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HomeMy WebLinkAboutMiscellaneous - 122 FARNUM STREET 4/30/2018 (3) Jf F 122 Farnum Street J r r C i i 122 FARNUM STREET JS-2004-0434 Project Detail Report Printed On:Fri Mar 19,2004 Project Name: GIS#: 7381 Project No: JS-2004-0434 Owner of Recordi ARAKELIAN,KARL Map: 107.A Date Submitted: Oct-29-2003 I I 1 BEAR HILL ROAD Block: 0073 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 122 FARNUM STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Septic System Repair Comments: test of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health YELLOW FLAG BHJ-2004-0029 3/4/04-COC signed off by Brian LaGrasse.-File General Files. 3/3/04-Mrs.Arakelian,h/o called looking for a final grade. Consulted with Brian. He will do final grade this week,and a COC will be issued at that point. Left message on h/o answering maching. 2/25/04-Mr.Arakelian,h/o,called to find out when the final grade inspection is going to get done. He called a couple of weeks ago,Brian went out,but there was still too much snow. Wanted to pin down a time when Brian could go out. H/o was told to call back when no snow is left on the ground,and a final grade inspection will be scheduled at that time. ° 11/13/03-Updated plans dated 11/12/03 received from NEES. Ben Osgood stated that Brian said these revisions could go through him,and not the consultant. Submitted to Brian for review. 11/10/03-Form U Comments: Need floor plans of existing house;Title V setbakcs not met, pump chamber is 6 feet from the foundation. 10/31/03-John Soucy picked up DWC permit. 10/30/03-Left file and Ben's letter on Brian's desk for review. Permit printed and ready 10/30/03-Letter received from Ben Osgood stating that the changes are limited to the footprint of the proposed addition and deck. The size and location changes slightly from what was originally proposed. No changes have been made to the plans in regards to the septic system. 10/29/03-Ben will be sending a letter to confirm the different plan submitted with the Form U and the Septic(Septic:3/25/02)and(Form U:9/24/03). Ben stated that he moved switched the location of the addition and deck per the order of the Conservation Commission. Minor change,and did not need to appear before their Board. Brian asked that Ben send a letter. Ben will fax it. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2003-0345 Oct-29-2003 SIGNED OFF JS-2004-0434 DWC Form U Signoff-construct BHP-2003-0365 Nov-10-2003 SIGNED OFF JS-2004-0434 Addition and Car port GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 2 /I 122 FARNUM STREET JS-2004-0434 Project Detail Report Printed On:Fri Mar 19,2004 Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Grade DWC-System Repair BHP-2003-0345 Mar-04-2004 FULL COMPLY Brian LaGrasse JS-2004-0434' GeoTMSO 2004 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 i f Lot & Street Map/Parcel 1671.417-5 CQNSTRUCTIQN APPROVAL Has plan review fee been paid: YES NO Permit# 5� Plan Approval: Date: Z Approved by: Designer: 05 Plan Date: `z- Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-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: _ f • SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit# Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: LA,. By: 1 Final Construction Approval: Date: L 1 By- Certificate Certificate of Compliance: Approval: 0'�, Date: 1/ Conintonwealth of Massachusetts D ; T �q--ANDOVER/-1�F► Rf MCIssachusettsT 2 5 1995 System Palm jn Record System Owner System Location )MOW t L a Date of Pumping: Quafitity Puinped: � `� gallon`s' cesspool: No Yes U Septic Tank: No U Yes L� i. System Pumped by: vcz&jo`s! 5 &Vgaa License# Contents transferrred to : Greaterwrence Satiltar1►District La- Date: Inspector: .C\ Commonwealth of Massachusetts man= City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Healtbq- Tit� S�ti u ping Record must be submitted to the local l3oard of Health or other approving au ority. A. Facility Information JUL 0 7 2008 Important: TOWN OF NORTH ANDOVER When filling out 1• System Location: L HEALTH DEPARTMENT forms on the t �� computer,use only the tab key Address to move your cursor-do not use the return City/Town State Zip Code kee'y, 2. System Owner: g Name i2arn.. f'.a Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping '� 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) ®`Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes B No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. S-ystem Pumped By Narpe ` � Vehicle License Number Company 7. Location where contents were disposed: gyp ,a T —Signaturd of Hauler Date http://www.mass-gov/dep/Water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts Town ofd— From: Soucy's Sewer Service Inc. Month: Date Address Owners Name Gallons pumped " H,G,C,D,S Contents tranfered to Condition of sytern G 4 &1196 65 ,o Z/ '. fJZ24�j 5 %fir77 �K. 7 10Y K =Lv 8 3k�. lG1 . L, S , fb. " s � �•7iF'a � c c9ic , 9 10 11 12 13 14 .15 16 - x,a• 17 JUL i U 18 V TOWN OF NORTF'AC ;'lE�t 19 HEALTH DEPART ENT L 20 ern *C= Cesspool, D= Drywell, S= Septic, G= Greasetrap, H= Holding Tank � . �," � �, �� ... �� V i -' Town of North Andover tAOR Office of the Health Department Community Development and Services Division fh 27 Charles Street North Andover,Massachusetts 01845ssc►+�ti{ Susan Y. Sawyer,REHS/RS Teleplo©ne(978)688-9540 Public Health Director Fax(918)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE March 4,2004 z This is to certify that the individual,subsurface disposal system constructed ( ) repaired (X) l t; y t 1 ` John Soucy "x k at r 122 Farnum Street North Andover, MA 01845 b 4. @. u: 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. The Issuance of this certificate shall not be construed as a guarantee that the system wffl- function �� to 4 satisfactorily. $r B '-':T. LaGras'se Healthlnspector BOARD OF APPEALS:688 954h BUILDING 68'8-9545 CONSE.RY. -ATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ° : _ - 1 � A - a e` y�_...tea r`''E.���� I�cal'Gw•1., 1Q 4. i XG iia (' t ' FORM U - LOT RELEASE FORM i INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fror. Boards and Departments having jurisdiction have been obtained. This does not relieVE r the applicant and/or landowner from com lianc e with any applicable or requirements. f` *****************************APPLICANT FILLS OUT THIS SECTION********* ** * y APPLICANT r- k e a PHONE �ott -1 --7S , � LOCATION: Assessor's Map Number. C)- PARCEL_Q O SUBDIVISION LOT(S) STREET ST. NUMBER__�D> _ „*********OFFICIAL USE RE MMENDA ONS.OF TOWN AGENTS: C NSERVATION.AD INISTRATOR DATE APPROVED 1-0 DATE REJECTED COMMENTSfi�ea_SS'cJ� T�e-e�:�.iJU'4tc (odF i 4 ri TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED LIG SEP IC INSPECTOR-HEALTH Y DATE APPROVED. DATE REJECTED 10 " COMMENTS sc7 Ezra rcr� — PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm ` 41 __ f t 'EROSION CONTROL 100 �'A o __._-- 1 500 GALLON /-� SYSTEM TIES LLON SEPTIC TANK /' PUMP CHAMBER --��' i 3 TO TANK 4 TO TANK i d �� 3 TO PUMP 2" SCH 40 PVC _ 00 0. 4 TO PUMP FORCE MAIN _ o 1 TO D-BOX 2 TO D--BOX BLOCK SHED i 1 TO A 44. 8' 1 TO Z 0 A 56.1 2 TO WLL .73 4 5 - 1 TO E 37.7' 1 TO -' 2 TO E 66.0' 2 TO OF Mqs k. RICCARp yN . TANGARD / / I EXlSrING DWEI LING 13021 100 BUFFER ZONA SILL ELEV 1 O 1. `` �U`— C F 20 ELEV 98.00 ✓ (V� \ � V This is to certify that New Englan 3 RESERVE AREA ' Services Inc. has inspected the st � � CO. TP 2 disposal system installed at 122 I North Andover, MA. The system he constructed in compliance with 31 The approved design plan dated 1 11 t:u o 11/12/03, and local requirem( N v� ,iA r noted herein. — EXISTING LAMP POS" BENCHMARK: SPIKE IN TREE {., , � � �r d :� ` r' +j(l ELEV 100.00 (assumed) J f ' a� ";; AS ILT SEPTIC S he S BU TP 48. � t 122 FARNUM 3° 20,11 NORTH` ANDOVER., _ L 1' 0' ALE. — .;-fATt rn; i57' C 2 DATE TP 1 t - - PT 1 NEW ENGLAND ENGINES EXISTING PRESSURE r �, a 60 BEECH.WOOD WATER SERVICE i �`w .` j � �. � : , 4 • ARA `~ y NORTH ANDO�' to # f ..t i m (978) 6,86- 1 d ` rH}, dn,= LAN IiECKED OO5AC3 DAWN BY:__ i � �� ��, � � _ '� NEW ENGLAND ENGINEERING SERVICES INC --4 YOMMISSION U 2003 � _ CON October 30, 2003 Brian LaGrasse North Andover Board of Health 27 Charles Street North Andover, MA O 1845 Re: 122 Farnum Street, Septic system design i Dear Brian: This letter is being written to confirm the extent of the changes to the most recent plan for the above referenced property. The changes are limited to the footprint of the proposed addition and deck. The size and location changed slightly from what was originally proposed.No changes have been made to the plans in regards to the septic system. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 10/30/2003 09:56 9786851099 NE ENGINEERING SVC PAGE 02 0 NEW ENGLAND ENGINEERING SERVICES INC a OCT 3 0 2000 ; r y � October 30,2003 Brian LaGrasse North Andover Board of Health 27 Charles Street North Andover,MA 01845 Re: 122 Famum Street, Septic system design Dear Brian: This letter is being written to cm&w m the extent of the changes to the most recent plan for the above referenced property. The ch2nges are limited to the footprint of the proposed addition and deck.The size and,location changed slightly from what was originally proposed.No changes have been made to the plans in regards to the septic system. If you have any questions please do not hesitate to contact this office. Sincerely, c D_ Ben�annn C. Osgood,Jr., President 60 BEECHWOOD DRIVE-NORTH ANDOVER,WA 01845-(978)888-1788-(888)359.7645-FAX(978)885-1088 i 10/30/2003 09:56 9786851099 NE ENGINEERING SVC PAGE 01 FAX MEMO TO: Brian LaGrasse FROM: Benjamin C. Osgood, Jr. New England Engineering Services DATE: 10/300/03 This transmission contains 2 pages including this cover sheet. If the transmission is,unclear or you experience difficulties you may call at 978-488-2996. MESSAGE: Letter regarding Farnum Street with corrected date. Thank you, Benjamin C. Osgood, Jr. : Town of North Andover, Massachusetts Form No.2 f MORrh BOARD OF HEALTH O L � w p Y^oi DESIGN APPROVAL FOR sSA�MUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant, Test No. Site Location oJ? Reference Plans and Specs. 3 L-ENGINEER DESI ATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. R CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 1/-(o i Commonwealth of Massachusetts Map-Block-Lot < 107.A-0073- Board Of Health Permit No North Andover -BHP-2003-0345 ---P-20------------- P.I. FEE F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted John-Soucy------------------------------------------------------ -------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 122 FAEtNUM STREET as shown on the application for Disposal Works Construction Permit No. BHP-2003-034--- ---Dated October 003 --------------------- ----------- ---- ------- -------- --- --------- Issued-On: -------IssuedOn: Oct-29-2003 Board Of Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map-Block-Lot 107.A-0073- Board Of Health ----------------------- North Andover Certificate of pliance THIS IS TO CTEE RTIFT,Th �ndiviidual Sewage Disposal System (Construct) by John So- u-- y - ------------- - ----- ------------------------------------- ------------------------------------------------ --------------------------- Installer atNo 122F STREET has be led 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-2003-034-- ---Dated October-30,_2003 -------------------- --------- - - - - --- ----------------------------------------------------------------- Printed On: Oct-30-2003 Board Of Health �Y. TOWN OF NORTH ANDOVER BOARD OF HEALTH ! ©� Location z J 26 its'! Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Constructiovl-x$ tJ'� Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ offal/Trash Hauler $ Other $ 7099 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer i 6F'HE 'T91 ` OCT 2 9 2003 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION.P_ER)I T DATE: 10- CURRENT INSTALLER'S LICENSE# LOCATION: J gt '�` 'l 4 tA i + C LICENSED INSTAL R. SIGNATURE: TELE HONE# ,�� CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Z Administrative Use Only PL/ $ .00 Fee Attached? Yes No Foundation As-built? Yes No Floor plAonL Yes No ApprovDate: (D i t, INSTALLER PROJECT MANAGEMENT OBLIGATIONS. As the North.Andover licensed installer for the construction of the septic system for the property at '� ,'� '�''"' relative to the application of dated for plans by and dated with revisions dated - I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto project manger, or any other person not associated with my company schedules an inspectio and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicabl inspections as indicated below. I understand that requesting an inspection,. withou completion of the items in accordance with Tile 5 and the Board of Health Regulations ma. result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally.first inspection unless there is a retaining wall which should be done first. Installffnust request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built 01 verbal OK from engineer must be submitted to Board of Health, after which installer calls foi inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in.the attached application for installation. I further understand that work 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 in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: the proper elevation of the excavation has been reached. a) Determination that b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi d Licensed ti staller a, Date: ���� 9?7� Dispo• 1 Works Co structio ermit# NEW ENGLAND ENGNIc EERING SERVICES December 8, 2003 Brian LaGrasse j Ti.,H North Andover Board of Health r�-- 27 Charles Street North Andover, MA 01845 DEC 10 2003 Re: 122 Farnum Street, Septic system as built Dear Brian: Enclosed are three copies of the as built plan and the original c rt' cation document. The certification document needs to be signed by John Soucy. �n If you have any questions please do not hesitate to contact thisTice. Sincerely, Benjamin C. Osgood ,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed; (,Y)repaired; Y tq U 510 0 C9 located at A)U AA ST2Pt was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# ,plan dated , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310 CMR 15.000,Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: 0--?, Seo -, t- Engineer 2Engineer Representative Installer: Lie.#: Date: G Engineer: Date: h DEC 10 2003 A TOWN N OF' NORTH L'�1�ANDOVER ER F NORTp, 3? 86;, ♦,, y OC HEALTH DEPARTMENT 27 CHARLES STREET _ NORTH ANDOVER, MASSACHUSETTS 01845 9 ��•�: i Ssac►+use Sandra Starr Telephone(978)688-9540 Public Health Director FAX(978)688-9542 June 7, 2002 Ben Osgood, Jr. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 122 Farnum Street Dear Mr. Osgood: This letter comes to alert you that the proposed plan dated 3/25/02 for the repair of the septic system at 122 Farnum Street will be approved conditional to the retaining wall meeting all requirements of the DEP policy concerning retaining walls and impervious barriers. (See enclosed policy.) Please review this policy, make any needed changes to the wall design and return to the Health Department for final approval. Also, please note that the retaining wall will need to be certified as stated in the design policy. If you have any questions, please do not hesitate to call the office. Sincerely, Sandra Starr, R.S., C.H.O. Public Health Director Cc: Owner BOH File l 051_21/02 _ UE 18:55 FAX Karl.Arakelian i NEW, ENGLAND ENGIcNEERING SERVICES i PO May 20,2002 i Karl Aiekelian 122 Farnum Street North Andover, ! 01845 Re. Synopsis of permitting for septic system 122 Farnum Street i Deer Karl I received your telebhone call regarding the status of,your septic system permitting last week.I felt it was appropriate to outline the steps this office has taken to try and obtain a permit once the original,plan had been submitted. 1. Original plan submitted to Town of North Andover for review. March 23,2001 2. First letter of disapproval received from the Town. April 4, 2001. This letter identifies three items that need to be corrected on the plan as well as the need for an additional test pit Oil site: 3. Revised plass submitted to Town with all specified deficiencies corrected. August 16,2001. Sandra Starr indicates that the plans will be reviewed by a different engineer for the;town than the one that did the initial review. -- 4. .New letter listipg 13 new deficiencies that were not listed previously dated August 24,2001. 5. Additional revisions completed and submitted to the Town on March 25,2002. At this time I have taut received an official response from the town.I have spoken to Sandra Starr and sloe his.:indicated she has some reservations regarding the use of the stackable block retaining wall.I submitted a subsequent letter on May 7, 2002 outlining the advantages of the stackable blocks. As of last week I had talked to Sandra Starr but an answer regarding the approval of the plan has not been received. I believe you shout I give Sandra a call and request that a decision be made.If you have any questions please do not hesitate to call. Sincerely Benja Osgood, ,EIT President i B0®EECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)688-1768-(888)359-7645-FAX(978)585-1099 ! SS ��a�z-_ for vehicle equipped with a cargo tank mounted ammable or combustible liquids. ank semi-trailer combination equipped with a cargo art thereof,used for the transportation of flammable Med and used primarily for drawing other vehicles than a part of the weight of the vehicle and load so uid capacity of less than 119 gallons into which at by means of a pump assembly. ,tomobile,van,truck,tractor or semi-trailer,or any echanical power and used upon the highways in the uL I>r transport vehicle,any combustible liquid within ;ported in accordance with the requirements of 527 ,o tank or transport vehicle,any flammable liquid -e with U.S.DOT,Title 49 CFR. tion of flammable or combustible liquids as herein any member of the Department,the head of the fire 527 CMR-78 SEPTIC PLAN SUBMITTAL FORM LOCATION:_ 0 t} rn NEW PLANS: YES $160.00/Plan REVISED PLANS: YES $ 60.00/Plan L� SITE EVALUATION FORMS INCLUDED: YES NO DATE: 0 Z- DESIGN ENGINEER: e DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. i r NEW ENGLAND ENGNIc EERING SERVICES March 25, 2002 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 122 Farnum Street,North Andover, Septic system design Dear Sandra: Enclosed are 5 sets of revised plans for the above referenced property. The issues noted in John Noonan's letter dated August 24, 2001 have been addressed as follows: 1. This issue does not pertain to the plans. 2. General note#6 has been revised. 3. The design data has been revised.. 4. A concrete wall has not been provided. The block wall is an acceptable engineering alternative. Variations from the concrete wall are allowed by DEP(see letter). A note has been added to the plan requesting the local variance. 5. The pump curve has been modified to indicate the system head as well as the pump curve. 6. The d-box placement has been revised. 7. The grades over the leaching area have been shown and a 2% slope has been maintained. 8. The water line has been labeled as a pressure line. 9. The discipline has been added to the stamp and signature. 10. A note has been added regarding the watershed area etc. 11. The slope from the tank to the house has been added. 12. The septic tank detail has been revised to indicate the tees should be no further from the end of the tank than 12". 13. A vent detail has been added. 14. The over dig has been identified on the plans. 15. The bottom of the imperious barrier has been lowed to be 2 feet into the parent material. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, Be C. e-41jr-,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm(Dnetway.com SOWN QF NORTH ANDOVER/ BOAR®OFHEA_LTH Date: August 24, 2001 �AU �'MOP Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/040 122 Farnum Street Assessors Map 107A, Lot 73 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated January 30, 2001, and revised July 24, 2001,by: New England Engineering Services, Inc.. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the following is addressed: 1) Need Board of Health Soil Logs 1 &2 and Perc 2 to complete review. 2 Remove General Note 6. 3) In the design data the 200%of daily flow is indicated as 660 gallons, not 880 gallons. 4) Provide concrete retaining wall NA 9.02 &255 (2)(g). 5) Plot pump discharge vs. head for various flows to determine operating rate. 6) Ensure placement and elevation of D-Box will allow 2-ft. level 232(3)(c). 7) Provide grades over leaching area for 2% slope 240(10). 8) Label water line as either suction or pressure. 9) Write in discipline for registration MGLC.l 12s.81M 10) It is assumed that the leaching facility is within a water supply area, tributary and public well unless otherwise stated. Provide necessary documentation and/or notes 220(4). 11) Provide slope of pipes from house to septic tank and septic tank and pump chamber. 222(2). 12) Inlet and outlet tees should not be more than 12" from face of septic tank. Provide dimensions on detail 227. 13) Provide a vent and end connection detail to ensure no pipe cross flow 241. Land Surveyors rve Civil Engineers Environmental Planners Y g 14) Identify over dig on plan 255(5). 15) Impervious barrier should extend 2 ft. into parent soil. Provide bottom of wall elevations 255. Respectfully, John 1. Noonan, P.L.S.-P.E. G:offi ce/forms/tonarev/1770040 Land Surveyors Civil Engineers Environmental Planners 2 - i f 1 FORM II - SOIL EVALUATOR FOoRM Page 3Location Address or Lot No. • or easonal Hi h Water Table .._ Determination Method Used: inches in observation hole.- m. ❑. Depth observed standing inches Depth weeping from side of observation hole i ❑ Depinches v- Z4 ® Depth to soil mottles = feet ❑ Ground water adjustment - .............. Index well level ... Reading Date .... ....... ... Index Well Number .................. ................... Adjusted ground water level Adjustment factor _Depth of Naturall 0ccurrin Pervious Material II areas ~- least four feet of naturally occurring pervious material exist ink Does at le the area proposed for the soil absorption system. '- observed throughoutPervious material? If not, what is the depth of naturally occurring I Certification I q he soil evaluator examination (date) 1 have passed ion and that he above analysis I certify that on expertise and experience approved by the Departmentwiih the required training, P I a performed by me consistent - was described in 310 CMR 15.017. ate a — Signatur DEP APPROVED FORM 1210'7195 V - k FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole NumberDate:. . Time:. ::. .:..:. Weathe Location (identify on site plan) TzcT L,�>CT ..,...............:........ Land Use ...AP- Slope (%) Surface Stones - Vegetation .. tones - Vegetation : Landform Position on landscape (sketch on the back) Distances from: Open Water Body 'J/"s?� feet Drainage way feet Possible Wet Area feet Property Line .:zd... feet Drinking Water Well feet Other .....:..-7�.:.....:.::.:::.:.:.:.._::. DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) m / / 7 O 2 �L�w S MINIMUM OF 2 H AT EVERY PR75POSED DISPOSAL AREA Parent Material (geologic) DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: s,� Weeping from Pit Face: .r Estimated Seasonal High Ground Water: O DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review AP Deep Hole Number Z Date:W Time:.&-:.4-e> 2_ 4-e> Weather �!2 76: u7 .Qi6.5T..:..:.::....:....._.:.:.:.:::::..::............::...:. ....:...... Location (identify on site plan) Land Use Slope (%) Surface Stones .: ..-:::.:.... Vegetation : 55 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 .....:..:v...... :.:.::::::...::.:.... DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders,Consistency, % Gravel) i� X085 2;'o).5 M11 )LES REQUIRED TT EVERY PROPOSED Ulb L AREA Parent Material (geologic) - �;?G L epthtoBedrock: a Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: ..__ DEP APPROVED FORM-12/07/95 I i FORM 11 - SOIL EVALUATOR FORAZ Page 2of3 Location Address or Lot No. On-site Review Deep Hole Number .3 Date:. .. . � Time:. l Weather '? � .:. .. Location (identify on site plan) J� :... .:L ...... Land Use Slope M .. Surface Stones .:7 ...: . Vegetation . .1�� .:..:. ::... Landform ... .. ..��.��t/.�iD. . .. G /.t/ . .. .. . .... Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet p Y 9 Y Possible Wet Area feet Property Line .2''�.. 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, % Gravel) �,�s.�,��� �•�i� � Cd _ S MINIMUM OF 2 HOLES REQUIRED AT EVERY PRUP AREA Parent Material (geologic)�yl, �^1� LG G DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: _ 2p '� Estimated Seasonal High Ground Water: i I DEP APPROVED FORM-12/07/95 • I i I I I FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date. Commonwealth of Massachusetts SNL -Z Massachusetts SeWggLbiTQsd oil uitability Assessment Performed By: Date: .... ................................................ ........ ................. ................................................................ Witnessed By: .. ...... owner*$Narne. Location A Address,and Lot I V0. -41v TckphorK I Ive. �ew construction 0 Repair Office Review Published Soil Survey Available: No El Yes Soil Map Unit Year Published ............ Publication Scale ....... ..... ..... ....... � ........ ......... 57 Drainage Class 0�zz. ................... Soil Limitations ..... . .... Surficial Geologic Report Available: No KI Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) ...................................................I................................................................ ....... ............. LandforTn ....................................................................................................................................................................... Flood Insurance Rate Map: Above 500 year flood boundary No Dyes Within 500 year flood boundary No Dyes ❑ Within 100 year flood boundary No Dyes ❑ Wetland Area: National Wetland Inventory Map (map unit) ............................................................................. Wetlands Conservancy Program Map (map unit) ......................................................................... Current Water Resource Conditions (USGS): Month ...... Range :Above Normal DNormal E helcw Normal ❑ Other References Reviewed: DEP APPROVED FORM•12/07/95 I . (� lU 1/1 ii I l' t.r- I- �f lL I-- U LIJ UJ ltJ UJ IJ 1 ll.l �i l LI 111 lIJ 0011u®�������r ���� mmm WMmm1111111041 �� ������� sf MM VIIII MM Hill Fm WINNIN Ml M��1�■1�i 3 T , - �------�---�-�- -- -MM ------- _-- --- --��-�_----_-M-_ -_�_-_- MMMM�� MM M MM MM MM M MM M MM MM M MM M MMMMMMM MM immommm ME _ __ z ___ _ ... �: -. � - __ _ �s �.. MMM _______ �MMMMM ������������ ��em MMMM MM r I � 1 r Ei I ' Sf4i C C 1 IN EO _ "OI 1ICIN SEi = Ti Ti NI EA7 I CV IC- T IVi E . z v�,vr -Wind2FMS-Noonan&-McDowell,Inc. oil I E��� �.� r,.. �,,.•.sem �� ...� -• x�F�.. �� akPro�ec 1770_^ of HealUa�sp`tireitad oe ��HlllinTppe Fbced Fee i diltiXrg s 150.00 ® . ToNA I��t�Ma � loritia` r�if�oin, Hlin � n .aL AccoI � r111►n9' s ���P4p4osal�Nmber = -- —— l Goniract N�ih1b`�� ._ ��— � s on �C�ontrDe 8!2012001 t �� WarkStarbpate 8/2012001 Survey engineering services required for plan review. FA Engineer: New England Engineering Services,978.686.1768 - •.?•aa�Applicant KarlArakelian � k Assessors Map 107A,Lot 73 << 122 Farnum Street say 'tt k --S- — — – – --- .r'N i �-.t„• sum � Savec 'FGlose MNN� �� � � o ffixl &A:.r ilY . Project Request Record Town of North Andover J Date: ��' l Client Id:ToNA Card Id:ToNA Client/Company Name.Boar of Health 1J '! + -ar(I rTj pCyChent`fl d!li a' J r t! ! llilttj/r�r t sr��Jjf of �ContactName JMs SandraJStarr '`' r '1 + + Phone 978-'688-9540 "J.- J '�'' JhrJ+Jr3+tr<J `lrl�f 1fi1,f1�; r!Title 1Director ! , z `.." r 1 r,t, !r ! ,tlr Y 7 , i/ /t!Jf rt+lJ t(1 rl !/ft r ( 1 ` Fax: 978-688x9542 ( f to a r r�; r ,,..' -. !I 7!it)i+r 1+ ! ! 1 !Address ' i;! d 127 Charles Street,!°t Email sstarr@townofnorthandover com al j/t rhk �r�r,�r��(tf(r{�t+rlly J+r", r t ! t + , Note$. r l t •r tits + , t/'a�J 1 J r� !l rJ lh,t(�Jrr�(�. h/J +Town + North Andover •' ,l „r ! r '�f3/rf, 11 t t f 4 8` t - , t f 3 - all rr° r F t State tr + MA Zip Code 01845 . , 3, ,,t!a t(t,.! l ft r I,J E!r Jf/le,r, 1 7_•r l / (1(r rr{!rr(( "Other contacts if applicable i n inee Installer r,l �f ryrt!! (a,eH err 1 1 wNamear dv GLr1� ., G , t`G hone :+ rdt 3 !31 fJ 1 � F 1 C , �3AddreSS/.�71/'Jf,q l�raJJtrr�rlt..� ,,�t!Jt j(Ei+ii'!f +! /� r-.., l ...•,,r r r. Email. �f J If I t- „< , It rl 1113 3lil /,ftt„ Notes f Town a ta= I'll,11, : 4,;i,i r,, ns,- f ,t a l!l- i l i + g,{ JH,?),l,:',+`Jt:fil?l rely�l•,da a11li J iJl',(RR1, Estate. Zi .Code. • !� (r, 7111!! 3 r t Y"t iri - - 3+-1 r1 t t. r + '+7 !1< tit J f r rl f 31.u b !t e" , ' 1 !IJ l l t� 4t7 Y u x,111 . (r//rj�(r(((f�r•.1r'. ,Nil �..,�-h (1„ �.l 1.7fi.{F113,i ..i1�(f�1. rffl Jl fH1l t(�tlt Project: Project Id: 1770 Project Title: Town of North Andover.Board of Health (JOB NO) (PROJECT NAME&STREET ADDRESS) Manager:NOW Billing Group: [ Billing Cod :Fixed Fee �© f�JJ'ff�3N1`t,1,,l,f�„llrrre rr l! ;' r Na ! a . , •”3 a. r a-3 pr/! rr f r, ! J 1t(jt(Irlfj Jl� t r}J�r J�i Contract Info �Prolect Description for each billing grouprr 1jBGL' ' f J Applicant �tAss_essors Map !J�"47�"Lot' �7 3 Street /ZVy�� f'i}T e of service" r llffyfJpjr JJ 1/P 1 t ([J t/Jr, �:J'r tr r t i_l j d( 13 r lfllrrJJ � f , tiff+Jtt:1 �Jfrtlr�f(nlfrfi/.,fl,l�r r1 �f1f'tl.i13 •,,f("l r(,+,:r,� �1r�F,� `'Jv•n ! �,-,rl •,,.. ,--r� !.... r,ra,,r+ 1 I I Office/forms/jbrqutona x, COMMONWEALTH OF MASSACHUSETTS 3, EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d 'k -DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional Office JANE SWIFT BOB DURAND Governor Secretary LAUREN A.LISS Commissioner March 6, 2002 Benjamin C. Osgood,Jr.,President New England Engineering Services, Inc. 66 Beechwood Drive North Andover,Massachusetts 01845 RE:Request for Clarification Septic System Downhill Slope Requirement(310 CMR 15.255(2) Dear .Mr. Osgood: On March 5,2002,the Metropolitan Boston-Northeast Regional Office of the Department of Environmental Protection received a letter from you requesting clarification of the requirements of 310 CMR 15.255(2)as it relates to adjustments to the downhill slope distance. Specifically you outline three scenarios and request Department comments on each scenario. 310 CMR 15.225(2) states that for the finished side slope of mounded systems shall not exceed 3:1. That requirement may be relaxed and the side slope requirement adjusted if a suitable impervious barrier is installed. The board of health determines what materials constitute a suitable impervious barrier. If a concrete retaining wall is selected as the impervious barrier,required specifications are provided. Please note that 310 CMR 15.255(2)(g)of the concrete retaining wall specification states"The distance from the wall to the edge of the leaching area should be at least ten feet." Use of the word should denotes this as a guidance or recommendation. This is not a requirement of the Code. Please note further that 310 CMR 15.255(2)(a)through(f)all utilize the word shall and not should. The use of the word shall denotes that those are requirements and not recommendations. Since the acceptability of an impervious barrier is at the discretion of the board of health,the Department will not comment on the three proposals you set forth in your letter. The clarification offered above should address some of your questions in this regard. , J\'department is currently working on an impervious barrier guidance document to assist designers and boards in this matter. No release or effective date has yet been set for this document. The Department trusts that this letter has adequately addressed your request for clarification of this regulation. Local boards of health may have bylaws or regulations that are more restrictive than Title 5, 310 CMR 15.000/ This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. 205A Lowell St. Wilmington,MA 01887 • Phone(978)661-7600 • Fax(978)661-7615 • TTD#(978)661-7679 Zia Printed on Recycled Paper ,_- Benjamin C. Osgood,Jr. Page 2 March 6,2002 Should you have any questions on this matter,please contact Claire A. Golden of my staff at(978) 661-7743. Very truly yours, Madelyn Morris Deputy Regional Director Bureau of Resource Protection MM/CAG/cg \2002clarification\imperviousbarriers l cc: • Sandra Starr,R.S.,Agent,Board of Health,27 Charles Street,North Andover,MA 01845 II ENNIIN INIIIIIIINN1111 IINNIINIIIINNIIIINIIIII � � _:� IIIIIIIIIIIIIIIIIIIIIINIIIII NI �� F � � NIII IN 11111111111111111111 ® � ��- M 11111 -SIN 111111 111111111 � Mill 111I I IIII�N11"111111111 ® `' 1 11111E IN IINIIIIIII�N1111 t 11111/1/ i1®11111 �1 11 11 � z+ �, NIIIE MINIM 11.1111111111 //111111 IINIINIIII1111111111 fa 1111111 111111111111111111111111 � IIn11i111IlIIli1i1�1111111i11i1111 MINE 1N1111111111111 '® r 1111111 I11I1,11111111111 11 11111111 { IIIIIIIII1 11111 Illlllllllllllll � }' a, : � , IllllIll1111 IIIIe�1�111�1 �� 111111111�i11111I1i®1®111�1�i111 11 LL � � Ax 111111111111111111011111111111,111111. r IIIININIIIIINIIIIIfli1i1Ii Mill 1 111111111®11�111111111i1L MINE 1111111111111111111111 ®® n111�111®I�IINII 11111111111 111 111111111 Ill NIIONIIINIIIIII 0 IW�1 i ~ t I Nf mmmmm INIVINNINNINEmommoompn l NINNINR'-�i �lORl MUN!!!!!!INNEWIN !!! t V m r,_IEwel lr �yl�r� mmmitvrgilt-,]Ml E. 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SEPTIC PLAN SUBMITTAL FORM LOCATION: j Z 2 6?anur" .S41 NEW PLANS: YES $160.00/Plan REVISED PLANS: CYES $ 60.00/Plan L — SITE EVALUATION FORMS INCLUDED: YES NO DATE: 011(.101 DESIGN ENGINEER: DATE TO CONSULTANT: When,the;submission is all in place, route to the Health Secretary. 9 200/ NEW ENGLAND ENGINEERING SERVICES INC August 16, 2001 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 122 Farnum Street,North Andover, Septic system design Dear Sandra: Enclosed are revised plans for the above referenced property. These plans have been revised to include an additional deep hole test in the reserve area and the dimension from the septic tank to the wetland. In addition a local variance has been added to the plan for the reduction in the distance between the wetland and the septic tank from the 75 feet required to 55 feet. Also enclosed is a check in the amount of 60.00 dollars for the approval of revised plans fee. If you have any questions please do not hesitate to contact this office. Sincerely, Benjar C. Osgood, ,EIT President OF 1*4 BOB°P0 OF A 19 2001 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 vt 91,- , A 7- 0C10N G0L vVI I N=- i —I I 2 ION I = 7-OT-1 Om `-C -TEST. i WE CI U =.i — — .i I�c-Z, T INI` =, _ I I I IVB C ,=• I _ w //hA/ s \\�� 6 CEJ'` I �IVI- r. _ IV=��— I.) � i L.r. �U v S7 - d Town of North Andover µORT"qti Q tLED ° Office of the Health Department 3� B`s'' Community Development and Services Division William J.ScottDivision Director 27 Charles Street SSArc' U�sy North Andover,Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 April 4, 2001 Ben Osgood, Jr. New England Engineering 60 Beechwood Drive No. Andover, MA 01845 Re: 122 Farnum Street Dear Ben: This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as followed: • Distances from the pump chamber and septic tank to wetlands is not shown as required by NA 8.03 a-c. • Septic tank appears to be less than 75 feet from wetland. (CMR 15.211) • Only one deep observation hole provided in the reserve area. (CMR 15.102(2) If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Arakelian file BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 JisGpP /ether— March 28, 2001 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 RE: Title V review for SDS Upgrade at 122 Farnum Street Dear Sandra, Enclosed find our review of the"Checklist for North Andover Septic System Plans" for the proposed septic system upgrade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. ❑ Distances from the pump chamber and septic tank to wetlands is not shown as required by NA 8.03 a-c. ❑ Septic tank appears to be less than 75 feet from wetland. (CMR 15.211) ❑ Only one deep observation hole provided in the reserve area. (CMR 15.102(2)) If you have any questions or comments please feel free to contact me. VD. P RT ENGINEERING bfi,3G Civil Engineers& Land Surveyors " One Harris Street �pR 2 200! Newburyport,MA ; 01950 (978)465-8594 \\Server P\NABH\P2884\FARNUM ST 122.DOC Mar-29-01 04: 54P Paul D. Turbide, PE/PLS 978-465-0313 P-03 March 28, 2001 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover,MA 01845 RE: Title V review for SDS Upgrade at 122 Farnum Street Dear Sandra, Enclosed find our review of the"Checklist for North Andover Septic System Plans"for the proposed septic system upgrade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. o Distances from the pump chamber and septic tank to wetlands is not shown as required by NA 8.03 a-c. u Septic tank appears to be less than 75 feet from wetland. (CMR 15.211) o Only one deep observation hole provided in the reserve area. (CMR 15.102(2)) If you have any questions or comments please feel free to contact me. Sincerely D. Tu P FWh0RT ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 \\Server P\NABH\P2884\FARN[JM ST 122.DOC SEPTIC PLAN SUBMITTAL FORM LOCATION: 12 2 Fri 2 nsy n^ -5 NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: NO DATE: 3)2 A DESIGN ENGINEER: c. qNg-_, L-,v C 1.� L at� G_ DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. WN OF BOARD GF 23 ? i NEW ENGLAND ENGINEERING SERVICES INC March 23, 2001 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01 845 i Re: 122 Farnum Street,North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of design plans, 1 with original signature. 2. Submittal form for approval. 3. Check to cover the fee. 4. Soil evaluator sheets. If you have any questions please do not hesitate to contact this office. Sincerely, Benjin . Osgoo r., EIT _..�� "ta - .=- President ti�, �Q 23 1; E l 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ON-t"eo 'b-1 - � '-.2eee)16 0 n o * APPLICATION FOR SITE TESTING/INSPECTION rED -1 �9SSACHUSE�� r Applicant ME ADDRESS TELEPHONE Site Location r--Azt� Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time it, zz . 2-;D DD /3 /Z�Z> h� CHAIRMAN,BOARD OF HEALTH Fee h Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Address 1 A a F=A 2IVv vA ST, Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes T action Document/ document/ Num. Action Department Board of Appeals -Board of Health — Planning Board — Conservation Commission — Building Departmer�fi Town of North Andover, Massachusetts Form No. 1 NORTH A. BOARD OF HEALTH Q* L �/w/ O `w `�9- 0 APPLICATION FOR SITE TESTING/INSPECTION ��SSACHl15���y Applicant %frr,L�'.( (r-� �� ' (�L��-►��% NAME ADDRESS � TELEPHONE Site Location 1A 01 �/ I Engineer NAME I I ADDRESS /f j TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee 1-% Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. a BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 ` APPLICATION FOR SOIL TESTS ` DATE: 2 © 0. LOCATIO OF SOIL TESTS: _J2 rip no M ST c£- /L "y.- -o Assessor's map & parcel number: &27 /- 7 0WNER: Y, w a-LaN TEL. NO.: ADDRESS: ,v_ A&)D ENGINEER:Ow ELj&,t-Aivp Fyr> vv4TEL. NO.: 273- 68 6- 1-7 6 S CERTIFIED SOIL EVALUATOR: R tc F iQ-o C ' 4rj<—A 6P-1 Avu-'N 6 Os 6-0 Intended use of land: residential subdivision, single family home, commercial Repair testing ,./^ Undeveloped lot testing N. A. Conservation Commission Approval: 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$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil;Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two_weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100) shall be submitted to % the Board of Health showing the location of all tests (including aborted tests). 7. :Within 60 days of testing soil evaluation forms shall be submitted. ��N ! 2 , (1/¢LLf� W �(VZl�3 ZZ1 o I, b `76 ISI BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: Z o 0 LOCATIO OF SOIL TESTS: � ),2Z rg2nv m STIe'c j—j- A_ u� Assessor's map & parcel number: /r_'7 fir -74 OWNER: TEL. NO.: ADDRESS: i z 2 � 2✓i�•� SC tLc7' tet/_ rin;� ENGINEER:Ak'(,V (sl-19N� Fly(-U1arL/'IrTEL. NO.: !27,?- 686- 1-7 (D5 CERTIFIED SOIL EVALUATOR: R Lc tg 20 �<� C. �'4D O's 6-0 zn Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped!lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of2$ 75.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soils Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. r 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. 1'. 12 ----------- AJ --AJ CZ, �12t i i X22 �(�-RNvM si� t H°RT►t Town Of North Andover Community Development & Services William J. Scott Director 27 Charles Street (978) 688-9531 North Andover, Massachusetts 01845 ,SS/1CHU5et Fax 978-688-9542 June 5 2000 Board of Appeals Karl Arakelian (978) 688-9541 122 Farnum Street North Andover, MA 01845 Building Department Y PP RE: Letter of Noncompliance -Notice of Septic System Failure (978) 688-9545 Conservation Department Dear Mr. Arakelian: (978) 688-9530 The North Andover Health Department has received and reviewed the Title 5 Health Inspection Report that was generated from the inspection of your septic system Department on May 20, 2000. Your inspector has determined that your septic system is (978)688-9540 failing to protect public health or the environment according to Title 5 of the State Sanitary Code. You are hereby required to retain the services of a Public Health Massachusetts licensed professional engineer(P.E.)or Massachusetts registered Nurse sanitatarian(R.S.) to design a new septic system in compliance with Title 5 and (978) 688-9543 North Andover Board of Health regulations. Please be advised that because there is effluent ponding on the surface of the ground, you have one month from the Planning date of this letter to begin the necessary upgrade work. Department (978) 688-9535 It is recommended that you hire a septic hauler to periodically pump your septic tank until such time as a repair can be completed. The Board thanks you for your willingness to help protect the environment, the ground water and public health. Please do not hesitate to call the Health Department office at the number above if you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. Health Director i Encl. P.E. list Hauler list Financial assistance info. Brochure Cc: File COMMONWFALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WIIJTER STREET,BOSTON MA 02108 (617)292-5500 TRUDY COXE 9 ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Comminioner SUBSURFACE SEWAGE DISPOSAL SYSTEiN MOWFIIM FORM PART A CERTFICATION Property Address:122 Farnum Street,North Andover Name of Owner:Karl Arakelian Address of Owner:122 Famum Street,North Andover,MA.01845 Date of Inspection:5/20/2000 Name of Inspector:Neil J.Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number.(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes Conditionally Passes Needs rth Evaluation By the Local Approving Authority F 's _ Inspector's Signature: Date:5/20/2000 The System Inspector shfthsystem copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspectionis 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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Printed on Recycled Paper _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 122 Farnum Street,North Andover Owner:Arakelian Date of Inspection:5/20/2000 INSPECTION SUMMARY: Check A, B, C,or D: A.SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B.SYSTEM CONDITIONALLY PASSES: One or move 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. Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination in all instances.If"not determined",explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9098 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:122 Farnum Street,North Andover Owner.Arakelian Date of Inspection:5/20/2000 C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a sail marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 sal absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 122 Farnum Street,North Andover Owner:Arakelian Date of Inspection:5/20/200- D.SYSTEM FAILS: You must indicate either"Yes"or"No to each of the following: X I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. _X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool. _X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. _X_ Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped— X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. _X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone I of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. !E.LARGE SYSTEM FAILS- You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 912/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 122 Famum Street,North Andover Owner:Arakelian Date of Inspection:5/20/2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No _X_ Pumping information was provided by the owner, occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _X As built plans have been obtained and examined.Note if they are not available with NIA _X The facility or dwelling was inspected for signs of sewage back-up. _X_ The system does not receive non-sanitary or industrial waste flow.The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. _X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _X Existing information.For example,Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [I 5.302(3)(b)] _X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 122 Farnum Street,North Andover Owner:Arakellan Date of Inspection:5/2012000 FLOW CONDITIONS RESIDENTIAL: Design flow_N/A_ .g.p.d./bedroom. Number of bedrooms(design):_N/A_ Number of bedrooms(actual- 3-Total DESIGN flow_N/A_ Number of current residents:_3 Garbage grinder(yes or no):_Yes_ Laundry(separate system)(yes or no):_No If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes or no):_No_ Water meter readings.N/A Sump'Pump(yes or no):_Yes_ Last date of occupancy: Current COMMERCIALII NDUSTRIAL: Type of establishment: Design flow: 9L(Based on 15.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of information:Pumped one month ago,owner. System pumped as part of inspection:(yes or no)_No_ If yes,volume pumped:_gallons Reason for pumping: TYPE OF SYSTEM _X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed if known)and source of information:15 years old.7/22/1985 As built plan. P � ( Sewage odors detected when arriving at the site:(yes or no)_Yes_ revised 9/2/98 Page 6 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 122 Farnum Street,North Andover Owner:Arakelian Date of Inspection:5/20/2000 BUILDING SEWER:X (Locate on site plan) Depth below grade:24" Material of construction: X cast iron_ 40 PVC _ other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"Cast iron thru wall.3"Cast iron in house. SEPTIC TANK:X (locate on site plan) Depth below grade: 17 Material of construction: X concrete_metal_Fiberglass_Polyethylene_other(explain) If tank is metal,list age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions:7'x 5'x 4' Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:Over baffle. Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:Over baffle. Distance from bottom of scum to bottom of outlet tee or baffle:Over baffle. How dimensions were determined:Measure scum&sludge in tank to baffle length. Comments:Inlet&outlet baffles ok.Liquid level above outlet invert.No evidence of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:122 Farnum Street,North Andover Owner:Arakelian Date of Inspection:5/20/2000 TIGHT OR HOLDING TANK:_None (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Material of construction: concrete_metal_Fiberglass Polyethylene_other(explain) Dimensions: Capacity:_ allons Design flow:_galions/day Alarm present Alarm level: Alarm in working order:Yes_No Date of previous pumping: Comments: DISTRIBUTION BOX.:_Xi (locate on site plan) Depth of liquid level above outlet invert:8" Comments:Unable to exposed d-box due to effluent above d-box.Ground around d-box was saturated with effleunt. PUMP CHAMBER:—None,gravity system_ (locate on site plan) Pumps in working order.(Yes or No) Alarms in working order(Yes or No) Comments: Revised 912198 Page 8 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)) Property Address: 122 Farnum Street,North Andover Owner:Arakelian Date of Inspection:5/20/2000 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions:20'x 30'leach field. overflow cesspool,number: Altemative system: Name of Technology: Comments:Soil mushy over leach area.Evidence of hydraulic failure,water above d-box. CESSPOOLS:None (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(cesspool must be pumped as part of inspection) Comments: PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:122 Famum Street,North Andover Owner.Arakelian Date of Inspection:5/20/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Driveway House Water Meter A A to Tank=24' Porch A to D-box=39' B Septic Tank B to Tank= 17'6" B to D-box=22' revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 122 Farnum Street,North Andover Owner:Arakelian Date of Inspection:5/20/2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 6" Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _X Observed Site(Abutting property,observation hole,basement sump etc.) —X—Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) Test hole dug in low lying area in rear yard. revised 912/98, Page 11 of 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover,Mass. 01810 Title 5 Inspection Report Property Address: 122 Farnum Street, North Andover Owner: Arakelian Date of Inspection: 5/20/2000 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. r it J. ateson Bateson Enterprises, Inc. UZ)/11/�'Uuu lo:Ji :DU0,J/,Jbbif S1tlVAKI/ANUUVtK PAGE ui Nor ANL61/el- 2-6. 4. S SEPTIC 'l9M SIItVI )ZO am St. 47 jWjp,QAD grpj= CE Na A ne�a✓.r B � M 81835 U..ul L i6/-pp N 978-372-7471 mom Y RzpatT FOR Taw CFact � LESS 6rcb�c. mod 31016 93 �$'herulaGb y wryS l6�d i lam 6eq;� P Ibov �� l 97 46rlt tr /4,7e Par - /Qdo '! Yf o? AI l D al gel �6dp - ,`jjttF , N ENTERPRISES INC.�� ' ting —Water&.Sewer Lines — Rentals CONSULTANT } 111 Argilla Road 1� Andover, Massachusetts o i 1 10 (617) 475.1474 !j Town of No. Andover July 26, 1985 i' Boani of Health Dear Sir--, II Flan as innt,-alled flor ,4r 122 Farnham Street home. Leaching; bed replaced with gray earth removed & replaced with washed sand. Leaching bed is 20' X 30' with 3 lines & a new D box & pipe to tank. J it <1 ;. f � i r 1 ' i ! t 37 /- 40-1 r ' r a Iti " TIGER ENVIRONMENTAL ,. Tp�I�`I�GF P�c;Ttf A[�eDVE4�/ ENGINEERING . A �O � 969 WASHINGTON STREET BRAINTREE, MA 021844X997 617-849-0088. , �I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT/ N"FO PART A °r i CERTIFICATION :::Address of Property: /Z Address of Owner: (if different) Town: Al. ANJb4VO/8 4S Owner's Name: RC)6 r,z: A a)G-WAt/L7'"" Date-of Inspection: .;U q El Voluntary Assessment Name of Inspector: G l Add f M. -:D�Z.-aU`TW Q (Not Reported) Name CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes Needs Further Evaluation By The Local Approving Authority _ Fails. Inspector's Signature: Date: �r� ""9 The system inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D A] SYSTEM PASSES: X I have not.found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired.The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not). f NO The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. 1 TIGER ENVIRO'N"'MENTAL {ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 ,_. K 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: • Owner: Z) 1AIAtltom`" w : ` Date of Inspection: B] SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due.to broken or obstructed. pipe(s)or due to a broken,settled,or uneven distribution box.The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced k obstruction is removed , distribution box is levelled or replaced ' The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if with approval of the Board of Health p ( Pp ) broken pipe(s) are placed obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ' n Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. f m1) .SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM.IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IFAPPROPRIATE) ' DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH z' AND SAFETY AND THE ENVIRONMENT: The system has aseptic tank and soil absorption system and is within 100 feet of a surface water supply or tributary to a surface water supply. i The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well: The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ; The system has,a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from'a private water supply well, unless a well wafer analysis for coliform bacteria and volatile.'organic compounds indicates that the well is free from pollution from that facility and the presence of ' ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 2 . TIGER ENVIRO"MMI ENTAL ry ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PARTA � CERTIFICATION(continued) } Property Address: ' 2Z rARAI(JA1 Sr Al. 0t+& Owner: Date of Inspection: D] SYSTEM FAILS: r I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to.correct the failure. Backup of sewage into facility or system component due to an 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 outle invert due to an overloaded or clogged SAS or cesspool ' Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year N T due to clogged or obstructed pipe(s). Number of times pumped Any portion of the soil absorption system, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water y supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. In ,a Any portion of a cesspool or privy is within 50 feet of a private water supply well. F 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. a E] LARGE SYSTEM FAILS: The following.criteria apply to large system s, addition to the criteria above `The design flow of system is 10,000 gpd or greater(large system)and the system is a signiflcant'tfireat to public" health and safety and the environment because one or more of the following conditions exist: The system is within 400 feet of a surface drinking water supply. The system is within 200 feet of a tributary to a suface drinking water supply. The system is located in a nitrogen sensitive area(Interim Wellhead Protection Area{IWPA}or a mapped Zone II of a public water supply well). The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. 4 The intent of 310 CMR 15.302 is to provide reasonable guidelines,for the inspection of existing systems in as,'--hon-intrusive a' manner as is possible to avoid damage to the system and any unnecessary disturbance of the surrounding soil area which is related to the treatment process. The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner.The inspection criteria are intended to allow for timely inspection to avoid undue delay in the transfer of property. ; x�e I understand that this report does not constitute a warranty or guarantee bf future operation. Client or Representative Date :: 3 � � eau:t-r � r•'+i..�•�> --�w,•:,� qr,.�:,,:g i;,; ; � r, ,�;r, r:,_eY,: ,�.,,.�y,�, u r t t r 7-TIGER ENVIRONMENTAL t . ENGINEERING r 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST�:7 Property Address: ' �/ZZ, ST. N/. Owner: ` Date of Inspection: y p f Check if the following have been done: Pumping information was requested of th owner, ccaaaac�-�sre#- dfi�. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Largevolumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. ' ` The facility or dwelling was inspected for signs,of sewage.back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout: All system components, excluding the soil absorption system, have been located on the site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of,sludge,depth of scum. t�on,s'st2m o.n,the..isite-has beemb ry - The size and`locatior�-df'theoil.ebsdrp y etermied°based on existing n ormatio or ;. ..� ; The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of subsurface disposal system. y k 4. Y-�..:r � � k RIb;X R.n4irvWMn 1"'�.''fy,rajr' 1 T ' � .. M' "'k. g "Ir',4f;.•w If` "f fG.y. CIrR i. , v. ,. 1,, , _.... :,. _ -.... off! .;"�. :• t TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-84970088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ` /ZZh?/tlrJM .S'i"=. /V- { /�/ i Owner: CAM Ua— Date of Inspection: &-.3047 FLOW RESIDENTIAL: Design flow: VW361W(6alIons (Ab -Z)C-Sr6At/ 1d&) Number of bedrooms: Number of current residents: Garbage grinder: (yes or no) Laundry connected to system (yes or no) ,, Seasonal use: (yes or no) Water eter readings, if available: (L`i*�, 3 b� 6 Q5 Z Oji S ZOQ) I 1 goo3&9=600 .5 • � 3 10119 Last 6ate of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment; " Design flow: gallons/day Grease trap present: (yes or no) Industrial waste holding tank present: (yes or no) .Non-sanitary waste discharged to the Title 5 system: (yes or no) +" 1Neter meter readings, if available: Last date.of occupancy: ` OTHER: (Describe) p Last.date of occupancy: , ya GENERAL INFORMATION p PUMPING RECORDS and source of information: GA5T/"urrlAZ oa-'& f�2 CwAlg2 /��royS 11'un�666 t /6*a { System pumped as part of inspection: (yes or no) �o .: If yes; volume pumped: gallons Reason for pumping: x TYPE OF SYSTEM: F: X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy /l a Shared system (yes or no) (if yes, attach previous records;if any) Other(explain) "f V,..0 r APPROXIMATE AGE of all components,date installed(if known) andsourceof information: SE�'rc.-7Axl� t 30 YA4s - K i 7� L. �Gf � 4 lZ Y2S 2 c9u IudL °�, AuDS-Zvi GT �s� PCs 8� 5 '%,S.J)'I:"..3' .'.�y,.,...'^s1'N">""t',�r:,;;;-"'1"r'*.+��}cry'r4r�'^.,-,.s....wsl:Y.;;,,•.^.:r-'�>rsup,4.....,a.,.yL'_rv+{�/e,Ma'�is.�,h'•;�.'"�'Lf"*«^`D T.t..aty'ffi trra ;:7� k. �..r+'<A�,v.dr , n..;q•_y'�aF ..�;r<b.. y . o o TIGER ENVIRNTAL ENGINEERING r 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION dontinued) Property Address: /2-2- )"&NUN! 5T. . A *Z)0Aw, YA Owner: -,---D6A1AL'L4— Date of Inspection: 50—q7 Sewage odors detected when arriving at the sfte:'(yes or no) SEPTIC TANK: (locate on site plan) a ,r Depth below grade: Material of construction: a( concrete metal FRP .: other(explain) IN' Dimensions: ,t - 00r " � : lr Sludge depth: &)OMr Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:- N6AW Distance from top of scum to top of outlet tee or baffler '" r Distance from bottom of scum to bottom of outlet tee or baffle: �,,,Comments: 1 {,recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, ' structural integrity, evidence of leakage, etc.) AI© �UMPl nl rz- RECI014 ?�ln 6' " /N 4V7 Live Et/W N Vc '`. No GREASE TRAP: .r,' t. � i '...� .-y t fit'•. , �,•,v�..X::r.•rt:}4 �3^,y ..+1• _ j (locate on site plan) Depth below grade: Material of construction: concrete metal FRP 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: Comments:. (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) -A t !; 6 w g ►f ' TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 rs, SUBSURFACE SEWAGE DISPOSAL SY.,STEM INSPECTION FORM 't PART C SYSTEM INFORMATION%{Continued) Property Address: ,RA&M S7., Aonlex, /VA Owner: ',-be fAJt7- Fa` Date of Inspection: 6 -30IN '97 4 TIGHT OR HOLDING TANK: .(locate on site plan) Depth below grade: Material of construction: concrete metal FRP other(explain) Dimensions: a Capacity: gallons Design flow: gallons/day Alarm level; Comments: (condition of inlet.tee, condition of alarm and float switches, etc.) ` DISTRIBUTION BOX: ES LV/7f{ j 07177.=—,S (locate on site plan) Depth of li uid level above outlet invert �� '� p q / °4 Comments: (note if level and distribution is equal evidence of solids carry over, evidence of leakage into or out of box, etc.) OF So u 7DcS LEA o Co-, 7— , PUMP CHAMBER: NO y (locate on site plan) Pumps ih working order: (yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) 'i 7 ��,,.x;y,.:w5t*^cs:x.::n�'.Ni,'.,'*'`+''A,�,3'�»$�I�,P(in�o:8'a���ir" .w+5r a _.3q,'"'.'..:fir,-- y.�+4,th}�" � •", sL:r,�a•;r-s._ry�..<.,s:.yr;�,- ,i�.,_i ,.�tti, .sy c.�.o•,.y,:.s:.��.s_ .r • ., ...-. . 4 NIGER ENVIROW ENTAL ENGINEERING 969 WASHINGTON STREET ' BRAINTREE, MA 02184 617-849-0088 = I . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C f SYSTEM INFORMATION(continued) Property Address: 122, MVM S'T Al— AOoVaz,AIA �. . Owner: Date of Inspection: r SOIL:ABSORPTION SYSTEM-'(SAS): � (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods)" If not determined to be present, explain: r k `. Type. ur 2w Leaching pits, number: t Leaching chambers,number: Leaching-,gal leries, number: � : L- Leaching trenches, number, length: nr7-6P2r5ES Id Leaching fields, number, dimensions: go'x 3b' Rea `�.. Overflow cesspool, number: A m i "A:° J, Comment's: (note condition of soil,.signs of hydraulic failure, level of ponding, condition of vegetation, etc.) r �5orc. over -E3olc /s b2 Rn SA�v ul EAr 8111 OIs ESSPOOLS: / (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: , + Depth of solids layer: I Depth ofkscum layer; Dimensions of cesspool + r -- .g 'I. f'r-�; '"•''M .y.-:r :., ^;.C>y"y, v `;': ns�K,M„'sib . Materials of construction. Indication of groundwater: ` Inflow(cesspool must be pumped as part of inspection) r Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) f i PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) i 8 TiiK'gt.4��'. 4. • TIGER ENVIR�i�111` ENT/AL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 . 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _ SYSTEM INFORMATION, (continued) • i Property Address: Owner: QDedhoL ' Date of Inspection: 6.w':3Q Pt_ SKETCH OF SEWAGE-`DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks .Locate all-wells within 100' Fko . Q. . . F,. A . 61 , .. As 14 . 1000 6ALf> sE S \ •AD • a'�`: . . ` �VJtG 10'rBEc..s6�P�E 5 . C3IT 22� . , < < / P '• • • +., , .;ti • :1 ;•, ti _,y�..YS'f ..�. - Yi. E h..i�:1' • -..' �" +..*�.,.x � •a•;N • �'��ti• • ... : i . . . . . . .>A, .AREA . . ,'`� otrrcer �iS~v?ie�rronl . GZoIx. �.v/. . .�, ;3ak 24,E L. &-fte , FES CSEEPGS SN . I:o� . .� . . . . . . . . . . . . . . . . . . . . . . 1�oW Pt,N&• ARES , . . DEPTH TO GROUNDWATER: k Depth to groundwater: feet Method of de4e*RiR or pproximati SLENAMOM ! O'sRAmEAM,Ff =_Rev Ce BeTWeEU Gsi�E AT}f'f SflS fn2.EA A&z> LOW L&16 ,AREA AT E&IC 5,fts ,OF EP4i'ER n --30 f40 68-woDtrJA't M :B Q_.)c1J`C" , 9 J V\J r ll) 111 c. 111 lu l 11, 1 � I I 10 t„ I `v II IL rAIII u �S III C) Q III <I" Q_ c,) cll ill .t. fl (J I, `t I.1 111 LJJ U_J UJ I11 ll.l �, 11.1 111 IIJ f-� —) IT] (11 13_ trl I— I— I— I U I— 7- 1—