Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 110 FARNUM STREET 4/30/2018
110 FARNUM STREET 210/107.q-? 74_0000.0 1' L I 'I I • S�.{'f�EA 764a' PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF. COMPLIANCE As of: 9/21/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Robert Daigle At: 110 Farnum Street Map 107.a Lot 74 Neth Andover, MA 01845 Th Is uan of this ce ' i tte s "11 not b construed as a uarantee that the g system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com i�a� � �� � ��� X05 r North Andover Board of Health Meeting Minutes Thursday—Jane 25,2015 7:00 p.m. 120 Main Street,2"d Floor Selectmen's Meeting Room North Andover,MA 01845 i I Present:Thomas Trowbridge,Larry Fixler,Frank MacMillan,Joseph McCarthy,Susan Sawyer,Michele Grant,Lisa Blackburn I. CALL TO ORDER The meeting was called to order at 7:00 pm. II. PLEDGE OF ALLEGIANCE III. PUBLIC HEARINGS A public hearing was held to amend the current tobacco regulations to raise the minimum legal sales age to buy tobacco and electronic cigarettes from age 18 to age 21.Properly advertised and licensed permit holders were notified. Frank explained reason why moving age to 21 was proposed. Motion made by Dr.MacMillan to open the public meeting,Mr.Fixler seconded the motion. Dr.MacMillan provides explanation on the proposal to increase the purchasing age to 21 within the Town of North Andover. Move that we amend our town regulation and that it be amended as one item. 1. Remove the definition of the word"Minor"in section 2.16 2. In section 2.22 remove the number"18"and replace with"21". 3. Delete the title in Section 3 and insert the following"Tobacco and Nicotine Delivery Product Sales to Persons Under the Age of 21 Prohibited" 4. In Section 3.1,remove the word"minor"and substitute it with the words"to persons under the age of 21:$ 5. In the last sentence of Section 3.2 remove"18"and insert "21" 6. In the first sentence of Section 3.3 remove"18"and insert"21" 7. In Section 10.1(a)remove"eighteen(18)"and insert"twenty-one(21)" 8. In Section 11.1(a)remove"eighteen(18)"and insert"twenty-one(21)" Dr.Trowbridge opens up the floor to all persons present for discussion. Larry Fixler made statements regarding the concerns of persons who feel raising the age to 21 would hurt armed service men.Mr.Fixler notes that he believes that if asked,most service men and women would not object to methods that are meant to keep tobacco out of the reach of the youth.Joe McCarthy voiced concern over your tobacco use and listed various bits of morbidity and mortality data on second hand smoke and smokers.He believes it will help limit the youth access to tobacco.He notes that many MA cities and towns have done this and is 2015 North Andover Board of Health Meeting Page I of 6 Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant E f surprised that the state of MA has not made this change already.He believes that it is something that should be done and from a health and safety perspective it is a wise thing to do. Ron Beauregard,Healthy Communities Tobacco Control Program,stated an editorial change in the wording in item#2;should read 2.22 instead of 2.2. Motion made by Dr.MacMillan to close the public hearing.Mr.Fixler seconded the motion.All were in favor and the public hearing was closed. Motion made by Dr.MacMillan to amend the regulation as previously stated in the record with the editorial change pointed out by Ron Beauregard.Motion seconded by Mr.Fixler.All were in favor # and the motion was approved. a Dr.Trowbridge stated that the regulation will take effect on September 1,2015.Mr.Fixler asked Mr. Beauregard if there will be new signage to reflect the change.Mr.Beauregard stated that new signs are available through the state,but our local regulation has a combination sign so he will change our sign to reflect the change.Ron also noted that language should be changed before signing to note only"as amended"for the September 1 start date.Cheryl Sbaira,Counsel to the Association of Health Boards of j Massachusetts,approached the podium and addressed the board.She discussed the amendment and the effective date.A discussion ensued regarding the pros for increasing the minimum legal sales age from 18 to 21. IV. APPROVAL OF MINUTES A. Meeting minutes from April 30,2015 and May 28,2015 were presented for signature. Motion was made by Mr.Fixler to approve the April 30,2015 minutes.Motion was seconded by Dr. MacMillan.All were in favor and the April minutes were approved. Motion was made by Mr.Fixler to approve the May 28,2015 minutes.Motion was seconded by Dr. MacMillan.All were in favor and the May minutes were approved. V. NEW BUSINESS A. 526 Winter Street—Vladimir Nemchenok,Merrimack Engineering,requesting: 1. A variance of Section 3,table 1,Setback Distance Table,in the local septic regulations to allow the septic tank to be 50 feet from a wetland where 75 feet is required. 2. A local upgrade approval for use of a sieve analysis as a substitute for a perc test. Mr.Nemchenok reviewed the requests for 526 Winter Street.A discussion ensued regarding the septic plan and placement of the septic system. Dan Ottenheimer,Mill River Consultant,gave his approval for the request. Motion was made by Dr.MacMillan to approve the variance of Section 3,table 1,Setback Distance Table,in the local septic regulations to allow the septic tank to be 50 feet from a wetland where 75 feet is required.Mr.McCarthy seconded the motion.All were in favor and motion was approved. Motion was made by Dr.MacMillan to approve the local upgrade approval for use of a sieve analysis as a substitute for a perc test.The motion was seconded by Mr.McCarthy,all were in favor and the motion was approved. B. 110 Farnum Street—Vladimir Nemchenok,Merrimack Engineering,requesting: j 1.Local upgrade approval to allow the septic system to be 4 feet above ground water where 5 feet is required for full compliance.(note:this item was added after the agenda was posted) 2.Set back from the Septic tank and pump tank to a wetland from 50' and 73'respectively where 75' is required 3.Set back from the SAS to wetland from 100'to 63'. E 2015 North Andover Board of Health Meeting Page 2 of 6 Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant e r North Andover Board of Health Meeting Minutes Thursday—June 25,2015 7:00 p.m. 120 Main Street,2°d Floor Selectmen's Meeting Room North Andover,MA 01845 F f Mr.Nemchenok reviewed the requests for 110 Farnum St.as discussion ensued regarding the septic plan and placement of the septic system. i Dan Ottenheimer,Mill River Consultant,discussed the wetland issues on the plan and stated that the first plans did not show the wetlands.He stated that it should have been identified back in May when Conservation Commission told Merrimack Engineering to look into it.Mill River also asked that the wetlands be double checked.Revised plans were submitted and again Mill River asked Merrimack Engineering to review with Conservation.Mr.Ottenheimer stated that this is not good engineering practice. The wetlands were approximated and are now 100 ft.closer to where the septic system is proposed and where Merrimack Engineering identified it previously.Last minute revised plans were presented this afternoon.Procedure concerns.Engineering firm did not look into it.Met with Conservation at 2:15 and presented plans received at 2:30 in afternoon.The new plans have not been evaluated yet by Mill River. Dr.MacMillan stated that he is not comfortable in putting plans forward that hasn't been properly vetted reviewed by town consultants.The engineer stated that he received the job in March and the snow made it hard to find the wetlands.Mr.Fixler made similar statements,noting to the consultant has not had time to review it.In response to Joe McCarthy's inquiry about the issue,Mr.Ottenheimer detailed that there was plenty of time and he is not comfortable with it either,as it just arrived this afternoon and Mill River has not reviewed it.Mr.Ottenheimer noted his frustration that this could have been avoided if the town's advice had been heeded.Mr.McCarthy noted his concern regarding the position the homeowner's are put in now.The members expressed their concern and noted that next time this should not come in last minute. The homeowner chose to speak on his engineer's behalf regarding wetlands and changes to the plan.He stated that the Engineer walked the whole property and identified them in back of property.He said the other area wasn't obvious.It is"perfectly dry,but it has wetland plants".The only plan changed would be to move pipe closer to the house and move further from wetland. Motion was made by Dr.MacMillan to delegate authority to Dr.Trowbridge to approve the plans following review by Mr.Ottenheimer if there are no unexpected findings,and after consultation with our consultant.Motion was seconded by Mr.McCarthy;all were in favor. Motion was made by Dr.MacMillan to approve the LUA to allow the septic system to be 4 feet above ground water where 5 feet is required for full compliance and all other requests as listed on the plan, pending Mill River's review. • To reduce the setback from the septic tank to the wetland resource area from 75'to 50' 2015 North Andover Board of Health Meeting Page 3 of 6 Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant • To reduce the setback from the pump chamber to the wetland resource area from 75'to 73' • To reduce the setback from the soil absorption system to the wetland resource area from • 100'to 63' • To reduce the separation distance from the soil absorption system to the estimated seasonal high ground water table from 5'to 4' • To reduce the requirement of soil test pits in the area of the proposed leaching facility from 2 test pits to 1 test pit The motion was seconded by Mr.McCarthy.All were in favor and motion was approved pending Mill River's review. Mr.Ottenheimer questioned Mr.Nemchenok about the size.Asking for 5ft instead of 4ft to reduce cost and ground disturbance,however made the system bigger which causes disturbance.Area is 795 sq.ft. instead of 595 sq.ft. Cost to the owner and the degree of variance would be less and rationalization for shorter height would be justifiable without extra 200 sqft.Mr.Ottenheimer does not believe that they have justified their reasoning for building larger than they need.Homeowner tried to explain the reason for this based on topography.Dr.Trowbridge questioned whether adding fill could be utilized rather than making the system bigger.The consultant felt the reasoning to make the field larger did not justify the board's approval of the I variance,but acknowledged it was the board's decision C.70 Raleigh Tavern Lane-Vladimir Nemchenok,Merrimack Engineering,requesting: WALK ON TO AGENDA REQUEST 1.Local upgrade approval to reduce the separation distance from the soil absorption system to the estimated seasonal high ground water table from 4'to 3'. 2.To reduce the setback from the soil absorption system to the wetland resource area from 100'to 84' Mr.Nemchenok reviewed the requests for 70 Raleigh Tavern Lane.A discussion ensued regarding the septic plan and placement of the septic system. Dan Ottenheimer,Mill River Consultant,explained the request for the reduction to the water table 4'to 3'. Gave his explanation on why the requests are different on the two properties.He stated that rapidly flowing soil needs to be 5'of separation.Silt/Clay soil only needs 4'separation.This allows for adequate treatment of the effluent. Dr.Trowbridge—Why is there another increased size of the field fiom 622 to 795 sq ft?This will increase the cost to the homeowner an extra$1000 to$3000? Does the homeowner understand that they are paying C extra for a larger system than required? Board members asked the homeowner,Walter Soule,if he understood about the additional money involved in the plan. A discussion ensued regarding the additional cost to the septic plan and if the homeowner was aware of the issue.The Board is making him aware and that this is something he can discuss with his engineer.Mr.Soule thanked the Board for all their help. Mr.Ottenheimer asks the question to Mr.Nemchenok of whether one could reduce the size and then reduce the variance?Mr.Nemchenok did not offer any additional information.As background on this property, Susan Sawyer explained the voluntary Title 5 that was done by the homeowner.A voluntary Title V requires that no Title 5 report paperwork is submitted to the Health Department.Hence this was done basically so an owner has additional time to replace the system. Motion was made by Dr.MacMillan to approve the local upgrade approval to reduce the separation ! distance from the soil absorption system to the estimated seasonal high ground water table from 4'to 3'.Motion seconded by Mr.McCarthy.All were in favor and the motion was approved. Motion made by Dr.MacMillan to approve the reduction to the setback from the soil absorption ; system to the wetland resource area from 100' to 841,Motion seconded by Larry.All were in favor and the motion was approved. 2015 North Andover Board of Health Meeting Page 4 of 6 Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant North Andover Board of Health Meeting Minutes Thursday—June 25,2015 7:00 p.m. 120 Main Street,2"d Floor Selectmen's Meeting Room North Andover,MA 01845 Dr.Trowbridge asked about the process of approving variances and local upgrades.Mr.Ottenheimer gave brief overview of guidelines of Title 5.Discussion followed. 0 The homeowner from 110 Farnum St.gave her thoughts regarding the septic installation process.She stated she felt that there were miscommunications in the process.Stated she did not receive the disapproval letter, however it was noted that the disapproval letter was sent out to them.Ms.Grant said the disapproval letter and final approval letter goes to both the homeowner and engineer as a standard procedure.However,Ms. Grant stated that it is not common practice for the homeowner to deliver the septic paperwork as Merrimack Engineering has their clients do.The engineering company usually does that.It is the engineer who should be guiding the homeowner through the process. VI. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION A. Dr.Trowbridge discussed current septic regulations that need to be reviewed.Some regulations are not being followed as they.Looking to take them out of the regulations.Maybe next month a discussion can be had to review the regulations which would require a public hearing. B. Susan discussed the trash truck that went into the lake at Flats Bridge in the morning. DEP,fire,police responded.She and Michele met them.Emergency response team.Discussion ensued regarding the response to the situation.Robo call was sent out to the residents.If call not received,please add name to the list on the town's website.There was a minimal release of fuel.JRM Hauling are responsible for the clean-up or anything else that might occur.Truck was permitted properly to come into town.No fines were issued by the Health.Dept.regarding the permitting of the truck.Discussion ensued.Water treatment plant will increase testing for chemicals in the water.There will be a full investigation on the incident. C. Dr.Trowbridge—discussion on heroin epidemic.Meeting tomorrow with youth services,fire,and police to discuss what can be done.Discussion ensued regarding drug use among youth and addiction. VII. CORRESPONDENCE/NEWSLETTERS VIII. ADJOURNMENT MOTION made by Dr.MacMillan to adjourn the meeting.Mr.McCarthy seconded the motion and all were in favor.The meeting was adjourned at 8:48 pm. Prepared by Lisa Blackburn, Health Dept.Assistant 2015 North Andover Board of Health Meeting Page 5 of 6 Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member, EdvMn Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant Reviewed by: All Board of Health Members&Susan Sawyer, Health Director Signed by: Lamy fY•er,-1 k of the Board Date Signed k 2015 North Andover Board of Health Meeting Page 6 of 6 Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr., M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Blackburn,Health Department Assistant iB d SUMMARY OF INVERTS BUILDING TIES ° SEWER 0 FDTN. 173.94 BLDG. CORNER A I B C D 1NOTE-0 THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 172.76 SEPTIC TANK OUT 21.1 24.8 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 172.39 PUMP TANK OUT 28.7 28.1 - - I SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK IN 172.29 DIST. BOX - - 24.3 25.4-1 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 175.51 COMPONENTS. DIST. BOX OUT 175.31 ' INV. IN CHAMBER 175.19 BOTT. CHAMBER1-1� 174.92 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE LOT 8 (44,700 S.F.) �ry ryo � ...mit a� *M44D BY NOM EN%iRONfMnAL 1ti � �" SINE 2013 00 119 0$ 1500 GAL. ?6. SEPTIC TANK 1y 0 1000 GAL. 5p PUMP TANK WMw EN E TAL 3A 4Ar CLEAN NORM SERVIMS,AAM=3 ff OUB... of B l'PA a A IgM PUMP CWROL BO x. rF.r�a�1s N Apmm i V= EXIST. 0TT.Co : LEACH FIELD �' 1 W/42 INFILTRATOR CHAMBERS i° a f INSPECTION v PORT VENT 17.0' 7 2 / _.. ...- —., _,..— _�...— .__ 150.001- �N OF mss D���T'` O� VLADIMIR L qty Flsl><l�Vl� sT NEMCHENOK AS BUILT PLAN ��pNAI tiN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IAT z NORTH ANDOVER, MASS./110 FARNUM STREET H AS PREPARED FOR JACK BURNS TM: 107A DATE: 8-20-15 w TL: 74 SCALE: 1"=40' 0 20 40 so F MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 PUBLIC HEALTH DEPARTMENT fommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired; By: �� 2 rk i, a o (Print Name) Located at: ` (� rA- V P 4f'I v/ j (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated & I — 1�; and last revised on —7-1 1'5 ,with a design flow of +40 gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date:�� G Engineer Representative(Signature) And—Print Name Final Construction Inspection Date: biw Engineer Representative(Signature) nr.��l��Gt� And—Print Name Installer: 4jeLLLt4,j (Signature) Date: Q And—Print Name Engineer: ✓C14/4uL tiK�446r—(Signature) Date: l0 Zoll— And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) ✓ All changes to the design plan have been reflected and noted on the as-built plan 2) ✓ As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3) /Street Address,Assessor's Map and Lot Number 4) V/ Lot Lines and Location of Dwellings served by the system 5) ✓ Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) ✓Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins ✓Property lines N 18 Dwellings or other structures iVPPrivate water supply or irrigation wells Watercourses or wetlands 8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system ./ 9) f Location of water,gas,electric lines,cable,control panel (if applicable) 10) Location of Structures within 6 Inches of Finished Grade 11) `� Original Stamp&Signature 12) (16 a Location and holder of any easements which could impact the system 13) ✓Impervious Areas;Driveways,etc 14) -✓ North Arrow 15) \//Location&Elevation of Benchmark used 16) ✓STATEMENT ON PLAN (NA 5.3) a. "I certify the locations,elevations, ties, cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the break out elevations,if applicable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was,or was not.constructed in accordance with the intended design and any manufacturer's specifications." Signature of Designer Date As of:Tuesday,September 15,2015 i • S�^rcEn r� � • North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 110 Farnum St. MAP: 107A LOT: 74 INSTALLER: Rob Daigle DESIGNER: Merrimack Engineering PLAN DATE: 6/1/15 rev. 7/1/15 BOH APPROVAL DATE ON PLAN: 7/6/15 INSPECTIONS TANK INSPECTION: 8/10/15 DATE OF BED BOTTOM INSPECTION: 8/10/15 DATE OF FINAL CONSTRUCTION INSPECTION: 8/20/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under accessp ort Z Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION-BOX • ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: Transition from 2" to 4" approximately 4 feet before D-box ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® . Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: Transition from 2" to 4" approximately 4 feet before D-box • S�ZTLBD'j�' • North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 110 Farnum St. MAP: 107A LOT: 74 INSTALLER: Rob Daigle DESIGNER: Merrimack Engineering PLAN DATE: 6/1/15 rev. 7/1/15 BOH APPROVAL DATE ON PLAN: 7/6/15 INSPECTIONS TANK INSPECTION: 8/10/15 DATE OF BED BOTTOM INSPECTION: 8/10/15 DATE OF FINAL CONSTRUCTION INSPECTION: 8/20/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: site was not staked out, full system with overdig was 38Lx27W, T-2 is 25" deep, T-1 is 30" deep SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Low Profile Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 7 ® Number of rows (trenches): 6 Comments: Total Chambers = 42 FINAL GRADE Loamed Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer :.`f` As-Built Plan Setup #1 Setup #1 BM = 178.15 BM = 178.15 HR = 0.70 HR = 1.95 HI = 178.05 HI = 180.10 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Setup #1 Building Sewer OUT 5.02 173.48 173.6 Septic Tank IN 5.75 172.75 172.65 Septic Tank OUT 6.12 172.38 172.40 Pump Chamber IN 6.22 172.28 172.35 2" Pump Chamber OUT 7.70 170.98 ----- Setup #2 (4")Distribution Box IN 4.20 175.55 175.40 Distribution Box OUT 4.41 175.34 175.23 Lateral 1 TOP 4.52 Lateral 1 INVERT 175.23 175.18 Lateral 2 TOP 4.49 Lateral 2 INVERT 175.26 175.18 Lateral 3 TOP 4.47 Lateral 3 INVERT 175.28 175.18 Lateral 4 TOP 4.51 Lateral 4 INVERT 175.24 175.18 Lateral 5 TOP 4.50 Lateral 5 INVERT 175.25 175.18 Lateral 6 TOP 4.50 Lateral 6 INVERT 175.25 175.18 Top of Chamber Bottom of Bed/Chamber 5.10 175.00 174.90 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance N s ( A 5.02). As defined in 310 CMR,10.55, 10.32, 10.54,and 10.30 respectively,pursuant to 3 15.211 p y,p ( ),also by NA wetland bylaws i Grant, Michele From: Grant, Michele Sent: Thursday,July 02, 2015 10:30 AM To: 'tat.boh@comcast.net' Cc: Blackburn, Lisa Subject: FW: 110 Farnum Street Attachments: 110 Farnum St- BOH meeting approval letter 7-2-15.doc Good Morning Tom, Please see the attached. If you could give me the approval, based on the Board Meeting, I can send the Approval letter for 110 Farnum Street. Please let me know if there's anything you may need. Happy 4cn Michele E.Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com sy'n U''w From: Isaac Rowe [mailto:irowe(�millriverconsulting.com] Sent: Wednesday, July 01, 2015 5:01 PM To: Blackburn, Lisa; 'Pam Lally' Cc: Grant, Michele; Isaac Rowe Subject: RE: 110 Farnum Street Lisa/Michele, Attached is the BOH approval letter for the above referenced property. I left the date of the letter in red. If it goes out later than 7/2 please change the approval validity accordingly. Based on the revisions we would recommend the Chairman approve the septic system design plan. Please let-me know if you have any questions. Thanks, 1 � a ' . rcrnJ Commonwealth of Massachusetts Map-Block-Lot �- !• 107.A0074 BOARD OF HEALTH - -- • Permitmit No North Andover -BHP-2015-0322------------- ----- ---- PA FEE F.I. $250.00 1W ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Robert Daigle___ __________ _ --------------------------------------------------------------------- to(Upgrade)an Individual Sewage Disposal System. at No 110 FARNUM STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2015-032 Dated,_July 30,2015 --------------------- - --------- COPY---------------------IF-1-LE------- ---------------------------- \ Issued On:Jul-30-2015 BOARD OF HEALTH � w • nu ,,�, Application for Septic Disposal System I TODA 'S DAT Construction Permit — TOWN OF NORTH ANDOVER, MA 01845 $250:00 -Component Important: Application is hereby made for a permit to: When filling out ❑ nstruct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your E] Repair or replace an existing system component–What? cursor-do not use the return A. Facility Information key. Address or Lot#VQ City/Town 2.-*TYP F SEPTIC SYSTEM*: ➢ Pump ❑Gravity(choose one) ***If pump system, attach copy of electrical permit to application`** ➢ ❑ onventional System (pipe and stone system) ➢ [!r Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. / ➢ [ Does the system require an effluent filter? Yes +' No If yes, does plan specify make and model of filter? YES =(no further info. needed) NO=(installer must specify brand of filter before DWC issuance) What is the MakeP ]�. What is the Model. �a 2. Owner Information Name �l V T� in ixA Address jf different fC (Mabove) / A City ��yy��44 StatCo')de �-� _( i �Zip U Email address Telephone lNumber 3. Installer Information t r 0. 5r. ame Name of Compan I4 eAil 4& Address) I(/tQ ©1 City/Town State Zi Code � b� Telephone Number(Cell Phone 70 if possible please) 4. Designer Informs ion Name� Name o Company City/TownATelleph—one—Nu / Zip Code bdr(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 t •-� t ° •. Application for Septic Disposal System TODAY S ATE Construction Permit — TOWN OF NORTH ANDOVER MA 01845 $250.00-Full Repair $125.00 -Component PAGE 2OF2 A. Facility Information continued.... i 5. Type of Building: Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I underst d t at until a final Certificate of Compliance has been issued by this Bo of Health, e i t d system is not approved. hok- W&e Date li atio Approved o r?I of H�alth-Representative) - 1 ame Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached. Yes-1 No 3. Pump System? Ifso,Attach copy ofElectrical Permit Yet No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approval letter, all paperwork received. Yes t No Sino- 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) 6. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by �/ / (Engineer) Relative to the application of ke (Installer's narn't V And dated (yriginal date) Dated Lo I, o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans p1jor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations mal result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (1'� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consmltant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining mall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: 1 (T da 's te) 'R(�b J 1 ame— Tint ame—Si e Grant, Michele From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Friday,June 19, 2015 3:48 PM To: Grant, Michele Cc: Isaac Rowe Subject: 110 Farnum St Attachments: 110 Farnum St - Soil test app Con Com comments.pdf Michele, Can you check with Heidi to see if she recalls how far the wetlands from the rear of the house. The design plan is proposing tanks in the rear of the house but also notes there are no wetlands within 100 feet of the proposed system. I want to make sure I word my comment appropriately. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(cD-mill riverconsulting.com www.millriverconsulting.com i Grant, ichele From: tat.boh@comcast.net Sent: Saturday,July 04, 2015 9:51 AM To: Grant, Michele Subject: Re: 110 Farnum Street Michele- You can issue the approval. Since the Board basically deferred the approval to the chair, maybe you should add "...and reviewed by the Chair." after the first sentence. This would keep everything in proper alignment. I will defer to whatever you think appropriate. Have a great holiday. Call me if you need anything next week while Susan is away. Tom From: "Michele Grant" <MGrant(a�townofnorthandover.com> To: "tat.boh _comcast.net" <tat.boh(a-),comcast.net> Cc: "Lisa Blackburn" <LBlackburn(a�-townofnorthandover.com> Sent: Thursday, July 2, 2015 10:29:42 AM Subject: FW: 110 Farnum Street Good Morning Tom, Please see the attached. If you could give me the approval, based on the Board Meeting, I can send the Approval letter for 110 Farnum Street. Please let me know if there's anything you may need. Happy 4th Michele E.Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com ,a UAW From: Isaac Rowe [mailto:irowe(&miliriverconsulting.com] Sent: Wednesday, July 01, 2015 5:01 PM To: Blackburn, Lisa; 'Pam Lally' Cc: Grant, Michele; Isaac Rowe Subject: RE: 110 Farnum Street 1 Lisa/Michele, Attached is the BOH approval letter for the above referenced property. I left the date of the letter in red. If it goes out later than 7/2 please change the approval validity accordingly. Based on the revisions we would recommend the Chairman approve the septic system design plan. Please let me know if you have any questions. Thanks, Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(cD-millriverconsulting.com www.miliriverconsulting.com From: Blackburn, Lisa [mailto:LBlackburn(a)townofnorthandover.com] Sent: Wednesday, July 01, 2015 3:48 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: FW: 110 Farnum Street Updated plans for 110 Farnum St. From: merrengi [mailto:merrenglCa�aol.com] Sent: Wednesday, July 01, 2015 2:59 PM To: Blackburn, Lisa Cc: Grant, Michele; jhugesCaltownofnorthandover.com Subject: 110 Farnum Street Lisa/Michelle/Jennifer Attached please find pdfs of the revised plan for the above subject site. Please ignore the last pdfs sent by Bill Dufresne from our office, I inadvertantly and electronically omitted the erosion control from the plan. My apologies, Frankie Ortiz Merrimack Engineering Services All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com 2 lfomnonweali olMamac4ujeff4 Official Use Only Apartment o0ire Serviced Permit No. 12,15416 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blarik)`. APPLICATION FOR PERMIT TO PERFORM ELEOTRIC�AL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),`527 CMR42.00 (PLEASE PRINT IN INK OR TYPE ALL INFOR TION Date: City or Town of: _ To the Inspector of Wires.• By this application the undersigned giv— o his or her intention to perforn?the electrical wbif d'escrdb ed below. Location(Street&Number) f Owner or Tenant - u Telephone No. Owner's Address Is this permit in.conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility.Authorization No, Existing ServiceAm ��., Ps C1 / `l`Cj Volts Overhead D/ Undgrd❑ No.of Meters Neiy Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity . Location and Nature of Proposed Electrical Work. ° Completion of the follow* table may be waived by the Ins ector of Wires; --1 No.of Recessed LuminairesNo.of Ceil:Susp.(Paddle)Fans No.of_ Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA (� No.of Luminaires Swimming Pool Above ❑ In- o.o mergency ig ing rnd. rud. El $atte Units No,of Receptacle Outlets No,of Oil Burners FIRE ALARMS No.of Zones No.of Swwtel:es leo,:of Gas Burners No.of Detection and Initiating Devices No.of RangesNo..of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Fump Number Tons. KW No.of Self eFn t°ained Totals: .........................••..................... Detection/Mertin Devices No.of Dishwashers Space/Area HeatingKW Municipal Local❑ Connection Other No,of Dryers HeatingAppliances KW Security Systems:* No.of Water No.of Devices or Equivalent No. No.of Heaters. KW Si ns Ballasts Data Wiring: No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: r OTHER: No,of Devices or Equivalent Estimated Value of Elec Attach additional detail if desired,or as required by the Inspector of Wires. ' al Work: (When required by municipal policy.) Work to Start: Ins ectio j ns to p be requested in accordance with MEC Rule 10,and upon completion. INSURANCE* OVE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liabilityinsurance including"completed operation"coverage or its substantial equivalent, The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE .[BOND ❑ OTHER 0,,, pecify:) . I certify, under the pal acid enaldes o p ofperjury,that the informationon this application is true and complete. FIRM NAME: . t` LIC.NO.: Licensee: Signature y . (Ifapplicable,enter `exem jf .LIC..NO.. p "m r license number e.) Bus.Tel,No.`7 5l'I �j���,13� Address: , *Per M:G.L.c. 147,s. 57-61,security ork requires Department of Public Safety License: Alt.Leo 1No: ZFL �� OWNER'S INSURANCE WAIVER:. I am aware that the Licensee does not have the liability insurancetcoverage normally required bylaw, By my signature below,I hereby,waive this requirement: I am the(check one ❑owner Owner/Agent ❑owner's agent. Signature Telephone No. PERMIT FEE: 1� ` II Date... ..... ...................... F NORT�y TOWN OF NORTH ANDOVER PERMIT FOR WIRING g$ACHUSE I • 1 This certifies that,.........:......... t. ....................w1�..,,.5 has permission to perform ..... '. ..........C...P.. l°a ....., ..t ........ f wiring in the building of.... � ^'� ........................................................................................... at i ArJ .` ....... ............................North Andover,Mass. Fee..............................Lic.No. ................. .................................................................................... ELECTRICAL INSPECTOR Check# 2548 II, t7 Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(a millriverconsulting.com www.millriverconsulting.com From: Blackburn, Lisa [mailto:LBlackburnC&townofnorthandover.com] Sent: Wednesday, July 01, 2015 3:48 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: FW: 110 Farnum Street Updated plans for 110 Farnum St. From: merrengl [mailto:merrengl@aol.com] Sent: Wednesday, July 01, 2015 2:59 PM To: Blackburn, Lisa Cc: Grant, Michele; jhuges@townofnorthandover.com Subject: 110 Farnum Street Lisa/Michelle/Jennifer Attached please find pdfs of the revised plan for the above subject site. Please ignore the last pdfs sent by Bill Dufresne from our office, I inadvertantly and electronically omitted the erosion control from the plan. My apologies, Frankie Ortiz Merrimack Engineering Services All email messages and attached content sent from and to this email account are public records unless qualified as'an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma 2 MD z . B�.E copy North Andover Health Department Community Development Division July 1, 2015 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 110 Farnum Street(Map 107A, Lot 74) Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated June 1, 2015,revised June 22, 2015, June 25, 2015 and June 30, 2015 and received on June 30, 2015 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. On sheet 1 of 2, additional contour lines or spot elevations should be added slightly beyond the new pump chamber location to ensure proper cover material is proposed over the tank. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. 'ncerely,, Michele Grant Health Inspector cc: Jack Burns File Page 1 of 1 North Andover Health Department, 1600 Osgood Street Suite 2035 P � g � , North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 MERRIMACK ENGINEERING SERVICES, INC. ` PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET• ANDOVER,MA 01810•(978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL info@merrimackengineering.com June 23, 2015 Michelle Grant Board of Health RECEIVED 1600 Osgood Street- Suite 2035 North Andover, MA 01 845 JUN 2 3 2015 RE: 110 Farnum Street TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Dear Michelle, We are in receipt of your review letter dated 6-19-15 for the above referenced site which we received via e-mail yesterday, 6-22-15. The plans have been revised to address the 3 items in your review. Enclosed are 3 copies of the revised drawings for review and approval. Vladimir Nemchenok will be forwarding pdf s of the revised design directly to your office. Your truly, William Dufresne, Project Manager Merrimack Engineering Services Grant, Michele From: wrdufresne@comcast.net Sent: Wednesday,June 24, 2015 9:26 AM To: Hughes,Jennifer Cc: Gaffney, Heidi;Grant, Michele; Kfoury, Eric Subject: Re: 110 Farnum Jennifer I will have a botanist visit the site and have it delineated. Thank You, Bill From: "Jennifer Hughes" <JHughes townofnorthandover.com> To: wrd uf resne(d)-co m cast.net Cc: "Heidi Gaffney" <HGaffney(a),townofnorthandover.com>, "Michele Grant" <MGrant townofnorthandover.com>, "Eric Kfoury" <EKfoury _townofnorthandover.com> Sent: Tuesday, June 23, 2015 4:57:40 PM Subject: 110 Farnum Bill, I was on-site today and walked the fence line of the property. I found wetland vegetation and hydrology (I did not auger off property) on 96 Farnum Street. Heidi also sent me the attached plan which shows a wetland flag on 122 Farnum (at the property line with 96) much closer to the tanks than the approximate line you showed. You should have this site reviewed by a wetland scientist. Let me know if you would like to discuss further. Jennifer A. Hughes Conservation Administrator Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978.688.9530 Fax 978.688.9542 Email jhughes townofnorthandover.com Web www.TownofNorthAndover.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. 1 a � North Andover Health Department (ommunity and Economic Development Division July 6, 2015 Jack Burns 110 Farnum Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 110 Farnum Street(Map 107A,Lot 74) Dear Mr. Burns: The proposed wastewater system design plan for the above site dated June 1, 2015 with a final revision date of July 1, 2015 and received on July 1, 2015, has been reviewed by the Chairman of the Board and ultimately has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a 4-bedroom (max 9-room)home utilizing a Quick 4 Low Profile Infiltrator Chamber system. This design plan approval is valid until July 2, 2017. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. At a regularly scheduled meeting of the Board of Health,this plan received the following approvals by the members. Local Upstrade Approvals: • To reduce the setback from the septic tank to the wetland resource area from 75' to 50' • To reduce the setback from the pump chamber to the wetland resource area from 75' to 73' • To reduce the setback from the soil absorption system to the wetland resource area from Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ' 110 Farnum Street July 6, 2015 100' to 63' • To reduce the separation distance from the soil absorption system to the estimated seasonal high ground water table from 5' to 4' • To reduce the requirement of soil test pits in the area of the proposed leaching facility from 2 test pits to 1 test pit This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)) 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, 1� uwkVVV Michele Grant Health Inspector Encl. Installers list cc: Vladimir Nemchenok, PE, Merrimack Engineering Services File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 IP 1MERRIMACK ENGINEERING SERVICES, INC, PROFESSIONAL ENGINEERS LAND SURVEYORS 9 PLANNERS 66 PARK STREET• ANDOVER,MA 01810• (978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL info@merrimackengineering.com June 2,2015 Board of Health RECEIVED 1600 Osgood Street AIN 0 2 2015 Suite 2035 North Andover, MA 01845 TOWN OF NORTH ANDOVER HEALTH DEPAR i MENT RE: 110 Farnum Street Dear Mr Chairman and Members: We have completed an upgrade septic system design for the above referenced site. The site poses many challenges and has many pre existing conditions in the rear yard that are not necessarily shown on the drawing such as in ground swimming pool,walkways, landscape features, etc., and resulted in a replacement system in the front of the house. Soil conditions in front are favorable but with a high water table resulting in a raised system. In order to maintain adequate flow of storm water runoff and not cause ponding, damming or trapping of surface water, it was necessary to design the system with a request for LUA to allow the system to be 4 feet above ground water where_ 5 feet is required for full comnkaie-- On behalf of the owner, Jack Burns, I respectfully request this matter be placed on your June 25th meeting agenda for consideration of this Local Upgrade Approval request. Your truly, out,_, William Dufresne, Project Manager Merrimack Engineering Services fi I Grant, Michele From: MERRENG@aol.com Sent: Thursday,June 25, 2015 1:19 PM To: Blackburn, Lisa Cc: Grant, Michele; Hughes,Jennifer Subject: (no subject) Attachments: 110 FARNUM ST.-NO.ANDOVER.pdf, 110 FARNUM ST.-NO.ANDOVER2.pdf Dear Lisa, We have been working with Jennifer Hughes regarding wetland issues on the subject site and adjacent properties. Attached here with are PDF's of the revised plan. Due to the presence of a small isolated wetland on a property at 96 Farnum Street, we have revised the design which requires variances for wetland setbacks pursuant to the NA Board of Health Regulations, the specific requests are noted on the attached plan. will be happy to discuss the variance requests, if the Board so wishes, during the scheduled hearing. Thank you, Vladimir Nemchenok, P.E., Progect Engineer Merrimack Engineering Services 66 Park Street Andover, MA 01810 tel 978 475-3555 fax 978 475-1448 merrenq(o)aol.com 1 Grant, Michele From: Blackburn, Lisa Sent: Tuesday,June 30, 2015 3:26 PM To: Grant, Michele Subject: FW: 110 Farum Street Attachments: 110 farnum st.pdf, 110 Farnum St 2.pdf Is this going to Mill River? From: wrdufresne@comcast.net [mailto:wrdufresne@comcast.net] Sent: Tuesday, June 30, 2015 3:23 PM To: Blackburn, Lisa Cc: Hughes, Jennifer; Vladimir Nemchenok; Jack Burns Subject: 110 Farum Street Lisa/Jennifer Attached please find pdfs of the revised plans for the above subject site. All wetland flags have been field surveyed and shown on the plan as well as the erosion control details, soil stockpile area, and wetland buffer zones requested by the Conservation Commission. Vladimir Nemchenok will follow up with stamped hard copies for your files. Thank You, Bill i i LOCUS MAP n Nor TO—E XIII _ NOTES e4.00 r.) Au aro u iii w R 55(luITIN, w " ` TT W,Neuae"xN°A. ( .SITE a) r wEB. 3 3 wx x1. rz.or rxE stmt rAxR P ru raou Ensnxo vuxs Axo arroaos.SEE ex.O.a.O. Od a Is�eo r� .1 ITT I 111 11 1111 a.) a xs ANO W onn o r0.) E or r r.) sr sreu rOERFDR�EDAxB IRE IllsIll" eE�u.rccR rz.) r ww(Oa uP—1 O1L smc INE Exls".s,S."Auo aaOp o n ANO wN�L n11 ra.) r uR(OR"""o")rot snrrus,urxE Err xc sEvrrc rAxr swu Os _NR IN-INRI AT Al I a) xO LIST OF LOCAL UPGRADE APPROVALS rxE —E.TU'wEus wRrxd zoo n.of rxE srsrEu rs.) . r.nanaL raou s.A.s.TO Es.w.r.raox s TO I re.) R. SNAU fit ANO ARE INTENDED To of IN""COIRORNAN "' LIST OF N.A. BOARD OF HEALTH VARIANCE net ssw.cE.vo cuR rr.) rxE drE Is.1 Lourm wnxd mE LAaE cowaxLw,d:w.rrasxr0.au. z. rraAer rRau rxr s sero ,O All TO Er wEnAxO rr saauaro ae LOT 6 y (44,]00 S.F.) "6N i N 6 N DESIGN CALCULATIONS ;w 4F/ BEt to PERI RATE eE . uvA/ar= � 'h 0 •aucn.ux sat cuss. ^.� _ t rw t y'za LGCNac nuO REO 0 OAL.r/>A cvB/s.r.- sr vAN/, / Vie. tNX 195 SAI-±'-73— roar./L F,c_Ll(12 cLuueras) Lr rt rh ,amu, auur s.r.An._ ut(zoor).e w aur xor usss mw Is.GAL. i i ��\\ stunt raxr PROVO.Ism 0- t I- PROP.SOL wont—AREA be. Ir e� rxrxiOurx;c i PRro.T= vRaP.rsoo cAL uoxourxic '.=IA' ccanrr rxxr. BLsrcx couvuas xarx rxE srAuoARo coNdnous sEvnc rxxa or AVPRovu roR anunwrOR auuacas B.Arco wr zz,sora coxrRBL/OARR;Ea ON co aor�ErEa sm. svavn wx OR rxc C.N.O. u AN AcrvAL SEE oEruL SNLE,i ;112-71 vudura xrucxExoR..R "1' � UPGRADE PLAN OF 77-1 a (' SUBSURFACE SEWAGE DISPOSAL SYSTEM 2 rwoci�oNc i� _ IfEAsaE •"P LN RAn w;Lb 's.r�I NORTH ANDOVER, MA FOR B " "Rr r �� JACK PBURNS EEcn Po x suee As sxawN ogre s ASSESSORS uAP/ rorA LOT )_ SUBD/VISION No. Barr By Rnivous —NDS 05 FARNUM h STREET 1 6 L a-zz-rs P£R AEYLS£D B.O.H.LENDS OArEO 6-19-6 I,HERR/MACK ENG/NEEWNG SERWCES -25-IS _ PLAN J 6-30-1e 5 OO WERANOS ANO POOL 66 PARK STREET _ ANDOVER, MASSACHUSETTS 01B10 1 OF 2 m.w,:trxJ°^ ,Fo�...,•.x,,��N w ,.K � .wcF�N,� """` u.,.d.�o.=..n..wrt�r��A;ro.la 7L J :rw°or nowmm•/,.`m .�,..,� _ ...=o .nrwr�awJ cx"`�°n=- � w mx..cr rtex wv ..r.ramro mlr - .,,..n sz..xY _ rox. w.ryw�w•/ n nmu :N was..wweer.vero.0 eroWs, m../ xrmK emr ae 'm4„"Pw"�o`�r°w M R K 4w �Ne roe 1 e"OeO� PROFILE ==6— nuTAcnME xE—ENEnrs ._ `•°=r 1 rmo r�°oFrrA'"".sl wr m wH Iii.. a INFILTRATOR FIELD END SECTION COMPOST FILTER SOCK �•e• erH� N-'?IIIiR-N-1 rov=e.r urc uor,o swE m PUMP NOTES fo rleocoxsrwc m n ..1 LI-1/cI.LN--'�T"T ru vrree.wr nM,xwom rw u n" r&--nm F QUICK4 PLUS STANDARD LP CHAMBER DETAIL F-I ' mrN INSPECTION PORT e"""1 Sp1Y rmm .I TYPICAL INSTALLATION DETAIL r`w4 w=r ro wu' °J � smugmmrr,.exur. PROP.GRA vagi w u ,I(.w.a'e(ru rtJ•..v uyn.-ase wr. E%1GR ------------ 75 --___-- rul urwmrn....,..uuJra nm m.•mu n. J,coeius `\ �15.5 r5 i _ _ -------------------- p- ___-_____ LEAs Frew rm. wnr Ixn mxiox BOUYANCY CALCULATIONS m•.w �.,,. I- - -I aAFrrE aov cx.usExs O m.ma,r� r __ , I EwSr _ o 1 Esw.i SM'rj'-IC 11EIT sFPnc rxn mr, O loco ox O � mmm� raP �' wuv T_ BOUYANCY CALCULATIONS POK. m fi .� - — m ""'m S r \Q 0\i�\ °'•.01 emxn SEC SCALE PROFILE ,e MONOLITHIC PUMP TANK OETAILS mmm masa s rmrs w mrm onmmn. x�R`"' •M ® MONOLITHIC H-20 O`BOX DETAILS DEEP TEST RESULTS PERC TEST RESULTS rtwxe.r���me. mm mm e..n,ammmme� „m, WSEPTrmIC rip tlp,ETAitmmm° .m PERFORMANCE CURVE r_ i.nr. arras mrru UPGRADE PLAN OF ws' Ir SUL7SURFACE SEWAGE DISPOSAL SYSTEM N e NORTH ANDOVER, AM AS PREPARED— .,ver=roe JACK BURNS .e .• us wows utas uwurt SLALE:AS SHOWN N OA)£`6-I-i5 a- a rox APPRO�[O ASSESSORS MAP/ r_ LO) )_ SUBOIVIS/ON LOr/ FXPFRrISF ANO FXPFR/ExOE OFSCR/eF0 w Ala ONR IS OI Ou,R[O FiRsIxING N0. OA)E BY REVISIONS: r = s ,NRF �a -aa_ls vN PER B.O.H.LCTI£R DATLO c-Is-/s I MERRIMACK ENGINEERING SERVICES : 35/5 VN EVISEO WFT4NOs s 6-30-IS SCA TREET A.W[TUNOS AND POOL BB PARK MASSA - ANDOVER, MASSACHUSETTS O1B1U 2 OF 2 r, . • FILE COPY North Andover Health Department Community and Economic Development Division June 19, 2015 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 110 Farnum Street(Man 107A,Lot 74) Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated June 1, 2015 and received on June 2, 2015 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. Please confirm with Conservation that there are no wetland resource areas within 150' from the proposed tanks and leach field (NA 3.2). 2. Indicate the location of the existing leaching facility(NA 3.2). 3. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use"will apply. Please provide the following as required by the approval conditions Section II(7): e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection; Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 v ' r Section II(18): c) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 5 IIA technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; 2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); 3. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 4. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, bac LC, Michele Grant 4 Health Inspector cc: Jack Burns File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 r •' TOWN OF NORTH ANDOVER .• Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept(a,townofnorthandover.com WEBSITE:httn://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: >- JUN 0 2 2015 Site Location: 110 PArww'! zn—, 'TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Engineer: New Plans? Yes / $225/Plan Check#(includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check#/ Site Evaluation Forms Included? Yes `✓ No Local Upgrade Form Included? Yes ✓ No Telephone#: `�77'" 7�� Fax#: E-mail: I j" ei ge 6&�T. ur Homeowner Name: _1 t'— 1? LC, OFFICE USE ONLY When the sub�Aisiion is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ / Enter on Log Sheet and Database 1 MERRIMACK ENGINEERING SERVICES, INC, ` PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET• ANDOVER,MA 01810•(978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL info@merrimackengineering.com June 2, 2015 Board of Health RECEIVED 1600 Osgood Street JUN C 2 2015 Suite 2035 North Andover,MA 01845 TOWN OF NORTH ANDOVER H,64LTH DEPARTMENT RE: 110 Farnum Street Dear Mr Chairman and Members: We have completed an upgrade septic system design for the above referenced site. The site poses many challenges and has many pre existing conditions in the rear yard that are not necessarily shown on the drawing such as in ground swimming pool,walkways, landscape features, etc., and resulted in a replacement system in the front of the house. Soil conditions in front are favorable but with a high water table resulting in a raised system. In order to maintain adequate flow of storm water runoff and not cause ponding, damming or trapping of surface water, it was necessary to design the system with a request for LUA to allow the system to be 4 feet above ground water where 5 feet is required for full compliance. On behalf of the owner, Jack Burns, I respectfully request this matter be placed on your June 25th meeting agenda for consideration of this Local Upgrade Approval request. Your truly, 0 William Dufresne, Project Manager Merrimack Engineering Services Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ' i'2ECElVe® A. Facility Information JUN p 2 20 E Jack Burns _ .. ,, nn GWH nnl�:OVFR t Owner Name � �v�r� G 140 Farnum Street 107A/74 HEALTH DEPARTMENT Street Address Map/Lot# I North Andover MA 01810 City State Zip Code B. Site Information 1. (Check one) E] New Construction ® Upgrade E] Repair 2. Published Soil Survey Available? ® Yes E] No If yes: 9-19-14 vers 10 1:15,800 421 i Year Published Publication Scale Soil Map Unit Canton Soil Name Soil Limitations 3. Sur ficial Geological Report Available? ❑ Yes E No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? E Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No I J 5. Wetland Area: National Wetland Inventory Map Map Unit Name { Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): 4/2014 /20/2014Year Range: El Above Normal ❑ Normal E Below Normal Month7. Other references reviewed: Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 I Commonwealth of Massachusetts City/Town of North Andover r Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) T-1 5-19-15 12 pm rain clouds 70 Deep Observation Hole Number: Date Time Weather 1. Location 4 Ground Elevation at Surface of Hole: 174. Location (identify on plan): See Plan 2. Land Use Residential None 8 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Ground Moraine Bootom Slope Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >100 Drainage Way >100 possible Wet Area >100 feet feet feet Property Line 25 feet Drinking Water Well >100 feetOther feet 4. Parent Material: Till Unsuitable Materials Present: ❑ Yes ® No I If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ® Yes ❑ No If yes: 68 79 Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 42 170.9 inches elevation I I Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist Munsell USDA Structure Consistence Other y (Munsell) ( ) truc Depth Color Percent Gravel Cobbles& (Moist) 0-11 A 10YR3/2 FSL Wk Gran Friable i 11-18 131 10YR4/4 FLS Massive Friable 18-30 B2 2.5Y5/3 FLS Massive Friable 30-102 C 2.5Y6/4 42 7.5YR4/6 >5 Sand 10 5 Single Loose Grain Additional Notes: 1 i i Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 i Commonwealth of Massachusetts CitylTown of North Andover = Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-2 5-19-15 12pm rain, clouds 70 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 174.2 Location (identify on plan): See PIAN 2. Land Use Residential None 8 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Ground Moraine Bottom Slope Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body '100 Drainage Way >100 possible Wet Area '100 feet feet feet Property Line 15 Drinking Water Well '100 Other feet feet feet 4. Parent Material: Till Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 60 78 5. Groundwater Observed: ® Yes ❑ No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 40 170.9 inches elevation i � I 1 Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts Cityfrown of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence Other Depth Color Percent ravel Cobbles& (Moist) Stones 0-11 A 10YR3/2 FSL Wk Gran Friable 11-25 B 10YR5/6 FSL Massive Friable 25-100 C 2.5Y5/4 40 7.5YR4/6 >5 LS 15 Massive Friable I Additional Notes: i i - Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 ` Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole in in inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 42 B. 40 inches inches E] Groundwater adjustment(USGS methodology) Aches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level i E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 18 Lower boundary: 102/ 100 inchess inches Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts C ity/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal { F. Certification + I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluator Date William Dufresne SE#640 5-9-96 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Isaac Rowe (Mill River) North Andover Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. I I Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 ' Commonwealth of Massachusetts _ City/Town of North Andover Percolation Test Form 12 qw M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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 the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on the computer, use Jack Burns only the tab key Owner Name to move your 110 Farnum Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 tL City/Town State Zip Code (617) 851-4961 Contact Person(if different from Owner) Telephone Number B. Test Results 5-19-15 12 noon Date Time Date Time Observation Hole# P-1 Depth of Perc 42" Start Pre-Soak 12:21 End Pre-Soak 12:36 Time at 12" 12:36 Time at 9" 12:40 Time at 6" 12:44 Time (9%6") 4 Rate (Min./Inch) `2 Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ William Dufresne SE#640 Test Performed By: Isaac Rowe Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 'Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval �M 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use Jack Burns Residence only the tab key Name to move your 110 Farnum Street cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): SAME '�d7f1 Name Street Address Cityfrown State (617)851-4961 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 BDRM House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Unknown t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 'Commonwealth of Massachusetts City/Town of North Andover a o Form 9A — Application for Local Upgrade Approval M 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe 5-19-15 Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: NA 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 'Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M 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. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." a4m wl!!Zl 6-2-15 Facili er's Si4Kture Date Jack Burns Print Name William Dufresne/Merrimack Engineering 6-2-15 Name of Preparer Date 66 Park Street Andover Preparers address City/Town MA/01810 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 `Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval wM 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Total System, see plan 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction 1.0 ft. Percolation rate 2 min./inch Depth to groundwater 4.0 ft. t5form9a.doc•rev.7/06 Application for Local Upgrade Approval, Page 2 of 4 r _ TA 0�SZ LAJ 1 a —_—_--— — .—_1.•- :/meg '; TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES ' HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,RENS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthdept(a,townofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: `j-—(," -t 5- MAP&PARCEL: i V7 A / 7+ LOCATION OF SOIL TESTS: � 10 L=/l p ��p t71— OWNER: 1 bkfa��° �� Contact 4o—) !�f lk I APPLICANT: I-A LA Contact#: ADDRESS: ENGINEER: Contact#: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision 4gle Family I3oln Commercial Is This: Repair Testing: V' Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-1.00')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date:- f 57l(S Signature of Conservation Agent: !' lr gp�,f' Date back to Health Department: (stamp in): BUYER: I�Q05i, 1.oT g 44,700 ; 1 # Variance granted 3-13-90 N1 i� 1 7 ' Lor # P^44 5,,,. Z.0 '_` 4r. si ' -- ---- �. --- l�Kt�k�lf�, ST. MORTGAGE INSPECTION PLAN TO THE LOCATED IN ' AND ITS TME INSURER& ow- 1 � s-p— I CER71FY THAT I HAVE ExAMINED THE PROMISES AND THE WILOINGS SHOM OO( ) Ma$$/t,CHUSETfS CONFORM TO THE ZONING LAWS AND AMENDMENTS. Le(FRONT. SIDE. &REAR YARD SETBACK ONLY) OF A.N'Lx:).V=-p_ NMEN CONSTRUCTED. OR ARE 001PT FROM VIOLATION ENFORCEMENT`ACTION UNDER MASS. G.L. TITLE V8. OWTER 40A. SECTION 7. UNLESS OTHERVWSE NOTED. l Blackburn, Lisa From: Pam Lally <plally@millriverconsulting.com> Sent: Friday, May 08, 2015 9:35 AM To: Blackburn, Lisa; 'Dan Ottenheimer'; 'Isaac Rowe' Cc: Grant, Michele Subject: RE: 110 Farnum St. Hi Lisa, We've scheduled this soil testing with Bill Dufresne for Tues. 5/19 in the afternoon. Isaac will probably be there around fpm. Let us know if you have any questions. Thanks,Pam -----Original Message----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent:Wednesday, May 06, 2015 1:35 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 110 Farnum St. Soil testing application for 110 Farnum St. -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent:Wednesday, May 06, 2015 1:48 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date:05.06.2015 13:47:54(-0400) Queries to: noreply@townofnorthandover.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north_andover www.facebook.com/northandoverma 1� \ r 1 G-0 I bk� �T in t < Commonwealth of Massachusetts W Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments f I �M 00 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altere inlany way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms DECEIVED on the computer, use only the tab 1. Inspector: MAY 9 2015 key to move your cursor-do not Chad Jablonski use the return DOVER key. Name of Inspector -JQHNLTH pEPARTMENT VYNC.J. Jablonski Septic Inspection and Repair raa Company Name 237 Merrimac St. Company Address r Newburyport MA 01950 City/Town State Zip Code 978-360-9358 4574 Telephone Number License Number B. Certification 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 Inspecto ature Date The system insp ctor shall submit a copy of this inspection report to the Approving Authority (Board of Health or DE 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•3/13 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 ° 110 Farnum St. M sv'y`• Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 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: B) System Conditionally Passes: ❑ One or more system components as described in the Conditional Pass section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ° 110 Farnum St. M Sv•y Property ert Address P Y Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town 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 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Re uired 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 un Y 9 der 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts z Title 5 Official Inspection Form a o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 110 Farnum St. M SV•y Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 310 CMR 15.302 5 PP P ) [ ( )l D. System Information Residential Flow Conditions: Number of bedrooms (design): No design Number of bedrooms (actual): 4 avabe DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): No design t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M ,•'�� 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town 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 El Yes ® No information in this report.) Laundrysystem in ? inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Attached 9 ( Y 9 (gpd))� Detail: Sump pump? ® Yes ❑ No Occupied Last date of occupancy: 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? ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts N w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 110 Farnum St. M Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 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: Source of information: Home Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: nagallons How was quantity pumped determined? na Reason for pumping: na Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 o1 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 110 Farnum St. SV• Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 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: Approximately 50 years. Original system Were sewage odors detected when arriving at the site? ❑ Yes ® No BuildingSewer locate on siteplan): ( � Depth below grade: 12" below top foundation feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: na feet Comments (on condition of joints, venting, evidence of leakage, etc.): Watertight at foundation Septic Tank(locate on site Ian): 11 Depth below grade: e0t 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: 5' deep 6.5 diameter Sludge depth: 4" t5ins•3/13 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 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 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 No way to measure, no outlet cover 1 Scum thickness Distance from top of scum to top of outlet tee or baffle no way to measure Distance from bottom of scum to bottom of outlet tee or baffle no wayt to measure How were dimensions determined? na 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 was structurally sound. Took pictures of outlet baffle appeared to be working 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments wM 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 �M •y'' 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. CityrFown 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 No box 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ;M 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 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: 1-46 ❑ 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.): Local soils test indicate a water table of 26"-30". The top of the existing trench was 36" bottom of trench is estimated at least 48". The end of the trench was under water. 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•3/13 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 110 Farnum St. M Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City[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 j where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately � ail G 'Vv e,sG t gl T Z —1 V t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 26"-30" Estimated depth to high ground water: 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: 6/22/2000 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Soils test performed at 122 Farnum St. (within 150 of trench) 6/22/2000 by R. Tangard and witnessed by S.Ford. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments i c�M 110 Farnum St. Property Address Burns Owner Owner's Name information is required for every N. Andover MA 01845 5/7/2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generated on 5/19/2015 3:25:30 PM by Maureen McAuley Page 1 Town of North Andover Tax Map # 210-107.A-0074-0000.0 Parcel Id 17899 110 FARNUM STREET BURNS, JOHN F. 110 FARNUM STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.03 Acres FY 2015 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until BURNS,JOHN F. Payor 110 FARNUM STREET N.ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14228.0-110 FARNUM STREET Last Billing Date 3/5/2015 2100224 02 Cycle 02 Active UB Services Maint. Account No. 2100224 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 57.00 /1 UB Meter Maintenance Account No.2100224 Serial No Status Location Brand Type Size YTD Cons 16336584 a Active ERT METE METE w Water 0.63 0.63 551 Date Reading Code Consumption Posted Date Variance 5/5/2015 1239 a Actual 18 21% 2/3/2015 1221 a Actual 15 3/20/2015 -4% 11/3/2014 1206 aActual 16 12/15/2014 -56% 8/1/2014 1190 aActual 34 9/11/2014 132% 5/5/2014 1156 a Actual 15 6/12/2014 0% 2/4/2014 1141 a Actual 16 3/17/2014 -16% 10/31/2013 1125 aActual 18 12/20/2013 -39% 8/1/2013 1107 aActual 30 9/18/2013 146% 5/1/2013 1077 aActual 11 6/18/2013 10% 2/7/2013 1066 a Actual 12 3/13/2013 -34% 10/30/2012 1054 a Actual 16 12/13/2012 -62% 8/3/2012 1038 a Actual 45 9/26/2012 263% 5/2/2012 993 a Actual 12 6/20/2012 3% 2/2/2012 981 a Actual 12 3/14/2012 -27% 11/1/2011 969 aActual 16 12/15/2011 -61% 8/2/2011 953 a Actual 41 9/14/2011 331% 5/2/2011 912 a Actual 9 6/13/2011 -18% 2/4/2011 903 a Actual 12 3/15/2011 -43% 11/1/2010 891 aActual 20 12/13/2010 -50% 8/3/2010 871 a Actual 41 9/13/2010 212% 5/3/2010 830 a Actual 13 6/9/2010 -7% 2/1/2010 817 aActual 14 3/11/2010 -46% 11/2/2009 803 aActual 26 12/11/2009 -3% 8/3/2009 777 aActual 26 9/11/2009 63% 5/7/2009 751 a Actual 17 6/16/2009 10% 2/2/2009 734 a Actual 15 3/16/2009 -18% 11/3/2008 719 a Actual 19 12/10/2008 -39% 8/1/2008 700 aActual 30 9/12/2008 136% 5/2/2008 670 a Actual 12 6/18/2008 4%