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Home My WebLink AboutMiscellaneous - 185 INGALLS STREET 4/30/2018 (2)It 08/14/2017 Address: 185 Ingalls Street OF NORrH qN � OCL 9SSACHUs�� North Andover Health Department (ommunity and Economic Development Division All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre -mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept@northandoverma. gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. YSincere , ian LaGrasse, CEHT Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key v l� Commonwealth of Massachusetts RECEIVEJ) Title 5 Official Inspection Form AUG 1.0 z Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0�, TOWN OF NORTH ANWM Pro Ingalls Street Property Address NMTHWAMIE* Teri and Frank Bowman Owner's Name North Andover MA 01845 08-02-2017 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Benjamin C. Osgood, Jr. Name of Inspector ILIW none Company Name 157 Bluff Street Company Address Salem City/Town 978-435-1324 Telephone Number B. Certification NH State 870 License Number 03079 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 0 08-02-2017 Inspector Signature VDate The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page t of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form RECEIVED Subsurface Sewage Disposal System Form - Not for Voluntary Assessments AUG 10 2017 185 Ingalls Street 100 OF NORTH ANDOVER Property Address HEALM D Teri and Frank Bowman Owner's Name North Andover MA 01845 08-02-2017 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): N/A t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Commonwealth of Massachusetts RECEIVED W Title 5 Official Inspection Form AUG 102Q17 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'roWN OF NORTH ANDOVER wM 185 Ingalls Street HEALTH DEPARTMENT Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover MA 01845 08-02-2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ . broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts RECEIVE® Title 5 Official Inspection Form AUG 10 2011 Subsurface Sewage Disposal System Form - Not for Voluntary AssessmentsTOWN OF NORTH ANDOVER HEALTH DEPARTMENT 185 Ingalls Street Property Address Teri and Frank Bowman Owner's Name North Andover MA 01845 08-02-2017 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 4 of 17 E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 RECEIVED Commonwealth of Massachusetts AUG 10 2017 . Title 5 Official Inspection Form ' �EALTH OFNORTH ANDOVER o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments PARTMENT 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover MA 01845 08-02-2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is North Andover required for every page. CitylTown C. Checklist RAA 01845 08-02-2017 Zip Code Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover MA 01845 08-02-2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1,500 gallon septic tank, distribution box, and leach field Number of current residents: 6D--li Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ® Yes ❑ No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No well ❑ Yes ® No current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) MA 01845 08-02-2017 State Zip Code Date of Inspection Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: March 2016 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) State 01845 08-02-2017 Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: System installed September 2014 Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: 3'feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe OK in basement. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 18" feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,500 gallons Sludge depth: 2" t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) Septic Tank (cont.) MA 01845 State Zip Code Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? 08-02-2017 Date of inspection 26" 211 6" 1411 Measure stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. SCH 40 PVC outlet tee equiped with a filter that was cleaned at inspection. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M °185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover MA 01845 08-02-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01845 State- Zip Code Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 08-02-2017 Date of Inspection Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box in like new condition. Liquid levels normal, no indication of leakage in or out.Flow levelers Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is North Andover required for every MA page. Cityrrown State D. System Information (cont.) Type: ❑ leaching pits ❑ leaching chambers ❑ leaching galleries ❑ leaching trenches ® leaching fields ❑ overflow cesspool ❑ innovative/alternative system 01845 08-02-2017 Zip Code Date of Inspection number: number: number: number, length: number, dimensions: number: 1 field 20 x 40 Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Stone in leach field dry and clean. No ponding, damp soil, or breakout observed. Vegetation was a bit greener over system due to moisture from system. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments page. Cityrrown D. System Information (cont.) MA 01845 State Zip Code 08-02-2017 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover page. Cityrrown D. System Information (cont.) MA 01845 State Zip Code 08-02-2017 Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is required for every North Andover MA 01845 08-02-2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately P c511_4,xtle� A- —74(,J)� I .r-, 3 �3- T,40 It, a s -,s o- 00Y 2 3,'7 71 Ei M 6S P>JA L7 ? c. %q N ICU C. L >✓ IT 4 I )AI 19- ?I OK P `sT4,uCIY IND w ELL - **_7 Iz51 t5ins • 3113 Title 5 Official inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: MA State 01845 Zip Code 4' feet 08-02-2017 Date of Inspection Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6-24-14 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: System designed and installed 4' above ESHWT. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 185 Ingalls Street Property Address Teri and Frank Bowman Owner Owner's Name information is North Andover MA required for every page. Cityrrown State E. Report Completeness Checklist 01845 Zip Code 08-02-2017 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 "ORT" 7981 3j • �c 1- Town of North Andover HEALTH DEPARTMENT S�CHUSt CHECK #: %$y DATE: S • /`� O /� LOCATION: H/ O NAME: /30wp) 0- CONTRACTOR NAME:('IsQonol ' Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $' ❑ . Offal (Septic) Hauler $ ❑ Recreational Camp $ 4 ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ t ❑ 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�0- 0 Other: (Indicate) $ <R He " Agent Initials White - Applicant Yellow - Health Pink - Treasurer 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476Web www.townofnorthandover.tom North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 185 Ingalls MAP: 105D LOT: 82 INSTALLER: Todd Bateson DESIGNER: Vladimir Nemchenok PLAN DATE: 6/24/14 BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: 9/25/14 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPE TI N' 9/30/14 DATE OF FINAL GRADE INSPECTION: 4 SITE CONDITIONS NA Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered. Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port .:a ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over inlet and outlet access ports ® Neoprene boots around inlet & outlet Comments: House to tank 10.4' DISTRIBUTION -BOX ® Installed. on stable stone base ® H-20 D -Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X. Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: 49'1"x31' FINAL GRADE [� Loamed Seeded V - [ Cover perIan p � Comments: DOCUMENTS NEEDED [ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer VAs-Built Plan SYSTEM ELEVATIONS BM = 124.40 HR = 1.20 HI = 125.60 ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 4.94 120.31 120.33 Septic Tank IN 5.02 120.23 120.23 Septic Tank OUT 5.23 120.02 119.98 Distribution Box IN 5.35 119.90 119.88 Distribution Box OUT 5.53 119.72 119.71 Lateral 1 TOP 5.57/5.77 Lateral 1 INVERT 119.68 /119.48 119.68 /119.48 Lateral 2 TOP 5.57 / 5.77 Lateral 2 INVERT 119.68 / 119.48 119.68 / 119.48 Lateral 3 TOP 5.57 / 5.77 Lateral 3 INVERT 119.68 / 119.48 119.68 / 119.48 Lateral 4 TOP 5.57/5.77 Lateral 4 INVERT 119.68 / 119.48 119.68 / 119.48 Bottom of Bed 6.72 118.9 118.98 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the.design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 10 -- ® Waterline .5 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells .20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowedfor a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55,10.32, 10.54, and I', 10.30, respectively, pursuant to 15.211(3), also by NA wetland .bylaws Ai North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 185 Ingalls MAP:LOT: INSTALLER: Todd Bateson DESIGNER: - PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPEC ION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TAN ❑ Building sewer in continuous grade, on ompacted firm base ❑ Cleanouts per plan Bottom of tank hole has 6" stone base ❑ Weep hole plugged ` 1500 gallon tank has been installed 0 loading Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing Inlet tee installed, centered under access port I ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working Pump On/Off floats working.. ❑ Separate on/off floats ❑ Drain hole in pressure line El -'cover at final grade installed over pump access port El Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped El Location of control panel::basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX - ❑ Installed on stable stone base ❑ H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: 1 I I Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As -Built Plan powrp Q O�itrfo ��q. T i • PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (,`constructed; ( ) repaired; By: _F0 b 0 (Print Name) Located at: (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on `?•-7i�� L-f , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: And — Print Name , L Final Construction Inspection Date:' ('7 And — Print Name Installer• -,(Signature) 7 Enginer• t/r �-0 /<e "��ure) l -j Engineer Representative (Signatu. Engineer Representative RECEiv 1t"'OV 0 ? 2014 TOWN OF NOk1-H ANDOVER e HEA i' RTil�l�r"tV Date:- f D -Z4-4 And — Print Name Date: -�= s FAMMIi7 And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fox 978.688.8476 Web http://www.townofnorthandover.com NO ' THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS. "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS—BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. t/f,Qo r/trc� N ;u c Ft�ir /d : SIGNATURE OF DESIGNER DATE INGA B STREET A�,(H QF Mqs„ 9 VL ADIWR L. c- 14 EMCHENOK . wl AS BUILT PLAN S/�NALEN OF a SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. /185 INGAU S STREET y IAS PREPARED FOR .FRANK BOWMAN TM: loSD c, o'SCALE: DATE: 9-30-14 TL: 82 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET A ANDOVER, MASSACHUSETTS 01810 wl .d (p OO .a O c N I �C 4 CD z O �� Cj C; N co w Y� Q z o o w o _ z � 0 LL O o� cu U Q Z cn OO i3r �" U O m E M W �, x E o � U as ISI O V � .• �,, Q t cd a� 00, a. •�C4Cd N ti 1911 A r AORT4 0? La Town of North Andover HEALTH DEPARTMENT ,SSwCNUStS CHECK #: LOCATION: H/O NAME CONTRACT 6962 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ I ❑ Other: (Indicate) $ t2 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Important: When filling out forms on the computer, use only the tab key to move your cursor do not use the return key. Q f Application for Septic Disposal System, Construction Permit —TOWN OF NOR'T'H ANDOVER, MA 01845 TODAY'S DATE Application is herebv.made for a permit to: JUL c- M `t ❑ Construct'a new on-site sewage disposal system' �,� TOWN OF NORTH ANDOVER Lr <;ir or replace an existing on-site sewage disposal'syste HEALTH DEPARTMENT ❑ Repair or replace an existing system component – What? A. Facility Information as 5 Address or Lot # City/Town ,off • / 2.- *TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump cavity (choose one) —If pump system, attach copy of electrical permit to application °** ➢ conventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser (Gravel -Less) {Attach a copy of your certification to instailthis type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) 2. Khat is the Make? Name Address (if different from above) ' Cityrrown What is theModa'VV, ",9- o foo' � State Zip Code Telephone Number 3. Installer Information 1 Name r Name of 4/ A rA Address Citylrown ' 0 4. Designer Inforthation 111 ARGILLA ROAD State Zip Code T" 6.,�/ ��5�� 4 7c2 3 Telephone Number (Cell -Phone # if possible please) it I I�id /.C.�, /� / / M ,- Name Name of Company Ci Le PAI 1 // L ST - t�DJQ. Address City/Town Jt - 0/1F/ 0 State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 °pTN Applicati-on..for Septic Disposal Svstem =Construction Permit' TOWN -OF �.,...R,h ORTH ANDOVER. NIA 01.845 TODAY'S DATE $.250.00 - Full Repair $125.00 - Component PAGE 2 OF 2 A. Facility• Information continued.... 5. Type, of Building; esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been Issue by this Board of Health. Name Date Applicatio proved (Board of Health RepresentOlve) Name Date A Icati Di§a roved, f r t following reasons: For Office Use Only 1 , Fee Attached. Yes �r No 2. - ProjectMa:iager Obligation Form Attaebed.' Yes No 3.: Pum shet 'm? S _ Ifso, Attach copy ofElectrrcal Permit` . Yes 4. F0und2d0-ft As Built.? (new construction -ronly), YeS (Same scale as approved plan) No 5. FloorMws?(hely construction only): Yes_ No Applin tion fior•p(sp4saI Systemonstruction Rermft Rage 2 of 2 SFY nc,SYSTIM. M M-A-PRO.MM MAN&-qM '. %rr-:0 LIC.ATIOM INST B Astbc.NgnhAndover,Hc=edlastaafq,rtlio -ft,168eptic �A, (Addyin of septic systm) P"D For PIMS by C t-;7- Roative to *e,oppVmtj=,Df. (ifs wlees -qmu) AM dated � L/ rev iono doted {Last revised dote) I undMtmd the following obligations for m9nagenlent ofOds P moject: i. As the fDsujle4.I Am.obligated ia 6bWa all pemAits and Board o'fflealth approve -4 plans- 02 to Imoat hwetheymmkonly sit" th on 2. -for my and idUspwdm. If horns cOntEActQt,,PtOjeCtmAW8er, or any O*erperam not 0380c&ted with my cmpiny 1644ef "a fdspmdon and the Mtein is not tudy, then item 3.As t6 Wdk. I atu rtqua ad to. havc.di pg# work i**eW.P#OP the'l It i*ecdoo 93 ijl*Ated b4m, T. ut at reftek&PAfl . •h�m�Li��eaet$�IIy., tliis#s tl��t.1 � .�aois-tta1�� rheic is•A: ., . ;+ fb.SpcWO4 but Oci.im• dot have to be prascrir: - - 6iew for 'etc, Ai4iffi a 4niba OK -(Or C-ma.ib; hisfrom the er4np&, must - be Aibitided of Re&4 1614f, V- N&H-utoft." fwin time. bepre'stin't far t:hi4.fnspccd6q, Wkb * putrtp SPMOIO� 'be ready . j ad able to cause pwq.t6work j(OdAlk= to 'Gin, is must requ"t kq=on vr c#jal gmdinj s not C. E441 a h •, llilviio be oafaite. � 4,., As -the WWIt;' I uitad that c* Ift &N $* iD COMPI .. y Ot6= tm"' IdeadW in M th6-JAktI&tj6n of th"t s" 6its heel htmli e A sollovi Og c=tmciioa Steps: PMP" Ofde eftcuftdaft 4JO'hoca reached b- IWPC&iYOV of theirsad and *true to be used a AWWRIYM, OftWk.D-.Vdir .jpY pgsoMfit.. RMt, . PMPchammber, &WjVV2 mff gad other W North Andover Health Department Community Development Division July 31, 2014 Frank Bowman 185 Ingalls North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 185 Ingalls Street; Map105D Lot 82 Dear Mr. Bowman: The proposed wastewater system design plan for the above site dated June 24', 2014 with a final revision date July 22, 2014 and received on July 30, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4 -bedroom (max 9 -room) home. This plan is generally good for 3 -years from the date of approval however, as this is for a repair system, this is reduced to 2- years. The plan received the following local upgrade approval. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 1`x`85 Ingalls Street July 31, 2014 shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director Encl. Local Installers List cc: Merrimack Eng. Services File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 �00 z z 00 �o o_ Q� O N a1 0�1 M O o 01 .--� O 00 00 ,--+ �-'i �' ,--� 'c� /� 00 N 00 00 ~ O /� °v 0o M M O N 00 `p N 00 - 00 -- � 00 -� .--i O N 00 O G7 C7 O W p00 O x oo O O O P-! w O O oo O O W xxv�w aw�r�`i'� > >��xO�wS >x H �a H NQ wOW Q UOO�OHw wW OE- H0O >01Q 1:1 zx> axe �z �Zz�w z¢¢ °��nQ a�¢c ¢z zzzzo O M V1 N a1 00 1-0 � d kn M ',t ti's � M O l� N \D r- � - -- O 00 O O o0 cr O N O d N M 01 N rl N 01 1.0 " - l— V'1 d' Q\ Ct 00 00 - N M O y \O N o0 r- M M M O kn M d Ln O h N N N a1 00 O It �O C*, w C, o I'D 00 d M �n — Q1 O - N d [� Do Q, N M N 'n Ln `D t— 00 00 d M �O 4 l� A M c 1 l� � v1 4 �O N It m "D MM 01 00 t!1 N M M M V1 M N 00 Q1 1p 0� N Ch 00 �O \p 00 00 00 00 M Da 00 00 M 00 00 00 00 M 00 00 00 00 00 00 M M 00 00 00 00 M W J J O co N N •3 NU. Q. ° Co Z W p LLJ F 0 c ° al � � 'v .� d> Z�W cr Z Cd x A m cci N c C a¢i aQi C �- I►a� U titik° °°°0. °tiF ° wv Of MORT11 , b V ` o ij • . .. of T Town of North Andover ..::� ' HEALTH DEPARTMENT SACHUSf CHECK#: DATE: LOCATION: -'l Yr-,% aOA 11 H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: 00 ySeptic - Soil Testing $� ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ • _. ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer • TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, RENS, RS 978.688.9540 —Phone Public Health Director 978.688.8476 —FAX healthdept@townofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: (4-7- MAP & PARCEL: 1619C�5 7% LOCATION OF SOIL TESTS: 11? 57" OWNER t £ � llit 0:70 �� J- � Contact #: � Z-45 ^ 60 APPLICANT: 6A Contact #: ADDRESS: ENGINEER: H 0/W W 46K Contact #: 7 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision / Ingle Fam' Home Commerci Is This: Repair Testing: V Undeveloped Lot Testing: Upgrade fo _Additio In the Lake Cochichewick Watershed? Yes No RECEIVED JUN 1 '12014 ]VKOF NORTH ANDOVER HEALTH DEPARTMENT THE FOLLOWING MUST BE INCLUDED WITH THIS FORM �— ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5" x 11 " Plot plan & Location of Testing (please indicate test nit sites on the plan) A 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 ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. .✓" ➢ Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Healty c showing the location of all tests (including aborted tests). 16 ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date.. r Q Signature of Conservation Agent: j 1'_S SOA1— Date back to Health Department: (stamp in): •1 � 1�� aT �} o Ste. L� �Q- � bd-u-�'r'� 1 (,'L H / %F%FD FOU` IDA % /ON PL AAA . OCATEC SCALE./ ` D4 TE= S.L_G/LES R.L.S. L A VIRE/'VCE 8 NORT/-1,4NDOVER 2) t I _ 5- 46t F f I I I ` 1V / E%?T/FY THAT THE l SE TS SHOWN 1 �s tetteg lFOR/✓1 TO THE [anmdZs J/NG BY L A Pl OF As� "2 o�/' ti r2I(1- OFFSETS SHO1411V ARE FOR THE USE OF THE BU/L DING INSPECTOR ONL. Y, 8 SUCH YSE /S FOR DETE WINQ RON OFZOIV/NG ^ONFORMITY OR /VON CONFORM/TY !//! //- A _Oz.ie%„ North Andover Health Department (ommunity Development Division July 22, 2014 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 185 Ingalls Street, Map 105D Lot 82 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated June 24, 2014 and received on June 26, 2014 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. /1. Please indicate the distribution box to have an H-20 loading capacity (NA 3.2) 2� Please indicate the orifice size in the distribution piping is to be 3/8"-5/8" in size (3 10 CNJR 15.251(8)) 3. Yease indicate the need for the base aggregate and the cover layer of pea stone to be double -washed stone (3 10 CMR 15.247) Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. cc: Frank Bowman File Page 1 of 1 Andover Health Department, 1600 Osgood Street, Suite 2035, Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 tea:. � - �.�, � �.�„ Blackburn, Lisa From: Dan Ottenheimer <dano@millriverconsulting.com> Sent: Tuesday, July 22, 2014 2:54 PM To: Sawyer, Susan; Grant, Michele; Blackburn, Lisa Cc: 'Isaac Rowe'; Pam Lally Subject: Disapproval letter - 185 Ingalls Street Attachments: Disapproval Letter - 185 Ingalls Street.docx Attached please find our suggested plan review disapproval letter for the above address. Feel free to contact me should you have any questions. Dan Mill River consulting Cavi1 y rtvt�-Ugmltat;.l Pe mfgtc.0 �i 1I %d2'i �.it (h�i f"y l!:nt01�13i-{ J{CI{Y:.N CC��itl FS lrf ��T(, Daniel Ottenheimer, President Mill River Consulting, Inc. 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014 x 802 www.millriverconsuIting.com dano@millriverconsulting.com Member: Massachusetts Association of Onsite Wastewater Professionals, Massachusetts Environmental Health Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association 1 Blackburn, Lisa From: Blackburn, Lisa Sent: Friday, June 27, 2014 11:21 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Subject: Design .Plans FYI ... Design plans and paperwork for 185 Ingalls and 326 Foster were put in today's mail. Have a great weekend[ Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com 1 _ 6842 Cf MORT � F _." .- 0 Town of North Andover `�'•�,,,,o .:,' HEALTH DEPARTMENT CHU CHECK #: DATE: 1 LOCATION: il �Mv;ul _ H/O NAME: CONTRACTOR N Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ xSeptic Septic - Soil Testing - Design Approval $ $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ 1-15 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER `w♦ Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone978.688.8476— FAX Public Health Director E-MAIL: healthdeptgtownofnorthandover.com WEBSITE: http://www.towDofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: (/ Iii' Site Location: Engineer: EM Id/X�� I l)l' Pa New Plans? Yes V/$225/Plan Check #_(includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes No Local Upgrade Form Included? L. Yes No Telephone #: 6'X) `t 7 5- -��'25 Fax #: 4V75-1 E-mailjL f,QU FIf��N Gp�-lC it. A.7F,� Homeowner Name: OFFICE USE ONLY When the subission is complete (including check): ➢ �/ Date stamp plans and letter ➢ IZ Complete and attach Receipt ➢ i,,/ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database I I. JUN 26 2014 TOWN OF NORTH ANDOVER 11EAr ru DEPART -M NT n 0 m m 0 m 0 1 m a 0 0 v m 0 CD 0 OD I r. 3 (D CD m CD 3 0 (D N CD P- rn p -N n CD D O T m 7 c j 3 7 N 0 CL tQ o D (D (D so p) (D -1 O cn O 0 O ' (D : m m 0 (D N N N N O 0 O 0 m CD (D o z a v 0 a 6 0 � 0 (`D a v a', a a 0 o O. (D 0 N (7 ` CD J CO El CD Cl)7 cn 0 v Q cn 7 < CD N (D(D (1) s 0 (D. v 0 o 0 � Qn o ❑ ❑ O 0 0 m -0 o nz d v 3 m (D 0 O (Q N X (D 0 w v Q (D •J El (D CO) a c O (D =' x (D O CL O. C N ❑ z m a 0 0 ,J O 7 N C 0 -K, �. 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DEP has provided this form.for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. A. Site Information Fjnjqj j�/ 0014 HA Owner Name 1 0!1A,!0 Street Address or Lot # City/Town State Zip Code 6-00 72Z566;*4 Contact Person (if different from. Owner) Telephohe Number B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) ®4 1 OAM Date Time P- I M I®'dip Its: 0 Gig Date Time Test Passed: M Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnessed By Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 LJ3 J -,Y "1 42 ( C -r P/- Z -S -' S7 4�f E�5 1,43 LJ3 J -,Y "1 42 ( C -r P/- Z -S -' S7 4�f E�5 ��;� a �� _ � e -.h �„K "��.�n,�.i�```f if' „+� �i�1- h� �'i a X+, + fy.'_ `;„r +i � �•# u i r�.r'th� tt� �,�ilj�'�`'try3r v ' ::t�'�' �� t t �,t t RRf y� t a � + , .✓'"ay�iM �^p�a �y t r � f ”- ., qtr r.� - y t� a: x�yt� �� 3�,'".art� d � 6k' j� � ,q� � '4dt�� • rk qua - � _ '+ .- wa�1 k S, �(f' � ��✓?'R i..x �r C - "", ti a = rt� � i & E}' .'�'r" i ��'� •�r+� j �fk dV`",��" "'tr 1 y .. � U W N. OF N UK1'M iNC?t:j 'SYsTp_K.j Pt%FriP1N() cok P40V - 20'05 �Y i � ® �R ► A ss • _ ." �. Y,C 1 Ei' �+� 3 Tp_yvt l i i7 h. z � �' ' tt ��.r.4�af� sM. t♦ es. « � t .i #�1#'iwgyrp�F y rt r"r F t N� rcJkt� Di Ub�t��Y�4'.i'16?t�P1r = r r s � r F oaP+�� rive }` J hCa�� (;��', ',�...ir►+I, 1.,M� Pli ��rn �. � . { yg y �e t k�'1p �p!p61�` i♦�f + � i.iDi ��ii �� //�� p . . do �1 s.i�`i1,V �6d �i®� ,• v �+N �L� Y� ,, 0Tx# R EXPLAIN (71 >Y►b� �.,� .. .:� .c?7 LTi' �.=1 tvNP�N1�•;r WILLIAM A. REYNOLDS ASSOCIATES INDEPENDENT INSURANCE ADJUSTERS P.O. Box 752 Nashua, NH 03061-0752 Telephone 603-594-9757 Fax 603-594-9759 Form of Notice of Casualty Loss to Building Under MA General Laws, CH 1393 S.3 TO: Building Inspector or Commissioner and of Health or Selectmen Town Hail SAME North Andover, MA 01845 RE: INSURED: Bowman, Teri and Frank BUILDING ADDRESS:/18-5-Ingalls StreetNortll Andover, MA, DATE OF LOSS: 7-24-99 POLICY NUMBER: 31-12O55257 CLAIM NUMBER: 9901-1642 Claim has been made involving loss, damage or destruction of the above captioned property which may exceed $1,000. or cause MGL, Chapter 143, Section 6 to be applicable. If any notice under MGL, Chapter 139, Section 3D is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. TITLE: Adjuster On this date, I caused copies of this notice to be sent to the persons named above at the I addresses indicated above by first class mail. Department of Environmental Management/Division of Water Resources �,. WATER WELL COMPLETION REPORT LOCATION Address W f ,3 W� oGa l l S �S+ree 1 City/Town No r l h (y(d OILP r- G.S. Quadrangle Map Grid LQc_aAon Owner J a S I `I arf i Y 14 Addres93 1 nQ 6C WELL USE Domestic /Public ❑ Industrial ❑ Other Method Drilled Date Drilled ICASING Length i� I Diameter w Type ' f --e L I-? i -b— STATIC WATER LEVEL e Feet below land surface Date measured I oh�_ v CONSOLIDATED WELL Type of Water -bearing Rock Water -bearing Z i nese. {' 1) From t L) To v 2) From To 3) From To 4) From—To— Depth romToDepth to Bedrock OCJ UNCONSOLIDATED WELL Water -bearing Materials Sand: fine❑ medium❑ coarse❑ Gravel: fine ❑ medium ❑ coarse ❑ Screen: GRAVEL PACK WELL Slot# length from to_ Yes ❑ No ❑ Split Screen (or 2nd screen) WATER QUALITY TESTS. M� Slot It length from to Chemical ❑ Biological Depth To Bedrock PUMP TEST Drawdown =kb feet after pumping daysYhours at GPM. How measured .l?/0 Recovery (lltfeet after hours. LOG of FORMATIONS Materials From To y jo r. , ilo' 4 { lc24 COMMENTS: (On well or water) yy� j DRILLER j y Firm�Y 'Addres�ss_ ,$( R e-' r h� a r f r '`-�-�-t \ City J N I& li I WN Registration No. �� { perator s Signature V@UM@ 90 M%UIER %M&LSV@O@ DRINKING WATER LABORATORY — CERTIFIED — 36 Pelham, -Rd. Salem, NH 03079 Laboratory Number: Submitted By: Mr. James Hartigan Lot 3 Ingalls Sample Source: North Andover, Mass Quick Results, Sample Pick -Up (603) 898-2504 (603) 898-1329 Dec 4-90 Analysis: According to Standard Methods of Water & Wastewater Analysis, 15Th Ed. Sample Date: Total Coliform ...... o per 100. mg/1 0 per 100 ml Chlorides ..........250, mq/1................ 32.o mg/L PH ............... 6,...5. . to8: 5 7.0 .............. Hardness ..........75 to 150 mg/l 132 mg/L Manganese ........o. 05 mg/l, , , , , , , , .. 0.052 mg/L Sodium ............?50 mg ./ ................ 13. 50 mg/L Iron ............... �: 3. mg/1.... .........Q.471 mg/L Nitrate .............. 10.mg/.l ................ 1.10 mg/L Nitrate ....... 10 mg/l 0.05 .......... .................. mg/L Arsenic ............: 05. mg�l............... 0.001 PSP/f3/ ma/l Comment: * This sample slightly exceed the limits for iron.. However, this sample meets current primary standards for drinking water. Analyst (ARD of I &MA111 NaI�TM AAJPnVe).;, MA, SS Z Li - _ AP�oyc"D 1YJTC—`- 5EPT-1 c S1� 5 i Ex l iPR�oULNG Aunioi?)T G CoNPlTio�vs :: DISAPPRUVGD 1ATE 1. RQSoNS : i D� .� st(�j'(C SYSTEM 11u S�iO (.L,�1'Io� Ex4v4Tto)I1 )"SPI�-6 i IOAJ U/JYG ---I��SS E] F41L- �wA� I ti5��flo� p PP(�dvE� AWTIOJAL l,JSF6:7:-1 SNS ()- At'y) DISl-�Pmo\jv cD RF/J,50 NS DA rCC FVAL APPh�jvaL DACE APFROO11J6 AUTO Oo / i - I -W iw6oj ��L APP WV16 /6v;HO9j F,j Board of Health - North •An&gver"a. BLPTIC SYSTEM � ' INSTALLATICK CHECK LIST LOT -ED DATB DI SA PFriCT�F� AQATIC�1 OK YAI L _-�`�� FM �� 1. Dib tance TO!' a. Wetlands r { b • Drains ;�- f c. WeI1 N`' 2. Water Line Location �3•.�No PPC Pipe_ T l: �•" =Sept3.6 Tank' {;g. a. -_Tess =_Length & To Clean Oat Covers. INA- . b. Cement Pipe to Tank '- QZ Both Sides of Tank . p1PG- '�I�ovL 5. Distribution Box 902318' . R- Covers & Box - No Cracks b. All Lines Flowing B,qual Amounts AJO-r 60 V 4 C.. ,eG,�' c. No Hack Flow 41I23167, 6. Leach Field or Trench ? a. Dimensions zb. F. Stone Depth _ Capped Inds d. Clean Double -Washed Stonebill 7. Leach Pits a. Dimensions = . b. Stone s c • spl Pads Y d. s e. err Mt Pipe to Pit -Both Sides. o Clean Double Washed Stone ,.q 8. No Garb age Disposal ��6 �� t► V c7 9• -Final Grading Inspection .� ID `11 f � - V� • � Z3l lA. Barricading Covered System 11. As Built Submitted` Lot Location . _ - --- b. Dimensions of System c. Location with Regard to Pere Test d. "Elevations r e: Water Table 0 SfIB&MFACE DISPOSAL DESIGN CHECK LISP Lar ti. APPROVED DATE DISAPPROVED DATE C Provideds Reasonss Ti a FAIL J31ocation Reg 2.5 ubmitted plan must show as a minimums e lot to be served -area, dimensions lot #,abutters cation and log deep observation hoes -distance to ties and results percolation tests -distance to ties sign calculations & calculations showing required leaching area cation and dimensions of system -including areserve area isting and proposed contours cation any wet areas Athin 1001 of sewage disposal system or X. disclaimer -check wetlands mapping (h) face and subsurface drains within 100, of sewage disposal / system or disclaimer (i location any drainage ' ea.sersents vithin 1001 of sev age disposal system or disclaimer -Planning Board Piles (j), -known sources of inter supply wi.tbin 2001 of sewage disposal stern or disclaimer location of aw proposed well to serve lot -1001 from leaching facility ( location of water lines on property -10, from leaching facility location of benchmark driveways garbage disposals no 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 Other elevations () maxum ground water elevation in area sewage disposal system s) plan mast be prepared by a Professional Esagineer or other professional authorized by law to prepare such plans Reg 6 Se tic Tanks Tka(a ca- ties- 50% of flow, water table, tees, depth of tees, access, pumping b leanout 101 from cellar wall or inground swindng pool - (d) �5, from subsurface drains Reg 10.2Atpe stribution Bones _. 1 4) greater than 0.08 Reg 10.4 b) suM FLYNN 74 SSOC. P.C. C SANITARY aro CCNS'RUCTION EN;INFERS P J H'Y ' 69 pla stogy °.E yr �'j lcsh re 03865 7e 1E' . X5-3559 September :Q, +99? r, o rP-, r ^di R J 1, 1 1 J e 11drnden Rua,i t 1 I P r' c a, "l a 5 s d c n U °, e* t `i C 0 6 t docnc. E ga1.1G Screet ec3r i". In CCm,,'ldnr P ,1.'h .lour oequest, I met with ill . Rosati., Inspect - Ur t'iv, '`I„r PnuL ` oard of Health, on this date at the refer- �d '. t , t0 rJ, Ll e dtsilosition of the existing subsurface K �s+ t i 1 d 1 to .Jecte?u the sgster,s thoroughly and discussed Pr%gtt- pr.rt L t1le n-pection, I hand dug observation _. ^ol iF ;°a� 5_�11e in Path bed. Ps a result, the following �i-k trl arcleNtance of the systems by the 1=oa•-ci �r• Trrtar ri ;tet t-' Fl -Pm,()ved an pipes remortared at thF CL1 .c tnr 1 I Pt it out lets, and distribution box in lets an et, *o' ,o _ar I:- ts, trer ranches and other debris ad - P' t tth' i r'i=`., 1 7p r 1 •vP(j and replaced with accepts :1e j L r )' _ � 1 * t0)le (')•litt)r C Ianed o f fines or repIar_ed a lt-,, r L t i.t 1 `. i t' C� 1 . ,,1 C f• d .. 1 t f- • i t ,� li) i t I, n P l0 .P ar d Ji-.tanves must • r > U 1 n j n 0 4 1 �,rr. ,. �. • lc , r 1. r o. aenience.� Mr. James Hardigan Re: Lots 2A and 3A Ingalls St. September 29, 1982 Page 2 ThanK you for allowing me to represent you in this matter. Sincerely, i LYNN fSSD . P.C. / ! r 11/ ell -resident iA ii n f cc: Mr. M. Rosati Board of Health ' ' � �`�.`' � P"�`'�"'F�S''��.;''°'#"5't�',si`�e+." �. k�'"raea'r +�, q.��,� "��'•e '�,i�,e+.ti""•-+C .rC'`��+"^.k' s'y..# �, ,t�-'� z�s �,�r y„"wss{- w...; bb r, i -. 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L`a .r '�•eyv �••x,...y..,e . `:t 4 •fir ..s. fi'-'#� rr "ie '�S ,•. 4i:.. w' �Yi •iY � ,Si 7P'.6 " +w.wz^� 'di ( "!+r- `•K +�., "S'�,. i. i M+ � .� J4''� .u'4 r : Y1.I1:1ii 'iWi�+ „�s- t .:'¢. t+ :. _.`.i "d•.•r s r.. • "f•. pwiopeEtTY Livia S1SrrZ7C LiWE ..479 � SPE.L.b �� G.�¢c¢ €�� ' P4b fi+� 1�£.� r�;. � � �`,�•�,',"�t,�� +�"-;. �' �..:•sr:v � r`'t. � .rerp� �,,c �, i .,,,�,�•.Y�+3 "� 1 ,,, v a •}+ ->r ,!?'�- h s ,r '"y`,,, q . y,, '"- �-zm a is - » •x... " 'Ry' a^�'". :�.� an -.0 �� d :6�iew^pP''lP,y4�..7y"`4. fir �v� 6�7.'�� {s ` C�� .. y�x'�.9 ��aT�Ci.2*� �4F�Si" <C� '��'�+ t "�b "Y�y+� '� p�"Z •�i'R�� .S " y r. y� �a 't{ -.a^ f-+ »'a +'r m ..r� !-yr¢. r tYs`x'"+-.:�• .1Z��"� �yTom,`., ••+,. �`. :. n�.•� { ei � -..rt" � -:rMs- rd•`a t i- a Y - e IgA mks �tyr"� '-*:z, ��4 i � r q, i so `: rt, .-; a'- ,E' 4. ��p �LG..�4►X'rcz+. �°i33�- �c��:u# r+��. �, 2-- :. Y. �� 'g'•"-.'„7' �.'+.�': ,;�awAr t ,Y,�vrt •�t�^rsr�.&s- ,. F r tkY�, +*c: �y• ,,��',s�;,. --�+ w� r �►-� i. � ,a' "fir t - i %2W6} .0 �i� tWAST�id� E�K%Da4t€e� 5 S r A V; x� iei V�aW a kT `.+1' . + •- �, r .S � a Y of " ; �.» . � ro m o # A�- i� S, M�+'h " ' 4✓', isw" f f < -4' �t j% F^.3' . i r_===` r ' OF Aggssa p JOSEPH J. CI&REAGALLO �j `•' Q i .I No. 464 J� M m (U zs qj zt �:1, �tV yJ y� r1 QQW A �j �Z � ��?off of V ♦I -� v ,, o oc or F. r: W v ? o o V, QV 064 4�� o QW X00 �c��. t ♦V 4' IVA 3 C IVA Town of North Andover, Massachusetts Form No. 1 :TN q BOARD OF HEALTH � 6 19 m APPLICATION FOR SITE TESTING/INSPECTION Applicant � •� � .�vt��»,� � NAME ADDRESS TELEPHONE Site Location Z'e"r 3 <� '-///'S S 3A Engineer NAME ADDRESS TELEPHONE Test/I nspection Date and Time C,7 r Fee u-23-7 10* Vq .3.H. S.S. Permit No. /s 7 D. ,-Plog/y CHAIRMAN, BOARD OF HEALTH (s Test No. Del W.C. No. C.C. Date Plbg. Permit No. /r - uxer !!TO ; , - Aq�OvEr_ QnA►_D or- iAEAL-To FROM: eA kt e. GLLI tVA S a Ass oe . T-Xx. NORTH ANDOVER, MASS. 1)6L % 19 fs BOARD OF HEALTH DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at Lo T 2A MNy &U�S �7 . Site Location North Andover, 1AA. .The grades. and construction materials are as -specified in my plans and specifications dated 1981 and p6- • 2 19 45 � L/, (� n -VT- . Prof. Enginee�/Reg. Sanitarian iv, L v -T 4-A �3 Z Z �1G7ALL 'b CJT, PUB\�1L (,VIP-THN/AK►f-S E LE \/AT l O N 5. F HSE MZWOMARM • •Fibs�•. • N FRA K' UGELINAS c -o p No 227380 �C'/STEL FS�7ON' L As 6vI L -r 5u6-5u;;?.r-A.CE DisPv SYA5-r am IN �jGA,LE I"= � rZIG1 FRANiL GC7ELiNAS � ASSUCI�.T'ES ENC�INEE�S� ARL4-IlT'E.GT'�3 p JOSEPH•; t _ No. 464 Q � AL INN �0 vi I 114 1 � i z� 0 Qj hVI 60 W V fit (V!3 V. W•i�,t�V� W st 3 ,4 .. i 0 v 0 W v GJ � o 0 0 0 C' e NEW ENGLAND ENGINEERING SERVICES INC ), October 13, 2001 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 185 Ingles Street, North Andover, MA Dear Sirs: uv HFF 7 2001 Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin 20sgood, Jr.7 60 BEECHWOOD DRIVE - NORTH. ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS C!! `l �' DEPARTMENT OFt ENVIRONMENTAL PROTECTION_ _ TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ( 55 �N 6-1. E5, S N0 Q'rH xt-)DDJC r2 MA Owner's Name: f770 w M A N Owner's Address: _L2LE J�_- N G--�_C-4s _�;l ivelt2 i 4 AN 0ooj t A4A Date of Inspection: qltg/y Name of Inspector: (please print) P-> L- OS6-1) Oil 7N Company Name: Mailing Address: L-0 e c% 14 G%_ tO 0, 0 R l C, Telephone Number. q'70- be&-17L- CERTIFICATION -t7L- J CERTIFICATION STATEMENT I certify that:I .have personally. inspected the sewage disposal system at this address and that the information reported below is:tue;,accurate andcomplete as of the time.of the inspection. The inspection was performed basedon my training and. gperience in the proper,function and maintenance of on site sewage disposal systems. I am a DEP ; approved system inspector:pursuant to Section 15340 of Title 5 (310 CMR 15.000). The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ✓?_ �� U—_ Date: �> The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not; address how the system will perform in the future under the same or different conditions of use. Page 2 of 11': OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r'ERTIFICATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: Ahave not found any information which indicates that any of the failure criteria described in 310 CMR 15303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: e or more system components as described in the "Conditional Pass" section n to be replaced or repaired.: system, upon completion of:the'replacement or repair, as approved by th d of -Health, will pass. Answer yes, no or no etermined (Y,N,ND) in the for the following sta ents. If "not determined" please explain. a septic tank is metal over 20 ears old* or the tic whether metal or not is structurally ep y ( ) y unsound, exhibits substantial infiltra or;`exfiltration or tank.fai a is imminent. System will pass inspection if the existing tank is. replaced with a compl ' septic tank as appro by the Board of Health. *A metal septic tank will pass inspection if i ' structurally und, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old vailab . ND ,explain: Observation of sewage backup or br out or high state ter level in the distribution box due to broken or obstructed pipe(s) or due to a broken, or uneven distribution x. System will pass inspection if (with approval of Board of Health): oken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The required pumping more than 4 times a year due to broken or obstructed pi s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 ¢ OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PROPERTY ADDRESS:185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION':' 9/19/01 C• Further Evaluation is Required by the Board of Health: nditions exist which require further evaluation by the Board of Health in order to �Zine if the system is failing to rotect public health, safety or the environment. 1. System pass unless Board of Health determines in accordance with 31 CMR 15.303(1)(b) that the system is no un ctioning in a manner which will protect public /health,fety and the environment: Cesspool or p 'vy is within 50 feet of a surface waterCesspool or pri is within 50 feet of a bordering vegetated we salt marsh 2. System will fail unless rthe, Board of Ntalth (and Pt6lic Water Supplier, if any) determines that the system is functioning in a manner that pro is the blic health, safety and environment: The system has •a septic tank and soil abs tion system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surfa t supply. The system has aseptic tank and S and the SA 's within a Zone I of a public water, supply. _ The system has aseptic tank d SAS and the SAS is in 50 feet of a private water supply well. The system has a.septic and SAS and the SAS is less t private water supply well**. ethod used to determine distance 100 feet but 50 feet or more from a **This system passes ' tele well water analysis, performed at a DEP certiN5m, ory, for coliform bacteria and volatil garlic compounds indicates that the well is free frofrom that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less tprovided that no other failure criteria a triggered. A copy of the analysis must be attached to th 3< Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESS] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOI PART A CERTIFICATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 D. System Failure Criteria applicable to all systems: You must indicate `yes" or "no" to each of the following for all inspections: Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool •' Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than ''/s day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of -times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. _ Any portion of cesspoolor privy is within 100 feet of a surface water supply or tributary to a surface water supply. . f Any portion of a cesspool or privy is within & Zone 1 of a public well. _ -_ Any portion of a cesspool or privy is within 50 feet of a private water'supply well. _ _✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed;_ at a DEP certified laboratory., -for 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.] NO (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. E: --_-Large Systems: To e co red a large system the system must serve a facility with a design o W of 10,000 gpd to 15,000 gYoou must indicate either " or "no" to each of the following: (The following criteria apply t e systems in addition to the above) . yes no _ — the system is within 400 feet of a s g water supply the system is within 200 of a tributary to a drinking water supply — _ the system is ted in a nitrogen sensitive area (Interim ead Protection Area – IWPA) or a mapped Zone II 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. Page 5 of 11 1. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health V'_ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period ? T✓Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) ✓. '_ Was the facility or dwelling in for signs of sewage back up _> Was the site inspected for signs of break out ? ✓ `_. Were all system components, excluding the SAS, located on site? >/_,,,-.-,:Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the.baffles br tees, material of construction; dimensions, depth of liquid, depth of sludge and depth of scum ? .Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. i/ 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)j . f F ;1S.Y Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C PROPERTY ADDRESS: 185 Ingles Street SYSTEM INFORMATION North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 FLOW CONDITIONS RESIDENTTAL Number of bedrooms (design): Number of bedrooms (actual): 17 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: 5 - Does -Does residence have a garbage grinder (yes or no): d -C'. Is laundry on a separate sewage system (yes or no): AVS (if yes separate inspection required] Laundry system inspected (yes or no): - Seasonal use: (yes or no): /VL) Water meter readings, if available (last 2 years usage (gpd)): w e i - A,1,3 A- Sump pump (yes or no): _A p Last date of occupancy. c Fti n F A, -r COMMERCIAL/MUSTRIAL Type of establishment: Design flow (based on 310 CMR .15.203): _gpd - Basis of design flow(seats/persons/sgft,etd.): 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: 5-' - I ei C v PeI- c9 v✓ r, t4- R e < ,et7T Was system pumped as part of the inspection (yes or no): AAD If yes, volume pumped: —gallons - How was quantity pumped determined? 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) _ 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 age of all components, date installed (if known) and source of information: 1G1� ii DL= AS L i Were sewage odors detected when arriving at the site (yes or no): d�O Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 BUELDING SEWER (locate on site plan) Depth below grade: 'Z Materials of construction: cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: Z0' Commen�t7s (on condition of joints, venting, evidence of leakage, etc.): 1' 1 PC- 1- O C iu s G -c ' -> I—) G t,} -S L /Vt t 7 - SEPTIC " SEPTIC TANK: _ (locate on site plan) Depth below grade: I Z Material of construction: ✓ concrete _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) Dimensions: 15`e 4 G -A'# -w n1 Sludge depth: 31. Distance from top of sludge to bottom of outlet tee or baffle: 3 6 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: 1..3 How were dimensions determined: M 1 < Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r14A-;ii, tIJ Oil-Ct`tiD [UUC ^P/� iZ'L S lit (;rL. CcIA- P 2,i t ab - 7<1 lr l li iN e .. � , �=c .ti a CI G 11#4 GREASE TRAP:/�(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS vA: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 TIGHT or HOLDING TANK: -A(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass __polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/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 leakage into or out of box, etc.): P� �x 1 Cre D (-L) eti PUMP CHAMBER:,ti/r4 (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Coutments (note condition of pump chamber, condition of pumps and appurtenances, etc.): • , Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMEN SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why. Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: ✓leaching fields, number, dimensions: r +i p Z- X yS` overflow cesspool, number: innovative/altemative. system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of -ponding, damp soil, condition of vegetation, etc.): F V OtC.4 L -�3+c5 A4 4 CESSPOOLS: ALA must be pumped as part of inspectionxlocate 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): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY:Ntq (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): • e Page 10 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 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. 0 wtw, L1 Z;' Page 11 of 11' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C cvcTEM INFORMATION (continued) PROPERTY ADDRESS: 185 Ingles Street North Andover, MA OWNER Tom Bowman DATE OF INSPECTION: 9/19/01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water % feet Please indicate (check) all methods used to determine the high ground water elevation: t" Obtained from system design plans on record - If checked, date of design plan reviewed: _ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: . 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