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Miscellaneous - 1312 SALEM STREET 4/30/2018 (2)
1312 SALEM STREET , 210/106.A-0160-0000.0 t y ?II. V— W I a ,,'1lmonwea1th of Massachusetts. - Title 5 Official Inspection Form ✓ , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l 4c �" 1312 Salem Street G.,y SSB Property Address Michael Cron4n Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. City/Town State Zip Code Date of Inspection forms may not be altered in an Inspection results must be submitted on this form. Inspectiony Y way. Please see completeness checklist at the end of the form. Important:When A filling out forms . General Information on the computer, OCT 15 2013 I use only the tab 1. Inspector: key to move your TOWN OF NORTH ANDOVER cursor-do not Kevin Usilton HEALTF,nrP&PTracvT use the return Name of Inspector key. Wastewater Treatment Services Company Name 44 Commercial Street Company Address Raynham Ma 02767 City/Town State Zip Code 508-880-0233 S113528 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Fu het E aluation by the Local Approving Authority 10/2/13 I n s p e c for's Si dnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 /,monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street - ° Property Address Michael Cron an Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f — Commonwealth of Massachusetts 4 - -Title 5 Official Inspection Form = = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street - - Property Address Michael Cronan - Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND"(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The - system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form = _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M a�" 1312 Salem Street Property AddreSA Michael Cron.an j Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No 11 ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Forth: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 1312 Salem Street Property Address - Michael Cronin - Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 - 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- 1 0,000g pd. E] ® 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 w 1:1 ® I II e 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 m in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 ` Commonwealth of Massachusetts a r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - ��M ,•'r 1312 Salem Street - - Property Address Michael Cronan Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. CityrFown 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. ® 1:1 approximation 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): 440gpd t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts m Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street Property Address Michael Cronian - Owner Owner's Name information is North Andover Ma 01845 10/2/13 - required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is designed for a 4 bedroom house @ 440gpd with a 1500 gallon 2 compartment tank - with an I/A technology(FAST)system in the 2nd.Compartment for treatment, the effluent then flows to a 1000 gallon pump chamber by gravity. The effluent is pumped to a leaching field @ 9.5'Wx56'L. Number of current residents: n/a Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd))� 68gpd Detail: attached a copy of the water meter readings from the last 2 years, system is under the design flow. Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No - Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No _ Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street - = Property Address Michael Cronan - Owner Owner's Name information is North Andover Ma 01845 10/2/13 required for every page: Cityfrown State Zip Code Date of Inspection D. System Information (cont.) n/a Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? um in Reason for pumping: g Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system-(yes or no) (if yes, attach previous inspection records, if any) ® Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract - ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): _ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 515 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street - Property Address Michael Crones Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 7 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3+1 Depth below rade: feet Material of construction: ❑ cast iron • ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): All piping looks good, no signs of leakage and venting is good Septic Tank(locate on site plan): COT Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) The septic tank has access covers to grade over the inlet tee and the baffle wall, as well as the FAST system observation port If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon 17'/15" Sludge depth: t5ins•3113 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 1312 Salem Street G'I,M yVey`ey Property Address Michael Cronan Owner Owner's Name information is North Andover Ma 01845 10/2/13 - required for 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 4" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and.outlet tee or baffle condition, structural integrity, - liquid levels as related to outlet invert, evidence of leakage,etc.): The inlet tee is in good condition and the structural integrity of the septic tank looks good, no signs of leakage or infiltration. The baffle wall that separates the 2 compartments is in good condition. The 2"d compartment has a FAST system with a builtin outlet tee and the liquid level is at operating level for a FAST system. Pumping reccomendations were made due to the scum layer in the settling compartment and the level of sludge in the 2nd compartment. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1312 Salem Street _ Property Address Michael Cronan Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. CitylTown 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•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,•''� 1312 Salem Street - Property Address Michael Cronan = Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 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 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.): 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.): The 1000 gallon pump chamber is in good condition and there are no signs of leakage or infiltration. The chamber consists of 1 pump and 3 floats. The components were tested during the inspection and are working as intended. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: - t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form M1 a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1312 Salem Street Property Address Michael Cronan Owner Owner's Name information is North Andover Ma 01845 10/2/13 - - required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: - ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: -3@56- El 56'❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of hydraulic failure, the vegetation looks normal. No signs of ponding or damp soils. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts R W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street Property Address Michael Cronan - Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts aro Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1312 Salem Street - Property Address F Michael Cron an Owner Owner's Name information is North Andover Ma 01845 10/2/13 required for 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts a W Title 5 Official Inspection Form = _ m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1312 Salem Street _ Property Address Michael Cronlan Owner Owner's Name information is North Andover Ma 01845 10/2/13 required for every page. City/Town State Zip Code Date of Inspection _ D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4+1feet 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: 2005 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Established ground water from the design plan on record with the Board of Health Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 Salem Street Property Addresp Michael Cron,an - Owner Owner's Name information is required for every North Andover Ma 01845 10/2/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked - ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 N/F HU •_. R °�° I 11 ELEV100.00 (ASSUMED DATUM)HTOP RIGHT CORNER OF CONCRETE PAD. 9y�SF c 0) BLOWER /VENT C ' LCOVEREOK ON SONO TUBES 9� IN •••• ::::::::::::.. � �.t, :: ......:•::.:. PRESSURE ii%iy;.y$jy};,• WATER SERVICE CLEANOUT ................TP4 99•aeiiii:':iir:: ........;............500 GALLON MICRO FASTPTI TANSE C K . .r : .. .=............ ........................................................................... ...................... ..............piiXii (. .....g............. 1000 GALLON ::.:.........:.:.............PUMP CHAMBER }} .........:::::::.....99•s. a ;: xisiiNct•.• irks ;;;4;iiirti:•:':;i:::i:i;;+:;:.i;:.....: :�i:::9B•89 ® ': ^::J:: .. . ...................................... . `' iiiRN�WAY'ii iiiii}i::-.*..8B• $ R35iiiii .....iiii iii.."':ii:iiii ibR0 PIPEN F MO•PfOL ... ... .INSP TI N EC D 3"SCH. 40 PVC \ \PORT TYP. i2;"X.:7iC{i{iv iii'5ii%iiiiii.i:( ) FORCE MAIN \ \ \ '•+ %it ''r' i?iii iiii:�iiiiiwi{t48:iiiii..:iii:�....:::ii rii:::..........-:iii ii: ......... iii::.LIMIT.OF SAND ro N F DONOVAN m �BTP2 / ...........i•. z - -- - - •..::.:.::..•iii ... .......... .......... ....................... -A + ve•ee 9e sa is^::i�'. • N ai:xt;;'%;:iiiiiOp 9�M 54'. 509 6' ................... o __ _ N ;.: O 9 y \ CLEANOUTS (TYP.) 96•]a 5 '14"W �,.. W �'� \ \ 9 0 TPI 4 40 MIIl IMPE�GIOUS i \ •.•`•::.....iiiiii�ii. \ \ PT1H / BARRIER../ e.•s�i \ =:ice s 94, --------------- �i `——————————————————-—— C> O -------------------.— CW tT CD N/F CARR a Cil] 20' 0 20' 40' 60' RFuC , .. I:e: Summary Record Card generated on 10R/201310:03:32 AM by Maureen McAuley Page 1 Town of North Andover Tax Map # 210-106.A-0160-0000.0 Parcel Id 17304 1312 SALEM STREET MICHAEL &JENNIFER CRONAN 1312 SALEM STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 3.7 Acres FY 2014 UB Mailing Index Name/Address Type Loan Number Activellnact. From Until MICHAEL&JENNIFER CRONAN Owner 1312 SALEM STREET NORTH ANDOVER,MA 01845 NEILSEN Previous Customer Inactive 6/4/2010 1312 SALEM STREET N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name ActivelInactive Bldg Id.17408.0-1312 SALEM STREET Last Billing Date 10/2/2013 3170078 03 Cycle 03 Active UB Services Maint. Account No.3170078 ' Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63518 7.82 1/ WTR WATER 01 ALL METER SIZE 342.40 /1 UB Meter Maintenance Account No.3170078 Serial No Status Location Brand Type Size YTD Cons 33605600 a Active ERT HH b Badger w Water 0.63 0.63 549 Date Reading Code Consumption Posted Date Variance 9/10/2013 639 a Actual 68 10/15/2013 62% 6/11/2013 571 a Actual 42 7/24/2013 183% — 3/12/2013 529 a Actual 15 4/22/2013 -65% 12/10/2012 514 a Actual 42 1/9/2013 -52% 9/12/2012 472 a Actual 91 10/15/2012 63% 6/11/2012 381 a Actual 54 7/16/2012 238% 3/13/2012 327 a Actual 16 4/14/2012 1% 12/14/2011 311 a Actual 16 1/17/2012 -12% 9/14/2011 295 a Actual 20 10/13/2011 6/6/2011 275 a Actual 19 7/20/2011 12% 3/9/2011 256 a Actual 17 4/13/2011 -7% 12/10/2010 239 a Actual 19 1/12/2011 6% 9/8/2010 220 a Actual 20 10/15/2010 156% 5/27/2010 200 f Final Bill 6 5/27/2010 32% 3/8/2010 194 a Actual 5 4/14/2010 -35% 12/10/2009 189 a Actual 8 1/12/2010 -58% 9/9/2009 181 a Actual 20 10/15/2009 92% 6/4/2009 161 a Actual 9 7/20/2009 -26% 3/12/2009 152 a Actual 14 4/29/2009 -2% 12/5/2008 138 aActual 13 1/20/2009 -21% 9/8/2008 125 a Actual 18 10/10/2008 -5% 6/4/2008 107 a Actual 17 7/16/2008 17% 3/10/2008 90 a Actual 15 4/11/2008 -17% 12/12/2007 75 a Actual 20 1/22/2008 4% 9/4/2007 55 a Actual 16 10/12/2007 -4% 6/14/2007 39 a Actual 19 7/20/2007 55% 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 1= Fax: (508) 880-7232 INSPECTION AND TESTING AGREEMENT Agreement entered into by and between Wastewater Treatment Services,Inc.(herein called WTS)and the FAST®System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of OWNER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: Equipment will be inspecte at least 1 time per year that this Agreement remains in effect,with the first inspections beginr n These inspections will include: F-77 7 1) Testing of the sludge depth in the septic tank. 2) Inspection,power testing and clean/replace intake filter of the air blower. _ 3) Inspection of the alarm system. 4) Inspect overall condition of FAST'System. 5) Notification to OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate,plus travel and parts. WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor time will be billed to the OWNER at our current labor rates of$78.00. - Emergency service between regular inspections will be provided at standard labor rates during normal business hours; at time and one-half after 5:00 PM and.on Saturdays; and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts, plus mileage and travel charges. The annual rate includes routine.maintenance,but does not include repairs required for damages caused by abuse,accident,theft,acts of third persons, forces of nature,or alterations made to the equipment.. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor disputes,non-cooperation by OWNER,or other factors beyond the control of WTS. a OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perforin its duties hereunder. Current W'TS practice is to send OWNER approximately 10 days before expiration of the teiin of the current contract an invoice for one year of service. It is OWNER's responsibility to timely return the payment.WTS must receive the payment before expiration of the current contract year to assure continuous contract coverage. Failure to return payment may result in suspension of service,cancellation of the contract and/or nullification of warranties, at the election of WTS. a - OWNER may not assign this contract without the prior written consent of WTS. It will remain in force until a - party cancels by written notice to the other at the address given herein. MANUFACTURER MODEL NO. SERIAL NO. LOCATION ANNUAL RATE PERMIT Bio-Microbics MicroFAST 25855 North Andover, MA $400.00 Remedial Includes(2)Field Tests EQUIPMENT OWNER l Wastewater Treatment Services,Inc. *Signed by OWNER: 1 Michael &Jennifer Cronan Sio jcd: _ �1 *Address: 1312 Salem Street 44 Commercial Street Raynham,MA 02767 Tele: (508) 880-0233 - *City: State: Zip: Fax: (508) 880-7232 North Andov T MA 01845 Telephone_ jr5;-j_ +14-411-10 Effective Date of Agreement �d E-mail address: 14 Lh , ��. OWNER understands that(1) ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is non-refundable; and (2) Current DEP Regulations require OWNER to maintain a service agreement for the lite of t le FA 'System. I HAVE READ AND UNDERSTAND THE FOREGOING. ' *Signed by OWNER: � Field Testing — Onsite testing performed twice per year will be used to demonstrate that the systems are operating at a secondary treatment standard of 30 mg/L of BOD5 and TSS. The following will be performed: 1) Visual examination of the effluent for color,turbidity and effluent solids. 2) Effluent pH to determine if the waste water is between 6 and 9 standard units. 31 Dissolved.Oxygen, 2m._/L or more. tc ensure that the system is o eratin%. 4) Turbidity,less than or equal to 40 NTU. If the effluent does not meet effluent quality standards, a grab sample will be collected for laboratory analysis. Results sent to state and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable access to effluent for field testing and/or to enable a grab sample to be taken for laboratory testing perfonned. If such laboratory sample is required, OWNER will be responsible for charges incurred. IF REQUIRED,THE COST FOR THIS ADDITIONAL TESTING W L $190.001VISIT. *Approval for Additional Testing if Required wner's Signature - Operator assigned: Michael Moreau Telephone: (508).98M74.4 v s P Commonwealth f Nia�sachus,etts' Title 5 Official Inspection Foran RECEIVED Subsurface Sewage Disposal System Form-Not for voluntary Assessn ients DEC 3 0 2009 1312 SALEM STREET I OWN OF NORTH ANDOVER Property Address HEALTH DEPARTMENT l � GAY NEILSON f> Owner Owner's Name •' information is North Andover MA 01845 10/31/09 �� �,.o required for 55 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way.Please see completeness checklist at the end of the form. Important: A General Information When filling out A. forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood,Jr. cursor-do not Name of Inspector use the return key. none Company Name 224 High Street Apt 1 9 P Company Address Newburyport MA 01950 City/rown state Zip Code 978-255-2261 870 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title S(310 CMR 16.000).The system: i ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/31/09 Inspect 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 some or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner owner's Name information is North Andover MA 01845 10/31/09 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 every page, Cityf own 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): required min more than 4 times a year due to broken or obstructedpipe(s). The ❑ The system equ� d pu p g y 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 every page.a e. CitY frown 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: I **This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than'/day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name informrequired is North Andover MA 01845 10/31/09 required for every page. Cityrrown 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, ❑ (0 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. i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 every page. Citylrown 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 Dart 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): 4 440 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): MA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 every page. Cityfrown 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current we Commerciallindustrial 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: Commonwealth of Massachusetts MENEM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 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: NOT SINCE NEW Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(Yes or no)(if yes,attach previous inspection records, if any) ® Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Fast Tank Commonwealth of Massachusetts Q D7 Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property address GAY NEILSON Owner Owner's Name information is North Andover MA 01845 10/31/09 required for every page. Citylrown State Zip Code Date of Inspection D. System information (cont.) Approximate age of all components, date installed(if known)and source of information: Built 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipe new in basement Septic Tank(locate on site plan): Depth below grade: 1.5 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: 1500 Gallons Sludge depth: 1'" Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is MA 01845 10/31/09 North Andover required for every page. Cityfrown 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 N/A Scum thickness <1 Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Measure Stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank in good condition.Outlet is Fast Treatment System i Grease Trap(locate on site plan): Depth below grade: feet I Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owners Name information is North Andover MA 01845 10/31/09 required for every page. Cityrrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 every page. Cityrrown 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 N/A 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.): No D,Box. Pressure distribution system 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.): Pump and appertinances in good condition.Water in pump chamber clear Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran»Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name information is required for North Andover MA 01845 10/31/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) E Type: ❑ leaching pits number: ❑ leaching chambers number: leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 -9.51 X 66, ❑ 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.): Area of leach field looks normal. No evidence of ponding, damp soil,or unusual vegetation. I 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name ion is requirequireddfor North Andover MA 01845 10/31/09 every page. City/rown 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.): it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name Informrequired is North Andover MA 01845 10/31/09 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 17-05 If checked, date of design plan reviewed: Date Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) database® Accessed USGS ase- explain: usgs maps You must describe how you established the high ground water elevation: System built 4 feet above ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON Owner Owner's Name Information is required for North Andover MA 01845 10/31/09 every page. Citylrown State Yip 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1312 SALEM STREET Property Address GAY NEILSON j Owner Owners Name information is required for North Andover MA 01845 10/31/09 every page. City/Town state Zip Code Date of Inspeetion 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 r3E,acwMftk< 76p'RiC-7H T ARA Ci i= ir'u, {QCT, 00 I �l tom+? d i C 4 CL:E-14,C N d r.{C, GAr—I f_I-rY 24 w V DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, October 21, 2009 11:24 AM To: DelleChiaie, Pamela Subject: FW: Title 5 Inspection for home resale From: Golden, Claire (DEP) [mailto:Claire.Golden@state.ma.us] Sent: Wednesday, October 21, 2009 11:18 AM To: Sawyer, Susan; theneilsons@comcast.net Subject: RE: Title 5 Inspection for home resale Gay and Susan, When there is an alternative technology included as part of a septic system, the alternative technology, in this case a FAST unit, is inspected twice yearly. However, this inspection does not qualify as a system inspection as required by 310 CMR 15.301 of the State Environmental Code. This is because the alternative technology is but one part of the septic system. The building sewer, pump chamber and soil absorption system (the leaching area)will also need to be inspected. When the System Inspector inspects your system s/he will include with the inspection report a copy of the most recent FAST inspection form. I hope that this clarifies things for you. If you have any additional questions, my contact information is found below. Claire Claire A. Golden Environmental Engineer IV Watershed Permitting Program MassDEP/NERO/BRP 2056 Lowell Street Wilmington, MA 01887 direct: 978-694-3244 fax: 978-694-3498 or 978-694-3499 claire.ciolden@state.ma.us From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Wednesday, October 21, 2009 11:11 AM To: 'Golden, Claire (DEP)' Subject: FW: Title 5 Inspection for home resale Hi Claire Below is auestion from a resident. I scanned the inspec. Section of title V and found no real reference to q p answer this. Can you help? Thx Susan 1 From: Gay Neilson (mailto:theneilsons@comcast.net] Sent: Wednesday, October 21, 2009 10:53 AM To: Sawyer, Susan Subject: Title 5 Inspection for home resale Hi Susan, I left a voice mail this morning, and then discovered I still had your email in my contacts list, so I'll elaborate on the message. You may remember my Septic System replacement which began in 2005 and was completed in 2006, the final certificate (for tax purposes), was generated in 2007. It was a long ugly process! We are moving to New Hampshire and preparing to put the house on the market. I know I will need to pass a Title 5 inspection. We have one of those"FAST" systems that is inspected twice per year by Wastewater Treatment Systems. It was last inspected in May and I expect it will be inspected again in November. The paperwork I get from the inspection includes a"DEP Approved Inspection and O&M Form for Title 5 1/A Treatment and Disposal Systems". Is this the same as, or the equivalent of a Title 5 inspection? Will I need a separate inspection, or will this be sufficient? Can you call or email me to confirm what I will be required to provide as sufficient evidence of a successful Title 5 inspection? Many thanks, Gay Neilson 978-807-5122 (cell, always available) 2 1 --------------------------; 1k --J ' 44.92' �■ ■ �� ' ■� ■ "s _ -- -- --- ----- 179.22' �� ■ .■�. . �■ ■ j, �u" Com- - ■ 87.73' 50.77 I.-_� - ,. II 7- ENLARGED ' -----------------l�$ ---- AREA ■ i � ■ �� KEY PLAN NOT TO SCALE ■ ■ cr 'CJ1 ■ ■ ■ -_HOUSE - APPROXIMATE PROPERTY LIMITS ECK�� — \\ GARAGE =mom =mono 0 _ ■ — \ ■ — ■ 'W.� l I \ ■ 1 O \\\ ----d--\ \ GJ l fjf \\ 23 SEPTIC ■ �� ■ �� ■ ...■�■ ■ ■ Q JE 7jt ■ �■ 0 11.6 i ■ �...� ■ 188.81' 58.6 ft ■ ISTE���`6``Q 1312 SALEM STREET z ' S�MAL E NORTH ANDOVER, MASSACHUSETTS Z ■ U ■ a ' PROPOSED POOL ■ LOCATION PLAN p 0 30 60 �T ■ NAPPROXIMATE SCALE IN FEET N L ■ c ' OCTOBER 2014 U • F+ s BENCHMARK: TOP RIGHT CORNER OF CONCRETE PAD. FL ti��'p ELEV. -100.00 (ASSUMED DATUM) `99 Ci3,� 19 c9 C7� BLOWER / VENT I f c ' COVERED DECK ON SONO TUBES 9 :. p� �9G'F. W PRESSURE O� :::' ' .... WATER SERVICE / CLEANOUT ...z'............. .. TP4 / }} 1500 GALLON MICRO FAST 99.45 .:..::':' SEPTI TANK C D 00 A 0 GALLON LON PUMP CHAMBER 1 oo•sa 99-54 99 s ��XI•• ��•E TI�� 99.88 ® RI �1. iD V WAY::�.::�.:•.::�::�..:�:�.:•:::t�.`:i: �;?:::;:;:;i �:�:�:�:•:�i:{•:�i:��:(�:�:�:•:•::•:•i::'�"..• \ E .:• :::..::..:..:::{.:::.:.:.:::•.. ....•...... 88 p 6'ISDR 35 p bRA�N PIPE \ :•W:::•:::•:::::�:.�. INSPECTION99`19 3" SCH. 40 PVC \ \ \ PORT (TYP.) FORCE ORCE MAIN �:�?1�.'•r �.•i.ii}{ ::��irF,.: �:�ii�.r..'�'�i:�}i::•`.{ •:.. ................. ............................................. ...:.......... ............... .............................................. .............. ............................ LIMITOF SAND \ .� � .........................••:.:�... 99.05 \ ................... F--- y -,1 - ---- - �:z- E- ai . — ---- -B 7*--ITP2 / 8 Q --•X — — -- A 95`04 54' 56' _ — _A _�i 98.86 / I 96-37/ g� _ - - -----; - 1 .81 o -, \\ CLEANOUTS (TYP.) 98'76 TP3 PT1 / N 5 14 W \ \ 98.70 �, 40 MIL/IMPE� IOUS \ TP1 BARRIER 94-56 94.56 / \ PT1B , , n \ _ / /96`94 \ \ \ \ - - - - - - - - - - - - - - - 98_35i / / / ul Fa \ _ / — \ _ — — — — — — — — — — — — -- - — — _ / / o ` — — — — — — — — — — — — W O N/F CARR 2 0' 0 210' 4.0' 60' 7 ] NORTI1 1 X91, J ,s•6 Sp pA► � A � ey O COCgCMl WI[M 7 ��A�q�TEO rPpy,�y 9SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division Ben Osgood Jr. New England Engineering 1600 Osgood Street North Andover, MA 01845 April 6, 2007 Re: 1312 Salem Street Dear Ben, n, This correspondence is in regards to the subsurface disposal system installation at the address noted above. This office has received inquiries from you, the installer and the homeowner, regarding the status of the Certificate of Compliance for the septic system. The following is a chronology of the facts surrounding this property. 1) Failed Title V 3/18/05 2) Soil tests done and plans submitted. 10/14/2005 Plans approved 3) 11/10/05 Disposal Works Construction permit issued 4) ***Installer hit extreme ledge. Redesign submitted 11/19/05 5) Need to go to BOH for variance 6) 11/18/05 waiver received from neighbors about hearing for the Board of Health meeting needed for complications due to site conditions(ledge)and 3' to lot line variance needed 7) 11/19/05 BOH meeting held, variance granted 8) 12/1/05 Began system inspection process w/Bottom of Bed. 9) 12/13/05 Final Insp incomplete due to pipes frozen-Final squirt test rescheduled 10)12/14/05 Received email from Gay Nelson requesting special consideration(see attached) 11)BOH letter 12/14/05 granted sign-off requested although final grading was not complete. 12)Building application for addition signed off 13)Received report that there were heavy vehicles driving on the new septic system area (company involved, Atlantic Restoration)Concern noted in the file, no further info on this. 14)February 6, 2006 As-built received and reviewed. Note written on letter and communicated to engineer, "We will need an As-built with a final grade" 15)On 8/7/06 B. Osgood related that the site work was still not complete 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com End of file communication In light of the issues with this installation as related above, it was determined in February of 2006 that a final grade would be required to be shown on the final As-Built. After additional review of this file, thirteen months later, it seems even more important to evaluate the completion of this project. A final grade determination will show whether the requirements to the lot lines,the swale along the home, the depths to the system components etc. are in compliance with Title V. Once the final As-built has been reviewed, and a final grade inspection has been completed by this office(when the snow melts)a Certificate of Compliance will be issued. Thank you for your anticipated cooperation in this important matter of public health. Sincerely, S an Sawyer, REHS/RS Public Health Director Cc: Gay and Paul Nielson 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTh tato Ivf br Op 1O 4L - O cetOMa�-cm 1• 1 �9SSACNUS PUBLIC HEALTH DEPARTMENT (ommunity Development Division CE RTI F1CATE O F CO-VISE I OYC E As of. 9Vlarch 30 2007 This is to certify that the indvidual subsurface disposal system received a SAMEACT0<i TlYSTECVoyo the. EullSeptic System Repair By. ,john Soucy At: 1312 Salem Street Yorth Andover, 911, 01845 The Issuance of this certificate shaff not be construed as a guarantee that the stem will g system function satisfactorily. I S an IT Sawyer, S, 1R5 (Pu6Cc Yfealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 0 TOWN OF NORTH ANDOVER of,kORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES 0 P HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'Ss,�C,,,,s�� 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept n townofnorthandover.com WEBSITE:hqp://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired; by 7101-(JJ —5;DuCU (Print Name) located at 2- t�L AndoyW- (Installation Address) was installed in conformance with the North Andover Board of Health approved plan,originally dated lQ and last Revised on dbV Iq QQ� ,with a design flow of g Per gallons day. The materials used were in conformance with those Y specified on the approved plan;the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations,and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Eng' eer Representati a(Signature) JIM L And-print Name` Final inspection date: Engine Representative(S ature) n -Print Name Installer: ® S. Date: . Ao- cv-, And-Pr• t Name Engineer: (Signature) Date: And-Print Name AS-BUIL CHECKLIST V/ LOT NUMBER STREET NAME ASSESSORS MAP & PARCEL =OF NIIMBERLOT LINES LOCATLLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE 111,4 TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA t V LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS DRAINS, WATERCOURSES WI ' THIN 150 OF SYSTEM LOCATION OF WATER, GAS, LECTRIC LINS,CABLE DISTANCE FROM CORNERS OF HOUSE TO CENTER OF / TANK &D- X �- y ORIGINAL STAMP& SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. ✓ NORTH ARROW LOCATION& ELEVATIONS OF BENCHMARK USED I r r 0TOWN OF NORTH ANDOVER 0 ItORTN OE4t °o °1ti Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT b 400 OSGOOD STREET NORTH ANDOVER MASSACHUSETTS 01845 �'"V ACHUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SEPTIC SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 1312 Salem Street MAP: LOT:_ INSTALLER: John Soucy DESIGNER: New England Eng. PLAN DATE: 11/17/05 BOH APPROVAL DATE ON PLAN: 11/19/05 INSPECTIONS TANK INSPECTION: n/a DATE OF BED BOTTOM INSPECTION: 12/1/05 (x),11:30 (Regent on 12/1/05 DATE OF FINAL CONSTRUCTION INSPECTION: 12/8/05 in the a.m. DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE 1. GRAVITY DISTRIBUTION...ED 2. PRESSURE DISTRIBUTION...❑ 3. PRESSURE DOSING...❑ 4. HOLDING TANK...❑ 5. ADVANCED TREATMENT...❑ 6. OTHER...0 FAST SYSTEM COMPONENT SUMMARY FROM PLAN 1. GALLON TANK = 1500 2. LOADING OF SEPTIC TANK= .56 gFsf. 3. GALLON PUMP CHAMBER = 1,000 4. LOADING OF PUMP CHAMBER 5. TYPE OF SAS = FAST SYSTEM 6. DIMENSIONS AND DETAILS OF SAS: 1-66.2'X W-18.6 Comments: Huge amount of ledge on this site. L-66.2'; W-18.6'; Variance; 3' Overdig on 1 side Page 1 of 4 J OTOWN OF NORTH ANDOVER NORTH .� Office of COMMUNITY DEVELOPMENT AND SERVICES a? ° HEALTH DEPARTMENT Y y 400 OSGOOD STREET NORTH ANDOVER MASSACHUSETTS 01845 SACNUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SITE CONDITIONS 1. Existing septic tank properly abandoned...❑ 2. Internal plumbing all to one building sewer...1 3. Topography not appreciably altered...❑ SEPTIC TANK 1. Bottom of tank hole has 6" stone base...M 2. Weep hole plugged...Ex 3. Tank has been installed (H-20) Tank Size: 1,500 -MONOLITHIC...❑x 4. Water tightness of tank has been achieved (Visual)... E 5. Inlet tee installed,under access port...❑ 6. Outlet tee as baffle or effluent filter installed under access ort...❑ � ) p 7. Cover to within 6" of final grade installed over one access port,must be over outlet of tank if effluent filter is present- Inches of Tank...❑ 8. Hydraulic cement around inlet&outlet...❑ ****Comments: **** Advised Warren to fill tank with water before Mill River gets out to do a Final. Asked Warren not to put anything larger than 1.5' crushed stone under any tank. Note: Warren used an H-40 Tank. PUMP CHAMBER—n/a 1. Bottom of tank hole has 6" stone base...❑ 2. Weep hole plugged...❑ 3. Pump Chamber Installed_Combo tank Gallons; (H-20) (Monolithic) 4. Inlet tee installed,under access port...❑ 5. Pump(s) installed on stable base...❑ 6. Alarm Float Working...❑ 7. Pump On/Off Float Working...❑ 8. Total # of Floats... 9. Drain hole in pressure line...❑ 10. Cover to within 6" of final grade installed over one access port...❑ 11. Water tightness of tank has been achieved—Visual or Vacuum Test or Water held for 24 hours circle 12. Hydraulic cement around inlet& outlet...❑ Comments: Page 2 of 4 y a TOWN OF NORTH ANDOVER 0 pORTN O tae • .� Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT * � f � 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �►q s"„rev t� Susan Y. Sawyer,.REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX 1. Installed on stable stone base...❑ 2. Inlet tee (if pumped or >0.08'/foot)... ❑ 3. Hydraulic cement around inlet& outlets...❑ 4. Observed even distribution...❑ 5. Speed levelers provided (not required)...0 - Comments: -Comments: SOIL ABSORPTION SYSTEM 1. Bottom of SAS excavated down to C Soil Layer,as provided on plan...❑x 2. Size of SAS excavated as per plan...❑x 3. Title 5 sand installed,if specified on plan...E 4. 3/4-1 1/2" double washed stone installed...❑ 5. 1/8-1/2" (peastone) double washed stone installed 6. Laterals installed and ends connected to header (and vented if impervious material above) 7. Gravel-less disposal systems: type, number and location as per plan.........❑ 8. Elevations of laterals installed as on approved plan...❑ 9. 40 Mil HDPE barriers installed...❑ 10. Retaining wall (boulder / concrete / timber / block) ...❑ 11. Final cover as per plan ...❑ *****Comments: ***** There is a 3 foot variance on property line. Overdig is 3 feet on that side. On notes,please see B layer to be used. L-66.2';W-18. CONTROL PANEL 1. Alarm&Pump are on separate circuits...0/ 2. Alarm sounds when float is tripped......U 3. Location of control panel: 4. Rated for exterior if placed outside...❑ Comments: 1 ,�A ,/�� I I n I �e� `-I'Ilk— `� V' r G K h Page 3 of 4 0 O TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES t e_;r •_�, e p HEALTH DEPARTMENT 41 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Ss" , ^C RUS< Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS 1. Benchmark: 2. Rod at Benchmark: 3. Height of Instrument: INVERT ON DESIGN INVERT PLAN ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 Inv Lateral 2 HIGH Lateral 2 Inv Lateral 3 HIGH Lateral 3 Inv Page 4 of 4 0- NEW ENGLAND ENGINEERING SERVICES INC February 6, 2006 Ms. Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 RECEIVED Re: 1312 Salem Street North Andover,MA FEB 0 6 2006 As-Built Septic System Design TOWN OF N�R'FH ANDOVER HEALThi DE:I'AR''M=NT Dear Ms. Sawyer, The following As-Built Plans for the above referenced property are being submitted for approval. 1. Three(3) Copies of the As-Built Septic System Design Plans. This plan is being submitted to depict the system construction however, the final grading is not complete. When the final grading is complete,we will send the signed certification forms. l If you have any comments or questions please do not hesitate to contact this office. Sincerely, ova' Benla�hin C. Osgood, Jr., E. President 9d 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 Commonwealth of Massachusetts Map-Block-Lot } `� •. qQr 106.A-0160 Board of Health i • Permit No North Andover BHP-2005-0713 P.I. ........ ---- I s�41CMU � F.I. FEE $250.00 I Disposal Works Construction Permit I 1 E Permission is hereby granted Jai-Soucy I to(Repair)an Individual Sewage Disposal System. l � at No 1312 SALEMSTREET - - ------------------------------ as shown on the application for Disposal Works Construction Permit No. BHP-2005-071 Dated November 10,2005 { --------------------- { f , Issued On:Nov-10-2005 - `_" P-ij ------- - I t} Lal _� _ ---"------------ - -' " Board of Health y { ............../..... ......... .................... ........ .. ...... f . ......'....................... ................ ................... NORTH Applicationop Septic Disposal Systee / O� °c TODAY'S ATE ` pConstruction Permit - TOWN OF / }-0 �,� Full Repair✓ 1',.�5 R4Ttq t&K(� NORTH ANDOVER, MA 01845 .00-(jj;1Component CHUS $A Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, useRepair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Information key. /3 (, S <74 rab Address or Lot# nn o� IQ-✓1�XD�'� RUR 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 (37"64 Name S lP Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information v Ccs w'L" �o Name Name of ComI5'aVy ,� , LI � Addres CitylTown State ip Code • Z Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Go Address City/Town —� State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 NO�TM Application for Septic Disposal System TODAY'S DATE AConstruction Permit - TOWN OF * r* ORTH ANDOVER MA 01845 X50.00— Full Repair 9 �4Ssq�HUSE�<� ' $125.00 -Component PAGE 2OF2 A. facility Information continued.... 5. Type of Building:OfResidential 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 is d by this Board of Health. Name Date Applic tion Approved By: Board of Health Representative) Nam Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attacbed? Yes V__� No 2. Project Manager Obligation Form Attacbed? Yesz No 3. Pump S sy tem? If so,Attacb copy f Electrical Permit Yeses/ No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approved plan) S. Floor Plans?(new construction only): Yes_ No I F �'` Application for Dispo ^' ystem Construction Permit•Page 2 of 2 INSTALLER PROJECT MANAGEMENT OB 1GATIONS As the North Andover licensed installer for the construction of the septic system for the property at/_? / ; ) �-�t relative to the application of5l,G c datedfor plans by A_1, and dated r7— revisions dated b I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection – Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be read and able to cause um to work and alarm to function. Y pump c) Final Grade–Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. ! 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. I 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi d U ensed Septic lnstalle Date: +q , 603 Date...x � -��.:. ....... F; .. A �.... �" Nor+o"x4, TOWN OF NORTH ANDOVER .1i . o t. o 3: 0 0 PERMIT FOR WIRING 0 . SACH05 � ,�, 4�..acres-''..��':-•'"••••••... I This certifies that . - 11�fission to perform ........ ............... .�. ... ti has Perm building of „b ..... .............. .c ............................... I x wiring in the ��/1.17jNorth Andovei,Mass. fft • /3/�......'�" - .............'. ..... ........... { at ......,.,.��v' Lic.NA)9..11s.J •• .\ LECfR[.. I SPE is Check # � rC�D L, Commonwealth of Massachusetts Official.Use Only M Permit No. EE , = Department of Fire Services c� � Occupancy and Fee Checked J(S _ BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/99 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),$27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO Tb N) Date: � � To the Inspector of Wires: City or Town of: Poo By this application the undersigned gives notice of his or her intention t perform the electrical work described below. Location (Street& Number) Owner or Tenant O Telephone No. Owner's s Address Is this permit in conjunction with a building permit? Yes ❑ No © (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps 22,71//,) Volts Overhead 9___ Undgrd❑ No. of Meters / New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /ZZ ,�� � � �17 Com letion.o the following table may be waived by the Inspector o WiNo.of res. No. of Recessed Fixtures No.of CeiL-Susp.(Paddle)Fans Trans Total Trsformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA Above In- No.o mergency rg in No,.of LightingFixtures Swmming,Pool ._rru _.n_. rn n Ba`te:. Uni FIRE ALARMS No o Zones 4 No.of Detection and InitiatinR Devicest No.of Alerting Devi es Date...�r............................. I No.of Self-Conta' ed Detection/Alerti Devices NORr►, Local ❑ Mnecptioln El Other TOWN OF NORTH ANDOVER o Security � •� � Secuit y Sy ems: ° ' PERMIT FOR WIRING No.of evicesorEquivalent Data Wi ng: No.of Devices or Equivalent ',`°"""`;.•" j Telecommunications Wiring: No.of Devices or Equivalent sAGMUs � f This certifies that . ::.......... ,. :. .... `......�• .�••• derail if desired,or as required by the Inspector of Wires l i rformance of electrical work may issue unless t has permission to perform ... �........ ........ s i coverage or its substantial equivalent. The to the permit issuing office. wiring in the building of •�tt..... .................................... he e e n o ir' i - f North Andover,Mass. (Expiration Date) I at.. �. :...... , i k icipat policy.) Fee ....... Lie.NO. ....:...'.�,�} ................... . ..: f r t: ............. IMEC Rule 10, and upon completion. ELECTRICAL INSPECTOR' r� 1pplication is true and complete. ;heck # - �` LIC.NO.: LIC. NO.:Z_ ?/2 Bus.Tel. No.9_;. y ii�TJ i /�7Co Alt.Tel.No.: OWNER'S INSURANCE NVAIVER: I and aware that the Licensee does not the liability insurance coverage normally I required by law. By my signature below,I hereby waive this requirement. I am the(check one)[I owner ❑ owner's agentl Owner/Agent PERMIT FEE: $ �l� Signature Telephone No. 7 r