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HomeMy WebLinkAboutMiscellaneous - 12 FARNUM STREET 4/30/2018 12 FARNUM STREET f 210/107.A-0044-0000.0 J� I �f Lot & Street /� �,Qjl//J t�•t v �` Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit# 997 Plan Approval: Date: �� Approved by: IJZ 2tt,�t Designer: -�9, 0:5600D JC Plan Date: h0 Conditions: Water Supply: Town Well Well Permit: `� Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Viri Si n-Off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO / Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: v SEPTIC SYSTEM INSTALLATION Is the installer licensed? YES NO Type of Construction: REPAIR � New Construction: Certified Plot Plan Review YES _—Na— Floor O Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: NO DWC Permit Paid? NO DWC Permit # Installer: , Begin Inspection: YES NO J` Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: TRusj� ihPlan Satisfac ry: : Approval of Backfill: Date: 7 /1fY By: Final Grading Approval: Date: - By: �r 6.1 By=Final Construction Approval- Date: Certificate of Compliance: Approval: Date: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Farnum Street Property Address Ilia Yaroslaysky Owner Owner's Name information is required for North Andover MA 01845 10/29/2015 every page. City town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out �����i forms on the e computer,use 1. Inspector: only the tab key to move your ��Neil J. Bateson �'�,� cursor- not Name of Inspector VANOF use the return � PJ(j,r key. Bateson Enterprises Inc. ACTH "t1� IDC3VFR y P Company Name 4 1.,,:.:P,rT 111 Argilla Road Company Address Andover MA 01810 City/Town 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/29/2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y M 12 Farnum Street Property Address Ilia Yaroslaysky Owner Owner's Name information is required for North Andover MA 01845 10/29/2015 every page. Cityfrown 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: After permit from B.O.H. , install new d-box& , inspection from B.O.H., septic system now passes Title 5 Inspection. 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 • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 10/29/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-Box By: Todd Bateson At: 12 Farnum Street Map 107.A Lot 0044 No Andover, MA 01845 Th ss ance f this certi ca shal n t b strued as a guarantee that the system will function satisfactorily. i 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 D t . � 4 North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: IJ �UVrn 5T EMAP: LOT: INSTALLER: g� _ DESIGNER: to - act , PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTION '✓ S TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF.FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septictank properly abandoned El 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 El Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading El Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 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 ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ElAlarm 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) �j Hydraulic cement around inlet & outlets [a' Observed even distribution - Speed levelers provided (not required) Comments: xi1 010Application for Septic Disposal,S ►stem� �O- F. � TODAY'S DATE Conion,,,--estr'uctrmit -- TOWN OF $2 t : NORTH ANDOVER; MA 01845 1>25.I -Compone i Important: Application Is hereby made for a Permit to: When:filring out Q Construct a new on-site sewage disposal system' forms on the computer,use ❑Repair or replace an existingon-site sewage disposal'system* only the tab key B16pair or replace an existing system component—What? Bo to move your cursor-do not use the return A. Facility Information key. Address or Lot# Alo City/Town RECEIVEDn ` 2.-*TYPE OF SEPW SYSTEM. 1 ❑ Pump BeGravity(choose one) OCT 2 O 2015 "*!f pump system, attach copy of electrical permit to application"` B;onventional System(pipe and stone system) TOWN OF NORTH ANDOVER ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification AWMA [icPaystem.) ➢ Q Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ Q Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) 'IVO=(installer must specify brand of filter before DWC issuance) [abatis theMakeP Wbatis the Modehs 2. Owner Information /y PZ ��-�{A Ard�/i9 ✓s��/ Mame � Address(if different from above) _ Cityrrow State Zip Code 16-0 Telephone,Number 3. Installer Information Name NameofCOMMON ENM9PRISES,INC. A q J14- 111 ARGIL-U\ Address L_ DOVER, MA 01810 � -Qa ver A44 Cityrrown State Zip Code 9 78 c61-5--a"703 Telephone Number(Cell Phone#if possible..please) 4. Desi.gner`1nformation Name Name of Company Address Citylrown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 • AppliGation..for Septic Disposalystern TODAY'S } =Construction Prrrrit = TO'CT O sDA , $:250.00*Full Repair ORTH ANDOVER, MA 01:845 . s $'125. Com on'ent s p PAGE 2 OF 2 A. Facility-Information continued.... S. Type,of BuMin : EgIlesidential 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 w/th the provisions of Title sof the Environmental Code, as well as the Loci/Subsurface Disposal Regulations for the Town of North Andover, and not to place the system hi operation until a Certificate of Compllatrce has been Issue y this Board of Heath. Nam Data i liication Appro d Board Health Representative) ame Date Application Disapproved,for the following reasons: For Office Use Only: v Y Pee Attached? Yes No 2.• ProlectManaget Oblr Iron Fo=Atwcbed.� � Yes No .. 3.: Prune Svstenr? Ifso, h 1 1 P rmrt ' 'es No 4. Fo undation As-B e o (h c nstructlon ronly). Yes No (Same scale as toyed plan) S. Floor Plans?the corisfru on only): Y.es No A"Pi(catton{or•pfsp03a[oystbth C:ond"cfi0h Permft Page 2 4f 2 Commonwealth of Massachusetts Title 5 Official Inspection- Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 12 Famum Street CCC Property Address ILya Yaroslaysky Owner Owner's Name information is required oevery North Andover MA 01845 9/26/2015 'e for e ry page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms [RECEIVED on the computer, use only the tab 1. Inspector: key to move your OCT G 7 2015 cursor-do not Neil J. Bateson use the return Name of Inspector IUVVN OF NUK I H ANDOVER key. HEALTH DEPARTMENT Bateson Enterprises Inc. rdy Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S 1 15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below'is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/26/2015 Insp cto 4sg4nature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. I " ""This report.only.describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 14 T&e 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection_ Form G Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 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•3113 , TMe 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 I "r 12 Famum Street Property Address Ilya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 page. Citylrown 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: r wh'❑ 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•3113 r. Title 6 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 w , ,r 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 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-box needs to be replaced. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: I 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 '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 12 Farnum Street Property Address Ilya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high groundwater 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 I I of a public water supply well i 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•3113 ,. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 ' 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts 93 Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is North Andover MA 01845 9/26/2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Vacant one month, owner 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped last year, owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the UA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3173 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 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: 17 years old, 6/30/1998, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.8 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" PVC through wall, 3" PVC in house, No leaks visible Septic Tank(locate on site plan): Depth below grade: 0.8 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10' x 5'x4' Sludge depth: 1" t5ins•3/13 Tillie 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 w 12 Farnum Street Property Address Ilya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 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 32" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last.pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owners Name information is required for every North Andover MA 01845 9/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. Evidence of leakage, has corrosion holes, needs to be replaced. Evidence of carryover. D-Box cover broken, replaced cover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* i Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i *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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 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: ® leaching fields number, dimensions: 1 field 25 x 36 ❑ 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Farnum Street Property Address Ilya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•W13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Disposal Sewage Dis g p System Form Not for Voluntary Assessments r 12 Farnum Street Property Address ILya Yaroslaysky Owner Owners Name information is North Andover required for every MA 01845 9/26/2015 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 where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately `J A Jf rtXXI�C_ �- 4 tt4 of D-� Do'a tf t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments w 12 Farnum Street Property Address ILya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high groundwater: 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: 10/2/1997 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: Test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Tule 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w �'4 12 Farnum Street Property Address Ilya Yaroslaysky Owner Owner's Name information is required for every North Andover MA 01845 9/26/2015 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 10/2/2015 10:44:29 AM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-107.A-0044-0000.0 Parcel Id 17870 12 FARNUM STREET ILYA YAROSLAVSKY 12 FARNUM STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.02 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until ILYA YAROSLAVSKY Owner 12 FARNUM STREET NORTH ANDOVER, MA 01845 ORTIZ,STEPHEN Previous Customer Inactive 8/17/2004 12 FARNUM STREET N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14292.0-12 FARNUM STREET Last Billing Date 9/4/2015 2100287 02 Cycle 02 Active UB Services Maint. Account No. 2100287 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 380.87 /1 UB Meter Maintenance Account No.2100287 Serial No Status Location Brand Type Size YTD Cons 34769936 a Active ERT HH b Badger w Water 0.63 0.63 1112 Date Reading Code Consumption Posted Date Variance 8/5/2015 1127 a Actual 75 9/14/2015 209% 5/5/2015 1052 a Actual 24 6/22/2015 10% 2/3/2015 1028 a Actual 22 3/20/2015 -62% 11/3/2014 1006 aActual 58 12/15/2014 4% 8/4/2014 948 aActual 55 9/11/2014 153% 5/6/2014 893 a Actual 22 6/12/2014 _14% 2/4/2014 871 a Actual 27 3/17/2014 -63% 10/31/2013 844 a Actual 68 12/20/2013 41% 8/2/2013 776 a Actual 47 9/18/2013 124% 5/6/2013 729 a Actual 21 6/18/2013 7% 2/7/2013 708 a Actual 22 3/13/2013 -47% 10/31/2012 686 a Actual 37 12/13/2012 -11% 8/3/2012 649 a Actual 43 9/26/2012 113% 5/3/2012 606 a Actual 20 6/20/2012700 2/2/2012 586 a Actual 22 3/14/2012 -7% 11/1/2011 564 aActual 43 12/15/2011 500 8/2/2011 521 a Actual 45 9/14/2011 102% 5/4/2011 476 a Actual 22 6/13/2011 -22% 2/4/2011 454 a Actual 30 3/15/2011 -58% 11/1/2010 424 aActual 68 12/13/2010 _19% 8/3/2010 356 a Actual 85 9/13/2010 215% 5/4/2010 271 a Actual 27 6/9/2010 -15% 2/2/2010 244 a Actual 32 3/11/2010 -30% 11/2/2009 212 aActual 45 12/11/2009 12% 8/4/2009 167 aActual 41 9/11/2009 89% 5/4/2009 126 a Actual 21 6/16/2009 7% 1 Map-Block-Lot Commonwealth of Massachusetts • J • 107.A0044 ----------------------- � �• BOARD OF HEALTH Permit No ` North Andover -----------------------BHP-2o-5-0885 0 P.I. FEE 'a4rct► F.I. $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted. - -Bates-on-Ent- -------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 12 FARNUM STREET as shown on the application for Disposal Works Construction Permit No. 13HP-2015-088 Dat -------------- 20,-2015--- 1 - - ---------- ----'-- -- -------- --------- Issued On: Oct-20-2015 BOARD OF HEALTH • y� ' rs�' Commonwealth of Massachusetts Map-Block-Lot 107.A0044 B RD OF H LTH orth And v r C TIFIC TE OF MPL CE THIS IS C RTIFY,Th the ndividual ewag Disposal yste (Repair) y atesEn ---- ------ ------- ----------- --------- staller at No 1 FA M TREE has bee ' stalled i a rdance with provisions o ITLE 5 of the e Environmen 1 ode as descri d' the application for Disp s Works Construction Permit No. BHP-2015-088 Dated__ Octo_er20,_2015___ ------------------------------------------ Printed On: Oct-20-2015 BOARD OF HEALTH • �� � Commonwealth of Massachusetts Map-Block-Lot ' - .• 107.A0044 �- �- BOARD OF HEALTH Permit No North Andover s. BHP-2015-0885 ------------ -- -- .«, n FEE �4 �yN $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT. Permission is hereby granted Bateson Ent ------ -------- -------- -------- --------- ------- -------- ------ ------------------ to(Repair)an Individual Sewage Disposal System. at No 12 FARNUM STREET as shown on the application for Disposal Works Construction Permit No. BHP-205 0'88 Dg0d . Mobef 20,2015 -------------- ---------------------------------------- Issued On: Oct-20-2015 BOARD OF HEALTH • • � 5EP'�°IC SY.$'�$M•i�'!'A�•�RB, !' .iV�ll��,F•.1�11�N'�•?C}BI.iGA�'I�i�fS . As flW-NqvhAadovarJJ wed&4uM tfourt#atnst mic O-Wheaepiiasyate farthe�pte? tyt� Ptv►7✓1 (AdOiNg ot ? •P`aarpUm by to tb�p � ��� �-�es�,� • Amaws . Aea dstod Dated i a W t mvbdm dated (last date) I nade» toad the foDowing obligatlow fort mmugemcat of phis pfgecC i. As the lasmlA!4 I-sm.obsffgatod io obWa affpe�md' of Health nppmvcd p �mi ,pedon*8 aap.' as R a#-- .1 um hoe 2. As :I. eatt ' ����� ��oho,pSa}ectmaflagtt,or o*ecpaaron not aitlocf:ied eat my campiaf •aa bwpmdm end dw systepa is notnady'thea �t �It=��sm�:'tt�ped>bo.bsvie�ey�c� �t the • . EmbIL ci i#1 �.; ism . ' *per a •b don r s asst iapect�csm lit 4ORmnot have to b4 plabot•Ohm . b. o vxi OIK"(ar erms�l t>� tfa ,da �AL-ep ' Kim the e* st • �ba ftibt'fiit�ed•>ixt xba-Sotttd`ofHaaltb,a$st: .` ���sp�ect�tii�u. i>i�st bap be tt y ad shle to" mmpimp•to age,-ftm =xt tcqmiw.t oaa i t � CQ P IustAffar Joest aot 4. Aa•theiasWi= Iebe. •`' •. :i �. . ted that dOO MMdM)O AM-fal*ed to mtaplete 9444, .� of this sp.tes�,ld is tb .�ed '> llaa j. . =mini for dcjgA-4rtfA#r3 5.. 4U titeloatdtlte>ty�I uhder�taad I aroa Asa th�pas>ice of oon9cstm ava" r a Deaddomt tbrrt.�re p�PerckAr�e c�ftlrr exade�tarr 1j�avL�s�G6ed�- . . . b� &Vvl fha oftlie"egad�aaT st aeit l awd a Plp *olrby8otoolaf. lailtar�t�ffarcoaeulf�utt' • . d Iaietar ciftar'ak+D'. aegee,VOPPArp chea*er, ftMi 's�tllaad o>Viar . -04 • '• _ .'�• -ti`. ..� a . . '.t:�+.dal- ••' .• � • Commonwealth of Massachusetts City/Town of 7]ER . System Pumping Record Form 4 TOWN OF NURTHNT DEP has provided this formfor us&.by local Boards of Health. Other forms maybe"us"erd bu 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 hous. Left ig Sid ;fh:ous:l, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Un er Address City/Town State Zip Code 2. System Owner. Name Address('d different from location) City/Town State � ✓��'�7rp Code^ Telephone Number r ; B. Pumping Record 1. Date of Pumping gate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas No If yes, was it cleaned? ❑ Yes ❑ No. ' 5. Conditicp o System: �� b � -V\1 6.' System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7.isig RHau ontents were disposed: Lowell Waste Water Date t5fomu4.doc•06/03 System Pumping Record•Page 1 of 1 I .. � •� �Y+S,�,I�.r�yy.,}+3�.1yI' �{t'A11irry'�VI:�ISf�J7`���1'� !]`�Li1:141'��� -:i �.r � 1 _.r._.._ __- YfY�=, 1 • 1 , l 1 I 1 T t NO (`�`(I R D SYSTEM PUM'PI:NG .R4C0P D , r 1 I EM UWNER & AUDft.ESS SYSTEM LOCATION. ��. (ezgmPit: Ic17 iron( of house) 'Al Or 1 . J (�UANTITY'I'UMC'GD _._ 1 UUL '.NO YES SEPTIC TANK: rr0 YES , aTUIKE OF SERYI.CE; '`ROUTINE ;le EM ERCEN'CY 6 , ,' CU(7D:CUNUITLON h'ULL.'0 COY C, k. Flfl'XYY CREA C'' (3AFFL'LS' IN I'I,ACI L.EACHFICLD RUNl3ACiK.., GXCESSIY SO11DS Fl.QO.DEDi SOCIu;' C R Yo `:-, YERH E (R �, xPLAIN) A R A t y r t1t•i, y ' :,I yrl} /i 'r it�'6 �I+VRr,1�1Xh1�1(.syl(}�l��,i 1 t..ft ♦� r, �„ 1 f ,i'.� t 'jt{yet 1� leu }�,{It W'l.i�jfr r��r�11 � u��I l;^t 1'S' 1'ItANS'�C►Z1��;D 'rv; AIJDOVER �ASSACHUSE CT 9 2008 I � "t� ����IJ 1• �IS�. � r.l�Iri r��.FS�',.I,�l�,�nl� .��..�� DEP hal provldod Shli (orm !^r eo , a;ai Roar TOWN %ORTHANDOVER ov +'��m!llvC fo the local 7^ �y oro:rlor OjJ fO', I(, A. Facillry Informac'on -- ..(�'�e.•, �.:^�� , ,. � $.9'T' 1,�1101^„ 4 i f J r A c 1,1 a Nln y I nar. 'I '_��'lrrN�lTll f;•� I• .,l'•II rNr r ArJdrei4 It 0 VI ffvn "fkn) n', 0 B,':PumP��9 Rekord1 �. Oel� o! Pumping ' Lw 3' Typo Gf oyaiam; ess;ool,$) Saouc Tar. , I�;�Ol�her (describe); a EMvenl Tae FOo(prpsent? yes rra9 ea a� es CondlPon B'; Syr P�'mped 8y: ' _ ',` , •f.-.�,,; Y.;fc�.�j=r �� , IIS ' ',r /I�''' Mon wnara oonlenl 'Ware c119po5ac e0y l/ 9 m a".gov/da;�weler/e� rove sllblorm �.,Tn i TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired (x) by North Andover Licensed Installer John Soucy at 12 Farnum Street, North Andover, MA 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 997 dated April 21, 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector FROM SOUCY'S SEWER SERVICE INC* PHONE NO. Au 26 1998 08:51PM P2 I SFP i2;j TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM NSTAL'LATION CERTIFICATION The uudersipcd hereby certify that the Sewage Disposal Syst=( )constructed; (�repaired; . by cfUf d(.rC located at '"L71�L2') was installed in conformance with the:Noi th:An' Byer 33oard•o£.Healtb approved plan:, Syst= Design Psrzait ` i .date3 `a�'i" r'I with an approved,design flow of s ons:per:day. Tlie mate;rs used were in conformance with those specified on the approved ' plap}the.system was i stalled in-accordanee with the provisions of•3 10 CMR 15.000, Title 5 and local:iex ations, the final grading*tcs substantially with theapproved plan. All work is acV11ratel :tepre- ed on... s-built which has been subinitfed to the Board.of Health. Installer: J1: Date: OF 3]esi�.F_xt eex' ,•' 'gn,;�ate. _ Z,y�,._.�� R1CHt?D ' '� TAS-s;=':,:2�J •��;j�= ss, I ` Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH 40RTN -� . pL W 1� 19 DISPOSAL WORKS CONSTRUCTION PERMIT • �9SSACHUSES Applicant NAME ADDRESS TELEPHONE Site Location ,/G� FY�/Li'N Permission is hereby granted to Construct ( ) or Repair ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 0.10 CHAIRMAN, 0ARDOFHEALTH Fee 7j D.W.C. No.. 8 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTA ER: �.-. oAC_ SIGNATURE: CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? YesNo Foundation As-Built? Yes No Floor Plans? Yes No Approval Date: p X - 5 s Town of North Andover, Massachusetts F°`"'No. 3 f NORTH BOARD OF HEALTH �f /� 9 o o L�I�U1/ DESIGN APPROVAL FOR SS^CNUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM r 5 y Applicant Test No. t Site Location } /r� Reference Plans and Specs. ENGINEER DESIGN DATE a Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. a i CHAIRMAN,BOARD OF HEALTH 97 Site System Permit No. 9 Fee Town of North Andover NORT), , OFFICE OF ��o t"`0 °oma COMMUNITY DEVELOPMENT AND SERVICES ti° A 30 School Street ". North Andover, Massachusetts 01845 Ssgc,HuSE��y WILLIAM J. SCOTT Director April 22, 1998 Ben Osgood, Jr. New England Engineering 33 Walker Road North Andover, MA 01845 RE: 12 Farnum Street Dear Mr. Osgood: This letter is to inform you that the proposed septic plans for 12 Farnum 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, �-- 'd� 7'D ti Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S Tony Randazzo File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES_. .. INC March 21, 1998 Sandra Starr, Administrator North Andover Board of Health 30 School Street North Andover, MA 01845 Re: 12 Farnum Street Dear Sandra: Enclosed are three copies of a new septic system design for 12 Farnum Street in North Andover. The owner requested that we redesign the system using the area of the existing above ground pool. The pool will be removed. This design requires a local upgrade approval for a reduction in the offset distance from the water table from four feet to three feet. No other local upgrade approvals or local bylaw variances are needed. The Board of Health approved the groundwater offset for the previous design. If you feel that that approval can be used for this plan then no new hearing would be needed. If you feel that the old approval can not be extended to this plan then I hereby request a hearing for the local upgrade approval. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., EIT 33 WALKER RD. — SUITE 22 — NORTH ANDOVER, MA 01845 — (508) 686-1768 -PLAN REVIEW CHECKLIST ADDRESS 1,2 ENGINEER �SGDOJI GENERAL 3 COPIES STAMP L--- LOCUS NORTH ARROW v SCALE CONTOURS ti PROFILE (Sc) SECTION (/ BENCHMARK f SOIL & PERCS '`� ELEVATIONS �''� WETS . DISCLAIMER WELLS & WETS WATERSHED2,k/6 DRIVEWAY _ WATER LINE FDN DRAIN r M&P SCH40 '�- TESTS CURRENT? SOIL EVAL SEPTIC TANK'.. -------MIN--1500:G-� ..1.7` INVERT- DROP v GARB. GRINDER (2.. comps: +200) 10 '- . TO FD` N^__) MANHOLE ELEV GW # COMPS:. l GB �J 7- D-BOX - SIZE _ °-#-LINES FIRST: --2 LEVEL STATEMENT c INLET �/�> OUTLET -17 (2 OR . 17 FT) TEE REQ'D? Ngo ?610 0 cl-s,g 3 �7 LEACHING - MIN 440GPD?------- - RESERVE AREA 4 '- FROM PRIMARY?�"i 2% SLOPE �- 100 ' TO WETLANDS 100.' TO WELLS v 4 ' TO S.H.GW_z,_ (5 ' >2M/IN) 20 ' TO FND & IN.TRCPTR-_DRAINS ✓ 400 ' TO SURFACE H2O SUPP -__ —_ 4 ' PERM. SOIL BELOW FACILITY s" MIN 12" COVER " FILL? ( 15 ' ) BREAKOUT MET? L-f TRENCHES / v MIN 440 gpd SLOPE (min .005 or 6 /100 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' )_z RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE?_�,X VENT? V ( >3 ' COVER; LINES >501 ) BOT ' 306 + SIDE _ ' X LDNG = TOT�y� (L x W x #) (DxLx2x#) (G/ft2) _ J Copyright 1996 by S.L. Starr c00 �-� i q � b I NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE FEE: PERMIT # DATE RECEIVED APPLICANT MAP /DPARCEL ADDRESS / Z I-Aelyo�d LOT ## STREET #� ENG. 6­5.6�0-06 -fQ -_.. STREET 71;MI!JO& 5r ENGINEER' S ADD. P LAN DATE / �/ 7 REV.. DATE . CONDITIONS OF APPROVAL. APPROVED -^-y- DISAPPROVED REASONS FOR DISAPPROVAL: (2/ I Thr Gs5 %v0 7- v �, SSS %/�-1 TJd ,�D��.>�GC��►TE iia c�I21 %ES C/ Z_ -L - NEW ENGLAND ENGINEERING SERVICES INC January 24, 1998 1. Sandra Starr, R.S., Health Administrator aQEQ= ;14; North Andover Board of Health 30 School Street JAN 2 6 ] North Andover, MA 01845 �99� Re: 12 Farnum Street septic design Dear Sandra Starr: The purpose of this letter is to address the comments contained in your letter dated December 31, 1998 regarding the septic system design submitted by this office. Responses to each of your comments are listed below. 1. All of the distances required are now shown. 2. The system is designed to be 70 feet from an isolated wetlands. A variance to the North Andover Health Bylaw has been requested to allow construction of the system 70 feet from the wetland in lieu of the required 100 feet. This design meets the Title 5 requirements. 3. The leach trenches are designed 6 feet apart in lieu of the required 10 feet in the North Andover Health Bylaws. A variance to the bylaws has been requested. This i desg n meets the Title 5 requirements. q 4. The bottom of the leach trenches are designed to be 3 feet above the groundwater in lieu of the required 4 feet. This is allowed as a local upgrade approval. A local upgrade approval is being requested for this item. 5. The pool is above ground and has been labeled as such. 6. The soil class data has been corrected in the notes. 7. A note has been added indicating that an additional test is needed prior to construction. I will be at your February Board of Health meeting to discuss the variances that are being requested. If you have any further questions please do not hesitate to contact this office. Yours truly, Benjamin C. Osgood, Jr., EIT 33 WALKER RD. - SUITE 22 - NORTH ANDOVER,. MA 01845 - (508) 686-1768 Town of North Andover °f N°RTM 1 OFFICE OF 3� yEtt O t do°L COMMUNITY DEVELOPMENT AND SERVICES ° F 70 30 School Street ` North Andover,Massachusetts 01845 �9SsncHuS���� WILLIAM J. SCOTT Director December 31, 1997 Ben Osgood Jr. New England Engineering 33 Walker Road North Andover, MA 01845 Re: 12 Farnum Street Dear Mr. Osgood : This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Distances not shown(N. A 8.03). 2. Less than 100' to wetlands (N. A. 5.02). 3. Trenches less than 10' apart (N. A. 14.01).. 4. Less than 4' to groundwater(3 10 CMB 15.212). 5. Is pool inground? If yes, leach area less than 20' (3 10 CMR 15.211). 6. Soil class type in design data incorrect - Class I. 7. Need additional deep @ East end of system prior to construction. If you have any further questions, please do not hesitate to call the Board of Health Office at the number listed below. Sincerely, G GZ2� Sandra Starr, R.S. Health Administrator cc: Tony Randazo William J. Scott Director MCD File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover of HORTN O.^FICE OF 3� �`i«e o e ti�OL COMMUNITY DEVELOPMENT AND SERVICES A 30 School Street ° North Andover,Massachusetts 01845 �,q`°^ •E°'°° cy WILLIAM J. SCOTT SSACNUSE Director December 31, 1997 Ben Osgood Jr. New England Engineering 33 Walker Road North Andover, MA 01845 Re: 12 Farnum Street Dear Mr. Osgood : This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Distances not shown (N. A 8.03). 2. Less than 100' to wetlands (N. A. 5.02). 3. Trenches less than 10' apart (N. A. 14.01). 4. Less than 4' to groundwater(3 10 CMB 15.212). 5. Is pool inground? If yes, leach area less than 20' (3 10 CMR 15.211). 6. Soil class type in design data incorrect - Class I. 7. Need additional deep @ East end of system prior to construction. If you have any further questions, please do not hesitate to call the Board of Health Office at the number listed below. Sincerely, -'Idol Sandra Starr, R.S. Health Administrator cc: Tony Randazo William J. Scott, Director, MCD File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 j i v .s l i i Town of North Andover., Massachusetts Form No. 1 BOARD OF HEALTH NORTH 3�pry�t�Eo 6�tiO0 W... e TION + TING INSPEC �A°4 = •,�^ APPLICATION FOR SITE TES / 7,9 A°RATeo S SACHUS Applicant [ DRESS TELEPHONE NAME Site Location Engineer NAM-, `W e ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOAR OF HEAL I H' �j ® + Test No. Fee S.S. Permit No. D.W.C. No.-C.C. Date Plbg. Permit No. lime i i hpRTM BOARD OF HEALTH a 146 MAIN STREET TEL.. 688-9540 SSS u5E NORTH ANDOVER, MASS. 01845 CN APPLICATION FOR SOIL TESTS DATE: q� Z3)9-7 LOCATION OF SOIL TESTS: l,P, kjVl Assessor's map & parcel number: 4c7 t-vT' OWNER: TEL. NO.: ADDRESS: /61 1�--el Alt,, r;-eo Lij-�o G irl r C 2tiv� ENGINEER: TEL. NO.: �s Q e- Get,-176 CERTIFIED SOIL EVALUATOR: 0.- Intended use of land: residential subdivision, single family home, commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-'100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. < `r ',}•• * I � "WRI k f ♦4 � `1 \ TVr � �•f r tt _ fir.Ptp1L:lJ ` T ` Y.: 'a t..1�ff���(= -CYJw TV ��,i t.`'�•i,{•,t" t, at ��7t iirr tJ:+� M3rtF P'£ i t r{4st i� �•'{ 't x r� �G` �' ert-E{fa t {k1''rfSt ...-. t 9+:..�r •I tE r r a {��i+" t r1 ,�,�ti.�.'::Y a �.�..- ,. r a^�, v . t f s a t t � + !t tt ���1f#pfe�ri, � k. #'� ry�,�� '' x °.'r0�•a _ ..'rut ii r at nr.r f 1.F :1,tc p 'Ftp ',� h• ,;rr? t �t'^Rw'i•.i 4`r ts,x r � n t t r ra DATE: __40 LOCATION: /� .�•,w, ENGINEER: -Psl�l BOH WITNESS: PERCOLATION TEST# BOTTOM DEPTH OF PERC TEST: TIME OF SOAK: (At least 15 minutes long) TIME AT 12" TIME AT 9° f b TIME AT 6" _ -c)- OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK: (At least 15 minutes) TIME AT 12" i TIME AT 9" TIME AT 6" I I 1 NEW ENGLAND ENGINEERING SERVICES, INC. 33 Walker Rd. Suite 23 NORTH ANDOVER, MA 01845 DATE JOB NO. PHONE (508) 686-1768 FAX (508) 685-1099 ATT .TIO TO � { j,� RE: i L WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. �y DESCRIPTION Z 0,11 e THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints 0 For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS �— s b fi s► `yl_ .��.i l B Gc���a �`zz� � �� COPY TO ... SIGNED: If enclosures are not as noted,kindly notifyus a once. Llrl OCT. 28. 19W( A:=6PM P ? PHONE NO. . G 1 3-a Cl 11 FORM 11 - SOIL EVALUATOR 1,,ORNI Page 2 of 3 c II L� ation Address or Lot No. OnMSlte QYrteW ', Dee Mole Number ! pate: ./d .:� Time::/�:� P - • l/� �� Weather Location (identify on site plan) Land Use ......f- i xIr/ Slope m . .� Surface Stones . — Vegetation . Landform Position on landscape (sketch on the back) ... � .. :.., � Distances from: Open Water Body . feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well . .:..... . . feet Other .. . ..... DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other �~ Surface(Inches) (USDA) (Munsell) Mottling (Structure, Stones,Boulders, Consistency; % ' Gravap F' S ,r. Parent Material(pcolagic �1 l` dpi L 4 Depthtoaedrock: De.th to Grouridwatee Standing W er in the Hole: Weeping from Pit Face: ,r E6�imated Seaaonsl High Ground Water: 157 DEP APPROVED FORM-12/07/95 R A F T --- ��36PM P-7 2 k '--FIROM' ':'"R.C.' TANGARD PHONE 110. CA JaC FORM 11 - SOIL EVALUATOR FORNq Page_ 2 of 3 i Location Address or Lot No. lC2— f//j'P On-site &view d� q � - to�,c• Deep Hole Number Date: Time: Weather{- Location (identify on site plan)L� - Land Use .... . ..... . .. Slope M . ..�:. . SurfaCe Stones . ... .. ..... Vegetation . .... ... >I`'�. ..........:.. Landform ..:...:.:..,..:,,,...... : . Position on landscape (sketch on the back) Distances from: Open Water Body . feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Weil feet Other , II DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil 01her Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, boulders, Con5wency. % Gravel) ve /46 Parent Material (geologiol �PCLIk" Oaptfitoeedrock: QyPtb to Groyndw0t0r: Standing Water in the Hole: Weeping from Pit Face: Espmated Seasonal High Ground Water: o� DEP APPROVED FOUL-12/07/95 '"""RAFT FORM 11 - SOIL EVALUATOR p RM page 1 of 3 No, Date. Commonwealth. of Massachusetts Massachusetts - Performed $y: .... ............. Date: /mea q Witnes3ed By Lofton A040 or �� � +�� � Oww'I Haft. T J kew Construction ❑ Repair 011'iap Review Publlshad Soil Survey Available: No ❑ ye'- Yew esYear Published /1? �• -- ......,.. )publication Scale l' J.3..r....,� Soil Map Unit �,6�.�..._.._..... Drainage Class � LSoii Limitations � �,. ...... �22 T,7.`.........................._�......._..__. Sur£ioial Geologic Report Avallabla No Q Yes Year Published Publication Scale �.w....� Geologic Material (Mals Unit) ..... ...................................................... ................................. Landfotm .............. . ......................:......._..................... .........................:.............................. .................... __.�...._ Flood Insurance Rare Map: Above 500 year flood boundary No ❑Yrs Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: NaUoual Wetland Inventory Map (reap unit) T ....................................._..................... ....._..__.. Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month Rang4 :A,bQra Normal ❑Normal ❑Bek--Normal Other Rafe renes Reviewed.- DEP eviewed:DEF AFPROvgD FORM.IN07195 DRAFT ot-T. _'R. 1997 4:36PIv1 F FROM R. C. TANGARD PHOHE 110. 61? 334 011'5 FROM R.C. TANGARD . PONE- rJO:•-•: '6i7-_. FOR 334•:_.0. 1 _ M II SOIL,LVALUATpR 01ZM Page 30t 3 Location Address or Lot No. Deter mies nal d ' ater Table ❑❑ Depth observed standing in observation hole Depth weeping from side of observationbole.,....;.„. ; inches © Depth to soil mottles inches - s/ r inches ❑ Ground water adjustment feet Index Well Number .................. Reading Date ............._.. Index well level -- Adjustment factor ' ................... Adjusted }round water Depth of Naturally pGc rrinQ Pervio s Metr�rial Does at least four feet of naturally occurring pervious material exist in proposed all p d for era the soil as or( absorption system? .� If not, what is the depth of naturally Occurring pervious materials' ------------ Certification I certify that on y d ( ate approved by the De artm ) I have passed the soil p ant of Environmental evaluator examination was ronmen msnati s perform tel Protec ' on ed by me consistent with the required Protection and that the above analysis described ' ui e i red Y n 3 q training, 10 CMR 15.p17, wining, expertise and ex aria i p nce Signature OL"Jt'R A F T DEP nppR0y1W FORM.12/0719S I