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Home My WebLink AboutMiscellaneous - 149 BRIDGES LANE 4/30/2018 (2) t �. Address l � � L 4GE4-' Al Title of File P. e 9 of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of DOGUment/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health Planning Board _ Conservation Commission — Building Departnilent COMMONWEALTH OF MASSACHUSETTS EXECUTNE J OFFICE OF ENVEtONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WD=STREET,BOSTON MA 0210$ (617)292-5500 TRUDY CORE SKretm ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commisdow SUBSt1RFACE SEWAGE DISPOSAL SYSTEM 111SPECTION FOAM PART A C8111IFlCATIM i i I Property Address:149 Bridges Lane,North Andover Name of Owner:Harvey Goldman Address of Owner.149 Bridges Lane,North Andover,MA. 01845 Date of inspection:3/10/2000 Name of Inspector:Neil J.Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address.711 Argilla Road Andover,MA 01810 Telephone Number:(978)475-4786 CERTIFICATION STATEMENT 1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:3/10/2000 'he,System Inspector shall Rsubmicopy \ inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a aced 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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS:After,permit from B.0.H.,installing new outlet tee with gas baffle,replacing 20'of outlet pipe to d-box,installing new inlet riser in j septic tank,system now passes Title 5 Inspection. !B B.O.R.inspected same. I revised 9/2/98 Page I of 11 S ♦ f � COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPA$TMENT OF ]ENWRONMENTAL PROTECTION ONE WMM STREET,BOSTON MA 02108 (617)2925500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS GovernorCoavtissionzr SUBSURFACE SEWAGE DISPOSAL SYSTEM pI�PBCTHM FORM PART A CER 11CA71ON Property Address: 149 Bridges Lane,North Andover Name of Owner.Harvey Goldman Address of Owner.149 Bridges Lane,North Andover,MA.01845 Date of inspection:3/312000 Name of Inspector.Nell J.Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Malling Address:111 Argilla Road Andover,MA 01810 Telephone Number.(978)475-4788 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes X_Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:3/3/2000 The System Inspector shall ubmit a copy t is inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a aced 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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS i i revised 912/98 Page I of 11 Printed on Recycled Paper -- h L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:149 Bridges Lane,North Andover Owner.Goldman Date of Inspection:3/3/2000 INSPECTION SUMMARY: Check A, B, C,or D. A.SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B.SYSTEM CONDITIONALLY PASSES: _X One or move 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. Outlet tee replacement&collapsed pipe replacement. Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination In all instances.If"not determined",explain why not. _No The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. —No„_ Sewage backup or breakout or high static water levet observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed �distribution box is leveled or replaced _No_ The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9098 Page 2 of 11 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:149 Briges Lane,North Andover Owner.Goldman Date of Inspection:3/3/2000 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 the public health,safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ' I Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and sal 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 sal absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.Method used to determine distance (approximation not valid). 3) OTHER revised 912198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 3roperty Address:149 Bridges Lane,North Andover ,caner:Goldman )M of Inspection:3/3/2000 D.SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this ietermination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cogged 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. Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped._, Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. T 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 1.00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for colfform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E.LARGE SYSTEM FAILS- You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 912198 Page 4 of 11 I •• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST II Property Address:149 Bridges Lane,North Andover Owner.Goldman Date of Inspection:3/3/2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flaw rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined.Note if they are not available with NIA. _X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow.The site was Inspected for signs of breakout. X T All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _x Existing information.For example,Plan at B.O.H. X Determined In the field(if any of the failure criteria related to Part Cis at issue,approximation of distance is unacceptable) 115.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 T .• . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION Property Address:149 Bridges Lane,North Andover Owner.Goldman Data of Inspection: 3/3/2000 FLOW CONDITIONS RESIDENTIAL: Design flow 150_ .g.p.Vbedroom. Number of bedrooms(design):-! Number of bedrooms(actual 4_ Total DESIGN flow_600_ Number of current residents:–2 – Garbage grinder(yes or no): Yes_ Laundry(separate system)(yes or no):_No If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes or no):_No_ Water meter readings.98 to 99=44,200 ft'x 7.5=331,500 Gals.1730 days=454 Gals./day Sump Pump(yes or no):_No– Last oLast date of occupancy: Current COMM ERCIALi1NDUSTRIAL: Type of establishment: Design flow: gpo(Based on 15.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no) Hon-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy. OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped Aug.99,owner. System pumped as part of inspection:(yes or no)_Yes_ If yes,volume pumped:_1500_gallons Reason for pumping.Inspect tank&tees. _ TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool ' Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) VA Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank` Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information:16 years old,2f7/1984,as built plan. Sewage odors detected when arriving at the site:(yes or no)_No_ revised 9/2/98 Page 6 of 11 I • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C • SYSTEM INFORMATION(continued) Property Address:149 Bridges Lane,North Andover j Owner:Goldman Date of Inspection:3/3/2000 BUILDING SEWER:X (Locate on site plan) Depth below grade:4'5" Material of construction: X_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"cast iron thru!wall,3"PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade:3'5" Material of construction:__X concrete metal_Fiberglass Polyethylene,_other(explain) If tank is metal,fist age____Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 10'x 5'x 4' x7.5=1500 gallons. Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:NIA Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:N/A WA= outlet tee corroded off. Distance from bottom of scum to bottom of outlet tee or baffle:N/A How dimensions were determined:Measure depth of scum S sludge. Comments:Pumped septic tank,inlet tee ok,outlet tee corroded off,needs replacement.Depth of liquid at outlet invert No evidence of leakage.Snaked outlet pipe to d-box,evidence of collapsed pipe. GREASE TRAP:None (locate on site plan) Depth below grade: Material of construction: concrete_,__metal Fiberglass Polyethylene,�other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle.- Distance affle:Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C •Q SYSTEM INFORMATION(continued) Property Address:149 Bridges Lane,North Andover Owner:Goldman Date of Inspection:313/2000 TIGHT OR HOLDING TANK:_None (Tank must be pumped prior to,or 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:_ allons/day Alarm present Alarm level: Alarm in working order.Yes_No Date of previous pumping: Comments: DISTRIBUTION BOX.:_X_ (locate on site plan) Depth of liquid level above outlet invert:0 Comments:D-box level&distribution equal.Evidence of carryover,pumped d-box to clean.No evidence of leakage. PUMP CHAMBER:_None,gravity system_ (locate on site plan) Pumps in working order.(Yes or No) Alarms in working order(Yes or No) Comments: Revised 912198 Page 8 of 11 } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)) Property Address:149 Bridges Lane,North Andover Owner: Goldman Date of inspection:3/3/2000 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number leaching chambers,number: leaching galleries,number leaching trenches,number,length: leaching fields,number,dimensions:1 Field 30'x 40' overflow cesspool,number: Aftemative system: Name of Technology: Comments:Soil ok.Vegetation ok No sign of ponding to surface. CESSPOOLS:None (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(cesspool must be pumped as part of inspection) Comments: PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: revised 912198 Page 9 of 11 ,j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Driveway Property Address:149 Bridges Lane,North Andover Owner. Goldman Date of Inspection:3/3/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Water Meter V—A B A to 1 =54'6" Deck A to 2=63'6" A to D-box=68'3" B to 1 =56'3" Bto2=64'5" B to D-box= 104'6" 1 2 D-box 30' 40' revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �b SYSTEM INFORMATION(continued) Property Address:149 Bridges Lane,North Andover Owner:Goldman Date of Inspection:3/3/20000 NRCS Report'name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater >6 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) X Determined from local conditions ___X_Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) Essex County soil map,sheet#30,Chariton soil,Water>6 deep. revised 912198 Page 11 of 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 149 Bridges Lane, North Andover Owner: Goldman Date of Inspection: 3/3/2000 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system Ne41ateson Bateson Enterprises,Inc. I APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERII�IIT c DATE: ! CURRENT Di STALLER'S LICENSE LOCATION: AA-1 , LICENSED INSTAL R: �r SIGNATURE: TELEPHONEr-"r CHECK 01 REP. : NEW CONSTRUCTION: P.` 19 IF NEW CONS TUICON, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only Fee V X75.00 Fe.. Attached? Yes No 0 Yes i Foundation As-13111,10/0 t o Floor Plans? Yes IN Approval Date: �P id-,5�` I +/J c �j S Vie-r✓G '�` �' 4 ,7, a e.ap "+� �.�e°"'P",�G�- cb�/T'�.. j� i� �°`6 � �.. � .�t �C�ate+ ,� fr->7'+�- ...�. f. � _.r�„s�. �•` MAR Board of Health North Anc�veraHass. BEPT'IC SZSTEH INSTALL4TIOK CHECK LIST LOT'60 ' (p5 $ PHOPF.D EXCAVATIN 76K FAIL �eaeans! � FAIL c 1. Distance Tot a. Wetlands b. Drains c.. Well 2. Water Line Location 3. No PPC Pipe lw,fG Mme% l�jSm ,b 4. Septic Tank a. _Tees -_Length & To Clean Out Covers. - - b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. . Leach Field or Trench a. Dimensions - b.- Stone Depth c. Capped- Ends- d: appednds--d. Clean Double Washed Stone' 7. /Cen(mt ns epth auls ipe to Pit -Both Sides" ouble Washed Stone 8. - No Garbage Disposal 9. Anal Grading Inspection 10. Barricading Covered System - ll.-- As Built Submitted a. -Lot Location b. Dimensions of System C* Location with Regard-to Perc Test t d. Elevations ` e: Water Table F Board of Health V. arty.jIndover,Mass SIIBSORI?ACE DISPOSAL DESIcN CHECK LIST IOQ' f U APPROVID MATE DISAPPROVID DATE - DATE Reasons: Title V FAII. Reg 2.5- e submitted plan Faust show as a minim=: the lot to be served-area,dimensions lot #,abutters location and log deep observation holes-distance to ties location and results percolation tests-distance to ties d design calculations k calculations showing required leaching area j location and dimensions of system-including reserve area DO,Ole'-xi sting and proposed contours g) location any vat areas Athin 100' of sewage disposal system or disclaimer-check wetlands mapping h) surface and subsurface drains within 10DI of sewage disposal ,,/system or disclaim' (�) location any drainage easements 14thin 100' of se�ge disposal system or disclain-er-Planning Board files vjo j) kno= sources of -ester simply within 200' of se,,;age disooral e _ { system or disclaimer _r osed. -vel-1 to serve lot-1001 from leaching facili'' ), "ati�n�f ,, location of nater lines on property-101 from leaching f&A itf location of benchmark (n) . 6ive,,ays ,),garbage disposals . no PVC to be used in construction (q) profile of system-elevations of basement, plunb, k., pipe, septic tan distribution box inlets and outlets, distribution field piping and V Ot,.Ler elevations f(r) maxlm m groimd -.,ater elevation in area see,-age disposal system (s) plan anst be prepared by a Professional Engineer or other Professional autborized by lair to prcpar6 such plans Reg 6 � Sematic Talks (a) capacities-150%' of flog, meter table, tees, depth of tees, * access, purr-ping (b) cleanout ool (c) 10' from cellar call or i.n. ommd s-4 P (d) 25+ from subsurface dra-ins Reg 10.2 stribution Foxes (,a) 'sTope greater than 0.08 Reg 10.4 I � b) �' SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No �� Z►D 4C- Lot No Loc/Subdiv. Pland Owner Investigator 50k- ✓oc Observer SOIL PROFILE DATES l Alev 2.El ev 3.Elev 4.Elev " o � o Z o -E) 0" '- i 1 1 1 Ti-es Pits est .. 2 2 2 2 31 3 3 3 5 5 5 5 6 6 6 6 7 gat, 7 9 7 7 IUD W4.TE� B 8 'P.G-��ss.t. 8 .8 9 9PN Fvsatr 9 is 10 , 10 10 Benchmark Location Elevation Datum I PERCO TION TESTS DATES GlL? 0 � Z7/l*'3 Pit Number 1 4 2 4 3, Start Saturation (: 4"t i%4CL Soak-Minutes -V dd, Zt 0 start e 1 t5 Drop of 3"-Time Drop of 6 '-Time M6ms.lst 3" drop -Lg - Mins.2nd " Drop Percolation q `Z 13 Y-tj -pc,jv L BOARD OF HEALTH DESIGN APPROVAL Lot # �g STREET � ,,1 Septic Tank Permit # Proposed Construction Approx Building Size �o DC7 Garage Under Attached None Min elevation of top of slab � •.� Min elevation of top of foundation Height of foundation wall � Footing in fill yes no Further Comments "Pk so 7 �Jr 4'4 -46-0 1 ` A rc COT 6;� '44 814 CD EXI,ONG FOUNCATION IA 3S J' -'t 140 TO HOUSCO�M, S W. STjtqLtt .9 ST 01 &WX OUR S. too 8 G .k vl� -F ACE PON SHOWING L SY WIPT RVICIALTYJ R' ZI MCAM OAS, A N DGIPS ro TWrTHE 15EM I C�-SYSTEM. -INSfACLIEb- S�OWrj��S THF isw ASA 'RRA 7� WA NV OF � PLA REP ID,W -17 C JERD NVf2 p '..Y/V N. 57,S pla Exl,�TIW- {i �. - - - .- ^...` �L..�� ►l III ��'��ir��•� �� f~ FOU I i .� � � ._ I t l i r I I 1 .. � i s 1 t t Town of North Andover, Massachusetts Form No.3 : Nor+rM BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT �SSACHUSES Applicant 1 d NAME ADDRESS TELEPHONE 1 Site Location r Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. o- CHAIRMAN, BOARD OF HEALTH Fee s D.W.C. No. /�SeZ INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at � ��` 9e5/.moi relative to the application of ��d ��4- dated 3 — ov for plans by and dated with revisions dated I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. 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 my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 'i 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank,D-box,pipes, stone,vent,pump chamber,retaining wall and other components. 5. 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. Unde ign Lice ed Septi Installer Date: 3 MAR - 9 ;��