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Miscellaneous - 1476 SALEM STREET 4/30/2018 (2)
1476 SALEM STREET 2101106.A-0018-0000.0 S �. ----------------- - -- I _ t t North Andover Boprci of Assessors Public Access - Page 1 of 1 NORTH I�corfh Andover Board of Assessors * ^ w* 7 � s �< S,CH 7,Zbroperty Record Card Parcel ID :210/106.A-0018-0000.0 FY:2012 Community: North Andover 0 Click on Sketch to Enlarge Click on Photo to Enlarge • � a FA { tk 1476 SALEM STREET Location: 1476 SALEM STREET Owner Name: KOENIG,ALBERT F - _ GENEVIEVE M KOENIG Owner Address: 1476 SALEM STREET- - City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 1.02 acres Use Code: 101-SNG1K-FAM-RES 'Total Finished Area: 2462 sgft 1 Total Value: 442,100 442,100 Building Value: A 235,000 235,000 Land-Value: - 207,100 207,100 Market Land Value: 207,100 Chapter Land Value: 'LATE STSMC Sale Price: 0 Sale Date: 01/01/1969 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book 01133 Page: 0456- http://csc-ma.us/PROPAPP/display.do?linkld=1 895332&town=NandoverPubAcc 3/28/2012 Residential Property Record Card PARCEL ID:210/106.A-0018-0000.0 MAP:106.A BLOCK:0018 LOT:0000.0 PARCEL ADDRESS:1476 SALEM STREET FY:2012 PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: _01133 Road Type: T' Inspect Date: _ 04/05/2010 Owner: Tax Class T Sale Date 01/01769 Page 0456 Rd Conditio_n_:_P Meas Date: 04/05/2010 KOENIG,ALBERT F Tot Fin Area _2462 Sale Type._ Cert/Doc: Traffic_ M Entrance C KOENI ,A MKT F TofLand Area: 1.02 Sale Valid: N Water Collect Id: __RRC__ GENEAddress: Grantor: Sewer: Inspect Reas: C 1476 SALEM STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CP Tot Rooms:_ 6 Main Fn Area: 1509_ Attic: T, NBHD CODE: -NBHD CLASS: 6 ZONE: R1 1 Story Height: 1.75 Bedrooms: _ 3 -Up Fn Area:_953 Bsmt Area: 1509 Seg Type _Code _Method Sq-Ft Acres ~Infl_ _Y%N�Valu - _ Class_ !] Roof: G YFutl Baths '3 `Add Fn Area: -T_ Fn BsmfArea: 1 1 P 101 S 43560 1.000 206,910 Ext Wall: FB Half Baths: Unfiri Area: Bsmt Grade: -- 2 R 101 A 0 0.020 152 Masonry Trim: Ezt Bath Fix. -0! Tot Fin Area: 24621 DETACHED STRUCTURE INFORMATION Foundation yCN Bath Qual T -RCNLD _226835 - -.n.__ Y ^0.00 19'88—'A �-___.. ra E ^^o _ �_ 1a-s-7 ---- - -- -- G Snit 150-1 0.002 988`Blt Arade Aond x//88 od P/F/E/R�/88 2,0000 Class Kitch Qua[: '�"�"TEff Yr Bwl#' 1980 Mkt Add 80 Heat Type: HW�' Ext Kitch: YearBuilt --1973—Sound Value:- Fuel Type. O__ Grade. AG Cost Bldg, T 226,80 Fireplace 2 Bsmt Gar P Ca : Condition: A Att Str Val1 VALUATION INFORMATION _ - - . _Pc_fCo_.m.� Central AC N�� Bsmt Gar SF:� plete: ---Aft Str Val2: Current Total: 442,100 Bldg: 235,000 Land: 207,100 MktLnd: 207,100 Aft Gar SF: 724%Good P/F/E/R: %/100/82 _ Prior Total: 442,100 Bldg: 235,000 Land: 207,100 MktLnd: 207,100 SKETCH PHOTO FM/B G FU".75/FM/B 14 238SJ% 724 Sq.F 22 31 1271 Sq.R 21 17 26 29 6 41 Parcel ID:210/106.A-0018-0000.0 as of 3/28/12 Page 1 of 1 North Andover Board of Assessors Public Access + Page 1 of 2 140North. Andover Boar9d. of Assessors t �-�g • MATCHING PARCELS "Ss^c"°SEt Click on a column title to sort data by that column 283 items found,displaying 201 to 250. [First/Prev] 1 1 2 1 3 1 4 1 5 6 [Next/Last] Fiscal Year Parcel ID StNo. Street Owner Name 2012 210/106.A-0158-0000.0 1288 SALEM STREET DONOVAN,WILLIAM J,BARBARA A DONOVAN • 2012 210/106.A-0122-0000.0 1289 SALEM STREET GUELI,MICHAEL,GUELI,FREDA i 2012 210/106.A-0123-0000.0 1299 SALEM STREET PICKARD,JOHN H, 2012 210/106.A-0159-0000.0 1300 SALEM STREET CARR,PAUL F,ROBIN A CARR 2012 210/106.A-0160-0000.0 1312 SALEM STREET CRONAN,MICHAEL J.,CRONAN, JENNIFER LESLIE 2012 210/106.A-0124-0000.0 1317 SALEM STREET ALTER,DEBRA A., 2012 210/]06.A-0161-0000.0 1324 SALEM STREET MOTTOLO,FRANK J,MARGARET L MOTTOLO 2012 210/106.A-0125-0000.0 1327 SALEM STREET MULLEN,KEITH J.,MULLEN,ROBIN 2012 210/106.A-0162-0000.0 1336 SALEM STREET SHURSKY,STANLEY J,JOANNE A SHURSKY 2012 210/106.A-0126-0000.0 1337 SALEM STREET BRENNAN,THOMAS M,DONNA M BRENNAN 2012 210/106.A-0163-0000.0 1348 SALEM STREET CANNING,PHILIP G,KATHRYN E CANNING 2012 210/106.A-0138-0000.0 1353 SALEM STREET GREENE,JEFFREY P, 2012 210/]06.A-0164-0000.0 1360 SALEM STREET GAN,PIN PIN, 2012 210/106.A-0139-0000.0 1365 SALEM STREET FIORE,STEVEN,FIORE,JOANNE E. 2012 210/106.A-0137-0000.0 1411 SALEM STREET HOLBROOK,JAMES M,ANDREA M HOLBROOK 2012 210/106.A-0120-0000.0 1412 SALEM STREET KOMARONI,JANOS G,JUDIT KOMARONI 2012 210/106.A-0026-0000.0 1423 SALEM STREET SCRUGGS,BRANDON T.,SCRUGGS, COURTNEY W. 2012 210/106.A-0022-0000.0 1424 SALEM STREET HALL,KERRI,HALL,JOHN 2012 210/106.A-0021-0000.0 1432 SALEM STREET LANZAFAME,TOMMASO,ANNUNZIATA LANZAFAME 2012 210/106.A-0032-0000.0 1435 SALEM STREET GAUL,JAMES H,EDITH M GAUL 2012 210/106.A-0020-0000.0 1440 SALEM STREET DAGHLIAN,ARSHAG,LUCY&SONIA DAGHLIAN 2012 210/106.A-0024-0000.0 1444 SALEM STREET HAMMERSMITH,RYAN,C/O JAMES C. MELDRIM 2012 210/106.A-0025-0000.0 1447 SALEM STREET BURNS,MARY B,C/O IRENE DEFREITAS 2012 210/106.A-0029-0000.0 1454 SALEM STREET MOLINO,THOMAS J,KARIN MOLINO 2012 210/106.A-0019-0000.0 1468 SALEM STREET NAJARIAN,STEVEN,NAJARIAN,NAOMI J. 2012 210/106.A-0031-0000.0 1469 SALEM STREET ODAMS,NEIL&LORRIE, 2012 210/106.A-0149-0000.0 F1472 SALEM STREET LAVISKA,RICHARD A,LINDA T LAVISKA 2012 210/106.A-0018-0000.0 1476 SALEM STREET KOENIG,ALBERT F,GENEVIEVE M KOENIG 2012 210/106.A-0023-0000.0 1483 SALEM STREET RALPH,THOMAS D,RALPH,HOPE T 2012 210/106.A-0030-0000.0 1499 SALEM STREET SHAH,ASHISH D,POONAM A SHAH http://csc-ma.us/PROPAPP/newSearch.do?noOwner--027%3BO84%3BO59%3BO04%3B 1... 3/28/2012 North Andover Board of Assessors Public Access ' Page 2 of 2 2012 210/106.A-0017-0000.0 ( 1500 (SALEM STREET REID,JOHN C,JANET F REID 2012 210/106.A-0037-0000.0 1504 SALEM STREET THE SIEGEL REALTY TRUST,SIEGEL, BARBARA E.TRUSTEE 2012 210/106.A-0208-0000.0 1507 SALEM STREET LEONARD,RONALD,M.JR., 2012 2101106.A-0028-0000.0 1510 SALEM STREET FRANCOLLA,RICHARD,DOLLY FRANCOLLA 2012 210/106.A-0027-0000.0 1514 SALEM STREET STASONIS,CHRISTOPHER,STASONIS, HILLARY JEAN 2012 210/106.A-0209-0000.0 1515 SALEM STREET FLAHERTY TRUST,THOMAS J,THOMAS FLAHERTY,TR 2012 210/106.A-0091-0000.0 1532 SALEM STREET NOEL,JAMES K,C/O DEBRA A. _ ARILLOTTA 2012 210/106.13-0001-0000.0 1535 SALEM STREET KONOPKA,SYLVIA B., 2012 210/106.13-0053-0000.0 1542 SALEM STREET PRYOR,KEITH T,SHERYL PRYOR 2012 210/106.B-0054-0000.0 1550 SALEM STREET SMITH JR,HENRY P,PAMELA J SMITH 2012 210/106.8-0002-0000.0 1557 SALEM STREET DEADDER,DONALD A,BERNADETTE M DEADDER 2012 210/106.13-0055-0000.0 1560 SALEM STREET CARBONELL,NELSON P,CAROL P CARBONELL 2012 210/106.13-0003-0000.0 1565 SALEM STREET TRAN,VINH,ANNE TRAN 2012 �210/106.13-0004-0000.0 1577 SALEM STREET BURKE,JOSEPH P,LISA C BURKE 2012 210/106.13-0056-0000.0 1580 SALEM STREET SEARS,GEORGE M,MARJORIE E SEARS 2012 210/106.B-0005-0000.0 1589 SALEM STREET GALEAZZI,RICHARD,MARIANNE C GALEAZZI 2012 210/106.13-0057-0000.0 1592 SALEM STREET TONELLO,CYNTHIA H, 2012 210/106.13-0006-0000.0 1601 SALEM STREET MERRILL,MATTHEW E.,MERRILL,ERIN M. 2012 210/106.8-0026-0000.0 1607 SALEM STREET MATEJA,THADDEAUS,LUCYNA MATEJA 2012 210/106.13-0080-0000.0 1619 SALEM STREET DALY,THOMAS M,LAURA E DALY 283 items found,displaying 201 to 250. First/Prev 1 1 2 1 3 1 4 1 5.1 6 Next/Last i I http://csc-ma.us/PROPAPP/newSearch.do?noOwner--027%3BO84%3BO59%3BO04%3B 1... 3/28/2012 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CEW2I FIC.��IE O F COIV1�1'GI.�XCE As of: ,S tem6er 26 2012 This is to cert that the individua(su6surface dzsposafsystem received a SA` 1-SFAC`701RT 1-rVSTEC` 10Yof the: Compate (pair and Construction of an On Site Sewage DisvosaCSystem (By: - IWI iam &denhiser At: 1476 Safem ,Street 210/106.B-00 18-0000.0 Map-1 06.B parcel-001 8 %orth Andover, 9M 01845 The Issuance of this certiftate sha!lnot be construedas a guarantee that the.system wifffunction satisfactorify. JK"eCe E. Grant (&6&7feaCth Inspector NorthAndoverMeafth(Department 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com OFTH °e*+ww ' OT ptao ra�YO �iC ��� � I 4 00 57 �SSwCNus TOVVI4 GE RCFTHF ANDOVER HE=ALTH DEP�R t'lViEfVT PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired; By: V t k.�'0.-y"" (Print Name) Located at: -7 CJA te4,-tj (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated M Al 1-0 and last revised on ���{ 2Z���) Z ,with a design flow of 4AO 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. I�r Bottom of Bed Inspection Date: 1 2 Engineer Representative(Signature) RIcm-� aApy And—Print Name i Final Construction Inspection Date: Engineer Representative(Signature) �G�(-1420 �"►'�p`� And—Print Name Installer: h_ _ J (Signature) Date: And—Print Name Enginer: (Signature) Date: 01 [And—Print Name 1600 Osgood Street, North Andover, filassachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com GRADY CONSULTING , L . L . C . Registered Professional Civil Engineers October 4, 2012 Susan Sawyer, REHS/RS l; amim nf:N'r RT,;zivn , r � Public Health Director Health Department 1600 Osgood Street Building 20-Suite 2-36 North Andover,MA'01845 RE: As-built Certification #1476 Salem Street Dear Susan and Board Members: Enclosed please find two copies of the revised as built plan. The plan has been revised to show.a tie table as requested. If you have any questions please do not hesitate to call. Sincerely, GRADY CONSULTING,L.L.C. •t k OF 1,4q 4s9c J-1 6 RICHARD yGu J. GRADY Richar rady,P.' : 1 o.38072 Principal Engineer CiV1�,�a cc: AlbertKoenig c/o Wind River Environmental 70 Batzak Drive Holliston, MA 01746 H:\GC\2012\12-072\Asbuilt cert.doc 71 Evergreen Street, Suite 1 • Kingston,,MA 02364 • Tel (781) 585-2300 Fax (781) 585-2378 ,s AS-BUILT CHECKLIST L/ All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40.feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number,Street Name,Assessors Map and Parcel Number —�� Lot Lines and Location of Dwellings served by the system ( / Locations&Dimensions of system,including reserve(if applicable) Ties to dwelling or Permanent Structure& eHs a.From Septic Tank ,l S C� b.From Leach Area iJ Ties to Lot Lines from leach area Locations of Deep Holes&Peres Elevations of Disposal System L/ Top of Foundation Elevation Locations of Wells,Drains,Watercourses within 150 feet of system (y Location of water,gas,electric lines,cable Distances from Corners of House to Center of Tank&D-Box Location of Structures within 6 Inches of Finished Grade Original Stamp&Signature I Location and holder of any easements which could impact the system Impervious Areas;Driveways,etc >/ North Arrow r� Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) `I certify the locations, elevations, ties, cover material; exposed component covers etc. shown on this as-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 I oloul AS-BUILT CHECKLIST v All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number,Street Name,Assessors Map and Parcel Number Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system,including reserve(if applicable) Ties to dwelling or Permanent Structure&-WeHs-- a.From Septic Tank b.From Leach Area T Ties to Lot Lines from leach area Locations of Deep Holes&Peres Elevations of Disposal System Top of Foundation Elevation Locations of Wells,Drains,Watercourses within 150 feet of system Location of water,gas,electric lines,cable Distances from Corners of House to Center of Tank&D-Box Location of Structures within 6 Inches of Finished Grade Original Stamp&Signature Location and holder of any easements which could impact the system Impervious Areas;;Driveways,etc i 1/ North Arrow ✓ Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) "I certify the locations, elevations, ties, cover material; exposed component covers etc. shown on this as-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 � ���� � � � �� � � � � � � � � sw hENGRADY CONSULTING , L . L . C Registered Professional Civil Engineers August 15, 2012 TOWN OF NORTH ANDOVER Susan Sawyer,REHS/RS HEALTH DEPARTMENT Public Health Director Health Department 1600 Osgood Street Building 20-Suite 2-36 North Andover, MA 01845 RE: As-built Certification—#1476 Salem Street Dear Susan and Board Members: We hereby certify that we have inspected the septic system at the above referenced address and the system has been constructed in compliance with 310 CMR 15.000,the approved design plans and all local requirements, and that any changes to the design plans have been reflected on the enclosed as-built plans. Enclosed please find two copies of the as-built plan. If you have any questions please do not hesitate to call. Sincerely, GRADY CONSULTING,L.L.C. OF Mgss�c RICHARD yGN J Richard Grady, P. , GRADY Principal Engineer Nu.38072 a� cc: Albert Koenig c/o Wind River Environmental 70 Batzak Drive Holliston, MA 01746 it • H:\GC\2012\12-072Wsbuilt cert.doc III - 71 Evergreen Street, Suite 1 • Kingston,MA 02364 • Tel (781)585-2300 • Fax (781) 585-2378 I PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division ATcF O T CO. 44PL IA2CE As of: Sqtem6er 26, 2012 This is to cert that the individual subsurface disposaf system received a SATISIAC ORT IMT E070y of the: Comprete (pair and Construction of an On Site ,Sewage �osa[System 'By: Wifflam Wqdenhiser At� 1476,Safem Street 210/106.B-00 18-0000.0 Wap-106.B~'arcef-0018 %orthAndover, WA 01845 e sanance of this certii to f of 6e construed as a guarantee that the system wifffunction satisfacporify. 9l&fiele E. Grant (PuMx Zeafth Inspector North AndoverZeafth(Department 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com DelleChiaie, Pamela From: Randy Burley [rburley@millriverconsulting.com] Sent: Wednesday, August 01, 2012 5:03 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 1476 Salem St I completed the final inspection today with Rodenheiser, checked the numbers onsite and all is well. I am off until Monday and will prepare the final report then. The only thing I cautioned him on is the amount cover cannot be more than 3 ft. He acknowledged and said he is going to slope the site down near the shed so as not to exceed 3' of cover. I liked what he did by cementing the inspection ports into the infiltrator and inserting rebar in the cement;this will give the inspection ports more stability and make them easier to find with a metal detector if they get buried. Sincerely, Randy Burley,Project Manager j Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax: 978-282-1318 www.millriverconsultinp-.com rburley@millriverconsulting.com o Mill ever cons ultin Crvif tngrneering * Cnv,rontne,rita l Permuting AR.UnaS�ppl �rsv-iranrne'nta� t�gaifts L:pn4UlLitl�.. I Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. i 1 • �RATED'A� North Andover Health Department Community Development Division I ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP: LOT: INSTALLER:��� � p /S&- DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: - /� k� ��dl DATE OF BED BOTTOM INSPECTION: DATE OF FI NAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ B g-sewer in continuous grade n /4Z,/-e- 2-Y a A/1 � 'rCleanouts per plan m_base r Bottom of tank hole has 6" stone base aid 0 Weep hole plugged ❑ LSc>i�) gallon tank has been installed Uhf '�� -�- � loading /G� � ��Mlonolithic tank construction Water tightness of tank has been achieved by �v �' testing l ,"� - � ❑ Inlet tee installed, centered under access port 5 ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMPCHAMBER Bottom of tank hole has 6" stone base Weep hole plugged 112 p,1�q-allon Pump Chamber installed ❑ E--b loading oM nolithic tank 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 ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or>0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to C soil layer, as provided on plan ❑ Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN 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 10' ® 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 1 Suction line 222(2) z 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 - Commonwealth of Massachusetts Map-Block-Lot . swL�p'�6 : 106.A0018 ----------------------- BOARD OF HEALTH Permit No • North Andover BHP 201-- -- -- PA. - P I FEE $250.00 F.I. ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted William-Rodenhiser- - -- -- --- ------------------------------------------------------------------------------------------ to(Repair)an Individual Sewage Disposal System. at No 1476 SALEM STREET -------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2012-069 Dated__July-25,201-2--------- ------------- --------------------------------------------------- Issu ------------------------------ Issued On:Jul-25-2012 BOARD OF HEALTH R H°RT� Application for Septic Disposal System 7 /7 /2 Of 4ylt0,�,NO TODAY'S DATE )Construction Permit - TOWN OF `• °' ORTH ANDOVER, MA 01845 $250.00—Full Repair '; $125.00 -Component cNuse�a Important: Application is hereby made fora permit to: When filling out Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return Facility A. acnormaon pp key. A � Ifti1'!.inV � 7b LC Address or Lot# City/Town T'aWN O NORTH ANDOVER HEALTH DEPARTMENT 2.-*TYPE OF SEPTIC SYSTEM*: Pump ❑ Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) Infiltrator or Blodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) [Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information W)LLIAIA (ZoD�NHIS�jZ. �o� N lSEI?_ CXcf<1v %rlm(s Name Name of Company 70 6,_1 Z_A 1L DRJ V6 Address RPLo .!,5-Tbo 11AA 017q� City/Town State Zip Code 0�— 921- q55-3, Telephone Number(Cell Phone#if possible please) 4. Designer Information 9[GC- G��- CQL,3&) .TtAJ6 Name, Name of Company 7 ( 6ve2&zt-E-0 s EEr Address )Lt t'�GsTbti MA 023(09 City/Town State Zip Code -iai- 5$S-23oo Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 ti I „pRTN Application for Septic Disposal System 7/1 L 3?•.,r °i TODAY'S DATE ° . w *Construction Permit - TOWN OF K Y .�; $250.00—Full Repair ORTH ANDOVER, MA 01845 $125.00-Component �wsSwcHuSE� PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: [residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date Applic7io/n . *proved By: (B d of Health Representative) j Na Date Application Disap oved for the following reasons: For Office Use Only: / 1. Fee Attached. Yes t1 No 2. Project Manager Obligation Form Attached. Yes No 3. Pump S sy tem? Ifso,Attach copy ofElecu cal Permit Yes V No 4. Foundation As-Built?(new construction ronly): s . No (Same scale as approved plan) 5. Floor Plans?(hew construction only): Yes No Application for Disposal System Construction Permit-Page 2 of 2 1, 6 • • ��fO�II/ •/DIO/tt/II•SO/If/IDf" f • `!I Osr Certified Installer BioDiffuser/ARC® Leaching Chambers This is to certify that: Rodenhiser Excavating William Rodenhiser 7o Bartzak Drive Holliston,MA 01746 Has successfully completed the ADS professional development training program for the purpose of installing BioDiffuser/ARC® Chamber subsurface sewage disposal systems and is certified to install and inspect BioDiffuser/ARC Leaching systems in the State of Massachusetts. Advanced Drainage Systems, Inc. and Hancor,Inc. offers this training workshop program as to the recommendations in the proper installation and use of subsurface sewage disposal systems. Participants have been instructed in the installation parameters that must be considered in order to evaluate and install BioDiffuser/ARC®Chamber subsurface sewage disposal systems in accordance with State approved design practices. This certificate was issued this 17th day of July, 2012 Registered Certification No. 351 Steve Minor On-site Specialist Advanced Drainage Systems, Inc. Hancor Inc 58 Wyoming Ave 30 Precesion Drive Ludlow,MA 01056 North Springfield,VT 05156 PH 800-733-9554 PH 802-886-8403 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for t e property at: y !` r7C S&-,6 m 5v-6cT ,E (Address of septic system) For plans by j TH DEPARTIN'TNIT-�� Relative to the application of W 1 LL(Pr A �D6N H1�/�/` �/ (Installer's name) And dated ( �C ��^^ ngina ate Dated �1 U/r1 Z �---•-- _ o ay s ate With revisions dated 1 —W (L t revised date)"`" I understand the following obligations for management of this project: TOWN OF NORTH ANDD►%R 1. As the installer,I am obligated to obtain all permits and Board of Health app tt 'SENT performing any work on a site. I must have the approved plans and the permit on site when agy r s 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 (VS 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: healthdelt(@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 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 of Health staff or consultant. d. Installation of tank D-Box, pipes, stone vent,pump chamber, retaining wall and other components. 6. As the installer.I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor,or any other persons shall absolve me of this obligation. Q/ Undersigned Licensed Septic Installer: Ul SIJ 7– Today's Date) w [tLJAM +� - (Name–PnntT —(Name–Sign Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. l _ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod�r/6111 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 electrical work described below. Location(Street&Number) N76 5AL-o'k sTrce 'f Owner or Tenant ��� �� l G Telephone No.c78--C3 Owner's Address to Is this;Ver_m7 i» - - --"`--a—.,.c:--�"'.*ra . ,,, �,�-•,�., ^^ (Check Appropriate Boz) r r thorization No. • Date • • . . . . . . Indgrd❑ No.of Meters hdgrd ❑ No.of Meters rSwKIL`YDj�, ' TOWN OF NORTH ANDOVER _ �; ... . PERMIT FOR WIRING- , 19 table may be waived by the Inspector of Wires. �- No.of Total . . • • . • . . . . . . . Transformers KVA This certifies that . . . . . . . . . . ` Generators K-VA —15 . S�yf Tom. . . has permission to perform . . . . . o.o mergency ig ng ` { l BatteryUnits i wlring in the building of . . . . . . . FIRE ALARMS No.of Zones S� ,No Andover, Mass. Ce- No.of Detection and f at : p 0670 Initiatin Devices --•�" No.of Alerting Devices Fee . . . . . L1c. No pp . . . . . . . . . . .� t ( b� r� ELECTRICAL INSPECTOR No.of Self-Contained �--^ Detection/AlertingDevices J Local❑ Municipal ❑ Other i• ,Check# Connection Security Systems:* H No.of Devices or Equivalent ' 0 � C3 0 `,6.71 Data Wiring: - No.of Devices or Equivalent No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (,�L9 (When required by municipal policy.) Work to Start: j Inspections to be requested in accordance with MEC 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE © BOND ❑ OTHER ❑ (Specify:) I certify,under the ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: lice n7 c I–L L_ LIC.NO.: ZcG( 0 �} Licensee: Li%�sS� �L� r Signatur LIC.NO.: (If applicable,enter "exempt in the 11'Ce&6, n tuberhived Bus.Tel.No.-�G— 'Z -6034, /� � / -Address: 0 R'1 . . . OyLZy S3 *Per M.G.L c. 147,s.57-61,security work requires Department 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 agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. r� GRADY CONSULTING , L . L . C . ' Registered Professional,Civil Engineers May 29, 2012 RECEIVED' Susan Sawyer, REHS/RS _ Public Health Director 4 Health Department JUN 1600 Osgood Street Ln �� -wu5g Building 20-Suite 2-36z North Andover, MA 01845 f RE: #1476 State Street—Septic System Repair Applicant—Albert Koenig Dear Susan and Board Members: Enclosed please find three (3) sets of revised plans for the above referenced property. The plan was revised in.response to a telephone call and letter from,Susan Sawyer dated May 21, 2012.Plan revisions and our response to comments are as follows: 1. As we discussed it was our opinion that there are four(4)bedrooms in this home per the Title 5 definition of a bedroom. The Title 5 Inspection Report dated March 27, 2012 also notes that there are.four(4)bedrooms on page 6 of the report. We have provided a floor plan sketch as discussed. 2. A scaled system profile of 1"=10' horizontal and 1"=1' vertical has been provided as requested. 3. The,effluent loading rate has been changed to 0.53 gpolsf as requested. As a result there is one additional chamber per row in the soil absorption system. 4.: The location of the percolation test has been added to the plan as requested. 5. The "Greenhouse"is set on the ground with cinder blocks around the perimeter and a dirt floor. For design purposes we have treated this as a slab foundation and is located ten(10) feet from the leaching facility. A separation distance has been noted on the plan as requested. The floor of the Greenhouse is above the leaching chambers so the ten(10) foot separation is appropriate. 6. We have added a notation to TH 2 showing the point where the depth measurements ` were taken from. The reason the measurements were taken from this point is that this is the highest elevation where mottling was observed. 7. A note has been added to the plan stating the building sewer is to be laid on a `.`compacted firm base" and as straight as possible as requested. 8. The slope of the building sewer has been revised from 0.019.to 0.020 as requested. 9.. The plan has been revised to plan to depict the tees in the septic tank to be centered under the manholes as requested. 10. A note has been.added to the plan stating the effluent tee filter is to be cleaned and . maintained on an annual basis as requested. 71 Evergreen Street, Suite 1 • Kingston,MA 02364 • Tel (781) 585-2300 Fax (781) 585-2378 r --- - 4l �. , . 11. Buoyancy calculations have been provided as requested. These were initially omitted as the nearest test hole shows no water at elevation 98.75 and the bottom of the lowest tank is at approximately elevation 99.8. For the purposes of this calculation we assumed groundwater at elevation 10 1.7 per the test hole farthest from the tanks. 12. The note on the distribution box has been revised to indicate a riser within 9" of final grade as requested. 13. The profile has been revised to depict a 2" force main as requested. 14. The plan has been revised to depict a Swale to direct surface waters around the dwelling as requested. If you have any questions please,do not hesitate to contact us. Sincerely, GRADY_CONSULTING,L.L.C:, Richard Grad , ,E. Principal Engineer CC: Albert Koenig c/o Wind River Environmental 70 Batzak Drive Holliston, MA 0.1746 H:\GC\2012\12-072%ohletter.doe i ol BUOYANCY CALCULATION 1500 GALLON SEPTIC TANK Job No.: 12-072 Location: 1476 Salem Street, North Andover 1500 Gallon Monolithic Pump Chamber -See Attached Drawings Buoyant Force of Tank 10.21' X 6.125' X 0.8' X 62.4 #/cf = 3,122 # Weight of Tank = 12,000 # Weight of Soil Over Anti-Flotation (74.5 in X 2 X 4.25 in) + (132 in X 2 X 4.75 in) = 1887.25 sq in 13.1 sf 13.1 sf X 6.1 ft X 85#/cf = 6792.35 # l i Over Tank 10.21 X 6.125 X 1.5' X 85#/cf = 7973 # Weight of Tank+ Soil 12000#+7973#=" 19,973 # >Buoyant Force-ANTI-FLOTATION COLLAR NOT REQUIRED page 1 of 2 sxt-trz�-' a _ -- -- - - -- _s=- � x c 2soi12't?� 7 f' Ceanuat Lids : 84"` 744 67 1** L . y t i n f .s� ttxee 4"D)$ tnhet8 't'tve a^oia_V C3irt _ ry -.i: .. _ ;r 101.7 105.45 i 6+►-712', � ,�. - �`57-712' ] y s 4 n I7] Cotitroft stearcxgth t'c4.000-fS .28'days. Dexter tW;PCF I2] CMent,Porttaftd Type t ot,f it ASTM 0160,:1 Is] Admbdums,air&ipFastic zeis. .RS IN C233-a2. , (41 Rdttlorpng A3Th1 ABi for xvbe f8btfc;Grade IS] bes"loading tai0:lase ti2tS Tanks}_ 16 j Constivat'ron jair+ts sealed witfi'Butjrl Aufaber i5C101�AFQ(7} page 2 of 2 Page 2 of 2 : 25 FM/8 FU•JS JFM/8 14 238 Sgit 14 6 724Sgtt Z2 1271 Sqft 17 31 26 u lS"t � 6 UFS 14'r't� A• -29 _ 41 luxr x 10 X i t = 5/22/2012 :z r DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, June 18, 2012 11:37 AM To: 'rick@gradyconsulting.com' Cc: Sawyer, Susan Subject: Septic Plan Approval - 1476 Salem Street, North Andover Attachments: 20120618105530257.pdf Attached is the plan review approval for 1476 Salem Street,North Andover. The original was mailed to the homeowner. Pamela DelleChiaie Health Department Town of North Andover " 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email odellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com i I 1 E North Andover Health Department (ommunity Development Division June 15,2012 Albert Koenig 1476 Salem Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 1476 Salem Street,North Andover, Massachusetts Map 106A lot 149 Dear Mr. Koenig, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Grady Consulting LLC, dated May 1, 2012, last revised on May 22, 2012 and received June 5, 2012. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom design. This plan is generally good for 3-years from the date of approval however as this is for a repair system this is reduced to 2- years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 � s ` -4476 Salem Street June 15, 2012 municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. ISSely, Y. wyer, -S ealth Dire for I cc: Richard Grady, Grady Consulting file North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Page 2 of 2 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i y TOWN OF NORTH ANDOVER *µORT' Office of COMMUNITY DEVELOPMENT AND SERVICES`'°�� HEALTH DEPARTMENT ` ` xi 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 sic usa Susan Y.Sawyer,RENS,RS 978.688.9540-Phone Public Health Director 978.688.8476-FAX healthdept@townofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: '-/ � 2s MAP&PARCEL: �O (o /`i LOCATION OF SOIL TESTS: / / CO % ST` r V Aidd"e - OWNER: Contact#: APPLICANT: f� Contact#: CSZ300 ADDRESS: Ij ENGINEER: 121`C // n�l Contact#: 2.3 0 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision in ily Home Commercial Is This: Repair Testing: Undeveloped Lot Testing Upgrade for Ad ' �1"U TOWN OF NORTH ANDOVER In the Lake Cochichewick Watershed? Yes No 412 THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) HEALTH DEPARTMENT ➢ 8.5"x 11"Plot plan&Location of Testin lease indicate test pit sites on the lan ➢ 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. �f GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. s� ➢ 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. f ➢ 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 1"-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 N.A. Conservation Commission Approval D te. l f Signature of Conservation Agent. Date back to Health Department: (stamp in): DelleChiaie, Pamela From: Gary Wolcott[gary@gradyconsulting.com] Sent: Thursday, April 12, 2012 1:26 PM To: DelleChiaie, Pamela Subject: Testholes Sketch for 1476 Salem Street Attachments: Proposed Testhole l.ocations.pdf Ms. DelleChiaie, Attached please find the requested testhole location sketch. Grady Consulting LLC 71 Evergreen Street, Suite 1 Kingston,MA 02364 Phone: (781)585-2300 Fax: (781)585-2378 iv%vw.GradyConsultin .com Check out some of our recent 3d laser scanning at the Newport Mansions Marble House htt .,Ilorchive.cyark.oraldialtal-repatriation-marble-house-blocs Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more Information please refer to:htto:ttwww.sec.state.ma.us/ore/oreidx.htm. Please consider the environment before printing this email. 1 ?/O:(9i5bn� UNy) :9327'N/MO00.�•> "tY;9,LSY7y NO-(N17,? es ter/ M•fO::DP'N •.00-Of// S•� _p ,• •. MrLO7 �I �.�..-. .SPLO/ ....... Is'0!. .; '/bf //�'" t......,� ��•�,VtOF...rP ,�a .. r C9. ��r�`•o+.�.�. ppb aF•Ja/ /P¢a,( Ogc��J4;'fid �4ob°p •.q 9 � "A b♦n h� W k O 6oz K • Q ;Ja= i�•f � II t OG •yp .... ria;�°� l `N:717091 NIIYOr 4N d 7 20 N V 7d Stull 9"7 -,-?7WLO G"Jl1 t MX7 Vim% 6 A�. 1 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millrivercon g-earn] Sent: Wednesday, April 25, 2012 10;2 To: DelleChiaie, Pamela; S er, Susan Cc: 'Randy Burley' Subject: RE: Soil Test Ap ication - 1476 Salem Street, North Andover Oops, sorry! I forgot to write back; yes, if e uled for Monday, April 30th @ 9:30 with Randy. Sorry about that! O From: DelleChiaie, Pamela Lmailto:pdellechCci)townofnorthandover.coml Sent: Wednesday, April 25, 2012 9:44 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Subject: FW: Soil Test Application - 1476 Salem Street, North Andover Hello, Is the scheduling for this all set? The homeowner called me this morning to ask about it. Thank you. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie(Mtownofnorthandover.com Web www.TownofNorthAndover.com ilia From: DelleChiaie, Pamela Sent: Wednesday, April 18, 2012 11:35 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: FW: Soil Test Application - 1476 Salem Street, North Andover Hello, Please go ahead and schedule soil testing for 1476 Salem Street with Grady Consulting,LLC -781-585-2300- Richard Grady is the engineer. No comments from Conservation. All set. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 1 FryIJ78.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com From: DelleChiaie, Pamela Sent:Wednesday, April 18, 2012 9:58 AM To: Gaffney, Heidi Subject: FW: Soil Test Application - 1476 Salem Street, North Andover Hello Heidi, Do you have any comments from Conservation on this site? O Thank you. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com ,t "AQ From: DelleChiaie, Pamela Sent: Thursday, April 12, 2012 2:01 PM To: Gaffney, Heidi; Hughes, Jennifer Subject: Soil Test Application - 1476 Salem Street, North Andover Hello, Attached is a soil test application for 1476 Salem Street. Please review the site and let me know of any comments or concerns with regard to Conservation. I will then forward for soil testing scheduling. Thank you. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 18, 2012 11:35 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: FW: Soil Test Application - 1476 Salem Street, North Andover Attachments: 20120412133220996.pdf Hello, Please go ahead and schedule soil testing for 1476 Salem Street with Grady Consulting, LLC-781-585-2300- Richard Grady is the engineer. No comments from Conservation. All set. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com From: DelleChiaie, Pamela Sent: Wednesday, April 18, 2012 9:58 AM To: Gaffney, Heidi Subject: FW: Soil Test Application - 1476 Salem Street, North Andover Hello Heidi, Do you have any comments from Conservation on this site? O Thank you. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com 1 ' Commonwealth of Massachusetts J1911 F Title 5 Official Inspection Form ���°�� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "M 1476 Salem Street Property Address G� Albert Koenigyp Y, Owner Owner's Name information is North AndMA 01845 March 27, 2012 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information `s filling out forms on the computer, use only the tab 1. Inspector: key to move your APR cursor-do not James Gallant use the return Name of Inspector ANDOVER key. HEALTH D;EPAR� Wind River Environmental Company Name 163 Western Avenue Company Address eru Gloucester MA 01930 City/Town State Zip Code 978-282-7315 S113402 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: I ❑ Passes � ❑ Conditionally Passes Fails ❑ Needs her Evaluation by the Local Approving Authority Inspector's Sig ure Date The syste inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 � T Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y p Y , p Y coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: The distribution box liquid level is 3" above the outlet inverts. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /< 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is North Andover MA 01845 March 27, 2012 required for every 'I page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all ,system components, excluding the SAS, located on site? Y p 9 ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® El approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual). 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No I Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well Water. 9 ( Y 9 (gp ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ElYes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): General Information � Pumping Records: Source of information: The home owner and Wind River Environmental are the sources of the information. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? The quantity was determined by the pump truck and it was measured. Reason for pumping: To check the structural integrity of the septic tank. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5 ns 1/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information Approximate age of all components, date installed (if known) and source of information: The approximate age of all components is 45 years old. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 25 feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): i Distance from private water supply well or suction line: 27'feet Comments (on condition of joints, venting, evidence of leakage, etc.): The joints are clean. The venting is good. There is no evidence of any kind of leakage. Septic Tank(locate on site plan): Depth below grade: 19 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 81 X 4'W X 5'H Sludge depth: 6 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments as 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is North Andover MA 01845 March 27, 2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 0" Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? The dimensions were determined with a sludge judge, rod and ruler. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). My recommendations are to have the system serviced annually. The inlet baffle is in place and in good condition. The outlet baffle is in place and in good condition. There are no cracks. The structural integrity is good. The liquid level is 3" above outlet invert. There is no evidence of leakage into or out of the tank. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments tee, 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 I page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 3 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The distribution box is level. The distribution to all outlets is equal. There is minimal carryover of solids. The distribution box has no evidence of leakage into or out of the distribution box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No I Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I i Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1, 8'W X 501 ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The soil is made of 8" clay with 2" top soil layer. There is signs of hydraulic failure.There is no ponding. The grass is green over the lawn. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth–top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form_Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ( 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction.- Dimensions onstruction:Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM Property Address Owner Owner's Name information is required for MA every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ?2 r U o-1-1 ec�ck IF G rccn oil , 1A 10 o o '0W F ® c ,4- E= 5' .q" A- o-bQ�c Ig' ab.5 �.G 1 2 5 , l F t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ® � 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 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: No plans on file. 1476 Salem Street, 1472 Salem Street. Pulled plans for 1468 Salem Street. ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: I established the high ground water elevation from pulling the plans from an abutting property at 1468 Salem Street. There were 2 test holes performed by John Pettis in 1996, witnessed by Susan Ford the health inspector for the town of North Andover. The test holes show the water elevation at 164.13' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 " Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Jit 1476 Salem Street Property Address Albert Koenig Owner Owner's Name information is required for every North Andover MA 01845 March 27, 2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i i i i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17