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Home My WebLink AboutMiscellaneous - 1580 SALEM STREET 4/30/2018 (2) Gh 1580 SALEM STREET 210/106.B-0056-0000.0 , r ' UPC 14081 Y0. -5 -2 BE a�oT�aoo.as 1580 SALEMSTREET JS-2004-0387 Proiect Detail Report Printed On:Mon Aug 30,2004 Project Name: GIS#: 6948 Project No: JS-2004-0387 Owner of Record SEARS,GEORGE M&MARJORIE Map: 106.13 Date Submitted: Oct-01-2003 1580 SALEM STREET Block: 0056 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location_1580 SALEM STREET \ Zoning: _ Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision at Description ROOF Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0067 8/13/04-Request from S.Sawyer to redo the approval letter and cha• �GJ the new one. And resend. C,Q Building,Electrical&Mechanical Permits GREEN FLAG BEM-2004-0315 0� Permit History Type: Permit No: Issue Date Status Work Category Contractor Building BP-2004-0305 Oct-08-2003 Expired Residential Alteration Plan Review BHP-2004-0490 Aug-13-2004 SIGNED OFF d��a 0 Soil Testing-Repair BHP-2004-0489 May-10-2004 SIGNED OFF �Y \ ©0,' , GeoTMS©2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 .d .4 C®mm ®nweaf�h Of Massachuse� s Ciy1Town ®i North Andover RECEIVED System Pumping Record ®>r>n t-',q 06 2014 DEP has provided this form for use by local Boards of Health.I'Oh*ef,�>coCmsYabe�usedbui the information must be substantial) the same as that provided here.-Ieiore uslReco tl m_crst be submitted to local Board of Health to determine the form they use.The Syst -pumping n date in the local Board of Health or other approving authority within 14 days from fie pumpi g accordance with 310 CMR 15.351. acility Informata®n impor�an,when 311ing out forts 1. System Location: on the computer, '1596 142,M use only the tab key to move your Address Ma 01886 cursor-do not North Andover Zip Code use the return State C"riy(1-own key. 2. System Owner: Bu Y-) Name l ramp Address(if different rom location) State Zip Code City/Town Telephone Number B. pumping Record M(Jd ct/-`3 2. Quantity Pumped: Gallons 1. Date of Pumping Date 3. Type of system: ❑ Cesspool(s) 9, Septic Tank ❑ Tight Tank E] Grease Trap ❑ Other(describe): IfYes,-was it cleaned? E] yes ❑ No .. Effluent Tee Filter present? ET Yes ❑ No 5. Condition of System: �0 6. System Pumpe �C Vehicle License Number j Name Stewart's Septic Service ' Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date re of Receivin Facility Date Signature natu 9 9 System Pumping Record Pag t5form4.doc•03106 _ Commonweal-th Of Massachusetts Cifylf®wn of forth Andover a S-Y-Stem PUMPing Record - � Form 4 w b DEP has provided this formslocal as that Prov ded heOther re. Be ore us ng bes form ,used, check with your information must be substantially the same ; Record must be submiited to local Board of Health to determine the form they use. The System Pumping n date.in s the local Board of Health or other approving authority within 14 days from the pumps g accordance with 310 CMR 15.351. 9 f A. Facility information �� Q! x,014 • t 4n i important:When ,r filling out forms 1. System Location: TrO VNO,. - 15 - on the computer, HEX-_ use only the tab key to move your Address 01886 cursor-do not North Andover Ma State Zip Code use the return City/Town key. 2. System Owner: M l Vi Name Address(if dFifierent rrom location) State Zip Code cityown Telephone Number B. Pumping Record Pumped: Gallons r bC�0?)— 2. Quantity 1. Date of Pumping Date ❑ 3. Type of system: ElCesspool(s) FV Septic Tank E] Tight Tank Crease Trap ❑ Other(describe): '- ❑ Yes ❑ No if.yes, was it cleaned? E] Yes ❑ No 4. Effluent Tee Filter present. 5. Condition of System: 6. System Pumped By: Vehicle License Number Name Stewart's Septic Service ' Company II 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date System Pumping Record-Pag t5form4.doc-03/06 Commonwealth of Massachusetts y W City/Town of No.Andover System Pumping Record �� Form 4 TOWN OF NORTH ANDOVER ^M HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Ot the + information must be substantially the same as that provided here. Before using this form, check with your 1 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 Important: When filling out 1. System Location: forms on the 1` computer, use �Gap _ Le(v _.�� only the tab key Address to move your No.Andover Ma 01845 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: tab l Name efA Address(if different from location) City/Town State Zip Code I Telephone Number B. Pumping Record 1. Date of Pumping 2. QuantityPumped:p g Date um p Gallons 3. Type of system: ❑ Cesspool(s) [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: qffd 6. ERT u ed By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewa re-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature o Hauler Date �^ iA Signature of ReceivincYFacility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 6449 CE NORT:,� Town of North Andover HEALTH DEPARTMENT ,sS4CN1'+tS CHECK#: 119©11 DATE:3b0j ) '2) LOCATION: H/O NAME: CONTRACTOR NAM I Type of Permit or License: (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 $ SEPTICS stems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $`�lJ ❑ Other. (Indicate) $ Health Agent Initials I White-Applicant Yellow-Health Pink-Treasurer Y 7 Commonwealth of Massachusetts + t 3 W Title 5 Official Inspection Form 3)Z� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 1580 Salem street Property Address !� George Sears 'Y ` Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. CityfTown — �• --- Zip Code Date of Inspection W s ection forms may not be altered in any we J F o e form. m Important:When N m filling out forms A. on the computer, k use only the tab 1 = m key to move your W ` -- -4 cursor-do not oz C use the return 0 0 key. rn =r O W 3 0 n ,e o � < o m z M -+ o — U) 01835 � Zip Code M 386 .. 7 7— e Number r,n KEECEIVEDI z O B. C z A 0 TOWN OF NORTH ANDOVER I certii fstem at this HEALTH PARTMENT inform rn the time of the inspection. The inspection was p, ler function and maintenance of on site sewag ?ctor pursuant to Section 15.340 of Title 5 ® ❑ Fails ❑ it Y All ITe � w o port to the Approving Authority (Board of H y, If the system is a shared system or has; Y 'he system owner shall submit the repo al should be sent to the system owner and ( \ authority. This I -J !ion and under the conditions of use at thk \ tem will perform in the future under the s; oo N 0 0 C) _ t5ins•11/10 N -n 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 ^M 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) j Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 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).- El ealth):❑ 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 b the Board of Health in order to determine if q y e 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 i 1 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1580 Salem street Property Address George Sears _ Owner Owner's Name information is North Andover ma 01886 3/5/13 required for every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•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 ,M 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. Cityrrown 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 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. Citylfown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ID ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 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 1580 Salem street _ Property Address George Sears _ Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ 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 H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' M 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Andover stewarts septic Source of information: - Wass stem pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site guage 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 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 8 years i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): i I I _ Septic Tank (locate on site plan): 11" 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1580 Salem street Property Address George Sears _ Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 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 30" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6.5 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Sludge 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 baffles are in good shape, liguid levels are good no leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ' 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1580 Salem street _ M Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. CitylTown 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 1580 Salem street _ Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.).- Dist. tc.):Dist. box equal, no soilds carryover, no leakage. i Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Ran pump by manually lifting floats in the 1000 gal pump chamber, all systems working. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: r 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 I r 1580 Sam e street Property Address George Sears Owner Owner's Name information is North Andover ma 01886 3/5/13 required for every page. CitylTown 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: 1-15x50 ❑ 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 condition of soils are good. Infictrator system 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1580 Salem street Property Address George Sears Owner Owner's Name information is North Andover ma 01886 3/5/13 required for every . 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.): i Privy (locate on site plan): Materials of construction: Dimensions Depth of solids — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage age D sposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1580 Salem street _ Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 — page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) I Site Exam: I ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bob 98.46 Wt. 94.46 4' seperationfeet I Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed. 12/24/2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: pulled files ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plans drawn by newengland eng. Dec 24to 2004 Shows 4'water seperation from bottom of bed . 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 Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1580 Salem street Property Address George Sears Owner Owner's Name information is required for every North Andover ma 01886 3/5/13 page. Citylfown 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 4 IlY k rl A2 3ENCHMARK: FRONT RIGHT I - -IORNER OF BOTTOM STEP. ' I100.00 (assumed datum) - �NREE - 2 - I 0 NOV56a _ , B4 gEpR00 1�p G\ EL E 25' NO DISTURB ZONE �= B3 ISOLATED WETLAND . 425 SQUARE FEET N 1500 SEPT 50' NO BUILD ZONE —__ B� cP_ BOULDER B2 O 1000 GALLON PUMP CHAMBER DISTRIBUTION BOX .TP 2 G A 100' BUFFER ZONE TP 1 �� )T TO SCALE PT1 LIMIT OF SAND BOXFORD ST i I I 5 A r 4 a R _ INVERT ELEVATIONS ACTUAL DESIGN FOUNDATION 96.61 96.68 TANK IN 96.12 97.00 TANK OUT 95.81 96.75 PUMP IN 95.74 96.70 PUMP OUT 95.89 96.45 D-BOX IN 99.31 ..: 99.27 - D-BOX OUT - 99.14.. .. - .99:10 A 98.99 99.00. B 99.00 99.00. C 98.97 ' 99.00 _ D 98.97 99.00 E 99.06 99.00 `. N� 1�ON�I-LD F 99:05 G 99.05 99.00 H 99.02 99.00 BOTTOM OF BED 98':49 98.46 SYSTEM TIES 1 TO TANK 37.8' 2 TO TANK 58.0' 1 TO PUMP 49.2' / 2 TO PUMP 70.0' 1 TO D-BOX 71.8' 2 TO D-BOX 92.5' / 1 -TO A 71.0' 1 TO E 77.7 2 TO .A 91.2' 2 TO E 87.0_ sH O1 TO Q 80.4' 1 TO H 87.0'. 2 TO D 100.4' 2 TO H 97.0' . BENJAMIN C. u OSGOOD,JR. a .r CIVIL NO.45891 r R GIST20' 0 20' 40' 60' 1 A c e"OT TTT 'P eWPTTI" qY.qTFM w- FINAL GRADE INSPECTION Date: Address: ❑ LOAMED? ❑ SEEDED? �-'�'�— -7� s G 41, COVER PER PLAN? Other: _.. .. .. RECEIVED TOWN OF N RTH ANDOVER sYSTE Pu P1NQ RECORL) NOV - 3 2004 TOWN OF DEPARTMENT ER SYSTEM OWNEK & ADDRESS SYSTEM LOCATIO Se 1--s •• . rl DATE OF PLJMPTN(3;__ �p_01,0p0,00, _ PUMPED: ..... .. .. ... . C LSSPWL: NO---.---__._...... ,. ...... Sapcic Tank: NU / // _ YES v N^ rURE OF SERVICE: Kou'CLNE_ _c---FLMERGENc)- UriSERVATIONS: QOOD CONDITION PULL To COVER HEAVY O"-ASE BAFFLES IN PLACE. ROOTS _ LE ACFIPIELD RUNBACK sXCFSSIVE SOLIDS __. FLOODED SOLID CARRYOVER -OTH`ER EXPLAIN Jy.tem Pumpcd by -15 Q._ -&raa419&, rra. WMMENTS. CUN 1 EN 1'S fRANSYbRRED fC) I r 7. 1��Y��..�l'` /�ti Ci+�.. .y -'t Ir > t > + ; :?;.• .+I,:�.�r�� n+;+•y'- '�' .a•:. :htt, .. , ` ) pdy, •' -j+ 'h r j3;1'ty.,•i:. VA NJA uu TOWN p�F 0$TH ANDOVER SYSrI'O U&TINC3ECRD RECORD ' 1 . _ , �• � ,. DATEJr D + t - , . SYSTEM OWNER&ADDRESS SYSTEM LOCATION _ ea,e 1 5.8 0` S Old S7r 11 d' CP U oovef2 ma, DATE OF PUMPINQ QUANTITY-PUMPED CESSPOOL NO YES SEPTIC TANK NO yES NATURE OF SERVICE;,,,RQt BMEROENCY OBSERVATIONS;'. :: GOOD CONDITION :. F( LL-TO COVER .4AVY OREASB ' : BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVBI OTHER EXPLAIN SYSTEM PUMPED BY 1 COMMENTS; CONTENTS TRANSFERRED TO ,� Town of North Andover . e NORT11 1 Office of the Health Department Community Development and Services Division 400 OSGOOD STREETToo 's°°+.•�s��-• `� North Andover,Massachusetts 01845 Acllus Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax C�E�;�I FICA�E OF COgVI�GIo�1�C'�E As of: -1 LF 13, 2005 i This is to cert that the individual subsurface disposal system repaired(f) — FuffSystem by James rl-7effett at 1580 Salem Street North Andover, SIA 01845 has been installed in accordance with the provisions of Titfe v of the State Sanitary Code and with the North Andover Board of Yfealth regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. I? - n TY. Sawyer Public Ylealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 M1 1 TOWN'OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( j constructed; ( repaired; .located at 15-Ro S ci le e,-� T� was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# ,plan dated ,with a design flow of gallons per day. The materials.used were in conformance with those specified -on the approved pian; the system was installed in accordance with the provisions of 31 P 0 ..CMR.15.000,Title 5 and local regulations,and the final gradin �substantiall w' g agrees y with the approved plan_ All work is.accurately represented on the As-built which has been submitted to the Board of Health. ' f Bed inspection date: Engineer Representative Final inspection date:—Z,;? Engineer Representative Installer: Lic.#: Date: 3 2-c 8 VA OF Engineer: `' Date: 000,it CML NO.46891 �FGISTE�� O 0 NEW ENGLAND ENGINEERING SERVICES INC December 21, 2004 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 1580 Salem Street, North Andover, MA As-Built Septic System Design Dear Susan, The following As-Built Plans for the above referenced property are being submitted for approval. 1. Three (3) Copies of the As-Built Septic System Design Plans. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE-.NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 o O Sawyer, Susan From: Andy McBrearty[amcbrearty@miliriverconsulting.com] Sent: Monday, March 21, 2005 2:29 PM To: 'Pamela Dellechiaie'; Susan Sawyer Cc: info@millriverconsulting.com; Lisa Kozel LeVasseur j Subject: 1580 Salem Street Construction Inspection 91 Salem Street.doc Hi Susan & Pamela, Here is the construction inspection for 1580 Salem Street. Note that we could not access the basement, so there were a couple of items that needed attention at final grade inspection: 1. Barrier and wall around tree had not been completed. 2. Alarm and pump control panel wiring has not been verified. 3. Internal plumbing to system has not be verified. ! thanks, -andy I i YJ -be, if E 1 a O TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET 1- NORTH ANDOVER, MASSACHUSETTS 01845 'SSACHUs�t Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ADDRESS: 1580 Salem Street MAP:106B LOT: 56 INSTALLER: James Kellett DESIGNER: New England Engineering PLAN DATE: 7/8/04 rev. 8/9/04 BOH APPROVAL DATE ON PLAN: 8/1 /04 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 12/16/04 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Could not access basement. Will verify plumbing and wiring on final inspection. Page 1 of 4 o 0 TOWN OF NORTH ANDOVER T NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o: HEALTH DEPARTMENT x} a y 400 OSGOOD STREET •° Ar• NORTH ANDOVER, MASSACHUSETTS 01845 CHU+Ej Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading 2-Piece construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee gas baffle installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: Installer claimed stone under tanks. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading2-Piece construction) ® Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line Z 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: D-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) Page 2 of 4 0 Q TOWN OF NORTH ANDOVER °•N°p*� , Office of COMMUNITY DEVELOPMENT AND SERVICES F? HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845CHU CH Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ® Hydraulic cement around inlet& outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ® Bottom of SAS excavated down to soil layer, as provided on plan ® Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ® laterals installed and ends connected to header(and vented if impervious material above) ® Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete I timber/block) ❑ Final cover as per plan Comments: Retaining wall and barrier around tree not completed. CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ❑ Rated for exterior if placed outside Comments: Could not access basement. Page 3 of 4 0 0 TOWN OF NORTH ANDOVER pt NORTM Office of COMMUNITY DEVELOPMENT AND SERVICES o �O HEALTH DEPARTMENT t . 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 "SS^CMUSE` Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-FAX SYSTEM ELEVATIONS Benchmark: 100.0 Rod at Benchmark: 4.32 Height of Instrument: 104.32 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 97.68 96.67 Septic Tank IN 97.00 96.14 Septic Tank OUT 96.75 95.82 Pump Chamber IN 96.70 95.74 Pump Chamber OUT 96.45 95.91 Distribution Box IN 99.27 99.32 Distribution Box OUT 99.10 99.14 Lateral 1 Invert 99.00 99.00 Lateral 1 Chamber top 99.46 99.47/99.51 Lateral 2 Invert 99.00 99.06 Lateral 2 Chamber top 99.46 99.47/99.47 Lateral 3 Invert 99.00 98.97 Lateral 3 Chamber top 9946 99.44/99.49 Lateral 4 Invert 99.00 98.97 Lateral 4 Chamber top 99.46 99.44/99.47 i i Page 4 of 4 0 0 " TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET •�---• , NORTH ANDOVER, MASSACHUSETTS 01845 cMus°t Susan Y. Sawyer,RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX I ADDRESS: 1580 Salem Street MAP:106B LOT: 56 INSTALLER: James Kellett DESIGNER: New England Engineering PLAN DATE: 7/8/04 rev. 8/9/04 BOH APPROVAL DATE ON PLAN: 8/11 /04 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 12/16/04 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Could not access basement. Will verify plumbing and wiring on final inspection. Page 1 of 4 0 O TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT t . 400 OSGOOD STREET 'Y NORTH ANDOVER, MASSACHUSETTS 01845 �'SswcNust� Susan Y. Sawyer, RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading 2-Piece construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee gas baffle installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: Installer claimed stone under tanks. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading2-Piece construction) ® Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: D-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets Page 2 of 4 o Q TOWN OF NORTH ANDOVER HORTM ^ Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT t •i .^� 400 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845 'SS'CHUstt Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ® Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ® Bottom of SAS excavated down to soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® laterals installed and ends connected to header (and vented if impervious material above) ® Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Retaining wall and barrier around tree not completed. CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ❑ Rated for exterior if placed outside Comments: Could not access basement. Page 3 of 4 o 0 TOWN OF NORTH ANDOVERf NORTH a Office of COMMUNITY DEVELOPMENT AND SERVICES �O HEALTH DEPARTMENT 400 OSGOOD STREET •°. •_---- >'' NORTH ANDOVER, MASSACHUSETTS 01845 'SSAc'" Susan Y. Sawyer, REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-FAX SYSTEM ELEVATIONS Benchmark: 100.0 Rod at Benchmark: 4.32 Height of Instrument: 104.32 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 97.68 96.67 Septic Tank IN 97.00 96.14 Septic Tank OUT 96.75 95.82 Pump Chamber IN 96.70 95.74 Pump Chamber OUT 96.45 95.91 Distribution Box IN 99.27 99.32 Distribution Box OUT 99.10 99.14 Lateral 1 Invert 99.00 99.00 Lateral 1 Chamber top 99.46 99.47/99.51 Lateral 2 Invert 99.00 99.06 Lateral 2 Chamber top 99.46 99.47/99.47 Lateral 3 Invert 99.00 98.97 Lateral 3 Chamber top 99.46 99.44/99.49 Lateral 4 Invert 99.00 98.97 Lateral 4 Chamber top 99.46 99.44/99.47 Page 4 of 4 This is to certify that New England Engineering Services Inc. has inspected the subsurface sewage disposal system installed at 1580 Salem Street, North Andover, MA. The system has been constructed in compliance with 310 CMR 15..00, the approved design plans dated 7/8/2004, most recent revision date 8/9/04, and local requirements, except as noted herein. *Note: Boulder retaining wall and impervious barrier not installed at time of inspection. INVERT ELEVATIONS ACTUAL DESIGN FOUNDATION 96.61 96.68 TANK IN 96.12 97.00 TANK OUT 95.81 96.75 PUMP IN 95.74 96.70 PUMP OUT 95.89 96.45 A5 D-BOX IN 99._31 . 99.27 A6 D-BOX OUT - 99.14-. - 99 10 A 98.99 99.00 B 99.00 99.00 C 98.97 99.00 D 98.97 99.00 _ E 99.06 99.00 N/F OWLLO F 99.05 99.00 G 99.05 99.00 H 99.02 99.00 / BO T TOM OF BED 98.49 98.46 SYSTEM TIES 1 TO TANK 37.8' 2 TO TANK 58.0' 18" MAPLE / 1 TO PUMP 49.2' 2 TO PUMP 70.0' 1 TO D-BOX 71.8' " 2 TO D-BOX 92.5' 1 TO A 71.0' 1 TO E 77.7' 2 TOA 91.2' 2 TO E 87.0' 1 TO D 80.4' 1 TO H 87.0' 2 TO D 100.4' 2 TO H 97.0' 40 MIL BENJAMIN IMPERVIOUS OSGOO�,�R CIVIL BARRIER No.46891 GIST 20' 0 20 40' 60' VENT 1 AS-BUILT SEPTIC SYSTEM 1580 SALEM STREET, NORTH ANDOVER, MA ASSESSORS MAP 106B, PARCEL 56 PRESSURE SCALE: 1" = 20' DATE: DECEMBER 14, 2004 WATER SERVICE NEW ENGLAND ENGINEERING SERVICES 60 BEECHWOOD DRIVE E NORTH ANDOVER, MA D"W-- GAS SERVICE (978) 686- 1768 T ELECTRICAL SERVICEDRAWN CHECKE14D Pix #' 863SAB BY: S.E.P. BY: S.G.B. & B.C.O. jr. N/ n1my & FINOCCNIMOS11°56'35"E 158.00 1580 SALEM STREET ASSESSORS MAP 106B, PARCEL 56 45, 100 SQ. FT A3 N/F CAM30NML BENCHMARK: FRONT RIGHT I - CORNER OF BOTTOM STEP. ELEV 100.00 (assumed datum) I E 2 ON�NOVS6a _ � - 4 pEpR ELS 100 G 25 NO DISTURB ZONE B3 SELL 1 W ISOLATED WETLAND . 425 SQUARE FEET N 1500 � SEPTI( 50' NO BUILD ZONE et cP_ BOULDER F B2 O 1000 GALLON PUMP CHAMBER DISTRIBUTION BOX TP` G A 100' BUFFER ZONE TP 1 �1 , LOCUS MAP NOT TO SCALE PT1 M F° LIMIT OF SAND BOXFORD ST INSPECTION PORTS (typ.) N� SITE 0.34' S 14°51'19"E LR w SALEM e vy Map-Block-Lot Commonwealth of Massachusetts �,`•• �• 106.B-0056- • ----------- Board of Health Permit No - : North Andover B-HP-- -------------2004-1193-- .«rXhS... • p.l. FEE F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted JAMES KELLETT - -------------------------------------- -------- ---------------------------- to(Repair)an Individual Sewage Disposal System. at No 1580 SALEM STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------s shown on the application for Disposal Works Construction Permit No. BHP-2004-119 Dated November 24 2004 ----------------------------------- --------------------------- Issued On:Nov-24-2004 -- ------------ -------------------------------------- Board of Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map-Block-Lot 106.B-0056- Board of Health ------------------- North Andover Certificate of Co "nc THIS IS TO CERTIFY,That the Indiv' u SST ewa e Disposal g p . System (Repair) by JAMES KELLETT -------------------------- -------------------------- Installer at No 1580 SALEM TREET ---------- --- -------- --- ----------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2004-119 Dated November 24 2004 - - - --- --------------- ------ ----------------------------------------- Printed On:Nov-24-2004 ------------------- Board of Health .........................................................................•------------------------ Town of North Andover Health Department en Date: 1�11"4171141 Location: ' (Indicate Address, if ResidentiaI,or Name of Business) Check#: d Type of Permit or License:(Circle) > Animal $ > Dumpster ➢ Food Service-Type. $ > Funeral Directors $ > Massage Establishment $ > Massage Practice $ > Offal(Septic)Hauler $ ➢IlLreational Camp > SEPTIC PERMITS: E3 Septic-Soil Testing Ll Septic-Design Approval $ to eptic Disposal Works Construction(DWQ E3 Septic Disposal Works Installers(DWI) > Sun tanning > Swimming Pool $ > Tobacco $ > TrashlSolid Waste Hauler > Well Construction > OTHER-(Indicate) Health Agent Initials 269 White-Applicant Yellow-Health Pink-Treasurer Q Q TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �9sSAHUCHH S Susan Y.Sawyer,RE.HSIRS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthde t autownofnorthandover com. www.townofnorthandover.con APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:—// LOCATION: Is—go 5,4 C. LICENSED INSTALLER NAME: Ile-/7Z PLEASE PRINT SIGNATURE. TELEPHONE# 1 l �3� � CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? �._ _ Yes No 6 Approval of Health Agent �J// Date: I Q 0 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at (3-9-o 9-o 5AI'fr^ Sf, relative to the application of t.)t dated 7 for plans by /V� er LInd dated —U with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site j when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the 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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction,steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Under ' tied Licensed Septic staller Date:.// 21V_ V Zoal Works Construction Permit# J . I TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( )constructed; ( )repaired; by located at was installed in conformance with the North Andover Board of Health approved plan, System Desi P y � cruet# , plan dated , with a design flow of 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. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: Lic.#: Date: Engineer: Date: C TOWN OF Ng �"hr N VER oe� �o ;�gtioflL HEALTH hEP RTMENT p 27 CHARLES STREET eh NORTH ANDOVER, MASSACHUSETTS 01.845 $ACHUS Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax healthdept@townofnorthandover.com www.townofnorthandover.com FAX Benjamin C.Osgood,Jr., EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES,INC. 60 Beechwood Drive North Andover, MA 01845 978-685-1099 Pages: Fax: 978-686-1768 Date: f� Phone: Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File 0 TOWN OF NORTH ANDOVERpOR*M Office of COMMUNITY DEVELOPMENT AND SERVICES "'° ��a°� 2. I ..,'° O HEALTH DEPARTMENT 27 CHARLES STREET c NORTH ANDOVER, MASSACHUSETTS 01845 'SsgCHU Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX August 13,2004 George&Marjorie Sears 1580 Salem Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 1580 Salem Street,Map 10613,Parcel 56,North Andover, Massachusetts i Dear Mr.&Ms. Sears, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services last revised on August 9,2004 and received by this office on August 11,2004. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(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 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. 3. The plan does not call for installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use,if you choose to install one.. 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. Sincerely, S an Y. Sawyer,REHS/RS ublic Health Director encl: List of licensed septic system installers cc: file New England Engineering Services Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, July 28, 2004 1:18 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 1580 Salem Street Sue and Pam, Attached please find the approval letter for the plan for 1580 Salem Street. Dan Mill River consulting Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com I 8/13/2004 0 o NEW ENGLAND ENGINEERING SERVICES INC August 11, 2004 Susan Sawyer FREeCTIVEDNorth Andover Board of Health 27 Charles Street 1 2004North Andover, MA 01845EPARTM NT R Re: 1580 Salem Street, North Andover Septic System Design - REVISED Dear Susan, Enclosed please find five (5) copies of the Revised Septic Design Plans for the aforementioned property. The revisions to these plans involve modifications to the wetlands lines only and do not affect the septic system design. The system is still located more than 100' from the wetlands. The purpose for this submission is to maintain consistency between the Board of Health records and Conservation Commission records for this property. Therefore, please have the approval letter refer to these newly modified plans. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 i. StoR*rh,9 TOWN OF NORTH ANDOVER or°.;� HEALTH DEPARTMENT F . _ 27 CHARLES STREET # X NORTH ANDOVER,MASSACHUSETTS 01845 S C64u5 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—Fax healthdept@townofnorthandover.com www.townofnorthandover.com FAX Benjamin C.Osgood,Jr., EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES,INC. 60 Beechwood Drive North Andover, MA 01845 Fax: 978-685-1099 Pages: 978-686-1768 Date: �,� Phone: s' Septic Plan Response CC: F e Re: ❑ Urgent x For Review ❑Please Comment ❑Please Reply ❑Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: 1115 �" A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File `� r/ M, TOWN OF NORTH ANDOVER O Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET I NORTH ANDOVER. MASSACHUSETTS 01845 �'ss•►�►1Ug�� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX July 28,2004 George&Marjorie Sears 1580 Salem Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 1580 Salem Street, Map 106B,Parcel 56,North Andover, Massachusetts Dear Mr.&Ms. Sears, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated July 12,2004 and received by this office on July 13,2004. The design has been approved for use in the construction of a replacement onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(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 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. 3. The plan does not call for installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use, if you choose to install one. 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. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director I encl: List of licensed septic system installers cc: file, L-,New England Engineering Services I TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET •ono NORTH ANDOVER, MASSACHUSETTS 018 'SSACMUgt� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX July 28,2004 George&Marjorie Sears 1580 Salem Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 1580 Salem Street,Map 10613,Parcel 56,North Andover, Massachusetts Dear Mr.&Ms. Sears, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New'England Engineering Services dated July 12,2004 and received by this office on July 13,2004. The design has been approved for use in the construction of a replacement onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil esaluation,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 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. 3. The plan does not call for installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use, if you choose to install one. 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. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director encl: List of licensed septic system installers cc: file New England Engineering Services Page 1 of 1 Dellechiaie, Pam �I From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, July 28, 2004 1:18 PM To: -usa Sn awyer;amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subj ct: 58 10 Salem Street Sue and Pam, II'I Attached please find the approval letter for the plan for 1580 Salem Street. Dan X11 River consulting Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 w.w__w millriverconsulting.com info�a)millriverconsulting.com 7/28/2004 �t O Totvn,v'f North Andover Health Department Date: Location: (Indicate Address,ifrResidential,�or Name of Business) Check#: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ Septic-Design Approval ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials 150 White-Applicant Yellow-Health Pink-Treasurer o Q NEW ENGLAND ENGINEERING SERVICES INC j July 12, 2004 Susan Sawyer RECE \0 North Andover Board of Health 27 Charles Street North Andover, MA 01845 JUL 13 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Re: 1580 Salem Street, North Andover Septic System Design Dear Susan: The following plans and enclosures for the above referenced property are being submitted for approval. 1. (5) Copies of the Septic System Design Plans. 2. (1) Copy of the soil evaluator sheets. 3. (1) Check for payment of the Town approval fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, S even E. Pouliot Project Manager i 60 BEECHWOOD DRIVE-.NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 ':;u. ,::Jr �,UU•: GL: i 7 1 i U1 JJ'\('/9:l�Jl1]i v - i HIYIHI:LG'. r PAQC_ —Ul.. FORM I I SOIL EVALUATOR FORM Page I of 3 No. Date-. �� ?ate: /JC�ommf onwealttJlk�.� of :�p1ssacchuse ��p� (t�ts etts Soil Suitability Assgssment ror On-site Sewage-Disposal Perforrned By: .... i� ,�'�. G' .�x��,�: Date. Witnessed By: f�}1�� ` l.c anon�dGress a �"J�� ';��.. .� • -1! h»<e'i Nl:+tt, �/�G�I�•S:�'�' „� .%' _� E { �ew construction ❑ Repair K Office Review Published Soil Survey AvaJable: No ❑ Yes ' t� b ' Year Prablish►cr �,.:.....:..: Publication Scale Soil-Map Unit :7 Drainage Class ' ..:...,..,Soil Limitations r� '�• .... . Surficial Geologic Report Available- No 21 Yes 'year Published - Publication Scale Geologic Material (Chap Unit) ........... Landform. -- 1=1 eod Insurance Rate Map: Above 500 year flood boundary No ❑yes V1 Within 500 year mood boundary No Oyes ❑ Within 100 year flood boundary No 17 yes ❑ Wetland Area: National Wetland Inventory Map (map un-it) ...... ......... .... Wetlands Conservancy Program Map (map unit) ................. ... _.. Current '`'Vater Resource Conditions(USGS): Month Range :Aboye Normal ❑Normal F�j'Belc i.v Normal ❑ Other References Reviewed: PEP AXPROVED FORM•17107195 J�i� 1 3n g ER 24 DHEALT Fi �EPARTMENT - Jv!'L.:Jr GJ!:JY G.cA .J 1i X1:7 J`tVLlJ IHl:il'1fil�lJr. [/`^J\] - rHVc. .0 ` FORM 1) - SOIL EVALUATOR toOkNI Page 2 of 3 Location Address or 1-ot rvG. - On-nits ReviFe� Deep Hole Number Date: lime://� �� Weather /'�fV Location bdeA*fy on site plant Land Use .. � / �/Ti{v�� Slope Surface Stones Vegetation A%71> Landform Position r,n iand;;cape �- '7 Disxa;l£es `rom: Open Water Body / ' feet Orainage way 4I1�0 feet Possible ',f4'et Area feet Property line 4. eet Drinking Water Well, /.fes feet Other DEEP OBSERVATION HOLE LOG I f pep t" froSoil Horizon r m Soil,TeXtJro Soil Color So:! Surface(inches' (USDA) (Munseli) Mitttling (Srry P.r.2, Stones, 4ovders, Consistency, `•;- j � `. eny� r 3 .. �.�/✓/^� � r f y 6l C2 o f Parerr. Materiel{pen(ogicl �""'��f Gam/ tae oBednx;t;: ,..�. . y 2ewt,>,-ta er Groundwat ; 5sanding Water inthe Hole: _ Weeping from Pit Face:_ <.F tea T Estimated Seasona? High t,rn•end r:Wat 9 8 DEP APPRON19O FORM• f 2r4'!SS �?7 4Vv4. .:L.1 D A /O_.:J-�4tJ11 rHiYUr-tKL4� f✓(-��'it Y� O FORNI. 1.1 • SOIL EVALUATOR };QlRM Page 2 (if 3 I ?,,cation Address or Lot NO, On-site &evte Deep Hole Number ... bat=o,47— tify d ��"- v --� Time. / Weather Location {ide� on site plan!L anti Use f }r'// J `r//g� slope Surface Stones vegetation Landform 4. . // Position on landscape j`"` 75 �O Distances from; Oper Water Body/: `f feet Drainage way �� feet ?oss;b;e Wet Area //0 feet Property line 6 feet Drinking Water feet Other .,. [SEEP OBSERVATION HOLE LOG raepth from Spit Horim Soil Tex+,uta Soil Color 5011 Qtrier y Swface(Inches) (USDA) (Munseil) Mottling i (structure.stones,80u1dsrs.Consi�ienor, ; Gravel) f ) fE ter. Parent Materiel(geologic) � ! / _ �i7 �L�t 7 Dapttsto�edraek: 2tej! to Grpundwatcr: Standing Ntater in thy Hole: weeping`rom.Pit Sacs; Evimateo seasonal high Gmvnd water;_ _ _ � ✓,.f�_��.. ---� _ _____, _._ DU AITROVED FORM-12107:95 i 1r'4 RIM I 1 - SOIL ,~~VALUATOR FoRAI Page 3 of 3 ,r- Location Address or Lot No. Dete in atio far Se or-.l Pi li ater Table ML hod Used. Depth observed standing in observation hole : :. . . . inches L_ Depth weeping from side of observation hole inches Depth to soil mottles .:: ...:. . inches -,�- oe Ground water adjustment ...... ..._.. feet rndex Well Number .. ............ Reading Date .......... ... Index well level .... Adjustment factor Adjusted ground water level ........ ....... .... ._ ... .. Ge.�!� c# Natuna{iv Occurring PErvious Material Coes 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 I cerxify that on (date) i have passed the soil evaluator examination approved by the Dep rtment of Environmental Protection and that the above enalysis was performed by me consistent with the required training, expertise and experience described in 310 0PAR 15.017. Sic�natur 'f „_ Date i DEP A4'PROVE:D FOMI•!z1t�7if5 tiORTH TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ' p 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 SRCHU`� Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax FAX DanielOttenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑Please Comment ❑Please Reply ❑ Please Recycle • Comments: / Septic Plan Review Soil Test OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: G� Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File-Address HP Fax K1220xi Log for NORTH ANDOVER 9786889542 May 112004 11:1 lam Last Transaction Date Time Twe Identification Duration Pae Result May 11 11:09am Fax Sent 819782820012 1:34 2 OK Towne North Andover Health Department Date: Location: � o CEJ (Indicate Address,if Residential,or Name of Business) Check#: (P . Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: e Septic-Soil Testing $ ttf ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER(Indicate) 053 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer T \ �• - { ^ L[OARD OF HEALTH \' NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: r`� 6 y MAP&PARCEL: Acio 10(0 df LOCATION OF SOIL TESTS: /Jrc�O �c I•ems OWNER: TEL.NO.: ADDRESS: 1EEQ >dem /lL64'k AyAoyer, AA ENGINEER:1v XP,.,) E. v, TEL.NO.:_I�T 7 8 I 68(.— J'768 CERTIFIED SOIL EVALUATOR: Ren - :Tr Intended use of land: Residential Subdivision Singl Family Home ) Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No 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 ofnew 425.00 per lot for �_p _construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 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 disposal area. 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. • Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: t a A Q O W e Set SHEET I ,� 3. So co 0 0AD •� o �Z 3�y�o,, w u , n1 �syr �pRTtd ,9 0# S44O 16 s kOp j)QV�R T®`xT'N ®F N®j�T� T ragp..a ,yx Yr i9SSACliUs'`•l C HARLES SA�U'ETTS 01845 ANDOVER,mp's 40_Phone NORTH„ 978.688.95 4? Fax 978.688.95 Sayer,REHSIRS I_"--- isan or �' 1 public Health Direct From: Pamela FAX Daniel Ottenheimer tConsulting o: Mill River pages, 978.282.0012 pate: Fax: i� 1.800.377.3p44 or Phone 978.282.0014 CC: Request for Soil Testing or Re Septic Plan Review [3 Please Recycle lease Comment ❑Please Reply ❑P U urgent X For Review �THER—� made to pick • Comments: Soil Testes or arrangements $eptic Plan Review' Plans will be mailed Ian reviews, this is notification only. Note. For p uested. them up as req I r3 s Address' with any questions. Thank you. Please call 978'6889540 for assistance Cc. File_Address HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 May 112004 11:1lam Last Transaction Bate Time Twe Identification Duration Pages Result May 11 11:09am Fax Sent 819782820012 1:34 2 OK BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS I DATE: MAP&PARCEL: 1 106 13 b f 5 6 LOCATION OF SOIL TESTS: I,6-s 0I OWNER: lar c'o C,le- ser -5 TEL.NO.: L ADDRESS:_�5_ '�C� �ci�I t�urn S� j .R��,r AiaLw , AA ENGINEER:%l� ` , w erre a �er�,�e� TEL NO.: (97 CERTIFIED SOIL EVALUATOR: Renw,awkyj Intended use of land: Residential Subdivision r'Singlami;i'y Home Commercial Is This: Repair testing g _ Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No_ x 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$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. OnlyCertified ed 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 disposal area. 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. Please Do Not Write Below This Line N.A.Conservation Commission Approval: p r, of dri Date Received: Check Amount: Chec .�_a e J T W11 OF NORTH ANt30l-r 0i BOARD OF HEALTH MAY 18 2001 c �w 0 ' 'p � e / f ,0' '7 SF S �- �- 3. S0 Ar co i I LV cp 04/ Ir a� ay • o i . ti - sv C4 ir! 0 � D• �L\ Commonwealth of Massachusetts o City/Town of NORT ANDOVER MA SA HUSUPTS System Pumping"Record NOV 1`4 2007 Form 4 DEP has provided this form for use by local Boards of He 11RMLAL"WMtTl6if*tb $' g Record must be submitted to the local Board of Health or other approve A. Facility Information Important: When filling out 1. System Location: forms the kkm Scomputeto r,use 79�.JJ cJ only the tab key A'dre- � L G cn,`ll r to move your `(V��l V V cursor-do not City/Town State Zip Code use the return key. 2. S stem Owner: Name Address(if different from location) I City/Town State C1 _ ,,,-,Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date vz 2. Quantity Pumped: Gallons 5o I Type of system: ❑ Cesspool(s) 2rSeptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes GeNo If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: ULM, luau wNt+ . N e *s . Vehicle License Number �Ao il t Company 7. Location where_ contents were disposed: �010 teal gnature of Hauler Date http://www.mass-gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) 0 DATE OF PUMPING: �`�9 ?� QUANTITY PUMPEDGALLO tS CL'SSI OUL. NO r/ YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY 013SERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYS TEM P BIPED BY: y Y- C O NI N1 E N T S: d ed t1 CONTENTS TRANSFERRED TO: TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS -SYSTEM LOCATION (example: left front of house) CA' DATE OF PUMPING:��' �?-Cl QUANTITY PUMPEDGALLONS CESSPOOL: NO v YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED e� SOLIDS CARRYOVER OTHER (EXPLAIN) SYS T EM PU`M-P ED BY: COMMENTS: TCS WN OF NORTH A;,"DO\, DEC - 7 2001 CONTENTS TRANSFERRED TO: toy Fvce�rst. b110D FORM 4- SYSQm PUMPING RECORD t i n�{lelMA 01949 fill 5�Q( C,�. 5 TOWN OF OF HEALTH I Z 1996 ..Commonwealth of.Massachusetts o)-A 4&1AAZoe- _, Massachusetts Cl.. Pumping Record ystern Amer 6ystern Location T `AAS Date of Pumping: - Quantity Pumped: lj De gallons Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes ®� System Pumped b.: License #: Contents transferred to: i Date Inspector I 04/06/1997 15:02 5083736611 STEWART/ANDOVER PAGE 01 San= enc 88 MME A/o r4 A nnay..- 67 p gam, Mh 01835 Q+av J Lie. !60-opµ 578-372-7471 . Aa7.0 "mm or pmICWcIP �R6 q tom► �: feod I' �j nnan .pr. tsoo (?Ar/ Asn lar e -� fog �'I i /0�5 13oclC �rd01C. !� -r �o o m tS I(a� an�'gr1 dar' 1 10 �aIle rrn Ign . SC�Q r TOWN'OF NORTH ANDOVER SYSTEM PUMPIN G RECORD 1 Ip <. tb r v tU y^, , I _.x1. t S p, +w'.,{ � 1. S a A� ,1-• r k div 14 J Y SYSTEM OWNER&.ADDRESS SYSTEM LOCATION p ,�r (example: l front of house) A I 1 Y�p wr R OV; � j M1�kk��rt}fsMtroa14 r�nl ..'NIIc 3i 'r 4n tk{ r p 4 . �.L ; 4^( ....,_.. r •, ri7777777 - �'��' �',rx�F ,.QUANTITY PUMP �� ED�_GALLONS ESSPOOLt' NO .YES_�. SEPTIC TANK: NO YES w ,I�IATIItE OF SERVICE: ~ ROUTINE EMERGENCY IN pf p urr 3,rFVATIONS;. �� ' :;'..00OD CONDITION ,.. �, FULL TO COVER if, tjt 5 HEAVY GREASE BAFFLES IN PLACE00 v <� EXCESSIVE ..._._ LEACHFIELD RUNBACK SIVE SOLIDS FLOODED SOLIDS CARRYOVER ------- OTHER(EXPLAI1Va OF RX �}1C�psR�. I tr P*■1T�M�7rf t a � i t+Th n, VI. , .77 < n h t• I i ,4 °r� y��ji�,��P ra��5/{��yk.l+µ k�°i^{A�l�at J.}jt t: hl f, z�jf,. ,•fin c.� 1»^ r q ;bqd t tl I k 7, r '. e TOWN tOFN0 T $ HANDOVER SYSTEMPWRECORD ,.J �- � a DATE_',ALOV•Q5 ok003 + w SYSTEM OWNER&ADDRESS SYSTEM LOCATION Sea -471) l IgD �lerrlsT N 01Vd6ve_r, 1 a DATE OF PUMPING //- QUANTITY PUMPED_ 00�) �_ CESSPOOL NO _ �.YES SEPTIC TANK NO YES___k NATURE OF SERVICE, ,RQyTINEEMERGENCY 7. f•�r OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE I ROOTS LEA HF C IELD R UNBACK -Z EXCESSIVE C VE SOLID S -FLOODED FL ODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY Z I k COMMENTS: CONTENTS TRANSFERRED TO OF NORTH'ANDOYM SYST�M PUkPING "Co" s1-.'TEM OWNER & ADDRESS r SYSTEM LOCATION - (example:-left front of house) . of fuse; /spa . Sc✓/r� .�� ''�� v:�'I'F OF PUMPING: QUAIKTITY PUMPED CALLc», CESSPOOL: N YE9 SEPTIC'TANX: NO YES a NATURE OF SERVICE; ROUTINE, EMERGENCY ollirRVATIONs - GOOD CONUITIOX FULL TO COVEk HEAVY GREASE BAFFLES IN PLACL ROOTS LEACHFIELD RUNBACK. FXCESSWE SOLIDS FLOODED SOLIDS CARRYOVER HftR (EXPLAIN) i1's'IT-11 t PUWt-613Y: • -' -`• ' r' C V�I lvi FATS: ONTE?TI'S TRANSPGRR80 T0: �.