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Home My WebLink AboutMiscellaneous - 168 SUMMER STREET 4/30/2018 (2) 7L168 SUMMER STREET38.0 0042-0000.0 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , °M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 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. µ -• Important:When , A filling out forms A. General Information AN 10 20114 on the computer, use only the tab 1. Inspector: key to move your -foINfN OF NC:-t H Ai J,3V-:.. cursor-do notHEALTH DE?ART, ,".-A I use the return John DiVincenzo .--.�_ --- -- - - key. Name of Inspector Stewarts Septic Serive ! Company Name 58 South Kimball street M Company Address Bradford MA 01835 Citylrown State Zip Code 978-372-7471 S113386 Telephone Number License Number B. Certification 1 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 ❑7..Y ds Further Evaluation by the Local Approving Authority s — :::�Qn c/ / U � � Ins"a or's Signature Date T 7e system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 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•3113 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 FIND (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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Citylrown 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 Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. City/Town State Zip Code Date of inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Citylrown 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? E-] ® 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): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: ; r -� C l Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Stewarts Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons gallons How was quantity pumped determined? Site guage on truck Reason for pumping: Inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 9 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 8" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Cityrrown 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 29" Scum thickness .5 Distance from top of scum to top of outlet tee or baffle 5.5 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure &sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both baffles in good condition. No leakage, liquid levels good. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ^M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Dist. box equal, no solids carryover, no leakage. I Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4-37.5 ❑ 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, dam soil condition of ( � 9 Y � P 9, P , vegetation, etc.): No hydraulic failure, no ponding, no damp soils. I I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert I Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 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.): E t5ins•3/13 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 w >'� 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is required for every North Andover Ma 01810 December 20,2013 page. Cityfrown 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: 110" 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: 11-19-04Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Pulled file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plans show water at elevation 207.5 bottom of bed 211.5. 4 foot water seperation from bottom of bed. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer street Property Address Denise Beaveoin Owner Owner's Name information is North Andover Ma 01810 December 20,2013 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' Commonwealth of Massachusetts --- - Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assess nts v �`-- -= JUN 4.� X011-- 168 Summer St Property Address -- ---- -- TOWN OF N" M Denise Beaudoin HEALTH DG ARI M8NT Owner Owner's Name information is required for No. Andover Ma— 01845 5/23/2011 ----- ---- — -- -- - -- — —-----Y every page. — Cit /Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your John DiVincenzo cursor-do not Name of Inspector use the return key. Stewart Septic Service Company Name 58 South Kimball Company Address Bradford _ _ _ Ma_ _ 01830_ _ eum City/Town State Zip Code 978-372-7471 S113386_ Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Need Further Eval tion by t e Local Approving Authority 5/23/11 Ins ct ,s Sig ature Date e system inspector shall submit ajCompyleting of this inspection report to the Approving Authority (Board f Health or DEP) within 30 days of 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 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 a future under the same or different conditions of use. l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts -_- = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 168 Summer St Property Address Denise_Beaudoin Owner Owner's Name information is required for No. Andover Ma 01845 5/23/2011 —. -- - — — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 168 Summer St Property Address Denise_Beaudoin Owner Owner's Name information is No. Andover Ma 01845 5/23/2011 required for __— — -- --— every page. City/Town State Zip Code Date of Inspection i 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 (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts t� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St Property Address Denise Beaudoin Owner Owner's Name information is No. Andover Ma 01845 5/23/2011 required for —_ _ — --- — -- --- -- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 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 '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 168 Summer St —_— Property Address Denise Beaudoin _ _ __ Owner Owner's Name information is required for _No.____Andover Ma 01845 5/23/2011 _ ------ - ---- -- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than.50 feet from 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 El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area– IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts -may Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St Property Address Denise Beaudoin_ Owner Owner's Name information is No. Andover Ma 01845 5/23/2011 required for -- -- ----- ----- every 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): 4 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form — 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St Property Address p Y Denise Beaudoin Owner Owner's Name information is required for No. Andover Ma 01845 5/23/2011 — every page. City/Town State Zip Code Date of Inspection D. System Information Description: 5 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 ears usage d 101 GPD 9 ( Y 9 (gp ))� Detail: Water Meter Reading Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: --—---^-- Design flow (based on 310 CMR 15.203): Gallons per day(gpd) —� Basis of design flow (seats/persons/sq.ft., etc.): — ---�-- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3° 168 Summer St Property Address Denise Beaudoin --_—__— Owner Owner's Name information is No.-Andover Ma 01845 5/23/2011 required for _.— _—_ _ — ------ ------ - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: date Other(describe below): General Information Pumping Records: Source of information: Homeowner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site guage on truck Reason for pumping: inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) I ❑ 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 I ❑ Tight tank. Attach a copy of the DEP approval. I ❑ Other(describe): 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 168 Summer St _ - --------- ---- Property Address Denise Beaudoin Owner Owner's Name information is required for No. Andover Ma 01845 5/23/2011 — — — - - - — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'-5" _ Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): --- ----- Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: eet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years -` Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: ---Sludge depth: depth: ---_— — 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 108Summer St Property Address Denise Beaudoin Owner Owner's---------�� Name information i's No Andover [Wo 01845 5/23/2011 required for every page. ^^,''~`~' State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) � � 1U^ Distance from top ofsludge tnbottom ofoutlet tee orbaffle � 2^ Scum thickness ----------�� 7" Distance fromtop of scum to top ofoutlet tee or baffle -------- 14" Distance from bottom ofscum bubottom nfoutlet tee orbaffle How were dimension sdetermined? Sludge Judge, Taper-measure Comments (on pumping naoommendatiuns, inlet and outlet tee or baffle onndition, structural integrity. liquid levels as na|abad to outlet invert, evidence of leakage, etc.): Inlet d outlet baffles good, no leakleakaqe and | |n d Grease Trap (locate on site plan): Depth below grade: �eu Material ofconstruction: El ounonahe [I metal El fiberglass Fl polyethylene El other(explain): Dimensions: Scum -----'----------'---------- 8uumthickness Distance from top of scum to top ofoutlet tee or baffle Distance from bottom Ofscum tobottom ofoutlet tee nrbaffle Date of nf|aatpumping: l5ate----- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ~ 168 Summer St Property Address Denise Beaudoin _— Owner Owner's Name information is No. Andover _Ma 01845 5/23/2011 required for — -- ---- -- -- every 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.): 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 rs Title 5 Official Inspection Form h-. s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St — Property Address Denise Beaudoin Owner Owner's Name information is No. Andover Ma 01845 5/23/2011 required for _ _ ___.. -- --- — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert ------ -- -- 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.): 1" solids caryover, no leakage_D-box level 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 equired):If SAS not located, explain why: 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St Property Address Denise Beaudoin Owner Owner's Name information is required for No. Andover Ma 01845 5/23/2011 _— —_—_ — - - ---- - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ------- - ❑ leaching chambers number: ----- -- ❑ leaching galleries number: -- _ 5 Infiltrator ® leaching trenches number, length: 4-37. -- ❑ leaching fields number, dimensions: ❑ overflow cesspool number: -- --- ❑ innovative/alternative system Type/name of technology: --- ------ Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydrolic failure , No ponding, No damp soils, No vegetation — Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -- ------- Depth —top of liquid to inlet invert — ---- ---- Depth of solids layer -- ------- ------ Depth of scum layer ---- — ------ Dimensions of cesspool ----- -- Materials of construction - — -- Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form =' =J Subsurface Sewage Disposal System Form Not for Voluntary Assessments 168 Summer St Property Address Denise Beaudoin Owner Owner's Name information is required for No. Andover Ma 01845 5/23/2011 __ _ — — — --------- — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pae 14 of 17 t5ins•11110 p 9 P Y � • Commonwealth of Massachusetts - Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Vr 168 Summer St Property Address Denise Beaudoin Owner Owner's Name information is No. Andover Ma 01845 5/23/2011 required for _ _ -- -- — — ------ — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St Property Address Denise Beaudoin Owner Owner's Name information is required for No. Andover Ma 0184_5 5/23/2_011 ---- -- — -- — ---- ----------- every 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: ' et Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12-10-04 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Looked in files ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plans drawn by Christiansen & Sergi Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 e Commonwealth of Massachusetts : 4a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 168 Summer St Property Address Denise Beaudoin Owner Owner's Name information is No. Andover Ma 01845 5/23/2011 required for —. - - — -- every page. City/Town 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth V Matsachusetts RECEIVE. _ 4, v Title 5 Official Inspection Form JUN 1 7 0081 �r Subsurface Sewage Disposal System Form-Not for Voluntary Assessment 5 a Y TOWN OF NORTH ANk0 �M 168 Summer St HEALTH DEPART f � Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Chad Jablonski cursor-do not Name of Inspector use the return key. Jablonski&Sons Inc. Company Name 10 Front St. Company Address Haverhill MA 01835 'B"A7 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 uation by the Local Approving Authority nspect Si Date The syst m ins ctor shall submit a copy of this inspection report to the Approving Authority(Board of Healt or P)within 30 days of completing this inspection" If the system is a shared system or has a d ' 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. 168 Summer St-Feather•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner owner's Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown 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: All components in good working order. No sign of hydraulic failure 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. Answer yes, no or not determined (Y, N, ND)in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed 168 Summer St-Feather•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cant.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 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. tea Summer St-Feather 03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cont.): ❑ 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 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: Dy 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 %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 168 Summer St-Feather•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 168 Summer St Property Address Heath Feather Owner Owner's Name informationairedfor is North Andover MA 01845 6/12/08 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 ❑ El 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 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. 168 Summer St-Feather•03108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 or 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner Owners Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown 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 facilityor dwelling inspected for signs of sewage back u ? 9 P 9 9 p ® ❑ 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)] 168 Summer St-Feather•OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 4 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 ears usage 275 gpd 9 ( Y 9 (gpd)) Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 168 Summer St-Feattw•03/08 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner Owners Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: System is 3 yrs old and has never been pumped Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 galtons How was quantity pumped determined? Pump truck Reason for pumping: Owner's request 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/Altemative 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): Approximate age of all components, date installed (if known)and source of information: 3 yrs-Certificate of Compliance dated 5/17/05 Were sewage odors detected when arriving at the site? ❑ Yes ® No 168 Summer St-Feather•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal g po System•Pege 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 168 Summer St Property Address Heath Feather Owner Owners Name information is required for North Andover MA 01845 6/12/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments(on condition of joints, venting, evidence of leakage, etc.): Watertight at foundation. No sign of backup or leakage. Septic Tank(locate on site plan): Depth below grade: 10"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: n/a years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10'6x68x5'8 Sludge depth: <2, I Distance from top of sludge to bottom of outlet tee or baffle 3011+ Scum thickness no scum Distance from top of scum to top of outlet tee or baffle liquid level 5" Distance from bottom of scum to bottom of outlet tee or baffle liquid level 10" How were dimensions determined? Title V Calibrated Stick 168 Summer St-Feather•03108 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner owner's Name Information is required for North Andover MA 01845 6/12/08 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Pumping recommended. Tank structurally sound. Inlet and outlet tee's in good working order. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ' ❑other(explain): 168 Summer St-Feather•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner owner's Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 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.): Box level and distributing evenly. Little solid carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 168 Summer St-Feather•03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4-37.5' ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): No sign of hydraulic failure, ponding, or damp soil. 168 Summer St-Feather-03M Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'' 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 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.): 168 Summer St-Feather•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. g- C 15;—7> u - ,� - b ps i I 168 Summer St-Feather•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 168 Summer St Property Address Heath Feather Owner Owner's Name information is required for North Andover MA 01845 6/12/08 every 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: 5'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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Perc test performed by Gene Willis witnessed by Mill River for 168 Summer St. on 3/26/04 168 Summer St-Feather-03108 Title 5 Oficial inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r 'nuCn of North Andover f NORTH Office of the Health Department Community Development and Services Division } i 400 OSGOOD STREET North Andover,Massachusetts 01845ss � wcause s Susan Y. Sawyer, REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax CEPX(FICAq&6E Off' COW(Pr TAj1VCE As of: .May 17, 2005 rrhis is to cert that the individual subsurface disposal system repaired(X) — Eul(System by Stephen Iacozzi at 168 (Lot 1) SummerStreet Yonh Andover, W,4 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the.7Vorth Andover 0oard of Yfeath regulations. ,The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. 9 Susan T Sawyer Pu6lic ifealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( constructed; ( )repaired; located at was installed in conformance with the North And ver Board of Health approved plan, System Design Permit.# ,plan dated—&15 with a design flow of 5-"O gallons per day. The materials used wer in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: - ,--_ Lic.#: Date: (� Date: S" O PHILIP G. CHRISTIANSEN CIVIL . c No.28895 A�'o 9FG/ST�Pt� Q RECEIVIE[ MAY 2 0 2005 r WN OF NOR Afy1110VEE HEALTH DEPARTA4EnF1' �r Q Q TOWN OF NORTH ANDOVER °<NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES r e�;f •_•.fie HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �gss'CH•eta �cNus Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: Lot 1 Summer Street MAP:38 LOT: 42 INSTALLER: Stephen lacozzi DESIGNER: Christiansen & Sergi PLAN DATE: 11/19/04 BOH APPROVAL DATE ON PLAN: 12/6/04 DATE OF BED BOTTOM INSPECTION: 4/22/05 DATE OF FINAL CONSTRUCTION INSPECTION: 5/5/05 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer 0 Topography not appreciably altered Comments: No plumbing in house yet 5/5/05. SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged 1500 gallon tank has been installed (H-10) (2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑x Inlet tee installed, under access port 0 Outlet tee (effluent filter) installed, under access port 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Comments: Observed stone in hole. No tank yet. 4/22/05. Page 1 of 3 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT b ~ 27 CHARLES STREET ► NORTH ANDOVER, MASSACHUSETTS 01845 ��sS cmu5 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health.Director 978.688.9542—FAX Plan calls for a monolithic tank but the tank at the site is a 2 piece tank. This is acceptable per code and the installer reported he checked with the designer and it was acceptable to them. Watertightness test to be performed. Tank being filled to outlet and to be checked at a later date. 5/5/05 D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan Size of SAS excavated as per plan D Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan ❑x Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: Sand ok Page 2 of 3 0 0 TOWN OF NORTH ANDOVER OE NORT1� Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET "►^, . , NORTH ANDOVER, MASSACHUSETTS 01845 CU U < Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-FAX SYSTEM ELEVATIONS Benchmark: 206.96 Rod at Benchmark: 10.22 Height of Instrument: 217.18 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 213.37 213.53 Septic Tank IN 213.13 213.28 Septic Tank OUT 212.88 212.97 Distribution Box IN 212.59 212.45 D-BOX OUT 212.42 212.28 Lateral Invert 212.42 212.28 Lateral 1 Top of 212.83 212.76 Chamber Lateral 2 Invert 211.42 211.35 Lateral 2 Top of 211.83 211.70 Chamber Lateral 3 Invert 211.42 211.33 Lateral 3 Top of 211.83 211.83 Chamber Lateral 4 Invert 212.42 212.29 Lateral 4 Top of 212.83 212.78 Chamber Page 3 of 3 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, May 12, 2005 12:06 PM To: amcbfearty@f-ni.l iverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subjet: Summer Street L 1 l.L Lot 1 Summer Street ins c ion ort attached. Michelle saw this one too. .Construction was generally adequate. Tank watertightness to be checked as they were going to fill the tank to the outlet and Michelle was going to go by sometime. Not sure if that was done. If you need us to tackle it just let me know. may have had an oversight in allowing an effluent filter to be installed but not having an access manhole to grade over the filter. We should bring that up with the installer but,the site may already be backfilled in which case we should probably let this one go. Dan X Daniel Ottenheimer,President Mill River Consulting, Inc. Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.mil lriverconsulti ng.com danoa,millriverconsulting.com 5/12/2005 ,&.N- Commonwearh of Massachusetts City/Town of Certificate of Compliance Foran 3 M 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. This is to Certify that the following work on an On-Site Sewage Disposal System Important: When filling out Construction of a new system forms on the Repair or replacement of an existing system computer,use Ej Repair or replacement of an existing system component only the tab key to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): use the return key. DSCP Number DSCP Date Facility Owner f.� / SSum1wui St 1Vla b 3q�) — I Street A dress or Lot# �. Al ,la MA- Citylrown State Zip Code Designer Information: 1 / /� a N1'fsZja�1i f%YJ S Sf�2 7 7ign Name of Company _ Date I, aller Information: 'A A n"Ll Name Name bf Company _ Signatur /;- i T Date Ze' -4 c � _5 Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1 i• Town of North Andover, Massachusetts Form No.3 NORTp BOARD OF HEALTH OR o •off...�.u:. +>� • �► '°•,..o��'`� DISPOSAL WORKS CONSTRUCTION PERMIT � ,SgACMUSEt Applicant M,7-1 I NAME ADDRESS TELEPHONE Site Location P I P Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. I OtCHAIRMAW,140ARD VHEALTH Fee D.W.C. No. I 1 I i TOWN OF NORTH ANDOVER f N?orh wa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 SSwC14 978.688.9540—Phone Susan Y.Sawyer,REHSIRS 978.688.9542—FAX Public Health Director healthdept(@townofnorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: /7/06 LOCATION: �q M Yv1ye r S4, kc LICENSED INSTALLER NAME: _( AA tvk PLEASE PRINT SIGNATURE: TELEPHONE# `Iy a CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): ($125) NEW CONSTRUCTION: , * If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes i/� No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yeses No Floor Plans? Yes �- No Approval of Health Agent Date: z5 S 0 O INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at SU_J%,q'M u $J— U)4 relative to the application of dated for plans by and dated with revisions dated G L I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necgssary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction.steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersign d JL censed Septic Installer Date:_ lo Disposal Works Construction Permit# stister�ns ItVC RN mil re•.uur••�•.n•eu:•.r•re•nar This is to certify that: Steve laeoZ d ! Tormmeo/ndnsrrles lI has 'atisfac " completed the required training program for the installation f INFILTRATOR leaching climber system for on-site wastewater disposal appl cat ons.f Th s person is certified to install the.INFILTRATORm chamber system as set forth by the Massachusetts DEP approval letter for INFILTRATOR drainfield chambers. All other guidelines as get forth by the latest revision of 310 CRM 15.00'of Title 5 will apply.This t certificate was sealed and issued 4/14/2005, Certification:MA1397 Lee Verbridge I •- ___ - ,. __._ ��_...._� N - Atlantic Regional-Manager FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ******APPLICANT FILLS OUT THIS SECTION ** * *********** APPLICANT 1CP•L Z�" rp PHONE-18 q'19 o074 LOCATION: Assessor's Map Number 3S _— PARCEL '5e SUBDIVISION— -5\3 S-1 CCe-+ LOT(S) STREET 5 Q cArn eY_ S7re-&- f _ ST. NUMBER ! OFFICIAL USE ONLY RECOM DATION OF TOW ENTS: ` p` . CONSERVATION ADMINISTRATOR DATE APPROVED O DATE REJECTED--_--- --___ COMMENTS_� cv ,��` ,Lf�1 TOWN PLANNER DATE APPROVED DATE REJECTED__ COMMENTS_— — — FOOD I ECTOR-HEA DATE APPROVED -- DATE REJECTED —� SPOTIC INSPECTO -HEA DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS_—�G?�l� DRIVEWAY PERMIT_— -1s�� -r�---1? \ FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR —__— _ --_DATE—____— Revised 9197 Jm TOWN OF NORTH ANDOVER NUR Try Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPAR"I HENT 227 CHARLES STREET NORTH ANDOVER MASSACHUSETTS 01845 ACHUSEt Susan Y. Saivver,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX December 7,2004 North Andover Realty Corp. 459 East Broadway Haverhill,MA 01830 RE: Subsurface Sewage Disposal System Plan for Lot 1 Summer Street,Map 65 lot 91,Map 38 Lot 42 } North Andover,MA 01845 Dear Landowner, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by Christianson and Sergi dated September 30,2004 and received by i this office on October 1,2004. The design has been approved for use in the construction of an onsite septic system for a residential home of 5- bedrooms(total of 11 rooms maximum). This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may l 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. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincere .• I c Stan Y. Sawyer,REHS/RS Public Health Director encl: List of licensed septic system installers cc: Christiansen and Sergi file i I i Please find attached five copies of the revised designs dated November 19, 2004. Should you have any questions please feel free to contact me j 6. hristiansen, P.E. w Enc. cc. North Andover Realty Corp., file#97066 WN OF NORTH ANDOVER ponrti TO Office of COMMUNITY DEVELOPMENT AND SERVICES �: •` 0 HEALTH DEPARTMENT 400 OSGOOD STREET '°°+ - ��-• ' ' NORTH ANDOVER,MASSACHUSETTS 01845 SgACNUg` Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX November 15 2004 Philip Christiansen Christiansen&Sergi 160 Summer Street Haverhill,MA 01830 RE: Lots 1 &2, Summer Street,North Andover,MA Dear Mr.Christiansen, The proposed septic system design plans for the above sites dated October 4,2004 and received on October 21,2004 has been reviewed. Unfortunately,they cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000,or North Andover regulation which is not met by this design. t 2. resource areas within the presence or absence of public water supplies and wetland a 1. Please indicate p P PP regulatory setbacks(3 10 CMR 15.220 and NA 8.02) continuous rade in straight line and to 2. For allpiping, lease specify watertight joints,piping to be laid on co g g , P be placed on a compacted,firm base(3 10 CMR 15.222) i .221 &228 the tank and distribution box 310 CMR 5 ) / 3. Pleases specify theappropriate stone size beneath ( L P fY 4. Please indicate the appropriate standards for distribution boxes:all outlets to be at the same elevation and pipes to be laid level for first 2' (3 10 CMR 15.232) 5. Please indicate that removal of soil horizons A&B shall extend at least 6"into the suitable soil of the C horizon.(NA 9.02) 6. Please provide the location and elevation of the foundation drain. If there is no drain,please make a statement to that effect on the plan.(NA 8.02y) 7. For Lot 2,please indicate the name of the person who delineated the wetland resource area,the date this was performed,and whether this has been accepted by the North Andover Conservation Commission. 8. For Lot 1,please attempt to refrain from using gravel-less chambers which need to be cut in half. Previous discussions with the manufacturer you specified have indicated their concern with maintaining appropriate operational standards for their product when cut. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely; � Su n Y. Sawyer, REHSS/"RS Public Health Director cc: Owner File r 0 0 - FORM 17 - SOIL EVALUATOR FORM Page 1 bf 3 ' Date: /� y No. ' Commonwealth of Massachusetts 4r6/&A--R assachusetts Soil Suitability Assessment for On-site Sewage Disposal S ..._......... .......... �Vl:e...�..i...�. .�. Date: PerformedBy: .... ... ......................................................... Witnessed By: .. ..iC1......FJ../CJ),kel.. l ..�`.. ?1c�r� .....j G....................... S� ,� 0/�.y leurn '"'1 o--,-,Name, North Andover Realty I Lw ess or l h�jPN' Address,and LO-dZ Telephone N 459 East Broadway p Haverhill,MA 01830 978-556-9834 strtion Repair h Office Review 05$ 10 Published Soil Survey Available: No ❑ Yes u � IIJ..�q Soil Map Unit Cc Year Published �� j....... Publication Scale ... Drainage Class Soil Limitations .LI ..GII �Cd��uyw-� .... ... —............ ISurficial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale IGeologic Material (Map Unit) ............................................................................ Landform .............................................................................................................................. Flood Insurance Rate Map: I ❑, Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No LJ Y ❑ ❑ Within 100 year flood boundary No [Eyes Wetland Area: ........................ National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit). ................. Current Water'Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belc-V Normal ❑ Other References Reviewed: FU .: T 2 i ' ^� ,94 DEP APPROVED FOPUNI•12/07/95 00qER ,;.NT - i I A y O O FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot: LOT SUMMER ST- GILLEN On-site Review Deep Hole Number:04-10 Date: 6/15/04Time: Weather: Location: (identity on site plan) Land Use: Slope: Surface Stones: Vegetation: Landf orad: Position on landscape: (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOVE LOG* Depth Soil Soil Soil Soil Other from Horizon Texture Color Mottles Structure Surface (USDA) (Munsell) Etc. (inches) explore to match 04-2 & 04-1 MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material: (geologic) Depth To Bedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12/07/95 FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot: LOT 1 SUMMER ST- GILLEN 0n-site Review Deep Hole Number:04-02 Date: 3/26/04Time: Weather: CLDY-55 Location: (identity on site plan) Land Use: LAWN Slope: 0-3o Surface Stones: BOULDERS Vegetation: GRASS Landform: TILL RIDGE Position on landscape: (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth Soil Soil Soil Soil Other from Horizon Texture Color Mottles Structure Surface {USDA) (Munsell) Etc. (inches) 0-7 Ap F.S.L. 10YR 3/2 GRANULAR, FRIABLE 7-22 BW1 F.S.L. 10YR 5/8 15% MASSIVE FRIABLE 22-140 C1 GRAVELLY 2. 5YR 6/3 HIGH MASSIVE FRIALBE LOAMY 5YR 5/8 20% GRAVEL SAND NO REFUSAL LOW: 2. 5Y 8/1 TO 39" MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material: (geologic) OUTWASH SAND Depth To Bedrock:> 140" Depth to Groundwater: Standing Water in the Hole: 124" Weeping from Pit Face: 110" Estimated Seasonal High Ground Water: 39" DEP APPROVED FORM - 12/07/95 - o a FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot: LOT 1 SUMMER ST On-site Review Deep Hole Number:04-01 Date: 3/26/04Time: Weather: CLDY-55 Location: (identity on site plan) Land Use: EDGE WOODS Slope: 0-3% Surface Stones: NO Vegetation: Oak, R Maple, W Pine Landform: KAME TERRACE Position on landscape: (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area >100 feet Property Line 30 feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth Soil Soil Soil Soil Other from Horizon Texture Color Mottles Structure Surface (USDA) (Munsell) Etc. (inches) 0-7 Ap F.S.L. 10YR 2/2 GRANULAR, FRIABLE 7-24 BW1 F. S.L. IOYR 5/8 20% MASSIVE FRIABLE 24-142 C1 GRAVELLY 2. 5YR 6/3 HIGH MASSIVE FRIALBE FLS 5YR 5/8 ROOTS TO 40" 15% GRAVEL NO REFUSAL LOW: 2 .5Y 8/2 TO 45" MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material: (geologic) OUTWASH SAND Depth To Bedrock:> 142" Depth to Groundwater: Standing Water in the Hole: 131" Weeping from Pit Face: 107" Estimated Seasonal High Ground Water: 45" DEP APPROVED FORM - 12/07/95 OFORD I - SOIL EVALUATOR FORM _ _ age3of3 _ i Location Add:-ess o' Lot No. cj C/ /( t Y, f ' i Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole................... inches ❑ Depth weeping from side of observation hole............ ..... inches Depth to soil mottles : ./:: inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level .................. Adjustment factor ................... Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on dc( (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis_ was performed by me consistent with the d r ing, expertise and experience described in 310 CMR 1 7. Signature D e DEP APPROVED FOP-41-12/07/95 o 0 FORM 12—PERCOLATION TEST Location Address or Lot No lot 1 SUMMER ST- GILLEN COMMONWEALTH OF MASSACHUSETTS NORTH ANDOVER, Massachusetts Percolation Test* Date: 3/26/04 6/15/04: 3/26/04: Observation Hole # 04-01 04-1A 04-02 Depth of Perc 39+19=58 27+16=43 38+19=57 Start Pre-soak 10:33 10:06 10:46 End Pre-soak 10:49 10:21 11:01 Time at 12" 10:49 10:21 11:01 Time at 9" 11:32 10:37 11:27 Time at 6" 12:26 11:05 12:06 Time 12"-9" 43 min (9-6")--28 min (9-6") = 39 min Rate Min./Inch - 10 min/inch 13 min/inch *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ® Site Failed ❑ perc 143 min/12-9" Perc 6/15/04 okay Performed By: Eugene Willis Witnessed By: Andrew McBrearty, Daniel Ottenheimer Comments: DEP APPROVED FORM-12/07195 06/28/2004 MON 13:55 PAL U y -' LAW OFFIC.F. OF DANIEL T. BOWIE, ESQ. 171 HIGH STREET NEwtSURYPORT,MASSACHUSETTS 01950 TELEPHONE(978)462.4045 FACSIMILE(971))462,5489 EMAIL VANIEI.13OWSELVERIZOWNET June 28,2004 Julie Patrino,Town Planner Office of the Planning Department 'Town of North Andover 7 Charles Strcet North Andover,M A 0 1345 VIA FACSTMILE(978)688-9542 Re: Galen property/Spring Hill Road,North Andover Dear Ms. Parrino: On the afternoon of Junc 15, 2004 Mr. Nardella of the Planning Board faxed me proposed language on the disputed portion of the stipulation. unfortunately, T was out of the otfcc and consideration b the Planning Board of business and c g not able to res and to it riot to the close Y P P that evening. 1 am enclosing a copy of the proposed language which T essentially can live with,except f or that portion that 1 have stricken on the basis that it does not snake sense and will only serve to confuse the situation- Otherwise, 1 believe it is consistent with >ny last proposed language to you. Plex%e contact me regarding this. Yours truly, L pf Daniel T. Bowie DTH/jij cc: William Gil len�i Itil}X eei i I r Dellechiaie, Pamela From: Dellechiaie, Pamela Sent: Wednesday, May 04, 2005 10:15 AM To: Grant, Michele Subject: FW: Lot 1 Summer Street- Final Construction Inspection Request -----Original Message----- From: Lisa LeVasseur [mailto:lisal@millriverconsulting.com] Sent: Wednesday, May 04, 2005 10:07 AM To: healthdept@townofnorthandover.com; 'Daniel Ottenheimer (E-mail) ' ; 'McBrearty Andrew (E-mail) ' Cc: mgrant@townofnorthandover.com Subject: RE: Lot 1 Summer Street - Final Construction Inspection Request Okay, inspection is all set for 5-5 at 8:00. All parties have been notified and are ready to attend. Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com -----Original Message----- From: health department [mailto:healthdept@townofnorthandover.com] Sent: Tuesday, May 03, 2005 2:05 PM To: 'Daniel Ottenheimer (E-mail) ' ; 'Lisa LeVasseur (E-mail) ' ; 'McBrearty Andrew (E-mail) ' Cc: Grant, Michele Subject: Lot 1 Summer Street - Final Construction Inspection Request Hello, Please schedule a Final Construction Inspection for the above and call Dan O'Connell of Christiansen & Sergi to schedule: 978.373.0310. Thank you. Best Regards, Pamela DelleChiaie Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA 01845 978. 688. 9540 - Phone 978. 688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 1 06/28/2004 MON 19:58 FAX a 1`3.4413 P.2 JUN.15.22103 2:-*-PM S&N FINANCE -0 RE: GILLEN PROPERTY SPRING DILL ROAD NORTH ANDOVER No portion of said Lot 3 shall be transferred or conveyed to auF to any property contiguous to or abutting Lot 3 for the purpose of creating a new buildable lot for the benefit of any such owner or abutter, or for the purpose of annexing any portion of said Lot 3 to any contiguous or abutting lot except for conservation, agricultural or passive recreation, Any portion of Lot 3 so transferred shall not permit or allow any owner of Lot 3, contiguous lot owner or abbuter to include any portion of Lot 3 in any residential development for any purpose, including but not limited to consideration of any portion of Lot 3 so transferred or conveyed to be used as open space, un buildable space, or for purposes of satisfying any minimum lot size, frontage or setback requirements imder the Town. of North Andover's current or future Zoning Code. i i i LAW OFFICE OF DANIEL T. BOWIE, ESQ. 171 HIGH STREET NEWBURYPORT, MASSACHUSETTS 01 950 TELEPHONE(978)462-4045 FACSIMILE(978)462-5489 E-MAIL DANIEL.BOWIE@VERIZON.NET To - 1MJF A14fiOV :n/ July 16, 2003 L'OARD OF HEALTH I Board of Health JUL i Municipal Building , 120 Main Street Ij North Andover, MA 01845 - „ VIA FAX & MAIL(978) 688-9542 Re: 168 Summer Street,North Andover, MA 01845 Dear Members of the Board of Health: I represent William Gillen of North Andover, who is negotiating a Purchase & Sale Agreement for the purchase of 168 Summer Street, North Andover. That property has an existing single family residence, serviced by a private septic system. It is my understanding that it is questionable whether the septic system will comply with current requirements of Title V of the State Environmental Code. The residence on the property is in disrepair, and it is Mr. Gillen's intention to demolish the existing T�.t drP; though he has c c,:ilam pl_�rs at this point. it is certain that the property will not be occupied after the transfer of ownership to him. In light of the expected use of the property, or rather the non-use of the property after the transfer, I am attempting to determine whether the Board of Health would permit an abandonment of the septic system as contemplated by Title V, section 15.354. This would avoid the necessity of a inspection of a system which, upon transfer of the property involved, will not be in use. At the suggestion of Brian, I am writing this letter in hopes that you may provide some guidance and clarification as to your board's position on this issue. Thank you for your anticipated cooperation. Yours truly, �9"_ td cll�IaTol(_4_11 Daniel T. Bowie DTB/jij ''� s:` �8•. 5, E e. Ti uk t'jtfTrkr: `C cc:``William'Gillenxt .. .. , _ .. . ......._, s. L 4- 0 Page 1 of 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 23, 2004 4:00 PM To: DelleChiaie, Pamela f Subject: FW: Summer Street perc tests -----Original Message----- From: Dan Ottenheimer [mailto:info@miliriverconsulting.com] Sent: Tuesday, June 22, 2004 3:48 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: Summer Street perc tests Sue and Pam, Attached please find the percolation test results for the property at Summer Street near Molly Towne Road. You may recall we were out there a few months ago with Christiansen &Sergi but needed to return for the percolation tests. Some of the perc tests they tried to run needed an overnight soak but were too wet to run the next day so we will be back out there again sometime when C&S asks. Dan - Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com infoaa millriverconsulting.com 6/23/2004 1I 6 p --sr od ` ! i s �oo T-a-q Al- T P i'.F —; k W ILS! i (3 C) OFL i Wa .611 I , : � v,-ocj 1 t f I Po ems*-m T. arr, fL iJ 1 �0 1 �f -04!1 r j F' 1 , 1 4 1 a 4 1 T 3 71 t I ` i I I Page 1 of 1 Dellechiaie, Pam From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Tuesday, July 27, 2004 3:24 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: Summer Street @ Molly Towne Sue& Pam, Perc test results for Summer Street @ Molly Towne Road performed today. Enjoy your trip. Dan Mill River consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultin2.com info@millriverconsultin .corn i 7/27/2004 i �Jr -7127101 'f,�,,;` Vis.�,,�. �► � �►�N+> - - I ?-CYLS-73-�L- A in- ..� — ' � 1 J_�.`.._ ti t j I Page 1 of 1 LJ Q i DelleChiaie, Pamela From: Dan Ottenheimer[info@mil.lriverconsulting.com] Sent: Tuesday, March 30, 2004 8:43 AM To: Susan Sawyer; Brian LaGrasse; 'Pamela Dellechiaie' Subject: soil tests, Salem Street Sue, Brian and Pam, Attached please find the soil test results for the two pro pe ' s at Summer Street/Molly Towne Road we bserved last week. The front parcel had wonderful soil depth and w only ed two deep observation The back lot, however, was a different story. They had shallow depth to I in certain areas and we had them dig a number of holes to confirm an area of suitable soil depth. Both locations, however, had percolation tests which were either too wet to administer or needed an overnight soak. The designer will contact us in the summer to schedule the percolation tests. Dan x, Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com i-n.fo@millriverconsultin2.com millri_v_erconsultina.com 3/30/2004 Q R' "+ ! S ev c 1 zi 4 ot (�-`u�r�' ��1� �J� �r �"i .�,'a � � .J-,a �"�,+i,�,M{.,� ` .'"5 �"[+k� �j r-qES"h.,a��_�t�t\.4"_S �`�'L �� 1`✓t;e�7r� A ry/ Al 1J sN L�-;oj I I .. i 00 , r 0 kov4 6 �jrGl Viiy�,h� �r 1 f � � 4 , s - » s - ,� kS17 `L 1 f (y d , . rl tO ' 0-7 a r'-"- Mr? 1-01"s 0) 17 <0 N30 � t►\ 'moi A7'° 1 i w , �t7 0 °� 12 � ,,� lit v 9 X71 ' -� JU s r-i) -Li i X75 c -70 70