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Miscellaneous - 1116 SALEM STREET 4/30/2018 (3)
_ 1116 SALEM STREET _ 210/106.A-0045-0000.0 1 A i i Lot & Street :5T• Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# - ILI)/q Plan Approval: Date: LJ 19 -9 Approved by:_, �C�/1lltl Designer: 05 660-b Plan-Date: �A� Conditions: ter Supply: own We1T: We tt. Driller: Well Tests: Chemical `' --_Dat Approved- Y Bacteria I Date Appr-aved-- Bacteria II --Date Plumbing.Sign-Off: Wiring.Sign-Off.' Comments: .Form"U" Approval: Approval to Issue: YES NO Date Issued By: - - Conditions: Final Approval: All Permits Paid? NO Well Construction Approval? YES NO Septic System Construction Approval? NO Certification? S�� NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? r-�> - Type of Construction: NEWP New Construction: Certified Plot Plan Review YES NO --� --- Floor Plan Review YES NO _- Conditions of Approval from Form U YES NO Issuance_of DWC permit: NO DWC Permit Paid? YES NO - _ ® y _ DWC Permit#�- _�� Installer: --- -Begin.Inspection S Np Excavation Inspection: _ _ -- _ Needed: — Passed: - By: - Construction Inspection: Needed: _ - - to As Built.Plan Satisfactory: YES: Approval of Backfill: Date: C��� By: �� - Final Grading Approval: Date: By: Final Construction Approval: Date: /_�-f11W By: Certificate of Compliance: Approval: Date: i �5.T J- ?� 06 /5 tbQ 1c,< P6 - � 779 Town of North Andover ZONING BOARD OF APPEALS t&ORTH Albert P.Manzi III,Esq.Cbainnauo`s,��o ,6 gtio Associate Afembers Ellen P.McIntyre,Vice-Chairman 3? 4. "' °e Michael P.Liporto Richard J.Byers,Esq.Clerk r° z D.Paul Koch Jr. Richard M.vaillancourt Zouiag Eyrforeemeut Officer Sge►+usE��y Gerald A.Brown Legal Notice North Andover Board of Appeals Notice is hereby given that the Board of Appeals will hold a public hearing at The North Andover Town Hall, 120 Main Street, North Andover, MA on Tuesday, December 13th 12011, at 7:30PM to all parties interested in the petition of Andre and Kathleen Farah, for property located at 1116 Salem Street (Map 106A, Parcel 45), North Andover, MA 01845. Petitioner is requesting a Variance from Section 7 Paragraph 7.3 and Table 2 (from the Zoning By laws) for relief of left and right side setbacks. Also a Special Permit is needed from Section 9, Paragraph 9.2 (from the Zoning By laws) in order to construct an addition to a pre-existing structure on a non conforming lot within an R-1 Zoning District. .y Application and supporting materials are available for review at the office of the Zoning Department 1600 Osgood Street, North Andover, MA, Monday through Friday from the hours of 8:30 AM to 4:00 PM. NORTH ANDOVER BOARD.OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at The North Andover Town Hall, 120 Main Street, North An- By order of the Board of Appeals dover, MA on Tuesday, December 13th,2011,at 7:30PM to all parties Albert P. Manzi 111, Esq., Chairman interested in the petition of Andre and Kathleen Farah, for property located at 1116 Salem Street(Map j 106A, Parcel 45), North Andover, MA 01845. Petitioner is requesting a Vari- ance from Section 7 Paragraph 7.3 and Table 2 (from the Zoning By Published in the Eagle Tribune on: setbacks.for relief of left and right side November 29th 2011 Also a Special Permit is needed from Section 9,Paragraph 9.2(from December 6th, 2011 the Zoning By laws)in order to con- 1 struct an addition to a pre-existing structure on a non conforming lot i within an R-1 Zoning District. Application and supporting ma- terials available for review at the of- lice of the Zoning Department 1600 Osgood Street,North Andover, MA; through Friday from the hours of 8:30 AM to 4:00 PM. By order of the Board of Appeals Albert P.Manzi III,Esq., Chairman ET—11/29,12/6/11 . 6wsrU0, g North Andover Health Department (ommunity Development Division November 16, 2011 Andre Farah 1116 Salem Street North Andover, MA 01845 Re: proposed addition to 1116 Salem Street Dear Mr. Farah, This correspondence is in regards to our conversations held recently about the proposed building addition at your home at 1116 Salem Street currently before the zoning board. As discussed,the Health Department reviews projects that may potentially impact the subsurface disposal system on a property. This review is based on the MA DEP regulation 310CMR 15.00. The review takes factors into account such as total habitable room numbers, design flow of the septic system and any restrictions that may accompany this site. Though your design is for a 4-bedroom home,at 440 gallons per day, your leaching capacity surpasses the required square footage. Hence.,when using the current 900 square feet system, we find that the system is designed for 540 gallons. The required design for a 5-bedroom home is 550 gallons per day,hence this is slightly shy. Tile unusual circumstance is in regard of the 1998 repair. The file is clear of your request for a 1000 sq ft system, however the final result submitted by your engineer and approved by the Health Office did not fulfill your request. Taking this into account I am approving the concept of the addition as proposed to date, as I count the new total room number as 10. (See attached definition of`Bedroom"for details on how DEP determines room number) As a compromise, your home would then be maxed out with regards to septic system capacity. No additional flow could be added to the system without a frilly compliant system upgrade. (see attached 15,023). Than ou, t� S sail Sa r, RS/ -E Public Health Director Cc: file Zoning Department 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.fownolnorthandover.com 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.002: continued Acre-a unit of land measure equal to 40,000 square feet which is considered a building acre in accordance with standard real estate practices. enc -an agency,department,board,commission or authority of the Commonwealth or of the federal government and any authority of any political subdivision,which is specifically created as an authority under special or general law. The term shall not include housing authorities permitted pursuant to M.G.L.c.40A. Alternative Systems-Systems designed to provide or enhance on-site sewage disposal which either do not contain all of the components of an on-site disposal system constructed in accordance with 310 CMR 15.100 through 15.255 or which contain components in addition to those specified in 310 CMR 15.100 through 15.255 and which are proposed to the local Approving Authority and/or the Department for remedial, pilot, provisional, or general use approval pursuant to 310 CMR 15.280 through 15.289. Approved Capaci tx—The capacity of a 1978 Code system reflected by the sewage flow as shown on the Disposal Works Construction Permit Application or as shown on the Certificate of Compliance, whichever is less for that system and not the calculated capacity based on 1978 Code loading rates which may account for over design or safety factors. For a system designed in accordance with 310 CMR 15.000,the approved calculated capacity is based on the loading rates found at 310 CMR 15.242. Approving Authority-A local Approving Authority as defined in 310 CMR 15.002; or the Department,with regard to systems owned or operated by an agency of the Commonwealth or of the federal government,or to systems serving a facility with a design flow of 10,000 gallons per day or greater,or on a case-by-case basis as determined by the Department to be necessary to carry out the purposes of 310 CMR 15.000. ASTM- The American Society of Testing and Materials. Bank(Coastal)-Any land or surface area so defined by the Massachusetts Wetlands Protection Act,M.G.L.c. 131,§40 and 310 CMR 10.30(2). Generally,the seaward face or side of any elevated landform,other than a coastal dune,which lies at the landward'edge of a coastal beach, land subject to tidal action,or other wetland. Bank(Inland)-Any land or surface area so defined by the Massachusetts Wetlands Protection Act,M.G.L.c.131,§40 and 310 CMR 10.54(2). Generally,a portion of the land surface which normally abuts and confines a water body. Barrier Beach-Any land or surface area so defined by the Massachusetts Wetlands Protection Act,M.G.L.c. 131,§40 and 310 CMR 10.29(2). Generally,a narrow low-lying strip of land generally consisting of coastal beaches and coastal dunes extending roughly parallel to the trend of the coast,separated from the mainland by a narrow body of fresh,brackish,or saline water or a marsh system. Bedrock-Solid rock exposed at the surface or overlain by unconsolidated gravel,sand,silt and/or clay. Bedrock includes weathered or saprolitic components thereof. Bedrock types are defined and most of their areal extent are described in the 'Bedrock Geologic Map of Massachusetts published by the Massachusetts Department of Public Works(1983). Bedroom-A room providing privacy,intended primarily for sleeping and'consisting stcng of all of the following: (a) floor space of no less than 70 square feet; (b) for new construction,a ceiling height of no less than 73'; I (c) for existing houses and for mobile homes,a ceiling height of no less than TO"; (d) an electrical service and ventilation;and (e) at least one window. it 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.002: continued Living rooms,dining rooms,kitchens,halls,bathrooms,unfinished cellars and unheated storage areas over garages are not considered bedrooms. Single family dwellings shall be presumed to have at least three bedrooms. Where the total number of rooms for single family dwellings exceeds eight,not including bathrooms,hallways,unfinished cellars and unheated storage areas,the number of bedrooms presumed shall be calculated by dividing the total number of rooms by two then rounding down to the next lowest whole number. The applicant may design a system using design flows for a smaller number of bedrooms than are presumed in this definition by granting to the Approving Authority a deed restriction limiting the number of bedrooms to the smaller number. Biological Mat-A layer composed of microorganisms and organic material located below a soil absorption system which forms on the infiltrative surface of soil and which provides biological treatment of septic tank effluent. lack ater-Wastewater from toilets,urinals,and any drains equipped with garbage grinders. Bordering Vegetated Wetland - Any land or surface area so defined by the Massachusetts Wetlands Protection Act,M.G.L.c.131,§40 and 310 CMR 10.55(2). Building-A structure enclosed within exterior walls or firewalls,built,erected,or framed of any materials,whether portable or fixed,having a roof,to form a structure for the shelter of persons, animals or property. Building Sewer-A pipe which begins outside the inner face of a building wall and-extends to an on-site system or municipal or private sewer. Campground-A facility regulated pursuant to 105 CMR 430.00 or 105 CMR 440.00 and any campground operated by the Department of Conservation and Recreation in a State Park. Cellar Wall-That portion of the outside surface of the foundation wall enclosing a full basement which is above the cellar floor and below the ground surface. Certificate of Compliance or Certificate- A certificate issued by the Approving Authority to the owner or operator of a system in accordance with 310 CMR 15.021 indicating that an on-site system has been constructed or upgraded, and inspected, as necessary in compliance with 310 CMR 15.000. Certified System - An alternative system which has been approved by the Department for specified uses or site conditions pursuant to 310 CMR 15.288. Systems which have been certified may be approved for use by approving authorities without further Departmental review but subject to any limitations on their use imposed by the Department pursuant to 310 CMR 15.000. Certified.Vernal Pool - A surface water body that has been certified by the Massachusetts Division of Fisheries and Wildlife as a vernal pool in accordance with the "Vernal Pool Certification Guidelines" pursuant to the Massachusetts Natural Heritage and Endangered Species Program administered by the Massachusetts Department of Fish and Game at the time a permit application is submitted to the Approving Authority. Cesspool-A pit with open jointed linings orholes in the bottom and/or sidewalls into which raw sewage is discharged,the liquid portion of the sewage being disposed of by seeping or leaching into the surrounding soils,and the solids or sludge being retained in the pit. Cesspools are nonconforming systems. ANI/ne 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.204: Increases in Design Flow to System No person shall increase the actual or design flow to any cesspool or to any other system above the existing approved capacity,or change the a of establishment of a facility served- type y ed by a cesspool, unless the cesspool or system is upgraded first. Upgrades to accept increased design flow shall be performed in full compliance with the requirements applicable to new construction unless a variance is allowed pursuant to 310 CMR 15.414. For purposes of 310 CMR 15.204,the approved design flow shall be the flow listed in the most recent Disposal Works Construction Permit. 15.211: Minimum Setback Distances (1) All systems must conform to the minimum setback distance for septic tanks,holding tanks,pump chambers,treatment units and soil absorption systems,including reserve area,measured in feet and as set forth below. Where more than one setback applies,all setback requirements shall be satisfied. Septic Tank Soil Absorption System Holding Tank Pump Chamber Treatment Unit Grease Traps Property Line 10[5] 10[5] Cellar or Crawl Space Wall, Swimming Pool(inground),foundation drain 10 20 Slab Foundation 10 10 Water Supply Line(pressure) 10[1] 10[l] Surface Waters(except wetlands) 25 50 Bordering Vegetated Wetland(BVW), Salt Marshes,Inland and Coastal Banks 25 50 Surface Water Supply- Reservoirs and Impoundments 400 400 Tributaries to Surface Water Supplies 200 200 Wetlands bordering Surface Water Supply or Tributary thereto 100 100 Certified Vemal Pools 50 100[2] Private Water Supply Well or Suction Line 50 100 Public Water Supply Well (2) (2) Irrigation Well 10 25 Open,Surface or Subsurface Drains which discharge to Surface Water Supplies or tributaries thereto 50 100 Other Open,Surface or Subsurface Drains (excluding foundation drains)which intercept seasonal high groundwater table[3] 25 50 Other Open,Surface or Subsurface Drains (excluding foundation drains) 5 10 Leaching Catch Basins& Dry Wells 10 25 Downhill Slope not applicable 15[4] [1] Disposal facilities shall be at least 18 inches below water supply lines. Wherever sewer lines must cross water supply lines,both pipes shall be constructed of class 150 pressure pipe and shall be pressure tested to assure watertightness. [2] The required setback shall be 50 feet where the applicant has provided hydrogeologic data acceptable to the Approving Authority demonstrating that the location of the soil absorption system is hydraulically downgradient of the vernal pool.Surface topographyalone is not determinative. 4/21/06 310 CMR-512 B. 0 UILDING PERMIT VtORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 4t Permit NO: Date Received ArE �SSACHU Date Issued: IMPORTANT:Applicant must complete all items on this page %' -4 Mi``77n ON,-- L- ''PRN J, 1W A -T V, .EMAP)N 4- -PARC=EL-,-,, -ZONIN.0015 TR]QT�. t4ebQiWri'bt1 yes �Sh6 .7 ---M� , 0� 9 s of ,illa TYPE OF IMPROVEMENT PROPOSED USE Resid �- Non- Residential N family ( dditio' Industrial r tration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other t r at ewers . r .__, _` _ t�_ .a, '.' X,. . r� .> . e �.. . sa �. ,-`�r \ Z -4 iC DESCRIPTION OF WORD TO BE PREF PRME-D:- Ix vp oi ctd0t(F%ZA-N Lw 6 o o, Identification Please Type or Print Clearly) OWNER: Name: Phone: q 7 � Address: VI-1 kC' 4 'Phone -7 NTRA'01 'Name: x., u " bb� , q - Y- �EXP) a e — 's tiftUidensA ( J �'Ij� ,,+� V� a flffibVhse.:� 13,X4 I A'? ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: "I Receipt No.: NOTE: Persons contracting with unre to ntractors do not have access to the guarantyfund p� o� t Signature of,Agent/O.. wner ' nature.of .. .... --r— Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on �4 Signature hh �� A , COMMENTS !Uo � C)C) HEALTH Reviewed on 41 k Signature - f COMMENTS - z s . Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments { Water & Sewer Connection/Signature &Date Driveway Permit r DPW Town Engineer: Signature: Located 384 Osgood Street , -�It '.y«tl! s -"K.'.\a '. i. 'Y^ � , e-'_!- (1 - -- FIRE�DEPARTMENT� TempDumpster on site ti�yes = x'2-"nog` �� G Located�at+1243Main Street; � 1 FireDepartmentsignatu�e/datel'�t }'• COMMENTYS y6 " _ f - — .fit.._ 14 1 �•J M �J b GN ----------------- 0 EX /S T/NG i4` Atf O G PROF 0SE0 ------------- N O. V Com � N o/ -2� - �2�'" Zo A/ ,L Av o.v7- \ r oRD cJY �v,x F S r F Qpmmonwealth of.Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments /,3 / 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA. 01845 12/7/2011 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A General Information forms on the computer,use 1. Inspectorz. only the tab key ? j 3 to move your Neil James Bateson cursor-do not Name of Inspector use the re$um �. key. Bateson Enterprises Inc. OR Company Name 111 Argilla Road Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: / ® Passes ❑ Conditionally Passes ❑ Falls ❑ Needs Further Evaluation by the Local Approving Authority ` 12/7/2011 Inspe or Signatuw Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Y PP pp g ut onty. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 v ' + Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owners Name information is required for North Andover MA 01845 12/7/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ' Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y E] N ❑ ND (Explain below): t5ins•11!10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 �a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address r Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12R/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ 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 t51ns•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ElN Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Citylrown State � Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 2 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth.&Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA \ 01845 12/7/2011 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ 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, Ian ® ❑ 9 p p at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 9 � Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2010, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ .Shared system (yes or no) (if yes, attach previous inspection records, if any) I ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 13 Years old, 11/19/1998, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No : Building Sewer locate on site plan): _ 9 ( P ) Depth below grade: 2'2 feet Material of construction: ® cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): 4"cast iron thru wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: '9 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x5'x4' Sludge depth: 2" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1116 Salem Street Property Address r Andre Farrah Owner Owner's Name information is required for North Andover MA r 01845 12/7/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 19" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid above outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass g El polyethylene El 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth.&Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑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•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. City/Town State Zip Code Date of Inspection D. System Infortoation (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence.of solids carryover, any evidence of leakage into or out of box,etc.): D-box level&distribution equal. No evidence of leakage. No evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pumped cycled on then off.Alarm has both audible&visual. i Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , rr 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching.chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 20'x 45' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer ,Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Ins g Disposal y g Inspection Form:Subsurface Sewage Dis sal S stem•Page 13 of 17 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �v A-A-o 1 d�- = L4, O t5ins•11/10 We 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 3 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. Date 1997 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1116 Salem Street Property Address Andre Farrah Owner Owner's Name information is required for North Andover MA 01845 12/7/2011 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information.—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17, Commonwealth of Massachusetts City/Town of System Pumping Record i Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address _I City/Town State Zip Code 2. System Owner: Cz Name Address(if different from location) City/Town State a Zip Code - C Y 7 Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system.: ❑ Cesspool(s) [3-S ptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [9-1go If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: /Jo 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: . S. Lowell Waste Water Sig' a Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 12/6/20112:35:04 PM by Karen Hanlon Page 1 Town of North Andover Tax,Map # 210-106.A-0045-0000.0 M Parcel Id 17192 1116 SALEM STREET FARRAH, ANDRE & KATHLEEN 1116 SALEM STREET N. ANDOVER_ , MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 0.54 Acres FY 2012 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until FARRAH,ANDRE&KATHLEEN Payor 1116 SALEM STREET N.ANDOVER,MA 01845 UB Account Maint. Account No+. Cycle Occupant Name Active/Inactive Bldg Id. 17313.0-1116 SALEM STREET Last Billing Date 10/4/2011 3160390 03 Cycle 03 Active UB Services Maint. Account No.3160390 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 86.33 /1 UB Meter Maintenance Account No.3160390 Serial No Status Location Brand Type Size YTD Cons 16336013 a Active 00 METE METE w Water 0.63 0.63 396 Date Reading Code Consumption Posted Date Variance 9/7/2011 1272 . a Actual 22 10/13/2011 -24% 6/6/2011 1250 ' a Actual 30 7/20/2011 0% 3/2/2011 1220 a Actual 27 4/13/2011 -7% 12/6/2010 1193 a Actual 30 1/12/2011 29% 9/8/2010 1163 a Actual 25 10/15/2010 -22% 6/4/2010 1138 a Actual 31 7/15/2010 2% 3/3/2010 1107 a Actual 28 4/14/2010 -4% 12/7/2009 1079 a Actual 32 1/12/2010 17% 9/4/2009 1047 a Actual 27 10/15/2009 -12% 6/3/2009 1020 a Actual 28 7/20/2009 2% 3/10/2009 992 a Actual 31 4/29/2009 8% 12/4/2008 961 a Actual 27 1/20/2009 -6% 9/5/2008 934 a Actual 30 10/10/2008 1% 6/3/2008 904 a Actual 28 7/16/2008 1% 3/6/2008 876 a Actual 28 4/11/2008 -6% 1211/2007 848 a Actual 28 1/22/2008 32% 9/13/2007 820 a Actual 23 10/12/2007 -20% 6/13/2007 797 a Actual 30 7/20/2007 4% 3/9/2007 767 a Actual 28 4/16/2007 13% 12/6/2006 739 a Actual 24 1/19/2007 10% 9/7/2006 715 a Actual 21 10/20/2006 -13% 6/12/2006 694 a Actual 24 7/10/2006 6% 3/17/2006 670 a Actual 24 4/17/2006 -2% 12/15/2005 646 a Actual 25 1/17/2006 29% 9/12/2005 621 a Actual 20 10/14/2005 -51 0/c 6/7/2005 601 a Actual 35 7/15/2005 62% 3/15/2005 566 m Manual estimate 25 4/5/2005 -250/c 12/8/2004 541 a Actual 29 1/14/2005 -30k 9/15/2004 512 a Actual 35 10/8/2004 -80/c 6/9/2004 477 a Actual 21 7/30/2004 15°/r ` t AOL COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION I� SVer TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_1116 Salem Street_ _North Andover_ Owner's Name:_Andre Farrah_ Owner's Address:_1116 Salem Street North Andover,Ma 01845_ Date of Inspection:11/1/2005_ RECEIVED Name of Inspector: Neil J.Bateson_ N O V 18 2005 Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ TOWN OF NORTH ANDOVER Andover,Ma.01810_ HEALTH DEPARTMENT Telephone Number:_(978)4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ' s , i Inspector's Signature: Date: _11/1/2005_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ' Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_1116 Salem Street_ _North Andover— Owner:_Farrah_ Date of Inspection:_11/1/2005_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: ' Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_116 Salem Street_ _North Andover — Owner:_Farrah_ Date of Inspection:_11/1/2005_ 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance_ "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: li Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_1116 Salem Street_ _North Andover— Owner:_Farrah_ Date of Inspection:_11/1/2005 i D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: i _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ No Liquid depth in cesspool is less than 6"below invert or available volume is''/i day flow. —No7 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No Any portion of the SAS,cesspool or privy is below high ground water elevation. No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. No Any portion of a cesspool or privy is within 50 feet of a private water supply well. No Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) I yes no _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_1116 Salem Street_ _North Andover_ Owner:_Farrah_ Date of Inspection:_11/1/2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes _ Has the system received normal flows in the previous two week period? _No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ _ Were as built plans of the system obtained and examined?Town did not have,engineer did. _Yes_ — Was the facility or dwelling inspected for signs of sewage back up? Yes Was the site inspected for signs of break out? Yes_ _ Were all system components,excluding the SAS,located on site? _Yes _ 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? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _Yes_ _ Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] i it Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_1116 Salem Street_ North Andover– Owner:_Farrah_ Date of Inspection:_11/1/2005_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual): 3_ DESIGN flow based on 310 CMR 15.203_440_ Number of current residents:_4 Does residence have a garbage grinder(yes or no):–No_ Is laundry on a separate sewage system(yes or no): No_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no): No Water meter reading: Yes_ Sump pump(yes or no): Yes_ Last date of occupancy:_Current COMMERCIAIA NDUSTRIAL Type of establishment:_ Design flow(based on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped two years ago,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: _Inspect tank&baffles_ TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool_Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval —Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_7 years old,11/19/1998, as built plan_ Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_1116 Salem Street_ _North Andover_ Owner:_Farrah_ Date of Inspection:_11/1/2005_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_28" Materials of construction: _X cast iron _X 40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _4"Cast iron thru wall.4"PVC in house, no leaks visible SEPTIC TANKS: X Depth below grade:_10" Material of construction: X concrete,metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions:_10'x 5'x 4'_ Sludge depth:_2"_ Distance from top of sludge to bottom of outlet tee or baffle: 25_ Scum thickness:_3" Distance from top of scum to top of outlet tee or baffle:_8"_ Distance from bottom of scum to bottom of outlet tee or baffle:_18"` How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 —N OFFICIAL INSPECTION FORM T FOR VOLUNTARY ASSESSMENTS O SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_1116 Salem Street _North Andover— Owner:_Farrah_ Date of Inspection:_11/1/2005_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOXES: X Depth of liquid level above outlet invert: —0 — Comments(note if lox is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.)_D-box level&distribution equal.No evidence of leakage. No evidence of carryover._ PUMP CHAMBER: X (locate on site plan) Pump in working order(yes or no): Yes_ j Alarm in working order(yes or no): Yes_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump cycled on then off.Alarm has visual&audible_ Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_1116 Salem Street_ _North Andover_ Owner:_Farrah_ Date of Inspection:_11/1/2005_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: _X leaching field,number,dimensions:_1 field 20'x 451 _ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok.No sign of ponding to surface_ CESSPOOLS: Number and configuration: Depth—top of liquid to inlet invert:_ Depth of sludge layer:_ Depth of scum layer:_ Dimensions of cesspool:— Materials of construction:_ Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_ i i 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.): I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_1116 Salem Street _ North Andover— Owner:_Farrah_ Date of Inspection:_11/1/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Driveway House A to SepticTank=15'3" A to Pump Tank=19'8" A to D-Bos=5218" B to Septic Tank=3417" B to Pump Tank=3114" B to D-Boz=48'1" Porch L/ Shed Septic Tank Pump Tank D-Box Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_1116 Salem Street_ _North Andover_ Owner:_Farrah_ Date of Inspection:_11/1/2005_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _3'_ Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_12/19/1997_ 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:_As per design plan— yamy��. 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Summary Record Card generated on 11/1/2005 11:22:03 AM by Elaine Barclay Page 1 ' Town of North Andover Tax Map # 210-106.A-0045-0000.0 1116 SALEM STREET FARRAH, ANDRE & KATHLEEN 1116 SALEM STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.54 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until FARRAH, ANDRE & KATHLEEN Payor 1116 SALEM STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 3442.0- 1 116 SALEM ST Last Billing Date 10/6/2005 3160390 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 67.80 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16336013 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 9/12/2005 621 a Actual 20 10/14/2005 -51% 6/7/2005 601 a Actual 35 7/15/2005 62% 3/15/2005 566 m Manual estimate 25 4/5/2005 -25% 12/8/2004 541 a Actual 29 1/14/2005 -3% 9/15/2004 512 a Actual 35 10/8/2004 -8% 6/9/2004 477 a Actual 21 7/30/2004 15% 4/16/2004 456 a Actual 43 5/17/2004 0% 12/11/2003 413 n New Meter 0 12/11/2003 0% Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 1116 Salem Street, North Andover Owner: Farrah Date of Inspection: 11/1/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. PeilBateson Bateson Enterprises, Inc. NEW ENGLAND ENGINEERING SERVICES INC TOWN OF NORTH ANDOVER/ BOARD OF HEALTH January 8, 199$ -JAN - 9 RA, North Andover Board of Health 30 School Street North Andover, MA 01845 t. Re: 1116 Salem Street septic system repair Dear Mr. Chairman: Enclosed are three copies of a septic system design for a subsurface disposal system repair at 1116 Salem Street. This plan requires the following Board of Health approvals prior to being approved. Local Upgrade approvals needed: 1.Reduction in the offset distance between the bottom of the leach area to the water table from the required 4 feet to 3 feet. Local Bylaw variances needed: 1. Reduction in the setback distance to a wetland from the required 100 feet to 84 feet. 2. Reduction of the leach bed size from the 900 square foot minimum to 740 square feet. Please include these requests on next Board of Health meeting agenda . If there are any questions regarding this matter please do not hesitate to contact this office. I Yours truly, Benjamin C. Osgood, Jf, EIT 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 Town of North Andover 40RTk OFFICE OF O� 14,0 J COMMUNITY DEVELOPMENT AND SERVICES A � X 30 School Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9SSAcHus�t Director March 2, 1998 Mr. Benjamin Osgood, Jr. 33 Walker Rd. N. Andover, MA 01845 Re: Map 106A, Parcel 45 Lot 1116 Salem St. Dear Ben: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Water line or well missing. 2. Bouyancy calculations required for tanks. 3. What is soil texture on TP 91 of horizon C2. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator S S/rel cc: Andre Farah File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC Ta r 1. f MAR 5 1c,- March c,March 5, 1998 Sandra Starr,Administrator North Andover Board of Health 30 School Street North Andover,MA 01845 RE: 1116 Salem Street septic repair design Dear Sandra: Enclosed are three copies of a revised subsurface disposal plan for 1116 Salem Street in North Andover. The following items have been added. 1. The water line serving the facility 2. The soil texture on one of the test pit logs. A separate sheet which is enclosed has the buoyancy calculations and they show that the tank will not float. Since all of your concerns regarding this design have been addressed I would expect the requested local upgrade approvals be acted on by the Board of Health at its next regular meeting. If you have any questions please do not hesitate to contact this office. Yours truly, Benjamin C. Osgood,Jr.,EIT president 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 NEW ENGLAND ENGINEERING SLERV=1,CfE-S INC SEPTIC TANK BOUYANCY CALCULATIONS 1116 SALEM STREET NORTH. ANDOVER MA DESIGN PARAMETERS: 1. Water table elevation is 20" below the surface of the ground 2. Concrete weight= 150 lbs./cu.Ft. 3. Soil weight= 110 lbs./cu.Ft. Determine weight of tank and soil above tank. Weight of tank=weight of top+weight of bottom+weight of sides. = 10.5'x 5.66' x 0.33' x 150 lbs./cu.Ft. + 10.5'x 5.66'x 0.33' x 150 lbs./cu.Ft. + 32.32'x 5.0' x 25' x 150 lbs./cu. Ft. = 11,943.57 lbs. Weight of soil above= 10.5'x 5.66' x 3.0' x 110 lbs./cu.Ft.x 110 lbs./cu.Ft.= 19,6111bs. Total weight of tank and soil=11,943+19,611 =31.554 lbs. Determine weight of water displaced. Weight of water= 10.5'x 5.66'x 5.66'x 62.4 lbs./cu.Ft.=20,989 lbs. If the weight of water is greater than the weight of the tank and covering soil,then the tank will float. CONCLUSION: Weight of water=20,989 lbs. Which is less than the weight of the tank and covering soil(31,554lbs.). Therefore,the tank will not float. 33 WALKER WA - _ - R D. SUITE 22 NORTH ANDOVER MA 01845 508 686-1768 I� Town of North Andover NORTN OFFICE OF 3?Oy o4 COMMUNITY DEVELOPMENT AND SERVICES 10A 30 School Street WILLIAM J. SCOTT North Andover, Massachusetts 01845 �9SSncHus�t�y Director April 22, 1998 Ben Osgood, Jr. New England Engineering 33 Walker Road North Andover, MA 01845 RE: 1116 Salem Street Dear Ben- As you should remember, I spoke to you about this site and the proposed septic system design prior to its discussion at the Board of Health meeting on March 26". I told you that I could not recommend the requested variance to allow less than 900 square feet of leach field as required in the local regulations. At the Board meeting, the owner, Mr. Farah, appeared and stated that he had asked you to design a leach area of 1000 square feet. The Board granted the request for a reduction to groundwater and the 84 feet to wetlands. They did not, howeverrant the request for a reduction 9 q ct on m the size of the leach area, but directed me to solve the difficulty with you. I have left messages and mentioned this to you on at least two occasions, however, to date the issue has not been resolved. If necessary, I would be happy to meet with you on either April 27th or 28th at 9:30 A.M. to discuss the matters. Please let me know if either of these times are convenient for you. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S Andre Farah File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i Town of North Andover t NORTh OFFICE OF °�t"`° '°1ti0 L COMMUNITY DEVELOPMENT SERVICES p 30 School Street North Andover,Massachusetts 01845 WILLIAM J. SCOTT 9SSACHUSEt Director May 19, 1998 Benjamin C. Osgood, Jr. New England Engineering Services, Inc. 33 Walker Road - Suite 23 North Andover, MA 01845 Re: 1116 Salem Street Dear Ben: This letter is to inform you that the proposed septic plans for 1116 Salem Street have been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Andre Farah File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Y Town of North Andover f NORTH OFHCE.OF r 0 t"'Lo -0 COMMUNITY DEVELOPMENT AND SERVICES 384 O s e-0.6b SF *CO 446 pffitift 9q ` # . North Andover, Massachusetts 01845 �9SSAcmUS���y (508)688-9533 August 17, 1998 Attorney Robert J. Rodger 100 Brickstone Square Andover,MA 01801 Dear Sir: Enclosed please find a copy of the septic plan approval letter for 1116 Salem Street,North Andover,Massachusetts, and a copy of the Disposal Works Construction Permit that was issued to John Soucy on July 11, 1998. "A successful bottom of bed inspection was performed by Susan Ford of this Health Department on July 29, 1998. This is the first inspection of the septic system installation in a series of at least three before a Certificate of Compliance can be issued: Please call the Health Department at the number below if you have any questions. Sincerely, Sandra Starr,R.S. Health Administrator i i i BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Staff Kathleen Bradley Colwell a... :I 6 k-TIC?l`i FOR D'ISE.n1.*A. DATE: CURRENT INSTALLER'S LICENSE# LQ 4 CHEClt, ` F"F.PAIR. NEW CONSTRUCTION: uM g y i3 ,rrwv b�L••�y. Administrative Use Only 6 575.00:Fee_ ttached? Yes... . N0 i I Town of North Andover, Massachusetts Form Np,a ' BOARD OF HEALTH NOR7M 19 A DISPOSAL WORKS CONSTRUCTION PERMIT ACHUSEt Applicant b Sc� v� NAME ADDRESS TELEPHONE Sif:e Location Permission is hereby granted to Construct ( ) or Repairs( ') an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S,S. No. -ZCHA+K S MAN,BOARD OF HEALTH D.W.C. No. 3 { Town of North Andover, Massachusetts Form No.z a ,►ORTM BOARD OF HEALTH //��'//���11 ��// 4 Q+tT�eD ,+,�0 //�/�7 / / 0 ... .. .e ° / 19 98 ° L nD DESIGN APPROVAL FOR ACHUS � SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant /'9�ul)zC Test No. /0/�? Site Location 57-- Reference Plans and Specs. /VGLcI CiCJ /¢�� �/(• ' ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee C�x� ' Site System Permit No. l6/� I r TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired ( X ) 10/24/98 by North Andover Licensed Installer John Soucy at 1116 Salem Street, North Andover, NIA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit Number 1019 dated May 19, 1998. v The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. y Board of Health Inspector DATE: �` 7 LOCATION: ENGINEER: r BOH WITNESS: —' PERCOLATION TEST# BOTTOM DEPTH OF PERC TEST: �� b o� TIME OF SOAK: /OP 3/ .) 16; 1 (At least 15 minutes long) TIME AT 12" A9 TIME AT 9" � TIME AT 6" OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK: (At least 15 minutes) TIME AT 12" TIME AT 9" TIME AT 6" i ------ ---- - - - i� -LSY 7 - . -- s , = I- I it `R T -- d�-- - -- --- y/ - - - -j-�7 I _ _ ��-moi _ ---14 -------- 7,< ; 2 s - s i4 PITS MIN 440 LEACHING MIN 1 ( 13 'x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 440 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS �s V'/�1�/��C MIN 440 GPD Vl" 900 ft2 BED o GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? `� 4" PEA STONE? L--' DIST LINE SLOPE . 005? >3 ' COVER-VENT ��� SCH 40 . MIN 12" COVER C� RATE ( 7 X 2 o ) X ° !o = TOTAL 444 7 4*6 L WLDG DOSING TANKS AND PUMPS DIMENSIONS-X X = PUMP CAPACITY 16 o'Z gpm L W D Vol . DISCHARGE SIZE //0 G. DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE L--- ALARM SEP . CIRC. L-- GW (Min. 1 ' below inlet) HWL32,4/ LWL%'15 CHECK VALVE BLEEDER HOLE c/ MANUAL OP . SWITCH ✓ ENUF STORAGE? Copyright © 1996 by S.L. Starr 1 PLAN REVIEW CHECKLIST ADDRESS ���� J�}LCi(�l ST ENGINEER Tj C�aQ GENERAL / 3 COPIES i/ STAMP LOCUS NORTH ARROW �✓ SCALE CONTOURS PROFILE L-"(Sc) SECTION ✓ BENCHMARK t/ SOIL & PERCS ✓ ELEVATIONS WETS . DISCLAIMERy WELLS & WET WATERSHED? AIQ DRIVEWAY t� WATER LINE k FDN DRAIN M&Py' SCH40 ✓ TESTS CURRENT? L� SOIL EVAL TA�C,4,'IJ SEPTIC TANK MIN 1500G . 17 INVERT DROP C/ GARB. GRINDERib (2 comps +200 ) 10 ' TO FDN MANHOLEk4- ELEV GW ## COMPS . GB L)o y/1/uc y D-Box c / I C 5, SIZE ## LINES 4FIRST 2 ' LEVEL STATEMENT � / INLET ,702 - OUTLET bi,JO 7 (2" OR . 17 FT) TEE REQ 'D? vGS LEACHING MIN 440 GPD? RESERVE AREA 4 ' FROM PRIMARY? 20 SLOPE ?, Vp2, . 100 ' TO WETLANDS� 100 ' TO WELLS 4 ' TO S.H.GW_- (5 ' >2M/IN) 20 ' TO FND & INTRCPTR DRAINS V 400 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER �,�FILL? �15 ' ) BREAKOUT MET? t/f TRENCHES MIN 440 gpd SLOPE (min . 005 or 6"/100 ' ) SIDEWALL DIST . 3X EFF. W OR D (MIN 6 ' ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? ( >3 ' COVER; LINES >50 ' ) BOT + SIDE = X LDNG = TOT ( L x W x #) (DxLx2x#) (G/ft2) Copyright '� 1996 by S.L. Starr