HomeMy WebLinkAboutMiscellaneous - 1591 OSGOOD STREET 4/30/2018 (2) 1591 OSGOOD STREET
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FILE COPY
North Andover Health Department
Community Development Division
August 7, 2013
John Sullivan,P.E.
22 Mount Vernon Road
Boxford,MA 01921
Re: Subsurface Sewage Disposal System Plan for 1591-1595 Street(Map 34,Lot 4)
Dear Mr. Sullivan:
The proposed wastewater system design plan for the above site dated May 10,2013 and received on July
23, 2013 has been reviewed. Unfortunately,the plan cannot be approved until the following items are
corrected. The specific section in Title 5: 310 CMR 15.000,or North Andover regulation that is not met
by this design follows each item where applicable.
d
/ A locus plan is required(3 10 CMR 15.220(4)).
he soil evaluation Form 11 for DTH-2 indicates redoximorphic features at 40".
c,—3. A scaled profile of the system is required(NA 3.2).
4-4-- Please indicate whether or not the presence of a wetland resource area is within 100' of the
proposed system.
L-Y`On Sheet 1.of 2, General note#18 indicates maintenance requirement for an effluent filter. If one
is being proposed in the existing tank please provide the DEP approved brand and model (NA
3.2).
On Sheet 1 of 2,the proposed grading is within 5 feet of the property line therefore a Swale
should be proposed(3 10 CMR 15.255(2)).
L,Y. On Sheet 1 of 2,the proposed grading between the 100, 102 and 104 contour is not a 3:1 slope
(310 CMR 15.255(2)).
�~ On Sheet 2 of 2,the distribution box indicates a 3"drop between inlet and outlet but the detail
indicates a 2"drop. Please indicate the correct drop between the inlet and outlet.
^L-9---On Sheet 2 of 2, please indicate the size of the proposed manhole cover above the distribution
box.
��On Sheet 2 of 2,the profile view indicates a 0.03' drop from the outlet of the distribution box to
the inlet of the Cultec chambers. However,there appears to be 18' from the distribution box
outlet to the most northern chamber inlet. A 1.0% slope should be maintained from the
distribution box outlet to the inlet of the Cultec chambers.
X11. Please reference the appropriate document that specifies the allowance of crushed stone between
the Cultec Chambers.
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
12. Since the Cultec Chamber system is proposed as an alternative soil absorption system the
"Standard Conditions for Alternative Soil Absorption Systems with General Use Certification
and/or Approved for Remedial Use"will apply. Please provide the following as required by the
approval conditions Section Il(18):
- proof that the Designer has satisfactorily completed any required training by the
Company for the design and installation of the Technology;
- certification by the Designer that the design conforms to the Approval, any Company
Design Guidance, and 310 CMR 15.000; and
- a certification, signed by the Owner of record for the property to be served by the
Technology, stating that the property Owner:
1. has been provided a copy of the Title 5 IIA technology Approval, the
Owner's Manual, and the Operation and Maintenance Manual, and the
Owner agrees to com ly with all terms and conditions
2. for Systems installed under a Remedial Use Approval, the owner agrees
to fulfill his responsibilities to provide a Deed Notice as required by 310
CMR 15.287(10) and the Approval;
3. for Systems installed under a Remedial Use Approval, the owner agrees
to fulfill his responsibilities to provide written notification of the
Approval to any new Owner, as required by 310 CMR 15.287(5);
4. if the design does not provide for the use of garbage grinders, the
restriction is understood and accepted; and
5. whether or not covered b a warranty, the System Owner understands
y �� y
the requirement to repair, replace, modify or take any other action as
required by the Department or the LAA, if the Department or the LAA
determines the System to be failing to protect public health and safety
and the environment, as defined in 310 CMR 15.303.
13. A deed notice will need to be recorded prior to construction in accordance with Section IV of
"Standard Conditions for Alternative Soil Absorption Systems with General Use Certification
and/or Approved for Remedial Use".
14. In accordance with Section 11(7)of"Standard Conditions for Alternative Soil Absorption Systems
with General Use Certification and/or Approved for Remedial Use",please provide a best
feasible upgrade plan.
Please feel free to contact the office with any questions you may have. We look forward to working with
you to obtain a wastewater treatment and dispersal system which will be in compliance with all
regulations and assure protection of public health and the environment of North Andover.
Sincerely,
Susan Y. Sa ;'/e /RS
Public Het th
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035 ,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
• S�gTL'ED'���' .
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PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 10/15/2013
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Construction of an
On-Site Sewage Disposal System
By: William Sawyer
At:
1591 Osgood Street
Map 034.0 Lot 0004
North Andover, MA 01845
i he'Issuance of this ce 'fic ,shall not e construed as a guarantee that the system will function satisfactorily.
likchhLel'eGrant
Public Health Agent
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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North Andover Health Department
Community Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 1591 Osgood Street MAP: 034.0 LOT: 0004
INSTALLER: William Sawyer
DESIGNER: Jack Sullivan
PLAN DATE: 9/12/2013
BOH APPROVAL DATE ON PLAN: 9/13/2013
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑ Contractor reports any changes to design plan
Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
Comments:
SEPTIC TANK (existing tank)
-�❑ Building sewer in continuous grade, on
� compacted firm base p
CleanoutsIan er �u�.
p p /�
2l(45 $tom Bottom of tank hole has 6" stone base
Weep hole plugged
1500 gallon tank has been installed
H-10 loading
Monolithic tank construction
Water tightness of tank has been achieved by
visual testing
Inlet tee installed, centered under accessp ort
t
Outlet tee installed, centered under access port
(gas_ baffle/effluent filter)
inch cover to within 6" of finish grade
installed over one access port
Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ \Alarmfl
ole plugged
❑ allon Pump Chamber installed
❑ ading
❑ hic tank construction
❑ installed, centered under access port
❑ ) installed on stable base
❑ at working
❑ n ff floats working
❑ te o off floats
❑ Drain hole in essure line
El cover at ",al grade installed over pump
access port
❑ Water tightness of to has been achieved by
testing
❑ Hydraulic cement around inlet & outlet
Comments:
CONTROLPANEL
❑ Alarm & Pu are on separate circuits
❑ Alarm sounds w n float is tripped
❑ Location of control el: basement
❑ Alarm signal located ins e: basement
Comments:
DISTRIBUTION-BOX
X Installed on stable stone base
X H-20 D-Box
X Inlet tee (if pumped or >0.08'/foot)
X Hydraulic cement around inlet & outlets
X Observed even distribution
X Speed levelers provided (not required)
Comments:
f
SOIL ABSORPTION SYSTEM (General)
X Bottom of SAS excavated down to C soil layer,
as provided on plan
X Size of SAS excavated as per plan
❑ Title 5 sand installed, if specified on plan (no
sand needed)
❑ 40 Mil HDPE barrier installed
X Laterals installed and ends connected to
header (and vented if impervious material
above)
X Elevations of laterals and chambers installed as on
approved plan
❑ Retaining wall (boulder/ concrete /timber/ block)
X Final cover as per plan
Comments: first section: 15'1"x127' —depth as top of system 6'
SOIL ABSORPTIONY -
SSTEM (Gravel less Chambers)
Brand and Model of Chamber: Standard Quick
4 Infiltrator Chambers
❑ Number of chambersp er row: 13
❑ Number of rows (trenches): 5
Comments: Total Chambers = 60 {
i f1 C.
/►t V
c.
-f- 2
, ✓Ga
FINAL GRADE
, S �,b�t��
X Loamed
X Seeded z� ��� q �� 3
X Cover per plan
Comments:
DOCUMENTS NEEDED
Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
As-Built Plan
L CL'
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
Tank SAS Sewer
® Property line 10 10 --
® Cellar wall 10 20 --
® Inground pool 10 20 --
® Slab foundation 10 10 --
® Deck, on footings, etc 5 10 --
® Waterline 10 10 101
® Private drinking well 75 1002 50
® Irrigation well 75 100
® Surface Water 25 50
® Bordering Vegetated Wetland ,
Salt Marsh, Inland/Coastal Banka 75 100
® Wetlands bordering surface
water supply or trib. (in Watershed) 150 150
® Trib. to surface water supply 325 325
® Public well 400 400
® Interim Wellhead Prot. Area
® Reservoirs 400 400
® Drains (wat. supply/trib.) 50 100
® Drains (intercept g.w.) 25 50
® Drains (Other)Foundation 10(5) 20(10)
® Drywells 20 25
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA
wetland bylaws
Town of North Andover — Septic System AS-BUILT CHECKLIST
1)
—!<All changes to the
design plan have been reflected on the as-built
2) {< Is of suitable scale; (one inch =40 feet or fewer for plot plans and one inch= 20 or fewer for details of system
components)
3) JV*"' Lot number,Street Name,Assessors Map and Parcel Number
4) t 'nes and Location of Dwellings served by the system
5) Locations,Elevations and Dimensions of system,includin serve (if applicable)
6) f Ties to dwelling or Permanent Structure&Wells
,,,,"./a. From Septic Tank&Distribution (D) Box
b.From Leach Area
7) Ties to Lot Lines from leach area
8)
*""Locations of Deep Holes&Peres
9) ' Top of Foundation Elevation
10) Locations of Wells,Drains,Watercourses within 150 feet of system
11) &e ocation of water,gas,electric lines,cable
12) �cation of Structures within 6 Inches of Finished Grade
13) riginal Stamp&Signature
14) Location and holder of any easements which could impact the system
15) —leffIm ervious Areas;Driveways,etc
16 K
North Arrow
17) �Location&Elevations of Benchmark used
18) STATEMENT ON PLAN(NA 5.3)
certify the locations,elevations, ties,cover material;exposed component covers etc.,shown on
this as-built substantially agree with the approved plan and have determined that the break out
elevations,if applicable,have been met."
Signature of Designer Date
"If a STUCTURAL WALL IS PRESENT W 4.9)a Letter or statement on the as-built hidicatjnz the
wall- was,or was not.constructed in accordance with the intended design and anvmanufacturer's
stiecifications." '
Signature of Designer Date
As of:Friday,April 29,2011
Sullivan Engineering Group, LLC
Civil Engineers&Land Development Consultants
October 3,2013
Town of North Andover
Board of Health
Re: 1591-1595 Osgood Street, North Andover
Certification for Alternative Soil Absorption System
Quick4 Plus Standard LP (Infiltrator)
Board of Health;
1591 Osgood Properties, LLC, owner of 1591-1595 Osgood Street,provides the following certification in
accordance with Section 11(l 8)of"Standard Conditions for Alternative Soil Absorption Systems with General
Use Certification and/or Approved for Remedial Use':
1) The owner has been provided a copy of the Title 5 I/A technology approval,the Owners Manual, and
the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and
conditions.
2) The owner agrees to provide a Deed Notice for the"Alternative Sewage Disposal System". Proof of
the recorded deed notice will be submitted to the Board of Health.
3) The owner agrees to fulfill his responsibilities to provide written notification of the Approval to an new
Owner, as required by 310 CMR 15.287(5).
4) The design does not provide for the use of garbage grinders and the owner understands this.
5) Whether or not covered by warranty,the System Owner understands the requirement to repair, replace,
modify or take any other action as required by the Department or the Local Approving Authority
(LAA), if the Department or the LAA determines the System to be failing to protect public health and
safety and the environment, as defined in 310 CMR 15.303.
Print Owners Name:
J,V/iS / 3
Date:
Owners Signature:
22 Mount Vernon Road Boxford,Massachusetts 01921 (978)352-7871-Phone 978352-7871 -Fax
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pr 'A ed: ,'ciober- 11 201: 'a• 1 '. 2G
Essex North Registry
M. Raul Iannuccilio
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Trans#: 2515ti ope -RRECO,
)9' YTI; rRuRER.TIES LLC
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Notice of Alternative Sewage Disposal System
M.G.L. c. 21A, § 13 and 310 CMR 15.0287(10)
This Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative
ewage Disposal System("Alternative System").]
NAME(S)OF OWNER OF PROOPERTy SERVED BY ALTERNATIVE SYSTEM:
40 /
SSA• cJrp��r i �s�, LLC.
ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM:
/tel — /�9�� sga®� �S'fre�t Nor'-fG� �✓�c�ay�r
TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and
complete each that applies]: _ /
Deed recorded with theESSeX A100%Registry of Deeds in Book/356 Page J�
_Certificate of Title No. issued by the Land Registration Office of the Registry District
Source of title other than by deed
[If Alternative System Owner(s)is other than Property Owner(s),complete the following:]
Alternative System Owner Name: A/ /
Alternative System Owner Address:
WHEREAS, Section 15.280 of Title 5 of the State Environmental Code("Approval of
Alternative Systems'),provides for the Massachusetts Department of Environmental Protection(the
"Department")to approve or certify, as appropriate,all proposals to construct,upgrade or replace on-site
sewage disposal systems using alternative systems;
WHEREAS, owners and/or operators of approved or certified alternative systems are subject to
general conditions,as specified in Section 15.287 of Title 5 of the State Environmental Code, 310 CMR
15.287, and may be subject to special conditions,as specified in the Department's approvals or
certifications; such general and special conditions potentially including,without limitation,requirements
relating to the use of trained operators,periodic inspections,maintenance, sampling,reporting and/or
recordkeeping;
WHEREAS, Section 15.287(10)of Title 5 of the State Environmental Code, 310 CMR
15.287(10),requires that"prior to obtaining a Certificate of Compliance for installation of a new or
upgraded system,the system owner shall record in the chain of title for the property served by the
alternative system in the Registry of Deeds and/or Land Registration Office, as applicable, a Notice
disclosing both the existence of the alternative on-site system and the Department's approval of the
system. The system owner shall also provide evidence of such recording to the local Approving
Authority[J"and
WHEREAS,the Property is served by an alternative sewage disposal system.
NOW,THEREFORE,Notice of an alternative sewage disposal system is hereby given for the
above-referenced Property, as follows:
1. Existence. An alternative system has been installed as a new or upgraded alternative sewage disposal
system,on or adjacent to the Property, and serves the Property. The trade name and model number(s)of
the alternative system are as follows: L� �__ JJ-- -J
Trade name of technology: /,[Ick `l 91a, S&noh rC, LP
Manufacturer Name: r fl W l frd far /7C
Model number(s):_QT�ck Ll
Page 1 of 2
2. ApMroval/Certification. On [date],the Department,pursuant to its authority
under the section of Title 5 as speci d beWv,approved or certified the technology used in the above-
referenced alternative system,under MassDEP Transmittal Number [Transmittal Number
of approval or certification].
[Check one of the following,as applicable:]
Approved for remedial use under 310 CMR 15.284
_Approved for piloting under 310 CMR 15.285
_Provisionally approved under 310 CMR 15.286
Y Certified for general use under 310 CMR 15.288
A copy of the Department's Approval/Certification is available from the Department in person or on-
line at the Department's website: http://www.mass. og_v/dep .
WITNESS the execution hereof under seal this -//�'aay of �� ,20_&_,made by
the above-named Alternative System Owner(s).
f9/ s z l�
[Alternative Syste Ow er(s)l
PrintName(s):.�,J�� �?�c�wl�5 ae-grltoAcAkk%(Me_, Ltj-2C)
COMMONWEALTH OF MASSACHUSETTS
S•P 4 , ss
On this( `day of a'�a ,2013,before me,the undersigned notary public,personally
appeared V"&^:Joa&_c name of document signer),proved tome through satisfactory
evidence of identification, vHfich were 4�1`l rS �j�i►..d� ,to be t11allic
NN is
signed on the preceding or attached document,and acknowledged to me tha � � signeu4LNE C.KLIER
voluntarily for its stated purpose. Mass ataPublic
mission Expires May]2018
(official i ature and seal of
------------------------------------------------------------------------------------------------------------------------------------
[Complete the following Property Owner(s)Consent if Alternative System Owner(s)is other than the Property
Owner(s):]
CONSENTED TO:
[Property Ow (s)] \
Print Name(s): �,.�a,�. N l c�o��.s�cc��� no.k )Crne �ec )
Date: td I y t 3
COMMONWEALTH OF MASSACHUSETTS
1< , ss
On thi4�da of KDftb 6_af ,20th before me,the undersigned notary public,personally
appeared IutC 6 o_,� (name of document signer),proved to me through satisfactory
evidence of identification, hick were dt`l itiQrS (t c,Qjy1aV,to be the person whose name is
signed on the preceding or attached document, and acknowledged to me that(he)(she) signed it
voluntarily for its stated purpose.
(official(si ature and seal of notary)
Upon recording,return to: __
[Name and address of Property Owner(s)] JOANNE CALIER
Page 2 of 2 Notary Public
Massachusetts
Commission Expires May 4.2016
MORTI+
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PUBLIC HEALTH DEPARTMENT OCT 0 4 2013
Community Development Division
+ANDOVER
HEALTH DEPARTMENT
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System Xj constructed;( )repaired;
By: /X960 9QA O/d r
(Print Name)
Located at: /JP— 1M 0560
(Installation Address)
Was installed in conformance with the North Andover Board of ealth approved plan,originally dated
5 ) and last revised on / —,with a design flow of
V 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.Al ork is accurately represented on
the As-built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: /
j-eA A` � En ' eer R rese rve re)
And—Print Name
Final Construction Inspection Date:
�V a, , �}�� � En ' eer res �agnature)
And—Print Name
Installer: (Signature) Date: ,D '7`� C
And—Print Name
Enginer: (Signature) Date: rj 13
And—Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
Blackburn, Lisa
From: Sawyer, Susan
Sent: Thursday, September 19, 2013 8:17 AM
To: Blackburn, Lisa
Subject: FW:Jimmy's installation
PIs add the email below to the file.
thx
From: Jack Sullivan [mailtoJacksull5Nbcomcast.net]
Sent: Wednesday, September 18, 2013 4:28 PM
To: Sawyer, Susan
Cc: Grant, Michele; Arco (arcoex(&comcast.net)
Subject: Re: Jimmy's installation
Susan,
I think you covered everything in your summary. We have found variable soil conditions during excavation of
the bed bottom, but with cooperation between all parties (installer, designer, and Town) it appears we have
clearly defined the limits of unsuitable soil conditions and with this plan revision I am confident that the
system will be properly located. I am preparing the revised plan now...I will forward an electronic copy and
paper copies to all parties.
Thank you...Jack Sullivan
From: "Susan Sawyer" <ssawver atownofnorthandover.com>
To: "Jack Sullivan (iacksuII53 aacomcast.net)" <iacksu1153P-comcast.net>
Cc: "Michele Grant" <mgrant(a)-townofnorthandover.com>, "Arco (arcoexpcomcast.net)"
<arcoex(ab-comcast.net>
Sent: Wednesday, September 18, 2013 4:08:57 PM
Subject: Jimmy's installation
Hi Jack,
Michele has updated me on the obstacles that have arisen at this installation.
As I understand it you will be submitting the soil log for a new deep hole and show the new location for the infiltrators
on a plan. It is acceptable with this office if you do a section just showing the changes and then the as-built will pull it all
together or a redlined plan. The installer should receive a copy of that as well.
The installer will let office know when the tank is to be crushed.We will request a photo of the excavation to ensure it is
done properly.
More than sufficient inspections have been done to verify that the system is being placed in the proper depth and that
unsuitable soils are being removed as needed.
As in all cases of installations, please call this office when you have done your final inspection including all ties;
elevations; even distribution etc. and that they conform to your plan. This office will confirm.Then the installation
certification needs to be signed by both engineer and installer and as-built submitted.
i
This was a very difficult site to work with and it is clear that you all worked very hard to complete it properly and
without severe impact on the clients business; i.e.the min golf course.
If you have any comments or disagree with facts in this email please let me know.
Thank you.
Susan
Susan Sawyer
Public Health Director
Town of North Andover
1600 Osgood Street
Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email mailto:ssawver@townofnorthandover.com
Web www.TownofNorthAndover.com
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more
information please refer to:hftp://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
2
� •a
I CERTIFY THE LOCATIONS, ELEVATIONS AND TIES SHOWN ON THIS OWNER: LEGEND:
CHRISTO
HER V.
PLAN RESULT FROM AN ACTUAL SURVEY MADE ON THE GROUND. ELEV. (FT) DTH-3 DEPTH (IN) 35 WEBS ERRSTREET,AUNTS302 -`49--- TWO FOOT CONTOUR
TAX MAP 34 LOT 31 - EAST BOSTON, MA szr.;0 SPOT GRADE
��+cnarrc 01599 OSGOOD STREET TOP OF PIT = 101.0' 00" APPLICANT:
S.P.E.C. REALTY TRUST HORIZON A UT7UTY POLE
013 SL 1595 OSGOOD STREET
SIGNATURE OF DESIGNER DATE HORIZON
-I 9 2 1591 OSGOOD PROPERTIES LLC w GwTPatn PRESSURE WATER SERA((
I
10 YR 3/3 NORTH ANDOVER, MA 01845 En T. BITUMINOUS
206.66'
100.3' $ CONC. coNCREE
- TOVY>,1 L,• r':p 1;�-�f,'••,DOVER HORIZON B DEED REFERENCE:
_H-HEALTH 0EPART;;`2NT
SL BOOK: 8351 PAGE: 87 EDP EDGE OF PAVEMENT
_ 10 YR 6/8 ASSESSOR INFORMATION: 0OjxO) PROP. SPOT GRADE
LOT AREA / - 98.75 27 TAX MAP 34 LOT 4 (98)- PROP. TWO FOOT CONTOUR
1.948 Act C-LAYER
COARSE SAND
(STRATIFIED) GENERAL NOTES
F_1 40% GRAVEL
1. ELEVATIONS BASED ON ASSUMED DAVM.
2.5 Y 6/4
2 EXISTING TOPOGRAPHIC INFORMATION FROM FIELD SURVEY.
3. THE CONTRACTOR SHALL TAKE THE NECESSARY
BOT. OF PIT =91.00' REFUSAL®NONE 120 STEPS TO PROTECT EXISTING PROPERTY AND ADJACENT PROPERTIES.
WATER WEEPING 0 NONE
4. ALL CONSTRUCTION METHODS AND MATERIALS
SHALL CONFORM WITH THE
%/ 1\ - t` n..•,i'�'(\ \ rW<\ NO MOTTLES
OF ENVIRONMENTAL PROTECTIONSACHUSETTS STATE ENVIRONMENTALT
NOTE: SOIL EXAMINATION (DTH-3) WAS PERFORMED CODE TITLE 5(310 CMR 15.00)AND THE NORTH ANDOVER BOARD
BY JOHN D. SULLIVAN 111 OF SULLIVAN ENGINEERING GROUP, LLC OF HEALTH REQUIREMENTS.
ON SEPTEMBER 18, 2013 AND WITNESSED BY MICHELE GRANT s, AUTHORITY ARE ENGINEER
TO BE NOTIFIED AT LEAST APPROVING
fez ��-y--'` AGENT FOR THE NORTH ANDOVER BOARD OF HEALTH PRIOR TO INSPECTIONS REQUIRED BY 310 CMR 15.00.
6. THE CONTRACTOR IS TO VERIFY EXISTING SITE CONDITIONS
't \ PERCOLATION RATE ASSIGNED <2 MPI BASED ON SOIL CONDITIONS AND NOTIFY THE ENGINEER OF ANY DIFFERENCES.
t_ ��•�o/ BEING THE SAME AS DTH-1. DTH-2.
7. THE CONTRACTOR IS RESPONSIBLE FOR ALL OF THE HORIZONTAL
AND VERTICAL CONTROL OF ALL SYSTEM COMPONENTS.
B. THE Fl ST TWO FEET OF EACH LINE EXITING
THE DISTRIBUTION BOX SHALL BE LEVEL
9. SEPTIC SYSTEM OWNER SHALL HAVE SEPTIC TANK
V INSPECTED&PUMPED OUT IN ACCORDANCE WITH
310 CMR 15.351,AND AT LEAST ONCE EVERY TWO YEARS. Q
10. THIS PLAN HAS BEEN PREPARED FOR THE y
SEPTICCONSTRUCTION OF THE PROPOSED MNY
ALLTERATIONS MUUST BE APPROVED INWRITINGBY
w... ..,..,r_
- y
t0.a ENGINEER,
11. THERE ARE NO PUBLIC OR PRIVATE WELLS WITHIN 100'
OF THE LEACHING FACILITY.
12. THIS SYSTEM IS NOT DESIGNED TO ACCOMODATE A
LOCUS MAP: GARBAGE GRINDER.
(Nor TD Scats) 13. THE SOIL PLACED AS BACKFILL OVER THE
'S 1baslJ SYSTEM SHALL BE A MINIMUM OF NINE INCHES.
EXCLUDING TOPSOIL PLACED IN LIFTS AND
PROP. SOIL ABSORPTION FIELD 2 NOT FOR CONSTRUC11ON SUFFICIENTLY COMPACTED TO PREVENT
-'-' Prop.6'PVC Inspection Port N DEPRESSIONS DUE TO SETTLING WHICH MAY
{ n/So- Type Top CONSISTING OF 60 INFILTRATOR 2 INTERCEPT OR COLLECT SURFACE WATER
TAX MAP 34 Lor 2
WIN 3'of Flnished QUICK4 PLUS STANDARD LP RUNOFF ABOVE THE SYSTEM. BACKFILL MUST BE
8 -J .de(Typ) (5 ROWS o
OF 12 UNITS)
X1609 OSGOOD
N/F HANG'N TREE R.7.STREET °' } m CONVENTIONAL PIPE/STONE DESIGN CLEAN AND FREE OF STONES AND BOULDERS ,
FIELD DIMENSION: AND LAYOUT. 6 TRENCHES, 90 FEET GREATER THAN SIX INCHES IN SIZE. TAILINGS,
prop W
\ A LONG,J a 74.15'x 48' > DEEP TRENCH CLAY OR SIMILAR MATERIALS ARE PROHIBITED. y
en1 G 2' WIDE TRENCH, 2'
p, pVG V ri WITH 6 FOOT SPACING BETWEEN TRENCHES. FINAL COVER ABOVE THE SYSTEM SHALL BE
GRADED TO REDUCE INFILTRATION O
r F SURFACE
PVC "' _ z WATER AND MINIMIZE EROSION. FINISH GRADE y y y
e
tO Mtn rn SHALL HAVE A MINIMUM SLOPE FEET PER l O ti
FOOT. SURFACE DRAINAGE SHALLLL BEE D DIRECTED
u, MINATURE GOLF COURSE P AWAY FROM THE HOUSE&SOIL ABSORPTION SYSTEM.
a+ G 14. THERE ARE NO TRIBUTARIES LESS THAN 325 FEET,NO e
RESERVOIRS/PUBLIC WELLS LESS THAN 400 FEET, AND NO DRAINSclI2
`?> ' LESS THAN 50 FEET FROM THE PROPOSED SUBSURFACE DISPOSAL
.� APPROXIMATE LOCATION OF EX i
PROP. SOIL ABSORPTION FIELD #1 I SYSTEM. THE DWELLING DOES NOT HAVE A FOUNDATION DRAIN.
\ SOIL ABSORPTION FIELD TO Z O O
CONSISTING OF 65 INFILTRATOR o BE ABANDONED IN PLACE 15. PIPE PENETRATIONS IN FOUNDATION, SEPTIC TANK, AND �y
9`'^os` Ex.2.500 GollonCEMENT. S p = 4
QUICK4 PLUS STANDARD LP " - ` _ _ _ i DISTRIBUTION BOX SHALL BE SEALED WITH HYDRAULIC
Cone.5 tit Tank
(5 ROWS OF 13 UNITS) ' �, I To R-i,I 16. THE BUILDING SEWER IS TO HAVE WATERTIGHT JOINTS,TO BE W V
FIELD DIMENSION: 1 i 10.0 LAID ON A COMPACT&FIRM BASE,AND IS TO BE LAID ON 2 W W
14.15'x 52' \ t 7-1J APPROXIMATE EX.D-BOX LOCATION O / ON CONTINUOUS GRADE IN A STRAIGHT LINE. ¢ 4
\ 1 TO BE ABANDONED IN PLACE 70,0. 17. MAGNETIC MARKING TAPE SHALL BE PLACED AROUND
Pe
Ex.Oultet Pi t O ALL SEPTIC COMPONENTS PRIOR TO BACKFILLING.
ICO�'4 M
be Cut at Tank I
Cued eitn Hydraun EX. BUILDNG
ce,nmt. Ex.2.500 canon I;;zx:: o
tO C.-Septic Tonk 18. THIS PROPERTY IS NOT LOCATED WITHIN THE DESIGNATED
To Remain WATERSHED OF LAKE COCHICHEWICK.
O n ti
19. THERE ARE NO KNOWN WETLAND RESOURCE AREAS WITHIN 1
O O / 100 FEET OF THE PROPOSED SEPTIC SYSTEM. I
P,op.Cone D-B.. RETAIL SPACE
(1-20 Rote,) �� -G- - - 1,260 S.F.t U
C_I.
croee ��� �.
Min.zo•Dipmetm a coeer , = ------ PROOF PLAN FOR CONVENTIONAL SYSTEM v, J
To to Septic Tonk
.
Ez.1,000 Gallon
C... I '� Ex.4'PVC To Recse Trop
C ..Gr- T-ZD
Trop to Remo7n EX. 1 STORY BUILDING
(Ins[olled In 1999) V J
_ W RESTAURANT Q
"a BIT.CONC.SURFOACE 44 SEATS ROOFED y N
ENTRY OElf
TAX MAP 34 LOT 44 (UNENCLOSED) O Ob
#1615 OSGOOD STREET I O � CD Z O 00
N/F MARK A. VALENTINO z
DESIGN ANALYSIS r�^ Z Z Q
Cr ll� 0
TAX MAP 34 LOT 47 ESTIMATED DAILY FLOW: v J
O > L111)
//7573 OSGOOD STREET 44 SEAT RESTAURANT X 35 GPD/SEAT = 1,540 GPD ' � Q
� ..
N/F MICROWAVE ENGINEERING CORP. 1,260 S.F. RETAIL SPACE = 200 GPD (MIN. PER TITLE 5) O Z Z Z O GO
I _
BIT.CONC.SURFACE TOTAL DAILY FLOW = 1,540 GPD + 200 GPD =1,740 GPD
G W (T GO
1�1 �l Z N
I I1 LEACHING AREA REQUIRED:
72' ^ A
60.99' - PERCOLATION RATE _ < 2 M.P.I. (CLASS I SOIL)
R=3,060.
L=214.01
ENCHMARK
L.T.A.R. = 0.74 GPD/SF
BA J
BONNET BOLT W/X-CUT LEACHING AREA REQUIRED:
ON HYDRANT 1,740 GPD / 0.74 GPD/SF = 2,351.35
ELEV=99.09' v J Z (n
(ASSUMED DATUM) LEACHING AREA PROVIDED:
OSGOOD STREET GRAPHIC 'SCALE LEACHING FIELD CONTAINING INFILTRATOR QUICK4 PLUS STANDARD LP UNITS ~
20 0 to 20 40 80 2 SEPARATE FIELD AREAS (14.17' x 52' & 14.17' x 48') '
1"=20 FEET
EFFECTIVE LEACHING AREA=4.73 SF/PER LF.OF INFILTRATOR(BOTTOM ONLY) OATEN
(IN FEET) 2,351 ST REQUIRED/4.73 S.F/LF. = 497.04 L.F. INFILTRATOR REQUIRED May 10, 2013
I inch= 20 IL 125 CULTEC UNITS X 4.0 L.F./UNIT= 500 L.F.TOTAL (PROVIDED) SHEEP ' Of 2
6' SCH. 40 PVC OR
ELEV. (FT) DTH-I DEPTH (IN) ELEV. (FT) DTH-2 DEPTH (IN) SDR-35 PVC PIPE 6' PVC END CAP, END PLUG
RISER OR CLEANDUT W/IN 3' OF FINISHED GRADE �1 9'� 4
TOP OF PIT = 101.0' 00 TOP OF PIT = 102.0' 00" 1
9' nin. T(6) 4' DIA OUTLET
HORIZON A SOIL BACKFILL PLASTIC PIPE SEAL
SL HORIZON A y, 1 (1) 4' INLET O O
10 YR 3/3 SL -B' 1� 7'
100.4' 7" 101.3' 10 YR 3/3 8„ T11
HORIZON B
SL HORIZON B 2
PLAN VIEW
99.5'—10 YR 6/8 18„ SL CULTEC No. 410-
10 YR 6/8 FILTER FABRIC SECTION VIEW
C1-LAYER
FINE SAND 99'8 27 WEIGHT
° ° ° ° ° ° ° o ° ITEM NO. B-6DBH W COVER 432
2.5 Y 6/4
C-LAYER ° 6 OUTLET H-20
97.6'---C2-LAY R 40 COARSE SAND NOTES:
COARSE SAND (STRATIFIED) TYPICAL CULTEC CHAMBER
(STRATIFIED) 40% GRAVEL INSPECTION PORT—/ 6' INTERNAL COUPLING 1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS, NOTES
40%GRAVEL 2.5 Y 6/4 2, DESIGN CONFORMS WITH 310 CMR 15.000, DEP
TITLE 5 REGS, FOR DISTRIBUTION BOXES. 1)PROVIDE 6-CRUSHED STONE BASE
2.5 Y 6/4 2)ALL D-BOX OUTLETS TO BE AT THE SAME ELEVATION
BOT. OF PIT =90.0' 132" BOT. OF PIT =91.00 132" 7Y 3 D-BOX TO BE WATERTIGHT
REFUSAL O NONE REFUSAL a NONE CULTEC, Inc. PHS (203) 775-4416 )
WATER WEEPING 0 NONE WATER WEEPING 0 NONE P.D. Box 280 PHS (600) 4-CULTEC
SOIL DAMP 0 132"(EI--90.0) NO MOTTLES 678 Federal ROad FXt (203) 775-1462
NOTE: SOIL EXAMINATIONS (DTH-1, DTH-2) AND PERCOLATION TESTS (PT-1)
� Brookfield, CT 06604 www.cultec.con D-BOX (6 OUTLET)BYSHEA CONCRETE PRODUCTS
WERE PERFORMED BY JOHN D. SULLIVAN III OF SULLIVAN ENGINEERING GROUP, LLC CULTEC Contactor and Recharger®
ON MAY 2, 2013 AND WITNESSED BY ISSAC ROWE OF MILL RIVER CONSULTING Plastic Septic and Stonnwater Chambers N.T.S.
(CONSULTANT FOR THE TOWN OF NORTH ANDOVER BOH)
I CERTIFY THAT IN OCTOBER 1995 1 PASSED THE SOIL EVALUATOR EXAMINATION APPROVED TYPICAL H10 INSPECTION PORT DETAIL
BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE ANALYSIS WAS N.T.S. FILTER FABRIC MIRAFI 140N TO
PERFORMED BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE ENCLOSE ENTIRE FACILITY
DESCRIBED IN 310 CMR 15.017.
102
E/
GRPD FINISHED GRADE INLET PIPE (TYP.)
DATE: EX. CI COVERS TO GRADE G/ 15' 4' HDPE
SOIL DATA jX15j FINISHED GRADE
C __.......... W
100 Z -- niAx �o Cb ••- (UICAP�USUSTANDARD LP
12" MIN. 34"WX4.O'LX8'H)
NOT TO SCALE / ( -p
INSPECTION PORI CU
DATE TEST N0. DEPTH BOT. ELEV. RATE z Cqnc. Riser Settion(s) TO GRADE 2" OF 1�8" TO 1\2" `O ------- - - --1 TOP EL=96.90'
w W/Mir. 20 Diameter Io 0 0 l
5/2/13 1 40"-58" 96.2' <2 MPI
98 .._..._... 4_........._..._Z..Z ............. G�:.co er at.Finllished�-Grode... .... .._........ .. ..._....._...._.._ PEA570NE I o � 0 �o I INV.=96.50'
o o - Cl
BOT. EL=96.22'
PERCOLATION TEST RESULTS x INFILTRATOR UNI S L--------= -- --
W ¢O ( O
96 ._......._.. __.._.... U Z................ .... ........... ... __.ELEV'96.22. _................
o USE CLEAN TITLE 5 SAND DESIGN: 5 ROWS
SIZING FOR CONVENTIONAL SYSTEM BETWEEN CULTEC UNITS
G AND WITHIN FILTER FABRIC
(NOT FOR CONSTRUCT 0N...PROOF i W ENCLOSURE PRO NDE MINIMUM 5 FOOT SEPARA PON REMOVE ALL TOPSOIL, SUBSOIL, AND y
TO SUPPORT CULTEC DESIGN) 94 ._..-..-........_....._....-_.. .......-..-.......--...___.._...-.._.-..-......-._...._L_ BETWEEN THE BOTTOM OF THE CULTEC UNIT UNSUITABLE MATERIAL VERTICALLY TO THE
UNSUI T L
LEACHING AREA REQUIRED: w AND THE SEASONAL HIGH GROUNDWATER TABLE. C-LAYER(SAND) ? ? o w
PERCOLATION RATE = 2 M.P.I. (CLASS I Soil) SUBSURFACE SOIL ABSORPTION FIELD—CROSS SECTION
L.T.A.R. 0.74 GPD SF 6,22'
/ / / - .__ --...-_ _.._ ._ i (NOT TO SCALE) W
LEACHING AREA REQUIRED: 9z -- ---�
1,740 GPD 0.74 GPD SF - 2,351.35 SF i 2
LEACHING AREA PROVIDED (PRIMARY): o o a
6 TRENCHES- 90' LONG X 2' WIDE X 2' DEEP= 2,397.60 SF GROUNDWATER=90.00' W
2,397.6SF > 2,351.35 SF REQUIRED 90 2 a o
SIDEWALL= 6 TR X 2 SIDES (901 X 2'D)=2,160 S.F. SYSTEM PROFILEs
BOTTOM= 6 TR X (901 X 2'W)=1,080 S.F. (SEE SYSTEM BELOW FOR DETAILED CONSTRUCTION INFORMATION)
DAILY FLOW CAPACITY: SCALE.' 1"=20 (HRR)
n
1---2-(VERTICAL)
(2,397.60 SF X 0.74 GPD/SF) = 1,774.22 GPD J
1,774.22 GPD > 1,740 GPD REQ'D 17 77
^ ti
SYSTEM PROFILE
(T.O.F) W U
NOT TO SCALE 4" PVC VENT W/ Q i
PROP. COVER TO GRADE ACTIVATEDCARBON J Q
FILTER
MIN. 20" DIA. Cl COVER
FINISHED GRADE FIRST 2' TO BE LEVEL 2% SLOPE - 0 Q
EX. COVER TO GRADE EX. COVER TO GRADE (MIN.) [r�
WASHED/S STONE
1/2 (J E
36" Q O
Z O OO
EX. 4" CAST IRON
DISTRIBUTION
S=0.01 -
TOP STONE O � Z Z Q I
9" MIN. EXCLUDING TOP SOIL EL.-96.90' � IN
( (27') 4" SOLID PVC SCH. 40 BOX H-20 36" MAX. INCLUDING TOP SOIL LU ] TO
To Remain) n O Q 0
4" SOLID PVC SCH. 40 �l =
5= Unknown
EX. 2,500 GALLONJ C7 z op DO
S=VARIES
EL.=97.34' CONCRETE SEPTIC TANK EL.=96.50' QUICK4 PLUS STANDARD LP UNITS Q O
6" CRUSHED ,
(TO REMAIN) STONE BASE SEE CONSTRUCTION DETAILS T W O
m
r. EL. 6.65' � � T Z N
NOTE FLOW EQUALIZERSA
TO BE PROVIDED AT ALL
EL.=96.22'
OUTLETS FROM D-BOX6,22' f1,
GROUNDWATER ^ eti
EL.=97.09' EL.=96.82' ELEV. = 90.0' S' MIN. r^ 0)
(BASED ON DTH#1) V I E
20' MIN. TO BLDG. 2 SEPARATE SOIL ABSORPTION AREAS N.T.S.
SEE SHEET 1 FOR DETAILED FIELD DIMENSIONS DA TE, May 10, 2013
SHEET, 2 of
2
• .� "� Commonwealth of Massachusetts Map-Block-Lot
__'. • 034.00004
BOARD OF HEALTH -----------------------
Permit No
North Andover BHP-2013-0885
-----------------------
FEE
$250.00
-----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted William--Sawyer
------ -- - - ----------------------
-----------------
to(Repair)an Individual Sewage Disposal System. I:L
] COPY
at No -1-5-9-1-OS-GOOD STREET
as shown on the application for Disposal Works Construction Permit No. BHP-2013-088 Dated September 04,2013
----------------------- -----------------------------
Issued On: Sep-04-2013
- ----------------------------------------
- ----- --- - — BOARD OF HEALTH
10RT//
' 650
Of o r �'90
3r • OL
Town of North Andover
HEALTH DEPARTMENT
,SSACHU`+ES
CHECK#: D DATE: -I
LOCATION: rd
H/O NAME:
CONTRACTOR NAME:
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 $
SEPTICSystems
:
❑ Septic-Soil Testing $
�❑ Septic-Design Approval $ Ell
lea Septic Disposal Works Construction(DWC) $
/❑, Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
Application for Septic Disposal System ] 11
3:.•..
• ; onstruction Permit—TOW OF TOD Y' DA E
1�1
ORTH ANDOVER MA 01845 $250.00—Full Repair
'�,�•�»A'fi+ � $125.00-Component
Important: Application is hereby made for a permit to:
When filling out Ej Construct a new on-site sewage disposal system*
forms on the
computer,use Repair or replace an existing on-site sewage disposal system*
only the tab key
to move your ❑Repair or replace an existing system component—What?
cursor-do not
kusetheretum A. Facility Information
VQ �
� Ai 1- --D S- vo�--
Adr�ess or Lot# --- --- -
CityRown
2.-*TYPE OF SEPTIC SYSTEM'.
❑Pump �ioravity(choose one) SEP 0 4 2013
***If pump system,attach copy of electrical permit to application"*
❑Conventional System(pipe and stone system) TOWN�f-NDRTH ANCJ�Y(,'F
HEALTH DEPARTMijpq
JR Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.
❑Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement)
❑Pressure Dosed(D-Box Present)S.A.S.
2. Owner Information
Name
14
Addres (ifdiffflerent from alT) 61
✓,—Csr State Zip Code
Telephone Number
3. Installer Information
Name Name of Company
Address
K1
a
Citytfown State Zip COW
Telephone Number(Cell Phone#ifpossfble please)
a. Designer Information
Name N me of Company
Address
City/T TL' State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
...... , Application for Septic Disposal
System
g I •+ Construction Permit—TOWN OF TODAY'S DATE
ORTH ANDOVER MA 01845 $250.00-Full Repair
� $125.00-Component
PAGE 2OF2
A. Facility Information continued._...
5. Type of Building: QResidential Dwelling or3dCommercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of
North Andover,and not to place the system in operation until a Certificate of Compliance has
been issued by this Bo ealth.
` 113
Name Date
Application p ved By: and of Health Representative)
Name Dale —��
App' Disapp ved for the following reasons:
For Office Use Only:
1. Fee Attached? Yes No
2. Project Manager Obligation Form Attached. Yes Q No
3. Pump System? If so,Attach copy ofElectrical Permit YesNo
4. Foundadon As-Bruit?(new construction ronly). Yes /J No
(Same scale as approved plan)
S. Floor Plans?(new construction only). Yes No
Application for Disposal System Construction Permit-Page 2 of 2
. , It
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property. at:
(Address of septic system) For plans by 'T�1...._ S.�� � +-V L
(Engineer)
Relative to the application of 414 •• (�,a�+�. ���aJ�/wce
(Installer's name) 0— And dated I D 2(7 3
'
kvi
Dated ngm ate
� ��
—L[
o ac s ate \C'itlr revisions dated
(Last revised date) Qr7S.,5'104
w
I tmderstand 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 tZ�'3
performing any«fork on a site. I must have thea roved cans and the ermit on site whern an ANDOVER
being done. RTMENT
2. As the installer,I must call for any. and all inspections. If homeou-ner,contractor,project mana
other person not associated X pith 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 requestiig an inspection,without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or
my company.
a. Bottom of Bed—Generally,this is the first(1')inspection sunless there is a retaining wall,which
should be done fust. The installer must request the inspection but does not have.to be present.
b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties,etc.
As-built of verbal OK(or e-mail to:healthdept cQt townofnorthandover.com)from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system,all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade—Installer must request inspection when all gtad ng is complete. Installer does not
have to be on-site.
4. As the installer,I understand that only.I may,perform the work(other than simple excavation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others Unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of mp license to operate in the ToR7i of
North Andover,sigiuficant 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.
Undersigned Licensed Septic Installer: �s1/} (Today's Date)
'J L(
ane— runt arae—Signed)
� 54'TTtED]�e •
MCOPY
North Andover Health Department
(ommunity Development Division
August 15, 2013
i
Property Owner
1591 Osgood Street
North Andover, MA 01845
Re: Subsurface Sewage Disposal System Plan for 1591 Osgood Street, Map 34,Lot 41
Dear Property Owner:
The proposed wastewater system design plan for the above site dated May 10, 2013,received on
July 23, 2013, with a final revision dated August 13, 2013, received on August 14, 2013 has been
approved.
The design has been approved for use in the construction of a new upgraded onsite septic system,
designed for a commercial property housing 1260 square feet of retail space and a 44 seat
restaurant.
During this time, a"licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover or the plan approval will be voided. This plan is generally good for 3-years from the
date of approval however, as this is for a repair system, this is reduced to 2- years. In the event
an imminent health problem such as sewage backup into the dwelling is occurring,the North
Andover Board of Health may reduce the time period for which this plan is valid.
This approval is also subject to the following conditions:
1. The owner will record the required Deed Notice prior to Construction. Proof must be
received by the Health Department.
2. The owner will provide written certification to the Health Department prior to
construction that Section Il (18) for alternative systems has been complied with.
3. 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(l)).
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
1591 Osgood Street August 15, 201 3)
4. 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.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Si ely,
usan�er, HS/RS
ublic He th Dir ctor
Encl. N Andover Installer's list
cc: Jack Sullivan, PE
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
f� jy
Sullivan Engineering Group, LLC
Civil Engineers&Land Development Consultants
August 14, 2013
Town of North Andover Health Dept.
c/o Susan Sawyer R2CF_TV="D
1600 Osgood Street, Suite 2035
North Andover, MA 01845 Al "i 4 2013
Re: Revised Septic Plans TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
1591-1595 Osgood Street
Ms. Sawyer;
Enclosed are three (3) sets of the revised Septic Plans for the above referenced property. I have also attached a
revised Soil Evaluator Form Sheet to correct a typo regarding Testhole 2.
The following changes/revisions were made based on the review letter;
1) A locus plan has been added to Sheet 1
2) The soil evaluator form has been corrected and is attached. There were no soil mottles encountered
during soil testing.
3) A scaled profile of the system has been added to Sheet 2
4) Note 19 has been added to the plan stating No wetland resource areas within 100 feet of septic system.
5) There is no proposed septic effluent filter for the existing septic tank. The note has been removed from
the plan regarding the effluent filter.
6) A shallow grassed swale has been added within 5 feet of the property line to insure no water flow onto
abutter
7) The proposed transitional grading from the SAS has been revised to be at a 3:1 slope per Code
8) The D-Box profile has been corrected to show a 2" drop from inlet to outlet
9) The size of the manhole cover over the D-Box has been called out on Sheet 1 & Sheet 2
10) A 1% slope has been accounted for from the D-Box to the Cultec units factoring in the first two feet of
the D-Box to be set level
11)In speaking with Mill River Consulting, I am proposing Title 5 sand between the cultec units in lieu of
crushed stone.
12) 1 contacted Cultec and at this time there is no required training for DESIGN of systems. Installers are
still required to be certified.
13)The owner will record the required Deed Notice prior to Construction. Additionally,the owner will
provide written certification to the Board of Health to comply with Section 11(l 8) for alternative
systems.
14)A best feasible upgrade plan showing a conventional system design has been shown on Sheet 1. The
calculations in sizing the conventional system are shown on Sheet 2.
22 Mount Vernon Road — Boxford,Massachusetts 01921 — (978)352-7871-Phone — 978352-7871 -Fax
r .
If you should have any questions or comments please feel free to contact me.
Very Truly Yours,
Jack S iv ,
i
A chment—Corrected Soil Evaluator Form
i
I
I
22 Mount Vernon Road — Boxford,Massachusetts 01921 (978)352-7871-Phone 978 352-7871 -Fax
Commonwealth of MaAsachusettg
U`
City/Town of ,�0% b �
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Deep Observation Hole Number:_2
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil
Depth Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other
(In.) Layer (Munsell) (USDA) (Moist)
Depth Color Percent Gravel Cobbles
&Stones
0-8 A 10 YR 3/3 n/a SL FINE
8-27 Bw 10 YR 6/8 n/a SL FINE
27-132 C 2.5 Y 6/4 n/a SAND 40 COARSE CLASS 1 SOIL
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7
6 5 5 2
. o
0 9
Town of North Andover
.� HEALTH DEPARTMENT
,•SS�CMU
CHECK#: q.�a DATE:
LOCATION: rn
H/O NAME:
CONTRACTOR NAME:
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 $
SEPTIC Systems:
0
Septic-Soil Testing $
1 Q1(Septic-Design Approval r�v t,t, $ j�
,[❑,Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate) $
Health Agent Initial.-
White-Applicant
nitial:White-Applicant Yellow-Health Pink-Treasurer
.�4iu:n�4r
TOWN OF NORTH ANDOVER '
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSETTS 01845
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone978.688.8476—FAX
Public Health Director E-MAIL:healthdeptntownofnorthandover.com
WEBSITE:http://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM
Date of Submission:July 23, 2013
Site Location: 1591-1595 Osgood Street
Engineer:John D. Sullivan III, PE
New Plans? Yes X $225/Plan Check# (includes l"submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes X No
Local Upgrade Form Included? Yes No X
Telephone#:978-352-7871 Fax#:978-352-7871
E-mail:Jacksu1153@comcast.net
Homeowner
Name ��)Q������ �����'p�,J L �'✓Y'`�i��
�96 4v- j�4 41Z
OFFICE USE ONLY RECEIVED
When the submission is complete(including check):
)0. _Date stamp plans and letter JUL 2 3 2013
Complete and attach Receipt TOWN OF NORTH ANDOVER
V Copy File; Forward to Consultant HEALTH DEPARTMENT
Enter on Log Sheet and Database
Blackburn, Lisa
From: Blackburn, Lisa
Sent: Tuesday,July 23, 2013 11:44 AM
To: Dan Ottenheimer;Isaac Rowe; Pam Lally
Cc: Sawyer, Susan
Subject: 1591-1595 Osgood Street
Good Morning,
I am mailing out today septic plans and accompanying paperwork for 1591-1595 Osgood St.
Lisa Blackburn
Health Department
Town of North Andover
1600 Osgood Street,Suite 2035
North Andover, MA 01845
Phone 978-688-9540
Fax 978-688-8476
Email Iblackburn@townofnorthandover.com
Web www.TownofNorthAndover.com
1
Sullivan Engineering Group, LLC
Civil Engineers&Land Development Consultants
July 23, 2013
Town of North Andover
Board of Health
c/o Susan Sawyer
Re: 1591-1595 Osgood Street
Septic Upgrade Plan
Ms. Sawyer;
Enclosed are the following as part of the Septic Upgrade application for the above referenced property:
1) Completed Septic Plan submittal form
2) Check payable to "Town of North Andover"for$225.00
3) DEP approval for General Use of Cultec Chambers
4) Two (2) sets of signed Soil Evaluator Forms
5) Three (3) sets of stamped/signed Septic Upgrade Plans
If yjSullan
uestions please feel free to contact me or e-mail me at jacksull53(&comcast.net
Ve ,
RECEIVED
Jac
JUL 2 J 2013
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
22 Mount Vernon Road — Boxford,Massachusetts 01921 — (978)352-7871-Phone — 978352-7871 -Fax
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTI
ONE WINTER STREET, BOSTON, MA 02108 61 -292-5500
-t y
DEVAL L.PATRICK \ IAN A.BOWLES
k9i
Governor
Secretary
TIMOTHY P.MURRAY LAURIE BURT
Lieutenant Governor
1 Commissioner
.OYAO
MODIFIED CERTIFICATION FOR GENERAL USE
Pursuant to Title 5, 310 CMR 15.000 FHEALTH
IVED
Name and Address of Applicant:
3 2013
CULTEC, Inc. OFTH ANDOVER
P.O.Box 280 PARTMENT
878 Federal Road
Brookfield,CT 06804
Trade name of technology and model: CULTEC Chamber models: Field Drain Contactors C4;
Contactor EZ-24, 100, and 125; and Recharger 180, 280, and 330XL(hereinafter the "System").
Schematic drawings of each model are attached and made a part of this Certification.
Transmittal Number: W037676
Date of Issuance: December 17,2003,revised April 18, 2006,revised July 24, 2006,July
19,2007,November 2, 2007,August 29,2008,Modified February 22,
2010
Authority for Issuance
Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of
Environmental Protection hereby issues this Certification to: CULTEC, Inc.,P.O.Box 280,
878 Federal Road,Brookfield, CT 06804(hereinafter"the Company"), for General Use of the
System described herein. Sale and use of the System are conditioned on and subject to
compliance by the Company and the System owner with the terms and conditions set forth
below. Any noncompliance with the terms or conditions of this Certification constitutes a
violation of 310 CMR 15.000.
February 22, 2010
Glenn Haas,Acting Assistant Commissioner Date
Bureau of Resource Protection.
This information is available in alternate format Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207.
MassDEP on the World Wide Web: http://www.mass.gov/dep
Printed on Recycled Paper
Commonwealth of Kqssachusetts
� u
City/Town of IL-,;OfLj
` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must
be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use.
A. Facility Information RECEf 'E®
1. Facility Information
Christopher V. Adams 20 13
Owner Name TOWN OF
1591-1595 Osgood Street Map/Lot: Map 34 Lot 4 HEALTHNORTNANpOVFR
Street Address OFPARTII�ENT
North Andover MA 01845
City/Town State Zip Code
B. Site Information
1. (Check one) New Construction ❑ Upgrade ® Repair ❑
2. Published Soil Survey available? Yes ❑ No ® If yes:
Year Published Publication Scale Soil Map Unit
Soil Name Soil limitations
3. Surficial Geological Report available? Yes ❑ No ® If yes:
Year Published Publication Scale Map Unit
Geologic Material Landform
4. Flood Rate Insurance Map:
Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No
Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No
5. Wetland Area: National Wetland Inventory Map
Map Unit Name
Wetlands Conservancy Program Map
Map Unit Name
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 1 of 7
I
Commonwealth of Massachusetts
City/Town of
w -
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
a e
6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑
MonthNear
7. Other references reviewed:
C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole Number: 1 May 2, 2013 10:00 am. 68 degrees/clear
Date Time Weather
1. Location
Ground Elevation at Surface of Hole_101.0 (Assumed Datum)
Location (Identify on Plan ) See Sheet 7 of 7
2. Land Use: Commericial Few 0-2
(e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%)
Wooded Terrace
Vegetation Landform Position on landscape(attach sheet)
3. Distances from: Open Water Body >200_ Drainage Way >200 Possible Wet Area >200
feet feet feet
Property Line 20 Drinking Water Well >200 Other
feet feet
4. Parent Material: Loose Sandy Glaciofluvial Deposit Unsuitable Materials Present: Yes ❑ No
If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes ® No ❑
If Yes: Depth Weeping from Pit_ Depth Standing Water in Hole - Moist at 132"
Estimated Depth to High Groundwater: Moist Soil at Bottom of Hole (Elev= 90.0')
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 7
I
Commonwealth of Massachusetts
City/Town of -
` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal -
M
Deep Observation Hole Number: 1
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil
Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other
(In.) Layer (Munsell) (USDA) (Moist)
Depth Color Percent Gravel Cobbles
&Stones
0-7 A 10 YR 3/3 n/a SL FINE
7-18 Bw 10 YR 6/8 n/a SL FINE
18-40 C1 2.5 Y 6/4 N/A Sand Fine CLASS 1
SOIL
40-132 C2 2.5 Y 6/4 n/a Sand 40% Coarse
Additional Notes
DEP Form 11Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7
Commonwealth of Massachusetts
City/Town of
` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal -
0`
C. On-Site Review (Cont.)
Deep Observation Hole Number: _2 May 2, 2013 10:00 Am. 68 degrees/clear
Date Time Weather
1. Location
Ground Elevation at Surface of Hole 102.0' (Assumed Datum)
Location (Identify on Pian ) See sketch plan on sheet 7
2. Land Use: Wooded—Commercial Few 0-2
(e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%)
Wooded Terrace
Vegetation Landform Position on landscape(attach sheet)
3. Distances from: Open Water Body_>200_ Drainage Way_>200_ Possible Wet Area > 200
feet feet feet
Property Line 15 Drinking Water Well >200 Other
feet feet
4. Parent Material: Loose Sandy Glaciofluvial Deposit Unsuitable Materials Present: Yes ❑ No
If Yes: Disturbed Soil[] Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes ❑ No
If Yes: Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inches elevation
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7
I -
Commonwealth of Massachusetts
City/Town of
lug,)4_4`
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal -
Deep Observation Hole Number:_2
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil
Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other
Layer (Munsell) (USDA) (Moist)
(In') Depth Color Percent Gravel Cobbles
&Stones
0-8 A 10 YR 3/3 n/a SL FINE
8-27 Bw 10 YR 6/8 n/a SL FINE
27-132 C 2.5 Y 6/4 48" SAND 40 COARSE CLASS 1 SOIL
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 7
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method used: ® Depth observed standing water in observation hole A. 132
inches inches
❑ Depth weeping from side of observation hole A. B.
inches inches
❑ Depth to soil redoximorphic features (mottles) A. B.
inches inches
❑ Groundwater adjustment (USGS methodology) A. B.
inches inches
2. Index Well Number Reading Date Index Well Level
Adjustment Factor Adjusted Groundwater Level
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system? Yes ® No❑
b. If yes, at what depth was it observed? Upper boundary: 18 Lower boundary: _132
inches inches
F. CertificatAhavp
I certify that Ised the <' eivaluator examination*approved by the Department of Environmental Protection and that the above
analysis wasd ctent with the required training, expertise and ex rience described in 310 CMR 15.017.
Signature ofS Eval Date . ♦ �3
Sullivan III, P.E._ October 1995
Typed or Prillted Nffne of Soil Evaluator 'Date of Soil Evaluator Exam
ISsac Rowe Consultant to Town of N.Andover BOH
Name of Board of Health Witness Board of Health
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 6 of 7
Commonwealth of achuse
City/Town of
` Form 11 - So il Suitability Assessment for On-Site Sewage Disposal
` �� J
Note: -r' — — _F
MINATURE GOLF COURSE
use20s /�
co r
99x64\
Bio
X10 46 101x62
100 78
THS PT-1 APPROXIMATE EX. D—BOX LOCATION
TO BE ABANDONED IN PLACE
100x 4
\\ a00
Ex. 2,500 Gallon 102x0
W Conc. Septic Tank
\\ 0
00X f '77
98x68
O 0 O
RETAIL SPACE
99X —G— — — 1,260 S.F.f
Ex. 4" Cl to Septic Tank
\ Ex. 4" PVC To Grease Trap I
Ex. 1,000 Gallon
Conc. Grease i I
G EX. 1 S70RY BUILDING
RESTAURANT
� ROOFED,W
98 8 44 SEATS D
BIT. CONC. SURFACE ENTRY
(UNENCLOSED)
w
0 600v �T
DEP Form 11 Sou
Commonwealth of Massachusetts
C ity/Town of OM ��
- Percolation Test
Form 12
GM
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important: A. Site Information
When filling out
forms on the
computer,use Christopher Adams
only the tab key Owner Name
to move your 1591-1595 Osgood Street
cursor-do not Street Address or Lot#
use the return
key. North Andover MA 01845
Citylrown State Zip Code
re
Contact Person(if different from Owner) Telephone Number
B. Test Results
May 2, 2013 10:00 a.m.
Date Time Date Time
Observation Hole# PT-1
Depth of Perc 40"-58"
Start Pre-Soak 10:00
End Pre-Soak 10:15
Time at 12"
Time at 9"
Time at 6"
Time(9"-6")
Rate (Min./Inch)
<2 MPI
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
John D. Sullivan III, P.E.
Test Performed By:
Issac Rowe, Consultant for Town of North Andover BOH
Witnessed By:
Comments:
24 Gallons of water absorbed during 15 minute presoak...assigned <2 MPI rate
t5form12.doc•06/03 Perc Test•Page 1 of 1
Sul
r � u �iu
a
Blackburn, Lisa
From: Isaac Rowe <irowe@millriverconsulting.com>
Sent: Thursday, May 02, 2013 3:07 PM
To: Blackburn, Lisa; 'Susan Sawyer (ssawyer@townofnorthandover.com)'
Cc: 'Isaac Rowe'; 'Pam Lally'
Subject: RE: 1591-1595 Osgood Street
Attachments: 1591-1595 Osgood St- Soil testing results 5-2-13.PDF
Susan/Lisa,
Attached are the soil testing results from today. Not sure why but our scanner keeps flipping the image upside down no
matter which way it is scanned.
Soil was very sandy with no groundwater observed.Jack will review the design plan for the system to the left of this
property because they have a raised system. Maybe there is a soil class change along the street.
Let me know if you have any questions.
Thanks,
Isaac M. Rowe, R.S.
Project Manager
Mill River Consulting
6 Sargent Street
Gloucester, MA 01930-2719
Phone: (978) 282-0014
Fax: (978) 282-1318
irowe@millriverconsultinp,.com
www.millriverconsulting.com
-----Original Message-----
From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com)
Sent:Thursday, April 25, 2013 1:25 PM
To: Dan Ottenheimer; Isaac Rowe; Pam Lally
Subject: 1591-1595 Osgood Street
Good Afternoon,
Please schedule a soils test with John (Jack) Sullivan.
-----Original Message-----
From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.comj
Sent: Thursday, April 25, 2013 12:52 PM
To: Blackburn, Lisa
Subject:
This E-mail was sent from "RNPOA428C" (Aficio MP C5000).
1
S?n Date:04.25.2013 12:52:28 (-0400)
Queries to: noreply@townofnorthandover.com
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices
and officials are public records. For more information please refer to:
http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices
and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
2
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OtAeORT H,4
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• Town of North Andover
' '••;;;o:: HEALTH DEPARTMENT
,SSACNUSt�
CHECK#: 0 DATE:4
LOCATION: �Lq IS9S)
-
H/O NAME: R d A
CONTRACTOR NAME:7a, al � IVo n
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 $
SEPTIC Systems: F�
ySeptic-Soil Testing $�v
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWO $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
5
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT y, u
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSETTS 01845
Susan Y.Sawyer,REHS,RS 978.688.9540-Phone
Public Health Director 978.688.8476-FAX
healthdeptntowno fnorthandover.com
w w.townofnorthandover,com
APPLICATION FOR SOIL TESTS N
DATE: / y 3 MAP&PARCEL: �A
LOCATION OF SOIL TESTS: 1 fy� O �D J/f u` J
OWNER: ���u� /oiU/�/JI� Contact#: 10VAYV �t b�1�51)
APPLICANT: ��i('- � ,f/ � Contact#:
ADDRESS: I " / / �J�C7 v'� ✓� / ►/, tw6w M�4 01
✓
ENGINEER: ��4Gf`- L 11-V �'" Contact 4: ` 79-J L-
CERTIFIED SOIL EVALUATOR: �6Y�YV C�►�'1� �V V�� 56Z37d
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing: ^ Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No C
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
/ey, , t� Proof of land ownership(Tax bill,otletterYom owner permitting test)
➢ 8.5"x 11"Plot plan&Location ofe-s7TQ(please indicate test nit sites on the plan)
➢ Fee of$425.00 per lot for new construction. This covers the'minimurn two deep holes and
two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or unerades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date. (3
h
Signature of Conservation Agent. 8
Date back to Health Department: (stamp in): J,/\ CX-v,4
SAY S �Q4eAnA;>A-z4p-�� +0
Commercial Property Record Card
PARCEL_ID:210/034.0-0004-0000.0 MAP:034.0 BLOCK:0004 LOT:0000.0 PARCEL ADDRESS:1591 OSGOOD STREET FY:2013
PARCEL INFORMATION Use-Code: 326 Sale Price: 1 Book: 01940 Road Type: T Inspect Date: 08/16/2012
Owner: Tax Class: T Sale Date: 03/15/85 Page: 0024 Rd Condition: P Meas Date: 08/16/2012
1591 OSGOOD TRUST NOMINEE TRUST Tot Fin Area: 3500 Sale Type: P Cert/Doc: Traffic: M Entrance: C
CHRISTOPHER V.ADAMS,TRUSTEE Tot Land Area: 1.93 Sale Valid: B Water: Collect Id: RRC
Grantor: ADAMS CHRISTOPHER V Sewer: Inspect Reas: C
Address:
35 WEBSTER STREET#302 Exempt-B/L% / Resid-B/L% / Comm-13/1-160/100 Indust-B/L% / Open Sp-B/L% /
EAST BOSTON MA 02128
COMMERCIAL SECTIONS/GROUPS LAND INFORMATION
Section: ID: 101 Use-Code:326 NBHD CODE: 34 NBHD CLASS: 4 ZONE: IS
Category Grnd-Fl-Area Story Height Bldg-Class Yr-Built Eff-Yr-Built Cost Bldg Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class
1 0 1982 390 700 1 P 326 S 43560 1.000 165,528
2 3500 D 1950 ,
Groups: 2 R 326 A 40511 0.930 11,160
Id Cd B-FL-A Firs Unt DETACHED STRUCTURE INFORMATION
1 326 3500 1 0 Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class
2 326 760 1 0 AS S 15750 0.00 1967 A A /// 0 3
LI C 19 0.00 1969 A A /// 0 3
OT C 18 0.00 1969 A A /// 0 3
SB S 64 0.00 1969 A A ///66 11,700 3
VALUATION INFORMATION
Current Total: 590,400 Bldg: 413,700 Land: 176,700 MktLnd: 176,700
Prior Total: 603,300 Bldg: 428,500 Land: 174,800 MktLnd: 174,800
SKETCH PHOTO
16 1SFR
1216 Sq.Ft '
v reA 5�
7 n 36 32
iSFR iS��FR/B 16
30 1048 51q.Ao Sq.Ft38 30
® ®
CY
22 440 Sq. 12
20
MS?Ft 1591 OSGOOD STREET a _
I
Parcel ID:210/034.0-0004-0000.0 as of 4/24/13 Page 1 of 1
- 4
1
April 24,2013
To whom it may concern:
I, Philip V Adams,Successor Trustee of 1591 Osgood Street Nominee Trust,with mailing address at 125
Central St Concord, MA 017842, hereby authorize Fotios Stamos and/or Nick Papantonakis to engage an
engineer to conduct a perk test of the septic system at Jimmy's Famous Pizza at 1591 Osgood Street,
North Andover Massachusetts.
A,, S
Philip V Adams
Trustee
North Andover MIMAP April 24, 2013
IN
77 4'A
1f= ri� rr n 3. �1A
At
..ter
�'► - ,Set '�'"' �, � ,k ,.*h' ,','�t" �
nv
l'125 ,E
Interstates
Interstate
—Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
Roads Meters Data Sources:The data for this map was produced by Merrimack
t.r Easements t NORTH, Valley Planning Commission(MVPQ using data provided by the Town of
Q ,, •o , r�. North Andover.Additional data provided by the Executive Office of
D MVPC Boundary ? e� ••GQ Environmental AffairslMassGIS.The intonnaGon depicted on this map is
—Parcels F p for planning purposes only.It may not be adequate for legal boundary
definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
« • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT
* o, .... • • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
?�,'Ooe�rcp•�`y'� THIS INFORMATION
SSACNUs�t
n=50
�,
Cf NORiM,� 6461
h p
i
Town of North Andover
� '•�,',;;�: ,' HEALTH DEPARTMENT
,s'SACNUSt�
CHECK#: 9B� DATE o 11). --6
LOCATION:'" o
H/O NAME: 1 ��
CONTRACTOR NAME:
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 $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
XTitle 5 Report $ y
❑ Other:(Indicate) $
L6
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
Commonwealth of Massachusetts
u W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°°M •' 1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information RECEIVED
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your MAR
I\ 2 6 2013
cursor-do not Chad Jablonski
use the return Name of Inspector fN R
key. i1EALTH DEPARTMENT
Jablonski & Sons Inc.
rea Company Name
167 Willow Ave.
Company Address
rem.I. Haverhill MA 01835
City/Town State Zip Code
978-360-9358 4574
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further ation by the Local Approving Authority
1 ;
Inspector's Signatur Date
The system s ector shall submit a copy of this inspection report to the Approving Authority (Board
of Health DSP) within 30 days of completing this inspection. If the system is a shared system or
has a desi!`n flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
' Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if (with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if (with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
' Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system 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 1/2 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
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOTdue 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
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
❑ ® Were all system components, excluding the SAS, located on site?
® ❑ 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): na Number of bedrooms (actual): na
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
N W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is North Andover MA 01845 3/10/2013
required for every ,
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
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:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment: Restaurant
Design flow(based on 310 CMR 15.203): No design available
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): No design- 44 seats in restaurant
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: Attached
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Occupied
Date
Other(describe below):
General Information
Pumping Records:
Source of information:
North Andover BoH
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: nagallons
How was quantity pumped determined? na
Reason for pumping: na
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
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
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:
Greater than 25 years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2911eet
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.):
Pipe is under a slab foundation.
Septic Tank(locate on site plan):
Depth below grade: 14"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: 12.5 x 5.5 x 5.5
Sludge depth:
4"
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
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness
1"
Distance from top of scum to top of outlet tee or baffle
3"
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
System is backing up into tank. Tank is structurally sound. Inlet baffle and outlet tee in good working
order.
Grease Trap (locate on site plan):
Depth below grade: 16"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
10' x 5 x5
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle
24"
Date of last pumping: North Andover BoH
Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease trap is structurally sound, Inlet and outlet tee's in good working order
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
s w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. Cityrrown 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 Unable to locate box.
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.):
Unable to locate box due to hydraulic failure.
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
D. System Information
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ 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.):
System exhibits hydrualic failure
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
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
N
�.
dU
0
SaS
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 24"-36"feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Multiple soils tests in the area
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Multiple soils tests performed on abutting properties. Observed mottling around 36"
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 1591-1595 Osgood St.
Property Address
Adams
Owner Owner's Name
information is
required for every North Andover MA 01845 3/10/2013
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
T /
Summary Record Card generated on 3/26/2013 2:22:59 PM by Karen Hanlon Page 1
Town of North Andover
Tax Map # 210-034.0-0004-0000.0
Parcel Id 12151
1591 OSGOOD STREET
JIMMY'S FAMOUS PIZZA
1595 OSGOOD STREET
N. ANDOVER, MA
01845
Class 326 Eating And Drinking Estab Property Type 3 Commercial
Zoning2 3 Commercial Zoning3 3 Commercial
Size Total 1.93 Acres
FY 2013
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
JIMMY'S FAMOUS PIZZA Payor
1595 OSGOOD STREET
N.ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 15254.0-1591 OSGOOD STREET Last Billing Date 3/5/2013
2120137 02 Cycle 02 Active
Bldg Id. 15254.0-1591 OSGOOD STREET Last Billing Date 3/5/2013
2120138 02 Cycle 02 Active
UB Services Maint.
Account No.2120137
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE 89.19 /1
Account No. 2120138
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.635/8 7.82 1/
WTR WATER 01 ALL METER SIZE /1
UB Meter Maintenance
Account No. 2120137
Serial No Status Location Brand Type Size YTD Cons
16335735 a Active ERT HH METE METE w Water 0.63 0.63 460
Date Reading Code Consumption Posted Date Variance
2/13/2013 644 a Actual 23 3/13/2013 -18%
11/5/2012 621 a Actual 23 12/13/2012 -10%
8/15/2012 598 a Actual 30 9/26/2012 -27%
5/11/2012 568 a Actual 37 6/20/2012 75%
2/14/2012 531 a Actual 24 3/14/2012 -3%
11/7/2011 507 a Actual 22 12/15/2011 -19%
8/11/2011 485 a Actual 28 9/14/2011 49%
5/12/2011 457 a Actual 18 6/13/2011 7%
2/14/2011 439 a Actual 19 3/15/2011 -22%
11/8/2010 420 a Actual 22 12/13/2010 -36%
8/12/2010 398 a Actual 36 9/13/2010 52%
5/12/2010 362 a Actual 24 6/9/2010 10%
2/8/2010 338 a Actual 22 3/11/2010 -6%
11/6/2009 316 a Actual 21 12/11/2009 -3%
8/14/2009 295 a Actual 24 9/11/2009 3%
5/13/2009 271 a Actual 23 6/16/2009 19%
2/10/2009 248 a Actual 20 3/16/2009 -20%
11/7/2008 228 a Actual 23 12/10/2008 3%
8/12/2008 205 a Actual 21 9/12/2008 -1%
5/22/2008 184 a Actual 26 6/18/2008 11%
2/11/2008 158 a Actual 22 3/14/2008 -9%
Summary Record Card generated on 3/26/2013 2:22:59 PM by Karen Hanlon Page 2
Town of North Andover
Tax Map # 210-034.0-0004-0000.0
• Parcel Id 12151
1591 OSGOOD STREET
JIMMY'S FAMOUS PIZZA
1595 OSGOOD STREET
N. ANDOVER, MA
01845
Class 326 Eating And Drinking Estab Property Type 3 Commercial
Zoning2 3 Commercial Zoning3 3 Commercial
Size Total 1.93 Acres
FY 2013
11/8/2007 136 aActual 23 1/15/2008 11%
8/10/2007 113 a Actual 21 9/14/2007 -1%
5/11/2007 92 aActual 17 6/22/2007 1%
2/27/2007 75 a Actual 26 3/23/2007 6%
11/6/2006 49 a Actual 16 12/22/2006 -12%
8/24/2006 33 a Actual 22 9/13/2006 9%
5/26/2006 11 a Actual 11 6/20/2006 -100%
4/7/2006 0 n New Meter 0 6/20/2006 -100%
4/7/2006 468 s Reset meter 9 6/20/2006 -33%
2/9/2006 459 m Manual estimate 20 3/13/2006 -20%
MSG. ERT NOT RESP.
11/16/2005 439 a Actual 27 12/14/2005 94%
8/16/2005 412 m Manual estimate 15 9/12/2005 -25%
ERT N/RESP
5/9/2005 397 a Actual 15 6/8/2005 16%
2/24/2005 382 a Actual 17 3/15/2005 -5%
11/19/2004 365 a Actual 17 12/17/2004 -7%
8/19/2004 348 a Actual 18 9/20/2004 -41%
5/20/2004 330 a Actual 23 6/14/2004 39%
3/12/2004 307 a Actual 29 4/16/2004 0%
11/12/2003 278 n New Meter 0 11/12/2003 0%
Account No.2120138
Serial No Status Location Brand Type Size YTD Cons
16335740 a Active ERT HH METE METE w Water 0.63 0.63 34
Date Reading Code Consumption Posted Date Variance
2/13/2013 40 a Actual 0 3/13/2013 -100%
11/5/2012 40 a Actual 0 12/13/2012 -100%
8/15/2012 40 a Actual 0 9/26/2012 -100%
5/11/2012 40 a Actual 0 6/20/2012 -100%
2/14/2012 40 a Actual 0 3/14/2012 -100%
11/7/2011 40 aActual 2 12/15/2011 -31%
8/11/2011 38 a Actual 3 9/14/2011 -100%
5/12/2011 35 a Actual 0 6/13/2011 -100%
2/14/2011 35 a Actual 0 3/15/2011 -100%
11/8/2010 35 a Actual 1 12/13/2010 -88%
8/12/2010 34 a Actual 9 9/13/2010 -100%
5/12/2010 25 a Actual 0 6/9/2010 -100%
2/8/2010 25 a Actual 9 3/11/2010 -100%
11/6/2009 16 a Actual 0 12/11/2009 -100%
8/14/2009 16 aActual 3 9/11/2009 -41%
5/13/2009 13 a Actual 5 6/16/2009 -100%
2/10/2009 8 a Actual 0 3/16/2009 -100%
11/7/2008 8 a Actual 1 12/10/2008 -6%
8/12/2008 7 a Actual 1 9/12/2008 -100%
5/22/2008 6 a Actual 0 6/18/2008 -100%
2/11/2008 6 a Actual 0 3/14/2008 -100%
11/8/2007 6 aActual 0 1/15/2008 -100%
8/10/2007 6 a Actual 0 9/14/2007 -100%
5/11/2007 6 a Actual 0 6/22/2007 -100%
2/27/2007 6 a Actual 1 3/23/2007 -100%
11/6/2006 5 a Actual 0 12/22/2006 -100%
8/24/2006 5 a Actual 4 9/13/2006 371%
5/26/2006 1 a Actual 1 6/20/2006 -100%
2/9/2006 0 a Actual 0 3/13/2006 -100%
12/21/2005 0 n New Meter 0 3/13/2006 -100%
12/21/2005 50 s Reset meter 0 3/13/2006 -100%
11/16/2005 50 m Manual estimate 20 12/14/2005 111%
MSG
8/15/2005 30 m Manual estimate 10 9/12/2005 -100%
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SITE PLAN FOR
� ,t9 OF GREASE TRAP FOR EXISTING When yl,netew
SANITARY DISPOSAL SYSTEM
rya SANITARY DISPOSAL SYSTEM 4vl `�'Y°`
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-' S.P.E.C. REALTY TRUST(CHRIS
ADAMS TRUSTEE), 1591 OSGOOD
�•�'
TE STREET,
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F`�S�GNAEN� � STREET, NORTH ANDOVER, MA.01922
JUNE 8, 1999 SHEET 4 9J&)4�X850
R'T� VE Mq 1
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hes provldad Shl� (orm for uao by local oard� H a h.
be iubmllted to Cha Iocal Board of HoaI(h or (hor J r 2 Sy tom Pumping
o In au( orl(y,
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Syclam Punpinp Rec
10: 51KKK,SANUY From:Prof.Thomas E.Phalen Jr. 78t-729-4372 10/20/98 11:46.02 Page 1 of 1
.Sent by the Award Winning Cheyenne Bitwaare
A&fin
✓�u�'78i 7�.f j9ai .�fi`ara�•97 74%�°O.SG
Jaz. 76i
7-0.¢, 7? fax 9j �e'5G
October 20, 1998
Board of Health n
N.Andover,Ma.01 845
Ms. Sandv Starr
Dear Ms. Starr:
Under separate cover is a copy of the observation well that is going to be installed on 1581
Osgood street shortly to comply with the Boards recent vote. Tha grease trap has been inspected by
the plumbing inspector and was found to be satisfactory.
Very truly yours,
Prof. Thomas E. Phalen Jr.
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
4/28/00
This is to certify that
the grease trap
constructed () or installed (X)
by
John DiVincenzo
at
1591 Osgood Street
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
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SITE PLAN FOR
� ,SH OFMgsJ, GREASE TRAP FOR EXISTING
�oZ► Q, SANITARY DISPOSAL SYSTEM
y� SANITARY DISPOSAL SYSTEM
N.f S.P.E.C. REALTY TRUST(CHRIS
�� STER ADAMS TRUSTEE), 1591 OSGOOD
Fps/ANAL EN� STREET, NORTH ANDOVER, MA.01922 Y'Z'Z o>9jo
JUNE 8, 1999 SHEET 4 9J�j4�8P50
Chris Adams mailbox:/C%7C/NETSCAPE/mail/INBOX?id—Pine...52.11417A-100000@world.std.com&number-649
Subject: Chris Adams
Date: Mon, 5 May 1997 21:35:14 -0400 (EDT)
From: Gayton Osgood <gayton@world.std.com>
To: John D Starr<jstarr@world.std.com>
Sandy,
Chris Adams called me this evening and he now admits that he has a failed
system. He says that he can't afford to fix it unless he rents his space.
He wants to know how many "years" he has before he has to repair the
system. Dreamer! !
I told him that he has to have the system inspected before we will know
what has to be done. He wants to rent his space and then he will have the
system inspected and after that he will decide when he will fix it.
This guy will not quit.
Gayton
- 05/06/97 09:16•`-
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F s Form No.3
Town of North Andover, Massachusetts
' BOARD OF HEALTH �y
s. r -NOR7M <
Of t��ao �a1 O 19
,,,.,,•s, �_ :- ,„a ,S �t� DISPOSAL WORKS CONSTRUCTION PERMIT
u , }
y' Applicant '
'I NAME ADDRESS TELEPHONE
,• _ :j , Site Location
1 .
Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption r
j: Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
Fee D.W.C. No.
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rums u-5UEL EVALUATOR FORM
Page 2of3
Locstio,i Address or Lot No. 1591 Osgood St, N.Andover
On-site Review
OMP NOW Number .. . . 0ete:..-,_3/31/98 Tkns: 1.4.AM weathar clear
Lection(k lantify on site plan) ....._....._.
Land Use._commercial_ sk>p.c1c1 3 surfeoe stone-
Vegetation.. _.. _.... __.........
Landform,....,.._....,.�.. ..... ..._..
Position on landscape(sketch on the back]
Distances from:
Open Water Body >500' feet Orainepe way tact
Possible Wet Area >500' feet Property one 60 feet
Orin"water Well >500' tees Other
DEEP OBSERVATION HOLE LOG'
asp*from pea"Mm ion tent- sap Cao► sol odw
aortae-(MeMel Na0A1 Meir+eep Wniino Istruesw.stem..abwader•.Cenehaney.x,
0-81, Fill .5YR3
8- 1T' Bw Loamy 10YF27/6 none Massive, friable
Sand
17-30" C1 Fine 2.5Y6/4 none Massive,friable
Loamy
Sand
30-120•' C2 Loamy 2.5Y8/1 none Massive, friable
Sand
Pam udow tweter,e_ acial aq,,,- -,k unknown
ase s weer iw w Nsw none wewhv snra Pft Fede: none
r eerw ft-ons 1e0 ONWW wMr_ >120"
sar�reaoesm sow•trv++oe
TEST PIT#1 FOR
�
it OF MGREASE TRAP FOR EXISTING
SANITARY DISPOSAL SYSTEM
SANITARY DISPOSAL SYSTEM
4
t + ASF o�890
!�� S.P.E.C. REALTY TRUST(CHRIS 719f-.70 A11-17
�o ADAMS TRUSTEE), 1591 OSGOOD rxaT.�f�d5or. r
.� /STERE
AL ENSTREET, NORTH ANDOVER, MA.01922 al 9,7a
JUNE 8, 1999 SHEET 51 .97-f-74�.Px5a
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4
, � "0 tNORT hAN[�`OVER ' MASSACHUSETTS `" �
fi ; .SV OPT
u ` 1t� Rec�o'rd'
;� 4tt.mp�1 g MAY Fotrm 4� J, ;� �'�lr�tiaJ�,�;�� `1 0 2007
T•OV1 N OC NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. The Syst p::Al RlddtTftFmTjst
be submitted to the lo
caf Board of Health or other approving authority.
A
Foci 11ty Information
;�-1i rtant. �,
. � ': .�may/ ��Q! �91z; .
j,�.Wr,en filUng out 1 . System Location
fo".on
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to move your .." 1,��/'Ilr- �1 J
cursor-do not CI /Town
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p Code'
C key.`,; 2 r
System Owner. �••
1
Name
Address(If different from location) ,
CitylTown State
Zip Code
Telephone Number
B ftliripIng Record.
,a • 1'
Date of Pum In
p g oat 2. Quantity Pumped: Gallons-
TYpe of system ❑ Cesspool(s) LTJ'Septic Tank
/ ❑ Tight Tank
❑'Other(describe);
t1
4 Effluent Tee Filter present? .❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5 Condition of'Syst9'm,'
em Pumped By:'
11 ,Vehicle Ucen$e Number
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Locd6h where contents Were disposed:
i
l
Date
httpJ/www.mass gov/deptwater/approv als/t5f0rms,htm#Inspect
t5forrn4 doC t>8/03 System Pumping Record-Page 1 of 1
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d1EP hasprovlded this form for use by local Boards of Health. tem �u720V
be submitted to the localBoard of Health or other approving aroping Record must
OF-NORTH ANDOVEF.
TH DEPARTMENT
A Facility Information -
:j,,.Wt>sn filltn9 out 1 System Location
computer,Use
only the tab key Address
to move Your:.,:,
cursor-do not
'use the return City/T Stat
SZip Pode.
ystem Owner r
1„ r
Name
""'` Address(If dlffergnt from location)
Clty/ToW11 State Zip Code
�• Telephone Number
P.u�nping eco d:
t1 , 6. R r
r. M t i b �,si,. x
la Date of Pumping Date 2. Quantity Pumped:
Gallo s
3, ,TYpe of system ❑ Cesspool(s) �eptic Tank ❑ Tight Tank
0',,Other(describe);
f` 4 Effluent Tee Filter present?.❑ Yes o If yes, was it cleaned? C] Ye ❑ No
( t {
itditi f:S stem '
,
6. Sy em Pumped By
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$+i • ° ,; ,C1•f/• „Vehicle UCen$e Number
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:,7 Locabontwhpre Contents Were disposed:
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:httpWwww.mass.gov/depJwafe�/apprOva)s/t5forms,htm#Inspect
t5fortn4 doC 06103 System Pumping Record•Page 1 of 1
Septic System Information
1591 OSGOOD STREET t
Printed On:Friday,March 03, 2006
System ID: BHS-2006-0003
General Svstem Information Latest Permit Information
Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench
Design Flow: One Two Capacity: Number.-
Design
umber.Design Flow Provided: Minutes per inch: Width: Width:
Total Flow: Depth: Length: Length:
Seasonal: No No Depth to Water: Diameter: Leaching:
Grinder: No No Soil Type: Depth:
Laundry: No No
Hauling/Pumping Listin Quantity
Type System Type Pumped Pumped By Transferred To Disposed At Date Pumpedgallons)
Routine Septic Tank Andover Septic STEWARTS SEPTIC 03/03/2006 2000
Comments: Riding High&Leachfield runback
Structures
Structure Tvpe Status Address
Restaurant OPEN 1591 OSGOOD STREET
� II
I'
I
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1
Commonwealth of Massachusetts
'City/Town of,NORTH ANDOVER, MASSACHUSETTS
. . System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. The System Pumping Record must
be submitted to the local Board of Health or other approving authority.
RL-
A. Facility Information
MAR 0 3 200
Important:
When filling out 1. System Location:
forms on the / L TO
HEWN
ALTHDEPARTfJENTF NORTH ANDOVER
computer, use
only the tab key Address �� ' La \
to move your Ir j/A�1(/ryl Jl�l JI
cursor-do not
use the return City/Town State Zip Code
key. .. s
2. System Owner:
irn s �zz
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Data U 2. Quantity Pumped: Gallons O
3. Type of system: ❑ Cesspool(s) ) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
lee
cl�te 0 . _yfe
6. System Pumped By: -
C L
ame Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date '
http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
volt �1 SY8TE+1�1 PUMPINQ RF_C�l�k1... OCT 0 7 2005
Y$r> pyy� TOWN OF NORTH ANDOVER
QR
ADDUSS ____ _. HEALTH DEP ,^;-, ,ENT
�Sti'eT'EM
ATI OF
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v I
-QUANTITY PUMNec
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TOWN OF NORTH ANDOVER ' fit
SYSTEM PUMPING RECORD
4
DATE ,o� 6--z�
SYSTEM OWNER&ADDRESS
SYSTEM LOCATION
DATE OF PUMPING a QUANTITY PUMPED d
CESSPOOL NO-Z YES SEPTIC TANK NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN LACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER OTHER EXPLAIN
SYSTEM PUMPED BY
COMMENTS:
CONTENTS TRANSFERRED TO O f
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
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�l D'I'EM OWNER & ADDRESS SYSTEM LOCATION �-
J, ^A m�S ���_�� (example; left front of house)
/iia
U.\"I'E OF PUMPING; 11,1d QUANTITY PUMPED CALL0
C. I- SPOOL: NO b-' YES SEPTIC TANK: NO YES
ATURE OF SERVICE: ROUTINE EMERGENCY
u13.>FRY.�\T10NS:
GOOD CONDITION. FULL TO COVER
HEAVY CREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
CXCESSI-VE SOLIDS FLOODED
SOLIDS CARRYOVER O�jHFR (EXPLAIN)
i
>1 'M PUMPCD BY:
c u.M �l FLATS:
uNTI:'.NTS tRANSFEIZRED TO:
TbwN O,FNORTH'APJ'D0VER . . : .,
SYSTEM PUM-PING R CORD
UWN�-R & AuDRESS „ SYSTCM I�OC'ATION
---� (�z9mPle; Icft iron( of housr)
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All
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u I'G OF PUM1'(N0.i (QUANTITY PUMPCD;A� l Lc� � �
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-\TURE OFSERYICE; 'ROUTINE. EMERCEN' '
CY
CUOD CVNUJI'ION, FUL'TU CUYCIt
FiTr1YY ..QREASC 13AFFlLS IN i'L•ACl? --'
KU.OTS l.>~ACHFICLD IZUNl3AC'K.,• --�
CXCESSIY&,SO.1�1DS FLOODED
SOI;I��i QARRY0YER Q�HRR (EXP� A.IN)
LM PUMPCly RY,: / �'�Y,
UN"i h'N'I'S1tlZANVICRRED TO:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
, D'I'EM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
5 `
U:vI'E OF PUMPING; O D QUANTITY PUMPER GALLO'6
Ll YES SEPTIC TANK: NO YES
C I�.»I UUL; NO
NATURE OF SERVICE: ROUTINE //"EMERGENCY
mi.SERV:�TIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER V�HER (EXPLAIN)
PUMPED BY:
C. U11!yIENTS:
UN"I ENT] T]ZANSF'EIZRED TO:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: � � (��
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
Ji S (example: left front of house)
)7/o,a- 3T
A/
DATE OF PUMPING: QUANTITY PUMPEDGALLONS
CESSPOOL: NO V YES SEPTIC TANK: NO YES
_L.Z
NATURE OF SERVICE: ROUTINE LZEMERGENCY
i
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK i
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
S t STEM a vTMPED I3 a
i
COMMENTS:
CONTENTS TRANSFERRED TO:
i
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
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DATE OF PUMPING:
QUANTITY PUMPED6bQ6 GALLONS
CESSPOOL: NO —)L YES
SEPTIC TANK: NO ---______ YES
:NATURE OF SERVICE: ROUTINE
K— EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE FULL TO COVER
ROOTS BAFFLES IN PLACE
EXCESSIVE SOLIDS LEACHFIELD RUNBACK
SOLIDS CARRYOVER FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY:
--OMMENTS:
ONTENTS TRANSFERRED TO:
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Town of North AndoverOf NORTH ,
OFFICE OF 32 yes e o e• ti0 L
COMMUNITY DEVELOPMENT AND SERVICES
0 A
27 Charles Street :10
WII LIAM J. SCOTT North Andover, Massachusetts 01845 1,9Ssgc,Hus���y
Director
(978)688-9531 Fax(978)688-9542
July 16, 1999
Phalen&Allen Limited
4 Eugene Drive
Winchester, MA 01890
Re: 1591 Osgood Street,North Andover
Dear Mr. Phalen:
Just a note to apprise you of the status of this project. The North Andover
Installer's test,was offered on July 14, 1999. Mr. Joel Rodriguez was notified at least
twice before the test was given. His comment to the Health Department secretary was
that he was on vacation and didn't want to come in to take the test. He did not appear for
the test. The next test, according to regulations, will be offered in September of 1999.
Unless I hear from you or from your client,Mr. Adams, to the contrary I will proceed to
attempt to locate an installer or two for the grease trap at 1591 Osgood Street. There is
also still the matter of some of the consultant's concerns. I believe you stated at the
recent Board of Health meeting that you would respond to them. I would appreciate that
being done so we can, hopefully, move forward on this project.
Thanks. Please call 978-688-9540 if you have questions.
Sincerely,
—ZkAlu
Sandra Starr,R.S.
Health Administrator
Cc: C. Adams
B. Halpin
BOH
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
24" MAX
4"tOPSOIL&GRASS
Z
w Z COMPACTED
GRAVEL
M FILL
(SOIL B)
4" COMPACTED
4" SCHEDULE 40 PVC
6" SAND
(SOIL A)
PIPE TRENCH FOR
� X11 Of , � GREASE TRAP FOR EXISTING V11e Ytmited
�o�► Ihvkqq� SANITARY DISPOSAL SYSTEM
E y� SANITARY DISPOSAL SYSTEM
j S.P.E.C. REALTY TRUST(CHRIS 781-7-09-7W
STE R� �c�@ ADAMS TRUSTEE), 1591 OSGOOD
AL STREET, NORTH ANDOVER, MA.01922
JUNE 8, 1999 SHEET 6 9�d-y4�8850
20"DIA CLEANOUT R
24"DIA COVER 24"DIA COVER
PLAN VIEW
1500 GAL GREASE TRAP,H-20 LOADING,SHEA TK4500H OR EQUAL IS SHOWN,
1000 GAL MIN IS REQUIRED IF AVAILABLE OTHERWISE THE 1500 GAL UNIT WITH
3 HATCHES WILL THEN BE ACCEPTABLE
INSTALL CHILDPROOF COVER
AND RISER TO GRADE
INSTALL CHILDPROOF COVER AND SEAL TANKICOVER JOINT
AND RISER TO JUST ABOVE
GRADE AND SEAL TANKICOVER JOINT 20"DIA CONCRETE
COVER WI GASKET
1"TAPER—
:z.
APE u,
9"MIN.
PIPE SE a.
• /—PIPE SEAL
il,
3"
IN. 3"MIN r/
8"TOP H-20 LOADING ', 3" ,. 4"DIA INLET
4"DIA OUTLET 6"+MIN
LIQUID L 10"MIN
1'-2" 4"x 4"TEE
` SCH 40 PVC
4"x 5"TEE SCH 40 PVC
4"DIA PIPE I a
3" SCH 40 PVC TONGUE AND GROOVE 4"DIA PIPE
4'-4" JOINT SEALED WITH SCH 40 PVC
GAS
BAFFLE BUTYL RESIN
4"
6"MIN.<514"CRUSHED STONE BASE SECTION VIEW
GREASE TRAP DESIGN CRITERIA.
1. SIZE REQUIRED IS MINIMUM AS PER 310 CMR AND LOCAL BOH OR 1000 GAL
2. FOR TANK DIMENSIONS AND NOTES SEE NEXT SHEET
3. 1500 GAL GREASE TRAP, H-20 LOADING, SHEA TK-1500H OR EQUAL IS SHOWN,
1000 GAL MIN IS REQUIRED IF AVAILABLE OTHERWISE THE 1500 GAL UNIT WITH
3 HATCHES WILL THEN BE ACCEPTABLE.
�H OF GREASE TRAP FOR EXISTING
'�gss9� SANITARY DISPOSAL SYSTEM ylfale�l & fll&yl ited
SANITARY DISPOSAL SYSTEM o�e90
1EN,JR, H S.P.E.C. REALTY TRUST(CHRIS
8172
Amo A ADAMS TRUSTEE), 1591 OSGOOD
�F �/STO,
`�SADNAL EN� STREET, NORTH ANDOVER,MA.01922 Y-Z-
JUNE 8, 1999 SHEET 7
GREASE TRAP NOTES:
1. THE DIMENSIONS SHOWN WILL DEVIATE FROM ONE MANUFACTURER TO ANOTHER ,
HOWEVER THE BASIC INVERT GRADES SHALL BE MAINTAINED.
2. ALL CONCRETE SHALL CONFORM TO THE LATEST ACI CODES AND STANDARDS AND
SHALL BE 4000 PSI CONCRETE WITH SULFIDE RESISTANCE (TYPE 2 OR 5 CEMENT)AND
REINFORCING ALSO CONFORMING TO ACI REQUIREMENTS AND ASTM C1227-93 WITH A
MINIMUM YIELD STRENGTH OF 40000 PSI TANK SHALL BE FULLY DAMPROOFED.
3. THE TRAPS SHALL CONFORM IN ALL RESPECTS TO MASS. REGULATIONS PROMUL-
GATED BY THE DEP AS TITLE 5 REGULATIONS UNDER 310 CMR 15.000.
4. TONGUE AND GROOVE JOINTS SHALL BE SEALED WITH A BUTYL RESIN.
5. TANKS SHALL BE DESIGNED FOR H-20 LOADING AS NOTED IN THE TABLE.
6. TEES AND/OR BAFFLES SHALL BE FURNISHED BY THE SAME MANUFACTURER AS
THE TANK. TEES ARE THE PREFERRED INSTALLATION.SIDE INLET SHALL EXTEND TO
CENTER OFTANK AND OUTLET TEE SHALL HAVE A CORROSION RESISTANT GAS
DEFLECTOR.
7. GREASE TRAP SHALL BE VACUUM TESTED FOR WATERTIGHTNESS IN ACCORDANCE
WITH ESSEX DESIGN STANDARDS 500.3.1 AND 500.3.2. OR EQUAL
8. THE BUILDING SEWER SHALL BE CONNECTED TO THE GREASE TRAP IN A STRAIGHT
LINE IF POSSIBLE. IF A BEND LESS THAN 90 DEGREES IS REQUIRED, PRECEDE THE
BEND WITH A CLEANOUT EXTENDED TO GRADE AND PLUGGED.
GREASE TRAP NOTES&DATA
10 Of FOR EXISTING
SANITARY DISPOSAL SYSTEM
SANITARY DISPOSAL SYSTEM
F .Jp S.P.E.C. REALTY TRUST(CHRIS jai I'fg-A1y
90 ADAMS TRUSTEE), 1591 OSGOOD
L EN��� STREET, NORTH ANDOVER,MA.01922 yam"a1.9ya
JUNE 8, 1999 SHEET 6 97�74f 1ffa
CORE DRILLED OR
PRECAST HOLE
INS.S.
EXPANSION MD
PIPE
COAT BAND WITH
COAL TAR EPDXY
PAINT ' • EXTERNAL S.S. RkND
KOR-N-SEAL EOOi
ALTERNATE 1
NEOPRENE BOOT FOR PIPES
4" DIA. AND LARGER
WALL INTERIOR
CORE DRILLED OR
PRECASi HOLE
PIPE
LINK-SEAL. WALL ALL METAL PASS TO EE
PENETrZATIO /_
N. STAINLESS STEEL AND
COATED WITH COAL TAR
EPDXY FOLLOWING INMALLAMN
O O
O�O '
0 0
ALTERNATE 2
LINK-SEAL FOR PIPES
AND CONDUIT
PIPE PENETRATION DETAILS FOR
,SN OF , f GREASE TRAP FOR EXISTING Yk& & SfllltYiinited
SANITARY DISPOSAL SYSTEM
�
SNE SANITARY DISPOSAL SYSTEM E �
S.P.E.C. REALTY TRUST(CHRIS �a�7xuy��y
o ADAMS TRUSTEE), 1591 OSGOOD
TER�
F`�S�ONAL EN� STREET, NORTH ANDOVER,MA.01922 y-4m
JUNE 8, 1999 SHEET 9 9J��G�x50