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Miscellaneous - 1532 SALEM STREET 4/30/2018 (2)
. . .: .. _ 1532 SALEM STREET Z 10/106.A-0091-0000.0 f 4 Lot & Street ��oZ �� m 577 Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit# 97U Plan Approval: Date: 16? Approved by: Designer. _73, 0S6fj�, Jk Plan Date: ov Conditions: Water Supply: Town - Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-Off: Comments: Form"U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? Y YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: 7 SEPTIC SYSTEM INSTALLATION Is the installer licensed? YF C J NO Type of Construction: NEW New Construction: Certified Plot Plan Review YES O Floor Plan Review YES Conditions of Approval from Form U YES NO Issuance of DWC permit: NO DWC Permit Paid? YE NO DWC Permit # 9.76 Installer: --V&,y 0 :5 ,6 Q6b Begin Inspection: NO Excavation Inspection: Needed: Passed:-c-- By: Construction Inspection: Needed: 64 re) -�0Ac_e 1113 t i� As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: 7 By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: Commonwealth of Massachusetts Cityfrown of System Pumping Record Foran 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information orraf :n filling out 1. System Location. puter,use the fab key Address ove your North Andover ma 01686 or-do not City/Town state Zip Code the return 2.• System Owner. j _-_ Name Address(if different from location) AUG -5 City/Town state Code TOWN OF NORTH ANO VER Telephone Number RTMENT B. Pumping Record :z II 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) LTJ"Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. s P m dB Name Vehicle License Number Stewart Septic Service Company 7. Location where contents were disposed: tea re treatment Plant 20 So. Mill St Bradford Ma 01835 nature of I u Date I Signature of F&&ivinj Facility Date xmCdoc-03106 System Pumping Record•Page 1 of 1 553 Cf NORTp • . Town ofNorth Ando �:L� • HEALTEPARTMENT ,SSACHustt CHECK#: 0�_ ATE: LOCATION: H/O NAME: CONTRACTOR NAM Type of Permit or LicenV(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Tit Inspector $ ,{/�_ Lel" Title 5 Report $ ✓l✓ ep ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer s -- - -- - - -- - �� <eN' Commonwealth of Massachusetts Title 5 official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary As essnI Ls � 9 1532 Salem St XMOF Property Address HEALTH BE James Noel Owner Owner's Name ----- ------------ ------- --- ------- information is _North Andover _Ma 01810 7/7/2011 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key I to move your _John DiVincenzo cursor-do not use the return Name of Inspector key. Stewart Sematic Service ,� Company Name 1 ran 58 South Kimball Company Address Bradford Ma _ _ _ 01830 of Cityrrown State Zip Code 978-372-7471 _ _S113386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails I ❑ Needs F rther val r ation by Local Approving Authority i ' �� 7/7/11 --------- — InspekSignature ,` Date 4e system inspector shall subs a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 d completing ys of this inspection. If the system is a shared system or Y 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . � 15_3_2_Salem St_ -- Property Address James Noel -- --__.—_-- __-- ----__-_-- Owner Owner's Name information is North Andover Ma 01810 7/7/2011 required for _ -- — — every 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be j 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 Commonwealth of Massachusetts ---- —0. Title 5 Official Inspection Form of Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532__Salem St Property Address James Noel Owner Owner's Name informatifor on is required North Andover Ma 01810 7/7/2011 _ �--------- — — — ------- --------- every 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): l ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): I ❑ 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 F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St _ Property Address James Noel Owner Owner's Name information is required for North Andover Ma 01810 7/7/2011 -- ---- — — -- — every 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. h SAS is within a Zone 1 of a public water � ❑ The system has a septic tank and SAS and the p supply. I . ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3..Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts _- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �n �= 1532 Salem St Property Address James Noel Owner Owner's Name information is required for North Andover_ _ Ma 01810 7/7/2011 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from aprivate water supply well with no acceptable water quality analysis.sis. [ 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. a ❑ 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 El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ' Commonwealth of Massachusetts -- ---- : Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St Property Address P Y James Noel _------ -- -- -- --------- -- --- Owner Owner's Name information is North Andover Ma 01810 7/7/2011 _ required for ------ --- State Zi Code Date of Inspection every page. CitylTown P P C. Checklist Check if the,following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ElPumping information was provided by the owner, occupant,p , 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? j ® ElWere as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 4- Number of bedrooms (actual): -- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440g�d __ t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St Property Address James Noel Owner Owner's Name information is North Andover Ma 01810 7/7/2011 required for — — ---- --- --- every page. City/Town State Zip Code Date of Inspection D. System Information Description: 2 Number of current residents: — 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): — Detail: Well Sump pum ? ❑ Yes ® No p Occupied Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: ---- ---- -- Design flow (based on 310 CMR 15.203): Gallons per day(gpd)V - Basis of design flow (seats/persons/sq.ft., etc.): --- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ------ — ---- t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 • commonwealth of Massachusetts - Title 5 Official Inspection Form ` s� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St_ Property Address .James Noel Owner Owner's Name information is required for North Andover Ma 01810 7/7/2011 _..__._ _—_— every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: O_ccu ied Date Other(describe below): General Information Pumping Records: Source of information: Stewart's Septic Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site tube on truck Reason for pumping: inspect 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i ' Commonwealth of Massachusetts Title 5 official Inspection Form -" Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6, 1532 Salem St — Property Address James Noel Owner Owner's Name I information is North Andover Ma 01810 7/7/2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 14 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): --- Distance from private water supply well or suction line: 100'+ _ feet i Comments (on condition of joints, venting, evidence of leakage, etc.): Well is 80' from Septic tank, 86' to pump chamber 100' +to leach field Septic Tank (locate on site plan): Depth below grade: 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: ---- Sludge depth: --- 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 �— 1532 Salem St Property Address James Noel Owner Owner's Name information is North Andover _Ma 0_18_10 7/7/2011 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 24 1.5" Scum thickness Distance from top of scum to top of outlet tee or baffle 6 — 14" Distance from bottom of scum to bottom of outlet tee or baffle -- — How were dimensions determined? Sluge judge, Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both baffela in good shape, no leakage levels good. 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 - -- -- I Date of last pumping: Date 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 • Commonwealth of Massachusetts ---__ Title 5 Official Inspection Form — _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments © _1_532 Salem St Property Address James Noel_ Owner Owner's Name information is North Andover Ma 01810 7/7/2011 required for _ __— —_ every page. Cityrrown State Zip Code Date of Inspection D. System Information 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): I 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 -:--_r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1532 Salem St Property Address James Noel Owner Owner's Name information is North Andover Ma 01810 7/7/2011 required for — --_ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box if resent must be opened) locate on site plan): ( p p ) ( p ) Depth of liquid level above outlet invert --- 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.): Pump Chamber(locate on siteplan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): pump in good shape, floats all workingump chamber built to grade 5" 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 UUTitle 5 Official Inspection Form IF21 Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 1532 Salem St --__ Property Address James Noel Owner Owner's Name information is North Andover Ma 01810 7/7/2011 required for _—.--_ every 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: 5-2'X45' ❑ leaching fields number, dimensions: ❑ 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.): No hydraulic failure, no ponding, no damp soils I 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 ' Commonwealth of Massachusetts _ Title 5 Official Inspection Form -t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "t 1_532 Salem St ---- -- ------ ----- Property Address James Noel Owner Owner's Name information is North-Andover Ma 01810 7/7/2_011 required for _--------- — -- — --- - ---- -- every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: ---- --- — Dimensions -- – Depth of solids • Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St Property Address James Noel Owner Owner's Name information is required for _North Andover Ma 01810 7/7/2011 —__—__— -- -- — 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 I i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St -- I Property Address James Noel Owner --- --- -- — — Owner's Name information is required for North-Andover Ma 01810 7/7/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 4 -- - — 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. 9/4/97 -- --- Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: went threw files_ ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: I You must describe how you established the high ground water elevation: _System is built 4' above water table, plans drawn_by New Englad.Engineering. 4/25/1997 Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I • Commoiriwealth of Massachusetts - -= Title 5 Official Inspection Form _ - — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1532 Salem St__ Property Address James Noel Owner Owner's Name information is required for North Andover Ma 01810 7/7/20_11 -- ------ ----- ---- — --- --- -- — every page. Cityfrown 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 92 u so Ulm SCALE 1 ". �- '2' SMEA MODEL B ' '013B .OR EQUAL FIRST TWO FEET Or PIPE OUT., OF BOX.,.TO `8E -SE,T LLVEL .. 24„ /4,= r0 1 ,i2„ DOUBLE WASHED. S?-ONE 1����;��J�Lrli �J�LR�I U�I�ULU lNI,In Ca nECCI li'L�CUM`l 12 MIlWMUM F:ARTN DOVER `_�( ��L =_ > In 2 a Vz, -10 i -- 11 /21' DOUBLE WASHED STONE , . . . 40 PE'RF P °V C:, . S — 0.005 -... WAc /i ' i)OUBLE WASHED S'IONU TO 3 > DATA 28 Time:12:00 P,T.'#1 52” • __._. 11:57 12: 12 12.12 - – ------: -- TQC°�I �, t, ;:,,I- 1 1 :45 1 l%t �u V r: i'1 r„b Li U .0 iI 2.03 �i Li` l \Cil�1 tTrI t1lSU`JCH N.1ECQ7�U 5GH � A pCOVE� 78 Min: D le 30 Min /Inch. :> — .` ti am in Osgdad Jr: �`� I __ c mature —_T � �� i-"tom ra Starr , :. ition: 141.76 of hole: 1'37.42: FLAN SHOWING Q�� Sq . SUBSURFACE DISPOSAL SYSTEM h2 Cy R N -P,b A , . . GC PREPARED FOR y. ,: r AARQ y, GEORGE VENIZELOS X`-. TE . 153.E SALEM STREET* /�2 ` NORTH ANDOVER, MASSACHUSETTS 01€34.5 T Its` 139.2:0 4 r ::'y ,, , Lysr s „r . :����✓ c'� � ,, z�la? SCALE: 1 — 20 MAY 26, t997 ALO W,♦ "i ..-� 1„ 'i ,.3 .� .� eti 'f- f..'.�.�t t.4•la.. PL _ '1 T '� '7 , 1 y ' 1 r. aEvisD NEW ,INGLA,N-D EI�TC,TN�,FRINCx S:F.IRVIC,�S INC. zt r V yi r lY L ! 10t, 4 33 WALKE . ,.� NORTH ANDOVER, MASSACHUSETTS 508 686--- 1768 b ? 1 4 � I)RAV,; CNE:CKEI BY. 19, BY: IG,O1. Jr, .,e'..t i. :�y. '�; iy; • ,'i Q Q ,:e` '}T' Y. ,a.i t,_ Y':, A�{. ; •,, ".�t� -s n 't l'�'J}Y.B. �:9 .`i, �..�,. ,u. ,.:1, =`a, Q` ,'. •DESIGN . -i � „�t`S�. .. •t. to �, 'L+.1;•r "";n:' � FILE� y. ��",� i�,• �.:�� P�a � �'i. � �• � til 1! . >>,•� � .�?c+`d { � r'�''�'4, r..b« n•+r �„ .�F.'., � �'ffi3 "�L>, iq§,�''°r,r.�:�?:.> �4 a ;,i.{,� r;�a:,-: ,�` , ' •,� {.�. ..`i f r,j �� s rf�'. .Irl-y. t $• L L'-< . N�..� , P��. � ''.� r?� � .. ' ., ��� •„. ,. . . .. : .. .. .: ... ' A' > f �. } .- ... t .I u : A,.. - .. rl , t � J ., , .r -..�: ;4 .. . .„ , . - • . a.. ,': ,1: :p ., . .. :. . . ... '...r. 'v+ i ,... i . , . a, 3 - . .. .. , 1 ,.i, '4. 'K. n. : r ... .. .-.. 1 h, u .. ...- r.:. , I, .:, , s - .. , ... .. .. : f.... .. .. LL 1. .t 1. I l t- .� ''A+' 't, . -. ,.,, .. 0 ,. a .. , , .. . -., r : .: :.. I, . - k . '4 . ,. , :. . . _ ` .. 1 . f � 8 , �_. . 1'. . :. i••:: :a .. - .. _ .. - �0 0 -......... ., I . .: - - - '. •:. .. r. - - . .,. ... 1'4 . 9.9 . . . - . 2„ aC�h I'` so .,4y .. :- '. . .. : Of2CE MA N . ,Fc ;01STYRIBUTiON BOX 1:46. „ - ��8 ' ': � F -HAMBER :IN - 14�'�9Q, OUT;. 147 ., FINIS1-1 8 -0 .. 1'.g0a GALLON . PU C 4” F :8" TO 2,► N'y .OUT = - 92.72 0. 1/ 1/ GR.4. .`"; .INV.; IN 4 .97, 1 . . .. : . . , :: IN D 97 HE T NE RISER:::TO WI THlN L 45f OF �4" SC 0 40 PERF .." b . . .. 1 .45 D . . , 20• DIA: 6: O. FINAL ,GRADE . -., .. . CLEANOUT-COVER O s o� , �. P.v o.o W 14� a f 9 ,.: i . 6; . DOUBLE 'WASHED . . . . - . 0 STON VEN T :. t �J ..: - i - - '4 3 ';. ... , . .. . y 94: 14 2 _ s . INV: i -147.4 :'• INV" - .1.4Z:2q . . . . V. 147:20 . FN V.° 14 :43 IN 2 . I . - . . 93 ., = 145:20 SC : . .40 = ... N V,. # 146 `4`3 I tyVr #3 . .. 4 ,M, _ - S. 0.02 'MIN::' '` INV.,: #5 -144 43 INV: 5 f`44'. 0a . ... 9 2: 14.0 .. . r-'GATE-vAt vE QUICK DISCONNECT .COUPLING' .. .� : 1 .3� d;OTTOM OF;.':TRENCHES; , . : 145 2E3 F' N T 5 1 SAND E 0 E ., _ a ...' . • .. .. . . 4 :,t�aV.G: �� 14S 2q 3.8'' #3=T44 20 . g . 0 wA, RPRO 4:.1 20.•:. . QF.' .J NC' ' _B0X .: IW:V_,x.•�'.,2.97 5 1 ,. V, # 42 20 . 1 .. 8 9 37 . .. VERTICAL CHECK Val VE 2 . NATER TABLE . . . ;`L V. 13J 2 . . .. i .. . . 88 A .. F�1T 136' ALARM. ON 91:13 Q . .'. : 2" 90.96 ; . PUMP ON � " .5 . 87 TANK G1LLON 'SEPTIC ' :. � •A ; : Q . :, I , . ., 22 INS ... INV..IN 93�32� OUT'. 93:07 . .12 PU.M0 'OFF 89 8 3:5 . . . .. - «, 2 �` O n + • , � �nnnn Q . iJl'N W.. .t _. ♦ .. - f) f . . _. ... . . „ ' `:: ..: S_ .ALE• ,1. ' .� ' 2 0•- H� 12'' COMPACT GRAVEL. . ' . . . . . ,.f?O11�tE#`J . . . GONRECE 1 . 2 MNkMUM : A o C b0 1 P�f�p C pS . .. �O A E RTH COVER. F :. - , A MOOEL `rK 1000.: PC OR EQUAL , ,LE 1. 2 SHE . . . I - , ., . . 1532 SALEM STREET NOTE TO FILE: On April 22, 2002, responding to a complaint about odor,viewed the newly- installed septic system at 1532 Salem Street from the vacant lot in the Long Pasture subdivision. Observed many tire tracks over the septic system and d-box excavated. Backhoe was grubbing out area adjacent to system Drove around to home at 1532 Salem and asked for owner. He was operating the backhoe. We discussed the tracks over the septic system and I explained about the threat to its integrity and the number of complaints about sewage odor. He was requested to hire a licensed septic inspector to determine whether the septic system had been compromised. I requested that he have his inspector call me to discuss what needs to be done. 3/ w L661 6 Z OnV IAPPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT i� DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: SIGNATURE: 7 TELEPHONE# / 76 9 CHECK ONE: REPAIR: Z NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes C---' No Foundation As-built? Yes o Floor plans on file? Yes N (� Approval Date: / q e� 4 Form No.3 \ - Town of North Andover, Massachusetts ' BOARD OF HEALTH t .• NORTH Q t 19 DISPOSAL WORKS CONSTRUCTION PERMIT cNUSE 4 Applicant NAMEA RESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. D OF HEALTH Fee D.W.C. No. 6 . Town of North Andover, Massachusetts Form No.z f 14ORTN BOARD OF HEALTH p•--, � w DESIGN APPROVAL FOR ,SSACMUSft SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Gsoe(sC V&iJl z GGS Test No. �/6 Site Location —�02 �JAL��►1 J7�. Reference Plans and Specs ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 97e ` -C Town of North Andover, Massachusetts Form No. 1 NORTH • BOARD OF HEALTH QF X f 0� � 19n O ^ °� COCX1CXfW1C "m APPLICATION FOR SITE TESTING/INSPECTION �9SSACHU`-'���5 Applicant NAME ADDRESS TELEPHONE Site Location � C �- & k— Engineer NAME ������//'' ADDRESS TELEPHONE Test/Inspection Date and Time A14V g-v n ei- 7 CHAIRMA ,BOA RD O HEALTH Fee - Test No. qqy S.S. Permit No.970 D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH O o Ew . APPLICATION FOR SITE TESTING/INSPECTION SACHu5���y Applicant �-� �-` �r%1 � ` NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time ` { iJ CHAIRMAN,BOARD OF HEALTH Fee , - Test No. +� S.S. Permit No. %r" D.W.C. No. C.C. Date Plbg. Permit No. ,.ted MOAT►, ... 3? •• - ' BOARD OF HEALTH •�', 146 MAIN STREET TEL. 688-9 540 'SSICMUSEt NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 51 23) R I LOCATION OF SOIL TESTS: 15,3Z �alew, sty e� Assessor's map & parcel number: OWNER: Osco nqe. Urw-'t Ze(� S TEL. NO.: A q- 7-7>7 3 I ADDRESS: 1/If+ ENGINEER: N,- il-m laJ Z i„ce/; TEL. NO.: l 6 /76 8 CERTIFIED SOIL EVALUATOR: 6e/, 0s o,,-0 Z72 c-hc-9 -7a '„D Intended use of land: residential subdivision, le family home com ercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1”-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. i Itl"r+'Yl eaFr.,r ''v $$��, • k,' 7i t;;. F ° I t 1 ?C t2 iir.tix. yy I '. ... :,:: f :- �. ._. � .:. .. ' < 'm.'..{ tt rf'.- st r uI3�. 1�. fd rt s„ 7 I t 1 ',.i{ i.�_ x �Y t :;•i s s! _.. { 4 - { _, )F f i`.i 3t rs,'t. •7{tt,l�j' t Fu spC'.i;' ?�t� t'a'll i` ' V i t i�kis t ,.1 '„ '. ,,,., _ - , (r,i':•,:t s lV� ±'� r �. a�J 7. s rl Ic : .>r(.��d xsx eriSkN.l�7d �a�ielJ.+�IAN.a,.:rx,t+e.... _ Form No.4 a 7 . e 1 � Town of North Andover, Massachusetts BOARD OF HEALTH CERTIFICATE 19 9�j- CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired by ���� OS6nn d r : INSTALLER SITE LOCATION has been installed in accordance with Board of Health Regulati ns as described in the Design QpP A royal Site System Permit No. [ dated 9�=—� The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH "e n 0. t ppVRA StiF L - ' 7Yin 4 i t 7 cF: t I F l i 4 t t G �, t•}i t F { 1� f t j- l � I I I i-II I - - 2N . . . . . . . . . - - -- -/� !� -------- ----- - -- : i I _ _ . . . . .. . . . (71 ci - -ilui y. r f ZI ./' � 7� �.. Tr _/OCL_:_-�• -- � - _ _ �� � fti F�.L�,�� r 77/L� L� t�n/ /+ •#U D � /( I ..— _y __ — - ... � +'7 j.��" 9 r:, �gi',"�,3kr ,i�•*.yt'L'ti / tc. t f. -- *�- -Fi'' ri" as a#3,'... t, dt d ` •t. j r4, R4 tttc5.xt .rpt="'� �,"-�eta"�+4.•�z {�a�tri� .t�£?�"y,.�� ,'^#�i'�+r,�f zt r�%'i . -5'�„ 7 ��x t ,r`5+9 t• a :, + t'►T .�, jS fit A t.. 1 4 t3,5"ttt'.,� 4 i z x• �. 'z S �., .,:. .. . ., +":;�.�rir `ssr-::sx.x.t �-i ^�s is alt.� x � tisa. R•i�Yt tt y tad. r k:' ��.a+ + ru' 4 4jx add„r r t-• slra'-: +{ t y . v :.,� a ;-;.,.. ,.: .$ ^:^3���a�4:"�W....S.....,.i,C•ti� i 3'.R �r�»�t's+ai�97i4t.:L..r. R�Aw'�#�z=rr���a.,rt'4�'h. •s:•,;, ,[,ti" Town of North Andover NORT1y f 1 OFFICE OF 3?c�t, • 0 COMMUNITY DEVELOPMENT AND SERVICES 41 30 School Street `► 9 •"« North Andover,Massachusetts 01845 �9 ° • ° tt9 WMLIAM J. SCOTT SSnCHUSS Director September 5, 1997 t Ben Osgood, Jr. New England Engineering 33 Walker Road North Andover, MA 01845 RE: 1532 Salem Street Dear Ben: This letter is to inform you that the proposed septic plans for 1532 Salem Street have been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, .Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S George Venizelos File ,(:(1NCFAVATf!)N."9-9531) AFAT,TH 6R8-9W Pr-Ar?NMG.68F-9535 -- BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE 2-1 ;>- NAME OF APPLICANT Mr. joseph RarhapalIn _ Rarnn Corp. LOCATION Lot #1 Salem St_regt Address of lot no. BUILDING: Dwelling . Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay__2L_ Gravel Sand PERCOLATION TEST 6 minutes per inch. r I MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE -SEPTIC TANK 1.000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. f ,A i William J. Dr coil, Engineer Board of Healt APPLICATION FOR SEWAGE DISPOSAL INSTALLATION Dir HEALTH DEPARTMENT - NORTH ANDOVER, MASS. /5-3 i I hereby make appli ation for a permit for a sewage disposal installation at c� / 1-tJ . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Farther, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1/ until 10 feet pre- ceding the septic tank, where, the grade shall not exceed 2%6. I will install a con- crete septic tank of /6-�-Z in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series, of trenches, the bottom of which will pro- vide a minimum of /F O lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I_further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE 'J_ - 7/ Si&fature of Ap icant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Z y Signature 'of Health Agent I have inspect d the uncovered system indicated above and find everything done as describe �. DATE Signature of I s cting Officer Percolation Test ` Garbage Grinder �� r BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. l4 1 Y I i f Pira s .7oi 1. NAME 0U R A DATE 2. ADDRESS L o )`/ -7/9-L E a+ S 7F'` LOT NO. / TEL. 3. NO. OF BEDROOMS DEN YES NO �- , 4. GARBAGE GRINDER YES N0_Z`_ 5. SHOW DIMENSIONS OF HOUSE t� 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES e-, 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL lG 0 a 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM i' 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE C� NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. i Cunllunll�rfall�l I+f AMasrrlcbuselts . Mass tool lung tts gs'llditt''tll�il0 "'5j'iteiii-Lnciil'o+ i + N. A Dale .-Not l"errtiuull tail � 1`a1 l�.l � �a �eS n + • . l,�Caise NI system Pumi►ed b+.,. Cunlews.Itnoslelled Ir: Dnl! �Ils�llrldt `, . IL 1 i' NEW ENGLAND ENGINEERING SERVICES INC July 21, 1997 t RW ASS �f North Andover Board of Health � � Off S Town Hall Annex School Streetn North Andover,MA 01845 Re: 1532 Salem Street Dear Mr. Chairman: Please accept this letter as a request to be included on the July 24, 1997 Board of health agenda for the above referenced septic system repair. The reason for the request is to consider the following: Two Local upgrade approvals: 1. Reduction of the offset distance to the water table from 4'to 3'. 2. Reduction of the slope requirement from 15 feet and 3:1 to 10 feet and 2:1 with a poly barrier. One local bylaw variance: 1. reduction of separation distance between trenches from 10 feet to 6 feet. I will be at your meeting to discuss these issues. Yours truly, Benjamin C. Osgood,Jr. 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 FORM 11 - SOIL EVALUATOR FORM Page I of 3 No. Date: s- e Z Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for--On-site-.,Sewage Disnosat Performed By-�� ............................................................... Date: -2, 0.; Witnessed By: .... .......... ..... .. ...................................................................................... ............. Ld..Add. Ad&css.and Tckphorx 4, New construction El Repair office Review Published Soil Survey Available: No El Yes Year Published Publication Scale Soil Map Unit Drainage Class 44�'�-e Limitations .....A'!Q� Z ;r' . . .................... Surficial Geologic Report Available: No Q Yes R Year Published Publication Scale GeologicMaterial (Map Unit) ................................................................................................................ Landform Flood Insurance Rate Map: Above 500 year flood boundary No E]Yes Z Within 500 year flood boundary No 0 Yes n Within 100 year flood boundary No 0 Yes El Wetland Area: National Wetland Inventory Map (map unit) ...................... ........................................................ Wetlands Conservancy Program Map (map unit) ....................................................................... .................. Current Water Resource Conditions (USGS): Month Range :Above Normal ©Normal r]l3elcwNormal F] Other References Reviewed: DEP APPROVED RMH-IM195 FORM 11 - SOIL LVALUATOR FOR Page 3 of 3 Location Address or Lot No. Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole.................. inches ❑ Depth weeping from side of observation hole........... ..... inches Depth to soil mottles . ✓���: inches ❑ Ground water adjustment ................. feet Index Well Number .................. Reading Date ................... Index well level ..... .._... . Adjustment factor .................. Adjusted ground water level .................................. .... ............ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification 1 certify that on 4 (date) I have passed the soil evaluator examination approved by the Dbo6rtment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signatur ��'/�/ ZDate X02 I UEP APPROVED FORM-12/07/95 Y - I I I FORM Il - .SOIL ;VALUATOR FORM Page 2 of 3 j Location Address or Lot leo. �S3Z S,DC6�I ST /�l�rz7F1 A/y7 ��' . On-site Review Deep Hole Number Date:.�� �/9 Time:.�l- ®� Weather �.—. O,G / � Location (identify on site plan) v I Land Use Slope (%) :5' Surface Stones ..Afe. 1/Y Vegetation .. G� Z>{d........ . . ... ... . :... Landform _ :. .. j Position on landscape (sketch on the back) Distances from: Open Water 6ody/P/m� feet Drainage way /2dm feet Possible Wet Areafeet Property Line . ... feet Drinking Water Well Zoo feet Other - . ..............._.. i DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) 11161,45 72V 1��PWIIV MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) DepthtoBedrock: i Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: _ Estimated Seasonal High Ground Water: �8, DEP APPROVED FORM-12/07/95 NEW ENGLAND ENGINEERING SERVICES INC August 25, 1997 TQtll►_iN OF RfO��'4��®VER/ Sandra Starr ROAR.Or'.iEaT14i North Andover Board of Health Town Hall Annex 'AUG 2 5 1997 School Street North Andover, MA 01845 Re: 1532 Salem Street septic system design Dear Sandra: Enclosed are three sets of revised plans for 1532 Salem Street,North Andover. These plans include corrections for the following comments which you had regarding the original sets that were submitted. 1. Elevations have been added to the percolation tests. 2. The"First 2' from D Box level"note has been added. 3. The pump has been specified to pass 1 1/4"solids. 4. The leach trench section detail has been corrected. 5. The emergency storage calculations have been moved on the plan to be included in the Pump Notes. They were located previously on the top left of the sheet. 6. A note regarding the absence of a reserve area has been added. Two other items on your list were taken care of at the last Board of Health meeting. The items that were granted variances were: 1. Separation distance to water table reduced from 4'to 3'. 2. Distance between trenches reduced from 10'to 6'. As far as how the trenches were designed for elevation is concerned, it was assumed that the water table elevation followed the slope of the hill so the depth of the water table at each trench was assumed to be at 58"below the surface at the highest elevation of each trench. Also enclosed with this letter is a check for 85 dollars to cover the initial 60 dollar review fee plus the 25 dollar re review fee. If you have any questions please do not hesitate to contact me. Yours truly, Zen,ZiC. Osgood r. 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 Epa- - - TOWN OF NORTH ANDOVERSYSTEM PUMpil-4(i RECORD DATE SYSTE-M OAR ADDRESS SYSTEM LOCATIONDATE _ OF PUMPING --2:tea a� _ TI PUMPEI) /D 6 y CESSPOOL N(2 ✓ YES SEPTIC TANK NO YES � NA'1 E OF SERVICE: RdUTINE Y EMERGENCY OBSERVATIONS: GOOD CONDITION ISI.TO COVER HEAVY GREASE BAFFLES IN LACE RAS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER.EXPLAIN SYSTEM PUMPED BY � COMMENTS: CONTENTS TRANSFERRED TO n Kr TOWN OFNOp.TH ANDOVER .:.SYSTEM PLWING RECORD DATENO % 3 SYSTEM OWNER &ADDRESS SYSTEM- �- L LOCATION DATE OF PUMPING__1,4-1 " T QUANTITY PUMPED CESSPOOL NO_l f3S SE / PTIC TANK NO YES tl .77 NATURE OF SERVICE;,RQUTINE /;EMERGENCY 'r OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS -FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BYE. COMMENTS: CONTENTS TRANSFERRED TO Y, .. : t; ,i Jf,';lt•�IT„,}rti., T'tl�✓f'.,�ri`la 4��F'atk��W'-�Wj>1±14;,'i'�}JJyv ��1i�Tt�.L -i � ttr•kzo� L5p `sk ; y. . 1F5;4 i �otirN{ kY� fiJ r�k,s'+i rh4', x 1 s rr +.y eC l i 4 Commonwealth of Massachusetts �� 2010 CityTi'own.°of NORTH ANDOVER M >► t6di�ffl System Pumping Record rnnENT 'Form 4 DEP has provided this form for use by loyal Boards of Health. The System Pumping Record mug be submitted to the local Board of Health or other approving authority. _A.•Facility Information Important: When filling out 1. System Locatlon: forms the computer,use only the tab key Ad to move your I NJ cursor•.do.not use the return Clty/Town State QpC keYr.... - � _ 2, Syst m caner Name Address(if different from location) Citylrown State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3...Type of system: . . ❑ Cessp ol(s) (Septic Tank ❑ Tight Tank {] Other(describe): 4. Effluent Tee Filterresent? p ❑ Yes ❑ No If yes;was it cleaned? ❑ Yes ❑ No 5. Condition of System: aoo4 6.. System Pumped By: me. Vehicle License Number . Company 7, Lo where contents were disposed: Sig ture Date http://www.mass.gov/de Miater/approvals/t5forms:htm#inspect t5fom14.doc 08/03 System Pumping Record•Page 1 of I v� r�� z�tid�, icrra { r s�r 4al�i`j JyrIw A�4rir�k F�11. i vtil t Y�avUkM9'C a,{ r I.�t.%+CYMVk t�lr!( N•rG r�,vfY4+r kcr s ,.rc. 7+'j . Commonwealth 'of Massachusett RCeV�D ::City/Town.of NORTH ANDOVER MASS ' TS System' Pumping Record /,Z ,Form 4 TOWN OF NORTH ANDOVER DEP has proylded this form for use b local Board AL D A M NT Y m In Record d mug 9 be submitted to the local Board of Health or other approving authority. _ A. Facility Information Important When filling out 1. System Location: forms on the computer,use , only the tab key. Address . to move your cursor-.do.not City/Towri use the return State Zip Code key.. 2. System Owner. i Name .. . Address(If different from location) City[Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Q 0 2. Quantity Pumped: Date p Gallons 3...Type of system: . . ❑ Cesspool(s) V--Septic Tank ❑ Tight Tank {] Other(describe): 4 4. Effluent Tee Filter present? ❑ Yes ❑ No If y6,-was it cleaned? ❑ Yes ❑ No S. Condition of System: 8.. SXstem Pumped By: �an le- ' erQQ_ me Vehicle license Number Company 7. Locatlo where contents were disposed: rn ee b Signature of H Date http://www.mass.gov/deg. er/approvaisA$forms:htm#inspect t5form4A"08/03 �., System Pumping Record-Page 1 of 1 �: ,; V. ���/fir,l ' �/,.�,.,i'.!' n� RT•^YN'FLti{)M�.+t"d '1„'ii� 'd I �u y ,.2 ,t :I� .. IV,t ,lut, ODJ I �'lll+iii'1(ia {,Ir,y, . 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