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Home My WebLink AboutMiscellaneous - 1440 SALEM STREET 4/30/2018 (2) � � iy�0 � �� _ _---- � __ ___ �� _-__-_ -___ __ ____ — - ---J s � � . n �. ,� .b �� 6hin SDS X77 v'�Q� 2fo(a� _ I no �5- � �� a� coy iY� F,� ��5 � �� i r North Andover Board of Assessors Public Access Page 1 of 1' e i ,►ORT1r North Andover Board. of Assessors Ot 4�ya° .a 1N0 O e° yr 'li, syn°✓a,rl°� 2�roperty Record Card Click Seal To Return Parcel ID :210/106.A-0020-0000.0 FY:2009 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge ' Search for Parcels ,`'• L• Search for Sales Summary " Residence w _ x Detached StructureY l," Condo 1440 SALEM STREET Commercial Location: 1440 SALEM STREET Owner Name: DAGHLIAN,ARSHAG LUCY&SONIA DAGHLIAN Owner Address: 1440 SALEM STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 1.01 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1350 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 417,500 428,400 Building Value: 208,800 219,700 Land Value: 208,700 208,700 Market and Value: 208,700 Chapter Land Value: LATEST SALE Sale Price: 0 Sale Date: 12/31/1977 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book: 01344 Page: 0457 http://csc-ma.us/PROPAPP/display.do?linkId=1464974&town=NandoverPubAcc 7/28/2009 4ORT" . DE 4ti1..0`A,MO 0 RECEIVED x DEC 3 .0 2009 PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH AND0Vf5R HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(Kconstructed;( )repaired; By:_ 34— Ael pc?Allaw (Print Nam6) Located at: (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated and last revised on �C<, ��, 20�,with a design flow of T gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310. CMR 15.000,Title 5 and local regulations,and the final grading.agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: ng er epresentative(Signature) And-Print Name 0 Final Construction Inspection Date:/)-/0 -2V f Engi er epresentative(Signature) And-Print Name Installer: _ - (Signature) Date: JZ/Q 0 J e Ile/74 1'6 And-Print Name Enginer: (Signature) Date: —o r Zoo And-Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com DelleCh!iaie, Pamela From: Isaac Rowe [irowe@millriverconsulting.com] Sent: Friday, November 13, 2009 3:38 PM To: 'Daniel Ottenheimer; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 1440 Salem Street Attachments: 1440 Salem Street-Construction Inspection 11-13-09.doc Susan, Please find attached the construction inspection form the above referenced property. You will notice I noted that the laundry system is still being used and will be connected to the new system when the addition is built. It appears that all the plumbing goes under the existing basement floor so there was no way to connect the 2 sewer pipes inside the dwelling. I would guess that the Health Dept. will have to sign off on the building permit for the addition. I not sure of the time frame of the construction for the addition, you may want to ask the engineer. I would recommend either holding off the issuance of the CoC or issue some form (letter?)of a temporary CoC until the laundry system is connected to the new system. Please let me know ifou have an questions. Y Y Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 ORT � � N hqw. 16' "IO 3? �..; O; o lb 4t A0 coc«ii«iwrt«�� 7.9 40"A SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 1440 Salem Street MAP: 106A LOT: 20 INSTALLER: Jim Kellett DESIGNER: Francis Nichols PLAN DATE: 9/8/09 BOH APPROVAL DATE ON PLAN: 11/2/09 INSPECTIONS l TANK INSPECTION: 111�lU11 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTI N: 11/13/09 DATE OF FINAL GRADE INSPECTION: Ib� SITE CONDITIONS ® Contractor reports any changes to design plan Z Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Existing laundry system still being used and will be connected to new septic system when addition is constructed per owner. Effluent line from laundry will be connected to new building sewer line with a Y-connection. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading mono construction 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 A6 tAORT#1 ,6�� ..6 0 O ti •Q4 COC.IC lWKM`y ��SSgcrNus��y PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Water tightness of tank has been achieved by Visual testing Z Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Outside of tank is waterproofed with tar. 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 floats working ® Separate on/off floats Z Drain hole in pressure line ® 24" cover at final grade installed over pump access port Z Watertightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet Comments: Outside of tank is waterproofed with tar. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: rear of existing dwelling ® Alarm signal located in rear of existing dwelling 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townotnorthondover.com i Inspection Form June 2008 i NORTFt q 6I D 161 LO .L r L N T g T � n DK•QA LOLMIL lwKM`v ��sSgc►+us��y PUBLIC HEALTH DEPARTMENT Community Development Division Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) Comments: 2" x 4" coupling approximately 4' from d-box inlet. Approximately 4' of 4" SCH 40 PVC pipe prior to d-box inlet. Vent off of d-box to provide air flow. SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Vent located near shed I 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTH q p t06� O 6.16 0 KII �•9A coc.cmw-00 `y1' ��SSgcHus��y PUBLIC HEALTH DEPARTMENT (ommunity Development Division BM = 106.82 HR = 4.16 H1 = 110.98 SYSTEM ELEVATIONS ROD AS-BLT INVERT ELEV DESIGN INVERT ELEV ELEVATION Benchmark 106.82 Building Sewer OUT 9.36 101.27 101.0+/- Septic Tank IN 9.55 101.08 100.47 Septic Tank OUT 9.89 100.74 100.22 Pump Chamber IN 9.93 100.70 100.12 Pump Chamber OUT 2" 10.36 100.45 100.37 Distribution Box IN 4" 5.66 104.97 104.95 Distribution Box OUT 5.84 104.79 104.77 Lateral 1 TOP @ Be /End 5.88/6.11 Lateral 1 INVERT 104.75/104.52 104.68/104.50 Lateral 2 TOP@ Be /End 5.88/6.12 Lateral 2 INVERT 104.75/104.51 104.68/104.50 Lateral 3 TOP@ Be /End 5.87/6.12 Lateral INVERT 104.76/104.51 104.68/104.50 Lateral 4 TOP@ Be /End 5.86/6.12 Lateral INVERT 104.77/104.51 104.68/104.50 Lateral 5 TOP@ Be /End 5.88/6.12 Lateral 5 INVERT 104.75/104.51 104.68/104.50 Lateral 6 TOP @ Be /End 5.88/6.12 Lateral INVERT 104.75/104.51 104.68/104.50 BED BOTTOM ELEV. 104.01 104.00 i 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTH q 16 ti O O to C'0 coc.cm. 4t e" 40 A so �9SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® , Slab foundation 10 10 -- ® . Deck, on footings, etc 5 10 -- ® Waterline. 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Inspection Form June 2008 DelleChiaie, Pamela j From: DelleChiaie, Pamela Sent: Tuesday, November 10, 2009 2:55 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Marianne Peters; 'Randy Burley' Subject: 1440 Salem Street- Final Construction Request Hello, Received a confirmation call from Frank Nichols, engineer for 1440 Salem Street-site is ready for a Final Const. inspection. Called and confirmed with Jim Kellett, Installer- 781.953.7146—he states it is all set. Please call Jim to schedule. Thank you. Feat wq�, Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20i Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pages/index-Website Notes: If copied to BOH Members-Reference Copy Only-no response requested at this time i I 1 A .A i l +?"TN � Commonwealth of Massachusetts Map-Block-Lot t�Q a 106.A0020 3 �t ----------------------- Board of Health �® 0 Permit No North Andover ----------------------- BHP-2009-0691 # � ` P.I. FEE �� ,cuus F.I. $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James Kellett to(Repair)an Individual Sewage Disposal System. at No 1440 SALEM STREET as shown on the application for Disposal Works Construction Permit No. BHP-2009-069 Dated November 02 2009 ----------------------------- Issued On:Nov-02-2009 - ------- ---- ---- ----- ------ oard of Health I N°R Application for Septic Disposal System ° TODAY'$_DA E Construction Permit - TOWN OF ° ORTH ANDOVER MA 01845 00-Ful - air CHUg<� $125.00 -Component Important: Application is hereby made for a permit to: When filling out forms on the'. Ela y g p Construct a new on-site sews disposal system* computer, useRepair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing Y p system component—What? cursor-do not key the return y. A. Facility Information /9,710 �Q lc✓� J-� Address or Lot# Cityrrown 2.-*TYPE OF SEPTIC SYSTEM*: f� Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** Conventional System (pipe and stone system) ❑ Infiltrator or BiodiffuserGravel-Less Attach a ( ) ( copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information Namp, e) Name of Company Address City own State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company ?. d crdk Address ciyr-v 0� City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 e F N°°TN q Application for Septic Disposal System 10 bzz Loi tQ.,e ti - TODAY'S DAIFE pConstruction Permit - TOWN OF ' ORTH ANDOVER MA 01845 • $ 250.00-Full Repair CHO t� � $125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building:dResidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not t place the system in operation until a Certificate of Compliance has been iss 1/ by this B d of Health. N e Date Applica n Approved : (Board of Health Representative) N Date Application isapprove for the following reasons: i For Office Use Only; 1. Fee Attached. Yesk No 2. Project Manager Obligation Form Attached. Yes v No i 3. Pump System? If so,Attach copy ofElectrical Permit Yes, No 4. Foundation As-Built. (new construction ronly). Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 RECEIVED OCT .2 3 2009 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Date.1.�.... :. .... Of NORTH ` ?�` �� °-,+ TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHUS This certifies that ..`� ► 'f �' ��---� ........................................... has permission to perform ............................. wiring in the building of..../ �'.: ' .................5.�. i� at../M.r� - .... . .. ............•••.•........ ,North Andover Mass. Fee.. ............. Lic. No. a... . ........................................................... i ELECTRICAL INSPECTOR Check # 7 9086 •<r SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the.North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans byj�a (Engineer) Relative to the application of U Kt(at y (Installer's name) And dated Q / ngina ate Dated t L 0"A /0 - 30 -01 oy a s ate With revisions dated (Last revised date) ' I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. .3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (V5 inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not i have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of 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 ofHealth staff or consultant. d Installation of tank,D-Box,pipes, stone, vent,pump chamber, retaining wall,and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: fl U (Today's Date) 7a—me–Print) –Signed) • 1 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives.notice of his or her intention to perform the elqctrical work described below. Location(Street&Number) ( /n Owner or Tenant Telephone No. Owner's Address. Is this permit in conjunction with a1 uilding permit? Yes ❑ No (Check Appropriate Box) Purpose of Building U>l x>' Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters i 10—,Me----MA- �.. d �dgr No.of Meters u iLoR Sw I acs Date./q . " a table m be waived by the Inspector of Wires. No.of Tota ;Transformers KVA o:°,.'� "o,� TOWN OF NORTH ANDOVER Generators KVA PER=MIT FOR WIRING 0.0 emergency Ligbang 1 4L Battery Units *►''^+,.,°�:«` � FIRE ALARMS No.of Zones �SS�ICHUSNo.o etection an (, Initiating Devices No.of Alerting Devices This certifies that : .i.t 3 Gt... .... ... ........ ........... . ed has permtssto `!! '' Det ction/AlertinmDevices n to perform ... A:4 : . J � f nl El other El Connection thebtulcing t.. tt ecurity ystems: at .,X �: ...i, tJ:7....................... ,North Andover,Mass No.of Devices or Equivalent Data Wiring: Fee.... Lic.No. .� ./�... ...... No.of Devices or Equivalent e ecommumcations irmg: ELECTRICAL INSPE No.of Devices or Ea uivalent 4 Check-# esired,or as required by the Inspector of Wires. 9 ( � ipal policy.) C Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov rage is in force,and has exhibited proof of same to the permit issuing office. 11 CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under the aims ant pena 'es of perjury,that the information on this application is true and complete. FIRM NAME: V fo P.Q�'l�>7 LIC.NO.: q� Licensee: ( n1 e Signature !�/ LIC.NO.: afdpplicable,enter"exem j :n the license number ne.)./ Bus.Tel.No.-,971-,5353? 0,Q ��' /f �Q ti l�u� /(. � �y Alt.Tel.No.: <� S� *Per M.G.L c. 147,s.57-61,security work requires Depakment of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ i TOWN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACHUSETTS 01845 0ORT►r Date Issued Q� "So , F= get A616 Up Expiration Date ��SSACHU 4 Jackie's Law — Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant !J //// Phone Cell JrQ/hrs �ie[le�f 7&l-ski- ?93y 7SI, gs`3_ Street Address i City/Town MA ZIP Name of Excavator(if different from applicant) Phone Cell Street Address City/Town MA ZIP III Name of Owner(s)of Property Few. Phone Cell Street Address City/Town MA ZIP Other Contact Permit Fee Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable/lines etc..)Pleas use reverse side if additional space is needed. 1 1 Insurance Certificate#: Y 1 Name/and Contact Information of Inssu/rrer: Policy Expiration Date: Dig Safe#: 2od5 $'67s"� Name of Competent Person(as defined by 520 CMR 7.02): 1'reL/-_Y�L Massachusetts Hoisting License# License Grade: Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS, G.L. c. 82A,520 CMR 7.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANT SIGNATURE DATE AVATOR SIGNATURE(IF DIFFERENT) DATE OWNER'S SIGNATURE (IF DIFFERENT) DATE: 21iPage I� For Ci /Town use--Do not write in this section PERMIT APPROVED BY PERMITTING AUTHORITY Date $ Application Fee CONDITIONS OF APPROVAL CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application,the applicant understands and agrees to comply with the following: i. No trench may.be excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164(DIG SAFE); ii. Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safe in order to familiarize themselves with the recognized safe hazards associated with Safety l� safety excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CFR 1926.650 et.seq.,entitled Subpart P"Excavations". IV. Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,accepting and signing this permit,the applicant hereby attests to the following:(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2)that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 1926.650 et.seq.,entitled Subpart P"Excavations"as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application,complied with the requirements of sections 40- 40D of chapter 82A. Vi. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at wwW.mass.gov/dps 3Page l� Summary of Excavation and Trench Safety Regulation 520 CMR 14.00 et seq.) This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L.c.82A and does not include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A,go to www/mass.gov/dps Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety,jointly with the Division of Occupational Safety, drafted regulations relative to.trench safety. The regulation is codified in section 14.00 of title 520 of the Code of Massachusetts.Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a trench made for a construction-related purpose on public or private land or rights-of-way. All municipalities must establish a local permitting authority for the purpose of issuing permits for trenches within their municipality. Trenches on land owned or controlled by a public(state)agency requires a permit to be issued by that public agency unless otherwise designated. In addition to the permitting requirements mandated by statute, the trench safety regulations require that all excavators,whether public or private,take specific precautions to protect the general public and prevent unauthorized access to unattended trenches. Accordingly,unattended trenches must be covered,barricaded or backfilled. Covers must be road plates at least V thick or equivalent;barricades must be fences at least 6'high with no openings greater than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators may choose to attend trenches at all times,for instance by hiring a police detail,security guard or other attendant who will be present during times when the trench will be unattended by the excavator. The regulations further provide that local permitting authorities,the Department of Public Safety, or the Division of Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury;the failure to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The trench shall remain shutdown until re-inspected and authorized to re-open provided, however,the excavators shall have the right to appeal an immediate shutdown. Permitting authorities are further authorized to suspend or revoke a permit following a hearing. Excavators may also be subject to administrative fines issued by the Department of Public Safety for identified violations. Summary of 1926 CFR Subpart P-OSHA Excavation Standard Tihis is a worker protection standard,and is designed to protect employees who are working inside a trench. This summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational purposes only and does not constitute an official interpretation by OSHA of their regulations,and may not include all aspects of the standard. For further information or a full copy of the standard go to www.osha.gov. Trench Definition per the OSHA standard: o An excavation made below the surface of the ground,narrow in relation to its length. o In general,the depth is greater than the width,but the width of the trench is not greater than fifteen feet. • Protective Systems to prevent soil wall collapse are always required in trenches deeper than 5',and are also required in trenches less than 5'deep when the competent person determines that a hazard exists. Protection options include: o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices,the equipment manufacturer's tabulated data,or designed by a registered professional engineer. o Shielding(Trench Boxes). Trench boxes must be used in accordance with the equipment manufacturer's tabulated data,or a registered professional engineer. o Sloping or Benching. In Type C soils(what is most typically encountered)the excavation must extend horizontally 1 'h feet for every foot of trench depth on both sides, 1 foot for Type B soils, and'/o foot for Type A soils. o A registered professional engineer must design protective systems for all excavations greater than 20' in depth. continued 41Page I • Ladders must be used in trenches deeper than 4'. o Ladders must be inside the trench with workers at all times,and located within 25'of unobstructed lateral travel for every worker in the trench. o Ladders must extend 3'above the top of the trench so workers can safely get onto and off of the ladder. • . Inspections of every trench worksite are required: o Prior to the start of each shift,and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person(see below). • Competent Person(s)is: o Capable(i.e.,trained and knowledgeable)in identifying existing and predictable hazards in the trench,and other working conditions which may pose a hazard to workers,and o Authorized by management to take necessary corrective action to eliminate the hazards. Employees must be removed from hazardous areas until the hazard has been corrected. • Underground Utilities must be: o Identified prior to opening the excavation(e.g.,contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected,supported,or removed once exposed. • Spoils must be kept back a minimum of 2'from the edge of the trench. • Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. • Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by creation of the trench,they must be underpinned,braced,or otherwise supported. o Sidewalks,pavements,etc.shall not be undermined unless a support system or other method of protection is provided. • : Protection from water accumulation hazards: o It is not allowable for employees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulation,this must be monitored by the competent person. o If the trench interrupts natural drainage of surface water,ditches,dikes or other means must be used to prevent this water from entering the excavation. • Additional Requirements: o For mobile equipment operated near the edge of the trench,a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath loads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high-visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4'if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist(e.g.,02<19.5%or>23.5%,20% LEL,specific chemical hazard),adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with guardrails must be provided for crossing over trenches>6'deep. o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. 5 Page i � tAORTri O Co ey � A- coc«�iriw.c. '�' 9SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division John Daghlian 1440 Salem Street North Andover, MA 01845 Date: November 12,2008 Re: Application for: addition;garage,family room, workshop at 1440 Salem Street Dear John, Your application for the addition has been reviewed by the Health Department. The application wasdeficient for the reasons we discussed on the phone. Please submit the requested items so that,we may assist you in moving forward in the process: 1. x Missing information 2. x Passing Title 5 inspection of septic system required 3. p Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing home—all rooms (plan for addition is sufficient already unless some existing rooms are changing in size) b. �Submit plot plan showing house, septic system and proposed project in scale. 0 . Distances must meet Title V requirements. Leaching area must be>20 feet from a V foundation and the tank must be>10 feet from the foundation. If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerel J iisan Sawyer, REHS S Health Director Cc: Building Department File I 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com I Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the �,M •'' 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. 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 15.404(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 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new desigr oved capacity of an on-site system constructed in accordance with either the 1978LE15.000. A. Facility Information AUG 0 4 2009 Important: When filling out 1. Facility Name and Address: TOWN OF'NORTH ANDOVER forms on the --" HEALTH DEPARTMENT f! computer,use 7 awl G 11-a", only the tab key Name to move your 1446 __!57A cursor-do not —� use the return Street Addresl /� key. Ab r//( JTYI J CAey-" City/Town State Zip Code 2. Owner Name and Address (if different from above): ffi'z Name Street Address City/Town St to '51,q- 4 ) � f Zip Code Telephone Number 3. Type of Facility(check all that apply): ( Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Conventional ❑ Other(describe below): � 6. Type of soil absorption sstem (trenches chambers, leach field, pits, etc): i %rte cue 5 t5form9a.doc-rev.7/06 Application for Local Upgrade Approval,Page 1 of 4 Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Susan Sawyer, REHS/RS Health Director Cc; Building Department File I I 1600 Osgood Street,North Andover Massachusetts 01845 9 , Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com NORTH - � N O O L yy L T - i► T O CO[N CNlwKM 1' �9SSAC HUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division October 13, 2009 John Daghlian 1440 Salem Street North Andover, MA 01845 RE: Septic System Design, 1440 Salem Street,North Andover, Map 106A, Lot 20 Dear Mr. Daghlian, The North Andover Board of Health has completed the review of the septic system design plan for.the above referenced property, submitted on your behalf by Frank Nichols, dated September 8, 2009, last revision date October 7,2009 received on October 9, 2009. The design has been approved for use in the construction of an onsite septic system. The 440 gallons per day(max 4-bedroom or 9 room total), has been approved for use in the construction of a replacement, Title V, subsurface disposal system. This approval is valid for two years from the date of the approval in accordance with current local regulations and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. The approval includes a Local Upgrade Approval for the request to have only one test pit within the area of the proposed system and a reduction of the 12 inch separation of the ground water elevation and the tank inlet and outlet tees. Please keep a copy of the attached document for your records. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement Please note that this system will be equipped with a Zabel Filter on the outlet tee. This filter must be maintained annually according to manufacture specifications. Your effort to provide a properly functioning septic system for your dwelling is appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerety, i S san Y. SavWer, REHS��— Public Health Director En& list of licensed septic system installers Cc: Frank Nichols, P.E. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts w City/Town of o Local Upgrade Approval Form 96 M DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab John Daghlian key to move your Name cursor-do not 1440 Salem Street use the return' key. Street Address North Andover MA 01845 „b City/Town State Zip Code 2. Owner Name and Address (if different from above): f Name Street Address Citylrown State Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 9pd 5. System Designer: Francis Nichols Name ® PE ❑ RS PO Box 185 Carver MA, 02330 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 1440 Salem St 9b 10.13.09•rev.7/06 Local Upgrade Approval* Page 1 of 2 i Commonwealth of Massachusetts z City/Town of a a Local Upgrade Approval .r Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: � North Andover Health Det r Approving Authority Susan Sawyer 10/13/09 Print or Type Name and Title ,. Signature Date 1440 Salem St 9b 10.13.09•rev.7/06 Local Upgrade Approval*Page 2 of 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, October 13, 2009 11:36 AM To: 'jdaghlian@newtonma.gov' Cc: 'fnichols@newtonma.gov' Subject: Septic- 1440 Salem Street-Plan Approval Attachments: SKMBT_60009101311190.pdf Importance: High Hello, Attached is your septic plan approval letter. Please call the office if you have any further questions. Best regards, a�sceQa �e�Pe Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www;townofnorthandover.com-Website Notes: 7f copied to BOHMembers-Reference Copy Only-no response requested at this time From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent:Tuesday, October 13, 2009 12:19 PM To: DelleChiaie, Pamela Subject: Message from KMBT_600 1 Frank Nichols, PE Consulting Engineer Civil En in r P.O. Box 185 Ph: 508-560-7411 Carver, MA 02330 Fax: 508-866-7024 October 7, 2009 _ RECEIVE® Susan Y. Sawyer, Health Director OCT - 9 2009 1600 Osgood Street g Buildin . 20; Suite 2-36 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT N. Andover, MA 01845 Re: Response to Review Comments - 1440 Salem Street (John Daghlian) Ms. Sawyer: In response to your review comments I have revised the plan and respectfully submit my revisions for your approval. The review items are in Italics and have been paraphrased. Specifically: Comment1: One test pit within the proposed leaching area - DEP approved Form 9A has been submitted for your review and approval Comment 2: Benchmark within 50'-75'of the proposed components a second benchmark within 75' of the system components has been added to the plan Comment 3: Magnetic Marking Tape- a note specifying this requirement has been added to the plan Comment 4: Show all watercourse - s or wetlands r�..- ds within 150 . there are no watercourses-or wetlands within 150' of the proposed system components. A note has been added to the revised plan. Comment 5: Provide a Disclaimer relative to no wetlands within 100'- a disclaimer has been added to the revised plan A/Comment 6: Irrigation well within 100'of the Proposed Leaching Field-the proposed leaching field has been shifted to achieve a 100' separation from the existing irrigation well �. Comment 7. Breakout Elevation has not been met-the proposed grading has been revised to comply with the 15' breakout requirement �f Comment 8: Soil Logs for TP's 3 & 4-test pits 3 & 4 as identified on the submittedp lan were �l excavated only to a depth of 3' minus. At this depth the original leaching system was l encountered. The test pits were abandoned and not logged. Comment 9: The Elevation & Depth of Percolation test was not provided-the percolation depth and relative elevations have been added to the revised plan. Comment 10: Effluent Tee requirement, Maintenance &Access Cover- a Zabel Filter, Model ' A1.800 has been added to the plan. The pump chamber detail was revised to include a 24" diameter watertight access cover to grade. A note relative to the annual maintenance has also been added. -4 Comment11: Watertight Tanks— plan notes have been revised to indicate all concrete structures are to be watertight (Sewage Disposal Note 3 & Pump Chamber Note 2) Comment 12: Separation Distance between ESHWT&Tank Inverts— please find attached '1 DEP approved Form 9A requesting a Local upgrade Approval for a reduction in the separation distance �, Comment 13: Tank Loading Specification—the plan notes have been revised to specify that both the septic tank & pump chamber are rated for H-10 Wheel Loading Comment 14: Building Sewer Installation requirements— a note has been added to specify the proper installation,of the sewer line in full compliance with Title 5 --Comment 15: Invert Elevations of DBOX— a note has been added to specify that all outlets of the DBOX are to be installed at the same elevation Comment 16: Outlet Pipes from DBOX— a note.has been added to specify that all outlet pipes exiting the, DBOX are to be level fora minimum of 2' Comment 17: Model Number of Shea DBOX—the plan has been revised to indicate the correct model number of the Shea DBOX Comment 18: Pump Performance Curve— please see attached. Comment 19: Manual Operation Switch requirement— Pump Chamber Note 2 has been �- revised to specify the manual operating switch requirement Comment 20: Pump Chamber Access Cover—the pump chamber detail has been revised to include a 24" diameter watertight access cover to grade Comment 21: Field excavation to extend 6 into natural soil—the field cross section detail has been revised to meet this requirement I trust that the revised plan and attachments address your comments. If however you should need additional information please feel free to contact me. Sincerely, ran ichols, PE Lic. No. 41554 Cc: John Daghlian [�GouLDs PUMPS Submersible Sewage Pump FEE t_ `w 3886 f5 ice• ,�....�; Prosurance available for residential applications. n �.+ypW6' APPLICATIONS against component damage starting torque. ■Power Cable:Severe duty Specifically designed for the on accidental reverse rotation. •Built-in overload with rated,oil and water resistant following uses: ■Fastener;:300 series automatic reset. Epoxy seal on motor end •Homes stainless steel. •%and'1h HP-16/3 SJTOW provides secondary moisture •Sewage systems n Capable of running dry with 115V or 230V three barrier in case of outer Jacket •Dewatering/Effluent without damage to prong plug. damage and to prevent oil •Water transfer components. •%and 1 HP—14/3 STOW wicking.20 foot standard ■Designed for continuous with bare leads. with optional lengths SPECIFICATIONS operation,when fully Three phase(60 Hz): available. submerged. •Overload protection must be 0 Motor Cover 0-ring; Pump: provided in starter unit. Assures positive sealing •Solids handling capabilities: MOTORS •'/r1 HP—14/4 STOW with against contaminants 2`maximum. bare leads. and oil leakage. •Discharge size:2`NPT. ■Fully submerged in high ■Bearings:Upper and lower ■Consult factory for informa •Capacities:up to 185 GPM. grade turbine oil for lubrica- heavy duty ball bearing tion on 575 V models ..: •Total heads:up to 38 feet tion and efficient heat construction. MH. transfer.All ratings are within ■Designed for Continuous AGENCY LISTINGS •Temperature: the working limits of the Operation:Pump ratings are 104OF 40°C ( )continuous TmtedWUl718and motor. within the motor C8A222108sMndar6 140°F(60°C)intermittent. manufacturer's recommended �Ck. syanaa�n sw°ds Class B insulation.•See order numbers onSingle phase(60 Hz): working limits,can be s A� s reverse side for specific HP, .All single phase models operated continuously voltage,phase and RPM's feature capacitor start without damage when fully Goulds Pumps Is 1509601 Rophfamd available. motors for maximum submerged. FEATURES "1eT M mer rs 60;---------, ----------- — ■Impeller.Cast Iron,semi- ! MODEL 3886 open,dynamically balanced, ! ; 2'SOLI non-clog with pump out ,o;•.-._____..i___ .__ > I ; RPM ;... ' 1725 vanes for mechanical seal protection.Optional Silicon ,o !wSi0i s + bronze impeller available. + ; ■Casing:Cast Iron volute type for maximum efficiency. Designed for easy installation "tea f i on A10-20 slide rail. s wsme + ■Mechanical Seal:SILICON + ' CARBIDE VS.SILICON i CARBIDE sealing faces for ! i i__. superior abrasive resistance, ! . ..j-.... . ;._ ' stainless steel metal parts, BUNA-N elastomers. o ° ..._:.. :. 0 20 ao so eo roo izo reo rao �i ■Shaft:Corrosion-resistant stainless steel.Threaded ° e t0 'g 20 a, f-1n CAPACrtY design.Lockout on three Goulds PtJl1ti phase models to guard 4?cRra11N6 n�i,.�i IT't'1t1�JuFtlJr loo GPm a 12 -1-09 14 f NORTIJ q O �t�ao - ? e` 1, •e OOH p �9SS�CHUS Health Department September 25, 2009 Francis A.Nichols, P.E. Frank A.Nichols, P.E. Consulting Civil Engineer P.O. Box 185 Carver, MA 02330 Re: Subsurface Sewage Disposal System Plan for 1440 Salem Street, Map 106A, Lot 20 Dear Mr.Nichols: The proposed wastewater system design plan for the above site dated September 8, 2009 and received on September 18, 2009 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that.is not met by this design follows each item. 1. There is only test pit in the proposed soil absorption system area. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested (3 10 CMR 15.405(k)). 2. A benchmark within 50'-75' of the proposed system components is required(3 10 CMR 15.220(4)(q)). 3. Please specify all system components shall be marked magnetic marking tape(3 10 CMR 15.221(12)). 4. Please show all watercoarses or wetlands within 150' of the system(NA 8.02(r)). 5. Please add wetland disclaimer if there are no wetlands within 100 feet of the proposed leaching facility(NA 8.02(s)). 61. A 100 foot setback distance is required from the existing irrigation well (NA 5.02). 7. The breakout elevation is not met on the down slope side of the proposed leaching facility. Please revise the finish grading to meet the breakout ( requirement 310 CMR q 15.255(2)). 8. Please provide the soil logs for test pits#3 and#4 (NA 8.02 (n)). 9. The elevation and depth of the percolation test was not indicated(NA 8.02(n)). 10. An effluent filter is required when use a pump chamber(3 10 CMR 15.23 1(10)). Please indicate to the brand and model to be used. Also note the required annual maintenance necessary(3.10 CMR 15.227(7)). Please depict the access cover above the septic tank outlet at finish grade as required with an effluent filter(3 10 CMR 15.227(7)). 11. Please indicate that the septic tank and d-box shall be watertight(3 10 CMR 15.221(1)). 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North,Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 12. It appears that the septic tank and pump chamber inverts provide less than a 12 inch separation to the ESHWT of 100.00'. Please propose a.Local.Upgrade Approval for..less f than 12 inch separation between the tank inverts and the ESHWT(3 10 CMR 15.227(5)). 13. Please indicate whether the septic tank and pump chamber are H-10 or H-20 loading(3 10 CMR 15.226(3)). 14. Please provide notes that the building sewer line shall have watertight joints,pipe laid on a compact firm base and pipe laid on continuous grade in a straight line (3 10 CMR 15.222(5-8)). 15. Please provide a note that all the outlets of the d-box shall be at the same elevation(3 10 CMR 15.232(3)(b)). 16. Please provide a note that all the outlets of the d-box shall be level for the first two feet (3 10 CMR 15.232(3)(c)). 17. The SHEA d-box model number references a 6 outlet d-box. Please depict the correct model number. 18. Please provide the pump performance curve for the proposed pump (3 10 CMR 15.220(4)(r)). 19. Please indicate that a manual operating switch shall be provided(NA 12.01). 20. The access cover above the pump chamber outlet is required to be at finish(3 10 CMR 15.231(5)). 21. The excavation of the leaching facility is required to extend 6"into the natural soil (NA 9.02). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. /SincerellSawye , REHS/RS. Public Health Director cc: Rev. Arshag Daghlian File ,AORTH q O .4 161 4�O � 6 OL O � coc.iiiwK. 1 TED 01PP`y'(y 9SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division John Daghlian 1440 Salem Street North Andover, MA 01845 September 22, 2009 Re: Application for: addition;garage,family room, workshop at 1440 Salem Street ,Dear Mr. Daghlian, On November 12, 2008 a review letter was sent to you in regards to the building permit submitted for your property listed above. In response to the concerns outlined in the letter, you engaged an engineer to begin the process of installing a new septic system. Soil tests were preformed and the Health Department received the septic plans on September 21, 2009. In addition,today an email was sent by you indicating your intention and desire to move forward with the installation in 2009. i i With receipt of your intent in writing,the Health Department has considered your request to begin construction on the proposed addition prior to the septic plan approval. Please note the plans have been sent to our consultant for review and generally take two weeks to review, although regulation allows for 45 days. The Health Department appreciates your effort in this matter and sees no issue with signing the "Form U" at this time. Below is a link to the approved septic installers, but note that it has not been updated with the 2009 information. Most have renewed, however please be sure to verify that any installer you hire has a 2009 license to install in this community. http://www.townofnorthandover.com/Pages/NAndoverMA Health/septicinstallers.pdf Sincer , ,mit/'/�'`'�� u an Sawyer, R iaRS Public Health Director j Cc: Gerald Brown, Inspector of Buildings 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Sep 22 09 11 :32a DPW RDMIM 6177961050 p.2 1 Frank Nichols, PE Consulting Civil Engineer P.O.Box 185 Ph:508-560-7411 Carver,MA 02330 fax:508-866-7024 September 21,2009 Susan Y.Sawyer, Health Director 1600 Osgood Street Building 20;Suite 2-36 N.Andover, MA 01845 Re Local Upgrade Approval Request—1440 Salem Street(John Daghlian) Ms:Sawyer: On behalf of my client,John Daghlian,I respectfully request the following Local Upgrade Approval pursuant to Section 15.404(Maximum Feasible Compliance)and Section 15.405(Contents of Local Upgrade Approval)of Title 5 of the State Environmental Code(DEP Form 9A attached). Specifically: ,Section 15.405(1)(k)--To allow the Proposed Leaching Field to be designed utilizing one deep- hole excavation and not the required two holes. This upgrade request is necessary due to current site conditions which prevented the excavation of the second deep-hole within the proposed leaching field footprint. Sincerely, Frk Nichols,PE Lic. No. 41554 Cc:John Daghlian Sep 22 09 11:32a DPW RDMIW 6177961050 . p.3 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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. 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 15.404(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 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site 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 the computer,use Rev.Arshag Daghlian only the tab key. Name to move your 1440 Salem Street cursor-do,not Street Address use the return key. North Andover MA 01845 Cityfrown State Zip Code +� 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Residence 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system(trenches,chambers, leach field, pits,etc): trenches FORM 9A.doc•rev,7106 Application for Local Upgrade Approval*Page 1 of 4 Sep 22 09 11 : 33a DPW ADMIN 6177961050 p, 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 455 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter,etc.(attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Applicant proposes to install a new 1500 gallon capacity septic tank, 1000 gallon capacity pump chamber and a conventional leaching field of 1,820 sq.ft. 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.4. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min.Jinch Depth to groundwater fL i FORM 9A.doc•rev.7106 Application for Local Upgrade Approval•Page 2 of 4 I Sep 22 09 11:33a DPW RDMIM 6177961050 p,5 X Commonwealth of Massachusetts City/Town of North Andover Form 9A — Application for Local Upgrade Approval 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well(explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ 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)(h)(1). The soil evaluator mustbe a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance,as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: FORM gA.doc-rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 SOP 22 09 11:338 DPW RDMIM 6177961050 P. 6 Commonwealth of Massachusetts City/Town of North Andover Form 9A — Application for Local Upgrade Approval 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. C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 5. The Application for Local Upgrade Approval must be accompanied by all of the following(check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I,the facility owner, certify under penalty of law that this document and all attachments,to the best of my knowledge and belief,are true,accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." E_'-:-: '.'f�f—+F�'. '�. -r 1-64< 9121/09 Facility Qwnef's Signature Date Rev. Arshag D ghlian Print Name Frank Nichols, PE 9121/09 Name of Preparer Date PO Box 185 Carver Preparer's address CityfTown MA/02330 508-560-7411 State/ZIP Code Telephone FORM 9A.doc rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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. 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 15.404(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 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. RECEIVE® A. Facility Information Important:When OCT — 9 2009 tilling out forms 1. facility Name and Address: on the computer, use only the tab John Da hlian TOWN OF NORTH ANDOVER HEALTH DEPARTMENT key to move your Name cursor-do not 1440 Salem Street use the return Street Address key. North Andover MA 01845 to�Ij Cityrrown State Zip Code 2. Owner Name and Address(if different from above): Name Street Address i Citylrown State jZip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Residence 9 Y 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): trenches t5form9a for ESHGWT Sep.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval M y,••" 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded systemgpds Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Applicant proposes to install a new 1500 gallon capacity septic.tank, 1000 gallon capacity pump chamber and a conventional leaching field. 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft. t5form9a for E$HGUVT Sep.doc-rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: i' 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)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation I i 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: r�S�IN� SeL,e�-Sc�v�c� r-x�Ts GdN J3ezvw j'10D 7a 1-7e-eoGt"r / r,sn1jc IBJ (v 6ASer c�vr f�rr�r�• �e� SPS. 15.229 QvMQ�rtC Setl< TIMAd IM e-xcess W ZS-'I, 00iw 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: t5form9a for ESHGWT Sep.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover oForm 9A — Application for Local Upgrade Approval al M 5•••� 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. C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "l, 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." �G/ AF ci ees Signature Date n Da hliannt Name 10, Frank Nichols, PE 10/5/09 Name of Preparer Date PO Box 185 Carver Preparer's address City/Town MA/02330 508-560-7411 State/ZIP Code Telephone t5fomt9a for ESHGWr Sep.doc-rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 1� TOWN OF NORTH ANDOVER + µoRT„ Office of COMMUNITY DEVELOPMENT AND SERVICES oa HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 "" NORTH ANDOVER,MASSACHUSETTS 01845 �9SsgcwusE� 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE: n ov,r.com SEPTIC PLAN SUBMITTAL FORM S E p 18 2009 Date of Submission: TOWN OF NORTH ANDOVER TH DEPARTMENT Site Location: � �� 15r Engineer: 161 New Plans? Yes �$225/Plan Check# /000,3 (includes 1'c submission and one re- review only) Revised Plans?Yes $75/Plan Check# I Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No Telephone#: Fax#: E-mail: i C62ea, Homeowner Name: �d f i OFFICE USE ONLY �e When the submission is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of North Andover F _ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal MassDEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information John Daghlian Owner Name 1440 Salem Street 106A/20 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2. Published Soil Survey Available? ❑ Yes ® No If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ® No If yes: Year Published Publication Scale Map Unit Glacial Till Drumlin Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No Within the 500-year flood boundary? ❑ Yes ® No Within a velocity zone? ❑ Yes ® No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts City/Town of North Andover R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal r` B. Site Information (Continued) 2009 July 6. Current Water Resource Conditions (USGS): July yYear Range: ® Above Normal ❑ Normal El Below Normal Mont7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Dee Observation Hole Number: 2 8/18/09 1:30 Sunny 85 Deep Date Time Weather 1. Location Ground Elevation at Surface of Hole: 105.5 Location (identify on plan): Residential Lot Yes 0:- 3. 2. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope'(%) Lawn Area Drumlin Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Oen Water Body ' 500 Drainage Way > 100 possible Wet Area ' 500 Open y g feet feet feet Property Line > 20 DrinkingWater Well ' 200 Other feet feet feet 4. Parent Material: Compact Till Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: N/A N/A Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 66 100.0 inches elevation TP 2 t5form11.doc•rev. 10/07 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Y' C. On-Site Review (Continued) Deep Observation Hole Number: 2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Consistence Other Depth(in.) Layer Moist(Munsell) (USDA) Cobbles& Structure Depth Color Percent Gravel (Moist) Stones 0 -4 A 10YR 3/2 - - - Fine SL - - - V.friable 4-23 B 10YR 6/6 - - - SL - - massive v.friable 23 - 101 C 2.5Y 6/4 66" V.Fine SL 2- 5 - massive V.Firm compact Additional Notes: TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of North Andover A _ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Continued) Deep Observation Hole Number: 2 8/18/09 1:30 Sunny 85 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 105.5 Location (identify on plan): 2. Land Use Residential Lot Yes 0 - 3 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Area Drumlin Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body ' 500 Drainage Way > 100 possible Wet Area ' 500 feet feet feet Property Line > 20 Drinking Water Well ' 200 Other feet feet feet 4. Parent Material: Compact Till Unsuitable Materials Present: ❑ Yes Z No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: N/A N/A Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 66 100.0 inches elevation TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y C. On-Site Review (Continued) Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix: Color- (mottles) Soil Texture %by Volume Soil Soil Consistence Other Depth(in.) Layer Moist(Munsell) (USDA) Cobbles& Structure Depth Color Percent Gravel (Moist) Stones Y Additional Notes: TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. B. 66 inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: acnes Lower boundary: n01 ches TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal sf F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. September 8, 2009 atu e o Soil Evaluator Date jSiir�ank Nichols, PE (SE1739) October 1995 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Randy Burley North Andover Representative Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of North Attleboro a _ s Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: TF2- she QtC , Pi TP i - F D [3 ->T Q ! = �, R _ ' STP Z 2 f 7 C T1 -7 2 3 T?4- TP 2 t5form11.doc•rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 Commonwealth of Massachusetts City/Town of North Andover N Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other for this s fos maybm, check e used, u h the information must be substantially the same as that provided here. Before 9 the local Board of Health to determine the form they use. Important:When A. Site Information filling out forms on the computer, John Da hlian use only the tab Owner Name key to move your cursor-do not 1440 Salem Street use the return Street Address or Lot# 01845 key. North Andover MA State Zip Code Cityrrown rib Telephone Number Contact Person(if different from owner) a B. Test Results 8/18/09 11:10 Date Time Date Time 1 Observation Hole# 57"to 75" Depth of Perc 11:10 Start Pre-Soak 11:25 End Pre-Soak 11:25 Time at 12" 12:30 Time at 9" 2:20 Time at 6" 110 minutes Time(9"-6") 37 mpi — Rate(Min./Inch) T ® Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Frank Nichols, PE Test Performed By. Randy Burley, Project Manager N. Andover Rep.) Witnessed By: Comments: Perc Test•Page 1 of 1 t5form12.doc•06/03 Z. r 4 TOWN OF NORTH ANDOVER f aoRrM Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 CEIVED Susan Y.Sawyer,REHS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX AUG 0 4 2009 healthde t townofnorthan Jover.com www.townofnorthandover.i ofWN OF NORTH ANDOVER HEALTH DEPARTMENT APPLICATION FO SOIL TESTS DATE: Q MAP &PARCEL: LOCATION OF SOIL TESTS: OWNER:, � p^54/c� �l/�4''/ Contact#: q 78 APPLICANT:IT Contact#: �fj173 ADDRESS: 14,40 51 Gam! c5)— ke A7 o�?Ve,- ENGINEER:4R&—JK /lf c U � Contact#: 53t6 —,$,` o-74.1 ) CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: "K, Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x ll"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and 'two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ .Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than I"-100')-shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line Conservation Commission A roval Date: / . N.A. 1 Signature of Conservation Agent: 111 Date back to Health Department: (sta p in): m + f�t v o�fen ��»r•mc�� D. rm- G. ��d� F�� Ti-� , ,r pv IT L e-aG" Fie la � �� ice. �•• � j . o � `- r6 0 ah 74.74 NZ9'SJ-�3t�•Y4' � a Sc�oo/ "� I 0 1) l9 rpt -30 w t�17 .t1 �= FORM U - LOT RELEASE FORM / ©' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION '- APPLICANT PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET `.440 �r ST. NUMBER USE ONLY**,"`—**"— `**�`*****��`�'`*� VNtl tADMINISfFWf0R OF TOW GENTS: COSERVATON DATE APPROVED DATE REJECTED COMMENTS w KC )00/ TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FO DIN ECTOR HEALTH DATE APPROVED SEPI FMvINSFECfiORHEAL Fly" "' "DATE APPROVED �'� � " '1 s DATE REJECTED ` k. COMMENTS (lk� ✓ V� 0 PU BLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm North Andover MIMAP 1440 Salem Street August 6, 2009 A-0035 _ _,__ :Y• __ _`.� - in 2 116.A-0120 ♦ 106A-013" ♦ Y ♦ tJ 10&-41-0022 ♦ 106A-0026 I i ♦ r, "I; ::' 106A-002 J, :: ' ? 106A-0032 r� 106A-0151 106.A-0020 - , 106A-0025 N106.A-1111 ,s 106A-0152 106.A-0019 106A-01.50 J� 1 106A-0132 106A-0024 1 A-01 106A-0031 10 -001 106A-0089 106A-0023 .A-01 --Rall Line Interstates Interstate I: Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Major Roads Meters Data Sources:The data for this map was produced by Merrimack - Roads f A01i qValley Planning Commission(MVPC)using date provided by the Town of O qua o North Andover.Additional data provided by the Executive Office of r;Easements d _ e<< e�.00 Environmental ANalrs/MassGIS.The Information depicted on this map is Tralls for planning purposes only.It may not be adequate for legal boundary definl8on or regulatory Interpretation.THE TOWN OF NORTH ANDOVER Streams — A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 0 MVPC Boundary # i THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY O Municipal Boundary + ?. OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ❑Parcels * o ••. * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION Hydrographic F eatures ��$SACNUs�t '}Wetlands G Exempt Lands li 1'r=116 ft I t � ' Commonwealth of Massachusetts -------------- Title 5 Official Inspection Fo mRECEIVED �s Subsurface Sewage Disposal System Form -Not for Voluntaryssess t >��% 4 2009 1440 Salem Street Property Address John Daghlian ARTME HEALTH DEPNTER Owner information is Owners Name required for No. Andover Ma. 01845 every,page. City/Town 11-29-08 State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Important: When fillingout A. General Information forms on the computer,use 1. Inspector: only the tab key to move your F. Paul Cardone cursor-do not Name of Ins dor use the return key. Septic Compliance, Inc. Company Name 447 Boston Street Company Address Topsfield Ma. City/Town 01983 State Zip Code 978-887-8586 or 978-681-0726 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority n or s ignature 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. Daghlian 114 Salem street No Andover 11_29..08,08/06 Title 5 Official lnspedion Forth.Subsurface Sewage Disposal System•Page 1 of 15 r ' Commonwealth of Massachusetts T Title 5 ®Ficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 1440 Salem Street Property Address John Daghlian Owner owner's Name information is required for No. Andover Ma. 01845 11-29-08 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was inspected in order for the owner to put up an addition on his property. where the proposed addition is to be built will not interfere with the function of the septic system. According to the owner he has not had any issues with the current system. In my professional opinion the existing septic system is not Title 5 compliant B) System Conditionally Passes: i ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y, N, ND) in the ❑ for the following statements. If"not please explain. ❑ The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or 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 ❑ obstruction is removed I Daghlian 114 Salem street No Andover 11.29.08•oa/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1440 Salem Street Property Address John Da hlian Owner Owners Name information is required for No. Andover every page. City/Town Ma. 01845 11-29-08 State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: j ❑ 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): j ❑ broken pipe(s)are replaced ❑ obstruction is removed I ND Explain: 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: —' ❑ Cessool or privy P is within 50 feet of a surface water. ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Daghlian 114 Salem street No Andover 11-29-08,08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 ' Commonwealth of Massachusetts Title 5 offic al_.Inspection Form Subsurface Sewage.Disposal System Form- Not for Voluntary Assessments M 51440 Salem Street Property Address John Daghlian Owner Owner's Name information is required for No. Andover Ma. 01845 11-29-08 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal eq to or less than 5 09 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 E] 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 invertor available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of timesum ed: p p ❑ ❑ 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. Daghlian 114 Salem street No Andover 11-29-08.08" Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 u la hrly puuun ul a cCssNuul ur privy Is witnln a Lone i or a puDiic Well. ' ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Daghlian 114 Salem street No Andover 11-29-08.08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1440 Salem Street Property Address John Da hlian Owner information is Owner's Name required for No. Andover every page. City/Town Me. 01845 11-29-08 State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes. No i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1440 Salem Street Property Address John Daghlian Owner information is Owner's Name required for No. Andover every page. City/Town Ma. 01845 " 1-29-08 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? ection. ❑ ® 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 age 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 f th Pect or econdition of the baffles or tees, material of construction, dimensions depth of liquid,P q d, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? a e dis s � P 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)] Daghlian 114 Salem street No Andover 11.29-08.08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1440 Salem Street PropertyAddress John Daghlian Owner Owner's Name information is required for No. Andover Ma. 01845 '11-29-08 every page. Cltyrrown State Zip Code Date of Inspection 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 Number of current residents: 5 Does residence have a garbage grinder? El Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ® Yes ❑ No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ® Yes ❑ No Last date of occupancy: Occupied 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? El Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Daghlian 114 Salem street No Andover 11-29-08.08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System sMsa y m Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1440 Salem Street Property Address John Daghlian Owner Owner's Name information is Andover- required for No. Andover. Ma. 01845 "11-29-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner told me tank was pumped one year ago. Was system pumped as part of the inspection? ❑ Yes Z No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: i ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. �� ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Owner told me tank from the 60's some sort of repair done in the 70's. Were sewage odors detected when arriving at the site? ❑ Yes ® No Daghlian 114 Salem street No Andover 11-29-08.08106 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1440 Salem Street Property Address John Daghlian Owner information is Owner's Name required for No. Andover Ma. 01845 11-29-08 every page. CitylTown State Zi Code Zip Date of inspection D. System Information (cont.) Building Sewer(locate on site;plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 214" feet Material of construction: ®concrete El 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: 8'x5'4"x5'5"invert 56" Sludge depth: 6° Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 4" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tape Daghlian 114 Salem street No Andover 11-29-08.08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1440 Salem Street Property Address John Da hlian Owner Owner's Name information is required;for No. Andover Ma. 01845 every page. Citylrown 11-29-08 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.): We recommend tank be pumped on a yearly basis,baffles have fallen'off, tank is very old, liquid level was veryhi h in outlet invert pipe almost full standing water in pipe. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: � EJ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): I Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection)p ) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene El other(explain): Daghlian 114 Salem street No Andover 11-29-08.Og/ps Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of IS • Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1440 Salem Street Property Address John Daghlian Owner Owner's Name information is required for - No. Andover Ma. 01845 '11-29-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: N/A Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑. No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Couldn't locate not sure if one exists. 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.): Tried for several hours to locate box , sent transmitter out many times dead ends, there was some work done in the 70's to--pair sstem adding trenches . Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Daghlian 114 Salem street No Andover 11-29-08.08p76 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 • Commonwealth of'Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM , 1440 Salem Street Property Address John Daghlian Owner Owner's Name information is required for No. Andover Ma. 01845 '11-29-08 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): N/A 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: Approx. 50'long I ❑ leaching fields number, dimensions:. ❑ overflow cesspool number: ❑ innovative/alternative system i Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Wet Appears that in the trench area there was a surcharge at one time deep depressions, No ponding, soil was damp grassy back yard area Daghlian 114 Salem street No Andover 11-2908.08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 1440 Salem Street Property Address John Daghlian Owner Owner's Name information is required for No. Andover Ma. 01845 '11-29-08 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication ofroundwater inflow nflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i Privy(locate on site plan): Materials of construction: N/A i Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I I DaghAan 114 Salem street No Andover 11-29-08.08/08 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 or 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1440 Salem Street Property Address John Daghlian Owner Owners Name information is required'for No. Andover Ma. 01845 11-29-08 every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. -� ,gc 9 A �t80 �y Daghfian 114 Salem street No Andover 11-294M.W= Title 5 OMC'W Oupecbm F01M%bUd&WSftVPDMP0Sa1 SYSISM-Page 14 of 15 h Commonwealth of Massachusetts Title _5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 1440 Salem Street Property Address John Daghlian Owner Owner's Name information is required for No. Andover Ma. 01845 '11-29-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 3+Feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record" If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS). ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Digging in the area looking for the d-box looked to be some mottling around the 3'area Daghlian 114 Salem street No Andover 11-29-M-oom Title 5 Official Inspection Form:Subsurface Sewage Disposal System'?/ FORM U - LOT RELEASE FORM / 0 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET 1440 � � � ST. NUMBER I *************** ************************OFFICIAL USE ONLY***** �� E' 'OM E D N OF TOW GENTS: CONSERVATION ADMINiStafOR DATE APPROVED DATE REJECTED COMMENTS �O W �" l`+�` (�` 1 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FO D IN CT R-HEA DATE APPROVED S�E ��O �. , � L �I E REJECTED SEP INSF ECTOR =1EMY-141n"'`� T At-It APPROVED DATE REJECTED i ` COMMENTS��(► J K� ri1�Yl�lys�les./''-e- o� ��;, � � E,zrp�� f `' �'_�r�'�.. �� ,. h �"'�.+r.. � - R.s..,o.;�,r. ,...- 2�..,_''•t�u�,;.y T�� "sJ ,,,�. c a ... PdJBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT i RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm 777-2668 L FAX 774-5623 JOHN H. DAGHLIAN CIVIL ENGINEER DEPARTMENT OF PUBLIC WORKS 1 BURROUGHS STREET TOWN OF DANVERS DANVERS,MA 01923 `.k G ` ale y17 00 „N A Q 1 0 3 Jai n �j,q� �• � ;n mac. �- ZA40 5A-Cem s, V) Ov PA ZO 8 � p v M-3 —=2-1^`ca.000a� � O � I Ix N