HomeMy WebLinkAboutMiscellaneous - 1619 SALEM STREET 4/30/2018 �� T 1619 SALEM STREET t +.
2101106.8-0080"0000.0
1
f
r
R'
1
_ J
e,
Lot & Street � Gf ¢fes M T` Map/Parcel x
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES NO Permit# � ) 49
Plan Approval: Date: Z ,/ Approved by:
Designer: �r�G��S�y��/1'1Ci?/I1M Plan Date:
Conditions:
Water Supply: Town Well
Well Permit: Driller:
Well Tests: Chemical Date Approved
Bacteria I Date Approved
Bacteria II -at-e--Approved
Plumbing Sign-Off: Wiring Sign-0
Comments:
Form"U" Approval: Approval to Issue: YES NO
Date Issued By:
Conditions:
r
Final Approval:
All Permits Paid? YES NO '
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
SEPTIC SYSTEM INSTALLATION
Is the installer licensed? 9NE
S NQ_
Type of Construction: p
New Construction: Certified Plot Plan Review YES �..
Floor Plan Review YES NO
Conditions of Approval from Form U -YES NO
Issuance of DWC permit: `YES NO
DWC Permit Paid? Y NO
DWC Permit # 134, Installer:
Begin Inspection: YES NO
Excavation Inspection:
Needed:
Passed: By:
v
Construction Inspection:
Needed:
As Built Plan Satisfactory:
YES:
Approval of Backfill: Date: Z66 9-By:
Final Grading Approval: Date:
Final Construction Approval: Date. y:
Certificate of Compliance: Approval: Date: / `Z
d� l
TOWN OF �vl 4f L -
SYSTEM PUMPING RECORD
F
r
APR { 8 2003
DATE:
f
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
Doj (example:left front of house)
-�o V& ko U�S--e- r
DATE OF PUMPING:' QUANTA PUMPED : GALLONS
CESSPOOL: NO
YES EPTIC TANK: NO YES___!-
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 1 — v t
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: '(-4L' UANTITY PUMPED t �Es� GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO:
NEW ENGLAND ENGINEERING SERVICES
INC
a
i
f t
AUG 5 .._
July 30, 1997
i
North Andover Board of Health
Town Hall Annex
School Street
North Andover,MA 01845
RE: TITLE V REPORT 1619 Salem Street,North Andover
Enclosed is the Title V report for 1619 Salem Street,North Andover,MA. The system failed our
inspection.
If there are any questions please call me at my office,686-1768.
Yours truly,
O
Be n C.Os od
P sident
33 WALKER RD. — SUITE 22 — NORTH ANDOVER, MA 01845 — (508) 686-1768
i
F
SEPTIC PLAN SUBMITTALS
LOCATION:
O
NEW PLANS: YES $60.00/P1an 0 3 & *c
I
REVISED PLANS: YES $25.00/Plan
DATE: l%►, ' 9 l �'l �'i 'z
DESIGN ENGINEER: J��i► p��,a
When the submission is all in place, route to the Health Secretary
FORM 11 - SOIL EVALUATOR FORM
Page I
No. ......................... ......... Date ................................
Commonwealth of Massachusetts
Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
PerformedBy: ......... ..................................................... ..................
Witnessed By: ...
..... ......... .... .. ...... ......
............1.1-..........-................ .......
...................................................................................................................................................................................................................................................................
Loation Address or t -t 44,1,e-ok- 5-4-. Owner's Name. 6e..,eye, /J. 13 iA5
Lot I Address.and /(,/t7 -544eA 4;.J-.
Telephone ff
New construction ❑ Repair
Office Review
Published Soil Survey Available: No F1 Yes LT
Year Published ....../fD/ Publication Scale Soil Map Unit .....(f,6
Drainage Class Fb.. Soil Limitations .................................................................................................
yt
Surficial Geologic Report Available: No Yes ❑
Year Published ................... Publication Scale .................
GeologicMaterial (Map Unit) ........................................................................................................................................................
Landform ............ .................. ............ ................................................................................................................ ...........................
Flood Insurance Rate Map:
Above 500 year flood boundary No El Yes 2/
Within 500 year flood boundary No Yes F]
Within 100 year flood boundary No Yes El
Wetland Area:
National Wetland Inventory Map (map unit) .................................................................................................................
Wetlands Conservancy Program Map (map unit)...................................................................................................
Current Water Resource Conditions (USGS): Month ..................
Range Above Normal El Normal El Below Normal El
Other References Reviewed: ck S-O' S m&0
z
FORM i 1 - SOIL EVALUATOR FORM
Page 2
On-site Review
Deep Hole Number A `i... Date:....`.. Time: Ar $`"�` Weather </RAf4/......................
s-
Location (identify on site plan) .............. ...............................................................................................................................
Land Use ........... � Slope (%) ..f�/O.... Surface Stones ...r............................................................................
Vegetation ........ al. "... .....................................................................,..............................................................................................
Landform ..........19K7...111..6...1..............................................................................................................................................................................................
Position on landscape (sketch on the back) .........................................................................................................................................................
Distances from:
Open Water Body .7...�°o..... feet Drainage way. ..1.v-..' feet
Possible Wet Areafeet Property Line feet
Drinking Water Well?loa.'... feet Other .........................................
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(Inches) (USDA) (Munsell) (Structure, Stones, Boulders,
Consistency, %Gravel)
D to
Ar
10-4 e'bills.
Parent Material (geologic) ............................................................................................................... Depth to Bedrock: ............................
Depth to Groundwater: Standing Water in the Hole: .....n.03"`kWeeping from Pit Face: ....17
Estimated Seasonal High Ground Water: ....(a Z,a
^ ^ `
~
'VI ��RM It - SOEL EVALUATOR FORM
Page 2
�
On-site Review
Deep Hole Number �" Date: 7lnme:' Weather 7 6.5. ............
�
Location (identify nnsite plan) ----. 401��..-------_----_-_--______________..__________
LmndUae - Slope <Y6} —to/W' Surface Stones ................-'---'--_------'---
� Vegetation ......... ................................................._..............................................................................................................................................
Landform .........orv...4'/';.1...................................................................................................................................................................................................
Position on landscape (sketch onthe back) ----------'------------------------'_---___---
Qimtmnmamfn»m:
Open Water Body feet Drainage mmy-. feet
^
Pnuaib|m Wet Area �������' feet Property Line .����» ��-.° feet
�
�
OrinWngWater \No\ -'40e-'- feet Other -------------'
`
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(inches) (USDA) (Munsell) (Structure, Stones,Boulders,
Consistency, %Gravel)
�
�
`
� }
� '
�
�
�
��
/z-
ParentK8ateha| (geologic) -----'�y�tt=-------------------------- Depth to Bedrock: ---------.
Depth to Groundwater: Standing Water in the Hole: A.A.L.V., Weeping from Pit Face: -0N.�~���
�
Eadrno�edS Seasonal h �� dWater: ����
� eouono g Ground -'
`
FORM 11 - SOIL EVALUATOR FORM
Page 3
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole inches
Depth to soil mottles .'�....... inches S 2
❑ Ground water adjustment ........ feet
Index Well Number .................. Reading Date ................... Index well level ...................
Adjustment factor .................. Adjusted ground water level ........................................................
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? �
I:
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was .
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature L47 l ,.ti Date
i
FORh1 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
ry�C'r�-elJ-cti , Massachusetts
Percolation Test
Date: 57 Time: .....................................
Observation Hole #
Depth of Perc
Start Pre-soak
End Pre-soak
�
Time at 12"
Time at 9"
/Z
Time at 6"
Time (9"-6")
p
Rate Min./Inch )0 ��,
Site Passed L9' Site Failed ❑
...............................................................................................................................................................
Performed By: QA�:gus-2
Witnessed By: fZQ'D2La
Comments: ....._....... ......................... . _.............. . ._ ........... ..
.......................
-------- -
T A
-\
COMMONWEALTH OF MASSACHUSETTS /
L EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
MENT OF ENVIRONMENTAL PROTECTION
�) DEPART
ONE WINTER STREET. BOSTON. AIA 02108 617-292-5560
TRUDY CORE
tkILL1A%1 F WELDScactru`
Govcmo
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: E 9 S A I e M S t h A nd oV e r, M R Address of Owner:
Date of Inspection: 7/a/97 (I( different)
Name of Inspector: BENJAMIN C. OSGOOD JR.
1 am i DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: NEW ENGLAND ENGINEERING SERVICES, INC.
Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 01845
Telephone Number: 508-686-1768
CERTIFICATION STATEMENT
1 cenify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Condrtionaliv Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: G• Date: as g
The Svstem inspector s submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this
inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, 8, C, or O
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310-MR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
B1 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.
Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If"not determined', explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspectdr with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revip.d 04/2S/97) Pag• 1 of 10
- -- --------..
... ..... ..._..... ...... .
q7-36
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: S A I e M S t. N. g n d o ve r.M 4
Owner: a e o r`9 e B i aS
Date of Inspection: 7/a f g 7
Bj SYSTEM CONDITIONALLY PASSES (conunuedl
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken. settled or uneven distribution box. The system will pass inspection if'(with approval of the
Board of Health;. Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than (our times a year due to broken or obstructed pipe(s). The system will pass
Inspection if(with approval of the Board of Health)
broken pip-e(s) are replaces
obstrumon Is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which reouire further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health. safety and the environment:
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (S.tS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximat;on not valid).
3) OTHER
(revived 04/25/971 Pay. 2 of 30
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Propertv Address: 1619 Sale M St. N. fa ndover� m•4
Owner:Ge0f9e Gio.5'
Date of Inspection: 7/a Jq 7
DJ SYSTEM FAILS:
You must indicate either -Yes" or "No" as to each of the following:
t have determined that the system violates one or more of the (61lowing failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or 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 liqureve in the di tnbutron box above oytlet t9,ven due to an overloaded or clogged SAS or cesspool.
�a<�� �r`y e !�l3ov� (jc�t P>` f.'PSS —S�/sfo•« vr�vsdo �a.L Y�'oa�4s .
2A• Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flov,.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
{{ Number of times pumped _.
Po SS t I Anl portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
✓ Am ponion o:a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
✓/ Any ponion of a cesspool or privy is within a Zone I of a public well.
y Am portion of a cesspool or privy is within 50 feet of a private water supply well.
_ ✓_ Am•pon,on of a cesspool or privy is less than 100 feet but greater than SO feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
Ej LARGE SYSTEM FAILS:
You must indicate either -Yes" or "No" as to each of the following:
The following criteria apph• to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(raviaad 04/25/97) Paq• 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART 8
CHECKLIST
Property Address: Sq Iem 5+. N. 4ndove(-MA
Owner: &eo r,3e
Date of Inspection: 7ya/97
Check if the following have been done: You must indicate either "Yes'or'No' as to each-of the following:
Yes No
N.A Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have riot been introduced into the system recently or
as part of this inspection.
NA As built plans have been obtained and examined Note i they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up-
V/
ack-up.V _ The system does not receive non-sanitary or industrial waste flow.
V _ The site was inspected for signs of breakout
_ All system components. excluding the Soil Absorption System, have been located on the site.
t/•. _ The septic tank manholes were uncovered, opened. and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum.
/ The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner(and occupants, if different from owners were provided with information on the proper maintenance of
�i Sub-Surface Disposal System.
NA Existing information. Ex. Plan at B.O.H.
Determined in the field (if anv of the failure criteria related to Pan C is at issue, approximation of distance is
unacceptable) (15.302(3)(b)j
i
(r.vi..d 04/75/971 P.9. 4 or 10
l
97-26
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1619 So,h2 rn S+. N. A n Jove r,/)1,1
Owner: George Bias
Date of Inspection: 7/,a J 17
FLOW CONDITIONS
RESIDENTIAL:
Design flow: Q. dlbedroom for S.A.S
Number of bedrooms: `i
Number of current residents: 4
Garbage grrr.der(yes or no!:,` Fs
Laundry connected to system (yes or no): -/,e S
Seasonal use (yes or no): N 0
Water meter readings. if available (last two (2) year usage (gpd):
Sump Pump (yes or no): NO
Last date of occupancy: / 16
COMMERCIAUINDUSTRIAL:
Type of establishment:
Design flow: Qallons/dav
Grease trap present: (ves or no)_
Industrial Waste Holding Tank present: Ives or no)_
Non-sanitary waste discharged to the Title 5 system ryes or no)_
Water meter readings, if available
Last date of o-cupancy:
OTHER: (Describe)
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information No('4
n i Ove r
System pumped as pan of inspection: (yes or no) Ct
I(yes, volume pumped: Qallons
Reason for pumping
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, aaach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components. date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no) N D
(revised 04/25/97)
Page 5 of 10
V-36
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 161q S A I e m S F. N. A n do v e
Owner: (Jeoro e 13 �S
Date of Inspection: 7P9 7
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explainl
Distance from private water supply well or suction lir�
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc-)
SEPTIC TANK:_
(locate on site plant
III r,
Depth below grade: i o
Material of construction: /concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal. Its( age _ Is age confirmed by Ceni icate of Compliance _(YeS/No)
Dimensions: 1000 G A L
Sludge depth- 4 t' �)
Distance from top of sludge to bottom of outlet tee or baffle: a 6
Scum thickness: 4()
Distance from top of scum to top of outlet tee or banle. 10 It
Distance from bottom of scum to bonom of outlet tee or barite: a,
I
How dimensions were determined: �C 'eo c ti- 'v 4 t h C A►i 6(- f e J S+t C k
Comments:
(recommendation (or pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) TA n k j S I n Dr, Condition
'I
f- Sbovld hove schedvle uo teeC nS+ailed
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
{
(r—i—d 04/15/97) P.q. 6 of 10
97-:-36
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 16I y S a 1 e rn S4. un d ov e
Owner: (37eof)e 91'ay
Date of Inspection: 7/9./97
TIGHT OR HOLDING TANK: rTank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacm gallons
Design 0o- — gallonJda�
Alarm level Alarm in working order _ Yes. _ No
Date of previous pumping:
Comments:
(condition of inlet tee. condition of alarm and float switches. etc.)
I
DISTRIBUTION BOX:_
(locate on site plani
tI I t
Depth of liquid level above outlet invert:
Comments:
(note ii level and distribution is equaleevidence of solids carryover, evidence of leakage into or out of box, etc.)
SCUM L►nes ;ndicrn�les &ffluen+ above inver+5 ' becaysc of non-use for- 7-8 month;,
e Iuen+ low in D-box.
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order: (Yes or Not
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
I
I
(r.vi..d 04/25/97) Pay. 7 of 10
q 7%6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1619 S g I e rn S+. N. 4 n d o ve r,In.A
Owner: 15 eo(-5e B saS
Date of Inspection: 7/a/97
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible;'excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number._
! leaching chambers, number_
leaching galleries, number.
leaching trenches, number length:
leaching fields. dumber, dimensions: a0 X O
overflow cesspool, number
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of veggtation, etc.)
No evidence of hydro,ukic fgtivre Vege+a+ on IS Un%-f:orm.
CESSPOOLS: _
(locate on site plan)
Number and coniiguration
Depth-top of liquid to inlet invert.
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as pan of inspection)
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.)
(r.via.d 04/25/97) P.q. 6 of 10
9 736
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1619 S em S+. N. .4 n J0ver,/V1 4
Owner: Gr e o f9 e B 10AS
Date of Inspection: -7 A
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
STEPS
k cZ a�
J J
3ox
I 1
i
(r.vi..d 04/25/971 P`4. 9 of 10
-__9713 .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propertv Address: 1619 S a e fn S t. N 14 f1 d,,ve f, M.4
Owner: &&Cr�e Bias
Date of Inspection: 7/ 7
Depth to Groundwater 8t Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
!i Observation of Site (Abuning property observation" hole, basement sump etc.)
Determine it iron local conditions
Check wth !oca! Board of health
Che6 FEMA n•tap5
Check
pumping records
Check local excavators, installers
Use USGS Data
Describe in vour own words ho%v you established the High Groundwater Elevation (Must be completed)
1e I�eVI '-Vv of USG5 Soil nl(45 i n a(V Q+es carton Se es
I h I
W t U Wgte � �I ,
i
(rsvi—d 04/]5/97) P.q• 10 of 10
Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
April 10 19 98
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X )
by Mike Reilly
INSTALLER
at 1619 Salem St. , North Andover, MA 01845
SITE LOCATION
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. g'I dated March 20 19 98
The issuance of this certificate shall not be construed as a guarantee that the system will
• function satisfactorily. �C�..�� ✓�,�j�i'
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed; Q'�repaired;
by I--I ►Le 1?,S t^L,`
looted at 1(o
was htstalled W conformance with the North Andover Hoard of Health approved plan,System
Design Permit dated �W ,with an.approved design flow of O
..gallons per day. The materials used were in eonformance with those specified on the approved
plait;the system was,installed in accordance with the provisions of 310 CMR 15.000,Title 5 and
local rgpdations,and the final grading agrees substantialty with the approved plan: All work is
-accurately represented on the As-built which has been submitted to the Board of Health.
Installer' Lic.#: Date: 4 79-,r
Design Engineer: Date:E eer:
No.3
9 �
1T
v
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: CURRENT INSTALLER'S LICENSE#
LOCATION: I S cz Pefy) .5 A
LICENSED INSTALLER:
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
j�
$75.00 Fee Attached? Yes No
Foundation As-Built? Yes No
.-Floor Plans? Yes No
Approval Date: , ���
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( ) constructed; ('^'I repaired;
-- by , /cr Rte: 11 -
_. located at _ /Z2 z
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit#f bp,,-) , dated with an approved design flow of
gallons per day. The materials used were in conformance with those specified on the approved
plan;the system was-installed in accordance with the provisions of 310 CMR 15.000, Title 5 and _
- - local regulations, and the final grading agrees substantially with the approved plan. All work is -
__- -accurately represented on the As-built which has been submitted to the Board of Health.
Installer: Lic. #: Date:
Design Engineer: Date:
Town of North Andover, Massachusetts Form N°.3 ! -
N°o'",
hBOARD OF HEALTH I.
/
3: �{•' •° ° rte- � 19�
L
}�'"°•,.,o��°"�# DISPOSAL WORKS CONSTRUCTION PERMIT
,SS^CRUSES
Applicant
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
Fee S D.W.C. No. b
Town of North Andover, Massachusetts Form No.3
40RTH BOARD OF HEALTH
t
�.. °!° �2
p 19�
DISPOSAL WORKS CONSTRUCTION PERMIT
SSACMUSEt
Applicant
NAME ADDRESS TELEPHONE
Site Location
I
Permission is hereby granted to Construct ( ) or Repair (/X an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee 7S
D.W.C. No.
-
C',
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: a "� a� CURRENT INSTALLER'S LICENSE#
LOCATION:
LICENSED INSTALLER:
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes �� No
,,.- F`oundation As-Built? Yes No
Floor Plans? Yes No
Approval Date:
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( ) constructed; ( repaired;
by
- located at /12 - S_7L,
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit 9/21,p? , dated 1,2 with an approved design flow of
gallons per day. The materials used were in conformance with those specified on the approved
plan;the system was-installed in accordance with the provisions of 310 CMR 15.000, Title 5 and -
- - - local regulations, and the final grading agrees substantially with the approved plan. All work is -
-accurately represented on the As-built which has been submitted to the Board of Health.
Installer: Lic. #: Date:
Design Engineer: Date:
Town of North Andover, Massachusetts Form No,s
A0*Th BOARD OF HEALTH
19 9F--
' '�''•' DESIGN APPROVAL FOR
CHUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
• Applicant ��d�'C- //S Test No. F/el
Site Location 4� 196&M :57'
Reference Plans and Specs �UF.�°�S iU /02�/�1'/�!7
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CHAIRMAN,BOARD OF HEACTH
: Fee Site System Permit No.MOO
PLAN REVIEW CHECKLISTn,�
ADDRESS / oZ2 ��LC/Ll S/"- ENGINEER
GENERAL
3 COPIES v STAMP �� LOCUS NORTH ARROW SCALE
CONTOURS PROFILE L,--' (Sc) SECTION L/' BENCHMARK SOIL &
PERCS ELEVATIONS WETS . DISCLAIMER L,'� WELLS & WETS
WATERSHED? DRIVEWAY 4--�WATER LINE cam' FDN DRAIN M&P
SC H40 V TESTS CURRENT? L/ SOIL EVAL'
SEPTIC TANK /
MIN 150OG L,-' . 17 INVERT DROPy GARB. GRINDERjv
(2 comps +200)
10 ' TO FDN c/ MANHOLE �' ELEV GW # COMPS . f GB
'I
D-BOX /
SIZE # LINES FIRST 2 LEVEL STATEMENT
y
INLET 97 l - OUTLET /,7 (2" OR . 17 FT) TEE REQD?
LEACHING
MIN 440 GPD? RESERVE AREA 4 ' FROM PRIMARY? `� 20 SLOPE--
100 '
LOPE/100 ' TO WETLANDS L-� 100 ' TO WELLSL— 4 ' TO S.H.GW (5 ' >2M/IN)
20 ' TO FND & INTRCPTR DRAINS 400 ' TO SURFACE H2O SUPP �-
4 ' PERM. SOIL BELOW FACILITY �� MIN 12" COVER C�-' FILL? 1--' ( 15 ' )
BREAKOUT MET? V 0b A i Q-"
TRENCHES f
MIN 440 gpd SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF.
W OR D (MIN 61 ) `� RESERVE BETWEEN TRENCHES? 'L-- IN FILL? rte MUST
BE 10 ' MIN. 0/6 4" PEA STONE? 1,-' VENT? ( >3 ' COVER; LINES >501 )
BOT 4�0 + SIDE c30e) _ / X LDNG = TOT
(L x W x ##) (DxLx2x##) (G/ft2)
Copyright 0 1996 by S.L. Starr
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
Q� t�ED q♦♦--
6 19",—
(� Q 7�
f
APPLICATION FOR SITE TESTING/INSPECTION
7q AOAATED PpP�.�S
SSACHUS
C9
/�
Applicant U�ote6- CJ/, 1017 SMXr,'CIISCT•
NAME ADDRESS ' TELEPHONE
Site Location !6 l9 cJ15146161-V 117—
Engineer A' zelml4cc
NAME A4DRESS TELEPHONE
Test/Inspection Date and Time 91& 7
CHAIRMAN,BOARD OF HEALTH
Fee-03 , Test No. 6l6
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
3� .46 0
Q
APPLICATION FOR SITE TESTING/INSPECTION
OA TEDPV
SACHUSE�
�`//
Applicant C: :_,_; C�l,•�J l.'il'�
NAME ADDRESS TELEPHONE
Site Location Ar/
n
Engineer
NAME / ADDRESS TELEPHONE
Test/Inspection Date and Time
_ CHAIRMAN,BOARD OF HEALTH
Fee Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
DATE:
LOCATION: / 6
ENGINEER: F
R) -
BOH WITNESS:
PERCOLATION TEST#
BOTTOM DEPTH OF PERC TEST: f
TIME OF SOAK: A,
(At least 15 minutes long)
TIME AT 12"
TIME AT 9" �p
TIME AT 6°
OVERNIGHT SOAK
TIME STARTED
NEXT DAY SOAK: (At least 15 minutes)
TIME AT 12"
TIME AT 9"
TIME AT 6"
i
i
MERRIMACK ENGINEERING SERVICES, INC,
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508)475-3555, 373-5721 FAX(508)475-1448
September 12, 1997 _
Town of North Andover
Board of Health
Town Hall Annex
School Street
North Andover, MA 01845
RE: 1619 Salem Street
Dear Members of the Board:
This office has prepared a septic system"repair" plan dated September 10, 1997, for the
above referenced site. As shown on the attached plan, a variance is being requested from the
minimum water table offset. This variance is necessary to avoid having to pump to the
proposed soil absorption system.
We appreciate your consideration of this matter and would be happy to discuss the matter in
more detail at your next scheduled meeting.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
Project Manager
cd