HomeMy WebLinkAboutMiscellaneous - 123 MARIAN DRIVE 4/30/2018 (2) 123 MARIAN DRIVE
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MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS
60 PARK STREET ANDOVER, MASSACHUSETTS 01810 4 TEL (617) 475-3553, 3MSn1
Commonwealth of Massachusetts
RECEIVED
Tithe 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments (�I�:x i Z 0 014
123 Marian Drive wr F
Property Address a..p
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:
When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Neil J. Bateson
cursor-do not Name of Inspector
use the return
key. Bateson Enterprises Inc.
Company Name
111 Argilla Road
Company Address
Andover MA 01810
City1rown State Zip Code
978-4754786 S115
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Fu her Evaluation by the Local Approving Authority
e
10/13/2014
Insp4tog S nature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
, a
Commonwealth of Massachusetts
uvTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for
North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber um
ps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further rther evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owners Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the.SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes o N
❑ N Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
i
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
s 123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is North Andover MA 01845 10/13/2014
required for
every page. CityrTown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
9p 9p
design flow of 10 000 d to 15 000 d.
9 � �
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
i
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Tithe 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
'
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
i
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® El available
as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
II
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected?
❑ Yes ❑ No
Seasonaluse?
❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)): Yes
Detail:
Sump pump?
® Yes ❑ No
Last date of occupancy: Current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?
❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Pumped 2014, owner
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? Measured tank/
Reason for pumping:
Inspect tank&tees
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection re
cords, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name g
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
8 years old, 10/21/2006, as built plan
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1.8
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
4" PVC through wall, 3" PVC in house, no leaks visible
Septic Tank(locate on site plan):
Depth below grade: •8
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 10'x 5'x 4'
Sludge depth: 3..
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Manan Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top 9
of sludge to bottom of outlet tee or baffle
30"
i
3"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
8"
Distance from bottom of scum to bottom of outlet tee or baffle
12"
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumped septic tank. Inlet tee ok. Outlet tee ok. Outlet filter clogged,clean same. Depth of liquid at
outlet invert. No evidence of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of
construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
I
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
'L Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is North Andover MA 01845 10/13/2014
required for
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r ' 123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box level &distribution equal. No evidence of leakage. Evidence of light carryover.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 42
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Soil ok. Vegetation ok. No sign of ponding to surface.Six rows of seven chambers per row
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y 123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is North Andover MA 01845 10/13/2014
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
.0
A4�
v Sq to,l
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123 Marian Drive
Property Address
Richard Cavanaugh
Owner Owners Name
information is
required for North Andover MA 01845 10/13/2014
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 4
feet
Please indicate all methods used to determine the high ground water elevation:
z Obtained from system design plans on record
If checked, date of design plan reviewed: 2/9/2006
Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Design plan
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe howou established the high gh ground water elevation:
As per test pit data on design plan.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
123Marian Drive
Property Address
Richard Cavanaugh
Owner Owner's Name
information is North Andover MA 01845 10/13/2014
required for
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
: Commonwealth of Massachusetts
I D2 City/Town of
System Pumping.Record
Form 4
DEP has provided this form for use-by local Boards of Health. Other forms may be'used, but the
information must be substantially the same as that provided here. Before using-this form, check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
PP 9 tY
A. Facility. Information
1. System Location: Left/Right front of house, Left i ht rear�housLeft/right side of house, Left/
Right side of building, Left/Right front of building, Le /Right rear of building, Under deck
Address
CWrown state Zip Code
2. System Owner.
Name
Address(if different from location)
Citylrown State l'Zip Code ;
Telephone Number
B. Pumping Record
1. Date of Pumping Data 2. Quantity Pumped:
Gallons ;
3. Type of system: ❑ Cesspool(s) 9-8liptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? �C] If yes, was it cleaned? P-Y9s ❑ Na
' 5. Condition of m:
C�
6: System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Lo re contents were disposed:
O- Lowell Waste Water
V
41
Houle
Sign"
Date
S
t5form4.dw 06M System Pumping Record•Pa9e 1 of 1
Summary Record Card generated on 10/9/2014 2:29:37 PM by Karen Hanlon Page 1
' , a Town of North Andover
Tax Map # 210-107.C-0049-0000.0
Parcel Id 18335
123 MARIAN DRIVE
CAVANAUGH, RICHARD
123 MARIAN DRIVE
N. ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Zoning2 1 Residential Zoning3 1 Residential
Size Total 1.08 Acres
FY 2015
UB`Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
CAVANAUGH, RICHARD Payor
123 MARIAN DRIVE
N ANDOVER, MA
01845
UB Account:Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 13646.0-123 MARIAN DRIVE Last Billing Date 8/4/2014
1090324 01 Cycle 01 Active
UB Services Maint.
Account No. 1090324
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 45.60 /1
UB Meter Maintenance
Account No. 1090324
Serial No Status Location Brand Type Size YTD Cons
16337172 a Active 00 b Badger w Water 0.63 0.63 322
Date Reading Code Consumption Posted Date Variance
7/23/2014 811 a Actual 12 8/13/2014 -5%
4/23/2014 799 a Actual 12 5/15/2014 10%
1/27/2014 787 aActual 12 2/14/2014 -10%
10/24/2013 775 aActual 13 11/18/2013 4%
7/23/2013 762 a Actual 12 8/15/2013 2%
4/25/2013 750 a Actual 12 5/20/2013 -6%
1/24/2013 738 aActual 13 2/13/2013 -36%
10/23/2012 725 aActual 20 11/9/2012 80%
7/23/2012 705 a Actual 11 8/14/2012 -21%
4/23/2012 694 a Actual 14 5/9/2012 12%
1/23/2012 680 a Actual 13 2/13/2012 14%
10/20/2011 667 aActual 11 11/14/2011 -3%
7/20/2011 656 a Actual 11 8/15/2011 -23%
4/22/2011 645 a Actual 14 5/16/2011 19%
1/25/2011 631 aActual 13 2/11/2011 -23%
10/21/2010 618 aActual 16 11/12/2010 45%
7/22/2010 602 a Actual 11 8/16/2010 -1%
4/22/2010 591 a Actual 11 5/12/2010 1%
1/22/2010 580 aActual 11 2/12/2010 -8%
10/23/2009 569 aActual 12 11/11/2009 5%
7/24/2009. 557 a Actual 11 8/12/2009 7%
4/27/2009 546 a Actual 11 5/13/2009 -10%
1/23/2009 535 aActual 12 2/10/2009 -45%
10/23/2008 523 a Actual 22 11/12/2008 77%
7/22/2008 501 a Actual 12 8/15/2008 4%
4/23/2008 489 a Actual 11 5/19/2008 2%
1/28/2008 478 aActual 12 2/19/2008 -36%
10/24/2007 466 a Actual 19 11/16/2007 5%
7/19/2007 447 a Actual 17 8/15/2007 66%
t%ORT ,
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PUBLIC HEALTH DEPARTMENT
Community Development Division
UP9r-j 4 -TE-IfCA� T (1-,' -14,(1).(,--1-ASCE
As of-.
June 26, 2007
h%s i.S to certify that the indi-oidyaf subsurface disposaCsystem. received a
SAV 5TA(-,'77kYI.9VSCJY-CTIGI V c f the:
Comp to Septic System Xepair
(By
. fe ezCC�y
At:
Wap 107.C- P'arcef 49
.worth Andover, 9W X 0184.5
`I(ae Issuance f this cert f:cate chaff not 6e construed as a guarantee that the system, wiff
f nctilon sati factorify.
Wit__
y
T'u.66c Jfeaft6 Director
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 478.688.8476 Web www.townofnorthandover.com
NORTIf
ssacweE{
DI
PUBLIC HEALTH DEPARTMENT
Community Development Division 7
[Z--
SEPTIC
L)OVER
TOWN OF NORTH ANDOVER ENT
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed;(,repaired;
e '
By: i�l i I�.E ISE i L-L�'�
(Print Name)
Located at:
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plaA,originally dated
71a 7-0C� and last revised an �
,with a design flow of
L4 4eg gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local
regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on
the As-built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: 10-1-Orp
Engineer Rep ntative(Signature)
21 We (214 F-"15,N6
And—Print Name
Final Construction Inspection Date: p0�Co
Engineer Representative(Signature)
at
And—Print Name
Installer: LP OA (Signature) Date:
6c
VLADIMIR L. �G
NE HEN K And—Print Name
m
Enginer: �% ignature) Date: Ib..Z`(
No.39840/
SSioSAt_E
And—Print Name
1600 Osgood Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
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SSACHUS�
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 123 Marian Drive MAP: 101C LOT: 49
INSTALLER: F.P. Rieley and Sons
DESIGNER: Merrimack Engineering
PLAN DATE:2-20-06
BOH APPROVAL DATE ON PLAN: 7-20-06
INSPECTIONS
TANK INSPECTION: IO_ �-b�
DATE OF BED BOTTOM INSPECTION)
DATE OF FINAL CONSTRUCTION INSPECTION: 10-16-06
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
Comments:
SEPTIC TANK
Bottom of tank hole has 6" stone base
® Weep hole plugged
® 1500 gallon tank has been installed
H-10 loading Monolithic construction
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
® Inlet tee installed, centered under access port
® Outlet tee (gas baffle or effluent filter) installed,
centered under access port
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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�SSACHUS��
PUBLIC HEALTH DEPARTMENT
fommunity Development Division
❑ 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
® Hydraulic cement around inlet & outlet
Comments:
DISTRIBUTION-BOX
® Installed on stable stone base
❑ Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
❑ Speed levelers provided (not required)
Comments: �I
SOIL ABSORPTION SYSTEM (General)
Bottom of SAS excavated down to 6 in into 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
® Retaining wall (boulder/ concrete /timber/ block)
❑ Final cover as per plan
Comments:
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
® Brand and Model of Chamber Infiltrator Quick 4
® Number of chambers per row 7
® Number of rows (trenches) 6
❑ Laterals installed and ends connected to header (and
vented if impervious material above)
® Elevations of laterals and chambers installed as on
approved plan .
Comments:
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
SYSTEM ELEVATIONS
INVERT IN FIELD PLAN INVERT ELEV.
Benchmark
Building Sewer OUT 94.68 94.62
Septic Tank IN 94.48 94.42
Septic Tank OUT 94.15 94.17
Pump Chamber IN
Pump Chamber OUT
Distribution Box IN 93.69 93.67
Distribution Box OUT 93.52 93.50
Lateral 1 INV 93.47 93.47
Lateral 1 TOP 93.81
Lateral 2 INV 93.47 93.47
Lateral 2 TOP 93.81
Lateral 3 INV 93.49 93.47
Lateral 3 TOP 93.83
Lateral 4 INV 93.49 93.47
Lateral 4 TOP 93.83
Lateral 5 INV 93.48 93.47
Lateral 5 TOP 93.82
Lateral 6 INV 93.46 93.47
Lateral 6 TOP 93.80
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.town ofnorthandover.(am
I
i
0 0
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Thursday, November 02, 2006 2:33 PM
To: Grant, Michele; Sawyer, Susan
Subject: Final Grade Requests
Importance: High
Hello,
Can one of you possibly take care of two final grade inspections for:
23 Ash Street
123 Marian Drive
Mike Reilly was the installer. Thank you.
8osf Regwads,
PAAV004 D¢BIMe4041 O
Health Department Assistant
Town of North Andover
160o Osgood Street
Building 20, Suite 2-36
North Andover,MA o1845
978.688.9540-Phone
978.688.8476-Fax
http://www.townofnorthandover.com
healthdept@townofnorthandover.com
i
i
1
Mp�TH Commonwealth of Massachusetts Map-Block-Lot
p j4eo e.�O
107C- -49
p OL
Yr 9
Board of Health
Permit No
` North Andover BHP-2006-0251
`�1,;: �:•f. '' P.I. --
FEE------- ---------
Ss�cHUSEt F.I. $250.00
----------- ----------
Disposal Works Construction Permit
Permission is hereby granted Mike Reilly
to(Repair)an Individual Sewage Disposal System.
at No 123 MARIAN DRIVE
------------------------ --------------------------------- ------------------------------------------------------------ ------ -----------------
as shown on the application for Disposal Works Construction Permit No. BHP-2006-025 Dated August 30,2006
-----
------------------------------------ ------
Issued O--Aug-30-2006 Board of Health
I
Je ilc lJIls osal S stem _
Construction Permit
TOWN OF- ----��`����
TODAY'S DATE
NORTH ANDON
:�5MCHUSR k� MA 01845 Su.00 I Re ai
$125.00 - omponent
Important: q lication is hereby made for a Hermit to:
When filling out
forms on the ❑ Construct a new on-site sewage disposal system*
computer, use
only the tab key ❑ Repair or replace an existing on-site sewage disposal system*
e m
to ovyour
to move o not ❑ Repair or replace an existing system component
use the return
key. A. Facility Information
Address—or --# —
ASM ed— ----
�P.wn
City own ------ --------
2.- *TYPE OF PTIC SYSTEM
❑
Pump Gravity(choose one)
***If pump system, attach copy of electrical permit to application***
❑ Conventional System y (pipe and stone system)
❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this ty'e of s s
El Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) y tem.
❑ Pressure Dosed (D-Box Present) S.A.S.
2. Owner Information
Name T `�
i
Address(if different from above
City/Town
Zip Code
Telephone Number
3. Installer Information
Name � 1nL
Name bdm;pany
Add ss �—
--------------
Cityi town`_ \
State Zip Code — —
Telephone Number(Cell Phone#if possible please)
4. Desi net Information
Name -- Nal 1�(3"�-.(V\°i
me of Company �
Address .. -- ---- `«
_......
—City/Town --------------------- ---
-- - -----
------- State ----- �-�_0 ti%.-----
Zip Code - -
Telephone Number(Best#to Reach)
i
Application for Disposal System Construction Permit-Page 1 of 2
i
sal System
Application for Septic Dlspo v
- n TODAY'S DATE
K pConstruction Permit - TOVN OF
, MA 01845 $ 250.00—Full Repair
NORTH ANDOVER
h !
$125.00 Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: esidential 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,4y this Board of Health.
A&f2oi
Name Date
Applic ' n Approved By: ( rd of Health Representative)
-3 D `8 _
me Date
Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached? Yes cl No
2. Project Manager Obligation Form Attached? Yes I,/ No
3. Pump System? If so,Attach copy of Electrical Permit Yes_ No L/
4. Foundation As-Built?(new construction ronly): Yes_ No
(Same scale as approved plan)
S. Floor Plans?(new construction only): Yes No
U
Application for Disposal System Construction Permit•Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As,the North Andover licensed installer for the construction for the septic system for the property at:
(Address of septic system) For plans by �'f"'�N�cc�
(Engineer)
Relative to the application of c Rpi�i
(Installer's name) And dated ._1M a5c.
ngma iat ate
Dated D — } r
o ay s ate (L;_ l With revisions dated ICA 1010
(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 is not ready, then
item three shall be applicable.
3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection,without completion of the items in accordance
with Title 5 and the Board of HealthRegulations may result in a $50.00 fine being levied against me and/or
my company.
a. Bottom of Bed—Generally, this is the first (VS inspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc.
As-built of verbal OK(or e-mail to: healthdeptQtownofnorthandover.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 M license to operate in the Town of
North Andover, significant fines to all persons involved are also possible.
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Board 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
approved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date)
- c
(Name—Print) (Name—Sighed)'
TOWN OF NORTH ANDOVER NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES 3 of't,10
F p
HEALTH DEPARTMENT
400 OSGOOD STREET "+ r
NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss�CHU t�
978.688.9540—Phone
Susan Y.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL:healthdept@townofnorthandover.com
WEBSITE:http://www.townofnorthandover.com
April 17,2006
Anthony Donato,P.E.
Merrimack Engineering Services
66 Park Street
Andover,MA 01810
Re: Subsurface Sewage Disposal Plan for 123 Marian Road,Map 107C,Lot 44
Dear Mr.Donato:
The proposed wastewater system design plan for the above site dated February 20,2006 and received on March 16,
2006 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The
specific section in Title 5: 310 CMR 15.000,or North Andover regulation that is not met by this design follows each
item.
1. A variance request from North Andover Board of Health Regulations is required to not remove the required
6"excavation into natural soil as indicated on the design plan(NA 9.01).Please submit a written request to
be on the next Board of Health meeting agenda for all variances proposed.
2. The excavation in the area of Test Pit 2 should extend no more than 42"below grade(not 48")as indicated
by the design plan if use of the`B"soil horizon is desired to be maintained as proposed.
3. Please note the location and findings of the unsuitable soil tests which were excavated at the site.
4. Please correct the description of the bottom elevation of test T-2.
5. Please indicate the type of retaining wall to be used and provide specifications. (The homeowner indicated
personally,that she is not choosing this.)
6. It is noted that the North Andover Conservation Commission has not approved the wetland boundary depicted
on the plan as the Commission has not reviewed this plan to date.If this wetland line is changed by the
Commission a plan must be submitted to this office with the changes.In addition, it would be best to submit
verification of the wetland line prior to the Board of Health meeting so that the members may be sure they are
voting on an accurate variance.
Additionally,you might wish to consider using an effluent filter in the primary(septic)tank.
Please feel free to contact the office with any questions you may have. We look forward to working with you to
obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure
protection of public health and the environment of North Andover.
Sincer ,
S an Y. Sawyer,REH /RS
Public Health Director
cc: Owner
File
MERRIMACK ENGINEERING SERVICES, INC.
` PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS
66 PARK STREET•ANDOVER,MA 01810• (978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL info@merrimackengineering.com
May 9, 2006
Ms. Susan Sawyer
Public Health Director RECEIVED
1600 Osgood Street
Building 20—Suite 2-64 MAY 1 .5 200E
North Andover., MA 01845
TO'1 N`sF NORTH ANDOVER
HEAL FH DEPARI-MENT
Re: 123 Marian Drive
Dear Ms. Sawyer:
We are in receipt of your review letter dated April 17, 2006 regarding the above
referenced site. The plan has been revised to address item 2— 5 of your letter.
With regards to item #3, the location of one additional test pit is shown on the plan,but
was abandoned due to the inability of the backhoe to remove a large boulder. The hole
was not formally logged in,but is designated on the plan.
With regards to item 46, a filing is forthcoming with the Conservation Commission at
which time all wetland issues will be addressed.
Lastly, with regards to item 41, we formally request time at your next Board of Health
meeting to discuss the variance request as noted on the plan from North Andover 9.01.
We appreciate your prompt attention to these matters.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
Project Manager
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Aviv
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PUBLIC HEALTH DEPARTMENT
Community Development Division
May 23, 2006
Pat and Dick Cavanaugh
123 Marian Drive
North Andover, MA 01845
RE: Septic System Design, 123 Marian Drive, North Andover, Map 107C, Lot 44
Dear Homeowner,
The North Andover Board of Health has completed the review of the septic system design plan
for the above referenced property, submitted on your behalf by Merrimack Engineering Services,
last revision dated May 9, 2006, and received May 15, 2006.
The Board of Health approved a variance to N. Andover's regulation 9.01 on May 25, 2006.
With this variance, the design has been approved for use in the construction of an onsite septic
system. The 4-bedroom(9-room maximum) design has been approved for use in the
construction of a fully compliant, Title V, subsurface disposal system. This approval is valid for
two years from the date of the approval in accordance with current local regulations and during
this time a licensed septic system installer must obtain a permit and complete this work, and a
Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover.
This approval is subject to the following conditions:
1. If site conditions are found in the field to be different from those indicated on the design plan
and/or soil evaluation, the originally issued Disposal System Construction Permit is void,
installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit.
2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic
system installer or other representative to ensure that all other state and municipal
requirements are met. These may include review by the Conservation Commission, Zoning
Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector.
The issuance of a Disposal System Construction Permit shall not construe or imply
compliance with any of the aforementioned requirement
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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
may have.
Sincerel ,
Susan Y. Sawyer, REHS/RS /
Public Health Director
Encl: list of licensed septic system installers
Cc: Merrimack Engineering Services
i
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 fax 978.688.8476 Web wwwjownofnorthandover.com
& io, ;i.
TOWN OF NORTH ANDOVEROORTh
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSA.CHLJSETTS 01845 ACHU
978.688.9540 Phone
Susan Y.Sawyer,RENS/RS 978.688.8476-.-FAX
Public Health Director E-MAIL:hea.IthdeptCq)towiiofiiorthandover.com
WEBSITE:hqp://www.townol-northandover.coni
SEPTIC PLAN SUBMITTAL FORM RECEIVED
Date of Submission: MAR 16 2006
Site Location: t2rz-i u e TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
tr:
r- AkK I TAENT
Engineer: P1 Cag-1 b,)gg Lgge,_j ND
New Plans? Yes—x/—$225/Plan Check# ?3/ (includes Is'submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? /JA Yes No NJA
Telephone#:(9:M j 4J-75--_ S 7 Fax#: ff3j�� *0
E-mail: 4 jr- Pit-F- 06gf Ac:>L,
Homeowner
Name:
y
OFFICE USE ONLY
When the submiss' n is complete(including check):
> LZDate stamp plans and letter
> Complete and attach Receipt
> Copy File; Forward to Consultant
> Enter on Log Sheet god Database
;ocafion: i v U A PEI A Awa Lys Onrocr`s Name:
Mapframel:__ 07 ?-
Address: I
Installer. —SIM New msq---Repgr
Date: WetbmdsJQF_>�ZoaeII_Soil Symboi—L'J'—Sou&mean Cl.,
Deep Observation HoleLogs,
Eletiwatioa Depth Soil H"n Solt Temre Son Color SOOMottling. `/.Gravel,Stones,eta:
LJ k4\f L4
o
Pasrnt 1►taledat. �i w �, _ -
Dgth t0�I�I f Y A Won dM$ _�Aegft=rMft ruF2c* EMM, ea
U.
Pareatt+iatetial �!�V �.
Depth to Bei �fJ 6q��Yatetla tlse Sota��Neepin=(tva�t!t Face —" ESBGLY: �7�
Date z—`l percolation Tests
Observation Hole I RECEIVED
Depth of Pere Z}-
StartPre-sos3; • 71 moi` 006
Time at na
Tune at 9" J?J ,ND.OVER
TImC at 6"
�HIEALTHWENT
i 53
Time(9"-
•Rate?Mmgnch-
Performedyc��,�,' Witnessed Br. A_ ".-0 mow_
TOWN OF NORTH ANDOVER MORTp
Office of COMMUNITY DEVELOPMENT AND SERVICES
0
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER. MASSACHUSETTS 01845
Susan Y. Sawyer,REBS,RS 978.688.9540 -Phone
Public Health Director 978.688.8476—FAX
healflidepQ)townotho rthan dover.coin
www.towiiofiiortliandover.coni
APPLICATION FOR SOIL TESTS
DATE: Lj
MAP&PARCEL:
LOCATION OF SOIL TESTS:
OWNER: I A TV,1- ilAe--i 4 A,-,.,42 Contact
APPLICANT: Contact#:
ADDRESS:
ENGINEER: 6 d,45 Contact r
CERTIFIED SOIL EVALUATOR: (vii,(-- 1"Zi
Intended Use of Land: Residential Subdivision SiCommercial
Is This: Repair Testing: V-11 'Undeveloped Lot Testing.-, Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
> Proof of land ownership(Tax bill,or letter from owner permitting test)
> 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan)
> Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
> Only Certified Soil Evaluators may perform deep hole inspections.
> Only Mass.Registered Sanitarians and Professional Engineers can design septic plans.
> At least two deep holes and two percolation tests are required for each septic system disposal area.
> Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH
representative.
> Full payment will be required for all additional tests within two weeks of testing.
Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
> Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date:
Signature of Conservation Agen`t�. ��.�...
Date back to Health Department: (stamp in):
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Page 1 of 1
DelleChiaie, Pamela
From: Lisa LeVasseur[lisal@millriverconsulting.com]
Sent: Friday, January 13, 2006 3:47 PM
To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela;
dano@millriverconsulting.com
Subject: Soil Test-123 Marian Drive-Scheduled for Jan 24th @ 9:00 a.m.
Hi,
The soil testing for 123 Marian Drive has been scheduled with Merrimack Engineering for January 24th @ 9:00
a.m.
Please call if you have any questions.
Thanks,
Marianne
Lisa LeVasseur
Mill River Consulting
Your Complete Source for Onsite Wastewater Management
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting.com
.com
1/18/2006
Page 1 of 1
DelleChiaie, Pamela
From: Dan Ottenheimer[info@millriverconsulting.com]
Sent: Monday, January 30, 2006 10:56 AM
To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela;
Sawyer, Susan
Subject: Soil Test; 140 Marian Drive; Tues. 31st
The soil evaluation for 14 arian Drive has cheduled for tomorrow; immediately following the already-
scheduled soil evaluatio for 123 Marian Drive. Whe they're finished at 123 Marian, they'll go over to 140.
Merrimack Engineering as med.
Please call if you have any questions.
Marianne
Daniel Ottenheimer, President
Mill River Consulting, Inc.
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsultiniz.com
daiig@Lmillriverconsultiniz.com
millriverconsulting.com
1/30/2006
Page 1 of 1
DelleChiaie, Pamela
From: Dan Ottenheimer[info@millriverconsulting.com]
Sent: Tuesday, January 31, 2006 9:13 AM
To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela;
Sawyer, Susan
Subject: Marian Drive is rescheduled for Feb. 9th, not 8th!
Sorry about that...I just e-mailed you saying that 123 & 140 Marian Drive soil tests have been scheduled for
February 8th...they've been rescheduled for Thursday, Feb. 9th. Sorry for the inconvenience.
Marianne
0
Daniel Ottenheimer, President
Mill River Consulting, Inc.
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting& rn
dano@millriverconsulting.com
1/31/2006
Page 1 of 1
DelleChiaie, Pamela
From: Dan Ottenheimer[info@millriverconsulting.com]
Sent: Friday, February 10, 2006 2:54 PM
To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela;
Sawyer, Susan
Subject: Soil Evaluation Report-123 Marian Drive
Attached are the soil evaluations for 123 Marian Drive. If you have any questions, please call.
Thank you,
Marianne
Daniel Ottenheimer,President
Mill River Consulting, Inc.
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsultin2.com
dano@millriverconsl4ltilig.com
millriverconsultilig.com
2/10/2006
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