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HomeMy WebLinkAboutMiscellaneous - 170 OLYMPIC LANE 4/30/2018 / - 170 OLYMPIC LANE 210/106.B-0126-0000.0 t i I 1 i Lot & Street /7J'\O M PIC Z�W� Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: Approved by: Designer: Plan Date: Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U"Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: s t �N SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? \.YES NO---.- Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: NO DWC Permit Paid? NO DWC Permit# Installer:_ -Dr Vjv) ct-- Begin Inspection: YES NO Excavation Inspection: Needed: 6 r) Passed: 10>IR D By--�le/ Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: 11 ( 16101By: T3 (^ Final Construction Approval: Date:. By: Certificate of Compliance: Approval: 11 I Date: L COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION yt I l V� A'. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ' Property Address: Owners Name: Owner's Address: Date of Inspection: . „ —12 Name of Inspector: Peaseprint) A/ Company Name: 5 �T / Mailing Address: Telephone Number: ?-- CERTIFICATION STATEMENT 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: asses Condition �y Passes eeds er Eval tion by the Local Approving Authority Fails Inspector's Signature: l ate: 140 The system inspector shall s mit a copy of this inspection report to a Approving Authority(Board of Health or DEP)within 30 days of co pleting 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 I le,.and the approving authority. F - O,, Notes and Comments DEC ' U ZOOI 9 ****This report only describes conditions at the time of inspection and under the ixaons of use at that time.This inspection does not address how the system will perform in the future under thes m'zr different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 y _ _. F .• :._.. .........:..:: ., _ ,......,. ....,_�.. ,rA'•_ tth-,•t Frew .. ... .. y Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A ,r CERTIFICATION(continued) r Property Address: / L 10 Owner: i Date of Inspection: 1 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. 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. i ND explain: Observation of sewage backup or break out or high static water,level..in the distribution box due to broken or obstructed pipes`or i�ue to a broken;settled of uneven distribution boz.'Sy-stem will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: 2 w Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 4441'a– Owner: WAI Date of Inspection: — 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 dett friines in accbrdance with 310 CMR 15.303(1)(b)that the " system is notfunctioning 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. _ 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::andwolatile.orga0c..compounds indicates that the wellis fteelroffi,pollution from that facility 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) i Property Address: '70 Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _V ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool } — r /D.ischarge or ponding of effluent tt the surface tof theground or sUtface waters'-due to an overloaded or — dogged"SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ /Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow _t,.-o9equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number f times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. LZAny 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. _ ,olqny portion of a cesspool or privy is within 50 feet of a private water supply well. _7k"'y 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria. are triggered.A copy of the analysis must be attached to this form.] AJO (Yes/No)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. Ai 1 E.„ -Large-Systems- 4 To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 �- -t �t[j ✓ Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: /76 m IC. 6,0v/E U+ Owner• Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Ye No Pumping information was provided by%kowner,occupant,or BArd of Health .-c . .. ZWere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? — Zliave 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? Z_ 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 to(,ation,Qf theSoilAbsorption System(SAS)on the site ha&been determined based on: Yes no Z_ 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)[3 10 CMR 15.302(3)(b)] 5 R`:! ':+ -:w.-..-1. ,- y _ _,y. ....:"t,.kiR rF'*k.l'A'.,l*.rti Jq+.-,�.:.^a„*FC?:iT7� 1R� 'N�: F-Y4 ,.". �_. _x�^+tY'f�' ..p 1r i. , !✓y..^tiF"h.riLi:k St:.y,v .. A+T +'!1 + fk rnV"`I"v...V"" _ �+:rR,r i i'ti••t'�"LaQ a'3,'.rI FqF Y.vy.J,.M''. r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION f Property Address: /70 Loz Owner: J Date of Inspection: /l)- 113 61 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of edrooms): Number of current residents: �.. Does residence have a garbage grinder(yes or no): tz iE' essePorateins eon re aired r JIs laundryon.a se aratesewa s stem ty Laundry system inspected(yes or no): ' Seasonal use: (yes or ho) - Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):�UO Last date of occupancy: ._0At COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records � �� Source of information: Was system pumped as art o the inspection(yes or no): If yes,volume pumped: allons--How was ti umped determined? Reason,for punpin S }y TYPFF 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) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate� e of al components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or novf/6 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(contigued) LOwneProperty Address: w 01— Owner: r• Date of Inspection: ?� BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:—1,eiM iron 40 PVC other(explain): Distance from private water supply well or suitioq line-: ; g , yConihients(on condition of joints-Venting,evidence bf leakage",etc.): ' SEPTIC TANK: locate on site plan) 0 Depth below grade: Material of construction: oncrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) �--� p Dimensions s /0 Sludge depth:4P, Distance from top of sedge to bottom of outlet tee or baffle: Q'l Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom outlet tee or baffle: How were dimensions determined: v Comments(on pumping recommen ati ,inlet and outlet tee or baffle condition,structural int grity,liquid levels !71aot to outlet in ,evide a of 1 ageetc "GAEASE T.R1AP: (locate oni'site.plan Depth below grade:_ Material of construction:_concrete metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): l 5 7 - - ,.•-..,� .. .. _..� ws n,:< :an�v..-.. . ..A .iA.. �.... f v .ynw-w-tis; „r ie"Tnr .-�r,.es-wzr +we.: � ....- .. r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 5 Property Address: e- / Owner: Date of Inspection: 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_polyethAyyene gther(explain): Dimensions: { Capacity: " gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): 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 leakagq into or out of box, c.): 4 ! l tt.t/' �USI G PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in workisig order(,yeas or po: Comments(note coAition of pump'chamb&-,condition ofpumps and appurtenance's,"etc:): + t 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17z � Owner: j Date of Inspection: /Q— SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not-required) If SAS not located explain why: x; fype,_ leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: V 5C3 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.): r, /�* t -/ 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 or no): Con`<rnents(note condition df_soil signs off draulic failure,level f ponding,co dition 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.): } 3 i; p' ,a 9 } -, _„_ .• ^',:.:r-�..vp.,w'ti�%•a.It .., .s,e',Y o rt1ti'�Siu�.�:,a rs.� ud.�.+1�,i`i!'.. .M+,�f;�, t,a�.aa.1H. .. �,. .'4��;�?r n-,`, ��`'�.ii:>.. o.f'��1.Ls;iw�/ .- -• ,m�:�,4-•+J"J�-reg,:i., dw.;� Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) k Property Address• /r. 1-,dZlr Owner: Date of Inspection: 4 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. f F1 4fit' / f V ell l O r f 10 2 Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION(continued) Property Address: J71-) / / / Z_A AM Ad"M XX 4 v Date of Inspection: It) 2V SITE EXAM Slope Surface water Check cellar i.: Shallow wells J , � •�:� ,- 4 ..Estimated depth to grwatelr-�_-i6'feet Please indicate(check)all methods used to determine the high ground water elevation: tained from system design plans on record-If checked,date of design plan reviewed: J" Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Che&ed.with local excavators,installers;(attach documentation) Accessed USGS database-explain: j You must describe how you established thq hl h ground water elevation: C low 11 i r Town of North Andover Office of the Health Department w A Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Public Health Director Fax(978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 4W01 This is to certify that the distribution box and connection pipe constructed () or repaired (X) by 94 John DiVincenzo at 170 Olympic Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. B ian J.LaGrasse Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Form No.3 Town of North Andover, Massachusetts NORTH BOARD OF HEALTH O�St.kD e,tip O A f' DISPOSAL WORKS CONSTRUCTION PERMIT '9Sg�1CNUgE'� ol Applicant v 94AME ADDRES TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH FeeAblo D.W.C. No. i BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: d 3 CURRENT INSTALLER'S LICENSE# LOCATION: f'y1 /G 1--a� LICENSED IN AL R: L7 ,v SIGNATURE: L �)Jf x1 LEPHONE# CHECK ONFl REPAIR: NEW CONSTRUCTION: Q �D 36) L � 162-Q 1 a ti -5 nX IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $160.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes- No Approval Date: 16 CS i i INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at j Q Q 11#122 C L- relative to the application of__0 G dated for plans by and I dated with revisions dated T I understand the following obligations for management of this project: J 1. As the installer I am obligated to 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 two shall be applicable. 2. As the installer I am required to have the,necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) . Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must besubmitted 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. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company 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 in the Town of North Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. 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. U ersi ned L•cen d epti Installer Date: isposal Works Construction Permit# ��L� �L1i�'.;r;i :aCF UIS =USAL Si�;TLli Ci� l; L] NORTH ANDOVER BOARD OF HEALTH _ f ` APPIOVED DATE PROVIDED DISAPPROVED DATE TIME AAA N � Title 5 Reg. 2. 5 Fail OK The submitted plan must show as a minumum: (a) the lot to be served (area,dimensions ,l.ot #,abutters) (Planning Board files) (b • location and log of deep observation holes-distance . - to ties (c) location and results of percolation tests-distance to ties (d) design calculations & calculations showing required leaching area e) location and dimensions sf system (including reserve area) 141existing and proposed contours 9 location of any wet areas within 100' of the sewage disposal system ot- disclaimer (check wetlands mapping) (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) (j) = knownsources- of=eater supply, within- 200' of sewage- disposal .system or disclaimer (k) location of any proposed well to serve the lot (100' from leaching facility) (1 location of water lines on property (10' from. leachinf facilities) location of benchmark driveways ) garbage disposers no PVC is to be used in construction (q) a profile of the system (elevations of basement , plum''pipe septic tank, distribution box inlets and outle=-s distribution -field piping and any other elevations) (r) maximum ground Mater elevation in area of sewage disp system 11 (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans - tic Tanks Reg. 6 ) Capacities - 150° of flow, water table , tees , depth of tees , access , pumping, b) Cleanout c) 10' from cellar wall or inground swimming pool (d) 25' from subsurface drains Nor�h. Andover Subsu{riaGe disposal system check list - Page 2 ' Tail OK Distribution Boxes Rc*g.10. 2 a) Slope greater than 0. 08 Re"g.10.4 (b Sump Leaching Pits Leaching pits are preferred where the installation is possible Reg.11 . 2 (a) Cal ulations of leaching area (minimum 500 S.F. ) Reg.11 .4 (b SIacing Reg.11 .1 c Surface drainage 2% neg.11 .11 d Cover material 2 iV 4" -fe ar Iio sk P,A of eaching Fields Reg.15.1 RoGreater than 20 minutes/inch Reg.15.1 Area (minimum_.900 S.F. ) Reg.15.4 4(d Construction of field Reg.15.8 Surface drainage 2% Reg. 3.? 20' from cellar wall or inground swimming pool Leaching Trenches Reg.1 4.1 (a Calculations of .leaching area (min. 500 S.F.) . Reg.14. 3 (b Spacing (4 f min. 6 ft. with reserve between) Re 4- -_ _-- -;(c ---Dimensions - 5 = = Reg.- 14.- 6 (d . Constr tion- _.zz Reg.14.7 _ (e) - Stone Reg.14.1 (f) Surf ce drainage 2% Downhill Slope �a� Sloe/ 3/0 tobe shown. Y 5 be shown Pumps Reg. 9.1 (a Approval Reg. 9.6 (b� Stan Eby power Board of Health North AndovervNass. SEPTIC SYSTEK INSTALLATION CHECK LISP LOT # a GRED DATE DI SUPROM EXCAVATION OK FAIL RwMs FAIL OK 1. Distance Tot a. Wetlands b. Drains �--- c. Well 2. Water Line Location 3• No PVC Pipe !t. Septic Tank a. Tees - Length & To Clean Out Covers b. Cement Pipe to Tank- On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts. c. No Back Flow 6. Leach Field or Trench a. Dimensions 411 b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. 'each Pits a. Dimensions b. ne D th C. Spl ads d. s Cement P e to Pit - Both Sides f. Clean Dou 7,,Washed Stone 8. No Garbage Disposal 9. 1nal (trading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations e: Water Table L�� � j f 5,56 VL ' O S,� C:7 15'Zr to t"',, ,A•.,`r \07Z •C' P%N lnp fir• k D5c 1c 'SJ SX-3ts C:F FiPC A"r' 1 :3, � tT4-i�. ��++►�f1'£�- 4"b'J'k sem^`+"" ��.NLB-� Cly Vii:-r.: y�"�" L.�VAT [ C> �. �t�V\z V-�v v4t) C V �� r�L-rs (. op 4 ro E5 u i L-r a.pox '_ -; , -�-, I bly- pt Pis at LT t?.,P.u2x ���J� � NORTH A,IN1 )0VEP MA rR PM p r C: '";15 #� �3G4LL I � - V : �r{ 7 4Tf4r Fi2AKV- GC7 L.INA�g AB oGt4'TES �-`'�:,` • . `t`�� � Et�tC-�1hiELiZS+�, A.12G�-{[T'EGT'$ •,:. -• r4 St .4r.1�►•/�i� �3T. t�ems.AN t7��1�=2. L©, t 0 �J �•\ (j r T C- 1 G,•O C=A.�. � i -1'Ay 1MG `sw ,, �r -y ' Gsh, ;2�' vet t't is ate- F`r�-1 0 V --r '✓ C�sbtu .ti S.Nb OF P p i. t %NJ A�X> 4� (x) 'r'NG. Atm•,v33A-7 1 G 3.3 Z ' S t to C.Q --1 Irl "- tit, -T k tr..'�VAT t ON'.�►. uMv, OM OUT OF HsF- 1 r�ro E5 u I 'L-T ---Q, ably PIPE:-Q �'[aErAW1L r,eA , �,�, � " J u it Ir w a D 14b P0600 I W_Pt VE IMTO D.SoaC I my a nuTD—max � � -4 '1 Y'3�"' EPS NORTH AtN0\,,' ER MA v M4 FRA r'JCtt.LG 1" a Aq©f * t c•A , ,�•rf - 4' FMA ,1-4V— C,GEA-1 IQ A,!% A'63vCl+dTES Y 2.1 C V�1F~�J N v ? i 1 QOQ r ¢GL4 VQ J lbu ' E.o. Lrr OF"sF- W•I,Rl Uj L-T ���.t ACID"�1L . •�g_�•"�,, �91f Qy U�rtl3T�1iL ;rs t„ '" ' 1J�— ►i, �!l L.. NORTH H P\ DOVER, M.A CF FRA R + w 5e-4� I"- 4o .�u� v �t, 1975 > Iia,-�-�.; �.. S 1N, p. 14 . "''w+,. y'"_ "' �+ � � •4�.t A►r.,1�/�.i� �3"T' t�10.A►.rt O�Cr•!�-fes.