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Miscellaneous - 129 CHRISTIAN WAY 4/30/2018
•� --- - -- __, - .- _.. 1� � - � � T 6391 Of NORH qh o, F _ p Town of North Andover HEALTH DEPARTMENT CNUSf� CHECK#: DA E: ,2w )4 LOCATION: H/O NAME: CONTRACTOR NAME �JA YA fil J Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $� ?�Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer WARREN R PEARCE JR/DBA PEARCE CONSTRUCTION 7061 Town of North Andover 2/21/2014 Title 5 filing 50.00 CITIZENS BANK 50.00 P7 si-I 3-VIC-S lto a p — D z. Y't �T Sit 5�� ✓ of.-ry r: r� Commonwealth of Massachusetts . Title 5 Official Inspection Form Ro, �ndd�� a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments p 129 Christian Way Property Address y�� Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014, every page. Cityrrown State Zip Code Date of Inspection'.' . . 1jf 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. ImpoWhen filling A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your Warren Pearce Jr cursor-do not Name of Inspector Z4 Z014 use the return key. Pearce Construction Company Name HEAL ;i D1iF "AT, �E;dT � 196 Park St - Company Address North Reading MA 01864 'eAO1 Cityrrown State Zip Code 978-664-5264 S11959 Telephone Number License Number B. Certification I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page t of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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-11/10 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 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ® N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 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 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityfrown 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 No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high 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 design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 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: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Forth: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 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gPd))� 65GPD Detail: 12-12-11 to 12-11-13 47,423 gallons Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumped in April by Bateson Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy .67 Z4 ;'9 ® Shared system (yes or no) (if yes, attach previous inspection records, if any) Z// ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 TRIe 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 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: ❑ cast iron ®40 PVC1 ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): All OK inside Septic Tank(locate on site plan): Depth below grade: 6"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 5'8"x 5' deep Sludge depth: 4" t5ins-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 7" 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.): Tees are in place. Outlet tee is crooked. Liquid level is OK. Tank appears OK. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11110 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 wM 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 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 3" 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.): Leach area is backed up into D-box. Leach area is failed, camera inspection showed area is full. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 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 .�' 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-24'x38' ❑ 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.): Flied is backed up into D-box. Leach field is in hydraulic failure. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 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 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. Citylrown 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: 6' + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: review files ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data from design plan from 12-9-1999 by Atlantic Engineering. Site was built up for system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Zi Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 129 Christian Way Property Address Scott Whalen Owner Owner's Name information is required for North Andover MA 01845 1-25-2014 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Summery Record Card generated on W4/201411:43:11 AM by Maureen Mm%My Page 1 Town of North Andover Tax Map # 210-104.D-0001-0000.0 Parcel Id 16699 129 CHRISTIAN WAY EXT WHALEN, SCOTT 129 CHRISTIAN WAY NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2014 UB Mailing Index Name/Address Type Loan Number Active/lnact. From Until WHALEN,SCOTT Payor 129 CHRISTIAN WAY NORTH ANDOVER,MA 01845 US Account Maint. Account No Cycle Occupant Name Activelinactive Bldg Id.17872.0-129 CHRISTIAN WAY EXT Last Billing Date 117/2014 3170537 03 Cycle 03 Active UB Services Maint. Account No.3170537 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 225.85 /1 UB Meter Maintenance Account No.3170537 Serial No Status Location Brand Type Size YTD Cons 48029750 a Active ENC FR.L NEPTUNE NEPTUNE w Water 11 1819 Date Reading Code Consumption Posted Date Variance 12/11/2013 3881 m Manual estimate 47 1/17/2014 -08% 9/12/2013 3834 a Actual 91 10/15/2013 AM 6/13/2013 3743 a Actual 155 7/24/2013 175% 3/14/2013 3588 a Actual 57 4/22/2013 20% 12/12/2012 3531 a Actual 47 1/9/2013 -74% 9/12/2012 3484 a Actual 182 10/15/2012 481% 6/12/2012 3302 a Actual 31 7/16/2012 31% 3/13/2012 3271 a Actual 24 4/14/2012 -2% 12/12/2011 3247 a Actual 24 1/17/2012 -84% 9/13/2011 3223 a Actual 166 10/13/2011 254% 61712011 3057 a Actual 44 7/2012011 -15% 3/7/2011 3013 m Manual estimate 50 4/13/2011 -13% 12/8/2010 2963 a Actual 58 1/12/2011 -789'0 919/2010 2905 a Actual 269 10/15/2010 3190% 6/8/2010 2636 a Actual 8 7/15/2010 -61% 3/9/2010 2628 m Manual estimate 20 4/14/2010 -75% MSG 12111/2009 2608 m Manual estimate 85 1/12/2010 -41% 9/812009 2523 a Actual 139 10/15/2009 120% 6/9/2009 2384 a Actual 59 7/20/2009 113% 3/16/2009 2325 a Actual 32 4/29/2009 -65% 12/8/2008 2293 a Actual M 1/20/2009 -29% 9/10/2008 2210 a Actual 126 10/10/2008 425% 6/6/2008 2084 a Actual 22 7/16/2008 6% 3/10/2008 2062 a Actual 21 4/11/2008 -49% 12/1212007 2041 a Actual 45 1/22/2008 -58% 9/6/2007 1996 a Actual 87 10/12/2007 107% 6/19/2007 1909 a Actual 51 7/20/2007 147% 3/15/2007 1858 m Manual estimate 20 4/16/2007 -45% 1 • S�'TLEb j�G • • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 6/6/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Warren Pearce At: 129 Christian Way Map 104.D Lot 0001 North Andover, MA 01845 The Issuance is certificate all not be construed as a guarantee that the system will function satisfactorily. Susao�iwyer Public Health gent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com SCHEDULE OF PIPE INVERTS 179 LOCATION LETTER INVERT 137.580' �--�` HOUSE OUTLET 175.37' 178 SEPTIC TANK INLET A 175.29' o �✓���- SEPTIC TANK OUTLET B 175.04' 177 - DISTR. BOX INLET C 173.20' DISTR. BOX OUTLET D 173.03' 176 DISTR. FIELD E 172.96' BOTTOM OF FIELD 172.29' SHED 177 ASSESSORS MAP 104D C VE LOT 1 PARCEL 1 176 0,560 T AREA: JU C 5 14 S.F, J_ TO N OF N RTH A 0 J-� 175 H LTH D PART N O W N 129 CHRISTIAN BENCHMARK \ o BOTTOM OF SIDING BIT ELEV. 177.77' '0 DRIVE. BIT. DRIVE. WS I h tea' ..��.. �. d H 3- - H�'98- 1 `cam ^q N ^ ^o 9 -1- 0) 1-rn 7 II •- ao 9.6 '�roco ^90 C CP* �R7 co a98 2 c?,cD r� 1 0.2' TH 3- 222 �ag.Ag RIVE. L � •� n A ti D-BOX 1500 GAL. ❑ ^`�' SEPTIC TANK FIELD N/A "� y LOT 104D - 18INSPECTION PORT THEODORE KNIGHT ��P� 40 MIL. IMPERMEABLE BARRIER 137 CHRISTIAN WAY "I certify the locations, ties, cover material, exposed component covers etc., shown on this s—built substantially agree with the approved plan and ha determi d that the breakout elevations, if lii le hove been met. PLAN VIEW " f' ture 5f Designer " SCALE 1"=20' pray No. 013 1"= scala 1"=20' JAMES M. KAVANAUGH, RE • �LO Dean. By. SEPTIC SYSTEM c 1 6/5/14 AS—BUILT 14 Shady Hill Drive Rev. Dote Description Drn• By. JMK N. Reading, MA 01864 Tel.(978)664-2925 �� Chkd. By.DMC CLIENT: Scott Whalen Appd. By. 129 Christian Way 129 CHRISTIAN WAY KCustom Homes — Remodeling — Septic System Designs N. Andover, Ma 01845 Date 6/5/14 Excavation/Installation Services SCHEDULE OF PIPE INVERTS 179 LOCATION LETTER INVERT 137.58' --_ HOUSE OUTLET 175.37' 178 SEPTIC TANK INLET A 175.29' SEPTIC TANK OUTLET B 175.04' 177 DISTR. BOX INLET C 173.20' DISTR. BOX OUTLET D 173.03' 176 DISTR. FIELD E 172.96' BOTTOM OF FIELD 172.29' rjS SHED 177 �j v ASSESSORS MAP 104D LOT 1 PARCEL 1 176 LOT AREA: 3,560 S.F. 175 O W N 129 CHRISTIAN BENCHMARK o BOTTOM OF SIDING BIT ELEV. 177.77' X01 DRIVE. i BIT. DRIVE. �y�A h�^ ;�- 0� WS H 3- - H'98-10 �� ! ^ O N rn CO N 17 � — 000 9.6 t M'00 ��b' Atea. Co• J �O� Q(' o 98 2 9 r 5 J 4z" C� 0 0.2' TH 3- egg 4 o� � RIVE. L r r r �LJ ti /� D-BOX 1500 GAL. F1 •`�-� ^`V SEPTIC TANK FIELD N/A LOT 104D - 188''' ' '� �P INSPECTION PORT THEODORE KNIGHT `' -� ��P� 40 MIL. IMPERMEABLE BARRIER 137 CHRISTIAN WAY,: .1Av ', KA ., :A" : C!!'� 110. Wt 66 "I certify the locations, ties, cover material, exposed component covers etc., shown on thiss—built substantially agree with the approved plan and =r = ; ' PLAN VIEW have eter ' d that the breakout elevations, if p ibble have been met." t otur of Designer trate SCALE 1"=20' Prol N 013 scale 1 JAMES M. KAVANAUGH, RE E. 1"="=20' F Dean. By.JMK SEPTIC SYSTEM'z 1 6/5/14 AS—BUILT 14 Shady Hill Drive Rev. Date Description 1— By: JMK ChkN. Reading, MA 01864 Tel.(978)664-2925 � d. Br DMC CLIENT: Scott Whalen Appd. By. 129 Christian Way 129 CHRISTIAN WAY KCustom Homes llRemodeling — Septic System Designs N. Andover, Ma 01845 Date 6/5/14 Excavation/Installation Services • ��'fT;�D r6a. 5 s North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 129 Christian Way MAP: 104D LOT: 1 INSTALLER: Warren Pearce DESIGNER: James Kavanaugh PLAN DATE: 4/7/14 BOH APPROVAL DATE ON PLAN: 5/7/14 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION:5/30/2014 DATE OF FINAL CONSTRUCTION INSPECTION: 6/5/14 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS N/A Contractor reports any changes to design plan N/A Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK N/A Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan N/A Bottom of tank hole has 6" stone base N/A Weep hole plugged N/A 1500 gallon tank has been installed H-10 loading N/A Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port Z Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over outlet access port ® Hydraulic cement around inlet & outlet Comments: Existing tank is being re-used DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 9 ® Number of rows (trenches): 5 Comments: Total Chambers = 45 • i FINAL GRADE �. q4 1-f [� Loamed [ Seeded [� Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan BM = 177.77 HR = 1.34 HI = 179.11 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Exist. Septic Tank IN Exist. Septic Tank OUT 3.73 175.03 174.86 Distribution Box IN 5.58 173.18 173.15 Distribution Box OUT 5.75 173.01 172.98 Lateral 1 TOP 5.83 Lateral 1 INVERT 172.93 172.92 Lateral 2 TOP 5.84 Lateral 2 INVERT 172.92 172.92 Lateral 3 TOP 5.83 Lateral 3 INVERT 172.92 172.92 Lateral 4 TOP 5.84 Lateral 4 INVERT 172.93 172.92 Lateral 5 TOP 5.84 Lateral 5 INVERT 172.93 172.92 I Top of Chamber 5.85 173.26 173.25 Bottom of Bed/Chamber 6.87 172.24 172.25 i I I i CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Environmental Consuftaut JAMES M. KAVANAUGH, P.E. • Real Estate Brokerage 14 Shady Hill Drive • Septic System Desi"ns North Reading,MA 01864 • Construction Services (978)664-2925 • Custom Home Builder '�tNRi June 5, 2014 RECEIVED Board of Health JUN 0 5 2014 Town of N. Andover 1600 Osgood Street TOWN OF NORTH ANDOVER N. Andover, MA 01810 HEALTH DEPARTMENT Att: Susan Sawyer Re: Septic System 129 Christian Way Dear Susan: Enclosed please find 3 copies of record drawings for the above referenced property. This letter is to notify the Board of Health that I, James M. Kavanaugh, P.E., certify that the system has been installed accordi-ig to the approved plan. If you have any questions or comments please do not hesitate to contact me at (978)664-2925. Sincely, 2 mes M. Kavanaugh, P.E. j Enc. RECEIVED JUN 0 5 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System X constructed;( )repaired; B Pe Ire C_ eIreC_ 6o...s�rv�7',a,✓ /01-1 (Print Name.) Located at: Z q Lor)S �'"/.' k/a (Installation Address Was installed in conformance with the North Andover Board of Health approved plan,originally dated -L0 y and last revised on A (,L3-6 1-o)q with a design flow of yy a 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 oil the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 3 � F gincer Representative(Signature) And-Print Name Final Construction Inspection Date: 6 f !`' Egineer Representative(Signature) And-Print Name Installer:: 4(Signature) � Date:- S " <L Atj nd-Print Narne Engineer: (Signature) /7(Date: �/S I v And-Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com INFILTRATOR Title 5 INNOVATIVEfALTERNATIVE SOIL.ABSORPTION SYSTEM(SAS) INSTALLER CERTIFICATION In accordance with Section II(21)of the Standard Conditions for Alternative Soil Absorption System with General Use Certification and/orlApproval for Remedial Use, Revised August 22,2013, I, Designer name(Printed) am the Infiltrator SAS installer at the below-listed property,and I hereby certify to the ASA designer,the Local Approving Authority(LAA),and the System Owner that I am a locally approved installer. Property Address: J / -,- 4 6. 4r, r1'ia— kt�1 Enter property address ✓y AN�lS�rr Enter town name Signed: Installer's Signature Installer's name(Printed) Date: INFILTRATOR Title 5 INNOVATIVE/ALTERNATIVE SOIL ABSORPTION SYSTEM(SAS) DESIGNER AND INSTALLER CONSTRUCTION CERTIFICATION In accordance with Section II(23)(a)of the Standard Conditions for Alternative Soil Absorption System with General Use Certification and/or Approval for Remedial Use, Revised August 22,2013, I,the system designer � &14yiAN-10Vj i S Designer name(Printed) And I,the system installer lea rY'r- PC'j"C Installer name(Printed) hereby certify to the Local Approving Authority(LAA)that the Infiltrator chamber SAS has been constructed in compliance with the General Use Approval. Property Address: I Z /o� 6�r► 4 "V4�, Enter property address Enter town name Signed: Date: S Design s Signature S?.�.,> ,C9Ya.,✓�ty� Designer's name(Printed) Signed: w 1 ` Date: Installer's Signature Installer's name(Printed) U�U r 4 Commonwealth of Massachusetts Map-Block-Lot BOARD OF HEALTH ----------------------- • Permit No North Andover BHP-2014-0624 P.1. _ FEE F.I. $250.00 --------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted warren Pearce Jr. to(Construct)an Individual Sewage Disposal System. at No 129 CHRISTIAN WAY as shown on the application for Disposal Works Construction Permit No. BHP-2014-062 Dated --May 22,_2014 ov ---------- - -4-- -u- Issued On:May-22-2014 BOARD OF HEALTH ---------------------------------------------------------------------------------- ................**"*......................... .............. ..........*'***"*..........................*......*......................... 129 CHRISTIAN WAY Reference No: BHJ-2014-000015 ................................... Permit No: BHP-2014-0624 Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Account No: Septic Account Rev Fee Type: .................................... DWC-Full Repair PERMIT Receipt No: REC-2014-001534 .................................... ......................................................................................... Paid By: Paid in Full On: Thu May 22,2014 .................................... Warren Pearce Jr. ......................................................................................... Check No: 7162 Received By: .................................... Lisa Blackburn ......................................................................................... DEPARTMENT'S COPY Amount: $250.00 :,:::................... ........................................................................................................................................ . .............................. r ` Application for Septic Disposal System S 'ra) O�S���e•��tiG =Construction Permit - TOWN OF TODAY' DATE $250.00—Full Repair ORTH ANDOVER, MA 01845 ,SS,cNust� $125.00 -Component Important: _Application is hereby made for a permit to: When filling out forms on the ElConstruct a new on-site sewage disposal system* computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return key. A. Facility Information I '-ck C14VU5 _ikK( 0))y Y�1 Address or Lot# /t( dN ©l9R,v' rn City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ❑ Pump Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ® Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information s'co-t Li Name Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information w ra-f h.K4V 1T_16� P-1 yZC Fz_ Name r Name of Company Address ter, City/Town r State Zi Code !379, - ,-; 17180 Telephone Number(Cell Phone#if possible please) 4. Designer Information Name VName of Company 1 Ll S t d 4t)y t+ LC D t\— Address LAddress No rLy 2,V,,r b I/C)) City/Town State Zip Code q 70 dl� �)'_s Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 } d µORTH Application for Septic Disposal System 0.,4ao��1�0 �? -Construction Permit - TOWN OF TODAY$DTEM r ORTH ANDOVER, MA 01845 $250.00-Full Repair as^� St $125.00 -Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f Healt Name Date plic ion Ap rov : (Board pf Health Representative) Na e Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump Svstem? If so,Attach copy ofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 0 INC This rs to—dy d1aP Warren F.'Pence,Jr. " Pemnr'onemar+on rtd sanali.rhy r.anpkrtd the rq—d v.,u,ing program lia th, .11,11 Airco ,f IIIc INf ILTP-k Ri'Izxclwrg chanlher systtln f,r-,ile evastzx ager dupoaal alghr,h,nTh rs r. pn.,,lr w rMllrcl It,uul,•ai the INFILTRATOR`chamber a)•altm w •cl r rd,by alt M1lassxalyyens bfP appmvol letter 1,, INFILTRATOR 1cam11e4l ehambtrs All oww ewd<Idls-a5 F:S:{wth hY Ilm latest r<rnu,n or 10 -NI IS.Pa„f T,&5 aA appll This rnYl.ak ai}s alta and issntd aria 29th clay,,r hf-1 IOOJ. C:enilicalunr\IA 1151 ' - Lee VtrM(L'e 111.nm.0.egi,mal M1lm.,.I Blackburn, Lisa From: Isaac Rowe <irowe@mill riverconsulting.com> Sent: Thursday,June 05, 20141:57 PM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; 'Isaac Rowe' Subject: RE: 129 Christian Way Attachments: 129 Christian Way- Final Construction Inspection.doc;IMG_0861.JPG Susan/Lisa, Attached is the final construction report for the above referenced property. Everything looked good. Also attached is a photo of the material that was under the old system. It was a compacted silty fill material above the natural soil but below the T5 sand. Hopefully this material was not used on other lots in the development. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone:978-282-0014 ext.804 Fax: 978-282-1318 irowe(cr,.millriverconsulting.com www.millriverconsulting.com From: Blackburn, Lisa [mai Ito:LBlackburn@townofnorthandover.com] Sent: Wednesday, June 04, 2014 3:09 PM To: 'Isaac Rowe' Subject: RE: 129 Christian Way Hi Isaac, Can you please call Warren Pearce for final construction inspection at 129 Christian Way? His number is 978.375.9780. Thank you. From: Isaac Rowe [mailto:irowe(cbmillriverconsulting.com] Sent: Friday, May 30, 2014 3:13 PM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Isaac Rowe' Subject: RE: 129 Christian Way Susan/Lisa, The bottom of the bed inspection went well, once I finally got to the site!They will be bringing in sand on Monday. 1 . .� Via°' j�,.,> �i 'i d•� bs� ��,-- ° � <: � Y�✓ ``�.•� i Ai 1�3a� 4 s "* ra�.,� Pe' .. � % .�, � . •• -iF' Y .: Lia ' ,: �a r aY� "tet ��� � ��., "��*, - >s • -�� �..F�cv-T ,�" i ��.� � ./ CA- i x i ii r F n� t r , f E . .% r, k � +'nrk pF, :.a.,., e. .4—Bio,:...'p,zE •'���.� �� '�"'.R,- fir.. � �� �i ,.. , a r , < , na 3 r < n. �l lit �, d, l tl�. � G-c� ,..�..r_.�.s �--�� '1 �� �J` n-Site Sewage Disposal ntal Protection pursuant to 310 CMR 15.017 to conduct soil .onsistent with the required training, expertise and experience soil evaluation, as indicated in the attached Soil Evaluation Form, t7. Date Date of Soil Evaluator Exam Board of Health to the approving authority within 60 days of the date of field testing, and v�� n-Site Sewage Disposal Map/Lot# State Zip Code ❑ Repair If yes: Source Soil Map Unit Soil Limitations If ves: ell En�� North Andover Health Department Community Development Division May 7, 2014 Scott Whalen 129 Christian Way North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 129 Christian Way,Map 104D, Lot 1 Dear Mr. Whalen: The proposed wastewater system design plan for the above site dated April 7, 2014 with a final revision date April 30, 2014 received on May 1, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom(max 9-room)home. This plan is generally good for 3-years from the date of approval however, as this is for a repair system,this is reduced to 2-years. The plan received the following local upgrade approval. 1) Separation from Soil Absorption System(SAS)to Estimate Seasonal High Water Table (ESWT) from 4 feet to 3 feet 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. In the event an imminent health problem, such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records (attached) 2. This system utilizes an infiltrator system and the owner has certified the understanding of this system, as found in the document submitted (see attached) 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 129 Christian Way May 7, 2014 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board,Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 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. SinfelSuawyer, RE S Public Hea6th Dire Encl. Form 9B Installers list cc: James Kavanaugh, PE File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts F City/Town of North Andover Local Upgrade Approval Form 913 �M DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Scott Whalen key to move your Name cursor-do not 129 Christian Way use the return Street Address key. North Andover MA 01845 rs4 Cityrrown State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. Designer:System James Kavanaugh x PE ❑RS Y g Name 14 Shady Hill Drive N. Reading MA 01864 Address Cityrrown State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 129 Christian Way Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts f City/Town of North Andover Local Upgrade Approval Form 9B e�G M B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 18 min./inch Depth to groundwater 3 ft. ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Det Approving Authority Susan Sawyer May 7, 2014 Print or Type Name and Title .' /Iig ature / - Date 129 Christian Way Local Upgrade Approval* Page 2 of 2 5/7/2014 TOWN OF NORTH ANDOVER PERMITTED SEPTIC INSTALLERS - RENEWED FOR 2014 Doing Business As Phone City Angelo Petrosino (978) 664-2030 NORTH READING,MA 01864 Bill Hall (978) 689-3711 METHUEN, MA 01844 Chad Jablonski (978) 360-9358 NEWBURYPORT, MA 01950 Daniel A. Giard (978) 686-7653 NORTH ANDOVER,MA 01845 David Maynard (978-375-7228 BARNSTEAD,NH 03225 David V. Zaloga, Jr. (603) 765-9296 EXETER,NH 03833 James H. Currier (978) 774-6685 MIDDLETON, MA 01949 James Kellett (781)953-7146 LYNNFIELD,MA 01940 John J. Soucy (603)216-7175 SALEM,NH 03079 John L. DiVincenzo (978) 372-7471 HAVERHILL,MA 01835 Joseph Surianello (978)458-9117 DRACUT, MA 01826 Joseph Watson (978)475-3262 ANDOVER, MA 01810 Matthew Manning (603)329-5077 ANDOVER, MA 01810 Michael W. Reilly (978)375-4811 ANDOVER, MA 01810 Peter Breen (978)265-7580 NORTH ANDOVER,MA 01845 Robert Daigle (978) 887-3703 HAVERHILL,MA 01830 Robert T. Amor (978) 948 3341 BOXFORD, MA 01921 Robert L. Innis (978)663-6006 BILLERICA, MA 01821 Rocci DeLucia,Jr. (603)974-1580 SALEM,NH 03079 Serge Beaulieu (603)235-3740 DERRY,NH 03038 Stephen Iacozzi (978)479-4407 METHUEN, MA 01844 Timothy Quinlan (978)457-0528 HAVERHILL, MA 01830 Todd Bateson (978) 815-2703 ANDOVER, MA 01810 Warren Pearce Jr. (978)-664-5264 NORTH READING,MA 01864 NORTH ANDOVER&KINGSTON,NH William (Tom) Sawyer (603) 642-8910 103848 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Ilk Required by 310 CMR 15.403(1) Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 5.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: ? L U 4 When filling out 1. Facility Name and Address forms on the computer,use Scott Whalen only the tab key Name to move your 129 Christian Way cursor-do not use the return Street Address key. N. Andover MA 01845 QCity State Zip Code 2. Owner Name and Address: Same "p7 Name Street Address City State Zip Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ® Commercial ❑ School 4. Describe Facility: Single Family Dwelling 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): tc):u6. Type of soil absorption system (trenches, chambers, leach field, pits, etc).- upgrade pgrade form•rev.5/02 Application for Local Upgrade Approval* Page 1 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility 440 _ gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): ® voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Construct new soil absorption field 3. Local Upgrade Approval is requested for: ❑ Reduction in setback(s)—describe reductions: ❑ Percolation rate for 30 to 60 min./inch: min./inch ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 4 ft. to 3 ft. ft. Percolation rate 18 min./in. min./inch Depth to groundwater 4 ---- ft. ❑ Relocation of water supply well (explain): upgrade form•rev.5/02 Application for Local Upgrade Approval* Page 2 of 4 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: cost prohibitive 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: cost prohibitive 3. A shared system is not feasible: n/a 4. Connection to a public sewer is not feasible: n/a upgrade form•rev.5/02 Application for Local Upgrade Approval• Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ® A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonnt for deliberate violations." 7A J�J= 0,0 / f ac' ty ner'Cs Signature Da , P int Name James Kavanaugh__________ Name of Preparer Data 14 Shady Hill drive ____ _ __ _ N. Preparer's address City Town MA 01864 _ 978-664-2925 State/ZIP Telephone NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before commencement of construction, upgrade form•rev.5/02 Application for Local Upgrade Approval* Page 4 of 4 Title 5 INNOVATIVE/ALTERNATIVE SOIL ABSORPTION SYSTEM (SAS) PROPERTY OWNER CERTIFICATION In accordance with the Standard Conditions for Alternative Soil Absorption System with general Use Certification andlor Approval for Remedial Use, Revised August 22, 2013, 1, TC -IVED Property Owner's Name(Printed) MAy 012014 hereby certify the following: TOWN of NORTH AtdDOVER HEALTH DEPARTMENT [am the owner of the property at the below listed address. 0 1 have been provided copies of the Infiltrator Systems,Inc. I/A General Approval and the current Infiltrator Systems, Inc. Design and Installation Manual for the State of Massachusetts by the system designer, and I agree to abide by its provisions; • The system as designed does not allow for the use of a garbage grinder,and a garbage grinder will not be installed without appropriate modifications being made to the system in accordance with 330 CMR 15.000; 1 will provide written notice of the type of system installed and the a copy of the I/A general Approval to any new property owner; and ® 1 will repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment. Property Address: Enter property address IL14 Ca AAIN IL/ Enter town name r Signed: OW[ r`s$ig dtwe JC m. tr Owner's name(Printed) Date: r" Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Tuesday, April 22, 2014 8:49 AM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; irowe@millriverconsulting.com Subject: RE: 129 Christian Way Attachments: 129 Christian Way- Disapproval Letter 4-21-14.doc Susan/Lisa, Attached is the disapproval letter for the above referenced property.There are a lot of items in the letter so please call with any questions. Please note there is no pump chamber or retaining wall proposed. I believe this was the prior reasoning for wanting to put the new system in the same locating as the existing system. Please call my cell phone with questions today.978.836.6412. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone:978-282-0014 ext.804 Fax:978-282-1318 irowe(c)-millriverconsulting.com www.millriverconsultinq.com From: Blackburn, Lisa [mailto:LBlackburn(a)townofnorthandover.com] Sent: Wednesday, April 09, 2014 9:31 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Sawyer, Susan Subject: 129 Christian Way Good Morning, Plan review for 129 Christian Way will be mailed out today. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com 1 Environmental Consultant JAMES M. KAVANAUGH, P.E. • Engineering Consultant 14 Shady Hill Drive • Septic System Designs North Reading, MA 01864 • Construction Services Tel./Fax(978)664-2925 • Custom Home Builder April 8, 2014 Board of Health Town of N. Andover - - 1600 Osgood Street N. Andover, MA 01845 APR 0 Y ?U14 Att: Susan Sawyer Re: Septic System Design. 129 Christian Way Ms. Sawyer: Please find enclosed 3 copies of a proposed plan for the upgrade of an existing septic system loacated at 129 Christian Way,N. Andover. The design calls for one variance from the Title V code and the Local Bylaws. If you have any question please do not hesitate to contact me at (978)664-2925. Sincerely, James M. Kavanaugh, P.E. TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES ` HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540–Phone Susan Y.Sawyer,REHS/RS 978.688.8476-FAX Public Health Director E-MAIL:healthdeptt(�i.;totimofnorthandover.com WEBSITE:http://Nxtivw.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: April 8, 2014 Site Location: 129 Christian Way Engineer: James Kavanaugh .New Plans? Yes X $225/Plan Check# (includes l"submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No X Local Upgrade Form Included? Yes X No Telephone#: 978-664-2925 Fax#: 978-664-2925 E-mail: kavanaughj@msn.com Homeowner Name: Scott Whalen OFFICE USE ONLY When the submission is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Title 5 INNOVATIVE/ALTERNATIVE SOIL ABSORPTION SYSTEM(SAS) DESIGNER CERTIFICATION In accordance with the Standard Conditions for Alternative Soil Absorption System with General Use Certification and/orApprovall for Remedial Use, Revised August 22,2013, I, -7 l M 't S kgy,9/.,4vq Designer name(Printed) hereby certify to the Local Approving Authority(LAA)the following: • 1 have provided to the property owner copies of the Infiltrator Systems, Inc.approval and the current Infiltrator Systems, Inc. Design and Installation Manual for the State of Massachusetts; • 1 have been trained in the design of the system by the manufacturer;and • the system is designed in accordance with the current Infiltrator Systems, Inc. Design and Installation Manual. Property Address: Enter property address / �o Y /� `l%, 6r(✓ Enter town name i Signed: _ DesignAs signature Designer's name(Printed) Date: y Ph d � u consulting Crv{I Engineering d Environmental Permitting Municipal Environmental Health Consulting TO: North Andover Health Department FROM: Daniel Ottenheimer, Mill River Consulting DATE: April 7,2014 RE: Onsite Wastewater System, 129 Christian Way, North Andover i It is understood that an undated letter was received from James M. Kavanaugh,P.E. regarding the onsite wastewater system at 129 Christian Way. The current onsite wastewater system is reported not to be properly functioning and there is a desire to construct a replacement soil absorption system in the same location as the currently active soil absorption system. The letter reports extensive solids in the pump chamber as being a factor which might contribute to the cause of the problem in the soil absorption system. i Based on review of this matter it is my recommendation to not allow the proposed activity to be I undertaken,and that the reserve soil absorption system area shown on the original approved onsite wastewater design plan be used for any type of replacement which might be needed. This reserve location was set aside and intended to be used for this very purpose. ' The reasons provided in the undated letter to not use the reserve area do not appear to overcome the concerns about undertaking a construction project in a location which is apparently the site of some biomat. Construction could prove to be difficult to implement correctly and complications would not be known until the existing system is removed. This is not prudent planning and engineering when a system can be designed beforehand and built without complication in the reserve area. i Before implementing a new design using the reserve area,the property owner is advised they might wish to consider a few options that could address some or all of the operational concerns they have documented. While not a regulatory issue controlled by the Health Department,this information is being shared as suggestions for consideration for possible resolutions to the problem and prevention of future problems. s i First,the heavy solids production which was described in the letter does not sound like it is typical for domestic wastewater usage. The owners should perhaps consider an assessment of the operations of the onsite system,with a focus on the wastewater source as possibly being a concern which caused this situation. Certain medications, production of higher-than-typical strength sewage, or excessive flow j volumes could all possibly be contributing factors to the problem. If one or several of these situations I i 6 Sargent Street, Gloucester, Massachusetts 01930-2719 j Telephone 978-282-0014 ♦ Fax 978-282-1318 I info(a)millriverconSL,'ting.com 0 www.m.11riverconsultin,,.com which caused the original operational difficulties remains and is not addressed, it is possible the problem might re-occur with the newly-constructed soil absorption system. There are firms who provide operation and maintenance services for onsite wastewater systems who might be able to assist with this diagnosis if this is not an area of specialization for Mr. Kavanaugh or others working on this project. j Second,the owners may wish to be aware of several types of technological solutions which have been approved for use by MassDEP for resolving problems similar to the ones described. These types of isolutions are generally described for systems which are relatively new and seem to be impacted by solids carry-over and perhaps could be beneficial if used here. To be clear,this suggestion is not a confirmation that these types of systems are slated to solve the problems found at this site,rather these are being mentioned here as a suggestion for consideration of possible means to remedy this situation in a less invasive manner than currently being considered. You will see SepTech/Pirana and Sludgehammer on this MassDEP website as two examples should this be prudent for you to consider http:/Iwww.mass.gov/eea/agencies/massdepZwater/wastewaterf title-S-innovative-alternative- technology-approvals.htmi I look forward to assisting further on behalf of the Health Department as might be needed. 1 i i 1 I IVA-A 14 tt� Blackburn, Lisa From: Sawyer, Susan Sent: Tuesday, March 18, 2014 10:15 AM To: Blackburn, Lisa; Grant, Michele Subject: FW: 129 Christain Way fyi From: Sawyer, Susan Sent: Tuesday, March 18, 2014 10:14 AM To: 'James Kavanaugh' Subject: RE: 129 Christain Way Jim, Hi, I wanted to let you know that 129 Christian Way's request cannot be heard at next week's meeting. The Chairman has informed me that they would only hear it after a reviewed submittal, because it really is just a hypothetical. I jumped too soon on that.So, if supported this would need to wait until another meeting. Also,this office has not been convinced yet that the argument to use the existing area outweighs the benefits of using the reserve area.There is no proof that any of the sand below the system is suitable to 4 feet below the bottom of bed and how would we be sure without digging deep into the system. Hence,the savings in sand are just conjecture at this point. I will continue to confer with my septic consultant, and possibly DEP,to give your request full consideration and will then email you again. I just wanted to start with the heads up that you are not on the BOH agenda for March 27`h Thank you Susan From: Sawyer, Susan Sent: Monday, March 17, 2014 4:04 PM To: 'James Kavanaugh' Subject: RE: 129 Christain Way I did receive your email, however I need to look into it more before I render a decision. Thank you, Susan From: James Kavanaugh [mailto:kavanaughi@msn.com] Sent: Friday, March 14, 2014 3:34 PM To: Sawyer, Susan Subject: 129 Christain Way Susan, Enclosed is letter, as discussed,to replace the existing system in the same location. Please acknowledge email, so I know that you recieved. I Environmental Consultant JAMES M.KAVANAUGH,P.E. •Real Estate Brokerage 14 Shady Hill Drive • Septic System Designs North Reading,MA 01864 • Construction Services (978)664-2925 • Custom Home Builder Board of Health Town of N. Andover 1600 Osgood Street N. Andover, MA 01810 Att: Susan Sawyer Re: Septic System 129 Christian Way Dear Susan: I would like to request to be put on the agenda for the next available meeting of the Board of Health. I would like to discuss the replacement of the existing failing septic system at 129 Christian Way. The system is working, but has failed a Title V inspection. I am requesting to replace the existing system in the same location as the present system. The current system was installed in December 1999. I have reviewed the test pit data/system design and are satisfied with the document content. The pumping records of the system indicate that there were unusually high amounts of solids, at multiple pumpings. It is possible that the high level of solids has clogged the upper, level of the system, reducing the capacity of the field. After a site walk of property and review of system plan documents, I feel that the following reasons justify the replace the system in the same location: Amount of sand fill required to install in reserve area, approx. 300 yds, cost of$7,50 Breakout near the driveway, impermeable barrier or possible retaining wall require , cost prohibitive — Existing plumbing may not accommodate location of reserve area, a one foot variance from groundwater or a pump may be required, cost prohibitive The request to replace the system in the original location has further benefits by keeping the system away from any wetlands. The approved design of the septic system does meet today's regulation requirements, so there would not be a need to modify the layout of the system. Also, by placing the system in the same location variance requests from the code would not be required. The existing system is relatively new, designed and installed according to today's code. We believe that we are proposing a practical solution that both accommodates the landowner and Title V Regulations. If you have any questions or comments please do not hesitate to contact me at(978)664-2925. Sincerely, ti James M. Kavanaugh, P.E. 43 , 672 S TDP FND. Q. c© EL.=177.86 D:BOX \ t - •r 4 - A F{ter. �,.�:"� f/f /,/, �// ✓ / l♦ /'} ` - ol ,.✓ i SEPTIC TANK Y A AS-BUILT FIELD J p DE X 38' LONG- SSEEPA�RATIM BE ITINEEN C7 �Ca Y UNE 0r SEPARATION BETWEEN UNES/EDGE FIELD 3' AS—BUILT LEACHING �+ AREA 912 S.F. lb Y �� r O)A `tW TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 3/23/00 This is to certify that the individual subsurface disposal system constructed ( X) or repaired ( ) by Arthur Hutton at Lot 1 Christian Way Ext. #125 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 will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER SENVAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal Syste:n \A constructed; ( ) repaired; by !�v���v `� ��.. s.r �c located at '_OT- opV_, was installed in conformance with the North Andover Board of Health approved plan, Sysrem Desi- .Pe.^lit dated with an approved design flow of gallons per day. The materials used were in coafor-nance with those sneeitied on the approved plan; the system was installed in accordance with the provisions c 310 CINIR 15.000, Title 5 and local rea-ulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-buil which has been submitted to the Board of Health. Bed inspection date: N07-;2.EQu13v CONT/)-4,-. Engineer Representative Final inspection date: I?,// 9 ArM&C-L-<e/,-ye-i�F-- Engineer Representative Install r: Lic.m: ;7,7y Date: Design Engineer. �2/ Date: d FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from- Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. �FPLICAI�T FILLS OUT THIS APPLICANT 111�il;J,4/70 Z PHONE LOCATION: Assessors Map Number PARCEL SUBDIVISION z � ���� LOT (S) STRI=ET C1�Ji� S °i�I 1/►�A f Gx7` ST. NUMBER �Z<S OFr1C1AL USE ONLY RF.C, QMMEND TIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED z DATE REJECTED COMMENTS i1�-��� c'► U a TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED I NSPECTOR-HEALTH DATE APPROVED' 22Z) DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY BUILDING ii ISPECTOR DATE Revised 9197 im c.. 'sem. LOT 1 43, 672 S. F. ± g TOP FN D. EL.=177.86 .., y0 9� �L / TO 6l5 / ppb �p �/ g F X03 / PLAN OF LAND A ILAN 11C ENG/NEER/NG & JOB N6 SURVEY CONSUL TANTS INC. IN 97 MWNEY SIREET - SU17E:5 SCALE 1 N . ANDOVER , MA rZORrZTOW, MA 01833 ON THE BASIS OF MY KNOWLE DA TE- OCT. 22, 1999 BELIEF I CERTIFY T0: .e�e.z.. r'TflAlr .�.� rnnoei f - _ Town of North Andover, Massachusetts Form No.a • pORTM BOARD OF HEALTH 3r � " c 19 # c ^ r DISPOSAL WORKS CONSTRUCTION PERMIT • 'I pDAD CH Applicant Applicant 3 . AM ADDRESS � f , l TELEPHONE Site Location Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption , Sewage Disposal System as shown on the Design Approval S.S. No.ZLIU CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. I , eke 1 ',` :' is ,.,: A, , ., " s'� i •. M �R - . FORM 3A - CERTIFICATE OF COMPLIANCE No. Fee COMMONWEALTH OF MASSACHUSETTS Board of Health, N, k4lPfy eW , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) R1 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( X), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at: LoT / c#1?15Tl4AI w/1-1� 6-X7-e-NT1,fN has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow 13 (gpd) Installer: Designer: ** Inspector: Date: %.Zh 9 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ** SEE ATTACHED ADDENDUM DEP APPROVED FORM 5/96 Atlantic Engineering & Survey Consultants, Inc. 97 Tenney Street — Suite 5 Georgetown,MA 01833 (978)352-7870 — Fax(978)352-9940 SEWAGE DISPOSAL SYSTEM / CERTIFICATE OF COMPLIANCE ADDENDUM DATE: SITE LOCATION: be Commonwealth of Massachusetts Form 1255, last revised May 1996, requires that the system designer for this"Sewage Disposal System" certify that the above system has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans. Atlantic Engineering& Survey Consultants, Inc. (Atlantic) was not been retained to provide any construction supervision, inspections, soils analysis or layout relating to the sewage disposal system and as such has no responsibility express or implied relating to said construction supervision. Atlantic was hired to perform the following services during the construction phase of this project and limits certifications to the scope of these services. 1. Stakeout the corners of the proposed system structures. 2. Provide a project bench mark. 3. Stakeout any lot lines less than 10 feet from the system. 4. Field locate the as-built septic components and prepare a system as-built showing the horizontal and vertical locations of the as-built system structures. 5. 6. Atlantic Engineering and Survey Consultants, Inc. and its officers, directors, employees and agents assumes no professional or financial liability for any erroneous or unsuitable construction related to the installation of this system for which Atlantic was not providing service. The issuance of certificate of compliance by the approving authority shall not be construed as a warranty or gu antee that the system will function as designed. ,g artin M. Halleran,P.E. D:\Files-WASeptic ForraASEPTCOMP.WPD APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE LOCATION: L O F 1 C h,.✓5T.',tw k) 0 � LICENSED INSTALLER: Vi 7-6,) HL')TTa r, SIGNAT TELEPHONE ��� _� 6 2r CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 575.00 Fee Attached? Yes �' No Foundation As-Built? Yes '- No Floor Plans? Yes `�� No Approval Date: e:a:=x ve&+r. ,fir GEDpR BIDILICf C17rG�6t GEDAfL 31Dit1Cclte>:Cr. ° - t--:Qdm tr r pli -A,14 FL -- cc's Y" t �( co:i_ - (ZIGr-,L ve"T \ C - � � p�(h1Al.T gHIkIG�Le3 all 1S1 �T�'IItFff-n � a ILIA -- rrn_ _ To•P - 0 0( -- _ i i � -mue. w/ I Ice ��,,,rc�•,. -=- T �-, t X r-L — — — - FIPST F1 FLc i 147 5,F �t�oF_Ip ��e t I a? ��F .- __ VA .. ALL DIMENSIONS MUST COPTRIGHTWO L u:VERIFIED.BY CONTRACTM I(tl?To at-us L. 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L 3t-9N r-ou 31-911 il'olr U'-ofry GPTtO"A,L CAi ac4e 14 G r ti F105T Ftc37V— .1-7455p, Fie FL cv /4 1. ALt otMeNstava Musa ! Y SE VERUlIED-ar CWTTRACTOM-: NO•tT Do'NOT SCALE-DRAVVMGS. tlBS•U®- . i �JD�-OII 6�•GI� I�-GII 3'-+�II I 10.�11 / I w 4--4IL I Iw t m j 51 lop NY �- I _ �1 Z <� - n o N L � m 4 N O Ic Z Di f F 1 O i � Q v G.J.BRUNO ASSOCIATES ARCHITECTURAL DESIGNERS !G 73 28 BERKELEY ROAp N.ANDOVER MA 01845 N 2o'-0j' x'2 g* I I t V I I IL�u II-%" 9-, 91-GI MO M•o 3 1'-pl' i31Gll lo'-�I' `L9i-It ; eera1L111.aCj �-- —..-- ------y' P — — 4Lp GL DIZ_ G CGd'�I D De - Fri 'I t2be g I ` 4 Id' - --f2�I � w,a,ta5�-ri_ t3M u I Q 2 i KTI - .— — — —_— — — _-- i 9'-��r 3'��IZ� �� W WPT4 � 1 I� 1 __ + I Z-3/2K11�8 I I I it Pa¢a I I,a M bM; Z'G x t2U BTZtPin - I WALig$C�ILtIk{ { .. I O w ¢ `� L�,�GII gTUD✓ I _ I z Y> KIALL I PPQ3T WbLI.. U w o Lum¢ -- - - - - a -- — I co z A/�� COM P4CTLD Gf P•4dF.L — �. Gxr, klawwM I&II-f ovEe HEA�r- I I' a F. GMIL VAPM ZF.TF, N - 1 1. ALL rWrr-RIFI D 1335 t413T COPYRIGHTED I - DE VCRIFIFD 6V CON'lRACTOR. + NOt''1'O BE USED �!''^• PERM1.SOON - 2. 00 NOT SCALE DRAWINGS, �MO� ��;" ,;�;'?+•�y A.wslw EDAM 1.►100!.6=MN spact .0 p.A.t.alw/10 p•..t.O.sd 2./2005 l fLOIIN6 ieACs 20 D•A•t.11Z.p.s.t.dA d J.t00T >iti•/10 p.A.t.dAsd 1.ARSE Maw C CRULUIN"S"O' 1/260 2.C anew C-cm NSiaa 1/260 n C.s,o u=LOAN ACiSS 2000 N.A.t. SOSSt rtiw C A110 DLSS.00Y25x0Y� CO Y 1r1TS SISM Wos.vto cows AND TA31Ci&CR.�Ae...IMIUM OS SUCKr SOMte• INw,Nt>0 w NTDsszATle iOrLY IOT r0oau TAOTsrxouL silriiN. , x•>ZO ON w 1000 p.A.a. tR DaY seAYNR)w t-SA1m w arpeL.ILL NITS 46 110 NtrotO Rasa, lOf. A.ADIOrxw SM"a 6 FOOMar3000 p.s.l.'(IS DAT STIAIOtSI 1.�IO�r SLUZ Y nu=w.rD2A1011Ar OR zp0 TILL SDA OR-O RO MIISa Or root mamram cors r WNW trio". -,QOR•fALT dHIr1GLES' ..o�vwem ssALL.Drrwz A NAmlw Or,•-s-•-.••-^-^p / D.s.tor.DerR.(AAsamN:a)-Ts Coare or Are.Acac COASTMO msC"D y. y A� a.asgo 2w-(rNisaoa an==am m m.l-TND rcr sar Roam rQa 1T (6 F'G•l•�F�RDI� TSNrms saTeluwOrtNs. . t.ADwoat2r wn-arTus A.6-aasa Ai _MW OR 66uTnxNa or y��(�• - _ :=,=171 AftltlR.lRt ar i0ilT6 SO 1N WVOm N/1S/RLS ANO A=`w Is' µ GTT FP t2NItR, w wAR6=TIIa J/16•IY ROT TO TC_OT T. 012CS" rsonctzw-r awns n taco eaw 20,00" Pyr Q�.�eg a ANeo scv-6•:a]•.=Ames 6 s•w•o.c. n t�� ••a.iLi. -�'A?lYCSV MM AOII.IOT A.1f1•w. �I 1`n poop v x -�- I!.!'4'G- S. .Zan D1RRRw.,ISOtiw•i•Sam.HOOD am OF ATT RIATX NIDlf m6tt0'P TY TOS ITSOGS Q ALL s as"S NIR 2/t•DLA SM" ALCw®AS]•-O.O.C.Q T TASTY W. ANO _ JOSAR. •S. IaOYI 1.srsa-6 J w•srw•GROOS SIG H n I roll a-a 2."Im•oRYA-N•1.300.000 p•..a./ra-T.1se D••.a. V2b-I 119ULe_. I. Tar A OU 2_1,200.oeo p.A.a./I�1.OS0 D•s•1. _ 6.N:Au.Tanmu-6 1 oArN. Cour fS l CHLlfE - .z•t"JC 4° fe s.masa oemortY srn•rwrtset blDOww JD.1M OAOY AUS TAaAiJ A't PAMS OTYIAOS. I AM I�l a)1N2 CROSS SRIMM 6 AACa MIST rY s.n 1. CORSAOCxir 1.ONNsiAL ROOAs-I/]•R.YNOCD IC-0 32/16 IR'AAA N/STT. 1(/2•RYYOOD(NmtAI.AS S COMass,SA)NITSAS pIAIsA SSTYS wOaaAOIAkTt0Aw-CiOSS,A ® -CrmY Sam ._-.-.._ .._ vtuowD tAT-ADA). C.aaar SOMRS" a 11� 1.( 4-1/2•R•Ytt000 IC-D 2t/0 Irr1'AIA N/en.MUS) G m (.OMORI}` 1i'a/AIN.IN6mATiw NprD NITS DIAWNAL 46 CwnisSO ,lQUT fs- i.AODI-1/2•pLYNo00(C-D 24/0 11R ANA N/NAT.-Ol D. INTSIIiw TraxY I.amzR\I,D zts'oSSYYISS IADIUTfO.ALL INTIRIOR RA-8 6"III= I Tyv�1..- AAI -- TO as COVWD ITS 1/2•Ciltw SMAR"'l SI rRAi.COMB ORIIID 1.iTARD i eAAwD. U.CASs A TDIIaT2A�A SAM RSSISSAMT /O1T SOAs0sSG11. 6.diati..*_ye. A.MLOSS OTe 34 OOTID PAMCISt 1.asmATxw R-if t•ALL SXfmOS NALUS. {//\y a_!9.IN'.LaDr apoe DNSERTED BpACAI I 1- /�.� ^1 �.� "t •v_"- A-]0 IS^'�M•'•`•CaiuNaS ATTACRD DIRLTLY'SO AMP 11-20 IS TOT TILOS CRxLirs 2.VAPOR NAXRSJR-IIITAIS.A 2 NII.-TmYITSTLIDIt VARA AANAIIDI w TSI J.NmJr"iss uaa nturz�'o11 mwAas AT Ara SYTdsxaa arAss AAGN 1 11 U to s auras IN ALL NLIDINa-5 Dooss 6 NINIaNN was TSAN Z>I L pil[�'� ��( ----a/►J-� //-�-I- - -/y II- I OI I -- JO•As-S TY nL .CARCt rocAL LVDP AOS a aSm 0A0UIRTIOfirl. Il 12�' �.ZriCld'(rC27F�d•�TE25 �I Ad ZI')'4.1 COLLAL-TI�3 3Z°a,G // Z° 121'21CYgt~eM LII1C10' 61:ILIL�GI LIOIgT 12" e Irl a•�_--�\� � ../. __ jI` IZX/Il E'zUL u - - !i°.IfiuOO 22 <4 -ro p ?J'XfJ`tI�S dYLuO 2�d11.16UL eErAen.a KJALL =+ rT - -- - - �I I�- eiFip loW ,cry CN , o Z' 8b G+ULu Jc:1 LJo,m H2.5 rem `n yuptd1 FI L131gT, an B b��46- i e6WF eAF-fMe ((n w 7i la", �I _ - F- z C)In i �2"X4"3ruvs @IG" iTOF a c7 I 0 y Est t ( V w o ►JO ULRQ Q - .1 r �_TO,P ,; 1 • Ver _. ( � � -�W.� 2°d4°'�P1t79E1(�'OG(� o r, 6 1 L K.I I. - -- - i 2ui(idl�ml:Lbl�f-tGtOC z F x> 3/SII r C1 IST`PL O w n L M.¢ rQ.G. ger •. -- =N z ---- - - 019 Wim' I itoxc}5 CI�1Z1'CE a -tk9TL �M ( .{_ I `�-fL 19 1�►gUL _._.._ Z",ti?11 � 'i �Z-Zp,c6°91LL pTtJ � �-_-__-- _ 4us: �. C�.i ,_G l yr✓iF: C 4' ,�I u}ILL �5F1SL i (---�-/�C g�'Fiez 3N1�1.(7� {Alii at, � �14 APOHOZ M,T� �t t�C�1 L I -I FfJ_F_$-. TPS 6 I G`-ot'Oe - I • f 4° Ct NL' 1--:L - �'" II)(�Zy �"fZIP (� •.FTCr IQVE.I7i GOMPA(::TSr0 ��.v�.. 1. ALL DIMEN'SIONL 111UST COPYRIaNTED ,,It-�I/- �I �' - -/J- -+ �✓-N 4'�J - �: //'I( (�.#• ID LAI.M I HE VERIFIED BY CONTRACTOR. Z.{ F le �Frt+j i I 2. DU NOT SCALE ORA\ZINGS. rHONOT T EH USD LE OSA G M I L VAGGts ZEC. w�ia«rr esA*QsaoH Y �, ---1- 3-0 4 f!�11. ��1 tl I i I I p 21 t6r �oF IZdF�!<PB' I f T i I-:t" tdl 7dFTEtZ 1011 O•G 1 I I t I I�1 rOG�I ,jI f I 101(.0; vCr.RT, b i I I i �{ O✓EZ FAMtL el 1 �� I I l I th 14NT 9T012K3E r�'�I C�GI��j� I �_�1 1 ' f I 1 41 Me&LLAM Flt-j I F�A11HPLAN --- (/��Ire• //��, - 4 e�I 427E r4&F`r5? I 0, ILIE-- - 1 ow a4 c5 rpw 1 d' a E' o � 1 I , PTLJ zil it- ]PULL a cc 1 TAMIL 2Mz Y> ! wo ><I -44 i I - t x H I OX45 1 m t�Yi m zQ T� �M �- 2 3,5,r1.81 j1 a tl__ ULPw;o�c4 t G lam`O G I -2.2"740, 2-3.5 C I I•B7 �� I 5i(IZI' } - - P•4P.J:t.LA'r'f tG�4M 1 -`. -��M,�esl.�.AM 6NI; • - ! HEApm&vee ; `°u l" I �r �7I 045T FOAM I � PLA �4 COPYRIGHTED I 1. ALL DIMENSIONS MUST !t-_ t- BE VERIFIED BY CONTRACTOR• -_ NOT TO BE USHD y. 4 2 DU NOT SCALE DRAWINGS, - -- -- ��� -_ VVMOUT FERMISMON t - 4M1.� V i TOWN k g Z� OS �YSTEN-1 P(JMP1NU KPCO 1.. OCT 0 7 2005 �YSr�M t7�YNRR �lgpitLSS .�-� _-,..__ _7-- -,_�___ TOWN OF THANDOTER. 5l STEM i.C ',� AL �.q ��JZia�C.v� �� �►�'� �7'"oh t o'� f-frJ�� DATI OF PUMPINQ: 'F� Q�JANr1ry ?�����.._._. FSE. � '-'0SPOOL; Np-- Yt;� `A rVKb pP s�xv,c : kvvriNG UM�ttl(Y J. � ROOD MUMS SOUP& �. Pt,UOD�p p KUNsn<:w, Y4LlDCARRYpYER., — OT�fGR EXPLAIN l'VMM�Nr�. Commonwealth of Massachusetts City/Town of �I � �013 AL3 System Pumping Record Form 4 HEALTH DEPAR DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatioefteft Rig front of se Left/Right rear of house, Left/right side of house, Left/ Right side of builtti g, Left/Right front of building, Left/Right rear of building, Under deck Address V)�Sj \c —D "\ CitylTown ��� S Zip Code 2. System Owner. Name Address(if different from location) Citylrown Sta� 7 6c:? Zip C'ip ode Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system. ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi 'o of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: jBign . Lowell Waste Water Hnaulelu Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of OUN U b 2012 j System Pumping Record Form 4 TO_HEWN ALTH D PARTM NTF NORTH ER � DEP has provided this form'for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatio . L lg front of house eft/Right rear of house, Left/right side of house, Left/ Right side of bui Ing, Left/Right ont of building, Left/Right rear of building, Under deck Address �. �` r� w City/Town State Zip Code 2. System Owner. Name Address(if different from location) City/Town Stat$^ q r — ,7 p Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Vo If yes,was it cleaned? ❑ Yes ❑ No 5. ConditionpoC)�em: s q _ � � U-�GC� ,�J C.J� . 1 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location contents were disposed: //G.L,S.Q Lowell Waste Water Sig4tufe I Haule Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 4R "I Tvil T� ANDOVER L 7 2008 DEP.has provided jhla form for use by local Board* o the t by +ubml(jed to local Board of Health ras �a4�gb�i P' o ocher ep r D5� Air TMENT A. Fgclllty Information -.-_ vr,.wrrdn Nj�na oul 1. System LvaUon, cYt1y lne lab koy Addras� -- .curia 04 •CI ' use' -,,v; : �Y v,�Glwwm,4i, ')',':.. ;+.y ,v A'I1.�y�.,,•'7. 1i 1', � '•'•' ..'fid i,' .1 q�""TS11 :51+'ft,�•,�,a.Sygrkam{Own,e�n;, .r.j,.• ,,•; �'. i 7 'ri;'' •'j'!�'tNtlTll i,ti• i..,1,r•, )..,:r, 'S'.1.• ''� ;�'i'Addrei-i (IldlNerenl rom buUon) Ckq/Town Stage TJ Tolepnone NvmOer - Y�6t',Purn pin Re�ord r -- '.� (h.f..'V'Iti'v't�i�;,',•r,,?n,,t,.!!'Y-CLQ'{'r,til.i,/.(•',�' l.f/ � fl Pumpin9 Dole 2' Quenu ry Pumped: -- YPa P .ayacem;, Cl ✓699p001(9� ❑ flc Tank >, C] T19N Tank ;' ,�❑<.Okher(describe � ���• El�uoril.Too FNe C.P+qsenl? .❑ Yes o I was Il nod? ❑ yes 6,l�ti.`,.OnVI�Pn.Q.(,8/; rrn.' • .. � � r f4 6 Sy P4imped ay G .' `'ayilji'•i'Ir' �')1 '� ir11�+Sw,h�i i'1 d iii Vi. :,� U e n+e Nwnber •. ,'+�r`. 'r%+�rq„c,•'��'�r✓'N'li1aA 1” ti, a on where oonlenks'wora dl�posed; , , ':+ � � ; S ` l,�r` ''1 ti'l'l{1(,,�•�!'y`!i'•�r�l .�lY �1//n• ,t .r 1.;;,' � \.4t,�!y,GrL{,•,i t !J•r��'..�;:�.'., �/.F��• W (/� • ',.,;�::,��'�%o; '%;;�.�r�.'./,!;S�pna•lule G(HeVb 1,. .. ha,?�AYYW'mass,8ov/dep!wales/approvaJs%l6(orms,hkm#In9pecc ..Tr�.Coa RAJ a t Lot & Street (,(��' �-Gt��,� Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: PSNO Permit" Plan Approval: Date: //�� Approved Designer: Plan Date: Conditions: Water Supply- Town _ Well. _Well Permit: _.Driller: - Well Tests: Chemical Date Approved Bacteria I Date-Approved Bacteria H 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? l YES NO Well Construction Approval? YES NO Septic System Construction Approval? (YES NO Certification? OYES NO Other YES NO Any Variance Needed? YES NO FLNAL BOARD OF TALTH APPROVAL: DATE: 3/�3y APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? ov, NO Type of Construction: N-EW_ REPAIR New Construction: - -_Certified Plot Plan Review 'ES NO -Floor Plan Review zNO Conditions of Approval from Form U YES (N0 _Issuance of DWC permit: - NO _DWC Permit Paid? —. NO - -DWC=Permit rrInstaller: 2� -- Beiinspection:_ NO - -Excavation Inspection: -'Needed: —Passed: _ By: i _ _ r ._Construction Inspection: Needed: As Built-Plan Satisfactory: YES` Approval of Backfill: Date: By: ,nor r .1 A,/\j ---Final Grading Approval: Date: By: Final Construction Approval: Date: Z,v By- _ Certificate of Compliance: Approval: Date: G' i' _.�•6, 'j� *'�,_'1 .. ..-, 'r'i �' . rl:lx^lr7 ,r ll.fy¢a aM1 i!}„ ,i { ..:.N•y i . .... ., .. .-, . . .. ,ORM zz SOIL EVALUATOR FORK ` Page I of Date: X3/5/98 No. Commonwealth of Massachusetts /V Massachusetts Soil Suitability .A�ssessrnent fol- 01 -site. Sewgg ,Dispgsal Datc: s h2,I b Performed By: h",At�Tlh E;A�I t=RAN AnAN70, ZU4 ---------_., �--�t— ----� Witnessed By: E Loauon Addrus or LO7 owme'l Name, MA R(�RST A N-mw E t LA r3 R W C 5•A R M — nearui,and 1111 cj ATEw ODD D R L«r NO RTµ AN'poV ER TC]CPIVM r A LE:xAt4I?R1Ac U� 2230 New Construction ❑ Repair ❑ ' Ofrcc Rcvicw Published Soil Survey Available: No ❑ Yes 1 D Soil Map Unit. •'D_ -- Year Published ISZ - Publication Scale y,1�13G Drainage Class - Soil Limitations +— Surficial.,Gcologic Report Available: No2' Yes ❑ Year Published .. . — Publication Scale -- Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No UYcs ❑ Within 100 year flood boundary No zYes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current'Water Resource Co ditions (USGS): Month --- ormal ❑Dcicw Normal ElRange :Above Normal N Other References Reviewed: DEP APPROM Nonni•12/0765 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 3Rook FARM — LoT I On-site Review Deep Hole Number 19-1-1-1 Date:....51W15 Time:.: . II 15AM Weather Location (identify on site plan) Land Use \14cx=9>r=Q — Slope M Surface Stones . Vegetation rot=REs-r Landform , M>17WA46AA VIA i til Position on landscape (sketch on.the back) . . Distances from: Open Water Body .4 100' feet Drainage way Glob feet Possible Wet Area < too feet Property Line L t o feet Drinking Water Well 4 too feet Other DEEP OBSERVATION MOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) IU Y R . I 1 A L: 3f2 .. lD YR 29 Io Y R Mot2E5 � 4g« 10% 121 �- S.L. 5 -t,SYR MINIMUM OF 2 H - 101 o3cLI 131b), USIA[;Ull a Parent Material (geologic) VSQC.6&JQ1�L C-3 wAStk DopthtoBedrock: Depth to Groundwater: Standing Water in the Hole: wwo Weeping from Pit Face: Estimated Seasonal High Ground Water: 45n Mx tAQ-MES -- UCP APPROVCD FORAI.12/07/95 ,(a:iC:l:v:'r.•.r:rel�'�r: .. . FOIZM 11 - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. 1312 f;,9 F k ;ZM - L ' ,Determination for Seasonal. Hi h Water Fable Method Used: D Depth observed standing in observation hole...H.wp .. inches ❑ Depth weeping from side of observation hole .......... .... inches a'Depth to soil mottles .'f$..:..:.: inches ❑ Ground water adjustment ................... feet. Index Well Number .................. Reading Date ................... Index well level .................. Adjustment factor ................... Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YE5 If not, what is the depth of naturallyoccurring pervious material? Certification I certify that on Lt (date) have passed the soil evaluator examination approved by the Depar of Envir .nmental Protectionand that bd ave anaence was performed by me consistent tion it the required g, expertise a described in 310 CMR 15. 7. Signature Date DL•'P APPROVLD FOX,N1-12/07/95 i.•.),Ii iNh: ti.• .. - r .. 1 (: �JI..•t:!.�a�.+i l-.1'�.. 1., i,+ .. .. FORM 11 - SOIL EVALUATOR FORM. Page I of 3 Date: 8/598 No. Commonwealth of Massachusetts Al. �q„l��QeV,, � , Massachusetts 8-oil Suitability ,Assessment for On-site Sewae �isal Date: Performed By: ti",AZcu4 "A� F_ts.RA ATA "^Q ► ,. Witnessed By: E T L=a on Addru►or p R MY, FARM -LdT / o ter,rra MA RGA R£r A NTOW E L.LA Address.and 1111 CZ A'TE-W ODD D R NORTH ANVovER Tdcph xI q`EXAq przlA VA 22307 ew construction ❑ Repair ❑ ' Office Review Published Soil Survey Available: No ❑ Yes Year Published al Publication Scale 1 SJUO Soil Map Unit. _ Drainage Class - Soil Limitations �S 13 C o F�2ioC,� Surficial.Geologic Report Available: No 2 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes lJ Within 500 year flood boundary No UYes ❑ Within 100 year flood boundary No UYes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current•Watcr Resource Co ditions (USGS): Month --�---- Ran a :Above Norm Normal ❑13cicw Normal ❑ . g Other References Reviewed: DEP APPROVED FORM-12ro765 a FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot.No. 5R00K FARM --Z-Of/ On-site Review Deep Hole NumberTF-'1'('91N Date:...bIZ19% - Time:.. 11 TO l' Weather L � Location (identify on site plan) Land Use O 0 0 Slope M Surface Stones . Vegetation . 02 -T— Landform . Ou-I w dt Std /:It ti Position on landscape (sketch on the back) . Distances from: Open Water Body .66 0 feet Drainage•way 47106 feet Possible Wet Area Z'10 0. feet Property Line /0 feet Drinking Water Well 10 d 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) to YR Lohse 10 Y R FKIABLF- 21 8 101R, MAse, 10 YR' 6/2. nizm 122 C, 5.L . sera � 5 � • 5/ c o et��s J.SYR . 5/8J. MINIMUM OF 2 /� {OPOGLDDI9jJ {. Parent Material (geologic) � fYL1�G)*t OUT-LUA � DopthtoDedrock: Depth to Groundwater: Standing Water in the Hole: I ZO Weeping from Pit Face: Estimated Seasonal High Ground Water: 2� 11 e;Y M L7fn-4CS — DEP AI'PROVI:D P0101- 12/07/95 FORM 11 - SOIL EVALUATOIZ FORM Page 3 of 3 I; I. li Location Address or Lot No. 132oDK -ARM — LOW � E i Determination for ,Seasonal High Water Fable Method Used: 2Depth observed standing in observation hole...120..... inches El Depth weeping from side of observation hole .......... .... inches IJ Depth to soil mottles .2..(0.:.:.:.: inches ❑ Ground water adjustment ................... feet. Index Well Number .................. Reading Date ................... Index well level .................. Adjustment factor ................... Adjusted ground water level .......................................... Depth of Naturally occurrinct Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally.occurring pervious material? Certification I certify that on "l (date) have passed the soil evaluator examination sis approved by the Depa rent of Enviro mental Pty trainion ing, an d experd that the above ience was performed by me consist t it the required9 described in 310 CMR 15.01r Signature Date U �� DLP APrRor•ED FOR,Nt-12/07/95 Loci of Test . Pits Brook Farm , North Andover , Ha.= _achusett'= Date of tests: April 14, 198 Board of Health Agent : Michael Graf Lot 1 Test Pit 41 Of - 2' Top .and Subsoil 2' - 8f Silt;: Fine Sand ti Water Table Test Pit 42 Of - 2'' Top and Subsoil 21 - 8f Silty Fine Sand Water Table Lot ` Test Pit 01 Of - 2' Top and Subsoil 2' - 7.5' Sandy Till 2' Water Table Test Pit N2 0" - Y Tori and Subsoil - Sandy Til '( 31' Water Table Lot Test. Pit 41 Of — 2' Top and Subsoil 21 — 8. Silty Gravel Wat Table Test Pit 42 0 - Top a.ndy_b_.ail 2' - o' Si 1 t;. Gra Water Table