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HomeMy WebLinkAboutMiscellaneous - 1591 OSGOOD STREET 4/30/2018 (2) 1591 OSGOOD STREET l 2101034.0-0004-0000.0 r i i 1 l I t V l • SETTLED X46' . • 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'���' . • 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 � �IU r i i • 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 r C t 1 p l pr 'A ed: ,'ciober- 11 201: 'a• 1 '. 2G Essex North Registry M. Raul Iannuccilio ier' Trans#: 2515ti ope -RRECO, )9' YTI; rRuRER.TIES LLC Nage: LFII os:t#. 29610 _s6 ke:.:10-i1-GC13 Cz 2'39:20r '91 cSGC00 51 (J0� :,r kNiVJ AM l�1CT I_t 50.00 ec..r a fee 5.Uu lcir CASH PMT r;� ti l:k 1 666 P--9241 -ow-'?tea''v 1.0 i o---1 1----2 O 1.3 a 02 : 39P 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+ E � �sswcNu� 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 r � T D i _ r ' 7�r f t` 64 / 8 OtAeORT H,4 . O � D • 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% + LL NW JN ,,,n. � O ZmZ - � N = O to yO � Q �VyJZO H Z V1 Q – J W Z a > Dim I Lu � JW V Wm 0 _j < OOYQH J � O a: LL U. 0 0ZOTLL < Lu ZW ui GJ Q WgWOJZ LLQ I-- Lu OOjOHWp Q GZa dJO D pzaiA : WWF—- Z m Zm 9 � J � LLWWW2m � 0 Z Lu d Q WmuCOI_L5aWJ � OWa = WQmU ? OZ2mlLOU �mF- c) a Z snooi / F- I i 3a313W SVJ / ....................... / Z W O ! NIVW3H Q „ W Z U Ol;!13 ..v 1SIX3Q J io Y ' CL •!% i N (LZ ' Ww ' X W H Q * WV� H i / � V . 1 ! ..JQ a W M x` O i W ' d` / Z I � oW :i Z / W o� U) LL I Q :m / c9 i w W Zx ...z0..... y I � X I � Lu � � J is m * c • w H REVISED 6/25/99 SITE PLAN FOR � ,t9 OF GREASE TRAP FOR EXISTING When yl,netew SANITARY DISPOSAL SYSTEM rya SANITARY DISPOSAL SYSTEM 4vl `�'Y°` E m ZwAftor"am.90 -' S.P.E.C. REALTY TRUST(CHRIS ADAMS TRUSTEE), 1591 OSGOOD �•�' TE STREET, �c� F`�S�GNAEN� � STREET, NORTH ANDOVER, MA.01922 JUNE 8, 1999 SHEET 4 9J&)4�X850 R'T� VE Mq 1 m li .Reco'rd SSACHUSETTS ,�Cr:..4V��ylY,rlt �•�J� ), tl<�I,p,.a; (� l �, ,.�i�'\ y;r1;;�', li,,.0 EIVED DEP 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, Ai Faclllty lnfor �tlon TrJVVNOr ,,JR -- HVOTr; :'A,RTMENT ,,TWi'W NIN out: ...1; :: System LocaUon:, crJy Cie laD koy Addras) -- a;rux /{mum uSI VN hwrn:Y�,;:.'i�• City/Tarm +r ""• ,.f: S(al or, OW et sle ` ".1, �• ,, '1 Cote n ' �'' :' ,1:'r,r,' •ti�,"jrl�;"")'',1�.�Nun�,•;;4;!'y';��.�.r.'!'1'?l;lf..' ,�..,.., l,'Addroit (II dlNerenlrcvn Loud m Toiapnono Numo,( --- Rumping�Rt 'fiord --- .� 1, Dah of Pumpin9 ;; Dole 2. Quantity Pumped: ---- . ' 3, ,.TYP.e•Pf,ayalem;' c�uon, } CDCesspools) epflc Tank ❑ TI9ht Tank or es r1 ,1 c b �1 Oth (dbe i): ,..,r ----- Effluanl Tea Fllla[I�,�resent? ❑ Ye5.21N o r,: 1 ,,y ,,a�;•� ;�l .r;��'���,�(�y�;;'rrl�r+M�� If yes, was I( cleaned? ❑ Ye Condl�Jdri'Q(SY; mI'l- •'.ei V^ fir, „�,IN�11'I!,)IIJ �ull.•� ,c7 of . � �,�=:���,Irl;,:. 1,1•;:•:r� .•rr IJ Cl l .j'a;,.;•/;'�,yi�'' ) I f .; ;, (,'r j,� .iY['''l�;r'` 1 VehICJe Ucan / N f •� .;-r;'�i,.l�'�r.ti,.l' �,�1H'?,yaA 11•�l.!?'.!,',.!�III� �'•���'• � I,'1, �': , �l' LOCA fi ,;'.t:�,,. •, , on.wh@re coylents' d -'. :.:;: ,f�, .<,.,.�,tl<,• ;,,,,, ,Were lsposew • ',,.. ,,' .1 '�� ALJ �� hap)N,ww,mass,gov/dap!v,%efar/approvaJall6lorms,hlm,dlnspect 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 lu - U) Lu W2 � � I-- Zzp mo m w z IL W J LLLL UZON 0 LL Q — w � ° z m o . � za m Lgc W � E... o wwww (L Q WmUm � tLLi. ja Lu wamv ? azx Zfn / .. ..........F.......................... . o Z ;- .WQ z 3AOw321I3 .31 / XWQ /\ -C W V) F- - x- ........................... - .• N ..... i 1 ' \ • /. ......................... ...i:..... �....l.v (L ! 'tea - / ' \ U �p yv 0 f- W ZcN Z ! W LL i w m ! t� x ;..ate...!�.. U) o 1 CL I � Lu • 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•`- w. 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. ' a - Sv r 'E jj .+ .tr ilk MM r S; krt4{a fir► ����� � ' � C fG�4;:; CCC: C C C. CCC _ C�CCCCC� MMEN M I �' 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 ,w. 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 Compu only the tab key Address n ;�,q to move your .." 1,��/'Ilr- �1 J cursor-do not CI /Town use the return tY State 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 t 4r 9+.t"a1• :rrir{tii''�(�`I� YtF, i,ik' ` � ✓Y)� • J.. i y J) -'!.' J...;1,,�hllil'1���A�t1Il Y.fyi��y({(l� 11.t�41 �Y'. t ,' 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 '.t`��� K'y •x J�l��Ir'4rr7ir y3.. ' t y } C � .�s 6 musetts k ` Q ,r kQf�;NORT ANI OV R MASSACHUSETTS :yster 'PUm �n Rec�o'rd p RECS µf'•r p1 Lmrvt*YVIN� 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 I $+i • ° ,; ,C1•f/• „Vehicle UCen$e Number t - •1r Vt,4 t1. try't 1Dn�yr�'rj��i.� tI'� I �. t .•VI ��l ' ,- +tri r ` r Y�,;�i+:•.�iy�;�jni'�I�f�tl`�tiit.l.,;.Y'? J �' . :,7 Locabontwhpre Contents Were disposed: 1 , ,, .,:..,• '„ GSI ��c �• Data :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$r> pyy� TOWN OF NORTH ANDOVER QR ADDUSS ____ _. HEALTH DEP ,^;-, ,ENT �Sti'eT'EM ATI OF I v I -QUANTITY PUMNec f..6-1570 Y�3 1A rvKb Ur 3bRylea: xvv'rIN� UA-r,ONa. GOOD CONDvrIUN Nul : f Ci �Ci� rx K4AYY Ossa To X1.83 IN +�c�9 B KOQ U$iY8 1,aACHAJ eL.4 501,1pe �,�.. PLC�DarD �OLCDC�lV�YOY�R' omeR.�xP�,,IN �'uMMaNT�. UN I frty 1'3 (1l�NyyGJK �,b0 1.t 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 null:: �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) i All Ile u I'G OF PUM1'(N0.i (QUANTITY PUMPCD;A� l Lc� � � NO tib YDS' _.SEPTIC TANK; N0 YES • .. -\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) �w 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: ti+ry• � l 3iY1IT r• V n7711 1 ifX'" - t ) 4 ! 1 .. 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Y•t !,j' �1 ,J v •R A3TL11�0 � rr.1.ti tlht J. 7 kk1aa SYS TRIM I.00ATIO � t ,t i dJ'i +h'S+I +t•�l• • �� ZG�• "� !Z * Ph, 't«• f!rA I t r, ( t r r ���r�••• _ �y .n4r I ... .. �� `J./�G .. } h Yom• � t • 71 'r `� `54 J`°;.�j y "�,�,p 1�fl r, ;s,.i' � r � r"'h�,rf i �����► '•�r15�t.�t�. Y���j t j t;Y ti.!.,,,r,y«.._ .. . - ;E •, a,t T P+ 'd° I +r .,ski, {; _. i -��� � �r,.f j j l '.:j�'� it �Y ) - .. • ��� L!/•'`�Jv��1� �r�� �s ( ,.�t .I 11 +� !•� IX 4+r(j✓1,.�"il N M' r�a.y GAUON,7 r J r Ct \ t" 11�, tr ti. 11 �M- t R i {:f I 1 • t ntiAre, c Iy'14t1 "•�S tt,�6� y��,• � 1��`y ,• I iQ. ,. { ' \. -:, ,t r ,, i ) � ,'�SIM,� ,.r,• SEPTIC TANK:NO YES }�ff pq 't 1 F/'�p ,J;a�1t�.,,•.'a.4...�.•r 4r .-:, lr �•i }r �;,', tt .�ir e j�!f�filr rl fit AON {l1 I Ii 1 + x{! � t ,rf(Ih M .�'': �,,�;h,,, ?+�:.��s GT��/4`w •: . ,Ir �1 •• T . O CONU ROO �•{�,L,1,1.•f f it , I, . mom HAMES IN PLACE �d� ��1s'a�fr♦•}f.�F.•,gg"t4��r1 l tcFrr� ,.;�r LEAcurvLDSOSDS vND A S0LIDS YOV14 FLOODED .� OTfmR ,yyrr r �f t •1""',r���p��1"rys�,t�r,�i� I "rst�Yt'f�,l�. • .'r J 5 r LAIM ! �/llTrnit4Ny.�C^ LLCA ,(>c, �. w RI rte♦r Ely}R':1•t�f y. f ,� � a..l • • f.l t .41yt r1' ♦ip41aiiiijillil �lt�,`Ir r �i of{f"' a'1{ i c t♦ , ' ,r ,', r��,.}�11.•) •�7A}• dr}r�7 J+t{t.�i'^ Ylli� { 'y.# Y r • '�'1'a'►f�` � f ��� is ' ''arr,*i �� . • 11 Miami ,''4a �: J � Jy♦�t,'*qtr} aNti aP i,�v �l f{! rl11,11111111111111 IRVIN 1111111111111 l�i+r � r• �tar N 4i '.t{'��,; ( jS i `, ^i 't`s )- a.I.fi` d+ ♦ 3 `, �•dt ',a�..� 5 }pl�titi,41y aylp ' ti1 G J 'Y� � tly,a tit�e JI if r • .� I t .•t!W t 7 • yr���'j,�f �'W �y ,�J �/1J 1 .rl: w .✓Ir t `M� �'GYlrj '7j1 �'!a{� '1YJF ,! �� ♦ f tr y ♦ i 1' �yy' f —,� --- -h •' '^nt '7!•!, ,} r y IC�.I4. l/t ZJII 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