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Miscellaneous - 120 WINDKIST FARM ROAD 4/30/2018 (2)
0 o > c ami m > c > ani a) CCJ ¢ c d Q = N T lL. 0 d LL C m (` 7 _E c°n 3 F LL 0 O' E 0 V � Z op co U z Q � U 0) op Z ® LO O OD G/ U O No. THE COMMONWEALTH OF MASSACHUSETTS FEE NORTlt /4A/IVUC-2B OA R D OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) 54complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at Q4 VVI M.0 4L157- FA-P.N► RUA-G, has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating toyp"io3,No. dated . Approved Design Flow 'S (gpd) Designjissnce Inspector Date The. of this certificate shall not be construed as a guarantee that the system will function as designed. FORMRTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 RECEIVED JUN 18 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ` ",.,•F NORTH ANDOVER, MASSACHUSETTS 01845s;C„,;�� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdentna,townofnorthandover.com WEBSITE: http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: Engineer: ew Plans? Yes $225/Plan Check # (includes 1St submission and one re - 7 view /view only) Revised Plans?Yes?Included? Plan Check # Site Evaluation Fo Yes No Local Upgrade Form Included? Yes No R,'L=-C�`: - MAR 1 8 2038 TOWN OF Nt . HEALTH DLPA+:f ..:w Telephone #: � 7 5�Y�-41A-V Fax #: cj �S(- V6 — Y�_ - V AE -mail: C Homeowner Name OFFICE USE ONLY When the sub mis ' n is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database I_ �� � r-�'"�_�'.a' r ter �z .iii iii I t4) LO'd ETCO-99V-8L6 Std/3d lap«7-An1 '0 LnRd d9Z:CO 00-OT-Lne TOWN OF NORTH ANDOVER F �fl�TH Q SZlEO ,6 qiI BOARD OF HEALTH ° 27 CHARLES STREET * �o NORTH ANDOVER, MASSACHUSETTS 01845 p�'p1ilo 4�` SsaCHU FRANCIS P. MACMILLAN, M.D. Telephone (978) 688-9540 CHAIRMAN FAX (978) 688-9542 Sandra Starr, R.S., C.H.O. Public Health Director May 22, 2003 Ms. Patricia Lambert 115 Windkist Farm Road North Andover, MA 01845 Re: Extension of soil tests Dear. Ms. Lambert: On March 27, 2003 the North Andover Board of Health unanimously granted a two year extension on the approved soil tests performed on Lot 10 Windkist Farm Road by Christiansen and Sergi in the late 1990s. This means that the results of those soil tests will remain valid until March 27, 2005. Please call the office if you have any questions. Sincerely, - ---,dl Q4L10i1A--1 Sandra Starr Health Director I, Cc: File 03/02/2007 14:14 9783723960 CHRISTIANSEN & SERGI PAGE 02103 SCALE - 400 FEET = 1 INCH of NoRrH qN t�[I�� LSSA C Hus�� PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 6/18/2013 This is to certify that the individual subsurface disposal system has been installed in accordance with the provisions of Title 5 of the State Environmental Code: Construction of an On -Site Sewage Disposal System By: Warren Pearce At: 120 Windkist Farm Rd. Map 109.0 Lot 0055 North Andover, MA 01845 The Issuanc/f this certificate shall not be construed as a guarantee that the system will function satisfactorily. wyer 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r �r OF r10 R Ty qti o�o�m FI, 5 I North Andover Health Department Community Development Division 6/6/2013 Mr. Warren Pearce 196 Park Street No. Reading, MA 01864 Dear Mr. Pearce, This correspondence is in regards to the septic tank installation that took place at 120 Windkist Farm Road. I understand from the inspector that upon inspection, on the afternoon of June 5`", it was found that the tank location had been moved in excess of 3 feet horizontally and that the Health Department had no prior discussion with you about this. While in itself, the change appears acceptable, it is a violation of our local regulation; Section 4.8, which states, "Deviations greater than the above (3' for tanks) must first obtain written or verbal authorization from the designer and Health Department. Verbal approval may be granted for these deviations or a revised plan may be required". (see attached) As I understand the situation, you, as the licensed installer, chose a new location for the tank hole and then had the tank placed in this different location without first gaining this approval. This put the inspector and the Town in a difficult position, as for the inspector to allow backfill without speaking to the engineer; would give the inference that the Town was taking responsibility and overstepping the engineer's plan. This liability is not in the inspector's purview. Consider what could have happened if the engineer did not like the new location; or possibly if the Health Department had required a revised plan prior to installation? The homeowner would have incurred additional costs and delays. What did happen was the possibility that due to your lack of communication; there could have been a dangerous hole left open overnight and that the inspector was looked at as the person who caused that situation. There will be no fine for this violation or further action before the Board of Health; however consider this letter 4 -warning that North Andover expects local regulations to be followed in the future. Susan Y. Sa'`Yer, SIS/RS Public Heaflth D' for Cc: Christopher Jennings Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 4. ONSITE WASTEWATER SYSTEM CONSTRUCTION 4.1 A Disposal System Construction Permit shall not be issued until all necessary documentation has been submitted to the Health Department, including any required maintenance agreements, easements, deed restrictions or approval from the Department of Environmental Protection (DEP). 4.2 Installation of onsite wastewater systems shall take place between March 1 st and December 1 st; weather permitting, with all systems completed by December 1 st of each year. All applications for onsite wastewater system installations in any given year shall be made prior to November 15th of that year. 4.3 For new construction, a foundation as -built plan (in equal scale to the approved onsite waste water design plan) and floor plans of the structure must be submitted prior to issuance of a Disposal System Construction Permit. This is required to review the location and elevation of the foundation and to confirm its placement and leaching capacity with the approved onsite wastewater system design plan. 4.4 A pre -construction meeting is required to occur with the Health Director for each onsite wastewater system construction project to review design plans, conditions of approval, and unique conditions specific to the site. 4.5 Concrete tanks with a capacity of 2,500 gallons or less are required to have joints or seams above the liquid level (known as "monolithic tanks"). All 2 -piece concrete tanks shall be vacuum tested once placed in the ground at the site by the manufacturer or an independent third - parry testing company. Certification that the tank is watertight shall be supplied by the manufacturer or an independent third -party testing company to the Health Department once testing has been completed. Tanks constructed of fiberglass, plastic or which are made from concrete but include a treatment device are excluded from the vacuum testing requirement. 4.6 All concrete distribution boxes must be H-20 load bearing 4.7 The leaching facility location will be required to be staked out by the designer if there are no permanent structures within 50 feet of the proposed area or as otherwise required. 4.8 Deviations less than the following may be.made with the designer and Health Department verbally notified. Horizontal — building sewer 3'; watertight tanks 3'; soil absorption system 1' Vertical — building sewer 1'; watertight tanks 0.5'; soil absorption system 0.1' Deviations greater than the above must first obtain written or verbal authorization from the designer and Health Department. Verbal approval may be granted for these deviations or a revised plan may be required. a ge 7 North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 120 Windkist Rd. MAP: 109 LOT: 55 INSTALLER: Warren Pearce DESIGNER: Christiansen & Sergi PLAN DATE: 2/14/13 BOH APPROVAL DATE ON PLAN: 3/6/13 INSPECTIONS TANK INSPECTION: 6/5/2013 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 septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on Jn compacted firm base l -C/ ❑^/ Cleanouts per plan L Bottom of tank hole has 6" stone base []� Weep hole plugged ❑ 1500 gallon tank has been installed Q-Goz j/�IY I H-10 loading t lam' Monolithic tank construction �n ��,, ❑ Water tightness of tank has been achieved by 1/0 1 visual testing ❑ Inlet tee installed, centered under access port C [y� r2❑ Outlet tee installed, centered under access port as baffle/effluent filter � (/ /� F]inch cover to within 6" of finish grade installed over one access port Hydraulic cement around inlet & outlt. Comments: _ — Nee (OU.6'4 O ib � � PUMP CHAMBER OOY ❑ Bottom of tank hole has 6" stone I> - Weep hole plugged u9i ��✓ Ute' ❑❑ 1500 sgallon Pump Chamber intalle I L ❑ H-10 loading .r�0 Monolithic tank construction `W�W X S ❑ Inlet tee installed, centered under access port Q❑ Pump(s) installed on stable base ❑ Alarm float working /' -A��.� ❑ Pump On/Off floats working oz ❑ 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 ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ❑ Installed on stable stone base ❑ H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As -Built Plan `r CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws a b�"► Commonwealth of Massachusetts Map -Block -Lot BOARD OF HEALTH ----------------------- North Andover CERTIFICATE OF COM LIA CE THIS IS TO CE hat the Individual Sewage D' posal System ( epair) byn Pearce Jr. ----------- - -------------------------------------- ---------------------- ----------------------------------------------------------------------- Installer at N 120 DKIST F --RM-ROAD ha been installed in nce with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. 13HP-20137076 Dated June 03 2013 -------------------------------------------------------------- Printed On: Jun -03-2013 BOARD OF HEALTH Commonwealth of Massachusetts Map -Block -Lot BOARD OF HEALTH ----------------------- Permit No North Andover -BHP-2013-0766 - --------------------- FEE $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted warren Pearce Jr. - ---------------------------------------------------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. l Wn (on at No 120 WINDKIST FARM ROAD -- ---------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2013-07 June- 03, 2013 -------------------- ---------- --- --------------- Issued On: Jun -03-2013 - 1 -- Copy-------- --- - - BOARD OF HEALTH ................................................................................................................................................................... Reference No: BHJ-2013-000019 ................................... Permit No: BHP-2013-0766 ................................... Department: North Andover BOARD OF HEALTH ......................................................................................... Account No: 1001001.1.5.0510.00 Fee Type: .................................... DWC-Component Repair PERMIT Receipt No: REC.-2013-00.1604 .... ......................................................................................... ........ .............. ....... Paid By: Paid in Full On: Mon Ju.n.03..,2013... ............................. JENNINGS, CHRISTOPHER & ANGEL ......................................................................................... Check No: 6819 ................................... Received By: Lisa Blackburn ......................................................................................... DEPARTMENT'S COPY Amount: $125.00 .............. :::: ......... L ..................................................................................................................................................... .................. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ,� Application for Septic Disposal System (Construction Permit - TOWN OF NORTH ANDOVER. MA 01845 Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information or Lot # N' V&NDo0tyL City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ®,Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component 25 Conventional System (pipe and stone system) ❑ Infiltrator or Biodiff user (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name C C2 Address (if different from above) � , )2 N b o 0 FLO, rn lg � r�'� 4 � City/Town State Zip Code Telephone Number 3. Installer Information to rl�_12Vt` P_< P lR- A V> eL PY��p - ra VL C_rL cAss7ibleplease) Name Name of Company VAdddress City/Town State �eJgplhone, Ner(CellPh ` la �( 5ab 4. Designer Information C 1+ l `3 i't Y&^A s N + S (� 9-C- % �' At C, Name I tb SL9 yntIVK S Name of Company Address /4A0tLVI -VYLUL �p City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 TN Application for Septic Disposal System �9Construction Permit -TOWN OF TODAY'S DATE r ; ORTH ANDOVERMA 01845 $ 250.00 -Full Repair ;:.�'�;�N, $125.00 - Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: ❑Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this and of He Ith. Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached. Yes No 3. Pump System? If so, Attach copy of Electrical Permit Yes No 4. Foundation As -Built? (new construction ronly) (Same scale as approved plan) Yes No 5. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 ➢ OTHER: (Indicate) Health Agent Initials rj1 White - Applicant Yellow - Health Pink - Treasurer Town of North Andover Health Department Date: � D �-- ,+ Y A� L(/GG''� +i� j��/i'✓% Location: _�� (Indicate Address, if Residential, or Name—of Bussiiness)1116-1 Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑,Septic Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) Health Agent Initials rj1 White - Applicant Yellow - Health Pink - Treasurer Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover, MA 01845 978.688.9540 healthileg a,,townofnorthandover. com SEPTIC PLAN AL FO RECEIVED 0 3 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DATE OF SUBMISSION:Cy//- �' SITE LOCATION: ENGINEER: NEW PLANS: YES -4 $225.00/Plan Check #:- (Includes 1"NEwPL" and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan SITE EVALUATION FORMS INCLUDED: YES LOCAL UPGRADE FORM INCLUDED: YES Check #: NO NO Telephone #:g")g Fag #•_2-) E-mail: HOMEOWNER NAME: Gam%%'�/�?i✓f'�,%�•�' i� OFFICE USE O.NL Y When the submission is complete (Including check): L Date stamp plans and letter Z. 107complete and attach Receipt 3. P" Copy File, Forward to Consultant 4. Enter on Log Sheet and Database TOWN OF NORTH ANDOVER BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 FRANCIS P. MACMILLAN, M.D. CHAIRMAN Sandra Starr, R.S., C.H.O. Public Health Director May 22, 2003 Ms. Patricia Lambert 115 Windkist Farm Road North Andover, MA 01845 Re: Extension of soil tests Dear. Ms. Lambert: f NQRTH 1 Q tt4E0 p• tip OR1Tf0 w�``'(y �9SSaC"us Telephone (978) 688-9540 FAX (978) 688-9542 On March 27, 2003 the North Andover Board of Health unanimously granted a two year extension on the approved soil tests performed on Lot 10 Windkist Farm Road by Christiansen and Sergi in the late 1990s. This means that the results of those soil tests will remain valid until March 27, 2005. Please call the office if you have any questions. Sincerely, Sandra Starr Health Director Cc: File ti n� W Ifth. '1 Y; A d a c b o 72 c a� y a � 0 0 3 Q y v OO ai o b�A •c c ^O O N o s o o S on o 3 L Oq=w Qom. S, V 0 .0 O O C O p V cn o y •v £ .� � v � on X o ce `cg 'g, o axi E ° aU c3 a v a o co •o o n o •p aU.. Y .m _N N O •� Q � N Oq cC U-2 o.x7 c`o" mo=o o`na ma a Y c 3 onoo cn c a a ° °E.00� �_ v U Y y U N= C a0i N E Y O 0 0 M Cl O O z fV = ::p i� m ct" Z a Q L I o Q w I IWzzz, Q O . cd L � > � L w C it V Y; A d a c b o 72 c a� y a � 0 0 3 Q y v OO ai o b�A •c c ^O O N o s o o S on o 3 L Oq=w Qom. S, V 0 .0 O O C O p V cn o y •v £ .� � v � on X o ce `cg 'g, o axi E ° aU c3 a v a o co •o o n o •p aU.. Y .m _N N O •� Q � N Oq cC U-2 o.x7 c`o" mo=o o`na ma a Y c 3 onoo cn c a a ° °E.00� �_ v U Y y U N= C a0i N E Y O 0 0 M Cl O O z fV = ::p i� m ct" Z a Patricia A. Lambert 115 Windkist Farm Road North Andover, MA 01845 (978) 681-5288 March 21, 2003 Board of Health Town of North Andover Town Hall North Andover, MA 01845 RE: Lot 10, Windkist Farm Road North Andover Gentlemen: Would you kindly consider extending the soil suitability tests performed on July 10, 2000 for the above lot. The lot is in the process of being sold and we discovered that the test had expired when the broker contacted the town. I was unaware of this problem. My husband had checked with the town in mid -2002 when the lot was previously in the process of being sold and came away with the impression that the test was good for four years. My husband became ill shortly thereafter and has since deceased, leaving this, along with a number of other items, up in the air. While I am an attorney myself, I am not a land use attorney, and therefore have no greater more familiarity with the regulations than anyone else. The soil tests on lot 10 were first performed in April of 1996 and again in July of 2000 with little change in the results. The septic design provides for the leaching field to be set back approximately 140 feet from the street at its closest point. Nothing has been done to the lot in this area. The topsoil is undisturbed. We have filled the front of the lot back a distance of approximately 75 feet from the street [the location of the house as shown on the plan] in preparation for installation of a foundation. Both the buyers and I would appreciate any help you can give us in this matter. Very truly yours, Patricia A. Lambert luu� 1v (-VVV 101 LV—V lug vlll\Iol L111YnAL11 U QLJW1 1, 010 01C JjUU r. UI CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND L4ND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01880.6318 PLEASE DENVER THE FOLLOWING PAGES) TO: NAME: pa; y 1 C I A L. 461w ��2 FIRM: FAX NUMBER: c� �� ie, FROM: L n TOTAL NUMBER OF PAGES: (including cover page) DATE SENT: CLIENT: MESSAGE: TIME SENT: FROM FAX (978) 372-3960 IF THERE IS ANY PROBLEM RECEIVING THIS TRANSMISSION CALL (978) 373-0310 AND ASK FOR: FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS "de_r , Massachusetts Percolation Test* Date: Time:. Observation Hole # Depth of Perc ,, C-% Start Pre-soak End Pre-soak Time at 12" Time at 9" _ Time at 6 Time (9"-6") Rate Min./Inch * Minimum of 1 percolation test must bo perfor� i In bots � ate primary area AND reserve area. Site Passed ICI Site Failed ❑ n....................................................................................................................................._..-..............._. Performed By: s� / Witnessed By: Comments:..:::.:. iiDEP APPROVED FORM - 12/07/95 SEPTIC PLAN SUBMITTAL FORNI LOCATION: a% le) �✓ gJ/�iS/ AJ NEW PLANS: S 125.00/P Ian REVISED PL,4NS: YES S 60.00/Plan SITE EVALUATION FORMS INCLUDED: ® NO DATE: D DESIGN EVGIIr EER: r S /ia ".s DATE TO CONSULTANT: *if you want your plans expedited, please submit three pians and included a stamped envelope with the correct amount of postage to mail pians to Port Engineering. When the submission is all in place, route to the Health Secretary. No. /VOr FORM 11 - )"A' " " _ page 1 of 3 Commonwealth of Mas Massachusetts .. � -- -- . Date: Solt 'NULLuvcaaa -- / Nij Datec. .........C�.11%.1-S - 0--%4.f%✓�.�.....-,/ TPerformed By: .,/� rlr-. oma. .$.racJ.>,. Witnessed By: ' / ,,} /_ to s owrcr': Namc. (2010 r Ltl 1/ /InUP 1.cnu0n Addrus a %rY !/ Id /`� s / y Add=. aid I[/ 4/,F lu d7y , 80stm -Sr Teiwrom/o. Rrrd� -c, /1�9 0/� ew Construction S Repair ❑ Office Review Yes Published Soil Survey Available: No ❑ L / ; /s' pc�D Soil Map Unit �� � / - .... Year Published ........... Publication Scale r..... ....... YCUY� .................................... ............................... ......... ............................. Drainage Class Well d - Soil LimitationsElSurf'icial Geologic Report Available: No 2�Yes ..._.::.:::: Year Published Publication Scale .. ......... aUnit).............................................................................. Geologic Material P -................................... Landform�iY..% l'V1..!%%................................................................................... Flood Insurance Rate Map: es l�Y Above 500 year flood boundary No 2'Y --e ❑ _ Within 500 year flood boundary No s Within 100 y ear flood boundary No es ❑ Wetland Area: .............. it) ........................................................ National Wetland Inventory Map (map un ............................... Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal []Normal❑Belc�v Normal F-1 Other References Reviewed: DEP APPROVED FORM - 12/07195 k Page Z'of 3 Location Address or Lot No.���,�iVl�/�IS� �Gt/vr� /1UG�f On-site Review - o, � o Deep Hole Number d.� 61 Date: /06/6° Time: /� D6 Weather Location (identify o�� n lite plan) Land Use .. %c`O a% Slope (%) S—�SSurface Stones Vegetation 4 SSS Landform .. �+^�+�► �i Position on landscape (sketch on the back) Distances from: Open Water Body feet Possible Wet Area feet Drinking Water Well feet )� —/'�e I C;L Drainage way feet Property Line feet Other DEEP OBSERVATION HOLE =0G' Soil Texture (USDA) Soil Color Soil Other (Munsell) Mottling (Structure, Stones, Bounders, Consistency,Grave /oYR 71 /vYA /104Nt G/� 111, 6• YK 51g %3�oy Fri ik /�/4c c. a.sY I 4e, Parent Material (geologic) / r �� Dep"oBedrock: G it Death to Groundwater: Standing Water in the Hole: �a.0 S% Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORA) - 12/07/95 Depth from Soil Horizon Surface (Inches) )� —/'�e I C;L Drainage way feet Property Line feet Other DEEP OBSERVATION HOLE =0G' Soil Texture (USDA) Soil Color Soil Other (Munsell) Mottling (Structure, Stones, Bounders, Consistency,Grave /oYR 71 /vYA /104Nt G/� 111, 6• YK 51g %3�oy Fri ik /�/4c c. a.sY I 4e, Parent Material (geologic) / r �� Dep"oBedrock: G it Death to Groundwater: Standing Water in the Hole: �a.0 S% Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORA) - 12/07/95 '5-a�l ID Su,/.-, PATUM ZWV 216.00 0+00 SOILS DATA SOIL EVALUATOR: DANIEL O'CONNELL INSPECTOR: SANDRA STARR TEST PIT NO. TP3 DATE 4/24/96 DESCRIPTION TEST PIT TO VERIFY UNDISTURBED SITE. ---� SOIL EVALUATOR: GENE WILLIS ---� INSPECTOR: CARLTON BROWN, PORT ENGINEERING TEST PfT No. oo-01 DATE: 7/10/00 x pESCRIP.TION : f OYR3/2. GRAN. V. SECTION HORIZONTAL SCALE: VERTICAL. SCALE: TEST PIT NO. TP4 �d DATE 4/24/ o ... pESCRfPTfON iW034JIIC2; C7: F.S.L.; 2.Sr6/4; VLOCMFnM 1N PLACE SYR5/8; LC 2.5Y6/3: MANY Cf PROMINANT F.SILTY L.; SYS/4; MASS. FIRM 1 PL. WEEP O 120"; STANDING O 1240 ..ieNO RMUSAL; Rii;NING NOT 1/8" WE PERC TEST NO. P4-1 DATE 8, START SOAK M24 a24 12" 11.36 36" 6" 11:61 6" 12:13 16" PERC RATE 6 WA PERC TEST NO. P4-2 8/21/ START SOAK 11:2 f 12" 11:42 36" 6" 12.04 6" 12:44 i80 PERC RAT1: 14 M Page _'of 3 Location Address or Lot No.���/�nQk�s � FCt�I'►� /\ V U �( On-site Review a /' Pin ChylLO Deep Hole Number.' Date: '5`/A Y19 Time: �� 7�� Weather r Location (identify 07 '? site plan) rW /a /Surface Stones'"` CO Land Use ... �a.�l�o�-� Slope (/o} �� vegetation ,aSS Landform rLk►--- Position on landscape (sketch on the back) Distances from: Open Water Body feet Possible Wet Area feet Drinking Water Well ;feet Drainage way feet Property Line feet Other DEEP OBSERVATION HOLE'OG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency,Grav L� 73 16CXY Fr ce es HOLES t tt Parent Material- (geologic) DepthtoBedrock: ff'' ' •%r� Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: -z Estimated Seasonal High Ground Water: 3 DEP APPROVED FORM - 12/07/95 Location Address or Lot No. etermination or Seasonal HighWater Taole Method Used: —, i Depth observed standing in observation hole .. inches Depth weeping from side of observation hole inches !Depth to soil mottles 3Ginches 7-71 i—IkJround water adjustment .............. feet Index Well Number .............. Reading Date ................. index well level Adjustment factor Adjusted around water level _. Deoth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring -pervious material exist in all areas observed throughout the area proposed for the soil absorption system? J If not, what is the depth of naturally occurring pervious material? certification I tify that on cer/1 i `7 (date) I have passed the soil evaluator examination approved by the Depast rtment wrth th required ntal ttraining ect on ne pertise ad that the nd experove a ae�c was performed by me consistent described in 310 CMR 15.017. Signature D ate 3 i DEP APPROVED FORA - 12/07195 En W❑ Z E Z Z Z Z c J 11 ca 9 N c if m `� `te�l// ❑ U 0 U w- -4 2. o n W W C O m - 0 CD 00 Ct - r m n A - 0° m 11v r 3 o N 0 - U OO Oa - -' o ❑ A p 7 m m 3 3 Z o N o m i - 3 - m CD Q w a ° Z o m m v o ccn w m N m -_ n ^ m ❑ Z mo m O O C, N w 3 cn oo co c n m o CD r 3 m o Z ° x L7 North Andover Health Department Community Development Division March 6, 2013 WJJ Planning & Construction 64 Haverhill St Reading, MA 01867 RE: Plan Approval Subsurface Sewage Disposal System Plan for 120 (lot 10) Windkist Farm Road, North Andover Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the revised septic system design plans, for the above referenced property, submitted on your behalf by Christiansen & Sergi, Inc., dated March 1, 2013. This plan was submitted as an addition to a plan approved in 2005, of which all requirements of installation of the septic leaching area have already been met, but requesting a new tank location. The design has been approved for the placement of a tank and piping which will complete a new onsite septic system for a five bedroom (maximum 11 rooms) design at 550 gallons per day. A licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover as soon This approval is also subject to the following conditions: 1. Prior to the issuance of the Disposal Works Installers Permit, the applicant must submit a foundation as -built at the same scale as the approved plan. 2. Prior to the issuance of the Disposal Works Installer's Permit, the applicant must submit the floor plans of the home showing no greater than five bedrooms or a total of eleven rooms. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Page 1 of 2 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 120 Windkist Farm Road March 14, 2013 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sinc ly, v� usan . Sawy , REHS/RS Public Healt irector cc: Philip Christiansen, P.E. file North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Page 2 of 2 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 TRANSMISSION VERIFICATION REPORT 0 TIME 03/08/2007 09:40 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATEJIME 03/08 09:39 FAX NO./NAME 819784471470 DURATION 00:00:50 PAGE{S} 03 RESULT OK MODE STANDARD ECM orth Andover Health Department 1600 Osgood Street Building 20, Suite 2.36 North Andover, ,ISA 01845 978.688.9540 - Phone 978,688.8476 — Fax healt denttowremfa�or�handove�.conn - E-mail w.w_w. towrtafnerthandov r. one - Website n Le tar of Transmittal Page .... of 11 To: DATE: COMPANY: F9DM: 0=916 Del Wale, health Department Assistant Phone: RE: /D G GGA Fax: / G� f' z/ 17.p 7 / /' / -�%2 � We are sending your © Copy of lelter O Plims /J Other t ll an below) These are transmitted as checked below: ➢ Q�ga►aeab�A ➢ Q�a► . A L7.�suoea► A afi r.wgpp and A ®rrlPvaxda"~ ➢ DC7 rir . giir!& ➢ Q� apfbrd North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdopt(CD-townofnorthandover.com - E-mail www.townofnorthandover.com - Website n Letter of Transmittal Page / of ri ONO `� O1- COCMN:WWKN -7• T0: G ��� DATE: COMPANY: a FROM: Pamela DalleChiaie, Health Department Assistant Phone: RE: /J�f �7 Fax: We are sending you: O Copy of Letter O P/ans O Other Ifi// in he%wj These are transmitted as checked below: ➢ 04Pvwdaefl&d ➢ MsAbWestd ➢ L7Asli'�geed )0- L7 ar4orw i ➢ Mrf ikivadamwe ➢ L7&ubWt ap�sfbr ➢ CA" WFwfor&t. REMARKS: COPY TO: — COPY TO: SIGNED: CY C—i� COPY TO: TOWN OF NORTH ANDOVER OE gORTp 1 Office of COMMUNITY DEVELOPMENT AND SERVICES a `��•� +•°� HEALTH DEPARTMENT 400 OSGOOD STREET ,r « NORTH ANDOVER, MASSACHUSETTS 01845 �'sS^CMU Susan Y. Sawyer 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D"- � � �k ,2 7 J DAV DEV Realty Trust David McNee 136 Andover Street Wilmington, MA RE: Subsurface Sewage Disposal System Plan for Lot 10 Windkist Farm Road, Map 109, Lot 55. North Andover, Massachusetts Dear Mr. McNee, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted by Phil Christiansen on your behalf. This plan dated August 21, 2000 was last revised March 9, 2005 and received at this office on March 14, 2005. In addition, the following local variance was approved at a regularly scheduled Board of Health meeting held on March 24, 2005. With the granting of this variance, the subsurface disposal plan has been approval. 1) To allow a waiver to the North Andover regulation — NA 9.02 - which requires the excavation of the bottom of bed to extend six (6) inches into the soil. The design has been approved for use in the construction of a new onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. This approval is subject to the following conditions: 1. The issuance of the disposal works construction permit is contingent upon the receipt of a foundation as -built of the dwelling. The as -built must be in a scale of 1" = 20` and a set of floor plans for the proposed home. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health o Department may be reached at 978688-9540 with any questions you might have. Sinw , Y. Sawyer, REHS/RS Public Health Director cc: Phil Christiansen, P.E. 12lue I'vledicare OFFS (Blue Cross Blue Shield of MA) Fallon Senior Plan (Fallon Community Health Plan) First Seniority Freedom (Harvard Pilgrim Health Care) Senior Whole Health Tufts Health Plan Medicare Preferi (Tufts Health Plan) I Medicare Card Number # I give permission to bill my insura (Signature of person to receive vaccine X For Clinic/Office Use: Vaccine name-\ -i J Injection site: ci—" Date \l Vaccine manufacturer: Name and title of vaccine administrator: Clinic/office address: Influenza Forms — MAHP/Masspro Plan Reimbursem� 649 vr; 1� �.o M7 LOQ' icy c.� b p .ql tv b2 3 i s Z c � r 43 LL � NLij 3 0 gg 3 v\ 'OW�9-,. �MNU91�17V 6 QallddaKbl044 .LI -,6 �9-,L�R1N310,t2NISvY1 ��B ,E ausoaa�'emorea�r+o�nawava ausoi9M=Ma a1,1L0d NYOd- Mi5 W ag NY -W MAMd w Q W A >v � ~ n .e- pz � z g A- bl j^L IIII ,,,lilt a mill .1L IIII O 11111 � � e � IIII LnryJ Ts � b III Ul - II r---1111 UP q-.6 LIIJ asi IIII ,z,4i IIII 'q' I 3 lilIt Ilii � S P � IIII a IIII IIII B -k , tr.L4 b p .ql tv b2 b c N x fl F 4 6 Q a1.1 n Z >L O O o �oIm Q Z4 Z � � O � o O 0 = V1 JL P w C i. a A- y4 ----------- —-------- ���� II IIII IIII IIII � Ilil IIII IIII ��8 �IIII O L J IIII ,�b•,5 Q 33 II J x� qs� aP5 ��4-,OI e .A -•L II .b,Zl n3 � poll fl I_ tl'd00,-M 4 Ra � ae o a'Xi a�A =v � f o X �II IIII I O tll S z _ �3 IID \| < . % \¥ f . \ ƒ \§ t! \} .. »1 \ . � \ \ -� E--- \ \ \ i j - / \ ! . \ � ± ( (E ) \ \ \ ` --- � « � \ . - � 1 » = / ¥ in� i � § & � � ` I § � � � S S { 2 : 3 (D ;» � � g .01-4 o o � ® S R Q § & * y 3jaa o� 2-1 f,,,�,4- ',:5�> 1 z5 Commonwealth of Massachusetts Map -Block -Lot : ° <<• ° '+. ? 109.0- 0055 - o n Board of Health Permit No North Andover ----__...- - --- � • BHP -20 008-0027 P. 1. FEE c►+ust< F. 1. $250.00 Disposal Works Construction Permit Permission is hereby granted David Murray — -- - - ---------------------------------- I to (Construct) an Individual Sewage Disposal System. I at No WINDKIST FARM ROAD --- ------ - _- _- - - -- -- ------------- - ---------------- - -------------- --- --- ---- ---------------- as shown on the application for Disposal Works Construction Permit No. BHP -2008-002 Dated March 20, 2008 --- ------ 1 Issued On: Mar -20-2008 Board of Health Commonwealth of Massachusetts Map -Block -Lot o: ,•'•• `•. oo� 109.0- 0055 - Board of Health --- --------------- ~ � A • North Andover °• Certificate of Compliance �s.T CHust� THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Construct) by David Murray Installer at No WINDKIST FARM ROAD ---------------------------------------------------------------------------------- -- -- --------------------------------------- -- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2008-002 Dated March 20, 2008 --- ----------- ------------ --- -- Printed -Ow -Mar -20-2-008 Board of Health Of NO DTM q� x 3 2 b 6 FO ♦ ., 9 ` Town of North Andover `+,'••,,,,o .: �+ HEALTH DEPARTMENT ,SSACMStt CHECK #: 88s' DATE: LOCATION: - H/ONRME: CONTRACTOR NAME: Gtr' !Y/ 6C,24 0,�1 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval Sep $ ,,l 0 tic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer N°RTH Application for Septic Disposal System -r pConstruction Permit -TOWN OF �N��' ORTH ANDOVER, MA 01845 250.00 -Ful air ^°"^n° $125.00 - Component nss�cHusf� Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _ I�:: Application is hereby made fora permit to: Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component – What? A. Facift Information Address or Lot # l2 (,�J i ,o�� ,C✓L/tcat /Q�� City/Town 2 *TYPE OF SEPTIC SYSTEM'"• ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** 119 h [ Conventional System (pipe and stone system) R ❑\\Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to inst this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. (A" r� v t &'1 o S �- Name 1 -a C' Address (if different from above) At el Citylfown State Zip Code Telephone Number 3. Installer Information f NamName of Compa y 2 (Q� V Ag v 1,� C Ad�ess --\--),S��� City/To 4. Desianer Information U` a; S} c— J -c'1 4 Name I ('0 S S,� Ad r ss ,. k" 1 City/Town State c Zi Code Telephone Number (Cell Phone # if possible please) Name of Company A A State or/ -6-3 0 Zip Code 9?$-37314?10, Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 N°RT„ Application for Septic Disposal System 3 �' TODAY'S DATE AConstruction Permit -TOWN OF ��'- •'" ORTH ANDOVER MA 01845 $ 250.00 - Full Repair $125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: MResidential Dwelling or OCommercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been iss ed by this Board of ealth. ZT� b Na Date Application Approved By: (Board of Health Representative) Name Application Disapproved for the following reasons: For Office Use Only: Date L Fee Attached. Yes,t/ No 2. Project Manager Obligation Form Attached. Yes,,No 3. Pump System? If so, Attach copv ofElectrrcal Permit Yes? No 4. Foundation As -Built? (new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans? (new construction only). Yes No Application for Disposal System Construction Permit • Page 2 of 2 SEPTIC SYSTVM IWSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: /4(,t),,,lc ,, " (Address of septic system) For plans by_ 6 �~ 4 �\ � (Engineer) Relative to the application of �J^, _ (Installer's name) And dated ngina ate Dated 3 2p � (I'ooda} slate With revisions dated � 1 g (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system isnot ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or MY company a. Bottom of Bed — Generally, this is the first (Vinspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdel2t&townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, gnificant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the a1212roved plans. No instructions by the homeowner,general contractor, or any other ersons shall ab,, me of this obligation. Undersigned Licensed Septic Installer:(Today's Date) ame — Print)a igne No. THE COMMONWEALTH OF MASSACHUSETTS FEE iyad-1 t3hdaW-,u BOARD OF HEALTH CERTIFICATE OF COMPLIANCE�� Description of Work: individual Component(s) ❑ Complete System moi. The undersigned hereby certify that the Sewage Disposal System; Constructed ( LKRepaired ( ), Upgraded ( ), Abandoned ( ) by: ff at C_Di 10 Wil -10 157- /fid l-t✓I _/2U /4 n has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design,plans/as-built .,plans relating to. application No. dated Approved Design Flow —6 S �U (gpd) The )6s7u Oce of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 PRINTED BY: Pamela DelleChiaie - PLEASE LEAVE IN PRINT-OUT TRAY....... THANK YOU. DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, December 07, 2010 2:32 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: Lot #10, aka 120 Windkist Farm Road - Final Construction Inspection Request Hello, Please call David Murray, installer for Lot #10, aka 120 Windkist Farm Road for a Final Construction Inspection. His number is: 978.375.4997. Thank you. 96e Mjae6, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 2 Office - 978-688-9540 2 Fax - 978-688-8476 D Email - pdellechiaie(@townofnorthandover.com 'SIL Website htto://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous I OF I DelleChiaie, Pamela