• C. Telephone 5�26 When the submission is complete (including check),date stamp plans, COPY for Conservation and place in existing file with green Design Approval Form. I APR 1 7 2003 I BOARD OF HEALTH --~ NORTH ANDOVER, MASS. 01845h APR «2 2b 978-688-9540 APPLICATION FOR SOIL TESTS .5 DATE'-=' MAP&PARCEL: LOCATION OF SOIL TESTS:SeFE cJ OWNER:C_L'Xj ; TEL. NO.:� ADDRESS<D-J ,D ENGINEER: — Iq TEL.NO.: CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision mgt' e Family H Commercial Is This: j Repair testing Undeveloped lot testing vfb, Gam' In the Lake Cochichewick Watershed? Yes No I THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof'of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs,require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be .required for all additional tests within two weeks of testing. g 6. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the locationof all tests(including aborted tests). 7. Within 50 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: ke' Date Received: Check Amount: Check Date: FORM 1 I —SOIL EVALUATOR FORN1 Location Address or Lot No. 107 Gray Street, North Andover_MA On-Site Review Deep Hole Number 1 Date: 4/08/03 Time: 10 A.M Weather: Snow Location(identify on site plan):_ see site plan Land Use-- Existing Lot Slope(°/a) 3 Surface Stones None Vegetation- Cleared woods Landform Position on Landscape(sketch on back) see plan Distances from: Open Water Bode feet Drainage way-_ ; feet Possible Wet Area 130 feet Property Line- 60 feet Drinking Water Well feet Other- DEEP OBSERVATION HOLE LOG* TEST HOLE#1 Depth Soil Soil Texture Soil Color Soil Other from Horizon (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Surface Consistency,%Gravel) (Inches) 0-12" A FSL 7.SYR3/2 12"-22" B FSL 7.5YR4/6 22"-106" C LS 2.5Y516 @40" Some boulders. massive.friable, 5 VR5/6 1%boulders,5%cobbles, 10YR612 10%gravel *M.INIMUM OF 2 HOLES REQUIRED AT.EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Outwash Depth to Bedrock: none Depth to Ground Water: Water in the Hole (d)71" Weeping from Pit Face: ca?7.1" Estimated Seasonal High Ground Water: n40" DEP:APPROVED FORM-121U7i95 I FORM 11—SOIL EVALUATOR FORM Location Address or Lot No. 107 Gray Street,North.Andover.MA On Site Review Deep Hole Number 2 Date: 4/08/03 Time: 10 A.M Weather: Snow Location(identify on site plan): see site plan Land Use- Existing Lot Slope(%) 3 Surface Stones None Vegetation- Cleared woods Landform Position on Landscape(sketch on back)_. see plan Distances from: Open Water Body feet Drainage way- •feet Possible Wet Area 95 feet Property Line- 55 feet Drinking Water Well feet Other- � w DEEP OBSERVATION HOLE LOG* TEST HOLE#2 Depth Soil Soil Texture Soil Golor Soil Other from Horizon (USDA) (Munsell) Mottling (Structure,Stones.Boulders, Surface Consistency,%Gravel) (Inches) 0-10" A FSL 7.5YR3/2 10"-20" B FSL 7.5YR4/6 20"-1.081, C LS 2.5Y5/6 0q..39" Some boulders,massive,friable, 5 YR5/6 1%boulders, 5%cobbles. 10YR6/2 10%gravel MINIMUOF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL ARE M A Parent Material(geologic) Out-wash Depth to Bedrock: none Depth to Ground Water: Water in the Hole x773" Weeping from Pit Face: (&73" Estimated Seasonal High Ground Water: 013 9 7 DEP APPRO\TD FORM--12/07/95 FORM 12—PERCOLATION Location Address or Lot No. 107 Gray Street,North Andover, MA COMMONWEALTH OF MASSACHUSETTS North Andover, Massachusetts Percolation Test* Date. April 8, 2003 Time: Morning Observation Hole 9 P-1 P-2 Depth of Pere 40" 39" Start Pre-Soak 10:35 10:40 End Pre-Soak 10:50 10:55 Time at 12" 10:50 10:55 Time at 9" 11:10 11:15 Time at 6" 11:45 11:40 Time(9"-6") 35 25 Rate min./Inch 12 MPI 10 MPI * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ✓ Site Failed Performed By: Alberto M. Gala. Certified Soil Evaluator Witnessed By: Steve Eriksen N.A.B.H. Comments: DEP APPROVED FORM-12!07/95 1 101 1087 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH q A LED F t APPLICATION FOR SITE TESTING/INSPECTION ATED �9SSACHUS���y Applicant C�/ r} r9. '" NAME,y ADDR SS TELEPHONE Site Location 12 Engineer C NAME ADDRESS TELEPHONE Test/Inspection Date and Time ,� CHAIRMAN,BOARD OF HEALTH Fee � �t7. � II Test No. Q S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. it • �� , + •�� ri Nurrat tNy 1 KUNMt N r AL 6497582 P- 01 Y i NORSE ENVIRONMENTAL SERVICES, INC. 3 Poadvlew Place Tyngsboro, Mess. 01879 M, (978)649-9932 FAX(978) 649-7582 April 17,2003 Sandra Starr,Director North Andover Board of Health 2 Charles Street North Andover, Mass. Re: Subsurface Disposal Services Ms. Starr, Attached are copies of field notes for your files for tests performed on 160 Boston Road and 106 Gray Road, as well as 1620 Turnpike Street. A short synopsis is as follows: I' 4%$/03 �e� On site where Al Gala, Engineer, owner Charles Hat and the backhoe operator.This is a repair to an existing system. Percolation rates were 9 min./inch and 12 mmmin inch. Water i tbles(Estimated seasonal high)were at 39"mW 40", fairly consistent over the site. This is an ice contact ablation till,lots of stones in a loamy sand soil. There was s wet area to the rear of the lot near the fence that had a Likely predominance of wetland venation and soils consistent with a potential wetland.I alerted the enginm to this and be hdbrmed me he would have a wetland scientist view the area No ledge or other site difficulties were Evident. There is a potential intermittent stream off site on adjacent lots,though the distance from this property do not seem to make it a problem. 160 Boston Road 4/17/03 On site were Jim Caroulis,Engineer and Kim Hwkvarian,owner,and the baeklae . operator.This was also a repair.Jim had five deep tests open,three to the front right of the lot and two to the rear. Water tables to the front were at 36r,30",and 30 .To the rear they were at 48"and 52". This is a basal till soil consisting of fens sandy kmik compact in place, massive but friable. One percolation test(perc 2)performed at 56"was started, !hut was going at greater than ten minutes per inch. I believe this test was into the seasonal high groundwater,or at least in the capillary layer resulting in the slower rate. A second test was performed slightly higher with a final rate of 19 minutes per inch. I believe this rate is representative of the soil. There are no wetlands,ledge,or other apparent difficulties on the lot. I i I I 1 II 1111111111. 1lJIIIIIIII!�11/■IIf�1/11� 111111111` �i.11����11NIfIj11G''�1��lil ���� 11111111111111111 II�IIIIIIii■�1111 ��_1 11111111111111111, X111111111111111 ��. R ,� < ,. 1 11111111111111��!�i11!�IINIIIIIIII t��� .,� -- 1 �1�1'u1111ir�,1�11i1L11i1iiut1111 �� '-fir' � '-9 IIIIIIIIIIhIII�i111` E1i1iE11111 1 NIIIIINi�1111111C �i1i�R1a111 '= , . • , �_ : � 1 111111111■11111111�IIrAIrr 11 NIIIIIIIIIIIIIIiI,IIi,If11111111111 �«� I 11 .11111 ._ 1 111�1�G��IIN1111111 ����i �► 1��1111�1111©� 11��`111111111 �� _ E��L�IIf i1E�����1 � ��i��i■1-z�11iii�' �, ���E, , 1/111/11 � ���Q��11,11�� T��JIIi�� . 1 II�1l:���;� �■J.�. 111111 �'LG� •� v' � ,��' .• INIIIIIIIIII��►ii�.�1�C�'IC����Z��!�I ����i����lll IIIIIIIIIIIIIIIIIIIIII�II�Iz�11 X11 ��r������� � AAPP . 1�11�111�1111111111111111111111111 ����:�"' •' !' • 1l1�►�Ii111111111111MEN11 _ 1 I�i1�iG��1 ��In111111111111111111 ��a�__ i r M r t i I 100 BENCHMARK NAIL EL, 100.00 LOT E i NOTE: EROSION CONTROL LINE O IS THE LIMIT OF WORK FOR THIS 96PROJE00 U VENT NOTE: EXISTING TA ��F, TO BE PUMPED, CR HEC J APPROXIMATE LOCA77ON •g AND BACKnLLEO N . 9 OF EXISTING LEACHING 0 9 i y AREA rx 9 5 0 REMOVE ONLY THOSE PORTIONS THAT INTERFERE WITH THE CONSTRUCTION OF PROP. PUMP THE NEW SEPTIC SYSTEM. CHAMBER 4,2' 9� 90 �� O BOX O 0 0 r G ROi Z s 8 � L T D re P-2 _ TP2 ' WETLAND DELINEATED BY L .C. T,0 ff O� A`S0 co �. A � �i o 2 FA�S/ 90 co N2B•3 3Q"W as 30 I-4� 86 L 0 T C 84 82 i i i p�ck 1-k" '-k" ' FORM U - LOT RELEASE FORM o 3 i INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE` "- I'- 91M I LOCATION: Assessor's Map Number I PARCEL SUBDIVISION LOT(S) STREET 61 1z! e ivy'. ST. NUMBER ************************************OFFICIAL USE ONLY******************** ************* RECO MENDATIONS OF TOWN AGENTS: CONSERVATION ADMINIS RATOR DATE APPROVED , 0 6 DATE REJECTED 3i COMMENTS -'o the f- _t,, e+d;de,,+� bwf,, ►,of scds, /1n Tvt,4.,u,a. wor K o�xyar�.s f7.e. r r IQY reu.ire. d TOWN PLANNE DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED )C/ SEPTIC INSPECTOR-HEALTH DATE APPROVED / DATE REJECTED' COMMENTS AUC .. a�-!v L'��,,J. eejS PUBLIC WORKS-SEWER/WATER CONNECTIONS �/ o✓� 3-1?�� DRIVEWA PERMIT )' FIRE DEPARTMENT r RECEIVED BY BUILDING INSPECTOR _ DATE Revised 9\97 jm FORM - U - LO' LEASE FORM ' INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. 1 APPLICANT ('_ PHONE q-1 V,—&gS—g So/ ASSESSORS MAP NUMBERc�"! / LOT NUMBER c-2 zP SUBDIVISION LOT NUMBER STREET G iZ✓n,y 5T • STREET NUMBER k5 soon News Esse ..Mtn.now one soon soon son.was now none.................son..Asa... OFFICIAL USE ONLY sommosom won Ono manommosessom MEN gamesome NNE neon one a man momemosmomwo Ono memo none a RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADNIINISTRATOR DATE REJECTED I COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED CON v ENTS �l DATE APPROVED 1 i FOOD INSPECT - - DATE REJECTED / fi DATE APPROVED /a Z) ..SES • SPE -HEALTH DATE REJECTED CONadviENTS PUBLIC WORKS-SEWER 1 WATER CONNECTIONS DRIVEWAY PERMIT i DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE �I —!/�LGU4t'i%�GE'./GI/��/�l/ e�C�/•����Z��GC�/�/1�� �C(/�Q/ , / "1111 ie44011044&rZ1 904&t?, c�G�cs.z S. RUSSELL SYLVA Commissioner 935-2160 �CUQ�ucwz, 07807 August 26, 1987 Mr. Steve Daniel RE: ANDOVER - ERB-N87-1113 107 Gray Street Oil/Hazardous Material North Andover, MA 01845 Release/Threat of Release at 107 Gray Street WRITTEN CONFIRMATION OF NOTICE OF RESPONSIBILITY/SUMMARY OF RESPONSE ACTIONS TAKEN/REQUEST FOR INFORMATION Dear Mr. Daniel: As a result of an investigation conducted by the Department of Environmental Quality Engineering (DEQE) on August 12, 1987, the Department has determined that there has been a release of #2 heating oil which was ,the result of a leaking fuel line from the above ground storage tank to the heating systema Such incident is governed by Chapter 21E of the General Laws of Massachusetts (herinafter "M.G.L. Chapter 21E"), the Massachusetts Oil and Hazardous Material Release Prevention and Response Act, which was enacted on March 24, 1983. The Department has reason to believe based on available information that you are, under the provisions of M.G.L. Chapter 21E, Section 5(a), responsible for the occurrence of such release. On July 26, 1987, at approximately 10:00 a.m. , Department personnel verbally notified you of your responsibility for such release and gave you one copy of a document prepared by the Department and entitled "Brief Synopsis of M.G.L. Chapter 21E, the Massachusetts Oil and Hazardous Material Release Prevention and Response Act." You accepted such responsibility at that time. Your acceptance of responsibility for such release means that you have entered into a contract with cleanup contractor, approved by the Department, named Clean Harbors, Inc. of Braintree, MA to take all necessary remedial actions (i.e. assessment, containment and/or removal actions) relative to such release and to pay for all response costs incurred by the Department due to such release. The Department hereby requests that you submit to Ernie Penta, the following information: (1) a brief account of why, how and where such release/threat of release occurred; and i y Mr. Daniel Page 2. j (2) a description of all assessment, containment and/or removal actions that have been and/or will be taken- relative to such release/threat of release; and (3) an estimate, to the best of your knowledge, of the quantity of oil/hazardous material released; and (4) copies of all hazardous waste manifests for the hazardous material released; and (5) laboratory results of all soil taken from the test pits, wells; and (6) any other information that is pertinent to the assessment, containment and/or removal of such release. Failure to comply, in a timely manner with the above-stated request will constitute a violation of M.G.L. Chapter 21E. A copy of the text of M.G.L. Chapter 21E is available, upon written request from the Bookstore, Rm. 116, State House, Boston, MA 02133. If you have any questions, please contact Ernie Penta, at 935-2160. Thank you for your cooperation regarding this urgent matter. Ve trulyrs, r� lel.: Richard J. a pin Deputy Regional RJC/EP/ae Environmental Engineer cc: Frank Sciannameo, DEQE,OIR, 1 Winter St., Boston, MA 02108 BOH, Town Hall, Andover, MA 01845, Attn: Gayton Osgood William V. Dolan, Fire Chief, N. 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