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Miscellaneous - 141 STONECLEAVE ROAD 4/30/2018 (2)
141".TONE('LEAVE ROAD Oad I i r � �s u �,�° N�/ c� ' _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the RECEIVED computer,use 1. Inspector: q��� only the tab key MAY 2 4 2016 to move your Neil J. Bateson cursor-do not Name of Inspector use the return TOWN OF NORTH ANDOVER key. Bateson Enterprises Inc. HEALTH DEPARTMENT Company Name VQ 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needsf urther Evaluation by the Local Approving Authority //fa-' 5/13/2016 1 nsiJ6ctVrV1gnature V Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. p I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. ' A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment, ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 official Inspection Fonn:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °r 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) • ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® El information the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes [I No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 ears usage(gpd))' On Well Water> 100'from S.A.S. Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is North Andover MA 01845 5/13/2016 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 1 1/2 years ago, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank. Reason for pumping: Inspect tank&tees. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sawage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road ,p Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 10 years old, 5/31/2005, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4.5 feet Material of construction: ® cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast Iron through wall, 3" PVC in house, no leaks visible. Septic Tank(locate on site plan): Depth below grade: 3.5 feet Material of construction: 0 concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 4.1 t5ins•3H 3 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �r 141 Stonecleave Road M V Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" It Scum thickness 4.1 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 9.1 How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Inlet cover has riser 1'deep. Pumped septic tank. III Grease Trap(locate on site plan): 9 Depth below rade: P feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): x Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. No evidence of carryover. No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump tank ok. Pump ok. Floats ok. Pump tank 3'deep. Has riser cover 8"deep over pump&floats *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-'3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is` required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 20'x 40' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction. Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate Where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 c� O-Goy ± 014 = I S v�t o t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road Property Address Sylvia Sasso Owner Owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/9/2004 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Design plan i ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Stonecleave Road ,p Property Address Sylvia Sasso Owner owner's Name information is required for North Andover MA 01845 5/13/2016 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 . N Commonwealth of Massachusetts City/Town of . System Pumping.Record Form 4 DEP has provided this form for use-by local Boards of Health.other forms may be'used,but the information•must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record`must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of house, Left t rear�reardf Left/right side of house, Left/ Right side of building, Left/Right front of building,Left/Riguilding, Under deck Address C-^� Cwrown State Zip Code 2. System Owner. Name Address.Cif different from location) cityrrown State . 1p Code • Telephone Number r B. Pumping Record 1. Date of Pumping tate 2 Quantity Pumped: Gallons . 3. Type-of sYstem: Cesspool(s) ❑ e tTank Tight ' Tank Other(describe): 4. Effluent Tee Filter present? ❑ Yep o if yes, was it cleaned? ❑ Yes ❑ Na ' 6. Condition f tem: 6: System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loiatio where contents-were disposed: S-f Lowell Waste Water Signitu a kiiii—wu Date 0orm4.doc-06/03 System Pumping Record•Page I of t U'L' IoT u&0nPle-A-qos; is J07 �� � • QK�•Itilj� 0! 'T► L �1�Q�it1�t.�GKrr.L 2®.3 4y1frItH, :CT is �► �Ecota of r4& ta�rrb�I Id 19.z AW 5L g V^11c 1 ap T.4L, ga.%n WA oy*lb-r 2 , I -04 L' I Z•o�i }. i q T-1 (►��, '1 (�3,hlaoclf.) 0� Pu HP 7AtQ- {: 5E v rl000d+cL,� ----: pwlVr/ / i 1 l &A v&7 AS BUILT PLAN OF { SUBSURFACE DISPOSAL SYSTLM _ LOCATED IN A N DOU 16a , HA,56, 14 I AS PREPARED FOR DATE: 5-31,05 -r1 -1 lopt SCALE: I e4o MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS 60 PARK STREET • ANDOVER. MASSACHUSETTS 01810 TEL (617)475.3533, 3MSnl xxr.e.: >+.e.:.-.................:.. ._.:ri,tir._;a+����t^•a{?.-[+..=rp:.tr+s 5 �,.,mr r" - - FvriJ kT : -r4 It, Pc�.� �c�.nFl��-�r IS Jar 2®.3 a I.t+.lr.�c�.rs-rY 0l:T►�E 5�+85ua �.� id S`d,TeH, 5 Is A �Ecora OF T_�& LaA bW 2 i9. or eaH ONtik^1 of aF •rW E W-yflNA *Y� 12 . 1 It At�i �r(o r ^ • �VertT T r FICLP 0 ANk SES T Nk — 13 q9. 171 y I , 1 !i SWELL "C-, �"f�di-��G LeAvt AS RULT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN AS PREPARED FOR VO 12ALJ LU 5 DATE: Ty..,T� I D SCALE: 1 "---- �p 0 �r MERRIMACK ENGINEERING SERVICES, INC. .. PROFESSIONAL ENGINEERS • LAND SURYEYOitS • PLANNERS '` REC lv/E 60 PARK STREET • ANDOVER. MASSACHUSETTS O1t10 I TEL (617) 475-3533. 3721 D JN 02 TOWN OF ORTH ANDOVER HEALTH DEPARTMENT Town of North Andover °f Na TIJ ,h Office of the Health Department 3? °'"' Community Development and Services Division # _ 400 OSGOOD STREET North Andover,Massachusetts 01845 SACHUg Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax C29Wq'ICAgW OF C09Y(V r T 0XCE As of: ,dune 13, 2005 This is to cert that the individualsubsurface disposal system Repair (f) by Todd Oateson At 141 Stonecleave Road North Andover, 911,4 01845 9fas been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board ofifealth regulations. The Issuance of this cert f cate shall not 6e construed as a guarantee that the system will function satisfactorily. Susan 2:Sawyer, RE,9fSIR5 Pu6Cu:9fealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i AS-BUILT CHECKLIST LOT'NUMBER, STREET NAME R� � ASSESSORS MAP& PARCEL NUMBERJ N 0 2005 ANDOV LOT LINES & LOCATION OF DWELLINGS To NO�THER HEALTH DEPARTMENT LOCATIONS& DIMENSIONS OF SYSTEM,. LN199HOM AJA- 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 AIA 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 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The dersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired: by o1M &[g!&bj located at �_ 4M'o PoAp was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #_ , dated with an approved design flow 0 of gallons per day. materials used were ' g p y ul 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: _, ��-•o� / Engineer Representative Final inspection date:—5—/-2—o 7 _ Engineer Repr entative Installer: Lic* Date: �S Design Engineer: Date: TOWN OF NORTH ANDOVER Of NORTa 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT � z � 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 SAtHU`•+ Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ADDRESS: 141 Stonecleave MAP:104B LOT: 13L INSTALLER: Todd Bateson DESIGNER: Anthony Korovos PLAN DATE:4/15/2005 BOH APPROVAL DATE ON PLAN: 4/20/2005 DATE,OF BED BOTTOM INSPECTION:5/13/2005 DATE OF FINAL CONSTRUCTION INSPE TI N�/18/2005 DATE OF FINAL GRADE INSPECTION: - 1510S SELECT SYSTEM TYPE Pressure Dosing COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Stone&Pipe Field DIMENSIONS AND DETAILS OF SAS: 51 x 30 SITE CONDITIONS ®Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer []Topography not appreciably altered Comments: Page 1 of 4 TOWN OF NORTH ANDOVER of NORTF1 Office of COMMUNITY DEVELOPMENT AND SERVICES o `',I :.•,� •. HEALTH DEPARTMENT x 27 CHARLES STREET b NORTH ANDOVER,MASSACHUSETTS 01845 �'SS��H„5 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around-inlet & outlet Comments: PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ® Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Page 2 of 4 TOWN OF NORTH ANDOVER OE NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��ss';�N„5 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX ❑ Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: Missing Hydraulic cement on pipes. SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 3/4-1 '/2" double washed stone installed ® 1/8-1/2" (peastone) double washed stone installed ® laterals installed and ends connected to header (and vented if impervious material above) ® Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Page 3 of 4 l TOWN OF NORTH ANDOVER pE NpRTM , .. Office of COMMUNITY DEVELOPMENT AND SERVICES a ','.o • F s p HEALTH DEPARTMENT 27 CHARLES STREET �� _; * �«.www �. NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SYSTEM ELEVATIONS Benchmark: 132.00 Rod at Benchmark: 5.68 Height of Instrument: 137.68 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 128.70 Septic Tank IN 128.64 128.51 Septic Tank OUT 128.39 Pump Chamber IN 128.35 Pump Chamber OUT 129.71 Distribution Box IN Distribution Box OUT 132.05 132.10 Manifold Lateral 1 HIGH 132.00 132.07 Lateral 1 LOW 131.60 131.85 Lateral 2 HIGH 132.00 132.05 Lateral 2 LOW 131.60 131.85 Lateral 3 HIGH 132.00 132.10 Lateral 3 LOW 131.60 132.85 Lateral 4 HIGH 132.00 132.09 Lateral 4 LOW 131.60 131.83 Page 4 of 4 FW: 141 Stonecleave - Send Final Inspection Report Page 1 of 2 DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, June 13, 2005 2:59 PM To: DelleChiaie, Pamela Subject: RE: 141 Stonecleave-Send Final Inspection Report Thanks, pis print out for the file. We should be close in getting some of these old ones closed. Susan -----Original Message----- From: DelleChiaie, Pamela Sent: Friday, June 10, 2005 2:32 PM To: Sawyer, Susan Subject: FW: 141 Stonecleave - Send Final Inspection Report HERE YOU GO.... -----Original Message----- From: Dan Ottenheimer [mai Ito:info@milIriverconsulting.com] Sent: Friday, June 10, 2005 1:26 PM To: DelleChiaie, Pamela Subject: RE: 141 Stonecleave - Send Final Inspection Report Yes, sorry about that one. Enjoy the weekend. See attached. Dan R I Daniel Ottenheimer, President Mill River Consulting, Inc. Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-001.2 www.millriverconsulting.com dano@millriverconsulting.com From: DelleChiaie, Pamela [mailto:pdellechiaie@townofnorthandover.com] Sent: Friday, June 10, 2005 10:57 AM To: Daniel Ottenheimer(E-mail); Lisa LeVasseur(E-mail); McBrearty Andrew (E-mail) Subject: FW: 141 Stonecleave - Send Final Inspection Report Hi, Can you send along the Final Inspection Report on above? Thanks. P 8/4/2005 FW: 141 Stonecleave - Send Final Inspection Report Page 2 of 2 W r -----original Message----- From: DelleChiaie,Pamela Sent: Thursday,June 09,2005 2:15 PM To: 'Daniel Ottenheimer(E-mail)'; 'Lisa LeVasseur(E-mail)'; 'McBrearty Andrew(E-mail)' Subject: 141 Stonecleave Hello, Did Susan send you the Bed Bottom Inspection info. for the above done on 5/13? If not, please let me know, and I will send it. Thanks. grit Ro#aads, P4#1004 D VAVOO lWO Health Department Assistant Town of North Andover 400 Osgood Street North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax h-t—tP—./-/-www.townofiiorthandover.com healthdept@townofnorthandover.com 8/4/2005 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES �2�`"Tt '`'°°< HEALTH DEPARTMENT 27 CHARLES STREET ` s NORTH ANDOVER, MASSACHUSETTS 01845 �9s.2 CHUS t�9 Susan Y. Sawyer,.R.EHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES /C>,t ADDRESS./y/ MAP:_ LOT: INSTALLER: a+-, DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: DATE OF BED BOTTOM INSPECTION: 54.3/©S` DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = /5v0 LOADING OF SEPTIC TANK = S+Y o GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: I X D ' SITE CONDITIONS Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Page 1 of 2 TOWN OF NORTH ANDOVER KOery Of i.a°,6'9y Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENTlot 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 ACNU`'E Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK Bottom of tank hole has 6" stone base Weep hole plugged t$Aallon tank has_been_i-nstalled (H-101or H-20) (monolit r 2 piece) N �a -ter tightness�an-k-has been achieved or Vacuum Test or Water held for 24hrs) Inlet tee installed _u.nder access port Outlet teegas baffl or effluent filter) installed, under access po ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER Bottom of tank hole has 6" stone base Weep hole plugged Jemallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: Page 2 of 2 Town 0%!Aorth Andover, Massachusetts Form No.3 f MORTN BOARD OF HEALTH 1 Oat �ao,aa ti0 . Lp l 4,5,,,o•E�h DISPOSAL WORKS CONSTRUCTION PERMIT SACMUS s �y Applicant �� �� 0/ NAME ADD SS i/d ./� J 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. CHA RMAN, BO D OF H LTH Fee D.W.C. No. TOWN OF NORTH ANDOVER f#oRTM, Office of COMMUNITY DEVELOPMENT AND SERVICES 0j .s a HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHU 978.688.9540—Phone Susan Y. Sawyer, REHS/RS 978.688.9542—FAX Public Health Director healthdepi a)townofnorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION• / 7�----- LICENSED INSTALLER NAME: PLEASE PRINT SIGNATURE: TELEPHONE# . l J CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION,please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the propertyat l it / AvC C Zov'�_ - relative to the application ofJ-46 �_�S for plans by � Rr °n'r ^'9. and dated with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger,or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necgssary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I_may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction.steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi ad iicensed Septic Installer YrdceDate: Disposal Works Construction Permit# ► Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover,MA 01845 978.688.9540 healthdet'qVmvnofnorthandover.cont RECEIVED MAR - 4 2005 SEPTIC PLAN SUBMITTAL FO WN OF NORTH ANDOVER ( HEALTH DEPARTMENT DATE OF SUBMISSION: SITE LOCATION: 1, I hh ENGINEER: HCTZ-ft o-14"�--I G rt-Q 6 1 F)rl--JZl J( NEW PLANS: YES $ .00/Plan ECheck#: � ncludes t wp and one Re-Review Only) REVISED PLANS: YES S 75.001PIan Check#: SITE EVALUATION FORMS INCLUDED: S NO LOCAL UPGRADE FORINT INCLUDED: YES NO a Telephone#: � �) 7 S" 3 5-S5--Faa#: 7 S- `f E-mail:L-i MgP,-6V_A0 f,Cg2L: HOMEOWNER NAME: PL< U L-L . OFFICE USE ONLY When the submission is complete(Including check): L Date stamp plans and letter 2. 4.1114,onmplete and attach Receipt 3. C pyF"de,-Forward to Consultant me 4. Enteron Log Sleet an4 Database Location: �� ��r� v e.,� / n owner's Name: �,e,t1 LL� MaplParcel:_'Sl. 7Co Address: �5� = Telt-�0,67-040 NewMNL-.Repair Date: I q- 5 Wetlands}Zone I[ =Son Symbol,42___Son RbmeL24►Z lJ SoU(Ass Deep Observation Hole Logs' Elmiddlon Depth Son HOruon Sall Testae Soft Color Soil hiottliag •/. Gravel,Stones,etc L 4. „ 1 9 Parcae Atatertat.—T`1� ► Depth to�r,c�.=stroma:St►.ear is the Heta�_/Weepin=tromm Faa �r ESBGttr: ? .` T'2 L I0*124 vr F,j A sy IV Lf-ro,WM,c.o ?,syr/ • (oyext S'T6� L 4 (wd 4 t� 6 Ko%iN Pareat Materia!�) 1 L Depth t.Belr�6tudfa:ghterla the 8ola�_Neepta=[roat?!t Faee�ESHCiY: �(i Date 'Percolation Tests Obserration Hole 6 Depth of Pere Start Pr-soil: Time at U& Time at 9" Time at 6" -Rate bflnllnch-- Performed Br. Witnessed Br. s _ LLMassachusetts Department of Environmental Protection Bureau of Resource Protection—Wastewater Management Program Form 9A - Application for Local Upgrade Approval - Required by 310 CMR 15.403(1) Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance, as defined in 310 CMR 5.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310_CMR 15.404 and 15.405,or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. } NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of 1 a.new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address forms on thet:5 N2 computer.use VAu. t�-S— only the tab key Name to move your 14t ( MVA P cursor-do not Street Address us?the return A-95 9� -K key. ij'9�rA Q Q 12oy zT2, M City State Zip Code a+ 2. Owner Name and Address: _ rcotT Name Street Address city Stath ZIP O Telephone Number 3. Type of Facility(check all that apply): [/Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 1�111 0 lr-t 1Z t:i t Io 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers,leach field, pits, etc): t5fonn9a•rev.5/02 Application for Local Upgrade Approval,Page 1 of 4 '— Massachusetts Department of Environmental Protection I Burbau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. FacilityInformation (continued) ( 7. Design Flow per 310 CMR 15.203: / I Design flow of existing system: gp d Design flow of proposed upgraded system d Design flow of facility pd gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): �oluntary ❑ Required by order, letter,etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Cyt �—TA VJ l 3. Local Upgrade Approval is requested for: ❑ Reduction in setback(s)—describe reductions: ❑ Percolation rate for 30 to 60 min./inch: min.finch ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction Le/Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate m;n./Inct, Depth to groundwater ft { ❑ Relocation of water supply well (explain): i. t5fonn9a•rev.5/02 Application for Local Upgrade Approval,Page 2 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) ❑ Other requirements of 310 CMR 15.000 that cannot be met.-describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(1)(1). The soil evaluator must be a member Ior agent of the local approving authority. High groundwater evaluation determined by: A, r, " Evalua--rtors Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: F>,tt.t, o+�ltll�la oiJ1,n tu5 U LT �� a, Iz4t.)er2 >,A S 9EA, r Cn�, :?2 en �-►� 7 � 'I I-+ �xf Fete Cn IAb(t-DQ AN0 t2kZA Ie- I5SJE5. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: ,i-u. 3. A shared system is not feasible: ^,a 4. Connection to a public sewer is not feasible: I t5forrn9a•rev.5/02 Application for Local Upgrade Approval*Page 3 of 4 I 1 (-- Massachusetts Department of Environmental Protection 1 Bureau of Resource Protection—Wastewater Management Program j Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 5. The Application for Local Upgrade Approval must be accompanied by all of the following(check the appropriate boxes): ❑ Application for Disposal System Construction Permit [Complete plans and specifications Ei/site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I,the facility owner,certify under penalty of law that this document and all attachments,to the best of my knowledge and belief, are true,accurate,and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Signatur Date Print Name Name of Preparer f Date � OGc!Qt Preparer's address O mown Lik-* o1010 ITS ) 'LZ������ State/ZIP Ye ephone NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before.commencement of construction. t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 4 of 4 TOWN OF NORTH ANDOVER pE NORTN 7 Office of COMMUNITY DEVELOPMENT AND SERVICES 3 1' f s F HEALTH DEPARTMENT 400 OSGOOD STREET • b, ..::�:.. «�'+ NORTH ANDOVER, MASSACHUSETTS 01845 �'ss';CM�S 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.9542—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:hn://www.townofnorthandover.com March 23, 2005 Anthony Donato, P.E. Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Proposed Septic Design for 141 Stonecleave Road, Map 104B,Lot 136 Dear Mr. Donato: The proposed septic system design plans for the above site dated February 23, 2005 have been reviewed. Unfortunately,the plans cannot be fully reviewed until a proper percolation test has- been completed. The test data submitted includes a percolation test from August 1977,which predates current design standards. The town representative, Andy McBrearty, noted that Mr. Dufresne had left the site prior to having a discussion regarding the inability of completing a perc test and proposal for using old test data. Due to the lack of information,the representative took a soil sample, which was provided to the excavator operator. It is not known if the sample is in Mr. Dufresne's possession at this time. Following a review of the old file information for lots on this street, the soil logs on the proposed plan, site information from the town representative and in consideration of the time that has passed since 1977, and this office has determined that an additional perc test must be conducted on this site. It is highly probable that this soil may prove to be other than a 5 min per inch soil. Therefore, according to the North Andover regulation found below, it is requested that you please reschedule a percolation test for this site or provide sieve analysis results from the sample taken by the town representative. North Andover subsurface system regulation — 7.08 The results of Percolation Tests shall not expire. Percolation Tests should be marked clearly in the field so as to eliminate confusion as to the location of such tests in the event such tests will be used for design at a much later date. The Board of Health representative may require the area previously tested to be reperced if there is some question as to the results, elevation or location of previous tests. In addition, a quick review indicates this design contains a requested reduction to the groundwater from the bottom of the soil absorption system. In order to avoid problems with this design plan when it is re-submitted, please be advised that this does not achieve the goal of full compliance as sought by Title 5 of the Massachusetts Environmental Code. As stated in section Page 2 March 23, 2005 To:Bill Dufresne, Merrimack Engineering Re: 141 Stonecleave Road 15.405(1)the request for a reduction to groundwater depth should be the last option to be considered in a series of setback or other reductions, and is only to be considered when full compliance cannot be provided. Justification has not been provided that this site cannot achieve full compliance with the design standards in Title 5. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of Andover. Sincerell r S san Y. Sawyer Public Health Director Cc: ➢ Homeowner ➢ File w v North Andover-Septic System Design Plan Review Checklist (Rev.Jan 28,2004) The following checklist incorporates Title 5 and local regulations for septic plans. Property Address: l y 1 �s.G. L4AIt Map:ldy Lot: /3 � Name of Applicant: t vs Name of Designer: Plan Date: Revision Date: t� Date received:at OH t a at MRC q/o MRC Staff Reviewer: Date of Review: Type of Plan: ❑new J�+upgrade Number of Bedrooms in Assessor's Records: Number of Bedrooms in Design:__`4 (4—�it gpd) Garbage Disposal Allowed: ey s/no General Information:NA=North Andover Design Standards Other numbers refer to Title 5 ❑ yes no Is the lot in the Lake Cochichewick Watershed? NA 6.00(requires Alt.Treatment) OK Problem N/A Street number and map/lot-220(4)(u) Names of abutters from recent tax map—NA 8.02j 1/ Name&address of record owner&applicant—NA 8.02k Name&address of designer—NA8.021 ►s Date plan drawn&any revision date—NA 8.02m Location and elevation of foundation drain(or note)—NA 8.02y Maximum scale of 1"=20'for profile and component details-220(4) Locus plan-220(4)(t) (Not to scale) _ Date(s)of soil testing-220(4)(h)&(i) Name of approving authority representative-220(4)(h)&(i) ✓ Now& of soil evaluator-220(4)(j) ✓ Complete profile of the system to scale-220(4)(o),NA 8.02c / Cross section of leaching facility—NA 8.02w(Not to scale) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted¬ed on plan-403(1) Original R.S./P.E.stamp,signature&date—220(1)&(2) t Surface supplies(w/m 400'),pub wells(w/in 400'),pvt.wells(w/in 100')-220(4)(k) —� Wetland disclaimer(no wetland w/in 100')—NA 8.02s �r RLS plan reference&certification(if property line setback variance)-220(3) ✓ Use approvals/standards checked for I/A system—DEP docs. ✓ System is in Nitrogen Sensitive Area?-215 Loading rate<=440gpd/acm(new construction)-214 Perc rate>30 MPI—check loading rate(differs w&w/o pressure dist)242(1)&(2) Perc rate >60 MPI—must ase modified tight tank or 1/A technology—245(4) •-� Proposed system qualifies as"shaded"system—002(definitions) Flow is over 2,000 gpd—No R.S.allowed—220(l) ✓ Number of bedrooms with design rales—NA 8.02i Minimum 4 bedroom design without deed restriction—NA 1.05,NA 13.01 ✓ Design flow was set in accordance with code—203 Leaching facility at least i'above Base Flood elevation—NA 9.05 All piping Sch 40 minimum—NA 10.01 Basement floor 1'minimum above groundwater elevation(new const)NA 5.04 Site Plan: Page I North Andover-Septic System Design Plan Review Checklist (Rev.Jan 28, 2004) 0K Problem N/A Maximum scale of 1"=40' for plot plan-220(4) Holder and location of all easements-220(4)(b) All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) ,�- Elevation of proposed driveway—NA 8.02t — Legal boundaries of the facility being served-220(4)(a) Location and dimensions of the system(incl.reserve area for new const.)-220(4)(e) All distances on site plan(ST 8c SAS to dwelling 8t property lines)—NA 8.03 a-c Limits of excavation of leach area on site plan—NA 8.022 North arrow-220(4)(g) Existing and proposed contours-220(4xg) Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4xi) Locations of waterlines,drains,and subsurface utilities-220(4)(m) Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Location of watercourses or wetlands w/in 150'of system—NA 8.02r Existing system location and note on proper abandonment-354 Setback Distances(given in feet) 15.211 (NA 5.02) OK Problem N/A Septic Tank Leach Facility Sewer ^� Property line 10 10 -- ,� Cellar wall 10 20 -- Inground pool 10 20 -- p.. Slab foundation 10 10 Deck,on Footings,etc 5 10 -- Waterline 10 10 101 Private drinking we112 751% 1003 50 Irrigation well 7340 1002S Surface Water 25 50 Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Bank' 7524 10030 u Wetlands bordering surface water Supply or trib.(in Watershed) 15025 1 SO 30 �-� Trib to Surface Water supply 325� 32S SAA Public well 400 400 Interim Wellhead Prot.Area not>440 g/ac/d(new const.only- 15.214) tr Reservoirs 400 400 Drains(wat.supply/trib.) 50 100 Drains(intercept g.w.) 25 50 Drains(Other)Foundation 10(5) 20(10) Drywells 2040 25 Downhill slope or barrier wall -- IS' to 3:1 slope w/o barrier 'Suction line 222(2) 2 New construction allowed up to 440 gallons/dey/acre when on a private well pursuant to 15.214(2). '100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 4 As defined in 310 CMR 10.55,10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Page 2 North Andover-Septic 4stenf Design Plan Review Checklist (Rev. Jan 28, 2004) Ucal Upgrade Aspmml Hierarchy Note than the goof for a septic systein design is EM compliance whemper feasible as set forth in 310 CMR 15.404(1). When frld compliance is not passible,allowed to reduce setback to following(405)w/o abutter notification unless property line or neighboring private water supply setback(with"a"the first preference.and"i"being LAST preference:) a) property line but seat Win 10'of another SAS-need survey if Win 5' b) cellar wall,pool,or slab e) Place leach area in soil between 30 and 60 MPI(na.if filed after 1111/04) d) Up to 25%reduction in size of SAS e) Relocate private well if septic system failed because of this criteria f) Setbacks to BVW's g) Setbacks to surface waters,salt marsh,inland and coastal banks,vernal pools,leaching CB's,dry wells,or surface or subsurface drains not leading to water supplies h) Setback to water Imes,private wells(not<50'),water supplies and Cribs.and drains leading to the same(not<100') s) Reduce required sepa Won to g w.(BOH must set GW,3 or 4'only(depending on pert rate),X2000 gpd flow,no increase in flow or square footage,no reduction to SAS size,setbacks to wells,BVW's,wetlands,sfc.waters,salt marsh,coastal bank,vernal pool, water line,water supplies or tribsJdrains). 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 e. Watertight joints specified-222(3)alt(41 NA 11.02 Pipe laid on compact,firm base-222(5) Pipe laid on continuous grade in straight fine-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 umk: i Z g, Length of run: l 2.. Slope: (minimum of 0.01 -0.02 desired)-222(6) Page 3 i North Andover-Septic System Design Plan Review Checklist (Rev.Jan 28, 2004) No tank allowed in a velocity zone or on a coastal beach, barrier beack dune, or in a regulated f 1oodway(213) Septic Took; septic tank below g w.table 9,yes ❑no D assumed OK Problem N/A Tank is accessible-228(3) 200%of flow(required&provided given, 1500 min.)-220(4xf)&223(1)(a) 2"(min}3"(max)drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) 3"air space above tees/baffks(minimum)-227(4) ✓ 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) f Tees extend 6"above flow fine-227(1) f inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) �G Gas baffle installed on outlet-227(4) Effluent filter Brand and model approved by DEP Filter type/name noted on manhole covers. Riser placed over filter Filter maintenance schedule specified Access manhole cover above center of tank&each tee(except 2 comport)-228(2) 3-20"manholes-228(2) 1 Childproof 20"riser/manhole w/m 6"of final grade if<1000gpd-228(2) 2 childproof 20"risers over inlet&outlet tees win 6"of final grade if>1000gpd-228(2) Inlet and outlet tees on center lime-227(1) Soil compaction below tank specified(if soil is non-native)-221(2) �,» v 6"of c--I'/a"stone beneath"specified-221(2)&228(1) 1f>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-2230)(c) Buoyancy Saks.required if tank at or below water table-221(8) yam^ Notation as to tank watertightness—221(1) 9"of cover over tank(minimum)-228(l) Top of tank<=36"below gra*-221(7) H-10 loading(min.)-H-20 if traffic-226(3) �. All pumping to tank(if applies)in accordance with—229 No tight tank allowed in a velocity zone or on a coastal beach, barrier beach, dune, or in a regulated Jloodway 213 Tigbt Tan (Check here if not present: )tank below g.w.table o yes ❑no ❑assume OK Probl wA 5009'*of design flow or 2000 gallons provided—260(2xa) 3-20"manholes-228(2) Soil compaction below tank specified(if soil is non-native)-22](2) "of<=1 Y:"stone beneath tank specified-221(2)&228(1) Bncy Sales.required if tank at or below water table-221(8) Notati�ras to tank watertightness—221(l) 9"of eovever tank(minimum)-228(l) Top of-tank<-36"below grade-221(7) H-10 loading( ' . -H-20 if traffic-226(3) All pumping to tank PPI in accordance with-229 AN alarm set at 3/5 tank ley—260(2xb) Alarm signal to loch mann* 4 hours per day if deemed necessary—260(2)(c) Tank is sex to keep old system in rvice during install if possible Min. 1-24"firame w/cover at finis —260(2xf) Year round access for pumping—260( Page 4 i North Andover-Septic System Design Plan Review Checklist (Rev.Jan 28, 2004) Odor control provided if required—260(2)(k) Distribution Boa(Check here if not present:_ ) OK Problem N/A Inlet elevation: Outlet elevation: w ` 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6"sump(minimum)-232(3xe) A4 outlets at same elevation(notation)-232(3)(b) i Outlet pipes laid level for fust 21(notation)-232(3xc) Inlet bafllehee min.I"over outlet invert for all d-boxes when pumped or steep slope(>.08)-232(3)(a) Soil compaction below distribution box specified(if soil is non-native)-221(2) V 6"of<= 1 '/h"stone beneath distribution box specified-221(2) Box is watertight(notation)-221(1) %/ Top of box<=36"below grade-221(7 Pomo Chamber(Check here if not present: ,pump tank below g w.table 0 yes 0 no 0 assume OK Problem N/A �. Volume specified: 't `f`f -220(4xr) Pump on elevation: 12 S -220(4)(r) ,s Pump off elevation: 12.4 -220(4)(r) Alarm on elevation: 17. 5. 5 -220(4xr) Number of cycles per day correct(4 dosestday,CL I soil)-220(4)(r),254(1)5 Minimum 2"delivery line to d-bax if gravity-254(1 x c) ✓ Cycles per day is consistent with chamber volume-231(3) Volume calculations include flowback volume-231(2) 24 hour storage capacity above pump on elevation-231(2) 2 pumps if system serves>2 dwelling units-231(6) Pump can pass 1 W solids(minimum)-231(7) Pump controls specified-220(4)(r) a-'" Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-231(9) Pump sequence correct(off-lead on-lag on-alarm on)-231(8) ✓ Pump performance curves included-220(4)(r) Vol Pump can provide flow needed against calculated head-220(4xr) ►/ Manual operating switch—NA 12.01 Check valve,bleeder hole—NA 12.01 1 childproof,24"riser/manhole to w/in 6"of final grade-231(5) WOO Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=1%s"CK"'in N.A spec)stone beneath chamber.specified-221(2)&228(1) Buoyancy calculations if chamber is at or below water table-221(8) Chamber is watertight(notation)-221(1) 9"of cover over chamber(minimum)-228(1) Top of chamber<=36"below grade-221(7) H-10 loading(min.)-H-20 if traffic(notation)-226(3) s Encourage more than I cycle per day. Page 5 c • North Andover-SePtic System Desig"Plan Review Chec"ist (Rev.Jan 28, 2004) prsite Soil and Groudwater Rellim' OK Problem N/A Plan-220(4)(h) Proper deep observation hole logs on P �_NA 7.05 Deep hole testing conducted within two yea All deep holes and pens shown,including aborted tests—NA 8.02n Soil evaluation forms 1 L&12 submitted within 60 days of field work-018(2) Existing grade elevation of each deep hole-220(4)(h) Elevation of percolation tests—NA 8.02n Proper percolation test log-220(4)(i) Soil logs and pert test logs match BOH records 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 pert testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) Pert test(s)done in most restrictive laYer- 104(2) Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n) soil class Pere rate loading rate(LTAR)- 7 eaebiag Facility(general complete for all designs exceot tight tanks) OK Problem N/A Wool SAS size calcs provided 220(4)(0,NA 9.021 50%larger if garbage disposal-240(4) SAS size x required size Trenches to be used whenever possible 240(6) No vehicle access or impery area above 11—NA 13.02 an*above 1.f wdess~eil-ble 240(7) 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-241(1)(c) All lines connected to vent-241(1)(d) ,�► 9"cover over peastone-240(9) Reserve area provided(new construction)-248(1) GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-251(9) Excavation extends 6"into natural soil—NA 9.02 Fill material specs provided—255(3) O Top of leach facility<=36"below grade-2210 WOO Final grade over 11 minimum 0.02 Wit-240(10) Surface&subsurface drainage away from 11-240(l 1)&245(5) Grading slopes away from dwelling L,eaehioe Facility(continued) 3/8 -5/8"orifices specified(gravity system)'251 8) Toe of fill slope stops 5'from property line or swale installed-255(2) 3:1 slope where grading required-255(2) Page 6 f w North Andover-Septic System Design Plan Review Checklist (Rev.Jan 28, 2004) ✓� Impermeable barrier if<3:1 slope or<15 feet to 3:1 slope-255(2) impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E.-255(2)(b) Top of retaining wall/barrier>--top of peastone elevation(breakout)-255(2)(1) 10'offset from edge of leach facility to edge of ret.wall-255(2)(g) Leach pipes S40-2&1(1}NA 10.01 Leach pipes minimum 4"diameter-X31{7}NA 14.04 Pressure dosing guidance followed if pressure distribution-254(2)(c) Orifice spacing<5' Dose volume 5x— I Ox void volume of leach lines Pump volume includes Dose Vol.+Drainback Vol. Squirt height on plan(min 2.5'). Pressure required over 2,000 gpd or with UA remedial use—231(1) Critical design paramder calculations Test Pit Numbers: elevation at grade P, L 3 a. top acceptable soil el. b. bottom acceptable soil el. c. naturally occurring soil depth(b-a) 2..p Y� ❑yes ❑ no >4' natural soil? 240(1) ❑if NO,variance(repair&I/A)415(l) a. ground water el. -� b. bottom of leach facility el. c. separation to groundwater(b-a) �-Ycs ❑no >4' (5' in sands)ground water sep?-212(a)&(b) a. top acceptable soil Cl. b. breakout el. s LI no 5'overdig required?-255(l) es ❑ no if specs for fill provided? Page 7 North Andover-Septic System Design Plan Review Checklist (Rev.Jan 28, 2004) Leach Fields(Check here if not present: OK OK Problem N/A Number of fields: (need dosing chamber if>1)-231(1)) Length(100' max.): 4/[> -252(2)(b) Width: 2--D Total area:L x W UP _ r;OD s.f. Minimum 900 square feet(new construction only)NA 9.01(1) Effective leach area given total of s.f. Loading factor. Effective area=total area $00 s.f.x LTAR , `I = S I Z g/day l Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2xa) �- 6' line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2xe) Reserve 4' from primary leach area-NA 9.04 _ t 10' minimum separation between adjacent leach fields-252(2)(0 Between 6"and 12"of 3/4- 1 1/2"stone beneath field-252(2)(g)&247(2) Ends of distribution lines tied together with solid pipe--251(9),NA 15.01 2"of 1/11"-1/2"2x washed peastone-247(2) Leaching Trenches(Check here if not present: ) OK Problem N/A Number of trenches: (minimum 2)—NA 9.01(2) Depth of trenches(max eff.29): ' .247(l) Width of trenches(2'min.,4' max.): ' -251(1)(b) Length of trenches(100' max.): ' -251(1)(a) Minimum 500 square feet(new construction only)NA 9.01(1) Trenches are vented(when>50')-251(11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth-251(1)(d),NA 14.01 Trench spacing>10' if in fill—NA 14.01 Available leach area given Bottom=L x W x # = s.f. Sidewall=L x D x# x 2= s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR — g/day Effective area is>=design flow of facility being served 2"of 1/8"-1/2"2x washed peastone-247(2) '/4"to l%:"double washed stone from bottom of SAS to dist.lines-247(1) Leacbint Pits(Check here if not present: ) OK Problem N/A #of pitstpit systems: (dosing chamber if>1,23 1(1)) Dimensions of each pit or system:L W D Depth of pits(max eff:2')DE: ` -253(I)(a) Available leach area given Bottom=L x W x#of systems= s.f. Page 8 ' stem Design Plan Review Checklist (Rev.Jan 28, 2004) North Andover-Septis' Sy x 2 _x#of systems=_______s•f• Sidewall=L+W x DE sidewall = —$.f. Total area=bottom Effective leach area given Loading factor:_— s.f.x LTAR = glday Effective area=total area Effective area is>=design flow of facility being served) Minimum of 2 pits at least 13'x16' –NA 9-010) 20' -253(6) Distribution for galleries/chmbrs.in trench config.-pipe every Distribution for galleries/chmbrs.in bed config.-ea.pip esery s 140 s.f.-253(6) Spacing-2 times the effective width Of 247(2),EDS 700.3.2(1) ( )( ) 2"of 1/8"-1/2"2x washed pestone-- 3/4"to 1 l/2"double washed stone-2470) Each pit has at least one 20"access cover,24"CI to grade over 2,000 gpd 253(3) Surrounding aggregate thickness between 1' (min.)and 4' (max.)- ( ) Vents,if necessary,extend under covers of Pit(s) -24l(e) Approvals Needed: Health Department,no LUA Health Department,w/LUA Board of Health,local regulation variance Board of Health,w/LUA Board of Health,Title 5 variance DEP,Title 5 variance DEP,holding tank Notice of Intent forms from Cons.Comm. Other: Draft maintenance agreement with hauler drafter for tight tank? 1 specified–260(2xd) removal-- uenc of � d Method an fret' Y Location and method of content removal–260(2)(e) Deed Restriction regarding#bedrooms requires this Distribution delivery W SAS requ ) Draft maintenance Agreement(Pressure _Proper License _ w/class 2 WWTP operator for Advanced treatment _ Licensed installer or hauler(or above)for simple Press.Dist. _Minimum 2-year term _ Quarterly scheduled maintenance Check pressure distribution if part of design Page 9 � l FORM U - VERIFICATION FORM i INSTRUCTIONS : This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. **************'**Applicant fills out this section***************** j APPLICANT: a `�`C- �-��1�l Phone ��7' LG LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) Street �t�`- �c-��- �L� St. Number Use Only************************ 'l D RECOMMENDATIONS OF TOWN AGENTS: 1 Date Approved Cons6"rvatlo Administrator Date Rejected / Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspectorr-F ealth Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date i r I 57// �. i � 1 Ll X7 ��v pv i \ ! ! I I j - i i i� _I 14 r 1 a /3% _ ���.. s� _ , , o ., ��i �' �� �:�;t�-: � .- .6. fir.,��.�; \ \ �` =<�. LL fila...��T 1�.'.4. � ��✓ /1 � � ' \ � �(7l � rl�'V � \\I-I / � � � ' � �� `� � �_/ / E . . , � ;� / / y � � /� / � �.� �, � �� � � . . - ' --� �� � �' � ,� � - - �� ,� / � rLJ ��J n ., rl t `U l % � � i n �0 ' � ��'� ___..: .-. . i', - - ...._.- i - t- :-- �, / � � _ � - .l� j-�� __- i . _ �., � . f �. - �` J' � �� .� � �{ � � .� WELL DATABASE A_GE OF ;N._ r ��`1'�-� ` W=LL DRE� r ER: 1; 7-r r - WELL LOCA-17-10NI : 71 r PSyff�'DA,=: D=-'TH OF W E� -- =OF �i DRIIZED b. DuG UNKNO v." -_- EIG �rLt4ti Y Ly' ELC'rigQi Y N GY Mo -L I D AT E,A-S ADDRESS- �. ACE OF=, � ° WELL D 7YELL LOCA l lO Y �/`L.L.PEF-7 �! DA": DEP% OF Wc�L i YTE OF WTHELL:: z. D LFD b. DuG i rPE OF WATERBE.=l-RRTG ROCK. ANA LYS?S DATE: Fes!GHtiL�VGA?LSE: `' N YSG�1 LEON: Y N OT�� CONTA PCNA-NTS: Y N Town of North Andover pf NORTq Office of the Health Department Community Development and Services Divis s"oq 27 Charles Street North Andover,Massachusetts 01845 9SS�CHU h!tp://www.townofnorthandover.com Susan Y.Sawyer,REHS/RS e-mail:healthdept®townofnorthandover.com P (978)688-9540 Public Health Director F (978)688-9542 INFORMATION REQUEST Health Department Please use this form if the Health Director is unavailable to pro de immediate assistance. Please fill out this form in its entirety to ensure an acc u ate and p response.Y All'tequests for information will be handled as soon as possible. , CONTACT INFORMATION /r I Date: Name: Phone number: ' Fax number: Address: t `t �T cl+�,t ay{ A wll� INQUIRY-Property in question: (Please include as much information as possible) Subject: Inquiry: OU r � R:el( 10 It V — F L) y V !rile c.I V Thank you for your interest and inquiry. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 s SNEW ENGLAND ENGINEERING SERVICES INC RECEIVED JAN 2 7 2005 TOHEALT�DEPTA RTMENTER January 25,2005 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover,MA 01845 RE: TITLE V REPORT: 141 Stonecleave Road,North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system FAILED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin C. Osgood, r.,P.E. Certified Title 5 inspector 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 COMMONWEALTH OF MASSACHUSETTS EXECU'T`IVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT JAN 27 2005 nE 2TH ANDOVER HEALTH DEP TITLE 5 -OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 141 5-100f- c L EAu 9'D Owner's Name: vo ns p q PAUL 0 s Owner's Address: j Ll I 6 ib N F C L9Ay,F- 2D lu o a7yil f'oN D OJ fid Date of Inspection: Name of Inspector.(please print) Benjamin C. Osgood, Jr. CompanyName:New England Engineering Services Inc. MadingAddress:60 Beechwood Drive. North Andover- MA 01.845 Telephone Number. 978-686-1768 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: C Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. i Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continue Property Address,. _i t-)I i C-RJC- RD iyo aTV /k-0 o O,j e& 10A Owner: V b"D h PAUL-U5, Date of Inspection: 2 Lo Inspection Summary: Check A B C,D or E/ALWAYS complete all of Section D A. System Passes: F I have not found any information which indicates that any of the facture criteria described in 310 CMR 15.303. r in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: L 0 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 N D)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(yhe(her metal or not)is structurally unsound,exlu'bits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the vAsting tank is replaced with a complying septic tank as approved by the Board of Health. *A metal 'c tank will 'on if it' septi Pass inspects �structurallysound,not 1 and if a Certificate of Compliance �� P indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage bac kV or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distnlxdon box.System will pass inspection if(with approval of Board of Health): 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. Page 3.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: J,41 u o 2fH a:�fl i?✓M ✓vtA Owner: u t.-v e, .Date of Inspection: 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.M3(1)(b)that the system is not fauctiomag 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 f3R 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 sod absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water suppler. _ 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 Bre well water analysis,performed at a DEP certified laboratory,for coliform bacteria sad volatile organic compounds indicates drat 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. Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address; i 4 i 5�v G<1, 4t;17 go _1Jo 2n4 Ai�j D Ove/L, Owner: von;D f PPfu L-v s Date of Inspection: 7j 6_6� D. System Failure Criteria applicable to all systems: You mast indicate`fires"or`Sno"to each of the following for all inspections: Yes No — Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool .� Discharge or ponding of effluent to the vz&,ce of the ground or surface waters due to an overloaded or clogged SAS or cesspool . _ Static liquid levet in the distribution box above outlet invest due to an overloaded or clogged SAS a cesspool _✓ Liquid depth in cesspool is less than 6'below invert or available volume is less than V2 day flow �[ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water 940Y• Any portion of a cesspool or privy is within a Zone 1 of a public well. An 'on of a 1 a is within Y 1� cesspool privy thin 50 feet of a private water supply well, . Any portion of a cesspool or privy is less than 100 feet but greater dnan 50 feet frau 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 facflity and the presence of ammonia nitrogen And nitrate nitrogen is egaal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis mast be attached to this form.) L (Ya No)Ike system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Ianrge Systems: To be considered a large system the system mast serve a facility with a design flow of 10,000 gpd to 15,000 1. You must indicate ' er`W or"no"to each of the following: (The following criteria ly to large systems in addition to the criteria above) yes no — —the system is within 400 feet surface drinking er supply _ the system is within 200 feet of a o a surface drinking. — g water supply — — the system is located in'a nitrogen sensitive area Wellhead Protection Area–IWPA)or a mapper Zone II o£a-pfli ilic water supply well If}fro love answered"yes"to any question in Section E the system is dered a significant threat,or answered `des"in Section D above the large system has failed.The owner or operator o y large system considered a significant threat under Section E or failed under Section D shall upgrade the cyst in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM ' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_4 y STo,� CRS ,29 i�1 J (��►-( Pt N�O iJ CIZ �►^A Owner: VO&)oR PAJ C-Ljs�- Date of Inspection: [ 2►' �S Check if the following have been done.You mast indicate`des"or"no"as to each of the following• Yes No z Pumping Wonmtion was provided by the owner,oacuQant,or Board of Health i/ Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? -V/'—. Were as built plans of the system obtained and examined?(if they were not available note as NIA) Was the f cilq or dwelling*pected for signs of sewage back up? Z_ Was the site inspected for signs of break out? Were all system components,excluding the SAS,looted on site? Zwere,die 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,depol of sludge and depth of scum?. _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no ✓ Existing information.For example,a plan at the Board of Health. /Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)t3 10 CMR 15.302(3)(b)] Page 6 of i 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: t H 1 670 N r iv�27u AN���e2 �A Owner:_ V©NPh4 PAUL US Date of Inspection•_ 117 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 Cl,15203(for example:110 gpd x#of bedrooms): ('00 C F c7 Number of current residents. Does residence have a garbage grinder(yes or no). Is laundry on a separate sewage system,(yes or no):Lt) [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use.(yes or no)t AL Water meter readings,if available(last 2 years usage(gpd)): w E t. Sump Pump(ves or no):-Y-0 Last date of COMMERCULMMUSMUL Type of establishment: _Design flow(based on 310 CMR 15203): 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): Damping Records INFORMATION FORMATION Source of information: Was system pumped as part of the inspection(yes or no): �Q If yes,volume pumped:gallons—How was quantity Pumped determined? Reason for pump TYPE OF SYSTEM 4 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/Altemative 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: Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ 1 LI) Sib i\-)o 2T14 AJ 0 C)Qe , Owner. *%Jcis DA QA0 LuS- Date of Inspection: �s BUILDING SEWER(locate on site plan) Depth below grade- /8 Materials of construction iron_40 PVCother(e .xplain). Distance from private water supply well or suction Tine: --,61 Comments(on condition of joints,venting,evidence of leakage,etc.)-. SEPTIC TANKS_(locate on site plan) Depth below grade:_ Material of construction�oonccete metal fiberglass_jolyethylene oth�(exPlain) If tank is metal list age:_ >s age confirmed by a Certificate of Compliance(yes or no): certificate) _(attach a Dopy of Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum 4aicimess, Distance from top of scam to top of outlet tee or baffle: Distance from bottom of sane to bottom of outlet tee or baffle- How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,eta): p L c 7 W GREASE TRAP:/1,E0oc ate,on site plan) Depth below grade:_ Material of construction- concrete m — _ etal fiberglass_polyethylene other (epi): Dimensions: Scam thidmess: 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 umping:Comments(on pumpingrecommendations, inlet and outlet tee or baffle condition,structural integrity,li id levels egn qu as related to outlet invert,evidence of leakage,etc): Pages of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 i��lz�nf ^�JDOOet A419 Owner. ' oNpR Date of Inspection:_ I I L oS TIGHT or HOLDING TANK:/V L(tank must be pumped at time of inspec tionxlocate on site plan) Depth below grade: Material of oonstnxion: concrete metal fiberglass_polyethylene other(explain� Dimensions: Capacitx Gallons Design Flow: aallonstday Alarm present(yes or no): Alarm level• Alarm in woddag order(yes or no): We of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: if present must be openeVocate on site plan) Depth of liquid level above outlet invert: b Comments(note if box is level and d nibudon to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc): ^� D� FJ LL 70 PUMP CHAMBER:Q](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 appmtenances,etc.)' Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 y 1 6J10 u - _�L%A u(; R AA A Owner: VokjoA 1,40 �v5 Date of Inspection: 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: leaching fields,number,dimensions: r overflow cesspool,number innovativelalternative system Typeiname of technology: Comments(note condition of soil,signs of hydraulic facture,level of ponding,damp soil,condition of vegetation, etc.): LE of 1 AQ �,4L 14/'0 POS r�-, AJ Cr- V qA,4 P u.u.Suti4 VeC�E?797?o u, CESSPOOLS:AM (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration. Depth-top of liquid to inlet invest: 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 f alure,level of ponding,condition of vegetation,etc-): PRIVY: IU ocate on site tan p ) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 . OFFICIAL INSPECTION FORM-=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinue� Property Address:141 970 N t,,►=Ou 6 iQ D tJ @j7K A,j D 0ue2 qtr Owner: Date of Inspection: ► i, o 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 caters the building. o � 0� 3�� Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: i y t s,t ,j c Owner: UoaD� �9uiuS Date of Inspection: (05, SI'Z'E EXAM Slope Surface water Check cellar $hallow wells /V o Ng Estimated depth to ground water 3 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: --)�-Observed site(abuttmg property/observation hole within 150 feet of SAS) Checked with local Board of Health-Wlain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain- You mast describe how you established the high ground water elevation: s t - c_ G a Q vn�u �t2�7 t c �Rt is x c3 e�..., } Or� bcS, revim.-, r P i TOWN OF NORTH ANDOVER ofµORTM Office of COMMUNITY DEVELOPMENT AND SERVICES h a p HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 1SSACHU'+tt Susan Y. Sayer,REHS/RS 978.6889540-Phone Public Health Director 978.688.9542-FAX April 19,2005 Scott and Vonda Paulus 14tStonecleave Road North Andover,MA 01845 Re:Proposed Septic Design for 141 Stonecleave Road,Map 104B,Lot 136 Dear Mr.And Mrs.Paulus: The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property,submitted on your behalf by Merrimack Engineering Services dated February 23,2005,final revision date of April 11,2005 and received by this office on April 11,2005.The design has been approved for use in the construction of an upgrade onsite septic system. Generally,a new plan approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period,for which this plan is valid,is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. This approval is subject to the following conditions: 1. The proposed location of the new septic tank and new pump tank must be five(5)feet from the existing concrete supports that support the porch.This is a requirement of the local regulations. Without adhering to this distance,the integrity of the porch may be in jeopardy.The plan does not indicate the distance.The installer must verify the distance.N any of the supports are within five feet of the tanks the installer must contact the engineer for appropriate action or alteration to the plan to correct the problem. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system,which will be in compliance with all regulations and assure protection of public health and the environment of Andover. Sincere S Sawyer,REHS Public Health Director cc: Anthony Donato,Merrimack Eng. File Q 00 pR�F cl �� � `�6' 8-r.j --_�'''�.;•��s .ter s�o� 107 w i r' f I