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Miscellaneous - 182 LACY STREET 4/30/2018 (2)
DelleChiaie, Pamela , From: R. David Lindsay DVM [RDL@4ltVetServices.com] j `b LV Sent: Monday, January 30, 2006 4:10 PM To: DelleChiaie, Pamela_ I Subject: Re: 182 Lac Street Do Kennel J Y 9 Hi Pam, I have never heard of this and have never done a pre -license inspection (or heard of my father doing one). I don't know that it is required (and I don't know for sure that it is NOT required). Perhaps Susan knows or knows how to find out about this?? Thanks, David R. David Lindsay DVM CVA Alternative Veterinary Services LLC 9 Hodges St. North Andover, MA 01845 978-683-5775 ----- Original Message ----- From: "DelleChiaie, Pamela"<pdellechiaie@townofnorthandover.com> To: "David R. Lindsay (E-mail)" <RDL@altvetservices.com> Cc: "Eaton, Janet" <jeaton@townofnorthandover.com> Sent: Monday, January 30, 2006 12:02 PM Subject: 182 Lacy Street - Dog Kennel Hi Dr. Lindsay, Janet Eaton at Town Hall told me that the people who reside at this address breed Golden Retrievers, and inquired about a kennel license. Janet believes that you need to inspect the premises. Can you let me know if that is in your purview, and when you can schedule it? Thank you. The message is ready to be sent with the following file or link attachments: Shortcut to: http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&LinkId=808373 Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. «Home . url>> 1 0 North Andover Board of Assc--ors Public Access Page 1 of 1 Parcel ID: 210/105.C-0050-0000.0 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO No Pictures Available Location: 182 LACY STREET Owner Name: VON STERNBERG, GREGG MARGARETHA VON STERNBERG Owner Address: 182 LACY STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 9.63 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 3164 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 637,000 518,000 Building Value: 386,500 283,200 Land Value: 250,500 234,800 Market Land Value: 250,500 Chapter Land Value: .LATEST SALE Sale Price: 358,500 Sale Date: 04/27/1999 Arms Length Sale Code: Y -YES -VALID Grantor: GEORGE HILLMAN Cert Doc: Book: 05412 Page: 0240 http://csc-ma.us/NandoverPubAcc/j sp/Ilome.j sp?Page=3 &Linkld=808373 2/21/2006 Nco Go N O O O x N O (6 N m :2 a CL m N a) C 0 U) O_ �2w0 c O LL w o �F-MOf 0 Y is O Q J 'O Vi Q -o 00 012 c c UOE U 0 (X L6 6 O O d Q O O a m N 7 c n m E E 0 U .l 0 O CD O c 4i.0 Q CL. - 0 O W �LLImUF�3 O O W Ix w e co � j Z U)i a Z Lo � W04CD. LL U V W Q LUT- co i N p O O 00 nQ. r U U) m Q 0 o L0(aU '2J_ Q 3>�.0a) �2 U Q a) J O o W U Oaf c. D: J J W Q 0 a �a cod}C9 a CD. cC, n.OH>o chO �-: confn(ni DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, February 21, 2006 1:49 PM To: Sawyer, Susan Subject: 182 Lacy Street Hi Susan, Jim Kellett installed the septic system here last April. I don't have Final Grade information on this. Do you recall anything on it? The homeowner, Greg Von Sterberg called today asking about it. I don't want to prepare the COC until I know it's all set. I'll bring in the file so you can look it over to see if you can recall anything. Thanks. Aside -- FYI - This is also the h/o who breeds Golden Retreivers -- remember that from January? 8¢gf R¢gaod8, PAiw¢Bu D¢�B¢G�lfiui¢ Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax _ http://www.townofriorthandover.com healthdept@townofnorthandover.com �Vi � a o � 1 r FINAL GRADE INSPECTION Date: Address: l�2 C:-Ic LO MED? EEDED? , / COVER PER PLAN? Other: I/ -^ -,� lyll eo,,t,, i, I. Page 1 of 1 . Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Friday, April 29, 2005 5:30 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: 182 Lacy Street Attached please find the construction inspection form for 182 Lacy Street. The installer used a different pump than the one on the design plan. This will need to be examined by the designer and deemed to be satisfactory, with a new pump curve submitted, prior to issuance of a Certificate of Compliance. Dan 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 _millriverconsultin2.com dano millriverconsulting.com 5/2/2005 0 0 . Dellechiaie, Pamela From: health department [healthdept@townofnorthandover.com] on behalf of Dellechiaie, Pamela Sent: Tuesday, April 26, 2005 10:01 AM To: 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Sawyer, Susan Subject: Final Inspections: 182 Lacy Street & 121 Raleigh Tavern Lane Hi, The above properties are ready for Final Inspection per Ben Osgood. Please call John Soucy directly @ 603.216.7175 to schedule for 121 R.T. Lane, and Jim Kellett fo 182 Lacy Stre @ 781.953.7146. Both installers are hoping for today if possible, as there will be heavy rains tomorro 8¢gf R¢gwadg, Pa�i¢�w D¢Bl�¢L�lfiwi¢ Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com No Dellechiaie, Pamelaxcf MILL RIVER CONSULTING Septic System Management Services TOWN OF NORTH ANDOVER SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 182 Lacy St MAP: 105C LOT: 50 INSTALLER: James Kellett DESIGNER: NEES PLAN DATE: 4/8/2005 BOH APPROVAL DATE ON PLAN: 3/9/2005, rev 4/8/2005 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 4/27/2005 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Pressure Dosing COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = h10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = h10 TYPE OF SAS = Pressure dose Infiltrator trench DIMENSIONS AND DETAILS OF SAS: 2 trenches, 9.5 chambers SITE CONDITIONS Inspections SExisting septic tank properly abandoned ®Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: Septic tank not reused - replaced with new 1500 gallon 5Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282.0014 infona millriverconsulting.com Page 1 of 4 EO MILL RIVER CONSULTING Septic System Management Services SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved test performed: Visual ® Inlet tee installed, over access port ® Outlet tee (gas baffle or effluent filter) installed, over access port ❑ inch cover to within 6" of final grade installed over one access port ❑ installed over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction ® Inlet tee installed, over access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Liberty .4 hp pump used instead of Hydromatic. Engineer to approve 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: 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978 282 0014 infoOmillriverconsulting.com Page 2 of 4 0 0 MILL RIVER CONSULTING Septic System Management Services SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-11/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and 95.65 vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ® Gravelless disposal systems: type, number and location as per plan ® 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: 9880 CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: ❑ Rated for exterior if placed outside Comments: Control panel in far -side of Basement SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 2.11 Height of Instrument: 102.11 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT. 97.39 Septic Tank IN 95.99 96.05 Septic Tank OUT 95.99 95.83 Pump Chamber IN 95.90 95.80 Pump Chamber OUT 95.65 96.13 Distribution Box IN 98.61 98.63 Distribution Box OUT 98.44 98.47 Manifold Lateral 1 HIGH 98.80 98.77 Lateral 1 LOW 9880 98.79 Lateral 2 HIGH 98.80 98.80 Lateral 2 LOW 98.80 98.79 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282.0014 infonamillriverconsulting com Page 3 of 4 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 SECTIO APPLICANT -....J , r�- b"ti _a "�,��u �- PHONE 3' LOCATION: Assessors Map Number PARCELID SUBDIVISION— LOT (S) STREET J—e, C� �ST. NUMBER 1 V L OFFICIAL USE ONL CONSERVATION ADMINISTRATOR DATE APP _ ROVED �• ?1 (�� DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECT DATE APPROVED DATE REJECTED DATE APPROVED — q DATE REJECTED tT. �a . � / PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RevhW HTIm e Disposal Works Construction Permit Permission is hereby granted JAMES KELLETT --------------------------------------------- to (Repair) an Individual Sewage Disposal System. J� at No - -1-82- -LACYfit- STREET ------------- ------------------------------------------ as shown on the application for Disposal Works Construction Permit No. BHP-2005-008Dated ----------------------- April _12- 2005 ------- ----- -- --- --- ---- Issued On: Apr -15-2005 Board of Health ------------------------------- — ----------------------------------------------- ............................................................................................................................................................................... Commonwealth of Massachusetts Map -Block -Lot R. 105.C- 0050 ---- --- --------------- Board of Health -- North Andover .13, Certificate of Compliances THIS IS TO CERTIFY That the Individeal Sez, Disposal System (Repair) by --- JAMES KELLETT ------- Installer at No - -1-82- -LACY STREET -- ------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. _13HP-2-0057008 DatedTIH 12I 2005 A ---- -------------- Printed On: Apr -15-2005 ----------------------------------------------------------------- ----------------------------------------------- ------------------------ --------- Board of Health of Massachusetts Map -Block -Lot 4Commonwealth 105.C- 0050 - Board of Health ----------------------- Permit No North Andover BHP -2005-0083 ----------------------- P.I. FEE ,SS rMoSt F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted JAMES KELLETT --------------------------------------------- to (Repair) an Individual Sewage Disposal System. J� at No - -1-82- -LACYfit- STREET ------------- ------------------------------------------ as shown on the application for Disposal Works Construction Permit No. BHP-2005-008Dated ----------------------- April _12- 2005 ------- ----- -- --- --- ---- Issued On: Apr -15-2005 Board of Health ------------------------------- — ----------------------------------------------- ............................................................................................................................................................................... Commonwealth of Massachusetts Map -Block -Lot R. 105.C- 0050 ---- --- --------------- Board of Health -- North Andover .13, Certificate of Compliances THIS IS TO CERTIFY That the Individeal Sez, Disposal System (Repair) by --- JAMES KELLETT ------- Installer at No - -1-82- -LACY STREET -- ------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. _13HP-2-0057008 DatedTIH 12I 2005 A ---- -------------- Printed On: Apr -15-2005 ----------------------------------------------------------------- ----------------------------------------------- ------------------------ --------- Board of Health Tow Vf N;ir4;-Andover f, Health Department Date: Location: / v r/, 2WI, ��Uf (Indicate Address, if Residential,o;illame of Business) Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ O -`Septic Disposal Works Construction (DWC) $� ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasIVSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 759 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer °W TOWN OF NORTH ANDOVER NORTp Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p ' 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 SACNUS 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.9542 — FAX Public Health Director healthdept@townofnorthandover.com - e-mail www.townofnorthandover.com - website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 4-)-3-os LOCATION: / 8 Z l- A G Y S T LICENSED INSTALLER NAME: 0;� M pS Kc l c' -E- PLEASE PRINT SIGNATURE: � CHECK &<E: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: TELEPHONE# %i-1- 6_3 ` 71'yt * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $250.00 or $125 Fee Attached? Project Manager Obligation From Attached? Foundation As -Built? Floor Plans? Yes No Yes No Yes No Yes No ($250) ($125) Approval of Health Agent Date: l9 S— INSTALLER PROJECT MANAGEMENT OBLIGATIONS y As the North Andover licensed installer for the construction of the septic system for the property at `k2- Z_,aC Y S I relative to the application of,TAA` ecilr-4 dated 3- 01- ' j for plans by /V£ �-'� and Z/ d date-//- �y with revisions dated 'e 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. Under igned Licensed Septic Installer Date: U S' Disposal Works Construction Permit # ommonwealth of Massachusetts' naap e'°ck-Lot 106.D- 0066 - Board of Health------Penit No «m' North Andover BHP -2005-0084 4a . - -- --------- FEE $250.00 ----------------------- Dis sal Works Co uction Permit Permission is hereby granted o C to (Repair) an Individual Sewage Disposal Sys at No 61 WINDSOR LANE as shown on the application for D' posal Wor s nst c i Permit No. BHP -2005-008 Dated 12, 2005 l Issued On: Apr -12-2005 oNioMealth y e 0 Commonwealth of Massachusetts Map -Block -Lot 41 105.C' 0050 - ft Board of Health Pe it No • North Andover HP-2oo5-oosa P.I. FEE F.I. $250.00 Disposal Works Construction P mit Permission is hereby granted John Soucy--------------------------- --_ ---- - - ---------------------------------------------------- to (Repair) an In dual Sewage Disposal System. at No 182 LACY EET -------------------------------------------------------------------------- - ---------------- -- ----------------------------------------------- as shown on the application for isposal Works Construction e it NP 005-008 Dated April_ Health 12, 2005 Issued On: Apr -12-2005 + b µR C mmon Ith of Massachusetts Map -Block -Lot �p 105.0-0050- 3`'.,. .. Boar of Health W. POW North A over •� .r Certificate of C pliance TH IS TO CERTIFY,That the Individual Sewage sal System (Repair) by John Souc --------------------------------- -------------------------------------------------------- Installer at No --1-8-2- ---LACY-STREET -------------------------------------------------------------------------------------------- -------------------------------------------- has been installed in a ance with the provisions of TITLE 5 of the State Environmenta ode as described in the application for ' posal Works Construction Permit No. BHP -2005-008 Dated April -12 ----- 05 ------------------------------------ ---------------------------- Printed On: Apr -12-2005 Board of Hea Tolvn or Ndrth Andover Health Department Date: Location: /� �� , (Indicate Address, if Residential, or-1k7�K siness) Check #: f �o �l' oo Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ fl/Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco ➢ Trash/Solid Waste Hauler ➢ Well Construction S ➢ OTHER (Indicate) 756 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 0 TOWN OF NORTH ANDOVER 0 0011'rh -�^ Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT F p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 CNUs •� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.9542 — FAX Public Health Director healthdept(a,townofnorthandover.com - e-mail www.townofnorthandover.com - website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ^ r � a LOCATION: LICENSED INSTALLER NAME: j t dur PLEASE PRINT SIGNATURE: � CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: TELEPHONE# CAO oL, 7/7S * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $250.00 or $125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No ($250) ($125) Approval of Health Agent Date: It' -P -5- f INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property atrelative to the application ofll)r�a�a dated for plans by /if, e and dated 5 0 with revisions dated 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 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 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. Undersofed Vicensed Septic Installer Date: e— > Works Construc �J Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director April 13, 2001 Gregg vonSternberg 182 Lacy Street North Andover, MA 01845 Re: Application for shed Dear Mr. vonSternberg: Telephone (978) 688-9540 Fax (978)688-9542 Your application for a shed at 182 Lacy Street has been reviewed by the Health Department. The application was denied on April 13, 2001 for the following reasons: 1. X Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable To address the problem(s): If # 1 is checked, please supply: a. Floor plan of existing and proposed addition Certified plot plan showing house, septic system and proposed project in scale If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Reviewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 " FQ'M - U - LOT RELEASE FOQ INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Bbards .and Departments having jurisdiction have been obtained. This does not relieve the applicant and' or landowner from compliance with any applicable requirements. �..r...■■■■■�.■........rrr.. rrr■■.r.rrrr. r..r�rrr.rr.rrr.rr..rrrrrr.■rrrr.. APPLICANT CR GG v o.J JMte0a 'c'G PHONE %<' ASSESSORS MAP NUMBERS. G-oo So ooso BLOT NUMBER a /A - SUBDIVISION LOT NUMBER STREET /B6?/,4GY S�-2FE�` STREET NUMBER /Sa �r■••rr•■�rrr■■rr.r■■r■r.rrrrrrrrrrrrrrrrrr■■■rrrrrrrrr..rrrrrrrrrrrr.rrrrr■ 01 ICIAL USE ONLY �..rrr..■rrrrrrr•■.■■■rrr■rrso-so man ■rrrrrrr.r••rrrrrrrrrrrr■■rrrr.rrr.rrrrnow . RECOIt4 ENDATIONS OF TOWN AGENTS CONSERVATION ADMINISTRATOR CON DAENTS TOWN PLANNER CONflVIENTS FOOD INSPECTOR -'HEALTH SEPITC INSPECTOR - HEALTH PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT . COMMENTS RECENED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED Ei7 � 1 .;• I 0 DATE REJECTED DATE APPROVED DATE REJECTED _ DATE APPROVED, DATE REJECTED DATE APPROVED DATE REJECTED RD E E 0 V E APO 12 E 2001 BUILDING DEPT. oil 01 WA yl 14�;4� oil 41 01 WA I It 14�;4� 41 van 01 WA van SECTION 4 - WORKERS COt,..._•ENSATION MG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this -application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition -0 Accessory Bldg. 0 Demolition 0 Other 0 Specify IBrief Description of Proposed Work: ./ Q� coa�e� � S1PtFVN SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 Phunbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) 1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I ✓" G2 E6G u0 w�Ee6 as Owner/Authorized Agent of subject property Hereby au r to act on My be all matters rel v o work authorized by this building permit application: -/// oVo i tgnature of Owner Date SECTION 7b OWNE ED AGENT DECLARATION T, as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name of NO. OF STORIES .SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS I ST . 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover �I Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director April 13, 2001 Gregg vonSternberg 182 Lacy Street North Andover, MA 01845 Re: Application for shed Dear Mr. vonSternberg: Telephone (978) 688-9540 Fax (978) 688-9542 Your application for a shed at 182 Lacy Street has been reviewed by the Health Department. The application was denied on April 13, 2001 for the following reasons: i,,1'.""X Missing information 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable To address the problem(s): If # 1 is checked, please supply: a. Floor plan of existing and proposed addition Certified plot plan showing house, septic system and proposed project in scale If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Reviewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Board of Health BEMC SYSTEK North •.•verti •. II:• / � t ... • JI I %% i 11 1 711 ,EM 1. Distance Tot a. Wetlands b. Drains 4- 0. Well ,-kb1 L orj 2. Water Line Location _A4e_V.- _rO 717-1-5 f'iTS ,j 3. 3• No PPC Pipe 4. Septic Tank a. _Tees -_Length & To C1ean,Dat Covers. 0, Pi PE b. Cement Pipe to Tank - Cn Both Sides of Tank -6 �TAj-A1_TO 5. Distribution Box i7�131 a. Covers & Box - No Cracks b. All Lines Flowing Fqual Amounts V b c. No Back Flow 6. Leach Field or Txen'�ch o q a. Dimensions. b. Stone De6th c: C 'd Fads d. �C� Double Washed Stone 7. = Leach Pits - / i a. b. Dimensions EE Stone Depth A �p '- �/� &rml cf c. Splash Pads d. e. Tees Cemmt Pipe to Pit - Both Sides. i f. Clean Double Washed Stone 8. No Garbage Disposal 9. -Final Grading Inspection 10. Barricading Covered System a. As Built Submitted a. Lot Location b. Dimensions of System c. Location vi.th Regard -to Perc Test d. Elevations e: Water Table 4 I /I -`' F_ - U - LOT RELEASE FO?' UCTIONS This form is used to verify that all -necessary approval/ permits from . S and Departments having jurisdiction have been obtained. This does not relieve the t� and or landowner from compliance with any applicable requirements. Bull APPLICANT �"�''r vo�S �"'B PHONE �-1?-5-CF6- i/ / q ASSESSORS MAP NUMBERS, Gao So &0"LOT NUMBER Q 1A . SUBDIVISION LOT NUMBER lzTRm 'r /8d 44cY --T-2cc-r" _ - STREET NUMBER / 8111 OFFICIAL USE ONLY ........................................................................... RECOMMENDATIONS OF TOWN AGENTS i......wagon ................................ Somme ...................... ONE .■ CONSERVATION ADNHNJSTRATOR COMbAE '1S DATE APPROVED DATE REJECTED DATE APPROVED TOWN PLANNER DATE REJECTED _ CQ_MMENTS DATE APPROVED FOOD INSPECTOR -HEALTH DATE REJECTED _ a. /."-.' DATE APPROVED SE C INSPECTOR - HEALTH !; • - "" ` `` `—> DATE REJECTED = COMMENTS �c A PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMI�iENTS RECEIVED BY BUILDING INSPECTOR TE E-r-e-:vJ_ j�m E INlEj1 APR 12 2001 BUILDING DEPT: O t o< a n J 0 LA 0 0 d agZR 0 bgb T 1 8 a r G r 10 0 NEW ENGLAND ENGINEERING SERVICES INC TOWN OF NORTH ANDOVER%I BOARD OF HEALTH •iR 010 March 8, 1999 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT 182 Lacey Street. Enclosed is a copy of the Title V report for Lacey Street, North Andover, MA. The systemap sses our inspection. If there are any questions please call me at my office, 686-1768. Yours truly, Benj. OsgoocYJr., E.I.T. President 33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Conuniss:oner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: e -Z c Si , Name of Owner �--t z (•I wlir^ t �'1^C S ,�'� ✓� `^ Address of Owner: /V. Date of Inspection: 21 Z i j q Name of Inspector: (Please int) Benjamin C. Osgood, Jr 1 am a DEP approved system inspector pursuant to Section 15.340 of rrde 5 (3 10 CMR 15.000) Cornpany Name: New England Engineering Services Inc. MaTng Address: 33 Walker Rd , Sid t e 2L North Andover, MA 01845 Telephone Number: 978-686-1768 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: a, e L v V Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should'be sent lo-Vw system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 A `, Primed on Recycled Pape, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /F Jac St N. A..cQ�•ic2 Owner: / -j • 1 /n, L• n Date of Inspection: 2 1 Z INSPECTION SUMMARY: Check A, B, C, of D: A.. SYSTEM PASSES: V 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the, existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping-Tnore then four -times a yeardue to broken or obstructed pipe(s). The system will Va. inspection if (with approval of the Board of Health): - - - broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2ofII 0 01 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �G c rj J+-. /' . Owner: Date of Inspection: S ✓ (� ` `� zlz �+ltiq 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 the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303 (1)(6) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH_.WILL.PRQTECT THE PUBLIC HEALTH,AND SAFETY. AND THE EIMBONMEI+LT: _ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 P2Rc3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ) g 2 ).c c ty S*, N . A„S. c) � r.2 Owner: \ •\l +nG., Z 1 Date of Inspection: i1a1411jcl D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into iacihty-or-sntem component due tto an overloaded orgylegged SAS-or•cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an- overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for —coliform bacteria, volatile organic -compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is -within 200 feet of-a-tsibutery-W a eurtaoadrinkiwg water supP1Y -- " the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: i 6 c2 1—ctc e� st. /.j. Owner: S j l l k' .O ^ Date of Inspection: l 1-1 1 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system .compnosnts.ham `'^^n pu;nj) d for-atleast two awasks an&the'ryctem hasAmwaxecaiwagwssal Aow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System, have been located on the site. f The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles _ or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System or the site has been determined based on: 1✓ Existing information. For example, Plan at B.O.H. ✓ '� Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)1 The facility owner (and occupants_ if different from navneri..were prnvided.with informal oann ?ha pn_nT f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 CJ C ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:/ 01 I_ e c a Owner: Date of Inspection: Sv) 1 JAr -Z -It 'tell FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms (design):_ Number of bedrooms (actual): Total DESIGN flow Number of current residents: Garbage grinder (yes or no):L% Laundry (separate system) (yes or no):A/ : If yes, separate inspection required Laundry system inspected lyes or no) Seasonal use (yes or no):-Z—V / Water meter readings, if available (last two year's usage (gpd): Sump Pump (yes or no):,4 Last date of occupancy: c: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd 1 Based on 15.203) Basis of design flow 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: OTHER: (Describe) _ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) 1/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date instaked+f i(nown)-and source of•information: Sewage odors detected when arriving at the site: (yes or no),[ -0 revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 102 J-ele e y Si`, tiJ A,u0c,Je�c Owner: !A•li mom+ 7 S✓I l;✓�,,, Date of Inspection: BUILDING SEWER: t (Locate on site plan) Depth below grade: Material of construction: cast iron _ 40 PVC _ other (explain) Distance from private water supply well or suction line .30'-:r Diameter Al" Comments: (condition of joints, venting, evidenc of teakage,-etcf.-) J nc /cam WS; V SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Js -age confirmed by Certificate of Compliance _ (Yes/No) Dimensions: / moo & &—//Grp y Sludge depth: /-6--" Distance from top of sludge to bottom of outlet tee or baffler -' Scum thickness:—4 I je Distance from top of scum to top of outlet tee or baffle:_0 Distance from bottom of scum to bottom of outlet tee or baffle: Z.; How dimensions were determined: _137«zs ux s 7)c-4 Comments: (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping evidence of leakage, etc.) _ condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: l P • 1 c!J Owner: j-1 11 rn ti,1 ; S� I i a Date of kupection: TIGHT OR HOLDING TANK:14 (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note� if level and distribution is equal, evidence of solids carryover, evidence/of leakage into or out of box, etc.) — - I-, /a+ b-v'('� !✓nc�•�'70/1 S �rn e,: S!Pn(L c+f1/!'rani• PUMP CHAMBER:11,14 (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 P2ge8Of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1g e7 Av owner: Gate of Inspection: 7 2 Z K'ct G SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible: excavation not required, location may be approximated by non -intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, da -ip soil, condition of vegetation, etc.) CESSPOOLS: Lv.q (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of pending, condition of.vegetation, etc.) PRIVY: '&'+ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 C C", SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: i—" ,ll Date of Inspection: r 0)ay���t SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) revised 9/2/98 Page 10 of 11 V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ; "I 1 y s+. ti A.��✓� Owner: Date of Inspection: )'� \l n,a . S.�'�l. ✓a,. NRCS Report name $, , l LSs e % L"o" '4 S. s Soil Type_ Typical depth to groundwater 1-1, USGS Date website visited 2 ( 4tyy Observation Wells checked c-- Groundwater depth: Shallow ^ Moderate �K Deep SITE EXAM Slope �Ge Surface water c Check Cellar Shallow wells Estimated Depth to Groundwater Cc7 Feet Please indicate all the methods used to determine High Groundwater Elevation: X Obtained from Design Plans on record Observed.Site (Abutting property, observation hole, basement sump etc.) X Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) tl. s�k Pl�.�s s��u; t4� no ..��_�cti tb 7 • �� ���� 2� (� S• 5.0-S. 1�,cpi .c�'. c c.� l w�-K2 �(s.0 j6Cto" -0�• .✓ revised 9/2/98 Page 11 of 11 6::"e C,,, —r - C C TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET "'-----:' NORTH ANDOVER, MASSACHUSETTS 01845CH C" `y 9SSAUStt Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX April 7, 2005 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 182 Lacy Street, Map 105C, Lot 50 Dear Mr. Osgood: The proposed septic system design plan for the above site dated March 9, 2005 and received on March 9, 2005 has been reviewed. Unfortunately, it 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 regulations, which is not met by this design. 1. The basement floor elevation for the addition should be stated on the plan. North Andover regulation 5.04 states that for new construction, the basement floor elevation should be 1' minimum above the groundwater elevation. 2. According to Construction Note #10, the existing 1500 -gallon septic tank is to be inspected for integrity and water -tightness, and fitted with new tees. Please include the following information along with a statement that if the tank specifications cannot be met, a new 1500 gallon tank may be required: a. specifications for the inlet and outlet tees in accordance with 310 CMR 15.227, b. specifications for the manholes and risers — 228(2) c. 9"to 36" of soil cover over the tank -221(7), 228(1) 3. As the proposed septic system is designed under new construction standards (increase in bedrooms), the Infiltrator Certification for General Use, section IV, 2 requires documentation for the sitting of an aggregate system. 4. A portion of the pump chamber is located in the over -dig. Please remove or explain why this is needed. 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 that will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Z wyer, 2S/RS� Public Health Director cc: Owner TOWN OF NORTH ANDOVER 0 HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director "006 Benjamin C. Osgood, Jr., P.E. To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 NORTH f 9 i , k �93SACHUS t� 978.688.9540 — Phone 978.688.9542 — Fax healthdept@townoffiorthandover.com www.townofnorthandover.com From: Pamela 978-685-1099 Pages: Fax: 978-686-1768 Date: Phone: Re: Septic Plan Response CC: File ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: Z L A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Approved: Not Approved: Other: l/ o v rcc� S v�c� l-t-,-� TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET = • NORTH ANDOVER, MASSACHUSETTS 01845 9SS�cHusE1 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX April 7, 2005 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 182 Lacy Street, Map 105C, Lot 50 Dear Mr. Osgood: The proposed septic system design plan for the above site dated March 9, 2005 and received on March 9, 2005 has been reviewed. Unfortunately, it 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 regulations, which is not met by this design. 1. The basement floor elevation for the addition should be stated on the plan. North Andover regulation 5.04 states that for new construction, the basement floor elevation should be V minimum above the groundwater elevation. 2. According to Construction Note #10, the existing 1500 -gallon septic tank is to be inspected for integrity and water -tightness, and fitted with new tees. Please include the following information along with a statement that if the tank specifications cannot be met, a new 1500 gallon tank may be required: a. specifications for the inlet and outlet tees in accordance with 310 CMR 15.227, b. specifications for the manholes and risers — 228(2) c. 9"to 36" of soil cover over the tank -221(7), 228(1) 3. As the proposed septic system is designed under new construction standards (increase in bedrooms), the Infiltrator Certification for General Use, section IV, 2 requires documentation for the sitting of an aggregate system. 4. A portion of the pump chamber is located in the over -dig. Please remove br explain why this is needed. 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 that will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Z wyer, 2SJZR� Public Health Director cc: Owner LETTER OF TRANSMITTAL North Andover Health Department 400 Osgood Street North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax healthdegt(&townofnorthandover.com - E-mail www.townofnorthandover.com - Website fpORTii O.Iquao '6 ~O °COC o ..,.../ TO: � DATE: COMPANY: FROM: Pamela DelleChiaie, Health Dept. Assistant % �. (CSO (p - / �/ RE. tPhone: Fax: SIGNED: We are sending vou: �oov of Letter OPlans L7 Other (fill in below) These are transmitted as checked below: OFor approval OApproved as submitted OFor�your use OApproved as noted AO" s Required OReturned for Corrections OFor review and comment OResubmit copies for approval OSubmit copies for dist. OReturn corrected copies REMARKS: COPY TO: COPY TO: SIGNED: - COPY TO: O r� TRANSMISSION VERIFICATION REPORT TIME 04/08/2005 14:50 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 04108 14:49 FAX NO./NAME 817818952883 DURATION 00:00:49 PAGE(S) 02 RESULT OK MODE STANDARD ECM Dellechiaie, Pamela From: Sawyer, Susan Sent: Friday, April 08, 2005 3:04 PM To: Dellechiaie, Pamela Subject: 182 Lacy Street 182 Lacy St ap 4.8.05.doc Please printout for signature Also, as a courtesy could you contact Mr. Von Sternburg an tell him it has been approved and we can sign the form U. 978 686-7119 v 1 ~ TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, RENS/RS Public Health Director FAX Benjamin C. Osgood, Jr., P.E. To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 �iORTN �,SSACH t� 978.688.9540 - Phone 978.688.9542 - Fax healthdept@townofnorthandover.com www.townofnorthanddver.com From: Pamela 978-685-1099 Pages: Fax: 978-686-1768 Date: ©S� Phone: Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: Z4�R �. A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you Cc File Approved: t/ Not Approved: Other: 0 DATE TIME ACTIVITY REPORT DURATION PAGE{S} TIME 04/08/2005 14:55 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 NO. DATE TIME FAX NO./NAME DURATION PAGE{S} RESULT COMMENT #208 03/18 09:25 817815991237 02:40 03 OK TX ECM 0209 03/18 10:11 818884868823 21 01 OK TX ECM #210 03/18 10:14 812156315997 52 04 OK TX ECM #212 03/18 10:36 89786836595 02:29 07 OK TX ECM #211 03/18 10:41 89786836595 00 00 BUSY TX #214 03/18 11:02 817812709406 01:04 07 OK TX ECM 03118 13:29 19788518547 58 05 OK RX ECM #215 03118 13:59 819782820012 56 04 OK TX ECM 03/18 15:07 978 682 5191 15 01 OK RX ECM 03121 09:09 978 682 5191 22 02 OK RX ECM #216 03122 09:36 89786851099 43 02 OK TX ECM #217 03122 09:42 812075673124 30 01 OK TX ECM #218 03122 09:45 816173380122 58 06 OK TX ECM #219 03123 09:51 89786851099 51 03 OK TX ECM #221 03/23 10:20 89784751448 02:27 06 OK TX ECM #222 03123 11:54 819786889556 01:04 07 OK TX ECM #223 03124 09:14 814017660958 27 01 OK TX ECM #224 03124 09:39 819784906122 00 00 BUSY TX #225 03124 09:43 819784096122 40 03 OK TX ECM #226 03124 10:19 819786941661 04:48 26 OK TX ECM #227 03125 14:27 89788518547 22 01 OK TX ECM #228 03/25 14:29 89788518547 18 01 OK TX ECM 03/28 11:19 7816741546 30 02 OK RX ECM #229 03129 10:23 89789752183 39 02 OK TX ECM 03/30 09:52 14 01 OK RX ECM #230 03/30 10:20 818884868823 38 02 OK TX ECM 03/30 11:21 01:04 02 OK RX ECM 03/30 16:35 9787258181 22 02 OK RX ECM 03/31 09:46 9787258181 22 02 OK RX ECM #231 03131 11:16 89789752183 42 02 OK TX ECM #232 03/31 11:44 89786859611 20 01 OK TX ECM 03/31 14:18 9786861212 02:03 10 OK RX ECM #233 04/04 10:29 19785254801 00 00 BUSY TX #234 04/04 10:31 816179738397 39 03 OK TX ECM 04/04 13:12 +9787948058 18 02 OK RX ECM 04/04 15:03 +9787948058 18 02 OK RX ECM 04105 11:14 0000000000000000000 14 01 OK RX ECM 04105 11:15 0000000000000000000 02:26 05 OK RX ECM 04/05 14:21 19788518547 26 02 OK RX ECM #235 04106 12:46 819786811340 58 04 OK TX ECM #236 04/06 14:53 89787626636 02:19 05 OK TX ECM 04/07 12:36 19417479270 02:22 02 OK RX ECM #238 04/07 13:24 819417479270 04:33 04 OK TX ECM #239 04/07 13:29 819417479270 04:05 02 OK TX ECM #237 04/07 13:34 819419479270 00 00 BUSY TX #240 04/07 14:38 819786851099 41 02 OK TX ECM 04/08 07:57 20 02 OK RX ECM 04/08 13:12 9783742337 01:23 04 OK RX ECM #241 04108 14:49 817818952883 49 02 OK TX ECM #242 04/08 14:54 89786851099 40 02 OK TX ECM BUSY: BUSY/NO RESPONSE NG POOR LINE CONDITION / OUT OF MEMORY CV COVERPAGE POL POLLING RET RETRIEVAL PC PC -FAX TOWN OF NORTH ANDOVER Ot NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET'S =mss—• NORTH ANDOVER, MASSACHUSETTS 01845 'sS.►CH�SE` Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX April 8, 2005 Gregg Von Sternberg 182 Lacy Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 182 Lacy Street, Map 105C, Parcel 50 Dear Mr. Von Sternberg, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by New England_ Engineering Services dated March 9, 2005, last revised April 8, 2005. The design has been approved for use in the construction of an onsite septic system that complies with new construction standards for a five -bedroom residence (or a total of 11 -rooms). 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 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. 3. As the new leaching field is in the approximate location of the existing leaching pits, any fill, pipes, old leach stone or other unsuitable material under the new leaching field shall be disposed of properly off site or used as fill on the side slopes of the system where available. 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. SY S san Sawyer, SIRS Public Health Director encl: List of licensed septic system installers cc: New England Engineering Services • file f� Town of North Andover Health Department Date: ! Location: V �� (Indicate Address, if Residential; or Nags(of Business) Check #• Type of Permit _or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ o�Sept c - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER (Indicate) 721 'Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer C 0 Town of North -Andover 0 HEALTH -DEPARTMENT 27 Charles Street North Andover, MA 01845 978.688.9540 healthdept(ownofnorthandover. com MAR � g 2005 TOWc LTH D�PRR MENS R SEPTIC PLAN SUBMITTAL P(I DATE OF SUBMISSION: 3 SITE LOCATION: /92 /-/G Y ENGINEER: Ne Ul NEW PLANS: YES $225.00/Plan ✓ Check #: 7 5 3: z - (Includes 1 w and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES Telephone #: 1�1 -19 - G-2 Com- 1-7 Cpy Fax #: q? a - S` - 1 a 9 9 E-mail: HOMEOWNER NAME: Ci �-g- I�d N izN g� OFFICE USE ONLY When the submission is complete (including check): 1. Date stamp plans and letter 2. V Complete and attach Receipt 3.Copy File; Forward to Consultant 4. Enter on Log Sheet and Database o NEW ENGLAND ENGINEERING SERVICES INC April 8, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street to North Andover, MA 01845 Re: 182 Lacy Street, North Andover, MA �Q� Np�PPR Septic System Design Plan Re -Submittal Dear Ms. Sawyer, This office has received your letter dated April 7, 2005 regarding the Septic System design plans for the above referenced property. Changes were made to the revised plan and have addressed the following comments: 1. Basement floor elevation for addition should be stated on the plan. The basement floor elevation is stated on the plan. 2. Construction note # 10 should address new 1500 gallon septic tank in the event the existing tank is not suitable. Construction note # 10 has been revised to address the scenario of using a new 1500 gallon septic tank. Also, a 1500 gallon septic tank detail has been added to sheet 2. 3. Additional documentation for the sitting of an aggregate system. A sketch plan showing an equivalent conventional pipe and stone system has been submitted to the town of North Andover. 4. A portion of the pump chamber is located in the over -dig. The pump chamber has been slightly relocated to not encroach the over dig area. Please contact this office with any questions or concerns. Sincerely, Thomas Hector Project Engineer 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 O .0 NEW ENGLAND ENGINEERING SERVICES INC March 9, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 182 Lacy Street, North Andover, MA Septic System Design Dear Susan, RECEIVED MAR - 9 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT The following plans and enclosures for the above referenced property are being submitted for approval. 1. (3) Copies of the Septic System Design Plans. 2. (1) Copy of the Form 11 Soil Evaluator Sheets. 3. (1) Check for Town fees. If you have any comments or questions please do not hesitate to contact this office. Sincerely, "i"w Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE -.NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 Board of Health - North Andover,Mass APPROVED DATE Provided: 01 SUBSURFACE DISPOSAL DESIGN CHECK LIST • LOT c� DISAPPROVED DATE Reasons: Title V FAIL Reg 2.5 a submitted plan must show as a mimirmim: a) the lot to be served-area,dimensions lot #..abatters location and log deep observation hoes -distance to ties location and results percolation tests -distance to ties design calculations & calculations showing required leaching area location and dimensions of system -including eeserve area existing and proposed contours location any wet areas within 1001 of sewage disposal system or disclaimer -check wetlands mapping ( surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sevmge disposal system or disclaimer -Planning Board files (j) knosn sources of water supply within 2001 of sewage disposal system or disclaimer location of any proposed well to serve lot -1001 from leaching facility location of water lines on property -101 from leaching facility ( location of benchmark driveways Vgarbage disposals _75Yno PVC to be used in construction (q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and ether elevations maxinum ground water elevation in area sewage disposal system :::Ts) plan roust be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Sematic Tanks (a) capacities -150% of flow, water table, tees, depth of tees, / access, pumping b) cleanout ( 101 from cellar wall or inground swimming pool 1,7(d) 251 from subsurface drains Reg 10.2 Distribution Boxes slope greater than 0.08 Reg 10.4 b) sump Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 14.1 14.6 14.7 14.30 Reg 9.1 9.6 -WiM ; I L r , Pare 2 1 Leaching Pits leaching pits are preferred where the installation is possible calculations of leaching area-ndnirm in 500 eq ft spacing ► surface drainage 2% cover material j 2'x2'x4" splash pad tee at elbow no beads in pipe from d -box to pipe Leaching Fields no greater than 20 minutes/inch ` area -minim= 900 aq ft )construction of field } surface drainage 2 % 201 from cellar wall or ingaround sw i raddng pool Leachins Wenches no ceacbing area -min 500 sq ft ft min 6 ft with reserve between c f) surface drainage 2% Io Slope a) sop 7/X = to be shown) b) y/x 150 = (to be shown) a) javalb) - power Town of North Andover Office of the Health Department Community Development and Services Division 400 OSGOOD STREET North Andover, Massachusetts 01845 Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 - Phone 978.688.8476 - Fax CEWq7CA2E OAF COJVl'LIANCE As of: March 1, 2006 This is to cert that the individual su6surface disposalsystem was a Full System Repair Completed6y: James ivellett At: 182 .Lacy Street North Andover, JKA 01845 .7fas been installed in accordance with the provisions of Titre V of the State Sanitary Code and with the YorthAndoverOoardof7feafth regulations. 'The Issuance of this certificate shaft not be construed as a guarantee that the system wiff function satisfactorify. Susan 7 Sawyer, 1RENIA,S 1Pu6ficWealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION688-9530 HEALTH 688-9540 PLANNING 688-9535 WEBSITE: http://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (X) repaired; by S J AA At -14-r- i —If (Print Name) located at Address) was installedinco ormance with the North Andover oar of Health approved plan, originally dated �/ % ®� and last Revised on '� � DS— , with a design flow of 5" gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: / ?,.d Final inspection date: Z Z O -16 i Engineer Representative (Signature) SrAOiy E �vu� And - Print Name j0q.._, c C? Engineef RepresentatiW(Signature) 0tn i 4jw*% C�— And - Print Name jkOSGOOD, JR. Al 7. '_. . - Clbl (Signature) Date:zl27 /,G And - P int Na F'S/OVAL .T (Signature) Date: And - Print Name 1 TOWN OF NORTH ANDOVER_) Office of COMMUNITY DEVELOPMENT AND SERVICES�r •'��� ' ''' °p HEALTH DEPARTMENT i 400 OSGOOD STREET • °• «•mss-• = • NORTH ANDOVER, MASSACHUSETTS 01845 1gsAClNgtt ; 'C 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476 - FAX Public Health Director E-MAIL: healthdeuta.townofnorthandover.com WEBSITE: http://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (X) repaired; by S J AA At -14-r- i —If (Print Name) located at Address) was installedinco ormance with the North Andover oar of Health approved plan, originally dated �/ % ®� and last Revised on '� � DS— , with a design flow of 5" gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: / ?,.d Final inspection date: Z Z O -16 i Engineer Representative (Signature) SrAOiy E �vu� And - Print Name j0q.._, c C? Engineef RepresentatiW(Signature) 0tn i 4jw*% C�— And - Print Name jkOSGOOD, JR. Al 7. '_. . - Clbl (Signature) Date:zl27 /,G And - P int Na F'S/OVAL .T (Signature) Date: And - Print Name iN3Ai2]Vd30 HilVDH bGAOGNV HI�JON 30 NMOL 900Z 8 9 833 a3AI3:D3U k , of LOT Z 1 L oc., A�T ED 1 N WQV. 2.7 1 1`�8 3 AV D "5-T T K c' E LL 1 H ENT) . 3Z PST �` 1 D wEL�..irscz X'� v \v ! A Q�be N oT 5 F eJ Q. G '�`c F c_p.-c-1 o t� P t_ tom: N 'F o R Vv T1� L '� ..� .,.^t•-::;. ;,ria; � •,i ' ♦��>.,d«:},,;r .tn '\i ;. - .. _ ti < �' �!� r 'lti k. t. rim! 1,�.+t �'.••S'aj P -r3 "�j t )` r ;� r•• .� �et,t RF _ � /��Pv�' -� K!`�>e.1e .�.� �2?` i s . ,, � � . ! Y i! - :`x a� Sri}! � r J � r 4 t t 31.�•{.�, 1..�ti; tir:t �`. t w r ••�='..,.1 :r f OJb � R;C� y dM1ib "t' l_ r .... 85,32 � ; ���,� .,.,, ..:d. �` yr�s��, � 7'. r' ��+;;�°• , a� b � , � . 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I.- , ,/� � �•y.. 1� 5 � ^'ri 7 �' t,� � • 1'' ''`N� i�'�'1� �y� ` `j R� Y L .. vt" t •-+, f+,h'y} •4 Zf r � 7 �y �`` `.!1' S' � , .� 3';r + I :1t� Al of `( ."• .J; (( r } yti5 0 ..�+; Sl r 'a,,. „j :, e♦�. ,• � t cn,(�� ic�'�, i / . :.K,� •° i- 1't� -;(v tt, , 1��-r,�� .f�F'.:.:rr.�:?(�s �,' � �. t, t !! jlk['7• . � .'�.�+''[;�l':!: .�.-Sl�� ♦n L[y,lt„�. ��” ra ;� ti t�°i � »r'•ur.. 7•r� ',�•1'��`� "��� � Jr `r� , � f.f?,t�. �t i �•`r �b. ;�'. • �, '-! :[r �� '� Y' " i� �tlP � .t sly; ,.� ,�;�� A:. L'. `�,�; 2 -, �='�';T .• `•� �.,i4r�+.� Min: `•i i.J� i. +';;i� h�. � .., �R •a,., ,n il FORM 11.- SOIL EVALUATOR FORM Page 1 of 3 No. 7P 1 ! 01Z Date: 3 q 0S Commonwealth of Massachusetts .)./or-OA Avtdove.r , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By:h.Q.xho.S.....:...... *efA r'................................... Date:�3��5._._... Witnessed By:. hdmu?...../' c ....(.CPat+��... �t�.......... t.e.r.....�caas.U�+.�.n�...................I Uatioa Address at I Sa L-oc,/ S-treet oma•. rte, �c eo Vov. S-"erynber5 Addy«:• &M %Uor+l\ AAcverj AA TdepbowI 18oZ .L.ac Street }��dover,�1,4 of SAES ew Construction Repair ❑ 7 8 8 (o -'7119 Office Review Published Soil Survey Available: No ❑ Yes Year Published -118.1.... Publication Scale I,'...l.S;.& o Soil Map Unit Dcainage Class Idell..... Soil Limitations Re i.d..... e..tx�., . .......................................... Surficial Geologic Report Available: No 2 Yes ❑ Year Published „�,h ..m,..... Publication Scale Geologic Material (Map Unit) Landform. Flood Insurance Rate Map: Above 500 year flood boundary No El Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No El Yes ❑ Wetland Area: _ National Wetland Inventory Map (map unit):................... ........ ........... ...................... .•-- ...._.......:....__..__,.. Wetlands Conservancy Program Map (map unit)..................................................... ......-..................... ....... _.._- Current Water Resource Conditions (USGS): Month Febrvar�00 Range :Above Normal ❑Normal 1WBe1cw Normal ❑ Other References Reviewed: DEP APPROVED FORD! - 12/07/95 C C :BORN 11 = SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot i4o. ) Sa L.aav I1 —1sf eet I 'ALA Ahc�avec On-site Review 11 Deep Hole Number .::::::.4:.:..:::: Date:., 3 : ��Time:-::.P ,o O Weather C �Qar ...3.5 0 Location (identify on site plan) Land Use ::�eS..tde.11 �. �:..::.::.::........: Slope M) Surface Stones Vegetation.,Gf'&Ss...:.::.::.:....:::.::.::..:.:....:.::.::_... . LandformvQ.V�..W:�t.��..:.::j%�cs.,c�..::.....:..:....::.v.::.,.:..,..:..........::.::::. ::: v ....::::...::.:....:..:::....: Position on landscape (sketch on the back) .. L.:aP...::�Sio�.._..:.:.,,.::.:::::::::.:::..:.:::.:.:..::..::....:.::...:::.::...::..:......:. , Distances from: Open Water Body :..7 :..:. feet Drainage way.oR .- feet Possible:Wet Area :./ ...:.: feet Property Line.. feet -Drinking Water Well feet feet Other ....�. ...M,_ ��,... Parent Material (geologic) fr�i.0 f wa llk DepthtoBedrock: -- Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face: ~ Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12/07/95 TORM .11 = SOIL F,VALUATOR FORM Page 2 of 3 Location Address or Lot i4o. J22, Lacy Street 46 AJover On-site Review Dee Hole Number Weather ,I2R(...:��+5. .:.. Deep ::.:::..:.:: Date:..Time:-:::(�.�:0:0.. Location (identify on site plan ja_�.a5-. ....:.. Land Use ....... ..::...... :...._:. Slope (°/,) __77.Surface Stones ::..:..:..,::.::..:::.. ...:.:.....:.:. Vegetation Landform ..:..a5k :..::.�.�.r\ .::..:...::. ::::...:..,.::_.......:........ ......:.::...: Position on landscape (sketch on the back)...::.:��-..:.:5.....e.... Distances from: Open Water Body > .PC: - feet Drainage wayoZ�.-, feet Possible. Area .,1.5'0.....: feet Property Line ._567.,-„_ feet Deinking Water Well feet Other :...�. �.... ,_., .M�. �:... Parent Material (geologic) r0 , DepthtoBedrock: nth to Groundwater: -Standing Water in the Hole: Weeping from Pit Face: j ll Estimated Seasonal High Ground Water. DEP APPROVED FORM - 12/07/95 DEEP OBSERVATION HOLE LOG` Depth from Surface,06ches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) D�73 A 5� ioip, � 3 -30— l .; ^S':.L 10yR lb I o'pjo 3 8 C 15-1110 cow. 75" 1o°/b GrAv. AQ�VeI 1 c>% 7syR5/6 Parent Material (geologic) r0 , DepthtoBedrock: nth to Groundwater: -Standing Water in the Hole: Weeping from Pit Face: j ll Estimated Seasonal High Ground Water. DEP APPROVED FORM - 12/07/95 Location Address or Lot No. a2 �cj r.V Street lover Determination for Seasonal High Water Table Method Used: Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole .................. inches ` fa�Deh to soil mottles _..:.,� inches pf:. ❑ Ground -water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level :.................. .Adjustment factor ................... Adjusted ground water level ...................................................... . Death 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? yes if not, what is the depth of naturally occurring pervious material? Certification certify that on 11 R 04 (date) I have: passed the soil evaluator .examin.atio:n approved by the Dep rt ent of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 3 as � Page 1 of 1 F Dellechiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Monday, March 07, 2005 10:56 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; dano@millriverconsulting.com Subject: soils for 182 Lacy Street 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.mil_l_riverconsultin2.com 3/7/2005 .1p -V. Cr Lon Qc f%4 at LA ce t \A t — 1 Ow t 2 a .1p -V. 77 1 Ow t Cr VA) cr INA 1 Ow t Ow E, Dellechiaie, Pamela From: Dellechiaie, Pamela Sent: Thursday, March 03, 2005 10:40 AM To: McKay, Alison; Merrill, Pamela Cc: Sawyer, Susan; Grant, Michele Subject: FW: 182 lacey street FYI -----Original Message ----- From: Lisa LeVasseur [mailto:lisal@millriverconsulting.com] Sent: Thursday, March 03, 2005 9:54 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 182 lacey street Soil test is RS to 3-3 at 11:00. thanks! lisa 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.millriverconsultin2.com 3/3/2005 0, Page 1 of 1 C Page 1 of 1 Dellechiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Monday, February 14, 2005 11:41 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: RS 182 Lacey Street The Soil test for 182 Lacey Street has been RS from 2-24 to March 1. Thanks, Lisa 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 2/14/2005 Page 1 of 1 Dellechiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Friday, February 11, 2005 9:54 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: soil test The soil test for 182 Lacey Street is scheduled for Thursday, Feb 24, at 9:00. Call me with any questions. Thanks, Lisa 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 2/11/2005 Towri pf North Andover Health Department Date:'' d �� c ^r Location: (Indicate Address, i/iff' Reside tial, Name of Business) Check #: / �_/ Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: O� ® tic - Soil Testing $ C�W - ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) �► iJ Health Agent Initials 673 White - Applicant Yellow - Health Pink - Treasurer O0 pORTM TOWN OF NORTH ANDOVER Community Development & Services Division HEALTH DEPARTMENT 400 OSGOOD STREET S^CRU NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax I" DanielOttenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: 1.800.377.3044 or Date: Phone: ✓O �� 978.282.0014 0� Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Address: Soil Test OTHER Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File 1? Fax,K 1220xi Last Transaction Date Time 0 Type Identification C Log for NORTH ANDOVER 9786889542 Feb 10 2005 2:28pm Duration Pales Result Feb 10 2:26pm Fax Sent 819782820012 1:36 3 OK 0 BOARD OF HEALTH O. NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: Q114or MAP & PARCEL: LOCATION OF SOIL TESTS: 182 1 A C e v -gy OWNER: 6rr 4 von S+er-16g S TEL. NO.412 f� (68(6 7111 ADDRESS: 18;2 L.a c e.r Sri re e4 'NO. --671) \ -1768 ENGINEER: �lI¢ w Enelaag En oi,�t�r„4 Sef�l ices TEL. NO : 4781 4 $ 6 CERTIFIED SOIL EVALUATOR:D2n�n�n C. OSom��Sr. / 7has 1G. }�ecr Intended use of land: Residential Subdivisioningle Family Home Commercial' Is This: Repair testing Undeveloped lot testing In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WrM THIS FORM: Upgrade for addition X_ No 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes. and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. .. . GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1”-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval:'. Date Received: Check Amount: Check Date: C PO,P.: iON- 7 ra B6.PB9N�aN�1� go.D l) PlIOPER7'�I G/�✓6S li�D DwEL.GtN G GvCA17v.v FQo.H E�j srt.d 6- PcA.cv aF rzEo.zf�. ZJ S6P77l6 S yS iC•K c,> A4ea A) A T 4, o, j* 7o Ns O C RrN u/E.� i.v ?K6r P/E LD R Y CC277Fre-p -77rl01- -r ivsPC�c7ai2 vlcz�- - Av�o 5FP77c s YsTCM !-dcA-VoN PMA) /8 ;L 4ACbY 57'Rb-ci /yo 127Y 4 N o o')r e /'I X-5 /V E - w FN&Z A X P �NCrl v �/z1N !s 5 6 R 6,0 o2 , to 4,vP 6a6:R 9r.0�moo 8.5 woo woo,57�'�� LOT �oo 200/pJoe ---WAwaftope j: G',p :��. /, vu UALLJ AJ .5GP1-7C 7-�4,vj< .E.r.CST/No- srwoe4z4zAw mor 2i.9 9. 63 r•9 E' Y '.00 f gORTN r TOWN OF NORTH ANDOVER Community Development & Services Division n HEALTH DEPARTMENTa 400 OSGOOD STREET "," •'';� ss�cNuse NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 - Fax FAX Daniel Ottenheimer To: Mill River Consulting From: RECEIVED FEB 15 2005 WN OF NORTH ANDO HEALTH DEO ARTM TER Fax: 978.282.0012 Pages: 1.800.377.3044 or Date: Phone: 978.282.0014 :f0 e-5 Red Request for Soil Testing or CC: Septic Plan Review ✓ ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review. Address: Soil Test " OTHER Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File ,�7 DATE: Qldoc BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP & PARCEL: LOCATION OF SOIL TESTS: 18a Lacey Stre of OWNER: Gree von 5+erAerg TEL. NO.: ADDRESS: 182 1-aG_e •r 5,f rQ e4 ENGINEER: Aleve �ne�au�� Ena;na�r:,� Setgices TEL.NO.: &7f� 48(6-1761b CERTIFIED SOIL EVALUATOR: Den�n»un C• DSaefl��3r. / %�ita+.as lG. }�eciror t'.. Intended use of land: Residential Subdivisioningle Family Home Commercial' Is This: Repair testing Undeveloped lot testing In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WrM THIS FORM: Upgrade for addition X No 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes.and two percolation tests required for each disposal area. Fee of 360.00 per lot for repairs or uQ rg ades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: C) -/ w 1 ab 1. 1 HY46 �• J Lu r a ti NN ' V , CL 0 N M r �vePn� OeAjl L q B� o av, 5 a: ,r, �'•1D..,n4+. µpr••,. ti,F r, V. , •'r�.vr;.j itsMAS •};�;`, i '+i+0.if. •! ;��r,� Il,�,r�•,S.✓��11t.,;1.1,.,••' t�t11 1.(ra..f5���Yr,'�;I�'4rali�i,,t;�s;�"� -1,�„ti^v:r;`'•4z' OVER DEP•,has provided 014 form for use by local Boards of Health, Tfl� OF N�RTARTMENT be'=ubmltted to th@.local'Soard of Health or other a rovin a E y ne Recorc m:;, ”. A; Facility .lnforttlon J, M' 'NLN ,out '' .1;. 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'.+;''•:,;.;::,i,`i',,i,�;%;�;•(:r;.;'.;:�;:Sbnal�u� cl Haula(w�s:';ro; v,•,',.:a.t:. httpJ/www.mass.9ov/dap!i+rafa�/apprCvaJs/t6forms,htm#Inspect t5fortM,doa�Od/Q3 � ';� Sytlem Pumping Recom ' Paye 1 0! , G C� TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE L i 3 b SYSTEM OWNER & ADDRESS Von's-k-mbe.r )ga Loc -v Ivo - a1y.o6 v6,e, ma SYSTEM LOCATION DATE OF PUMPING %) 3J 6 0 QUANTITY PUMPED � 5� CESSPOOL NO YES / SEPTIC TANK NO NATURE OF SERVICE: ROUTINE V EMERGENCY YES V OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY J71'0 S /A� COMMENTS: f;. CONTENTS TRANSFERRED TO �d S,��- 6069 Of NORTN ,� * Town of North Andover ` * HEALTH DEPARTMENT ,SS4CNU5�� CHECK #: DATE:t LOCATION: H/O NAME:'Z CONTRACTOR NAME: Tvve of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) G- $ ! �� �Hea Ant n:lials White - Applicant Yellow - Health Pink - Treasurer