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HomeMy WebLinkAboutMiscellaneous - 140 JOHNNY CAKE STREET 4/30/2018 L140 JOHNNY CAKE STREET reet 21011.07.A-0197-0000.0 r i North Andover Board of Assessors Public Access Page 1 of 1 r y Parcel ID: 210/107.A-0197-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge 140 L-51 JOHNNY CAKE STREET Location: 140L-51 JOHNNY CAKE STREET Owner Name: POTTER, DANIEL B JOAN M POTTER Owner Address: 140 JOHNNY CAKE STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 1 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2974 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 603,300 539,600 Building Value: 385,900 347,900 Land Value: 217,400 191,700 Market Land Value: 217,400 Chapter Land Value: LATEST SALE Sale Price: 589,000 Sale Date: 08/27/2001 Arms Length Sale Code: Y-YES-VALID Grantor: ROBERT GORMAN Cert Doc: Book: 06336 Page: 0199 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=810628 10/20/2006 North Andover Board of Assessors Public Access Page 1 of 1 Parcel ID: 210/107.A-0197-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge 140 L-51 JOHNNY CAKE STREET Location: 140L-51 JOHNNY CAKE STREET Owner Name: POTTER,DANIEL B JOAN M POTTER Owner Address: 140 JOHNNY CAKE STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 -8 Land Area: 1 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2974 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 603,300 539,600 Building Value: 385,900 347,900 Land Value. 217,400 191,700 Market Land Value: 217,400 Chapter Land Value: LATESTSALE Sale Price: 589,000 Sale Date: 08/27/2001 Arms Length Sale Code: Y-YES-VALID Grantor: ROBERT GORMAN Cert Doc: Book: 06336 Page: 0199 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=810628 10/20/2006 / l r Lot& Street D Map/Parcel 1 CONSTRUCTION APPROVAL Has plan review fee been paid: ES NO Plan Approval: Permit# Date: /6 // 0 Designer: 14111w�Approved by: r w Plan Date: Conditions: Wat r..pply_ Town --` Well Well Permit: ` '�,�^ � Driller: Well Tests: Chemical �`�", ate Approved Bacteria I Bacteria II Date� oved Date Approve Plumbing Sign-Off: Comments: Wiring Sign-off: Form "U"Approval: 7 Date Issued Approval to Issue: YES NO Conditions: By: Final Approval All Permits Paid? Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES YES NO Any Variance Needed? NO YES NO ate- "71 �fv FINAL BOARD OF HEALTH APPROVAL: p4Z 7L68Z6 DATE: 7 ac�o� APPROVED BY; r r IJ SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? Type of Construction: NO New Construction: Certified Plot Plan Review NEW YES Floor Plan Review YES Issuance of DWC permit: Conditions of Approval from Form U YES DWC Permit Paid? YTD) NO DWC Permit# NO Installer: �G�`' Begin Inspection: YES NO Excavation Inspection: Needed: Passed: LLBy: Construction Inspection: Needed: �-Plarn. atisfactory: YES: Approval of Backfill: Date: Final Grading Approval: Date: /7 0 By: l` Final Construction Approval: Date:–ZZ/7�62- 11112!:!y— --------------- Certificate of Compliance: Approval: Date:_ 711,711 Commonwealth of MassachusettsZused, u City/Town of .° System Pumping Record MAR Form 4 TOWN OF N HEALTH DEP has provided this form for use,by local Boards of Health. Other forms may be 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 Location: Left/Right front of house, Left/fig 'rear hous , Left/right side of house, Left/ Right side of building, Left!Right front of building, Le Ight rear of building, Under deck Address Aj . Cityrrown State Zip Code 2. System Owner. Name Address(if different from location) Cit ylTown Stat Zip Code Telephone Number B. Pumping Record � -c3 � 1. Date of Pumping Date 2. Quan ' -Pumped: Ganons 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. Condition of System: OC �Akak V11- 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo*Haule nts were disposed: Lowell Waste Water SigDate t5form4.doc•06/03System Pumping Record•Page 1 of 1 i� . Commonwealth of Massachusetts City/Town of a System Pumping Record RE-C i� ® .r Form 4 (� 1 — 4 N Z DEP has provided this form for use by local Boards of Health. Other f rms may be used, but the information must be substantially the same as that provided here. Be f tI�itiy�tt�siI�tlr6a�@��� ith your local Board of Health to determine the form they use. The System Pu i 4 itted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Av\KJO oe�- City/Town State Zip Code 2. System Owner: Name 1(\ Address(if different from location) City/Town Stat L y�^ Zip 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 to If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of y tem: [OCA v� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: .L S. Lowell Waste Water Sign t e Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i i Commonwealth of Massachusetts City/Town of Zumpingg VED System Pumping Record g` Form 4 2008 DEP has provided this form for use by local Boards of Health.Oth �pbEMt e information must be substantially the same as that provided here. with your local Board of Health to determine the form they use. The Systemd must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the .V\,* �. ��v computer,use only the tab key Address to move your cursor-do not C use the return dylTown State Zip Code key. 2. System Owner: AA Name I Address(if different from location) Citylrown St Trp Telephone Number B. Pumping Record �j f 1. Date of Pumping Die ~/7—© 22. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes �o If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System- 6. ys 6. System Pumped By: Name Vehicle License Number Company 7. Location ere co nts re disposed: <� _ Si ur Hauler Date t5form4.doc^06/03 System Pumping Record a Page 1 of 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information RECEIVE® Important: When filling out 1. System Location: forms on the 14 0 JOHNNY N O V 2 O 2006 computer,use CAKE STREET only the tab key Address to move your N. ANDOVER TONIN OF NORTH ANDOVER cursor-do not HEALMMEPARTMENT 01845 - use 1845use the return City/Town state Zip Code key. 2. System Owner: "ISI DEAN PATTER _ Name Address(if different from location) City/Town State Zip Code I � Telephone Number i B. Pumping Record 1. Date of Pumping Date 10.104/06 2. Quantity Pumped: 1500 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? R] Yes ❑ No 5. Condition of System: GOOD 6. System Pumped By: _RAGGS SEPTIC SERVICE INC__ Name Vehicle License Number Company 7. Location where contents were disposed: �— 'FTTCHBURG� TR .A M .NT PT ANT I 11/15/06 Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 '-w ommonwealthlof.Massachusetts 'City/Towr of NORTH 'ANDOVE R MASSAC I USETTE Sy..stem Pumping Record Form 4 SEP - 6 2006 DEP has provided this form for use by local Boards of Health. ThgN "fiF1r �;,'R oRd mu: be submitted to the local Board of Health or other approving auth L 11 `� t pp g A. Facility Facility Information - Important: When filling out 1. System Location: forms the � � j� computer, use ,, v (] I only the tab key Address to move your cursor_do not - use the return Clty/Tewn State key. Zip Code 2. System Owner: Name Address(if different from location) City/Town _.. --------- Stat ..- -------- Zip Code - Telephone Number — 8. Pumping Record 1, Date of Pumping -_ P 9 � 2, Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): -- .------....._.-. ._. - 4. Effluent Tee Filter present? ❑ Ye5.�o If yes, was it cleaned? ❑ Yes r ❑ No 5. Condition of System: 6. Sy em Pumped By: ame Vehicle License Number ----~' (5 Q Company 7. Location where contents were disposed: Si azure of jpro �/ ...__--_ _-. X30 Date - - - http://www,masg,gov/dep/wateyals/t5forms.htm#inspect t5form4.doc,06/03 System Pumping Record Page 1 of TO WN OF' NORTH AN'DUYEk UA i.t �� ®S SYS'T'EM PUMPINQ RECORD SYSTEM OWNER ADDUSS SYSTEM LOCATION DATE OF PVWNQ; vc011� PUMPED, _ k'tSSPOOL: NO�YBg.. Sopuc Tank: No YES N^ I'UItE ON SERVICE: itUU'fINB _ _ �MkRU(aNC'�' — 1 RECEIVED ObSUVA'('(ONS; GOOD CONDITION PULL ,� COYER ROOT' JUN 0 3 2005 OO SB _.._ 13AF'3'1.BS IN PLACL TOWN OF NORTH ANDOVER M LBACF�Q�1UD RUNBACK HEALTH DEPARTMENT BXCRSSIVE SOL103 FLOODED . -SOLID CARRYOYER—OTNPR EXPLAIN ._._. �y•t.m Pwnp d by 177x. it ..._.... _.........._.,.,.,,... l:uN('tN'I'S ('K11NSF'lrRRfiU ' Cont non Health of Massachusetts • , Massachusetts stem Pumping Record System Owner System Location Date of Pumping: ``C— --, Quantity Pumped: �jL G�gallons Cesspool: No I Yes U Septic Tank: No U Yes H--J System Pumped by: varco4rt License# Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector: Coinnionw ealth of Massachusetts Massachusetts System Pumping Record System Owner System Location -� Date of Pumping: uairtity Pumped: c,S �V gallons Cesspool: N� Yes L) Septic Tank: No U Yes System Pumped by: Fared rt 51&vvlldP,.d License# Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector: 'HEALTH P 1999 Cun,►unuaeoil 11 of Alass,tchusells Nlassdcltusalls 07c> ,c MQV) AJ g 'lla)i(t'U�rna 5file„i Lucaion I Z . I ,l„ '. tete or t „►„e � K”' Vet License ki Srsleu► lluu,l,ed I)%. n CuMeWs tmosletreJ 1)nle IItsl,eclut i TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 7/17/2002 This is to certify that the individual components Q, entire (X) subsurface disposal system constructed (), repaired (X), or upgraded ( ) by Michael Reilly at 140 Johnnycake Street has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5), North Andover Board of Health septic system regulations, and the design plan approval # dated August 1, 2001. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Y Board of Health Inspector i TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The u ersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired: by - _ f'liILL% .P.tta, located at 1 440 Jo N tJo was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# . dated with an approved design flow of*10 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: v Engineer Representative Final inspection date: — 71-02 �, _'V„ Engineer Representative Installer: Lic.#: Date: 1 Design Engineer: Date: . 7- 1 q-r;'Z� - 17-0 Zi � r70TUBOARD 0-F HEALTIA JUL 2.6 2002 Town of North Andover, Massachusetts °►m No.s °t p°RT11 BOARD OF HEALTH .4Tl.°Vel do *off_<«;�?Ml: ,. • " no DISPOSAL WORKS CONSTRUCTION PERMIT �SSACHUSFt t Applicant P NAME ADDRESS 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. CHAIRMAN,BOARD OF HEALTH Fee-- L D.W.C. No. i i I ' i BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: e, LICENSED INSTALLER: A- _ t � S �,nC-., j SIGNATURE: r TELEPHONE# CHECK ONE: Pcv2r' REPAIR: ./ NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS'BU>[LrF OR ra A Wit, 0ARi3 OF HEALTH NOY - 9 2001 Administrative Use Only $160.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval L, Date: �J �/ i TO A m c0 � i AS-BUILT CHECKLIST t/ LOT NUMBER, STREET NAME ASSESSORS MAP &PARCEL NUMBER �-� LOT LINES & LOCATION OF DWELLINGS LOCATIONS &DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS ✓/ ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM + LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX �. ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. `-� NORTH ARROW LOCATION &ELEVATIONS OF BENCHMARK USED I b2—O. AS-BUILT CHECKLIST LOTNUMBER, STREET NAME ASSESSORS MAP& PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS& DIMENSIONS OF SYSTEM, V4,4.- TIES TO LOT LINES& DWELLING, d. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES& PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN bLEVATION LOCATIONS OF WELLS,DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER GAS ELECTRIC / , _ LINES,CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF / TANK&D-BOX ORIGINAL STAMP& SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. / NORTH ARROW V^ LOCATION&ELEVATIONS OF BENCHMARK USED COMMONWEALTH OF MA`SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a !L. DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ; ,' CERTIFICATION Property Address 140 JOHNNY CAKE STREET OCT 12 2006 NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER TOWN OF NORTH ANDOVER Owner's Address: 140 JOHNNY CAKE STREET HEALTH DEPARTMENT NORTH ANDOVER,MA 01845 Date of Inspection: OCTOBER 4,2006 Name of Inspector: (please print)HAROLD T. LINCOLN,JR. Company Name: RAGGS,INC. Mailing Address: P.O.BOX 1027 CONCORD,MA 01742 Telephone Number: 978-369-1100 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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. Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 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. Notes and Comments: 5 _ ****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. i Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name:. . DAN POTTER Date of Inspection: OCTOBER 4,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: - -Observation-of sewage backup or breakout 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): j broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: i Title ai)nnn 2 Page.3 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: _ DAN POTTER Date of Inspection: OCTOBER 4,2006 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: T41. lncnorfinn Pnr r/1 ai,)nnn 3 Page 4 of 11' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845. Owner's Name: DAN POTTER Date of Inspection: OCTOBER 4,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow —X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _NO_(Yes/No)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- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 anquestion in Y ySection E the system is considered a significant threat or answered anyY g , "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. T41. P^r oVI i InAn 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER Date of inspection: OCTOBER 4,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: g Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks X_ _ Has the system received normal flows in the previous two week period? X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X_ _ Was the facility or dwelling inspected for signs of sewage back up? X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? X — 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 _X_ _ 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: Yes no _X_ _ Existing information.For example,a plan at the Board of Health. _X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] T41a G Tncnortinn P^� !./1 G/)AAO 5 Page 6 of 1j OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER Date of Inspection: OCTOBER 4,2006 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 5 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no):N/A Seasonal use:(yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 318.67 AVG GPD (NOTE: SITE HAS SPRINKLERS.) Sump pump(yes or no):YES Last date of occupancy: OCCUPIED COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: SERVICED 5/05,6/04,8/00,9/99,4/96-OWNER&BOH RECORD Was system pumped as part of the inspection(yes or no):YES If yes,volume pumped: 1,500 gallons--How was quantity pumped determined?FIELD ESTIMATE Reason for pumping: TANK AND TEE INSPECTION i TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:2002-PER OWNER AND RECORD Were sewage odors detected when arriving at the site(yes or no):NO T41P G rnannrtinn iz^r 4/1 /7 6 � nnn _ I Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address 140 JOHNNY CAKE STREET _. NORTH ANDOVER,MA.01845 Owner's Name: DAN POTTER Date of Inspection: OCTOBER 4,2006 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction:_cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):GOOD;OK;NONE SEPTIC TANK:_(locate on site plan) Depth below grade:2" Material of construction:—X—concrete_metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10'6"X 5' X 5' Sludge depth:.3" Distance from top of sludge to bottom of outlet tee or baffle: 38" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: FIELD ESTIMATE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): RECOMMEND ANNUAL PUMPING;OK,OK;LIQUID LEVEL AT OUTLET INVERT;NO EVIDENCE OF LEAKAGE OBSERVED GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): T41.G ►ncnortinn P^r All a»nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER . Date of Inspection: OCTOBER 4,2006 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): BOX IS LEVEL WITH EQUAL DISTRIBUTION. NO CARRYOVER OR LEAKAGE OBSERVED. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title G fnenortinn vnn ul ai)nnn 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER Date of Inspection: OCTOBER 4,2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: _X_leaching fields,number,dimensions: ONE FIELD— 10' X 80' -800 SF-SEE AS-BUILT PLAN 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.): SAND;NO SIGNS OF HYDRAULIC FAILURE OR PONDING ABOVE GROUND;DRY;GRASS 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 or no): 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.): Titin 4 T--tin"Tz^_rui ai,)nnn 9 Page.10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • . PART C SYSTEM INFORMATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER Date of Inspection: OCTOBER 4,2006 i t SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. THIS SKETCH IS NOT TO SCALE. A DESCRIPTION A B C TANK -- 23' 12' vD D-BOX p r t- z s . #w0 / 12eA-IL oAP D wtZu Nv / De&K / 0 0 — ---` T i Tifln S IG/1 igr)nnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address 140 JOHNNY CAKE STREET NORTH ANDOVER,MA 01845 Owner's Name: DAN POTTER Date of Inspection: OCTOBER 4,2006 SITE EXAM Slope Surface water Check cellar X Shallow wells Estimated depth to ground water 3 feet MIN.BELOW SOIL ABSORPTION SYSTEM Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked,date of design plan reviewed:7/25/01 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: SEASONAL HIGH GROUNDWATER NOTED TO BE AT ELEVATION 165.6 AND THE BOTTOM OF THE SYSTEM DESIGNED TO BE AT ELEVATION 168.6. THIS DESIGN REQUIRED A LOCAL UPGRADE APPROVAL TO ALLOW THE MINIMUM FOUR FOOT OFFSET BETWEEN THE BOTTOM OF A SYSTEM AND GROUNDWATER TO BE REDUCED TO A MINIMUM THREE FOOT OFFSET.PLEASE REFER TO PLAN. Talsa c l 1 Tnenortinn T.nrrn ui ei�nnn naeae cab pawn.a an ,, PIN by uai war«► ftP, �. Town of North A der . Tax Map #--,21 "#7;A-01 97-0000.0 140 JOHNNY CAKE STREET POTTER, JOAN.& DAN , 140 JOHNNY CAKE STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1 Acres' FY 2007 US Mailing Index Name/Address Type Loan Number Active/inact. From Until POTTER,JOAN&DAN Payor 140 JOHNNY CAKE STREET N.ANDOVER, MA j 01845 US Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14190.0- 140 JOHNNY CAKE STREET Last Billing Date 9/7/2006 2100179 02 Cycle 02 Active US Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 406.24 /1 US Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 0030495747 a Active ENC F.RT. ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 8/21/2006 4492 a Actual 91 9/13/2006 265% Trouble Code:03' 5/25/2006 4401 a Actual 30 6/20/2006 1% Trouble Code:03' 2/8/2006 4371 a Actual 27 3/13/2006 -24% Trouble Code:03 11/4/2005 4344 aActual 32 12/14/2005 -11% Trouble Code:03 8/10/2005 4312 a Actual 38 9/12/2005 61% Trouble Code:03 5/11/2005 4274 a Actual 22 6/8/2005 -16% 2/15/2005 4252 a Actual 27 3/15/2005 -30% Trouble Code:03 11/19/2004 4225 a Actual 44 12/17/2004 -46% Trouble Code:03 8/11/2004 4181 a Actual ^ 74 9/20/2004 162% Trouble Code:03 5/13/2004 4107 a Actual 27 6/14/2004 14% Trouble Code:03 2/17/2004 4080 a Actual 28 4/16/2004 0% (� CT- = 10O 0- F ;::7 HCl g a( ung you See 1� • *4GGS General Maintenance Recommendations Proper maintenance of your septic system can help prevent premature failure of your soil absorption system. RAGGS, INC. recommends the following: 4 DO PUMP your system on a regular basis, preferably ANNUALLY for most households. Larger systems, such as those serving multi-family locations or commerical properties, may require more frequent pumping. The purpose of pumping is to remove solid material and scum material from the tank. This will help prevent unwanted material floating out to the leaching facility. 4 DO OPEN your D-Box every THREE TO FOUR YEARS. This is a good way to spot little problems before they grow into bigger ones. 4 DO ensure that your VENT PIPES are INSTALLED properly. Vent pipes are used to allow oxygen into the system, thereby allowing bacteria to breathe and grow. 4 DO make sure you know WHERE your TANK is LOCATED. Check the covers to make sure that they are not deteriorating and causing a potential hazard. 4 DO make sure you know WHERE your LEACHING FIELD is LOCATED. If the field ever goes into failure and "break out", it would be necessary to isolate the area for health protection. 4 DO look for GREEN STRIPES over leaching field. Ifyou see this, it is indicative a field starting to back-up. Act immediately when you see this warning sign. 4 DO check to determine if you can smell any ODORS from field location. Odors can indicate that the leaching facility is having a problem. DO raise the tank COVERS O ERS up to WITHIN 6 OF GRADE. 4 DO USE LIQUID DETERGENTS and USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.. 4 DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS. RAGGS SEPTIC SERVICE,INC. d.b.a.E.A.COMEAU SEPTIC P.O.Box 1027 Concord,Massachusetts 01742 (978)368-1100 (800)287-6641 FAI((978)89741848 website:httpYA ww ragpinc.com e-mail:info@ragpine.com \ I ee 15 *4GGSpyou Stn 1 4 DO USE ENVIRONMENTALLY SAFE PRODUCTS. 4 DO INSTALL WATER SAVING DEVICES, where appropriate. 4 DO AVOID having roof gutters and downspouts DRAIN ONTO the LEACHING FIELD. THE DON'TS 4 DON'T DISPOSE any NON-BIODEGRADABLE MATTER IN TOILETS. Foreign items can cause blockages in the lines and back-ups. (i.e.: cigarettes, sanitary napkins, diapers) 4 DON'T wash paint brushes used in latex or oil PAINT. Paint residues are not broken down by a leaching system. In fact, they will travel out to the leaching facility and impede its ability to function. 4 DON'T allow any PAINT, THINNERS, OR ANY OTHER TOXIC OR CAUSTIC LIQUIDS, to go down sink or toilets. 4 DON'T allow ANY GREASE or FAT to enter system. Residential sites do not have grease traps. Therefore, if grease is allowed into the li system it will congeal and travel out to the leaching facility leading to damage. 4 DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS, DENTAL FLOSS, OR FIBROUS MATERIAL, etc. when using a garbage disposal. However, it is recommended that garbage disposals aren't used at all. 4 DON'T use POWDERED DETERGENTS with phosphates. They don't break down and can re-solidify. 4 DON'T use an DRAIN CLEANERS, such as Drano®, Li uidPlumbr@. Y q Call a rooter professional or buy a small rooter snake at the hardware store. Drain cleaners KILL bacteria. Bacteria keeps your system alive. RAGGS SEPTIC SERVICE,INC. d.b.a.E.A.COMEAU SEPTIC P.O.Boz 1027 Concord,Massachusetts 01742 (978)369-1100 (800)287-6641 FAX(978)8974848 webeite:http://www.ragpinc.com e-mail:___6 er .00m J�, ' YOU Since 1 �• �GGS, 1� THE DON'TS 4 DON'T use any ENZYMES or BACTERIAL ADDITIVES. These products usually have too low a pH to be effective. Often they are sitting on a shelf too long. Normal activity and proper use of a septic system should provide plenty of bacteria naturally. 4 DON'T use any GREASE DISSOLVERS. Degreasers allow grease to flow out of the tank and into your field. 4 DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON. In the event of a clog or other plumbing problem, contact your local plumber, rooter or pumper. 4 DON'T PLANT any trees or shrubs WITHIN 10 FT. OF THE LEACHING FIELD. Root systems can cause damage to the piping in the leaching facility. 4 DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES OVER the LEACHING FIELD. Doing so will saturate the field, damaging the system's performance. Systems are designed to handle up to a certain quantity of flow. 4 DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP of the LEACHING FIELD. Damage to piping could result. 4 DON'T INSTALL a swimming pool, a patio, or a driveway over the tank or Leaching field. If installing a swimming pool, ensure that the backwash does not enter the leaching system. Do not obstruct access to the tank otherwise it will be difficult to maintain. 4 DON'T CONNECT a basement SUMP PUMP to a household DRAIN. 4 DON'T ALLOW WATER USAGE to EXCEED the DESIGN FLOW OF YOUR SYSTEM. 4 DON'T ALLOW a WATER SOFTENER TO BE HOOKED UP to a SEPTIC SYSTEM. Check with the local authority to see if an alternative place for the backwash can be used. i RAGGS SEPTIC SERVICE,INC. d.b.a.EA.COMEAU SEPTIC P.O.Bos 1027 Concord,Massachusetts 01742 (978)369-1100 (800)287-6641 FAX(978)897.8848 website:http:/Awww.raggainc.com e-mad:inh@raggsinc.com Town of North .Andover Qg t%°pTp�h Office of the Health Department Community Development and Services Division * . 400 Osgood Street North Andover,Massachusetts 01845 9SSAca+uSEs Michele E. Grant Telephone(978)688-9540 Board of Health Inspector Fax(978)688-9542 Date: January 19, 2005 To: Mrs. Joan Potter From: Michele E. Grant North Andover Health Inspector Re: 100 Johnny Cake Street Dear Mrs. Potter, On the morning of January 19, 2005,we received your complaint regarding an unusual amount of water flowing through your yard, as well as the property next door to you, 150 Johnny Cake Street. As you know, at your request, DPW was dispatched to the site to take a Water Sample from the wet area of concern. The Water Sample indicated "No Fluoride". As a result of the findings,that would eliminate Town Water as being a problem,therefore eliminating a Septic System problem. A site inspection was conducted by the Board of Health as well as the Conservation Department on the afternoon of January 19, 2005. We were unable to determine exactly what was causing the problem. A review of the records was conducted and found that the Water Table is 18" below the surface. There weren't any Ground Wells in the area. The plans also indicate that the Johnny Cake neighborhood is historically in a high water table and in very close proximity to the Wetlands. This being the reason Conservation inspected the site as well. We definitely recommend you speak to the homeowners of 100 Johnny Cake Street. They may be unaware of the issues. It appears that this problem has been ongoing for sometime now. It is obvious that there is a serious water problem and is turning this into a dangerous situation. We encourage all parties to come together to find resolution to this issue and seek out the problem to rectify. We are completely baffled by the amount of water'in this area. In conclusion, to The Health Department's investigation the information derived from these inspections, points towards Ground Water or an Underground Pipe as being a possible source. The location is on private property therefore it is not in the Town of North Andover's jurisdiction to continue any further investigation, unless new findings are discovered by a Private Drainage BOARD OF APPEALS 688-9541 BIJILDING 688-9545 CONSERVATION 688-9530 HEALTI1688-9540 PLANNING 688-9535 { t w ae s% 1 n , 4 t[ iJY� f � � Fa r a _ b yr § s s....l••.i .r •� Y1�d � �'li�}4. t a�` �F f' t . e u, 4 ;k k ppp �1 ig r t t 4 W *t \ j Specialist. It would be appreciated by the Health Department to be informed of any findings so as The Health Department may identify any future problems in the area. Please, if you have any questions, call me at 978-688-9540 Sincerely, Michele E. Grant North Andover Health Inspector Cc: Jack Sullivan Department of Public Works Pamela Merrill Conservation Dept Susan Sawyer Public Health Director 06/14/02 FRI 10:36 FAX 17812722531 AMTNITY INC. @001 VU FAXCIMILE To: Sandra Star North Andover Board of Health Copy: Mike Reilly, FP Reilly Bob Gorman From: Dan Potter RE: Concerns related to new septic system at 140 Johnny Cake Street Sandra, I understand that you visited my property yesterday to assess the concerns raised in our conversation of June 4. As we discussed,I continue to be very concerned about the poor drainage caused by the new septic system installed and what appears to be contaminated water running off the front of my property and onto the street and stone drain. I have turned off the sprinkler system on the front lower two-thirds of the house,but the water level continues to remain very high. We also discussed my concerns about the foundation of the ho�m e being lower than the slope of leech field which,if not addressed on the side and front,will eau.ae water damage to my finished basement. FP Reilly installed the system,and the contractor has acknowledged that there is still work to be performed on the side yard,but not the front. I would like to talk with you this as soon as possible for answers to the following: 1. Did you take any samples to test if the water if contaminated? 2. Has the final Title 5 inspection occurred? 3. Has the"as built plan"been submitted? The contractor is believes the work has been completed and is expecting payment. The previous bomeowner, Bob Gorman,has put funds in escrow for completion of this work which is now well above the estimate. I believe the concerns above need to be addressed immediately prior to any payment. i T11ank you r your assistance in this matter. Dan Potter 140 Johnny Cake.Street North Andover 617-513-3138 i North Andover Health Dept. 27 Charles Street North Andover, MA 01845 Tel. 978-688-9540 Fax 978-688-9542 facshRe ftwsmiftal To: Daniel Potter Fax: 1-781-272-2531 From: S.Starr Data: 6/14/2002 Re: 140 Johnnycake septic Pages: 1 CC: M.Riley O urgent ❑For Review 0 Please Comment ❑ Please Reply 0 Please Recycle Mr. Potter, It is a fact that with the design engineer I inspected your site yesterday. I left a message on your answering machine requesting a scaled plan showing the layout of your sprinkler system. This plan should show the linkage of all lines and the exact positioning of the sprinkler heads. I cannot make any further comments on your site until 1 review this plan. Kindly submit it to the Health Department at 27 Charles Street as soon as possible.. Thank you. Annual MHOA conference- 4 staff, 2 days room&board=$550: r i Conference fees for annual MHOA$69 X 4= $276 4 quarterly meetings-2-3 staff @ $50 each=$600 2 DEP trainings 3 staff @ $35=$210 2 MEHA meetings- 3 staff @ $60= $360 " MAHB certifications -Board and 1 staff @ $80= $320 2 DPH trainings 3 staff @ $60= $360 Annual MAPHN conference- 1 nurse @ $80= $80 5322 Training& education Food safety training and certification- 1 staff @ $200 Certification for septic site evaluation- 1 staff @ ? Haz mat 40 hour recertification program- 1 staff @ $475 OSHA awareness training for 3 staff @ $125 = $ 375 n Seminar for nurse- 5341 Telephone "� aj.• .tx Vis. �; `' � •, �.::. 5342 Postage Services �U, W This amount is to cover postage expenses for approximately 280Q ptee esaof mail. It includes the proposed raise in postage costs to$.37 per ounce ! Un 5345 Internet Service .'e Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3�oy�t�Eo APPLICATION FOR SITE TESTING/INSPECTION 7 A�AATED PPa`�y �SSACHUS�� J Applicant NAME ADDRESS TELEPHONE Site Location 1 Engineer ^ NAME ADDRESS TELEPHONE Test/Inspection Date and Time-)n ' � O BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. i Town of North Andover, Massachusetts Form No. 1 o� NORDTil qA BOARD OF HEALTH - 32 =1.9 �RAORgrEp PPpy y APPLICATION FOR SITE TESTING/INSPECTION �SSACHUS�� Applicant NAME J ADDRESS TELEPHONE Site Location-/ v ' Engineer%�� � 1-fir1��`, �_ ;i Gf/1' �'r./�ft NAME �] f� ADDRESS TELEPHONE Test/Inspection Date and Time ,f �A -CHAIRMAN,BOARD OF HEALTH / Fee `�," Test No. S.S. Permit No. �.A,- D.W.C. No. C.C. Date Plbg. Permit No. l �e-2���rM1h AO INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO ILYlials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon W� 3. Edge of excavation specified distance from foundation,etc. - Comments: I B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: I I C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 1 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line I� 8. Cleanouts precede all change in alignment and grade �. 9. Manholes at any 90°change 10. 10' minimum offset to water line 's Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffl eP resent on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20"manholes tl 7. Inlet tee minimum 12"under invert 8. Outlet tee minimum 14"under invert 9. Outlet line cemented 10. Air space 3"above tees i 11. 2"7 3"drop from inlet to outlet 12. Pipe set 13. Compact base with 6"of 1/4"crushed stone under tank 14. Tank is watertight Comments: I ' T Yes NO E. Pump Chamber 1. If separate.from tank,compact base with 6"of 1/4"stone underneath 2. Minimum 2"pipe to d-box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d-box Comments: F. Distribution Box 1. D-box level 2. Minimum 0.17"(2")drop from inlet to outlet 3. . Minimum 6"sump 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement -=L/ 8. Schedule 40 pipe Comments: G. Soil Absorption system n 1. All stone double-washed-'/4"- 1 '/z" -pea stone Bucket test done? 2. Minimum 2"of pea stone above distribution linesy 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope / 6. Minimum of 9"of fill graded over system i 7. Toe of slope stops minimum 5' from edge of property; if not,then swale Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan-Minimum 2';maximum-4'. 4. Vent present if<50 feet or specified 5. Distance between trenches minimum 4'and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6"per 100' 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: [. Leach Field 1. Maximum length of field 1x00' ►� /1 2. Pipe slope minimum 0.005 or 6"per 100' ✓ l 3. Separation between pipe 6'maximum 4. Pipes connected at endy 5. Separation between adjacent fields 10.'minimum ------ 6. Pipes set on stable base ✓ . 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines — 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48"wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 v 2. All system components covered by at least 9"soil -- 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling >/ 5. No areas over system that may pond -� Town of North Andover f AORT11 3r 0 ,11 "s rye `.0 Office of the Health Department Community Development and Services Division ; 27 Charles Street North Andover, Massachusetts 01845 "Ss "°S Sandra Starr Telephone (978)688-9540 Health Director Fax(978)688-9542 October 30, 2001 Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 I Re: 140 Johnnycake Street Dear Mr. Dufresne: This is to notify you that the revised plans dated 10/3/01 for 140 Johnnycake Street have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at i 978-688-9540. I i Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: File Gorman-�1-e act ss /o q /lea m leerk6t vie, s✓ozr �f-h An do v)or /0/3 C� ✓ SS/aem BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 { Town of North Andover, Massachusetts F°'"' No.s „oRT„ BOARD OF HEALTH O ' F w • °----• DESIGN APPROVAL FOR s S"CLAUSE SOIL ABSORPTION SEWAGE:DISPOSAL SYSTEM Applicant Test No. Site Location A 17 Reference Plans and c , 7' 1 DESIGN`- 'DATE • i3 Permission, is granted- for anIndividual loll, a.bso,rptlon sewage disposal .system to be installed in accordance'with regulat gns of Boar&of Health !: HEALTH CHALRMAN B'ARD'OF i. Fee Site System ern -No. 11C y { j vi &A wo-A A I MERR MACK .ENGINEER NG (SERV CES INC. Engineers • Surveyors a Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE (508) 475-3555 ATTENTION Fax (508) 475-1448 TO RE: ��/� ✓l�/VN ��� g O D 3 WE ARE SENDING YOU ❑ Attached �❑ Under separate cover via p the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION rLM-4 e10:9-3� F � THESE ARE 7ITTED as checked below: pproval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS oi4 COPY TO SIGNED:��/ If enclosures are not as noted kindly notify us at once. l MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com September 26, 2001 Ms. Sandra Starr, Director .= Health Department rtw r 27 Charles Street h r North Andover, MA 01845 C- 282001 RE: 140 Johnny Cake Road Dear Ms. Starr: We have received your letter dated September 21, 2001 with regards to the above referenced site. Enclosed herewith is three (3) copies of the revised sewage disposal system plan. Items 1, 2, 3, 4, 7, 9, 11 and 12 have been addressed. With regards to item 5, we request that an additional test pit be performed at the time of the bottom excavation inspection. It can be difficult with upgrades to predict the required location of test pits before surveys are completed and design are finalized due to the existing site constraints with which we must work. With regards to item 6 of your letter, we simply and professional disagree. There is no setback distance from decks to septic tanks according to Title 5. Title 5 states that that no structure may be located above or upon a tanks access location which interfere with performance, access, inspection, pumping or repair. According to this design, no structure is located above or upon the tank at all let alone the access locations. The close proximity of the tank to the existing deck is a design feature necessary to maintain a gravity flow system. With regards to item 8, buoyancy calculations were not provided as we cannot intelligently predict the E.S.W.T. in the tank location without further testing, however, with logical reasoning we can predict the likelihood of the tank floating as the current tank has existed in this location for over 15 years without problems and it is 1.5 ft. lower than the proposed tank. With regards s to item 10 which simply states, less than 4 feet to groundwater", the plan clearly requests a local upgrade to 3' from groundwater and the letter submitted with the original plans makes the same request so we are unclear as to the meaning of this comment. Item 13 refers to a minimum leach field of 900 S.F. pursuant to NA 9.01 and again the plan and letter both request a variance from your local regulations to allow a 750 S.F. leach field so we are again unsure as to the intent of this comment. I� Ms. Sandra Starr, Director September 26, 2001 Page 2 Finally, with regards to item 14 we feel the S.A.S. as designed conforms to the requirements of Title 5 and the N.A. Regulations and regardless of its configuration will function properly. We ask that you review the revised plans and applications and approve the design as resubmitted. On behalf of our clients, Bob &Liz Gorman, we appreciate your prompt attention to these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd MERRIMACK ENGINEERING SERVICES,INC. 66 PARK STREET ANDOVER,MASSACHUSETTS 01810 I TOWN OF NOR'T'H ANDOVER o� �oRVH q g� �•t gs.,, r.,va Oot HEAL'T'H DEPARTMENT F , 27 CHARLES STREET a NORTH ANDOVER, MASSACHUSETTS 01845 9SSRCHU`�E� Sandra Starr Telephone(978)688-9540 Public Health Director FAX(978)688-9542 September 21, 2001 Bill Dufresne Merrimackn E gmeermg � 66 Park Street Andover, MA 01810 Re: 140 Johnnycake septic Dear Mr. Dufresne: This letter comes to notify you that the plans for the proposed septic system repair at the site noted above have technical deficiencies that must be addressed before approval can be given. These are: 4: All variances requested not listed on the plan. (3 10 CMR 15.220(4)(p)) 2. Original signature of engineer missing from plan. (3 10 CMR 15.220(1) & (2)) ,3. No LUA request form accompanyinglan. 310 C p ( MR 15.403(1)) A. All deep holes must be shown on the plan-Tl missing. (NA 8.02n) V5- Insufficient deep holes in disposal area;none in northern section. 6. Tank is less than 5 feet away from deck and the line to the tank is inaccessible. (3 10 CMR 15.228(3)) v7. Cleanouts before changes in pipe alignment missing. ✓4. No buoyancy calculations. (3 10 CMR 15.221(8)) v 9. No vent details, (3 10 CMR 15.241(a) & (b)) A .,Less than 4 feet to groundwater. (3 10 CMR 15.212(a) &(b)) v� Impervious barrier not poured concrete. (NA 9.02) -42. Only 10 inches of percolation test done in most restrictive soil layer. (3 10 CMR 15.104(2)) -13. Leach field area less than minimum 900 square feet. (NA 9.01(1)) 14. Perhaps another location for the vent and a butterflied leach area might be considered. Please remember that all resubmission require a$60.00 review fee. If you have any questions, please do no hesitate to call me at 978-688-9540. Sincerely Sandra Starr, Director Cc: Owner File MERRIMACK ENGINEERING SERVICES, INC, PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475 1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: RE: I �a�JLi1�- TM: 107A TL: I q OWNER(NAME& ADDRESS) V&,'36 2T fELJ:IM06F0 Members of the Board: An upgrade sewage disposal system plan dated: 7-7--5 -tel has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations,Local upgrade approval and/or variances are being sought from the following sections. 1) L.L-IA, Foy .3) �&k ed-1, ZatiIV C-0970-H61-1 10 Ll FU OFGviU�f��`� Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES r (V William Dufresne n� SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: YES $160.00/Plan REVISED PLANS: S $ 60.00/Plan a� SITE EVALUATION FORMS INCLUDED: YES LN I DATE: DESIGN ENGINEER: rn K�� Z DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. . 82001 4 t � Page 1 of 5 9A-APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non-conforming system with a design flow of<10,000 gpd,where full compliance, as defined in 310-CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non-conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: VPli�'T_ Ce-wWA-pj r Address: 1,40 ,Wptoo� CAS ►2V, Phone#: Oji._ 15,&14 Address of facility: h � 2) Applicant(if different from above) Name: Address: Phone#: 3) Ty of Facility: ---Residential Commercial School Institutional (Specify) Page 2 of 5 4) Type of Existing System: _privy cesspool(s) Z onventional system other(describe) Type of soil absorption system(trenches, chambers, pits,etc.) 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system 4*2 gpd Approved: des Approval date: no Why: b) Design flow of proposed upgraded system+J�gpd Why c) Design flow of facility gpd 6) Proposedypgrade of existing system is: a) oluntary required by order, letter,etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: G-1 W J t 'rtf rit-., Tc.s A-;� l �CXI c) Which of the following are applicable to the proposed-upgrade? Reduction of setback(s)(list setbacks to be reduced with proposed setback u� distances) Percolation rate of 30-60 minutes per inch(state actual perc rate) AA Up to 25%reduction in subsurface disposal area design requirements (state required&proposed size) AIA Relocation of water supply well(identify well,describe relocation) Reduction of required separation between bottom of SAS &high groundwater(specify proposed reduction& perc rate) 4,97 t �Jp gyp( i i Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met(specify sections of the code) System upgrades that cannot beP erformed in accordance with 31 CMR 15.404& 15.405, or in full compliance with the requirements of 310 CMR 15.000,require a variance pursuant to 310 CMR 15.410-15.417. 7) 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 ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: I Distance from soil absorption system to high groundwater 2-7 feet As determined by: Evaluator's name: `2 r4 t Evaluator's Signature Date of evaluation: '�F— 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date,time and place where the upgrade approval will be discussed. If the department is the approving authority,then such notice to abutters must be completed prior to the date of submission of the application to the department. L The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. to Page 4 of 5 List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1),is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: I�l,c-II�� Chtl�..�f"y'�- Gvn)�rT1��i1S b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. c) A shared system is not feasible. IQ'. d) Connection to a sewer is not feasible. ,v�rrt-iG�fa i i 10)An application for a disposal system construction permit,including all required attachments(e.g. plans&specifications,site evaluation forms),must accompany this application. Is the DSCP application attached? es no g Page 5 of 5 11)Certification 1,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 imprisonment for knowing violations." z � Facility 0 er's Signature bate Print Name VU Name of Preparer Date A- e ne s 0($110 �7!;:--zs5;75) Telephone N o. &Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. i CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applic t:� /. +i6�,z,�W q,%,Name of Designer: A 01—&06-5%c Plan Date: ZAJ leu Revision Date: Date of Review: Property Address: /`�'G1 �n/1 til AV!c rl k le Map: Lot: BOH Reviewer: /�i> Type of Plan(new or(pgrade,: • Number of Bedrooms in Assessor' s Records: gpd)Garbage Disposal Allowed: _ General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A f Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) Legal boundaries of the facility being served-220(4)(a) Names of abutters from recent tax map- NA 8.02j / Number of bedrooms,design calcs.,-NA 8.02i Name&address of record owner&applicant- NA 8.02k Name&address of designer-NA 8.021 L-- Holder and location of all easements-220(4)(b) ✓ Date plan drawn&any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) ✓ All distances on site plan-NA 8.03a-c Elevation of proposed driveway-NA 8.02t f'- Location and elevation of foundation drain-NA 8.02y ,�. Location and dimensions of the system incl.reserve(new const.)-220(4)(e) �. Limits of excavation of leach area on site plan-NA 8.02z Locus plan-220(4)(t) (Not to scale) t/ North arrow-220(4)(g) �✓/" Existing and proposed contours-220(4)(g) V Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) Existing grade elevation of each deep hole-220(4)(h) 1, Elevation of percolation tests-N.A. 8.02n t/ Name of approving authority representative-220(4)(h)&(i) -� Name of soil evaluator-220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines,drains,and subsurface utilities-220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system-220(4)(n) Complete profile of the system to scale-220(4)(o),NA 8.02c ✓ Cross section of leaching facility-NA 8.02w (Not to scale) f Location of benchmark(s)within 50-75 feet of facility-220(4)0 Note listing ail variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) 'r 2 c/ Original R.S./P.E. stamp,signature&date-220(1)&(2) t� If P.E.,discipline specified within stamp. MGL C. 112 s. 81M sfc.supplies(w/in 400'),pub.wells(Win 250'),pvt.wells(w/in 150')-220(4)( Location of watercourses,wetlands,wells,etc.Win 150'of system—NA 8.02r Wetland disclaimer—NA 8.02s ✓ RLS plan reference&certification required(prop line setbacks)-220(3) Plan contains designer's certification statement -�� Use approvals/standards checked for I/A system-DEP docs., Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) l�j Perc rate> 60 MPI-must use modified tight tank or UA technology-245(4) i, Proposed system qualifies as"shared"system-002(definitions) c/ Flow is over 2,000 gpd-No R.S.allowed-220(1) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment-354 Leaching facility at least 1'above Base Flood elevation—NA 9.05 All piping Sch 40 minimum—NA 10.01 ✓ Basement floor minimum 1' above groundwater elevation—NA 5.04 ✓ Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK. /Prob N/A Proper deep observation hole logs on plan-220(4)(h) P All deep holes and peres shown, including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) �— Proper percolation test log-220(4)(i) Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) _ Ample perc testing(one in each disposal area, 3 in prim.>2,000 gpd)- 104(4) Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: ground elevation el. 1 ( _ /, Y acceptable soil el. Leach facility invert el. ground water el. refusal el. j bottom of leach facility el. thickness of acceptable soil before&after soil R&R separation to groundwater separation to refusal l s soil class 2 3 perc rate %U • / /P u--' 'iz is ,� G loading rate > �fj septic tank below g.w.table (yes or no) Ekb-ld-� pump tank below g.w.table (yes or no) Lf in fill -255(l) Setback Distances(Given in feet) 15.21 1 YES ONO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A . Septic Tank Leach Facility � Property line 10 10 Cellar wall 10 20 Inground pool 10 20 L- *" Slab foundation 10 10 Deck,on footings,etc. 10 Waterline 10 10 YPrivate drinking well 75 100 Irrigation well 75 100 V Wetlands 75 100 L-G�ublic well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib.To Surface Water supply 325 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 t/ Drains(wat. supply/trib.) 50 100 Drains(intercept g.w.) 25 50 Foundation drains 10 20 Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope 3 4 w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses(check 230 for details) �r Pipe diameter listed(4"minimum)-222(1) 7 Pipe schedule listed-222(3) i/ Pipe cast iron or Sch 40 PVC—NA 11:02 Watertight joints specified-222(3)&(4) t/'r Pipe laid on compact,fin base-222(5) 1 Pipe laid on continpous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) L/ Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment change-222(8) Invert elevation at building: Invert elevation at septic tank: Q Y L- Length of run: /7` Slope: (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank OK Problem/ N/A Tank is accessible-228(3) JF No structures above tank—(228(3) _y/ Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) 2-3"drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) 3"air space above,tees/baffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6"above flow line-227(1) V Inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) a/ Access manhole cover above center of tank&each tee(except 2 compart) 228(2) ✓ 3-20"manholes-228(2) 1 childproof,24"riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) vl Soil compaction below tank specified(if soil is non-native)-221(2) t� '-b-" 6"of<=3/4"stone beneath tank specified-221(2)&22 8(1) If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp.-223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart.tank-223(l)(c) Buoyancy calcs.required if tank at or below water table-221(8) Tank is watertight-221 (1) 9"of cover over tank(minimum)-228(l) H- 10 loading(min.)-H-20 if traffic-226(3) Top of tank<=36"below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible 4 5 Tight Tank(Check here if not present: �� ) OK Problem N/A 500%of design flow or 2000 gallons provided—260(2)(a) 3-20"manholes—228(2) Soil compaction below tank specified(if soil non-native)—221(2) 6"of<=3/4"stone beneath tank specified—221(2)&228(1) Buoyancy calcs.Required if tank at or below water table—221(8) Tank is watertight—221(1) 9"of cover over tank specified(minimum)—228(1) H-10 loading(min.)—H-20 if traffic—226(3) Top of tank<=36"below grade—221(7) All pumping to tank(if applies)in accordance with—229 AN alarm set at 3/5 tank capacity—260(2)(c) Min. 1-24"frame w/cover at finished grade—228(2)(0 Year round access for pumping—228(2)(g) Distribution Box(Check here if not present: .._._,Problem N/A %6� Inlet elevation: Outlet elevation: -3_ 0.17'drop from inlet to outlet(minimum)-232(3)(b) ' 6"sump(minimum)-232(3)(e) ' All outlets at same elevation-232(3)(b) Outlet pipes laid level for first 2 ft. -232(3)(c) Pipe Sch 40-NA 10.01 Number of outlets: Number of laterals: Size of outlets: —I"' Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a), �-� Soil compaction below distribution box specified(if soil is non-native)-221(2) _ 6"of stone beneath distribution box specified-221(2) Box is watertight-221 (1) S/ Top of box<=36"below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8) Pump Chamber(Check here if not present: ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day-220(4)(r)(also 254(l)(d)if gravity from d-box) Minimum 2"delivery line to d-box if gravity-254(1)(c) Pressure dosed l.f if flow>=2,000 gpd-254(1)(a)&254(2)(a) Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 5 6 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4 "solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 Check valve,bleeder hole-NA 12.01 I childproof,24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr. specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9"of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36"below grade-221(7) I Leaching Facility(general-complete for all designs) OK Problem N/A ✓r 50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) No vehicle or imperv.area above l.£unless unavoidable-240(7);NA 13.02 L/ Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) t/ Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c)— 5 09 y 2.5� All lines connected to vent if bed or trenches-241(1)(d) 9"cover over peastone-240(9) Reserve area provided(new construction)-248(1) Reserve 4' from primary leach area—NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a)&(b) -� 4'(down to 2'with variance or I/A-upgrades only)of natural soil under U. t� GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 -251(9) Require 5'removal and replacement if in fill-255(5) ;✓ Top of leach facility<=36"below grade-221(7) :✓ Final grade over l.f.minimum 0.02 ft/ft-240(10) i/ Surface&subsurface drainage away from I.f.-240(1 1)&245(5) / Minimum design flow 440 gpd without deed restriction—NA 13.01 1_�- 3:1 slope where grading required-255(2) 1� Toe of fill slope stops 5'from property line or swale installed-255(2) ✓�_ Impermeable barrier if<3:1 slope or< 15 feet to—3:1slope-255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E. -255(2)(6) :I,X Top of retaining wall>=top of peastone elevation-255(2)(fl 10'offset from edge of leach facility to edge of ret.wall-255(2)(g) Perc test(s)done in most restrictive layer- 104(2) •Perc test.4'below leaching elevation—NA 7.06 ✓ Design flow listed and required/provided leach area given-220(4)(f) ✓� Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4"diameter except for dosed system—NA 14.04 6 7 Leach lines capped,vented,or connected together-251(9) v Pressure dosing guidance followed if pressure distribution-254(2)(c), �-- Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) I Leaching Trenches(Check here if not present: t/ ) i OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) ! Trenches are vented(when>50')=251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) In fill or reserve between trenches, 10'min. -NA 14.01& 14.03 Available leach area given(Min. 500 s.f.)-NA 9.01(2) Bottom=L x W x# = s.f. Sidewall=L x D x# x2= s. f Effective leach area given Loading factor: Effective area=total area s.f.x LTAR = g/day Effective area is>=design flow of facility being served 2"of 1/8"- 1/2"2x washed peastone.-247(2) Trench depth of 3/4"to 1 1/2"double washed stone-247(1) Leaching Pits(Check here if not present: ) OK Problem N/A #of pits/pit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit or system:L W D Depth of pits(max eff.2'): -25 Available leach area given Bottom=L x W x#of systems= s.f. Sidewall=L+W x D x 2 x#of systems= s.f. Total area=bottom +sidewall = s.f Effective leach area given Loading factor: Effective area=total area s.f.x LTAR =_____,g/day Effective area is>=design flow of facility being served Minimum of pits at least 13'X16'—NA 9.01(3) Distribution for galleries/chmbrs. in trench config. -pipe every 20'-253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1 /2"2x washed peastone.-247(2) 3/4"to 1 1/2"double washed stone-247(1) Each pit has at least one 20"access cover.24"Cl to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents,if necessary,extend under covers of pit(s)-241 (e) Leach Fields(Check here if not present: OK Problem N/A Number of fields: _ (need dosing chamber if> 1,231 (1)) 7 /;l � � � .- �� v �� � � . . J � f 1 i it �... ! � � �/' • -v .. �: 1 f !� � ' ! �V � I ' t / ' 1 � i r. � � �� � .r .� � �� i � � � I♦ _�s, .. _ � �� 8 Length(100'max.): -252(2)(b) Width: /0 Total area:L 7c.,5- x W /0 = 76 &s.f. Minimum 900 square feet-NA 9.01(1) ✓ Distribution lines connected with solid pipe—NA 15.01 ✓� Effective leach area given O Loading factor_ $4o — �-� Effective area=total area — � ���s.f x LTAR� g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) 10'm inimum separation between adjacent leach fields-252(2)(f) ✓ Between 6"and 12"of 3/4- 1 1/2"stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2"2x washed peastone.-247(2) Final Grading OK Problem N/A f Slope over leach area minimum of 0.02 feet/foot—240(10) c/ Grading shall divert drainage away from leach area—240(11) Grading slopes away from dwelling 5/24/01 8 � . l �U/� � c( ,� Y . . /�a ©icec o c� �- . � � rlcc v f IVA Iro e hO If 513 A w r\ ,7 7-/ 6/c� � -� o f --e ry Wax . Tvi. e bl cf,V1 o sj y k e--porr-p (!-,h 0-rl�r e s /h l� � j) Uoyak, CCA2- Z d, Ts r e 5 5 a� � j-6 G o a , �,,Iy �o `' o -F enc �� e J o� jo , pt. 3 i f B��/� 3NN 1Nn1 INI .. � I.�l11C �IIIn INN iw rl �,��.= - - � IN111111111111n1111N 1 IIIINII �. n1NNE 11I 11 1 1111 :_ : �,:• 1111 111 N 1 11111 NNI IN 1 NNII IIINN1 IINI �' .�� � :_ IINIIIIIIIIIIN 1 IIn INNINIIi IIIINIII ��, .' INIIII NIIII 111 1 r - �_• p in IINni 1 mim. IINIIII In111 _ IIINn INNu111 11 NIIIIIINInI 1111 � / _ N 11111 N 1 11 Location: 14V p r owner's Name: Map/Parcel:- (q 1 Address: A-e F, Installer. Tel R:—&L --5,`�f New tstsol Repair Date: Wetlands "'� Zone II --- Soil Symbol _Soil 1Qame Soil Class G Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Te=ture Soil Color Soil hfottling % Gravel Stones,etc: Opp" r-! L v . .sAV . _ 3��3N C' S•1,.. Z.� 5;4 50 ,5Y l-l�s�lvl F�p�-1 Parent hi.aterial +1 L Depth to Bedmct•"" Standingg Water in the Hole;_26LWCCPin:fr°m Pit Face ♦_„et t' �/ FSHGIY;�_ r�to ri L 6, ..r -.... . I u 14.4 ` r �s 1=r •rl� FK j4owl .64 G, .•y. L Z,S Y S/4 F- A*0 l v E r1W I . T Parentliiaterial OTILL Depth to Bedrock!"' Standing water in the Holc fn lveepin;from Pit Face i ESHGtiY: t! Date —!!i-d! Percolation Tests Observation Hole-ft Depth of Perc ► I Start Pre-soak- Time, re-soakTimet at 12" ! Time at 9" ' Time at 6" ; 2 Time(9"- Irate Min/Inch Performed Bv:_ -12arMc \ t)I t- 1„ v a, I c. • III J II1 III • I � I Qyti) 11 I U I 11 <L t)) III t'1 f <[ V (_) -1- fI' I— LIJ LIJ LIJ L1JII' I-_ <I- `I• �[- O 7 O III C� Z Z Z j Ll l l i l 1.1 111 l I J ' (fl it-1 IJ_ t— I— I— 1— J -- U /t Q MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: ''�-2 4► l RE: TM: 1071-1 TL: OWNER(NAME & ADDRESS) p ( lOr s�6600 "A-0 Members of the Board: An upgrade sewage disposal system plan dated: 7-0-5 has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. .3) r . Please consider these requests for approval on your earliest available rne6f5h1g agenda _ -- r We respectfully request your consideration of these matters. Jud 3 200 Very truly yours, 4 -----°� MERRIMACK ENGINEERING-SERVICES r Z/ William Dufresne 1 cd SEPTIC PLAN SUBMITTAL FORM LOCATION: 1140 !A��. Q„ a K NEW PLANS: YES $160.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: NO DATE: 7-Z-7-01 DESIGN ENGINEER: DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. i "ifJVV�!(3�F 3�sH O 913 C)F H�XLTH-� c - �u �u nl d 1, u � tl- -c — `� � c_l i•1 — _ ��— I— cit _ I— lil J ? 11— I— I— U 'l uJ u.l uJ w mak. yd BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS I V E DATE: FEB 2 6 2001 LOCATION OF SOIL TESTS: I 'LL Assessor's map & parcel number c-1 o:ZA "^_ OWNER: ��� ,4= TEL. NO.: - � ADDRESS: H-0 jotgt\jorr� � L� ENGINEER: ME1212► r M61 U 4TEL. NO.: CERTIFIED SOIL EVALUATOR: _ l____ I i-V Intended use of land: re 'dential subdivision, single family home, commercial Repair testing �. Undev ed to g N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill,-deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of 1276.00 per lot forep w construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75,00 per lot for repairs or uparadgs. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform y pe m deeR p hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 9 6. Within 45 days of testing, a scaled plan (no smaller than 1'-100') shall be submitted to the Board of Health showing the location of all tests (Including_aborted tests.).: 7. Within 60 days of testing soil evaluation forms shall be submitted. ; 6n E S �j R ' 6 201 r 74r' _S i 4),q V19 t ,�OAIi _; u-------- - _.._. P.:X 69 /6 8,SZ. ora COM,yoN� i __�_l.._.__....__.... y nl n <� p Z � r y b n.At I G. � F .a 00 G S 4. Healtxi 1dover,Mas SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT J APPROVED DATE_2 � DISAPPROPED DATEw F Provided: � .�� Reasons s 1 V Title V FAIL OK Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot ,Y,abutters --- - location and log deep observation hoies-distance to ties c location and results percolation tests-distance to ties- d design calculations & calculations showing required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours (g) location any wet areas within 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal system or disclaimer-Planning Board files (3) known sources of water supply within 2001 of sewage disposal a system or disclaimer (k) location of any proposed well to serve I )t-100I from leaching facility (1) location of water lines on property-101 from leaching facility, (m) location of benchmark (n) driveways Wgarbage disposals no PVC to be used in construction (q) profile of system-elevations of basermt, plumb, pipe, septic tank, distribution box inlets, and outlets, .tin ribution field piping and btker elevations (r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional bngineer or other professional authorized by law to prepare such plans S Reg 6 Septic Tanks (a) capacities-150% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground suimadng pool (d) 25+ from subsurface drains ' Reg 10.2 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 b) sump NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nmAnetway.com it Date: August 17, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/035 140 Johnnycake Road Assessors Map 107A, Lot 197 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated July 25, 2001,by Merrimack Engineering Services. It is our opinion that the proposed design will meet the requirements of Title V and the North Andover Board of Health`By-Laws"if the following is addressed: I 1) Plan needs to be redrawn with an eye to meeting the requirements of Title V and the local by-laws. Respectfully, I John L.Noonan,P.L.S.-P.E. Qoffice/forms/tonarev 1770035 Land Surveyors Civil Engineers Environmental Planners MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering I DATE: i RE: i4 �0.0kiNy , TM: 107A TL: 1'9-7 OWNER AME& ADDRESS) f ICU�T�( �I��Q�I��; ►^-lam D r� Members of the Board: An upgrade sewage disposal system plan dated: 7-0--5 --c�j has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or g pg pp o variances are being sought ht from the following sections. I) I, L-1 A. Fob �I�a"i"/ T�J f �i�'j Gr � -t-O -�;'l 3) Please consider these requests for approval on your earliest available meeti:n ,wtends. , . gg_ We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne cd CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS N&M Job 1770/ J The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant:X42$'-'7 Name of Designer: Plan Date: Revision Date: Date of Review: Property Address: / f 4 c7al�f�ti vc�¢� -��P Map: 10'74L Lot: BOH Reviewer: Type of Plan(new or(pgrade): Number of Bedrooms in Assessor's Records: gpd)Garbage Disposal Allowed: General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for -lot plan 220 4 P P O 41,T, Maximum scale of 1 "=20'for profile and component detail - II/'V P P s 220(4) Legal boundaries of the facility being served-220(4)(a) S Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.021 Name&address of record owner&applicant- NA 8.02k Name&address of designer-NA 8.021 jHolder and location of all easements-220(4)(b) Date plan drawn&any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) All distances on site plan-NA 8.03a-c Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system incl.reserve(new const.)-220(4)(e) Limits of excavation of leach area on site plan-NA 8.02z Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) Existing grade elevation of each deep hole-220(4)(h) Elevation of percolation tests-N.A. 8.02n Name of approving authority representative-220(4)(h)&(i) Name of soil evaluator-220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines,drains,and subsurface utilities-220(4)(m) Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n) Complete profile of the system to scale-220(4)(o),NA 8.02c Cross section of leaching facility-NA 8.02w (Not to scale) Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) Original R.S./P.E.stamp,signature&date-220(1)&(2) If P.E.,discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies(w/in 400'),pub. wells(w/in 250'),pvt.wells(w/in 150') -220(4)( Location of watercourses,wetlands,wells,etc.w/in 150'of system-NA 8.02r Wetland disclaimer-NA 8.02s RLS plan reference&certification required(prop line setbacks)-220(3) Use approvals/standards checked for I/A system-DEP docs., 2 Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) Perc rate>60 MPI-must use modified tight tank or UA technology-245(4) Proposed system qualifies as "shared"system-002,(definitions) Flow is over 2,000 gpd-No R.S.allowed-220(1) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment,,,Z 354 Leaching facility at least 1' above Base Flood elevation—NA 9.05 All piping Sch 40 minimum—NA 10.01 Basement floor minimum F above groundwater elevation—NA 5.04 Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK Problem N/A j Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown,including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(i) Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: ground elevation el. acceptable soil el. Leach facilitv invert el. ground water el. refusal el. bottom of leach facility el. thickness of acceptable soil before&after soil R&R separation to groundwater separation to refusal soil class perc rate loading rate septic tank below g.w.table (yes or no) pump tank below g.w.table (yes or no) l.f in fill -255(l) Setback Distances(Given in feet) 15.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility Property line 10 10 Cellar wall 10 20 2 �,. 3 i Inground pool 10 20 Slab foundation 10 10 Deck,on footings,etc. 5 10 Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib.To Surface Water supply 325 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains(wat.supply/trib.) 50 100 Drains(intercept g.w.) 25 50 Foundation drains 10 20 Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC—NA 11.02 Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) Pipe laid on continuous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment change-222(8) Invert elevation at building: Invert elevation at septic tank: j Length of run: Slope: (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) I 3 4 ``: Septic Tank OK Problem N/A Tank is accessible-228(3) No structures above tank—(228(3) Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) 2-3" drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) z3"air space above tees/baffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6" above flow line-227(1) Inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 compart)228(2) 3-20"manholes-228(2) 1 childproof,24"riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) Soil compaction below tank specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath tank specified-221(2)&22 8(1) If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp.-223(l)(b) If plan specifies disposal must be 2 tanks in series or 2 compart.tank-223(1)(c) Buoyancy calcs.required if tank at or below water table-221(8) Tank is watertight-221 (1) 9"of cover over tank(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(3) Top of tank<=36"below grade-221(7) All pumping to tank(if applies)in accordance.with-229 Tank is set to keep old system in service during install if possible Distribution Box(Check here if not present: OK Problem N/A Inlet elevation: Outlet elevation: 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6" sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b) Outlet pipes laid level for first 2 ft.-232(3)(c) Pipe Sch 40-NA 10.01 Number of outlets: Number of laterals: Size of outlets: Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6"of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36"below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8) Pump Chamber(Check here if not present: ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r)fL Number of cycles per day-220(4)(r)(also 254(1)(#)if gravity from d-box) Minimum 2"delivery line to d-box if gravity-254(1)(c) -.a a 4 . f 5 Pressure,dosed Uif flow>=2,000 gpd-254(l)(a)&254(2)(a) Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4"solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 Check valve,bleeder hole-NA 12.01 1 childproof,24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr.specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9"of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36"below grade-221(7) Leaching Facility(general-complete for all designs) i OK Problem N/A 50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) No vehicle or imperv.area above 11 unless unavoidable-240(7);NA 13.02 Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9"cover over peastone-240(9) Reserve area provided(new construction)-248(1) Reserve 4'from primary leach area—NA 9.04 4'(5'if pert rate<=2 MPI)separation to g.w.-212(a)&(b) 4'(down to 2'with variance or UA-upgrades only)of natural soil under 11. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-251(9) Require 5'removal and replacement if in fill-255(5) Top of leach facility<=36"below grade-221(7) Final grade over It minimum 0.02 ft/ft-240(10) Surface&subsurface drainage away from 11-240(1 1)&245(5) Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) Impermeable barrier if<3:1 slope or< 15 feet to—3:1slope--255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E.-255(2)(b) To of retaining wall>=to of easton . P g p p e elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret.wall-255(2)(g) Perc test(s)done in most restrictive layer- 104(2) Perc test 4'below leaching elevation—NA 7.06 Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC—NA 10.01 �ch pipes minimum 4"diameter except for dosed system—NA 14.04 ;h lines capped,vented,or connected together-251(9) *� asing guidance followed if pressure distribution-254 2 (c ), sing required over 2,000 gpd or with UA remedial use-231(1) 5 6 + Leaching Trenches(Check here if not present: ) OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) In fill or reserve between trenches, 10' min.-NA 14.01& 14.03 Available leach area given(Min.500 s.f)-NA 9.01(2) Bottom=L x W x# — s.f. Sidewall=L x D x# x 2= —s.f. Effective leach area given Loading factor: Effective area=total area s.f. x LTAR = g/day Effective area is>=design flow of facility being served 2"of 1/8"- 1/2"2x washed peastone.-247(2) Trench depth of 3/4"to 1 1/2"double washed stone-247(1) Leach Fields(Check here if not present: ) OK Problem N/A Number of fields: (need dosing chamber if> 1,231 (1)) Length(100'max.): -252(2)(b) Width: Total area:L x W = s.f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: Effective area=total area s.f x LTAR = g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(f) Between 6"and 12"of 3/4- 1 1/2" stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2"2x washed peastone.-247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feet/foot—240(10) - Grading shall divert drainage away from leach area—240(l 1) Grading slopes away from dwelling 5/24/01 f./office/forms/tonackltr.doc �l i 6 Noonan McDowell, MUM NINE t,Fle.��E t Tool Data���.�f��mtam�ProcesY�e`"�,R� d 14tuaws x: it PTOf C 1770 i:..'� �Q�f17` ©f �:,,,. ® .�r•z i,. ;°� ��' ;: rilih Fixed Fee 150.00 ® ToNA 8 , I Mair 6i iinlhfo � x ontra;-{I�ifo ash -"fit'or+u � G � lung � S tfirt ,+,oposal umber x.� � � b 9p - ra G ntr ©at 811012001 W 5 abaft 811012001 este Fini��at rep, 4`� Survey engineering services required for plan review. Engineer. Daniel Koravos,Merrimac Engineering,978.475.35552 Applicant: Robert&Elizabeth Gorman Assessors Map 107A,Lot 197 a: - 140 Johnny Cake Road L `�5t�t �Q,�cl�Launch} �' •s `�� �Wind�FM5K+a4na �az�T�oS°-�i�rkd�h>t '�so ��>t�tl Ex S Project Request Record Town of North Andover Date: f O t? Client Id:ToNA Card Id:ToNA Client/Company Name:Board of Health 't."rlFllll r r-ar :CardirTvpeilt{ri,-Client'! j:, rJ/f�Id�k' +/ )tli IP+tf Pt,'PfJd;';pj# r3t;pldFtr/dtr//.�1/I,1/, �: f1d? t:rlt ylrrd` ,rr/f{rrr� raP 11.r;J ' r„tP,7ftJlflt, l.l'f,.,ir r if`t•jr.# l�rrr trdxr r t r{P I7jContact Name fJJMs'Sandra Starr.,Prt,JJr tJ:IfJdfJ1J{P ' i trr!Phone'd'+t 9781688-9540 f 7f fIP r,j{•if t/41`(lf; r'; rJ r/it f f Ali' .,,.r.. 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J{J n Ff td._e J e J,i r•`I(f rr`�f': Proiect: Project Id: 1770 Project Title: Town of North Andover,Board of Health (JOB NO) / (PROJECT NAME&STREET ADDRESS) d� J Billing Cod :Fixed Fee �0 Manager:NOW Billing Group: g _� f IPlliff/dPub�dfdNe'itJln't',al lgtffr,tfr�r I'laJ/rrtp...ct. ,'..,,rte'! tt,rr . ..... ;fr J, J''`':, J.i Y`' i t ,lfdt zrJfa,. 1( d.rfd'/g {d /f•'sf`f' Contract Info'Pro ect Descrt tton for,each{billtn ro +, t ,pr J" ,'1 tt It , 1tfrJPj rtl !, Ja,'/�`r'1r?f fJ/tJ�f� tfJf°f re..a a p frBG// (figpplrcantt d fi' 7� /T It / ✓t`:T3 -/��Y�r tt: 0.�2-/r'��J• ltrr/ ft1l/j td f rdtlitrrr t.r.. ad r.-:•f r9 - � 7�(1�; ssessors Ma ' .:0 /f-Lott (�°1�']}e�irfrJJ t(dr1 rtdet/�'rJtdftrrrt ffJf�tr moT Jf )/ f 4(W , rf t1h FI rtr t � t t s t r a J t:f ” u J rjrt//jf` t �r JJ t1 (tr t jJrrd 1�tfl'/(�J, flrpp!-!t r(rt J rJr r " ,t rr ilrer-!/ 1 t. ! t r r , r'; t,r• r f �tlrr./li.0 rfr, �'r ES<.ff.nite, h tri 7.n..P-.:rJ�tr,J t,.1 r>.,a, trN> � �.1, `Gd fd•'- dr r,Pit�'=fl ff r/r' tr r Jt(' f tl r J tr+ P , P tr sJ J Jfp ff//f( •t'' - £tnt -`t Ft ' rr7d a tdr r r , , r =P rx r •a'- r r (r Yrr r{f ..•a,. I - .... r- r r7 (1,. ;I PJIIIJJ, t rlJfr/r It lf:If-t t fJ�� ,Pd f Ir {k; t 'f t { t r x P J , 1 J(rd :3d rllu fdr,.. i{Jtfirlf,+il✓/li.rll.d.,:rdi i t,.t,raN a 1G9�c'6• illi r o,.' , .. °rr/ ., r .. r r. .r.._.1Jt fr .r .t pd ft=)rtdJrlFJtr�d9.�l.i.ti+/rfh.,�,.f r Jt�(fl?itl°; Office/forms/jbrqutona Location: 0 a u iyV6A V-e Owner's Name: Map/Parcel:_ 1 j7 A- Address: Installer: Tel R: _&C-:5560 E—T New(Sisol Repair Date:_ 'O Wetlands Zone n Soil Symbo Soil Rhme 0 G. Soil Class G Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Tenure Soil Color Soil Mottling % Gravel,Stones,etc: 0� 1� � Lct�a�I� W F'iws, �4 PIA 1-115 OF Parent Material +1 L1/ Depth to Bedrock Standing Nater in the Hole: tiVee mo from Pit Face �u " -��_ P ESHGIV:--LL_ o Fr►-Ih*Led Fe. w>wl Parent MAterial ,n L L Depth to Bedrock�Standing Water in the Hole•. r•' ins\Vet ! p �from Pit Face `�_ESHGtiV._J6 tt Date ?— Ito, -i-OPV . 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