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Miscellaneous - 190 MILL ROAD 4/30/2018 (2)
f !r d' f I I� . i ��� ���_ i I �! ^� ,'� I !� 1 i I _��� �;_ � I i �4 � . �I �j✓./ ��c�C�� C���� i North Andover Board of Assessors Public Access Pa-- North a—North handover Board of Assessors 41 #i # �SSAC«�5¢t Moroperty Record Card Click Seal To Retum Parcel ID:210/107.A-0064-0000.0 FY:2010 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales 71 Summary - - Residence Detached Structure Condo I �� 190 MILL ROAD Commercial Location: 190 MILL ROAD MOGLIA,JOHN Owner Name: MOGLIA,THERESA Owner Address: 190 MILL ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 1.01 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2868 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 445,100 481,100 Building Value: 247,700 283,700 Land Value: 197,400 197,400 Market Land Value: 197,400 Chapter Land Value: LATEST SALE Sale Price: 499,200 Sale Date: 07/14/2004 Arms Length Sale Code: Y-YES-VALID Grantor: LOWERY, CATHERINE Cert Doc: Book: 8929 Page: 18 http://csc-ma.us/PROPAPP/display.do?linkld=1519369&town=NandoverPubAcc 11/4/2010 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CE �IFICA�IE O F COWIJ- .I-.J.Ll L As of: ,dune 20, 2011 ghis is to cert that the individual subsurface disposal system received a S,4T1S, AC`IT01RTIYYPECTIONof the. Comp&te flair and Construction of an On-Site Sewage 04osa[System (By. James Kgdett At: 190 WILL R�,A1 210/107.A-0064-0000.0 .la 1 0 ZA parcel-0064 North,4nefiner, WA 01845 die Issua o this cert,Icate sFiall not 6e construed as a guarantee that the system urillficnction satisfactorily. S�tixwlleSa awyer,Ct< filrector i 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com 41 SETTLED Inc • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CF1R2I FIC.4r1E O F COMPIC, T. 4XCE As of: .duly 5, 2011 This is to cert that the individuafsu6surface ATosaf system received a SATIS FACT0RT IXS(EM0X of the: Complete (pair and Construction of an 4n Site Sewage DisposalSaystem By: At: 190 9WIT WPad gWap-10 7 0~1 arcef-0064 XorthAndover.9 31.E 01845 The Issuanceif this certificate shaflnot be construed as a guarantee that the system wifffunction satisfactoay. ,F SuQ T Sa , "q S/ 4'uMc lfeaft Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com AS-BUILT CHECKLIST -/ All changes to the design plan have been reflected on the as-built V Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number,Street Name,Assessors Map and Parcel Number Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system,including �(ifa cable) k---, Ties to dwelling or Permanent Structure&Wells a.From Septic Tank ✓"�` b.From Leach Area t/�^ Ties to Lot Lines from leach area ✓ Locations of Deep Holes&Peres Elevations of Disposal System !� Top of Foundation Elevation ��- Locations of Wells,Drains,Watercourses within 150 feet of system ✓' Location of water,gas,electric lines,cable ✓� Distances from Corners of House to Center of Tank&D-Box ✓/ Location of Structures within 6 Inches of Finished Grade ✓ Original Stamp&Signature Location and holder of any easements which could impact the system Impervious Areas;Driveways,etc North Arrow Location&Elevations of Benchmark used Y STATEMENT ON PLAN(NA 5.3) `I certijy 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." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 NORTp It I p TSS^;HUgEt JIM �:SA78V'l PUBLIC HEALTH DEPARTMENT(ommunity DevelopmentDivision 21 TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System 00 constructed;( )repaired;, e By: feeds f f ff0v0-f,4S 1-4-C (Print Name) Located at: 1'4d MILL I?D Al Ak)xyt_T (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated {® � and last revised on l C -Z6 I b 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. o Bottom of Bed Inspection Date: Co I lgineer Representative(Signature) And-Print Name Final Construction Inspection Date: �5 / E gineer Representative(Signature) And-Print Name Installer: '- (Signature) Date• A -Print Name Enginer• (Signature) Date: And-Print Name O1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandaver.com � I I Commonwealth of Massachusetts City/Town of JUN 20 toll Certificate of Compliance TOWN OPNORTRM§0VM Form 3 HEALTH 09PARTM NT / M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the infnrmntinn mi ict ha ci ihct?ntiollu tha coma 2c thot nrnviriarl hart Befnra 1 Icinn thic fnrm rharrV with II II VII II411V1 I IIIVJl 1/V-.Y 111V-111V- 1I 1 V. IIVI\i. VVIVIV 4J 111\J. 1111) IVI111, VIIr VI\ YY 1111 the local Board of Health to determine the form they use. This is to Certify that the following work on an On-Site Sewage Disposal System Important: When filling out ❑ Construction of a new system forms on the Repair or replacement of an existing system computer,use ❑ Repair or replacement of an existing system component only the tab key_ to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): use the return key. DSCP Number DSCP Date Facility Owner 1:9q 1AA I LL 9.D Street Address or Lot# City/Town State Zip Code Designer Information: James Scanlan, P.E. Scanlan Engineering LLC Na Name of Comp ny ture Date _6staller Information: Name r%! �T Name of Company S' ure Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc•06/03 Certificate of Compliance Y Page 1 of 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, June 20, 2011 3:01 PM To: 'Jim Scanlan'; DelleChiaie, Pamela Subject: RE: 190 MILL RD-SEPTIC INSTALLATION Jim, we generally release the COC to the owner via mail or they can pick it up here at the office.We could scan it as well, but the original will be mailed to the address unless we are given other instructions. If they are out of the area,and want others to pick it up,they must send us a note to allow us to release it. Thank you Susan From: Jim Scanlan [mailto:jim@scanianengineering.com] Sent: Monday, June 20, 20112:55 PM To: DelleChiaie, Pamela; Sawyer, Susan Subject: RE: 190 MILL RD - SEPTIC INSTALLATION Susan: I have revised the asbuilt plans, to show the manhole and the line from the screenroom to the dwelling. A copy is attached to this e-mail. I will drop three (3) sets into mail. As discussed on the phone, the structure by the pool is simply a screenroom with a sink and a bathroom. It is not heated and is really a one-season room. I do not believe it would enter into the"bedroom count". There is a kitchen area (which includes a family room), a living room, a dining room, a den, an office and three bedrooms. Therefore I believe the room count to be eight. The manhole is connected to the pool filter, and is not part of the septic system as suggested by the owner. It contains the shutoffs for the water lines to and from the filter. The sewer line from the screenroom to the dwelling is under the brick patio. It enters the dwelling right by the building sewer pipe outlet to the septic tank. I have placed the approximate location onto the plan. There is currently no sump pump in the basement. There was one in the basement, years ago, per owner, but it has not been a problem since the catchbasin was installed adjacent to the garage. Please contact me with any questions or concerns. Sincerely j Jim Scanlan James Scanlan, P.E. Scanlan Engineering, LLC P.O. Box 906 Georgetown MA 01833 (978)372-3440 e-mail: jim(ascanlanengineerinq com -----Original Message----- From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Monday, June 20, 20119:34 AM To: 'Jim Scanlan' 1 Cc: Sawyer, Susan; Grant, Michele Subject: FW: 190 MILL RD - SEPTIC INSTALLATION Importance: High To Jim Scanlan-Scanlan Engineering re: 190 Mill Road Hi Jim, Here is the As Built Checklist. If there is indeed a rush on this property due to a closing tomorrow as Jim Kellett states,please submit the information ASAP. See Susan's note below. If getting the documents here is an issue,you may send them electronically as long as the As-Built is printable and readable,and send the originals in the mail. Thank you. Sint Re"$W4, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 Q Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaie@townofnorthandover.com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: Sawyer, Susan Sent: Monday, June 20, 20119:14 AM To: 'Jim Scanlan' Cc: DelleChiaie, Pamela Subject: RE: 190 MILL RD - SEPTIC INSTALLATION Hi Jim, Jim Kellett has told us that you had already submitted the final paperwork, but Pam does not seem to have it. He also requested a final grade inspection for today, because the closing is Tuesday. We cannot issue the COC until everything is in. Thank you Susan Pam have we sent Jim the newest check list for the as-builts?Could you forward one so he can self check if you don't think so? Thx From: Jim Scanlan [mailto:jim@scanlanengineering.com] Sent: Thursday, June 16, 20119:53 AM To: Sawyer, Susan Subject: RE: 190 MILL RD - SEPTIC INSTALLATION Susan: Pump and controls are all set and working properly. I have prepared as-built plan and will forward shortly. Thanks Jim -----Original Message----- From: Sawyer, Susan [mailto:ssawyer@townofnorthandover.com] Sent: Wednesday, June 15, 20112:52 PM To: 'jim@scanianengineering.com' Cc: Grant, Michele; DelleChiaie, Pamela Subject: RE: 190 MILL RD - SEPTIC INSTALLATION 2 DefieCh ale, Pamela From: DelleChiaie, Pamela Sent: Thursday, June 16, 20119:17 AM To: Sawyer, Susan; Grant, Michele Subject: FW: Septic- 190 Mill Road -TANK SETTING NOTIFICATION -2 P.M. -Jim Kellett Importance: High Follow Up Flag: Follow up Flag Status: Flagged Ok to schedule a Final Construction Inspection for this one now? Let me know. Thanks. &At Reganda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 W Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaieotownofnorthandover.com Website hM://www.townofnorthandover.com/Pages/index "We can never seethe path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: DelleChiaie, Pamela Sent: Wednesday, June 15, 20119:51 AM To: Grant, Michele Subject: FW: Septic - 190 Mill Road -TANK SETTING NOTIFICATION - 2 P.M. -Jim Kellett Michele, My note was on the construction file I left on your chair yesterday after Jim called. Please call and confirm with him about the tank setting inspection. Thanks. haat Regwrda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 W Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaieotownofnorthandover.com -2 Website http_//www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."—Anonymous From: DelleChiaie, Pamela Sent: Tuesday, June 14, 2011 11:00 AM To: Sawyer, Susan Subject: Septic - 190 Mill Road -TANK SETTING NOTIFICATION - 2 P.M. -Jim Kellett Jim Kellet-781.953.7146-call this one......that was the wrong one I gave you earlier. feat Ref a44, 1 Pamela DelleChiaie Depar.ftentalrAssistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 1 Fax-978-688-8476 El Email-pdellechiaie(@townofnorthandover.com ''�l Website Wp://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. —Anonymous From: DelleChiaie, Pamela Sent:Tuesday, June 14, 2011 10:57 AM To: Sawyer, Susan Subject: Septic - 190 Mill Road -TANK SETTING NOTIFICATION - 2 P.M. -Jim Kellett Importance: High Hi Susan, Jim Kellett just called to let you know they are setting the tank at 2:00 p.m. Please call him at:781.439.9097. Thank you. fiat Rganda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 R Fax-978-688-8476 I1il Email-pdellechiaiePtownofnorthandover.com -1 Website httl2://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: Sawyer, Susan Sent: Friday, June 10, 20119:46 AM To: DelleChiaie, Pamela Subject: RE: Septic- 190 Mill Road - Bed Bottom Inspection Request-Jim Kellett Done, called him. From: DelleChiaie, Pamela Sent: Friday, June 10, 20119:32 AM To: Sawyer, Susan Subject: Septic- 190 Mill Road - Bed Bottom Inspection Request-Jim Kellett Hi Susan, Jinn Kellett just called. He states 190 Mill Road will be ready for a BB by noon. He said the soil there is great. Please call him to confirm:781.953.7146. Thank you. Feat;egaada, 2 Pamela DelleChiaie Depar�inental'Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 i Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 Fax-978-688-8476 [] Email-pdellechiaiePtownofnorthandover.com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet"--Anonymous From: DelleChiaie, Pamela Sent:Tuesday,January 18, 2011 1:22 PM To: Sawyer, Susan; Grant, Michele Subject: FW: 190 Mill Road - Scanned Health Department File Importance: High Fyi.......in case the homeowner calls after getting this and has more questions................... VW RegetA Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street i Bldg 20 I Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 R Fax-978-688-8476 E Email-pdellechiaie@townofnorthandover.com -?5 Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet —Anonymous From: DelleChiaie, Pamela Sent: Tuesday, January 18, 2011 12:36 PM To: 'tllavoie@aol.com' Subject: 190 Mill Road - Scanned Health Department File Dear Theresa, Attached is a scanned copy of your file for 190 Mill Road as you requested. I apologize for the delay,but I was having problems with the scanner feature,and can only attribute it to our server which has been slow the last few days. Please call if you have any additional questions. Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 Fax-978-688-8476 El Email-pdellechiaie@townofnorthandover.com -1 Website http://www.townofnorthandover.com/Pages/index We can never see the path of our life if we are too busy focusing on the pebbles under our feet"--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. 3 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 15, 20112:52 PM To: 'jim@scanianengineering.com' Cc: Grant, Michele; DelleChiaie, Pamela Subject: RE: 190 MILL RD-SEPTIC INSTALLATION Jim, When we get the verbal from you that we are all set, Pam will let our consultant know to call Jim. Can you confirm whether you looked at the pump today? Thank you Susan From: DelleChiaie, Pamela Sent: Wednesday,June 15, 2011 10:08 AM To: Sawyer, Susan; Grant, Michele Subject: FW: 190 MILL RD - SEPTIC INSTALLATION FYI From: Jim Scanlan jmailto:jim(.ascanlanengineering.com1 Sent: Wednesday, June 15, 20119:57 AM 'To: DelleChiaie, Pamela Subject: RE: 190 MILL RD - SEPTIC INSTALLATION Pam: When I was out last night, the pump chamber and septic tanks were already in. The only thing I was not able to see was the alarm panel/alarm, which I will do today and a pump test. I was able to locate the tanks, and got the relevant elevations. Jim -----Original Message----- From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com1 Sent: Wednesday, June 15, 20119:43 AM To: 'Jim Scanlan' Subject: RE: 190 MILL RD - SEPTIC INSTALLATION Susan has a question,the tanks have not been set yet,and have not been notified that the tank has been officially set yet,and this includes the pumps,so not sure it is okay for your final as built? Please let Susan know. Thank you. fiat�iga�rds, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 Fax-978-688-8476 H1 Email-pdellechiaieotownofnorthandover.com '6 Website http://www.townofnorthandover.com/Pag_es/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: Jim Scanlan jmailto:jim@scanlanengineering.coml Sent: Wednesday, June 15, 20118:03 AM 1 To: DelleChiaie, Pamela Subject: 190 MILL RD - SEPTIC INSTALLATION Pamela I have been out to the site to do my as-built inspection, and everything looks good. Please let me know what I need to do to schedule as-built by Isaac. Thanks Jim Scanlan James Scanlan, P.E. Scanlan Engineering, LLC P.O. Box 906 Georgetown MA 01833 (978)372-3440 e-mail:jim scanlanengineering.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.see.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Thursday, June 16, 2011 12:04 PM To: 'Susan Sawyer(ssawyer@townofnorthandover.com)' Cc: DelleChiaie, Pamela; 'Dan Ottenheimer'; 'Randy Burley'; 'Marianne Peters' Subject: 190 Mill Road Attachments: 190 Mill Raod -Construction Inspection 6-15-11.doc Susan, Attached is the construction inspection for the above referenced property. Everything looked good. Please let me know if you have any questions. Thanks, Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street I I I 1 r 61oucester,MA 01930-2719 Phone: (978)282-0014 Fax:(978)282-1318 irowea-millriverconsulting.com www.millriverconsultinq com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:ham://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 VE ID) - �--: - • North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 190 Mill Road MAP: 107A LOT: 64 INSTALLER: Jim Kellett DESIGNER: Jim Scanlan PLAN DATE: 10/7/10 BOH APPROVAL DATE ON PLAN: 11/8/10 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 6/15/11 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 TANK ® Building sewer in continuous grade, on compacted firm base NA Cleanouts per plan ® Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by Visual testing ® Inlet tee installed, centered under access port Z Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to final grade installed over outlet access port ® 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 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 ® 24" cover at final grade installed over pump access port ® Watertightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® 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 NA Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ 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 NA 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 Low Profile Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows (trenches): 6 Comments: Total Chambers = 48 BM = 100.00 (SAS) BM = 100.00 (Tanks) HR = 7.61 HR = 2.38 HI = 107.61 HI = 102.38 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark 100.00 Bldg Sewer OUT @ Cl 4.97 97.06 97.0 Septic Tank IN 5.05 96.98 96.70 Septic Tank OUT 5.38 96.65 96.45 Pump Chamber IN 5.41 96.62 96.40 (2")Pump Chamber OUT 5.15 97.06 96.65 Distribution Box IN 2.90 104.36 104.30 Distribution Box OUT 3.08 104.18 104.13 Lateral 1 TOP 3.21 Lateral 1 INVERT 104.05 104.08 Lateral 2 TOP 3.16 Lateral 2 INVERT 104.10 104.08 Lateral 3 TOP 3.16 Lateral 3 INVERT 104.10 104.08 Lateral 4 TOP 3.16 Lateral 4 INVERT 104.10 104.08 Lateral 5 TOP 3.16 Lateral 5 INVERT 104.10 104.08 Lateral 6 TOP 3.16 Lateral 6 INVERT 104.10 104.08 Top of Chamber 3.11 104.5 104.5 Bottom of Bed/Chamber 103.8 103.8 I R' V 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 5 10 -- ® Waterline 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 allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws FINAL GRADE INSPECTION Date: t;p c r Address: (7,C) All-,LOAMED? SEEDED? COVER PER PLAN? Other: )) R 0"rh Commonwealth of Massachusetts Map-Block-Lot o lie a a 107.A0064 - ' BOARD OF HEALTH Permit No North Andover BHP-2011-0717 ry B --- 7 P.I. FEE �s�4cwusEi F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James_Kellett to(Repair)an Individual Sewage Disposal System. at No --190-MILL-ROAD as shown on the application for Disposal Works Construction Permit No:...BHP-2011-071 Dated June 09,_2011 ----------------------- ;,, -_fir -,q } zgn -- r). -\/. Issued On:Jun-09-2011OF HEALTH ,; O�pORTh Application for Septic Disposal System June 2,2011 3r�','+' `�•���� =Construction Permit — TOWN OF' TODAY'S DATE t . '`'°• - --• ' ORTH ANDOVER. MA 01845zso.00 im�ponent Important: Application is hereby made for a permit to: When filling out forms on the El Construct a new on-site sewage disposal system* computer,use ❑■ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return A. Facility Information r7p key. �. -I�1n... .�_190 Mill Road IVEO _ Address or Lot# North Andover,MA uY t — f-- City/Town TOWN OF NORTH ANDOVER 2.-*TYPE OF SEPTIC SYSTEM*: HEALTH DEPARTMENT ❑■ Pump ❑ Gravity(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 install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information John Moglia Name 190 Mill Road Address(if different from above) North Andover MA City/Town State Zip Code 617-620-9004 Telephone Number 3. Installer Information James Kellett Kellett Excavating, LLC Name Name of Company 400 Salem Street Address Lynnfield MA 01940 City/Town State Zip Code 781-599-7934 Telephone Number(Cell Phone#if possible please) 4. Designer Information James Scanlan Scanlan Engineering Name Name of Company PO Box 906 Address Georgetown MA 01833 City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 Application for Septic Disposal System June 2, 2011 �s��`+' 't'•• o� Xonstruction Permit — TOWN OF TODAY'S DATE `'°• •-=--• •�# ORTH ANDOVER MA 01845 $250.00—Full Repair '+s''"• �' P $125.00-Component s,►c,wsa PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑■Residential 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 issued by this Board of Health. James Kellett June 2, 2011 Name Date Appli t' n Approve y: (Board of Health Representative) . ,4e Date cation sapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Pro'ect anager Obligation Form Attached. Yes No 3. Pump System If so,Attach copy of Electrical Permit Yesf/ No 4. oundation As-Built?(new construction ronly) !✓ "� No (Same scale as approved plan) /" 5. Floor Plans?(new construction only): es No Application for Disposal System Construction Permit•Page 2 of 2 "W "SEPTIC SYS'rEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 120 Mill Road (Address of septic system) For plans by Tames Scanlan (Engineer) Relative to the application of James Kellett (Installer's name) And dated October 7;2010 ngina ate Dated June 2,2011 o ay s ate With revisions dated Ortoher 26,2010 (Last revised date) 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 manager, 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 Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company a. Bottom of Bed—Generally,this is the first (Vinspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdeptntownofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a 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. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done 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. Undersigned Licensed Septic Installer: June 2, 2011 (Today's Date) James R. Kellett (Name—Print) e 1 e -t i 1 0125 Date... ' ..-1 .... NOR1F� � " TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING SS�CHUS This certifies that ...... /�� �.r�........ e.c �E .. ✓............................. has permission to perform ..1 :.' �..... ..Ti.�....... <-z. ` ............. wiring in the building of.........,�f�.�i......... �,?/ ............................... at../�G /� �� .. .-..................../....... ,North Andov r,Mass. ' .. .......... . �z ......... Lic.No!". y .... .�......... ............ Check 7,2 ELECRICALINSP INSPECTOR .. I No. FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, Q —/ V1)bt,L72 ,MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( Repair( Upgrade) Abandon( - 0- omplete System ❑Individual Components Location ® /n/� Owner's Name 1101w? lVioghei, Map/Parcel# - 107A - Address no 1/ Lot# Telephone# Installer's Name Designer's Name C �� Address Address Telephone# Telephone# z1110 / Type of Building Lot Size y3 � sq.ft. Dwelling-No.of Bedrooms 0/1 ry Garbage grinder Y VO Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min. -eq ired) � gpd Calculated design flow g110 Design flow provided VD gpd Plan: Date D Number of sheets 2 Revision Date Title ' 3VS125M UP-69AJ�E Ino 4Q Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator 1 /GAJ of Evaluation l DESCRIPTION OF REPAIRS OR ALTERATIONS er PL 6-/j The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections ,•. _ .-.:tic.. c:en.ac.a::res.ss.i sse ceci oo oaoc.�.e.ii elle.Oii00 e.111ii'•v+se ssa0000•ssooasoaoo•s.o•asooee.sos.0000•oa ease soe.so.►c No. COMMONWEALTH OF MASSACHUSETTS FEE Board of Health, CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ...•............-s ...o....o.....e..a<.•.u..,.....,......_�..os.-.J...-.._...-�....a.-.-.—.....,.�v...-.........._.....,: �...,�.��.....�..,..�....�.......+. No. FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Chadestmvn,MA Date Board of Health 08/24/2010 14:07 FAX IR1 003 TOWN OF NORTH ANDOVER Permit Number • . r NORTH ANDOVER,MASSACHUSETTS 01815 a ponrh Date Issued 6M Ana.,.�'�' �•----------- - IL Expiration Date .., Veit 113 Jackie's Law — Permit A lie on � , Pursuant to G.L. c.82A§1 and 520 CMR 7.00 et seq.(as amended) THIS FULLY COMPLIED PRIOR TO CONSIDERATION Name of ApplicantG4 j tvCCr � Phone \ Cell +� Street Address Yom- S C?�� v 7e) C hewn MA ZiP Name of Excavator(if different from appli ant) Phone can_, Street Address i City/Town MA ZIP i ..[ t i Name al Omer(s)ofriropeyty L-AJ0(F- Phone Cell set Address /' I-7 O l LL 0 l� f City owu MA ZIP Ab/ A" Other Contact permit Fee Recdved No Yes Oescrlption,location and purpose of proposed trench., Please describe the exact location of the proposed trench and Its purpose(include a description of what is(or is intended)to I� 1 be laid in proposed trench(eg;pipeslcable lines etc..)Please use reverse side if additional space Is needed. -AeCc —1 FS-q�6- Insurance Certiffeate*• 08/24/2010 14:07 FAX 0004 Name and Contact Information of Ewwrer: t PoHSZ Ex radon Date: Dig Safe#: moo! 3 t Name of Competent Person(as defined by 520 CMR 7,02), s L CGE Massachusetts Hoisting License# Litease Grade: C 0 A— iral#lop pate• BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR AL �DCE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G-L.e.82A,520 CMR 1.00 et seq.,AND ANY APPLICABLE :MUNICIPAL ORDINANCES,BY-LAWS AND REOVLATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PRRMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR T)fIE PERMIT AND TIN EXCAVATOR TO UNDERTAKE SUC*I WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED IfIRgETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMI'MD TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TA"N BY THE MUNICIPALITY TO PROTECT THE PU tLIC 5 WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. i ' THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS TII>&MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY',CAUSES OR ACTION,COSTS,AND EXPENSES y RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LASS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER IHSS PERMIT. l S� APPLICANT SIGNA DATE ,: CAVATOR SIGNATUPLEIF DIMRENT) DATE 7 y OWNER'S SIGNATURE'(IF DIFFERENT) "llG DATE: 0 27 0 21Pagc r ' 08/24/2010 14:07 FAX 0 004 r. Name and Contact Information of Insurer: S Polfsz Ex ration Date• Did sur$ Name of Competent Person(as defined by 520 CMR 7,02): `` cc C._ J Massachusetts Hoisting License# License Grade• zc8 iA- Es iration Date• BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLE DGE AND CERTIFY THAT THEY ARE FAMILIAR WITH 011, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSTIA REGULATIONS,G.I.c- 92A,320 CMR 1.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND M GVLATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PRRMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECT$AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY ICOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY. THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONI'T'OR AND INSPECT THE WOAk FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COS"AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED TH EREUNDTLR,INCLUDING BUT NOT LIMI'T'ED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL,MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER,THIS PERMIT. APPLICANT SIGMA MATE /o+� EXCAVATOR SIGNATU (IF DIFFERENT) DATE `1 � OWNER'S SIGNATURE_(IF DIFFERENT) DATE: 27 ! I ` f 4 I North Andover Health Department (ommunity Development Division November 8,2010 John Moglia and Theresa Lavoie 190 Mill Road North Andover, MA 01845 RE: SUBSURFACE SEWAGE DISPOSAL SYSTEM PLAN FOR.190 MILL ROAD,MAP 107A LOT 64, NORTH ANDOVER,MASSACHUSETTS Dear Mr. Moglia and Ms. Lavoie, The North Andover Board of Health has completed the review of P the septic system design p y plans for the above referenced property, submitted on your behalf by Scanlan Engineering, LLC dated October 7,2010, last revised October 26, 2010. i The design has been approved for use in the construction of a replacement onsite septic system for a maximum four(4)Bedroom or nine(9)room home. This approval includes the Health Department approval of a local upgrade for allowing the reduction for the offset of to the Estimated Seasonal Water Table from four feet to three feet and a reduction of less than twelve inches between the water table and the tank inverts. Please keep a copy of the attached document for your records. This plan is good for 3-years from the date of 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)). North Andover Health Department 1600 Osgood Street Building 20 Suite 2-3 6North Andover MA 01845 Phone:978.688.9540 Fax:978.688.8476 Page 1 of 2 4 ✓ 190 Mill Road Septic Plan Approval November 8, 2010 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. Your effort to provide a properly functioning septics stem for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincer usan Y1Sawye HS/RS Public Health Director cc: Scanlan Engineering, LLC file North Andover Health Department, 1600 Osgood Street Building 20 Suite 2-36,North Andover MA 01845 Phone. 978.688.9540 Fax:978.688.8476 Page 2 of 2 Commonwealth of Massachusetts a City/Town of North Andover Local Upgrade Approval Form 913 wM DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab John Moglia key to move your Name cursor-do not 190 MITI Road use the return key. Street Address North Andover MA 01845 City/Town State Zip Code V 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: James Scanlan PE ® RS Name PO Box 906 Georgetown MA 01833 Address City/Town State,ZIP I B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction Local Upgrade Approval, Page 1 of 2 sr: Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 9B �M B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 16 min./inch Depth to groundwater 3 ft. ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department Approving Authority / Michele Grant, Health Inspect. % �L November 9, 2010 Print or Type Name and Title ignature Date Local Upgrade Approval* Page 2 of 2 1 � S�TTL'ED-j� x. IFILEICOPY 3� T North Andover Health Department Community Development Division October 25,2010 James Scanlan,P.E. Scanlan Engineering,LLC P.O.Box 906 Georgetown,MA 01833 Re: Subsurface Sewage Disposal System Plan for 190 Mill Road(Mal)107A Lot 64) Dear Mr. Scanlan: The proposed wastewater system design plan for the above site dated October 7,2010 and received on October 15, 2010 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. sheet 1 of 2,please indicate the names of the abutters from the most recent tax map(NA 3.2). �2 On sheet 1 of 2,the FLOW PROFILE and SECTION A-A indicates"bottom of stone elevation". Infiltrator Chambers are not approved to be designed with crushed stone. Please clarify this discrepancy. 0-/On sheet 1 of 2,the SECTION A-A indicates a bottom of stone elevation of 100.3'but it appears this e vation should be 103.80'based on the ESHGW of 100.8'. Please clarify this discrepancy. 4. On sheet 1 » of 2 lease indicate the depth p p of the percolation test and indicate the time from 12 to 9 . 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, 1 f� J' Susan Y. Sawy5r,,REHS/RS Public Health Director cc: John Moglia&Theresa Lavoie File Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 TOWN OF NORTH ANDOVER r°RTh Office of COMMUNITY DEVELOPMENT AND SERVICES Z HEALTH DEPARTMENT ' 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER,MASSACHUSETTS 01845SACltllg 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM F" DEPARTMENT CEIVED Date of Submission: 1 � t Z) r—�D ®e' r /y,, V d ZU10 Site Location: l �j A ' l I TOWN OF INORTH ANDOVFR, Engineer: ��_,ti t,�� New Plans? Yes�$225/Plan Check# 1 (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes V ; No Local Upgrade Form Included? Yes 1/ No Telephon #4 /�1 ® � —� Fax#: E-mail: Homeowner Name: b ( L .o OFFICE USE ONLY When the submission is complete (including check): ➢ �� Date stamp plans and letter ➢ ,✓ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database r i } SUBSURFACE SEWAGE DISPOSAL SYSTEM PUMP DESIGN 190 MILL ROAD NORTH ANDOVER MA MAP 107A LOT 64 OWNER: MOGLIA PROPERTY 190 MILL ROAD NORTH ANDOVER MA OF A4.4s'y �a .JAMES B GJ, SCAN LAN !VEL S DATE: 1 11/2010 I Scanlan Engineering LLC #0330 P.O.BOX 906 GEORGETOWN, MA 01833 978-372-3440 190 MILL ROAD MOGLIA PROPERTY NORTH ANDOVER MA 190 MILL ROAD MAP 107A LOT 64 NORTH ANDOVER MA 10/11/2010 PUMP CALCULATIONS: DAILY FLOW: 440 GALLONS/DAY SOIL PERC RATE: 16 MIN/IN SOIL TYPE: CLASS II 4 DOSES/DAY VOLUME/DOSE: DOSE 110 GALLONS PIPE 21.0 GALLONS TOTAL 131.0 GALLONS/DAY FORCE MAIN: 2 DIA. C-VALUE: 140 PUMP CHAMBER: (INSIDE DIMENTIONS) 1000 GALLON MONO TANK LENGTH 8.83 FT WIDTH 4.17 FT EFF. DEPTH 4.00 FT PUMP CHAMBER INLET 96.40 SUMP 92.40 OFF 93.40 ON 93.90 ALARM 94.40 STATIC HEAD: 93.40 PUMP OFF 104.30 DBOX Hs 10.9 FEET EQUIVALENT LENGTH: (2"SCH-40 PVC PIPE) PUMP CHAMBER 1 90 DEGREE BENDS 5 FT 1 GATE VALVE 1.2 FT 1 CHECK VALVE 14 FT TOTAL 20.2 FT USE: 21 FT PIPE RUN 3 90 DEDGREE BENDS 15 FT 0 45 DEGREE BENDS 0 FT 1 TEE 12 FT LENGTH OF PIPE 129 FT ADDITIONAL LENGTH 13 FT TOTAL 169 FT USE 169 FT TOTAL EQUIVALENT LENGTH 190 FT 190 MILL ROAD MOGLIA PROPERTY NORTH ANDOVER MA 190 MILL ROAD MAP 107A LOT 64 NORTH ANDOVER MA 10/11/2010 SYSTEM CURVE: Q V Hf/100 FT Hf Hs TDH GPM FT/SEC FT/100FT FT FT FT 20 1.80 0.73 1.38 10.9 12.28 25 2.25 1.10 2.08 10.9 12.98 30 2.71 1.54 2.92 10.9 13.82 35 3.16 2.05 3.89 10.9 14.79 40 3.61 2.62 4.98 10.9 15.88 45 4.06 3.26 6.19 10.9 17.09 50 4.51 3.96 7.53 10.9 18.43 PUMP SPECIFICATIONS: MANUFACTURER LIBERTY PUMPS MODEL# LE41A HP 0.4 VOLT - 115 PHASE 1 FULL LOAD AMPS 12 DISCHARGE 2 INCH IMPELLER DIAMETER STD INCH OPERATING POINT: HEAD 17.1 FT FLOW RATE 45 GPM TIME ON 2.9 MINUTES i 190 MILL ROAD MOGLIA PROPERTY NORTH ANDOVER MA 190 MILL ROAD MAP 107A LOT 64 NORTH ANDOVER MA 10/11/2010 BUOYANCY CALCULATIONS: STRUCTURE: 1500 GALLON MONOLITHIC 2-COMPARTMENT SEPIC TANK DIMENSIONS: (OUTSIDE) LENGTH 11.00 FT WIDTH 5.83 FT HEIGHT 5.83 FT INVERT-BOTTOM 4.58 FT WEIGHT: 13320 LBS MANHOLE DIAMETER 2 FT #MANHOLES 3 FOOTPRINT 64.1 SF ELEVATIONS: FINISH GRADE 98.8 MANHOLE GRADE 98.8 ESHGW 95.6 INLET INVERT 96.7 TOP 98.0 BOTTOM 92.1 SOILS INFORMATION: UNIT WEIGHT OF SOIL 110 LB/CUBIC FT WEIGHT OF SOIL* 5115 LBS FORCES: BALLAST WEIGHT 0 LBS WEIGHT OF SOILS 5115 LBS WEIGHT OF TANK 13320 LBS WEIGHT OF DISPLACED WATER 13926 LBS NET FORCES**: 4509 LBS (NEGATIVE INDICATES FLOATATION) FACTOR OF SAFETY: 1.32 *Neglect weight of soil over ballast. **Station assumed totally dry inside. Neglect weight of equipment inside and outside soil friction force. y 190 MILL ROAD MOGLIA PROPERTY NORTH ANDOVER MA 190 MILL ROAD MAP 107A LOT 64 NORTH ANDOVER MA 10/11/2010 BUOYANCY CALCULATIONS: STRUCTURE: 1000 GALLON MONOLITHIC PUMP CHAMBER DIMENSIONS: (OUTSIDE) LENGTH 9.67 FT WIDTH 5.00 FT HEIGHT 5.83 FT INVERT-BOTTOM 4.41 FT WEIGHT: 14825 LBS MANHOLE DIAMETER 1 FT #MANHOLES 1 FOOTPRINT 48.4 SF ELEVATIONS: FINISH GRADE 98.8 MANHOLE GRADE 98.8 ESHGW 95.6 INLET INVERT 96.4 TOP 97.8 BOTTOM 92.0 SOILS INFORMATION: UNIT WEIGHT OF SOIL 110 LB/CUBIC FT WEIGHT OF SOIL* 5128 LBS FORCES: BALLAST WEIGHT 0 LBS WEIGHT OF SOILS 5128 LBS WEIGHT OF TANK 14825 LBS WEIGHT OF DISPLACED WATER 10892 LBS NET FORCES**: 9061 LBS (NEGATIVE INDICATES FLOATATION) FACTOR OF SAFETY: 1.83 i 'Neglect weight of soil over ballast. "Station assumed totally dry inside.Neglect weight of equipment inside and outside soil friction force. ahertyp us® 1, Pump Specifications , 0 Series Sewage4/10 HP Submersible Pump LITERS PER SECOND 0 1 2 3 4 5 6 7 8 6.0 20 5.5 5.0 4.5 15 4.0 to 3.5 F W w Z. LL Z Z p 3.0 Q ¢ w = 10 = J J Q 2.5 p O F 2.0 1.5 5 I 1.0 I � { I 0.5 0 0.0 j 0 20 40 60 80 100 120 140 GALLONS PER MINUTE LEJO_Pl RIA22009 Copyright 2009 Liberty Pinups Inc. All rights reserved. Specifications subject to chauge without uotice. Iii��y LE40-Series Electrical Data FULL LOCKED THERMAL STATOR CORD MODEL HP VOLTAGE PHASE SF LOAD OVERLOAD WINDING LENGTH DISCHARGE AUTOMATIC AMPS AMPSR TEMP CLASS FT LE41A 4/10 115 1 1.00 12 22 105`C 221°F B 10 2" YES LE41A-2 4/10 115 1 1.00 12 22 105°C 221°F B 25 2" YES LE41M 4/10 115 1 1.00 12 22 105-C 221°F B 10 2" NO LE41M-2 4/10 115 1 1.00 12 22 105°C 221`F B 25 2" NO LE40-Series Technical Data MULTI-VANE IMPELLER ENGINEERED POLYMER SOLIDS HANDLING SIZE 2" PAINT POWDER COAT MAX LIQUID TEMP 60'C 14WC MAX STATOR TEMP 130'C 2661F THERMAL OVERLOAD 105 C 221'F POWER CORD TYPE SJTW MOTOR HOUSING CLASS 25 CAST IRON VOLUTE CLASS 25 CAST IRON SHAFT STAINLESS I HARDWARE STAINLESS ORINGS BUNA N MECHANICAL SEAL UNITIZED CERAMIC CARBON WEIGHT 40 LBS LE40_P3 R3;12'2009 S,Copytiaht 2009 Liberty Pumps Inc. All tights reserved. Specifications subject to chanee without notice. lu11`* 1 LE40-Series Dimensional Data i 10.5" [264mm] 192mm I ° 2"NPT DISCHARGE i I 1 15V CORD ASSY 1 15V PIGGY BACK t � 13.811 [350] 11� 6" [150] PROPRIETARY AND CONFIDEMIAE LE40 SERIES DIMENSIONAL WC'14ATC'COnPA-NEOh.THS I;af:N1\;i'S�H:$Oil C� ".SE?�CGY'F.`:f 1JA.Ys Iles=>.Pt:Y Y,tY'.:)U::L:�iU`,!:✓AY.i C'F.AJ A VIhU':f rtl CUT THE VPo'F4 PEFVJW SUN OF TA NOVEMBER 142006 A 9'SF3i C:TYlA.":Y tJ:•:•._IY"i=>S I 1C-0 ^,not 51 1 1F^cr,avcJ^, LE40_P1 R x12!2009 :CCopy'Tight 2009 Liberty Ptunps Inc. All rights iesaced. Specifications subject to change without notice. uhnfry Pug* �,. -eommonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 9B DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab _John Moglia key to move your Name cursor-do not 190 MITI Road use the return key. Street Address North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: James Scanlan Name PE ® RS PO Box 906 Georgetown MA 01833 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction Local Upgrade Approval, Page 1 of 2 I t .-4ommonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 9B �M B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 16 min./inch Depth to groundwater 3 ft. ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department Approving Authority Michele Grant, Health Inspect. November 9, 2010 Print or Type Name and Title signature —bate— Local ateLocal Upgrade Approval* Page 2 of 2 r� Commonwealth of Massachusetts ���LLL (, yffown of North Andover ty .a y< �d w Form 9A - Application for Local Upgr de App r al TOWN 0I;N0KTH5N60VM HBEA Its bi DEPAIRTMEN �M DEP has provided this form for use by local Boards of Health. Other form information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use John Moglia only the tab key Name to move your 190 Mill Road' cursor-do not use the return Street Address key. North Andover MA 01845 CitylTown State Zip Code lab 2. Owner Name and Address (if different from above): John Moglia 190 Mill Rd Name Street Address North Andover MA City/Town State 01845 (978)683-8568 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Dwelling 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption stem (trenches, chambers leach field its etc YP P Y , pits, :) unknown t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts eity/Town of North Andover J = Form 9A - Application for Local Upgrade Approval 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 your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: New system including septic tank, pump chamber, dbox and leach field. 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: I ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. i Percolation rate 16 min./inch Depth to groundwater 3 t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval c�M 5 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 your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. : High groundwater evaluation determined b 9 Y Isaac Rowe 9/21/10 Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: The existing building sewer pipe exits dwelling at elevation which puts the septic tank inverts at the ESHGW elevation, with a minimum slope between the dwelling and proposed septic tank. The reduction to ESHGW at the leach field is to minimize the mound required by the ESHGW. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative is not desired by client, and would not have an impact on the septic tank invert elevations. The owner would choose other options over installing an alternative technology. t5form9a•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 , ommonwealth of Massachusetts City/Town of North Andover a Form 9A — Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: There is no interest in a shared system. 4. Connection to a public sewer is not feasible: There is no public sewer in the area. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." 9�t�, — ,( O (Lt (O aci Ify Owner's Signature Date Print Name Jim Scanlan October 12, 2010 Name of Preparer Date PO Box 906 Georgetown Preparer's address City/Town MA 01833 978-372-3440 State/ZIP Code Telephone t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 TOWN OF NORTH ANDOVER HORiM Office of COMMUNITY DEVELOPMENT AND SERVICES F:•a, �p HEALTH DEPARTMENT 1600 OSGOOD STREET;BUILDING 20• SUITE 2-36 '• `'` NORTH ANDOVER,MASSACHUSETTS 01845 _ Susan Y.Sawyer,REHS,RS 978.688.9540-Phone Public Health Director healthde 847 ,townofnorthand er.cZP { ?010 www.townofnorthandover.c N��_fife APPLICATION FOR SOIL TESTS �PARTM DATE: August 24, 2010 MAP&PARCEL: Map 107.A Block 64 Lot 0 LOCATION OF SOIL TESTS: See Plan OWNER: John- Moglia Contact#: (978) 683-8568 +l Vl Same APPLICANT: Contact#: ADDRESS: 190 Mill Road North Andover MA ENGINEER: Scanlan Engineering LLC Contact#: (978) 372-3440 CERTIFIED SOIL EVALUATOR: James Scanlan, P.E. SE-2159 Intende Use of Land: Residential Subdivision Single Family Home Commercial X Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X 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 pit sites on the plan) V ➢ 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 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: //0 2Z Signature of Conservation Agent: / Date back to Health Department tamps�- �Cr�2 412 r w w 190 mill rd •� " 4 North Andover 41 'rt 4k„ a r (J NaYTeq MA Other Streets Names 56 NavTeq MA Other Streets ♦., � ' ,.'S �` a. .rte", F ' � t [yj Areas Affected by Tale 5 ^ �c �Massachusetts Town Boundaries ,j' EJ �. 3 R y . 4 4 t it (J U5G5 Calor Ortho Imagery 2006 30cm r. w . v R ^ r ..� ,g•�l y y a` r, J * R. �20 m (1:854) se?.me:A T,76PS(www.mass.gou/aagisj,A18ps V1ARMNG,TN-raap ekes not meet rtatiorrar arro'plmfos are firpkraMr�g purposes a My. map accuacy staridam's,ardearrrmt be used t�rrera�7neernagpwposes,Please carts�att corrdrtroos of use at http Jlww w.state.ma.uslmgrst Y C \ �c - po vvt Fv'/ J f7, d 1 \v� v DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Thursday, June 09, 20112:35 PM To: DelleChiaie, Pamela; Sawyer, Susan; Grant, Michele Subject: Soil testing @ 196 Summer St scheduled for June 16th @ 9:30 a.m. Testing with Bill Dufresne for 196 Summer is 6/16 @ 9:30 a.m. ill River ConSUIting . Civil En inPedinE i Ifnvira3nrn:Paitnl PmariiHing muai::ipel Environmental Oleldlh C:ankuiting Marianne Peters Office Manager 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 Fax: 978-282-1318 www.millriverconsulting.com mpetersp,millriverconsulting.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. I I I 1 Commonwealth of Massachusetts City/Town of F Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information John Moglia Owner Name 190 Mill Road Map/Block/Lot 107A/64 Street Address North Andover MA 01945 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ® Repair ❑ 2. 'Published Soil Survey available? Yes ❑ No ❑ If yes: 8/2008 1:800 311C Year Published Publication Scale Soil Map Unit Woodbridge Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes® No ❑ Within the 100 year flood boundary? Yes❑ No -1Nithin the-500 year flood boundary? Yes❑ No ® Within a Velocity Zone? Yes❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑ Month/Year 7. Other references reviewed: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 1 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TT=1 9/21/10 Warm Clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 104.0 Location (Identify on Plan ) 2. Land Use: Yard None 33=8 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grass Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 100+ Drainage Way 20+ Possible Wet Area 50+ feet feet feet Property Line 10+ Drinking Water Well n/a Other Feet feet 4. Parent Material: Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil[] Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit none Depth Standing Water in Hole none Estimated Depth to High Groundwater: 38 100.8 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M Deep Observation Hole Numbeff-1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-12 A 10yr3/3 Fine sandy Massive' Friable loam 12-22 B 10yr4/6 Fine Sandy Massive Friable Loam 22-60 C1 2.5y5/4 38 >5% Loamy Massive Friable Sand 60-120 C2 10yr4/6 Loamy Massive Friable sand Additional Notes No obs GW No Refusal DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 4 r` C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TT=2 9/21/10 Clear Warm Date Time Weather 1. Location Ground Elevation at Surface of Hole 102.3 Location (Identify on Plan ) 2. Land Use: Yard None 33=8 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grass Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 100+ Drainage Way 20+ Possible Wet Area 50+ feet feet feet Property Line 10+ Drinking Water Well n/a Other Feet feet 4. Parent Material: Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit none Depth Standing Water in Hole none Estimated Depth to High Groundwater: 38 99.1 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 4 of 7 Commonwealth of Massachusetts City/Town of a ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M Deep Observation Hole Numbeff-2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-8 A 10yr3/3 Fine Sandy Massive Friable Loam 8-16 B 10yr4/6 Fine Sandy Massive Friable Loam 16-58 C1 2.5y5/6 Loamy Massive Friable Sand 58-120 C2 10yr4/6 Loamy Massive Friable Sand Additional Notes No Refusal DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 5 of 7 Commonwealth of Massachusetts City/Town of a ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ® Depth observed standing water in observation hole A. none B. none inches inches ® Depth weeping from side of observation hole A. none B. none inches inches ® Depth to soil redoximorphic features (mottles) A. 38 B. 38 inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. 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 ❑ No❑ b. If yes, at what depth was it observed? Upper boundary: 22 Lower boundary: 120 inches inches F. Certification I certify that I have passed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis was perforTo by me consistent with the required training, expertise and experience described in 310 CMR 15.017. c..i— October 12, 2010 Si' i ture of Soil Evaluator Date �J es Scanlan Aril 1995 C yped or Printed Name of Soil Evaluator "Date of Soil Evaluator Exam ' Isaac Rowe N.Anoder Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 6 of 7 Commonwealth of Massachusetts City/Town of m ' Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M ? 1 Use this sheet for field diagrams: d PJ\, �� , y Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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. Important: When filling out A. Site Information forms on the computer,use John Moglia only the tab key Owner Name to move your 190 Mill Rd cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code rjb Contact Person(if different from Owner) Telephone Number B. Test Results 9/21/10 Date Time Date Time Observation Hole# P-1 Depth of Perc 36"-18" Start Pre-Soak 10:40 End Pre-Soak 10:56 Time at 12" 10:56 Time at 9" 11:32 Time at 6" 12:20 Time(9"-6") 48 mins Rate (Min./Inch) 16 min/in Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ James Scanlan Test Performed By: Isaac Rowe Witnessed By: Comments: I I t5form12.doc•06/03 Perc Test•Page 1 of 1 i w uLuTAM 50 CONCORD STREET, NORTH READING, MASSACHUSETTS 01864 TOWN OF(NORTH AN00V FRr 978-470-2860 BOARD OF HEALTH FAX 978-470-1017 JAN 2 7 2004 January 26, 2004 sa>� I lil 9iRF W, ' Health Department Town of North Andover 27 Charles Street North Andoxer_.V 01845 RE, AAsbestos A)bate l9U Mill Road Dear madam: Please be advised that Dec-Tam Corporation will be performing an asbestos abatement project at the above referenced location. This work has been scheduled for February 9, 2004. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Brenton D. rgenstern Sales Estimator BDM/jmp Enclosure A ASBESTOS ABATEMENT A MOLD REMEDIATION LEAD ABATEMENT www.dectam.com E-mail: solutions@dectam.com �• Commonwealth of Massachusetts E . Pleeasease EEnnter Decal# Asbestos Notification Form ANF-001 N° 770782 A. Asbestos Abatement Description Important: When filling out 1. Facility Location: forms on the computer,use Ms Catherine Lowery 190 Mill Road only the tab key Name of Facility Street Address to move your North Andover Ma 01845 978-682-8165 cursor-do not City/Town State Zip Code Telephone use the return. key. Worksite Location: �b Basement Building name,#,wing,floor,room. 2. Is the facility occupied? ® Yes ❑ No 3. Asbestos Contractor: Dec-Tam Corporation 50 Concord St Name Address INSTRUCTIONS N. Reading. MA 01864 978-470-2860 1.All sections of City/Town Zip Code Telephone this form must be AC000035 completed in order DOS License# Contract Type: ®Written ❑ Verbal to comply with Brenton D. Morgenstern Sales Estimator DEP notification Facility Contact Person Contact person's title requirements of 310 CMR 7.15 Charles Brewer ASB30534 and the Division 4. Name of On-Site Supervisor/Foreman DOS Certification# of Occupational Safety(DOS) FLI Environmental AA000144 notification 5' Name of Project Monitor DOS Certification# requirements of FLI Environmental AA000144 453 CMR 6.12 6. Name of Asbestos Analytical Lab DOS Certification# 2.Submit Original Form to: Commonwealth of 2/9/04 2/9/04 Massachusetts 7• Project Start Date End Date Asbestos Program PO Box 120087 Boston MA 02112-0087 7am-4pm NA Work hours Mon-Fri. Work hours Sat-Sun. 8. What type of project is this? ❑ Demolition ® Renovation ❑ Repair ❑ Other, please specify: 9. Check abatement procedures: ❑ Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup ® Other, specify: CriticalBarrier/Neg Air/Poly Walls/Devon/ ❑ Full containment Remove floor tile/2xbag 6-mil poly 10. Is the job being conducted: ® Indoors? ❑ Outdoors? . 04010046 LoweryNoAndoverMa•9/02 Asbestos Notification Form• Page 1 of 4 Corrirnonwealth of Massachusetts E770782 Please Enter Decal# . Asbestos Notification Form ANF-001 A. Asbestos Abatement Description (cont.) 11. Total amount of each type of Asbestos Containing Materials (ACM)to be removed, enclosed, or encapsulated: 525 pipes or ducts(linear ft) other surfaces(square ft) Boiler,breaching,duct,tank surface / / Insulating coatings lin.ft sq.ft cement lin.ft sq.ft Corrugated or layered paper pipe insulation lin.ft sq.ft Trowel/Sprayer coatings lin.ft sq.ft Spray-on fireproofing lin.ft sq.ft Transite board,wall board lin.ft sq.ft Cloths,woven fabrics lin.ft sq.ft Other,please specify: / /525 Thermal,solid core pipe insulation lin ft sq ft Floor Tile Only lin.ft sq.ft 12. Describe the decontamination system(s)to be used: Three Stage 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): Material will be wetted and placed in double bags and labeled for transporatation 14. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: Name of DEP official Title Date of Authorization Waiver# Name of DOS official Title Date of Authorization Waiver# 15. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 ori27A—F apply to this project? ❑ Yes® No B. Facility Description 1. Current or prior use of facility: residence 2. Is the facility owner-occupied residential with 4 units or less? ® Yes ❑ No 3. Ms. Catherine Lowery 190 Mill Road Facility Owner Name Address North Andover 01845 978-682-8165 CityJTown Zip Code Telephone 4 Ms. Catherine Lowery Same as Above Name of Facility Owner's On-Site Manager Address City/Town Zip Code Telephone 04010046 LoweryNoAndoverMa•9102 Asbestos Notification Form• Page 2 of 4 r Commonwealth of Massachusetts E770782 Please Enter Decal# Asbestos Notification Form ANF-001 B. Facility Description (cont.) n/a 5' Name of General Contractor Address City/Town Zip Code Telephone Commerce& Industry WC9694329 12/28/04 Contractor's Worker's Comp.Insurer Policy# Exp.Date 6. What is the size of this facility? . 2700 2 Square Feet #of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary)to final disposal site: Service Transportation Group 58 Pyles Lane Note:Transfer Name of transporter Address Stations must New Castle, DE - 19720 302-778-5930 comply with the City/Town Zip Code Telephone Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 As Above Name of transporter Address City/Town Zip Code Telephone 3. Refuse transfer station and owner Address I City/Town Zip Code Telephone 4. Minerva Landfill n/a Final Disposal Site location name Owner's Name 9000 Minerva Road Waynesburg Address City/Town OH 44688 330-886-3435 State Zip Code Telephone D. Certification The undersigned hereby states, under the Brenton Morgenstern ;-. penalties of perjury,that he/she has read Name Authorized Signature and Date the Commonwealth of Massachusetts Sales Estimator Dec-Tam Note:Contractor regulations for the Removal, Containment must sign this formPosition/Title Representing for DOS notification or Encapsulation of Asbestos, 978-470-2860 50 Concord St purposes 6.00 and 310 CMR 7,15, and thhatat the CMR information contained in this notification is Telephone Address true and correct to the best of his/her N. Reading,MA 01864 knowledge and belief. City/Town Zip Code Fee exempt(city,Town,district, municipal housing authority,owner-occupied residential of four units or less?) 2 Yes ❑ No i 04010046 LoweryNoAndoverMa-9/02 Asbestos Notification Form- Page 3 of 4 i NEW ENGLAND ENGINEERING SERVICES INC i - Yl� �0�1�saa �V 4 F,c�, SEP 2 32003 September 19, 2003 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT:O T. 190 Mill Road North Andover MA Dear Sirs: 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 C. Osgo , Jr. 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 w 4 03-. 7(o COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL < ,AIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 'OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _10 ti1i� c. RD UY Owner's Name: 90 LL, t-ow c Owner's Address: ,52 Date of Inspection: Name of Inspector:(please print)-Benjamin C. Osgood, Jr. CompanyName:New England Engineering Services Inc. Mailing Address:6Q.Beechwood Driye, North Andover, KA 1845 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 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.o00� The system:. ✓irasses . Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: C �.. Date: /he- a The system inspector shall submit a copy of this ins 'on 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. i . 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 QFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:. 140 M 1 c,_1 !u6 azu� A N o d �� Owner: sultc--k!= i.ow E(ly Date of Inspection: Inspection Summary: Check A B C,D or E/ALWAYS complete all of Section D A. .System Passes: ave 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: e or more system components as described in the"Conditional Fars'section need to be replaced or repaired. a system,upon completion of the replacement or repair,as approved by the Board of Healthf will pass. Answer yes,no or n determined MN,ND)in the for the following statements.If` determined"please • explain. • The septic tank is m and over 20 years old*or the septic tank(wheth etal or not)is structurally unsound,exhibits substantial' tration or exfiltration or tank failure is ' ent.System will pass inspection if the existing tank is replaced with a cc lying septic tank as approved by the d of Health. *A metal septic tank will pass in 'on if it is structurally sound,no beaking and if a Certificate of Compliance indicating that the tank is less than 20 s old is available. ND explain: Observation of sewage backup or break o high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled a distribution box.System will pass inspection if(with approval of Board of Health): en pipe(s)are ced obstruction is remo distribution box is level or replaced ND explain: T�n system required pumping more than 4 times a year due to b ken or obstructed pipc(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 l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ _I c sic i {�o�-n Owner: Vau R R F I-L- c,.nwC 9-1 Date of Inspection:, C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system sting to protect public health,safety or the environment. 1. stem will pass unless Board of Health determines in accordance with 310 CMR 15.30 )that the m Is not functions In which ng a manner will protect public health,safety and the a ronment. 1 or privy is within 50 feet of a surface water _ Cess or privy is within 50 feet of a bordering vegetated wetland or a salt 2. System will fail unless the rd of Health(and Public Wat Supplier,if any)determines that the system Is functioning In a manner at protects the public h li�h,safety and environment: _ The system has a septic tank an it absorptiT em(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s ce wa s=upply. The system has a septic tank and S e SAS is within a Zone 1 of a public water supply. . Th a system has a septic tank d SAS and the S is within 50 feet of a private water supply well. The system has aseptic and SAS and the SAS is than 100 feet but 50 feet or more from a Private water supply welt* .Method used to determine dis **'This system if the well water analysis,performed at a D ccrtified laboratory,for coliform bacteria and vol 'e organic compounds indicates that the well is fr om pollution from that facility and the presence�onia nitrogen and nitrate nitrogen is equal to or Z 5 ppm,provided that no other failure cri are triggered.A copy ofthe analysis must be attached to 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address; lqo ROA-fl iUo(L� Ay n dycc 2 Owner: 0�0 R Lo V-1VVv Date of Inspection: 3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`nd'to each of the following for ail inspections: Ye$ 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 L,- Static liquid level in the distribution box above outlet invert due to an overloaded or clpgged SAS or — cesspool _f Liquid depth in cesspool is less than 6"below invert or available volume is less than YZ day flow — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply. „ Any portion of a cesspool or privy is within a Zono 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well, . v An portion on of a of or privy is less than 1 — Y im 00 feet but eater than 50 feet from a private water cesspool p vy — 1;x 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.] (Ites)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 be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You igyst indicate either"yes'or"no"to each of(he;surface (The foal777 ' ly to large systems in addicriteria above) yes no — ^ the system is wiihi 4 0 feet of a surface dsupply the system is within 200 feet o bu drinkin water su lg supply _ the system is located in area(Interim Wellhead Protection Area–IWPA)or a mapped Zone II of a public tsupply well If you have ar s}r er es"to an oestion in Section>?the 'y y q sys considered a significant threat,or answered- system nsweredsystem considered a si�niflt�ant tlueat ands Section E or failed under Section D shall upgrade the s tem in accordance with 310 CMR 15.3Q4.The system owner should contact the appropriate regional office o£the De artment. r \ Page`5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_ tan ^Ai i,a.. Ms) No2Tu A.,-3pou•e4– Ownert u a V-C-' L-0,VG(LI Date of Inspection: 03 Check if the following have been done.You must indicate"res"or"no"as to each of the following: Yes No Pumping information was provided by the owner,oocupant,or Board of Health ere 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? Z Were as built plans of the system obtained and examined?(If they were not available note as WA) 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 onsite? _� Vere the _• ie tank manholes uncover o and the sept ed,opened, interior of the tank inspected for ffie condition of the baffles or tem material of construction,dime rasions 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 Son!Absorption System(SAS)on the site has been determined based on: Yo 'Existing information.For example,a plan at the Board of Health. _._ determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15,302(3)(6)] page 6 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: -/!To /ii-s- 1 +0 Owner: i2 eQ-L �owGfL� Date of Inspection: yf 1 /oma -- FLOW CONDITIONS RESmENTIAL Number of bedrooms(design): — Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example- 110 gpd x#of bedrooms): Number of current residents: 3 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no):NQ (if yes separate inspection required] Laundry system Inspected(yes or no):— Seasonal use:(yes or no):&0 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COM MCIALIMUSPRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qnd Basis of design flow(seatstpersonslsq%de.): 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 occupancyluse: WHER(describe): GENERAL IlVFORMATION Pumping Records Source of information: Pu m AY zoo Erz ow,v 2 Was system pumped as part of the inspection(yes or no):" If yes,volume pumped:_--pllons--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) Tight tank Attach a copy of the DEP approval Other(describe): - - Approxim,�e ago of all components,date installed(if lmown)and source of information- VU I L-M i 60 PER D,UAJ L Q Were sewage odors detected when arriving at the site(yes or no):AO .Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: i oto svt L-- mo&p is2 o&T%4- AN o 6�Z-V.. Owner: '13(j i Fu— "w E(zY Date of Inspection: --t I L 6 i a3 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEP'T`IC TANK:__._(locate on site plan) Depth below grade: �3 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: /oo-"' 6-4 4G.O.vS Sludge depth: ;" Distance from top of sludge to bottom of outlet tee or baffle. f Scum thickness: G Distance from top of scum to top of outlet tea or baffle: L" 'Distance from bottom of scum to bottom of outlet toe or baffie: z.2" How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc): ';ri4NK AJ J2 /A-'Ljc7_ Crcv.��Nil GREASIJ TRAPY;/4Vocate 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 bafflo: 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 it OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: SRO A41LL.. itot}� Owner: Date of Inspection.- TIGHT nspection:TIIGHT or HOLDING TANK:U&(tank must be pumped at time of inspection)(locatc on site plan.) Depth below grade: Material of construction: concrete metal fiberglass��olyethylene othet(explain): Dimensions: Capacity: aaltons Design Flow: aallonstday 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): DM RIBUTION BOX: (if present must be opened)(locate on site plan) Mth of liquid level above outlet invert: ments(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): 11C1 dA, court 111,1art t>�i►�'�b��:�_ - AL-� Jt n c=.AUC- ' G b C 2 G Lr 5 JP P1.CF.4e V7L'D w►int ^&W010P. PUMP CHAMBER:/V4' (locato 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.): I Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_ PART C SYSTEM INFORMATION(continued) Property Address: IqO ,u/Cc_ Ab- 1vc7 gXe AAj QoyeJ . 4 Owner: u 'U- 1..0wE911j Date of Inspection: z 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: Teaching fields,number,dimensions: TN;; X YJ' overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ftA,6A- t>I= E-I'Le D L. • _P�N,Di.cs� ►..,. tsoiZa,�-► ��F s�N� e��sErt D -woe /s 02y VBG-CT�??Jr., is �02��}-cam � �. ��a�..�,..._s.•• Q.�; CESSPOOL&AI - cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulio 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.): Page 10 of 11 OFFICIAL INSPECTION FORM ' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM It4FORMATION(continued) Property Address: /10 m t U L -�2o,4n Owner: L,2b w c Ry Date of Inspection:a/t aq.1 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewago 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. �1Y 01 I - I..l00S i 25.E zs0 d pc9oc7 c>c=�c-.n. c!:>v�cC> cs> -m� CB Page YI of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: I act /w rc.g. ape AAA- Owner: c,o we RY Date of Inspection: W t g/pz SM 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.: Obtained from system ddsign plans on record-If chocked,date of dbsign plan reviewed: Observed site(abutting property/observation hole within 154 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: . —_s5��t`ts'�iyl 3 t F3E'[-bw C�LAIND t/y /��/ 1i'/LL�Q- �bt'T "•'W-•� S ci G, t9S s ,v pr c S S` 3 Zc�..v n a 7 6 r•v c-NES ,tc3d.je' w 044G A . TbWN OF NORTH ANDO V 1 S'SCSTEM PUMPING �� a� i kltlit RECORD RD 5V-STEM (JWH&R & ADDRESS SYSTEM LOCATION --� —. (example: left fro t of house) • Alo es = ��� `9041P 7 . UATF OF PUMPJNCs 5-00 Z QUANTITY PUMPED��Q 'LLON NO ,_. YE3 SEPTIC TANK: NO YES oil XATURi'0F$ERY1C$. ROUTINE , EMERGENCY utiseRVATIQNS;• 00OD C0111OlTI0H. FULL.TO coven HEAVY GREASE -BAFFLES IN PLACE ROOTS LEACHFIRLD RUMBACKw EXCESSIVE SQLlDS FLOODED SOLIDS CARRYOVER . ,PfH1tR (EXPLAJN) y1'S't•l: l PUMPI:I� By.. • •' f , ' �.r d c.o-i ivi rMTS: U' •I•Isi�I•!'S' 'I'RAN5'PVt R20 T0: DECATAM 50 CONCORD STREET, NORTH READING, MASSACHUSETTS 01884 r_ .Yc1WN OF NORTH AWnc i'-� V 978.476.2860 $OAFiD OF HEALTH FAX 978-470-1017 ,)AN 2 7 2004 January 26, 2004 Health Department Town of North Andover 27 Charles Street North Andover,..-MA 01845 RE: Asbestos Abate ent ` x.90 Mill Road Dear Sir-ori idam: Please be advised that Dee-Tam Corporation will be performing an asbestos abatement project at the above referenced location. This work has been scheduled for February 9, 2004. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, (Brenton D. rgenstern Sales Estimator BDM/jmp Enclosure A ASBESTOS ABATEMENT A MOLD REMEDIATION LEAD ABATEMENT www.doetam.com E-mail: solutions Odectam.com Cordmonwealth of Massachusetts E770782 Please Enter Decal# Asbestos Notification Form ANF-001 NQ 770762 A. Asbestos Abatement Description Important: When filling out 1. Facility Location: forms on the computer,use Ms Catherine Lowery 190 Mill Road only the tab key Name of Facility Street Address to move your North Andover Ma 01845 978-682-8165 cursor- not use the return Cfty/Town State Zip Code Telephone key Worksite Location: Basement Building name,#,wing,floor,room. 2, Is the facility occupied? ®Yes ❑ No 3. Asbestos Contractor: Dec-Tam Corporation 50 Concord St Name Address INSTRUCTIONS N. Reading. MA 01864 978-470-2860 1.All sections of City/Town Zip Code Telephone this form must be AC000035 completed in order DOS License# Contract Type: ®Written ❑Verbal to comply with Brenton D. Morgenstern Sales Estimator DEP notification requfremeetsoff Facility Contact Person Contact persoNs title ree�ts 310 CMR 7.15 Chanes Brewer ASB30534 and the Division 4, Name of On-Site Supervisor/Foreman DOS Certification# of Safety Occupational Safely(DFLI Environmental AA000144 S notification Name of Project Monitor DOS Certification# requirements of FLI Environmental AA000144 453 CMR 6.12 6, Name of Asbestos Analytical Lab DOS Certification# 2.Submit Original Form to: Commonwealth of 219/04 2/8/04 Massachusetts 7, Asbestos Program .Project Start Date End Date PO Box 120087 Boston MA 02112-0087 7am-4pm NA Work hours Mon-Fri. Work hours Sat-Sun, 8. What type of project is this? ❑ Demolition ® Renovation ❑ Repair ❑ Other, please specify: 9. Check abatement procedures: ❑ Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup ® Other,specify: CriticalBarder/Neg Air/Poly Waifs/Devon/ ❑ Full containment Remove floor file/2xba 6-mil poly 10. Is the job being conducted: ® Indoors? ❑ Outdoors? . 04010046 LoweryNoAndoverMa•9102 Asbestos Notification Form-Page 1 of 4 " Commonwealth of Massachusetts E770782 Please Enter Decal# Asbestos Notification Form ANF-001 B. Facility Description (cont.) 5. n/a Name of General Contractor Address Cityrrown Zip Code Telephone Commerce_&Industry WC9694329 12/28/04 Contractor's Worker's Comp.Insurer Policy# Exp.Date 6. What is the size of this facility? 2700 2 Square Feet #of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary)to final disposal site: Service Transportation Group 58 Pyles Lane Note:Transfer Name of transporter Address Stations must New Castle, DE - 19720 302-778-5930 comply with the Cltyrrown Zip Code Telephone Solid Waste Division 2. Transporter of asbestos-containing waste material from removalitemporary site to final disposal site: Regulations 310 CMR 19.000 As Above Name of transporter Address City/rown Zip Code Telephone 3. Refuse transfer station and owner Address Cityrrown Zip Code Telephone 4. Minerva Landfill n/a Final Disposal Site'location name Owner's Name 9000 Minerva Road Waynesburg Address Cityfrown OH 44688 330-886-3435 State Zip Code Telephone D. Certification The undersigned hereby states, under the Brenton Morgenstern penalties of perjury,that he/she has read Name Authorized Slbhature and Date the Commonwealth of Massachusetts Sales Estimator Dec-Tam Note:Contractor regulations for the Removal, Containment Positionrritle Representing must sign this form or Encapsulation of Asbestos,453 CMR.00 � for Dos notification or and 310 CMR 7.15,and that the 978-470-2860 50 Concord St purposes information contained in this notification is Telephone Address true and correct to the best of histher N. Reading,MA 01864 knowledge and belief. City/Town Zip Code Fee exempt(city,Town,district,municipal housing authority,owner-occupied residential of four units or less?) ®Yes ❑No 04010046 LoweryNoAndoverMa•9/02 Asbestos Notification Form•Page 3 of 4 i • ' TECHNICAL REPORT 07 June 1984, Page 1 of 1 CLIENT: Paul E. Driscoll General Contractor 190 Mill Road North Andover, MA 01845 CASE NO: 17179 REFERENCE: Per your request PROJECT DESCRIPTION: Analysis of one (1) well water sample for acetone, benzene and toluene. SAMPLE IDENTIFICATION: Two 40-m1 vials of water identified: 11379 Boxford St. , North Andover, well water" Sample received 6 June 1984. ' METHOD OF TEST: EPA method 602. Gas chromatography with purge-and-trap concentration and flame ionization detector. RESULTS: Parts per billion (Micrograms per liter) Acetone <20. Benzene < 1. Toluene 2. 2 Note: A trace of an additional substance was detected in the gas chromatogram of the submitted sample. This material was not iden- tified. It is intermediate in volatility between acetone and benzene. The .concentration of this material is estimated to be in the part per billion range. Respectfully submitted, SKIN ER & SHERMAN LABORATORIES, INC. Harel Lacey D. Chemist HL/rm \ This report is rendered upon all of the following conditions:Skinner&Sherman Laboratories,Inc.retaim ownership or this icp vit until stsiviatN subuilltN invsaee is satisfied.Expert witness services shall be available in conjunction with this report only if prior notification tit this potential reyuuemcnt was nude and xt�-cptel, before the andfysis.This report is not to be reproduced wholly or in part without special permission in writing.Total liability is limited to the invoi.•e amount.Skinort &Sherman,Inc.,Skinner&Sherman Technology,Inc.,and/or New England Laboratories name mrdfor Ingos may not he used tit conjun:tiou.ah lite roments of this report in any advertising media.The results listed refer only to tested samples and applicable parameters,product eudorscmntt is ncidier intenN not impltN. Skinner&Sherman Laboratories.Inc.will exercise due diligence but will not be responsible for lost or doll tit samples or evidence unless diem male.appnspnate insurance coverage arrangements.Samples are held for thirty days following issuance of upon.Santpin will be x1nIN m client's evlt•nse,if unhunrcJ m%runs*. 1 1ST/�lll�� StlUNTM17 1-31-117©'E711 ES OdlC. New Englafid Laboratories 300 SECOND AVENUE, P.O. BOX 521, WALTHAM, MASSACHUSETTS 02254 its 617-890-7200