HomeMy WebLinkAboutMiscellaneous - 2177 TURNPIKE STREET 4/30/20183 e+
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Lot &Street Map
/Parcel
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CONSTRUCTION APPROVAL
Has plan review fee been paid: GR NO Permit#
Plan Approval: Date: 4"kApproved by: �A
Designer:
Conditions:
Plan Date:
y�
(St jCS�` e-(c<eCkeX
Water Supply: Townell
Well Permit: , / Driller:
Well Tests: Chemical Date Approved
Bacteria I Date Approved
Bacteria II Date Approved
Plumbing Sign -Off: Wiring Sign -off:
Comments:
Form "U" Approval
Date Issued
Conditions:
Final Approval:
Approval to Issue
By:_
YES NO
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other? YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
t
4r a
CONDITIONS:
SEPTIC SYSTEM INSTALLATION
Is the installer licensed?
YES
NO
Type of Construction:
NEW
REPAIR
New Construction:
Certified Plot Plan Review
YES
NO
Floor Plan Review
YES
NO
Conditions of Approval from Form U
YES
NO
Issuance of DWC permit:
YES
NO
DWC Permit Paid?
YES
NO
DWC Permit #
Installer:
Begin Inspection: YES NO
Excavation Inspection:
Needed:
Passed: By: --
Construction Inspection:
Needed: —
As Built Plan Satisfactory:
YES:
Approval of Backfill: Date: By:
Final Grading Approval: Date: By: -
Final Construction Approval: Date:. By:
I Certificate of Compliance: Approval: Date:
L,5� )0deci ,,��11 �e5�-�� ,�rid 1� C6�
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Owner
information is
required for every
page.
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J
Owner's Name
North Andover
City/Town
rMi
nv
TOWN OF
MA 01845 8-6-2015
State Zip Code Date of Inspection
ANDD',.'
FTMEN'
" - ` L
Inspection results must be submitted on this form. Inspection forms may not be altered in any vv10°
way. Please see completeness checklist at the end of the form. YL e
A. General Information
Inspector:
Michael J Wood
Name of Inspector
Service Pumping & Drain Co., Inc.
Company Name
5 Hallberg Park
Company Address
North Reading MA 01864
City/Town State Zip Code
978-276-0217 5021
Telephone Number
B. Certification
License Number
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
8-13-2015
inspect' Sign Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins • 3113 Title 5 ficial Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
quine d fotifo is every
eNorth Andover MA 01845 8-6-20
quire
page. Cityrrown State Zip Code Date of I
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ one or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17
i
r
15
nspection
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ one or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if (with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if (with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner's Name
North Andover MA 01845
City/Town State Zip Code
B. Certification (cont.)
8-6-2015
Date of Inspection
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
11 ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
`Fc� 3y 7177 Turnnikp Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection
Area — IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins • 3113 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
® ❑
Pumping information was provided by the owner, occupant, or Board of Health
❑ ®
Were any of the system components pumped out in the previous two weeks?
® ❑
Has the system received normal flows in the previous two week period?
❑ ®
Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Z ❑
Was the facility or dwelling inspected for signs of sewage back up?
® ❑
Was the site inspected for signs of break out?
® ❑
Were all system components, excluding the SAS, located on site?
® ❑
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑
Was the facility owner (and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑
Existing information. For example, a plan at the Board of Health.
❑ ®
Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 GPD
t5ins • 3113 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 6 of 17
Commonwealth of Massachusetts
N Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder?
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.)
Laundry system inspected?
Seasonal use?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
Last date of occupancy:
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
Gallons per day (gpd)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
currently
occupied
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
owner
gallons
Date
Type of System:
Septic tank, distribution box, soil absorption system
❑ Yes ® No
❑ Single cesspool
Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
IR Other (describe):
septic tank, pump chamber, d -box, SAS
t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
5 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
The system is approximately 10 years old according to plans dated 4-10-2005.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer (locate on site plan):
Depth below grade: 20
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other (explain):
Distance from private water supply well or suction line: >100'
feet
Comments (on condition of joints, venting, evidence of leakage, etc,):
There are no visible signs of failure or leakage.
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
® concrete ❑ metal
8"
feet
❑ fiberglass ❑ polyethylene ❑ other (explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 10'x 6' x 5'
Sludge depth: `1
t5ins • 3113 Title 5 Official Inspection. Form: Subsurface Sewage Disposal System • Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°r 2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle >2
no scum
Scum thickness
Distance from top of scum to top of outlet tee or baffle no scum
Distance from bottom of scum to bottom of outlet tee or baffle no scum
How were dimensions determined? tape measure/ sludge judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
There are no visible signs of failure. Both the inlet and outlet tees are intact and appear to be working
as designed.
t5ins • 3113
Grease Trap (locate on site plan).
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
feet
❑ polyethylene ❑ other (explain):
Date
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
gallons
gallons per day
❑ Yes ❑ No
Alarm in working order: . ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
'1
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert at invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
There are no visible signs of failure.
Pump Chamber (locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins •-3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17
Commonwealth of Massachusetts
t,= Title 5 Official Inspection Form
'' >1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑
leaching pits
number:
❑
leaching chambers
number:
❑
leaching galleries
number:
❑
leaching trenches
number, length:
®
leaching fields
number, dimensions:.
❑
overflow cesspool
number:
❑ innovative/alternative system
1. 20'x 50'
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
There are no visible signs of failure.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow
t5ins • 3/13
❑ Yes ❑ No
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,III0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r� 2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins - 3/13 Title 5 Official Inspection Form* Subsurface Sewage Disposal System Page 14 of 17
Owner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner's Name
North Andover MA 01845 8-6-2015
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
hand -sketch in the area below
® drawing attached separately
t5ins • 3/13 - Title 5 Official Inspection Form_ Subsurface Sewage Disposal System - Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
2
Check Slope
®
Surface water
®
Check cellar
Z
Shallow wells
Estimated depth to high ground water:
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed:
4-10-2005
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health - explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Plans that were supplied by the homeowner.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
2177 Turnpike Street
Property Address
Joseph P and Alice J Casey
Owner Owner's Name
information is
required for every North Andover MA 01845 8-6-2015
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information — Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17
I
ra
Town of North Andover f NORTH
Office of the Health Department b
Community Development and Services Division--
400.OSGOOD STREET
North Andover, Massachusetts 01845 �Ss�cHus�s
Susan. Y. Sawyer, REHS/RS 978.688.9540 - Phone
'Public Health Director 978.688.8476 - Fax
CWqWq7CA?E Off' C09IL'GIANCE
As of:
May 20, 2005
This is to cert that
the individual subsurface d�,sposal system
Constructed( -) or Repaired(l-'4-1" — EuCCSystem
by
Craig ZUaeCty
at
2177 Turnpike Street
North Andover, 31,4 01845
has been installed in accordance with the provisions of Title v of the State Sanitary Code and
with the jVorth Andover 0oard of Yfealth regulations.
The issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
Susan T Sawyer
Tu6lic Yfealth Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( ) constructed;
( ) repaired;
by
located at
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # , plan dated , 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.
Bed inspection date:
Engineer Representative
Final inspection date:
Engineer Representative
Installer:
Engineer:
Date:cJ
Date:
rvED
MAY 12 2005
TOWN OF NORPAR M TER
HEP?r-1 -
"o"'" Commonwealth of Massachusetts Map -Block -Lot
of .`p ty 108.C- 0066 -
i fid` .` �'• a0L
Board of Health Permit -No
•
BHP -2004-0672
North i
North Andover
b p
„... ' P.I. FEE
�i '.a..o -''y h - --
�"SACH us�t F.I. - --- $250.00
Disposal Works Construction Permit
Permission is hereby granted Craig Waelty
to (Repair) an Individual Sewage Disposal System.
at No 217-7 Turnpike Street
- --- ---- -- --- ----- ---- --------------- - ----- --
as shown on the application for Disposal Works Construction Permit No. BHP -2004-067 Dated October-05,2004--
Issued
ctober05,2004Issued On: Oct -05-2004
nAo
d of Health
t Noy*"
Commonwealth of Massachusetts Map -Block -Lot
+� 0
108.C- 0066 -
Board of Health
• • North Andover
Certificate of Complia c -e -f__.
1ssAS"ustt
THIS IS TO CERTIFY,That the Individual ge Disposal System (Repair)
by Craig Waelty _
------------ -
Installer
at No 2177 Turnpike Str
has been installed in ordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. BHP -2004-067 Dated October 05, 2004
-- ---- --- -
----- ---- --- -
Printed On: Oct -05-2004 Board of Health
0
Town of North Andover, Massachusetts Form No. 3
NORTH BOARD OF HEALTH
O�t�No ia,�O 1
�,S �•���^''<� DISPOSAL WORKS CONSTRUCTION PERMIT
SACHUSE
Applicant C.�/s-4 Z 0- 1! '—�a
�
NAME ARES
TELEPHONE
Site Location 4- DD ! i 7�--
Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHA AN, BOA, D OF HE H
yj �` ✓Y—E Ear
Fee— D.W.C. No.
TOWN OF NORTH ANDOVER oµORTH q
Office of COMMUNITY DEVELOPMENT AND SERVICES 3 stt4eo ,d roQc
HEALTH DEPARTMENT `
27 CHARLES STREET "9 r
AATPy5
NORTH ANDOVER, MASSACHUSETTS 01.845 "SsaCEP1. w4 0
Susan Y. Sawyer, REHS/RS
Public Health Director
978.688.9540 — Phone
978.688.9542 — FAX
bealthdept@townofnorthandover.com
www.townofnortliandover.com
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE:
r l
LOCATION:_
LICENSED INSTALLER NAME:
PLEASE PRINT
/
E: � TELErHONESIGNATUR_�! #
/
CHECK ONE:
FULL SYSTEM REPAIR:
COMPONENT REPAIR (indicate what parts):
* NEW CONSTRUCTION:
* If NEW CONSTRUCTION, please attach the Foundation As -Built Plan.
$250 Ob Fee Attached? Yes No
Project Manager Obligation From Attached? Yes No
Foundation As -Built? Yes No
Floor Plans? Yes No
Approval of Health
Date:
RECEIVED
OCT 0 1 2004
TGvVN Or NORTH ANDOVER
HEALTH DEPARTMENT
FROM CBA-COUN
J
PHONE NO. : 978 658 7544 Sep. 27 2004 01:27AM P1
CERTIFIED PLOT FLAN Scott L. Giles R.P.L.S,
LOCATEDFrank. S. Giles R. P. L, S. /N NORTH ANDOVER, MASS. 5Q Deer Meadow Road
SCALE.' 1"=50' DATE:71I/2004 North Andover Mess.
TURNPIKE STREET
S 47'4445"E
47.56' S 47"07'28" E 148.42'
M.H.B.
DoT I -c 4
PLAN #12164 N. E. R. D.
56,771 S.F.
"
`A-5 WETLANDS
N
N
5d�
o EXIST. HSE.
a FND.
t.�
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a
er
W i
tq
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A-3
�~-A-2�
A-
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`A-5 WETLANDS
I
A6
A-1
c;
N,
ai
N 47°4445" W 181.57'
1 CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS OF THE BUILDING INSPECTOR ONLY 8 H
SHOWN COMPLY AND SUCH USE IS FOR THE $' t3972
WITH THE ZONING DETERMINATION OF ZONING 9FC/STERE�
BYLAWS OF CONFORMITY OR NON -CONFORMITY �'��oag1 Lpgv°�
NORTH ANDOVER WHEN CONSTRUCTED.
7 $ 2
TOWN OF NORTH ANDOVER f NORTI{
Office of COMMUNITY DEVELOPMENT AND SERVICES `�•�
HEALTH DEPARTMENT
400 Osgood Street
NORTH ANDOVER, MASSACHUSETTS 01845
cMus�t
Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone
Public Health Director 978.688.9542 — FAX
SEPTIC SYSTEM CONSTRUCTION NOTES
ADDRESS: MAP:_ LOT:
INSTALLER: ' . i' airuvrk-llkilj
DESIGNER]
PLAN DATE: ; *n t20D 0
BOH APPROVAL DATE ON PLAN:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SELECT SYSTEM TYPE
GRAVITY DISTRIBUTION
PRESSURE DISTRIBUTION
PRESSURE DOSING
HOLDING TANK
ADVANCED TREATMENT
OTHER
COMPONENT SUMMARY FROM PLAN
GALLON TANK =
LOADING OF SEPTIC TANK =
GALLON PUMP,CHAMBER =
LOADING OF PUMP CHAMBER =
TYPE OF SAS =
DIMENSIONS AND DETAILS OF SAS:
SITE CONDITIONS
Comments:
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
Page 1 of 4
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES or `x?4+0
HEALTH DEPARTMENT
400 Osgood Street ��,q �,np•: ��
NORTH ANDOVER, MASSACHUSETTS 01845 "SS�CNuS�t
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX'
SEPTIC TANK
Bottom of tank hole has 6" stone base
C Weep hole plugged
&/�lSoO-,gallon
tank has been installed
(H-10 or H-20) (monolithic or 2 piece)
❑
Water tightness of tank has been achieved
(Visual, or Vacuum Test or Water held for 24hrs)
&-"7
Inlet tee installed, under access port
Outlet tee (gas baffle or effluent filter) installed, under
access port
❑
, inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
L] Bottom of tank hole has 6" stone base
I Weep hole plugged
2'A0 n Pump Chamber install
�n�lettee
or H-20) (Monolithic 2 piec -
installed, under access port
Pump(s) installed on stable base
❑ Alarm float working
❑ Pump On/Off float working J `�
00" Drain hole in pressure line
❑ inch cover to within 6" of final grade installed over
one access port
I�t1 Water ti ss of tank has been achieved
isual r Vacuum Test or Water held for 24 hrs
❑ Hydraulic cement around inlet & outlet
Comments:
Page 2 of 4
TOWN OF NORTH ANDOVER °f ,ORTF,
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT '°
♦ i ^ �
400 Osgood Street •,�•.,
-NORTH ANDOVER, MASSACHUSETTS 0].845
�C tom.
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
D -BOX
❑ Installed on stable stone base
❑ Inlet tee (if pumped or >0.08'/foot)
❑ Hydraulic cement around inlet &.outlets
❑ Observed even distribution
❑ Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM,
El
Comments:
PRESSURE DISTRIBUTION
11
El
\� Comments:
Bottom of SAS excavated down to soil layer, as
provided on plan
Size of SAS excavated as per plan
Title 5 sand installed, if specified on plan
3/4-1 Y2" double washed stone installed Y1 �--
1/8-1/2" (peastone) double washed stone installed
laterals installed and ends connected to header (and
vented if impervious material above)
Orifices @ 5 & 7 o'clock positions
Gravelless disposal systems: type, number and
location as per plan
Elevations of laterals installed as on approved plan
40 Mil HDPE barrier installed W-yt+
Retaining wall (boulder / concrete / timber/ block)
Final cover as per plan J
inch manifold
laterals installed with end sweeps
size:
material:
Squirt -test -ft in height
Equal distribution to all laterals
orifice size inch as per plan
Page 3 of 4
TOWN OF NORTH ANDOVER of Noer►,
Ott
Office of COMMUNITY DEVELOPMENT AND SERVICES 3 `t�°•o
• j. •.,'° 0
HEALTH DEPARTMENT p
400 Osgood Street
NORTH ANDOVER, MASSACHUSETTS 01845 "SS,CNUS�t
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
CONTROL PANEL
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel:
❑ Rated for exterior if placed outside
Comments:
SYSTEM ELEVATIONS
Benchmark:
Rod at Benchmark:
Height of Instrument:
INVERT ON DESIGN PLAN ELEV @ TOP OF PIPE INVERT ELEVATION
Building Sewer OUT
Septic Tank IN
Septic Tank OUT
Pump Chamber IN
Pump Chamber OUT
Distribution Box IN
D -Box OUT Manifold
Lateral 1 HIGH
Lateral 1 LOW
Lateral 2 HIGH
Lateral 2 LOW
Lateral 3 HIGH
Lateral 3 LOW
Lateral 4 HIGH
Lateral 4 LOW .
Lateral 5 HIGH
Lateral 5 LOW
Page 4 of 4
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SEWAGE PUMP STATION
DESIGN COMPUTATIONS
OWNER & APPLICANT
Single Family Dwelling
Lot 66, Turnpike Street
North Andover, MA
Joseph Casey
65 Federal Street
Wilmington, MA 01887
DATE: 6/12/00
'Jo'fyll
5ERW ATKA
VIL
,,35961
PUMP.XLS
DESIGN DATA:
PUMP:
DESIGN FLOW
440 Gal/Day
SOIL CLASS
2
PERC RATE
30 Min/Inch
FORCE MAIN DIA.
2" SDR 21 PVC
HAZEN-WILLIAMS COEFF.
150
MANUFACTURER: PEABODY-BARNES
MODEL #: SE -411 HORSEPOWER:
PUMP CHAMBER:
STORAGE
PRIMARY
RESERVE
VOL. IN PIPE RUN
TOTAL
DIMENSIONS
LENGTH*
WIDTH*
DEPTH*
ELEVATIONS
INLET INVERT
SUMP
OFF
ON
ALARM
STATIC HEAD:
DBOX INLET ELEV.
PUMP OFF ELEV.
TOTAL STATIC HEAD
PUMPALS
M-
440.0 gallons PS9 DA_(J
440.0 gallons
0.0 gallons
880.0 gallons
7.50
4.70
4.00
*INSIDE DIMENSIONS
88.20
84.20
84.70
86.37
86.53
93.70
FT
84.70
FT
9.00
FT
I
EQUIVALENT LENGTH:
FRICTION LOSSES IN PUMP CHAMBER:
1
2"DIA 900 BEND
5.0
FT
0
2"DIA 45° BEND
0.0
FT
1
2"DIA CHECK VALVE
14.0
FT
1
2"DIA GATE VALVE
1.2
FT
9
TOTAL LOSS
20.2
FT
1.09
1.13
21.0 FT
10.13
30
2.7
FRICTION LOSSES IN PIPE RUN:
1.58
9
1
2"DIA 900 BEND
5.0
FT
2
2"DIA 450 BEND
5.0
FT
0
2"DIA 22.50 BEND
0.0
FT
1
2"DIA TEE
12.0
FT
55
LENGTH OF RUN
55.0
FT
5.4
MISC. PIPE
5.5
FT
14.72
TOTAL LOSS
82.5
FT
7.61
* ( 83.0 FT
16.61
-
TOTAL EQUIV. LENGTH:
SYSTEM CURVE:
104 FT
Q
V
HF/100
HF
Hs
TDH
GPM
FPS
FT
FT
FT
FT
20
1.8
0.72
0.75
9
9.75
25
2.3
1.09
1.13
9-
10.13
30
2.7
1.52
1.58
9
10.58
35
3.2
2.03
2.11
9
11.11
40
3.6
2.59
2.70
9
11.70
50
4.5
3.92
4.08
9
13.08
60
5.4
5.50
5.72
9
14.72
70
6.3
7.32
7.61
9
16.61
80
7.2
9.37
9.74
9
18.74
90
8.1
11.65 1
12.12 1
9
121.12
FROM ATTACHED PUMP CURVE:
65 gpm @ 16 TDH
TIME ON: 6.8 minutes
PUMP.XLS
BARN ES® SUBMERSIBLE NON -CLOG PUMPS
Series: SE, Manual & Automatic
1-1/2" Spherical Solids Handling
Series: SEA HP 1750 RPM
(SE411 & SE421)
THE BELOW LISTINGS ARE FOR
SE411, SE411A & SE421 ONLY.
ca® Canadian Standards Association
File No. LR16567
UL Underwriters Laboratories Inc.
File No. E142177
Description:
SUBMERSIBLE NON -CLOG SEWAGE
PUMP DESIGNED FOR TYPICAL RAW
SEWAGE APPLICATIONS.
Sample Specifications: Section 1 Pages 13-14.
.3
CRANE PUMPS & SYSTEMS
Barnes Pumps, Inc.
Distributor Sales & Service Dept.
420 Third Street/P.O. Box 603
Piqua, Ohio 45356-0603
Ph: (513) 773-2442
Fax: (513) 773-2238
Specifications
DISCHARGE:
LIQUID TEMPERATURE
VOLUTE:
MOTOR HOUSING:
SEAL PLATE:
IMPELLER:
Design:
Material:
SHAFT:
SQUARE RINGS:
HARDWARE:
PAINT:
SEAL: Design:
Material:
CABLE ENTRY:
SPEED:
UPPER BEARING:
Design:
Lubrication:
Load:
LOWER BEARING:
Design:
Lubrication:
Load:
MOTOR:
Design:
Insulation:
SINGLE PHASE:
FLOAT:
OPTIONAL EQUIPMENT:
Barnes Pumps, Inc.
Bid -To -Spec & Project Sales
1485 Lexington Ave.
Mansfield, Ohio 44907-2674
Ph: (419) 774-1511
Fax: (419) 774-1530
SECTION
1A
PAGE
1
DATE
5/94
REPLACES
7/93
2" NPT, Vertical
104° F Continuous.
Cast Iron, ASTM A-48 Class 30.
Cast Iron ASTM A-48, Class 30.
Cast Iron ASTM A-48 Class 30.
2 Vane, Open, With Pump Out
Vanes On Back Side. Dynamically
Balanced, ISO G6.3.
Zytel 70G43 Nylon, Glass Filled.
416 Stainless Steel.
Buna-N
300 Series Stainless Steel.
Air Dry Enamel.
Single Mechanical, Oil -Filled Reservoir,
Secondary Exclusion Seal.
Rotating Face - Carbon
Stationary Face - Ceramic
Elastomer - Buna-N
Hardware - 300 Serigs Stainless
15 ft. Cord w/Plug On 115 and 230 Volt,
Pressure Grommet For Sealing And
Strain Relief.
1750 RPM (Nominal).
Sleeve
Oil
Radial
Single Row, Ball
Oil
Radial & Thrust
NEMA L Torque Curve. Completely
Oil -Filled, Squirrel Cage Induction.
Class A.
Permanent Split Capacitor (PSC).
Includes Overload Protection In
Motor.
Automatic Models. Wide Angle,
Polypropylene, 15ft. Cable.
SE411A & SE421A, Float w/Plug
Attached To Discharge Piping,
SE411AU & SE421AU Float Attached
To Pump. ON and OFF Points are
Adjustable.
Seal Material, Additional
Cable and Cast Iron Impeller.
MEMBER
SECTION
1A
PAGE
2
DATE
5/94
REPLACES
7/93
SE411A & 421A
SE411 & SE421 (Less Float)
�c
0.75
5.32 1.56
1200
Pumping
Pumping
9.00
Differential
I I 16.00
0 3.86
4.00.
0
a
7.72
SE411AU & 421AU
10.75
32 1.56
120' 9.00
Pumping
Differential
o
3.86
16.00
- - �- 7.72
0
4.00
MODEL PART HP VOLT PH RPM NEMA FULL
LOCKED CORD CORD
CORD
NO. NO. (Nom) CODE LOAD
ROTOR SIZE TYPE
OD
AMPS
AMPS
SE411 068701 0.4 115 1 1750 A 10.0
19.0 14/3 SJTOW-A
0.390
SE411A 082215 0.4 115 1 1750 A 10.0
19.0 14/3 SJTOW-A
0.390
SE411AU 093193 0.4 115 1 1750 A 10.0
19.0 14/3 SJTOW-A
0.390
SE421 082089 0.4 230 1 1750 A 5.0
9.5 14/3 SJTOW-A
0.390
SE421A 093194 0.4 230 1 1750 A 5.0
9.5 14/3 SJTOW-A
0.390
SE421AU 093195 0.4 230 1 1750 A 5.0
9.5 14/3 SJTOW-A
0.390
Mercury Switch on SE411A & Mechanical on SE421A, Cable 16/2, SJOW-A, 0.320 O.D., Piggy -Back Plug.
Mechanical Switch (SE411AU & SE421AU), Cable 14/2, SJOOW-A (UL), SJOW (CSA), 0.370 O.D.
IMPORTANT I
1.) DO NOT USE THIS PUMP TO PUMP FLAMMABLE LIQUIDS.
2.) THIS PUMP IS APPROPRIATE FOR LOCATIONS CLASSIFIED AS DIVISION 11.
3.) THIS PUMP IS hQI APPROVED FOR USE IN SWIMMING POOLS, RECREATIONAL WATER INSTALLATIONS,DECORATIVE
FOUNTAINS
OR ANY INSTALLATION WHERE HUMAN CONTACT WITH THE PUMPED FLUID IS COMMON WHILE THE PUMP IS RUNNING.
4.) PUMP CAN BE OPERATED DRY FOR EXTENDED PERIODS WITHOUT DAMAGE TO MOTOR AND/OR SEALS.
[CRANE PUMPS & SYSTEMS
Barnes Pumps, Inc. Barnes Pumps, Inc.
Distributor Sales & Service Dept. Bid -To -Spec & Project Sales
420 Third Street/P.O. Box 603 1485 Lexington Ave.
Piqua, Ohio 45356-0603 Mansfield, Ohio 44907-2674
Ph: (513) 773-2442 Ph: (419) 774-1511
Fax: (513) 773-2238 Fax: (419) 774-1530
'MEMBER
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MEMBER
BARNES®ALARMS
Wall Mounted
P/N: 061486
FOR INDOOR USE ONLY.
P/N: 061487
FOR INDOOR USE ONLY.
CRANE PUMPS & SYSTEMS
Barnes Pumps, Inc
Distributor Sales & Service Dept.
420 Third Street/P.O. Box 603
Piqua, Ohio 45356-0603
Ph: (513) 773-2442
Fax: (513) 773-2238
SECTION
6A
PAGE
43
DATE
7/93
REPLACES
10/85
Specifications:
061486 High Water Alarm includes stainless steel wall plate
with red jewel light and one mercury level control
with 10 ft. of 18/2 cord.
2.75
I
2 HOLES FOR .
6-32 x 1/4
3.81 SCREWS
O
4.25
O-
I
061487 High Water Alarm (Solid State) includes stainless
steel wall plate, audible and visual alarm with
silencer button and one mercury level control with
10 ft. of 18/2 cord.
4.56
I I
I '
3.28 4.50
Barnes Pumps, Inc.
Bid -To -Spec & Project Sales
1485 Lexington Ave.
Mansfield, Ohio 44907-2674
Ph: (419) 774-1511
Fax: (419) 774-1530
1.81
BARNES®MERCURY LEVEL CONTROLS
Pipe Mounted & Suspended
Pipe Mo
P/N's. 073613A73615 &
073617
Suspended:
P/N's: 073612, 073614 &
073616
UL "
CRANE PUMPS & SYSTEMS
Barnes Pumps, Inc
Distributor Sales & Service Dept,
420 Third Street/P.O. Box 603
Piqua, Ohio 45356-0603
Ph: (513) 773-2442
Fax: (513) 773-2238
Specifications:
CABLE: Material.-
Size:
aterial.Size:
HOUSING: Material:
Color
CLAMP:
WEIGHT:
TEMPERATURE RATING:
SWITCH:
SWITCH RATING:
Description:
SECTION
6C
PAGE
47
DATE
7/93
REPLACES
1 7/92
18-2 SJO W -A, 41 Strand x #34, 90°C
.29 Dia. x (See Chart for Length)
Polypropylene
Normally Open - Blue
Normally Closed - Red
Adustable 1"-3" Stainless Steel with
Polypropylene Saddle.
(Models 073613, 073615 and 073617)
Suspended, 2.25" Sph. lead weight
with Adjustable stainless steel fittings
(Models 073612, 073614 and 073616)
60°C
Mercury, Narrow Angle., Horizontal
4.5A @ 115VAC RES
2.25A @ 230VAC RES
The Mercury Level Controls are available in either a pipe mounted
or suspended configuration with 25 to 200 feet of cable on P/N's
073612, 073613, 073614 & 073615; P/N 073616' with 15 feet
'(use 073612, for longer lengths). P/N 073617 with 15 & 20 feet.
They are pilot duty devices which control the function of motor load
devices, such as contactors, motor starters, and power relays, to
automatically cycle a pump or pumps. They can also be used for
alarm signaling devices. Two Mercury Level Controls for a one
pump operation; three for a two pump operation. If an alarm device
is used, add another Level Control.
LEVEL CONTROL SELECTION CHART
Control
Number
Cord
Length
Type
Installation
Contacts
073612
25 to 200Ft.
Suspended
Open
073613
25 to 200Ft.
Pipe Mounted
Open
073614
25 to 200Ft.
Suspended
Closed
073615
25 to 200Ft.
Pipe Mounted
Closed
073616
'15Ft.
Suspended
Open
073617
15 & 20Ft.
Pipe Mounted
Open
State cord length at time of ordering
Barnes Pumps, Inc.
Bid -To -Spec & Project Sales
1485 Lexington Ave.
Mansfield, Ohio 44907-2674
Ph: (419) 774-1511
Fax: (419) 774-1530
SECTION
6C
PAGE
48
DATE
7/93
REPLACES
7/92
D
TYPICAL SIMPLEX WIRING SCHEMATIC
L1 L2
oL1—�-{, pN L2
d.
OFF STARTER
COIL
AUXILIARY
CONTACT
TO MOTOR
TYPICAL ALARM WIRING SCHEMATIC
L1 120V
1r
L_�J
ALARM CONTACT-'
(MINI -FLOAT)
TYPICAL PIPE MOUNTED INSTALLATION:
General Comments:
1. Never work in the sump with the power on.
2. Attach the Level Controls to the mounting pipe or
the pump discharge pipe. The "off' float should be
below the "on" float in a "pump out' application.
3. Arrange the Level Controls so they do not tangle
or hang up.
4. Insert the hose clamp through the two slots in
the pipe/cable clamp, circle the discharge pipe
with the hose clamp, feed the end of the hose
clamp through the screw and tighten.
5. Measuring the difference between mounting
points given the "pump down" differential.
Important Notes -Mercury Level Controls are pilot
duty devices. They cannot be used to directly power
pump motors. Also, do not use Mercury Level
Controls in gasoline or other combustibles. Mercury
level control are compatible with intrinsically safe
relays.
CRANE PUMPS & SYSTEMS
Barnes Pumps, Inc.
Barnes Pumps, Inc.
Distributor Sales & Service Dept.
Bid -To -Spec & Project Sales
420 Third Street/P.O. Box 603
1485 Lexington Ave.
Piqua, Ohio 45356-0603
Mansfield, Ohio 44907-2674
Ph: (513) 773-2442
Ph: (419) 774-1511
Fax: (513) 773-2238
Fax: (419) 774-1530
AUDIBLE
MOUNTING OR
DISCHARGE PIPE
"ON" FLOAT
DIFFERENTIAL
I
"OFF" FLOAT
N
BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: r c O MAP & PARCEL: /G
LOCATION OF SOIL TESTS: 4z,
OWNER: L —F9. TEL. NO.:
ADDRESS: &,5 ' S-> , W L0 s A/ ,�-- To^/, N4 -
ENGINEER: �7 ''' TEL. NO.: 4;'eP3 — 6 * '::5 t'
CERTIFIED SOIL EVALUATOR: C2 4 w e5:
Intended Use of Land: Residential Subdivision le Family Home Commercial
Is This:
Repair Testing:
Undeveloped lot testing: X
In the Lake Cochichewick Watershed? Yes
No X
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic }dans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the
BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board
of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
APR 2 0
Please Do Not Write Below This Line
N.A. Conservation Commission
Date Received: Check Amount: Check Date:
i | |
Maly-05-00 02:46P Paul D. Turbide, PE PLS 978-465-0313 P.02
t-7
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 Osgood Street `t =4s�• •�''�
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.9542 — FAX
Public Health Director E -Mail: healthdept@townofnorthandover.com
Website: www.townofnorthandover.com
November 8, 2004
Mr. Joseph P. Casey
2177 Turnpike Street
North Andover, MA 01845
RE: Notice of Board of Health Decision
Dear Mr. Casey:
This letter is in regard to your property at 2177 Turnpike Street. As the owner or trustee of this property, it is
important that you understand the current situation at this site.
On October 21, 2004 the Health Department received a letter from you regarding a requested proposal to install an
abbreviated sewage disposal system for a 12 -month period. The following decision was made by the Board of
Health members at the October 28, 2004 meeting:
Ms. Barczak states that the homeowner needs to stay somewhere for 6 months, or longer, until the
sewer connection is ready and available. The Board of Health does not have a variance for this type
of situation. What was requested is something that the Board of Health is not allowed to grant, and
the Board needs to adhere to the state sanitary code. Therefore, the North Andover Board of
Health is unable to approve your request for an abbreviated sewage disposal system.
If you have any further questions, please contact us at the above number or via e-mail. Thank you for your
cooperation in this matter.
/Sincerel Sawyer, HS, RS
Public Health Director
Cc File
Post Office Box 428
Wilmington, MA 01887
October 21, 2004
Town of North Andover
Health Department
27 Charles Street
North Andover, MA 01845
ATTN: Ms. Susan Y. Sawyer, REHS/RS,
Public Health Director
OCT 21 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
RE: 2177 Turnpike Street -Disposal Works Permit No. BHP 2004 0672
Dear Ms. Sawyer:
I hereby request that the Board of Health entertain my proposal to install an
abbreviated sewage disposal system at the above captioned under -construction home
owned by me..
An extension of the public sewer is slated to be installed along the frontage of my
property by North Point Development within the next 12 months. North Andover Water
and Sewer Superintendent Tim Willett has indicated that he will direct the contractor of such
sewer line to include a lateral stub to my property at the time of construction. The house
construction is 70% complete with occupancy possible by December. In the interim
installation of the on site system as designed will require not only a large expenditure which
will only be utilized for only a short time, but more importantly, the removal of mature trees
and landscape which now provide the property with a buffer to Route 114 and help
maintain the natural slope on which they grow will be disturbed. Financially, ecologically, and
environmentally it makes sense to seek an alternative.
I have been informed that a so called "tight -tank" to store waste is not allowed. I
would then propose in the interim that an abbreviated on site system be allowed, using all
the components of the approved system, but with only one leaching trench installed. (see
highlighted septic design) This configuration would allow for a functional interim system, while
maintaining a simple transition to public sewer, or, worst case, if necessary, completetion of
the original design.
The performance of this approach could be guaranteed by a deed restriction which
would mandate either tie in to the municipal system or installation of the original design within
one year of occupancy.
I respectfully urge the Board to consider this proposal. Given the time of year
approaching, it will be necessary for me to go forward one way or the other very soon.
S
Joseph P. Casey. ---
TELEPHONE: 978-988-0001
TOWN OF NORTH ANDOVER °t �10R7k 1
Office of COMMUNITY DEVELOPMENT AND SERVICES
s e�.,, M. •e u
0 y �
HEALTH DEPARTMENT
. w
27 CHARLES STREET
NORTH ANDOVER MASSACHUSETTS 01845 "SS��►+,S�t
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
healthdepta, townofnorthandover.com
w,A-AI. t ownofnorthandove r. com
Joseph Casey
PO Box 428
Wilmington, MA 01887
September 9, 2004
Dear Mr. Casey,
This correspondence is in response to your request for information regarding the status of your septic design for
2177 (previously Lot C) Turnpike Street, North Andover. The septic design for your property was approved on
12/12100. According to Title V, approvals are good for three years from the date approved, unless a disposal works
construction permit has been issued or a one-year extension to the plan has been granted.
A review of the property's file indicates that a well installation permit and a building permit were applied for and
granted in the fall of 2003. During our conversation, it was clear that you felt that time was not a factor since the
construction on the house had commenced within the three years. Unfortunately, at that time it would have been
appropriate to have your installer apply for the disposal works construction permit as well. Conversations held with
you and with the Board of Health Chairman have determined that due to improper information supplied to you, you
inadvertently let your three-year septic approval expire. As it was and still is a general practice to allow a
homeowner to receive the one year extension, and due to your issue with time constraints, the Board Chairman has
sanctioned the granting of the one year extension of the septic plan.
This extension will expire December 12, 2004. A licensed installer, prior to that time, must apply for the disposal
works construction permit or the plan will become invalid. A complete list of currently licensed installers has been
included with this letter. Thank you for your cooperation in this matter.
Sincere
Sawyer,
Public Health Director
NUMBER FEE
108.0 / Lot 66 COMMONWEALTH OF MASSACHUSETTS $125.00
North Andover
Board of Health jj
R" C
CASEY, JOSEPH P & ALICE J CASEY
------------------------------------------------------------------------------------------------------------------------
NAME
0 TURNPIKE STREET
----------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires ________________ July 28,-2004 ----------------- unless sooner suspended or revoked.
------------------------------------------------------
July 28, 2003
---- ----- Board
-------------- -----` of
------------- -- -N,
---------------------------------- Health
-----------------------------------
i
APR -28-2005 11:41 AM CHARLES M ROLLINS CO. 9TS 887 9491 P.01
AW -10
66 LITTLETON ROAD, WESTFORD, MA 01886 V (976) 592-8395 FAX (978) 882-0023 t�tivut>ga• �o
Repelt Numbw, 91156 Report J)do: 4/28/OS
OWN: Sfftttplo ml�8tiou:
Ax caMcy
CRA Cnnsmillm 2177 Turmmkc 3t.
200 kftrscm Bt, Suite 105 N. Andover MA
W11miu6Con MA 0.1887
Sampled by: C.M. Hollins vete Received: 412&/OS Dow Satnplod: 4/26/05
'csl PAt910dar FPA 1-iIDi
Tots! Coliform M) 0 0
Cecal Conform (P) AbsLml Absent
E.tnll Abrcnt Omit
Px.T100m1
pffl•olhnl
pet 1001u1
RECEIVED
APR 2 9 2005
TOWN Cir NQRTH ANDOVER
HEALTH DEPARTMENT
This water ample at submitted, meele all Rtatc, Local and Federstl (SPA) t`8**U=% fW C0100M Rfr W00 -
Mau achusutte ce Mention 0 MA048
iet P. Cxrlecm. I'tn
fh0nUAse4 lAboratory Inc
LOO/ 100*4 96$08 masmal6t10Hl EZOOZ69OLS Lo m SOOZ1921AYN
-tjbVVN GF
OF
i LAU�
iQG
BO D OF' 11tALTH
NORTH ANDOVER, MASS.
`APPLICATION FOR WELL AND PUMP PERMIT
Z 7
Permit # Date �(� / - G 3
A permit is requested to: drill a well ✓'`; install a pump!
LOCATION: Lot # 6 L
Owner Address aa. -1 Tel
Well Contrctr � L� J,:��,Add. MA Tel /-2.32 -d'
Pump Contrctr JAAe, Add. Tel
tatdrdrde**dr**de.devt***de*dede,de devFdedeerde*de do*de****de*de*dr*iekk*de de dr*kk*deF de de do*delle**.de*deck***
WELLS (To be completed at'time of pump test.)
Type of well 4Use •
Diameter of.well Size of casing
77,
Depth of bed rock /oC "% Depth .casing into bedrock mac.
Seal been tested?" Yes . (') ' No' (_) Date of test 7
Depth of well Water -bearing rock
—r
Depth to water 1 Delivers -2� GPM for ! / %S•
(how long?)
Drawdown feet.after,pumping Y hours at GP
Date of completion
Signatu e of well contractor
PUMPS (To be filled in before installation.) (�
Name & size of pump ��-�S Z i-� �i Type
(a ,ntiTi� �,•
Size of tankPump delivers t GPM
Pipe used in well: Cast iron (_)
Galvanized (_)
Sleeve used to protect pipe? Yves (_) No
Date
Signa u
Plastic (%,:f)
(�C) TypUwe seal UR KQP
e of pump installer
Date water analysis report submitted to Board of Health ; 0
Plumbing inspector
Wiring inspector
Board of'Health
TOWN OF NORTH ANDOVER
HEALTH' DEPARTMENT
27 CHARLES STREET
NORTH ANDOVER, -MASSACHUSETTS 01845
•
Sandra Starr
Public Health Director
.`•4•�
o
sACHUS
Telephone (978) 688-9540
FAX (978) 688-9542
Applications, fora permit; to; drill, a well:
Before a permit can be issued, `you must have your contractor submit the
following:
1. Submit to the Health_Department a site"plan showing your house footprint
and location on the lot
2. Indicate any wetlands within 200 feet of the proposed location for the well
3. Indicate the well location' i' , —."
4. Submit a check for $125.00 with the application
Note: All submittals must be drawn` to'scdle. " Please note that you may also be
required to file with the, Conservation,.Commission)if wetlands are_near_.to the.
proposed well, and�to the Planning Board if you are located,in the Watershed
District.
.*****,Please turn over•to fill..out.application .*****
CADocuments and Settings\pdellechWy Documents\Wells\Well Drill Applications.doc 2003
Massachusetts Department of Environmental Management 122780
Office of Water Resources
TYPE OR PRINT ONLY Well Completion Report
. WELL LOCATION TGPs (OPTIONAL) LATITUDE LONGITUDE
Address at Well Location: O lti LJl_ �/� Property Owner: zo
Subdivision: Name: Mailing Address:
City/Town: City/Town: ZM
Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available
Board of Health permit obtained: Yes C Not Required ❑ Permit Number Date Issued
2. WORK PERFORMED
3. PR POSED USE
4, DRI ING METHOD
U'New Well EJAbandon
omestic ❑Irrigation
❑ Cable . ❑ Auger
❑ Deepen ❑ Recondition
❑ Monitoring ❑ MunicipalIr
Hammer ^❑ Direct Push
❑ Replace ❑ Other
❑ Industrial ❑ Other
E?I.jMud Rotary,, ❑ Other
5. WELL LOG M
Unconsolidated
Consolidated
6. SITE
SKETCH (Use Permanent landmarks withAstances)
Permeability
a
m
iu
L 1.1
W
Qs
From (ft) To (ft)
HighLow
`o
co
0
m
Other
Rock Type
f
v
S"Q�t
t2- d
7. WELL CONSTRUC'TI'ON
8. CASING
Total Depth Drilled
From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type
30
Date Drilling Complete
9. SCREEN
From (ft) To (ft) Slot SizeScreen Type and Material Screen Diameter
.10. FILTER PACK / GROUT / ABANDONMENT MATERIAL
11. ADDITIONAL WELL INFORMATION
Developed? TK Yes ❑ No
From (ft) To (ft) Material Description Purpose
Fracture
Enhancement? �9 Yes ❑ No
'
C-,
Method
Disinfected? ER�Yes ❑ No
12. WELL TEST DATA (PRODUCTION WELLS)
13. STATIC WATER LEVEL
(ALL WELLS)
Yield-,' .Time Pumped Drawdown to Time Recovery to
Depth Below
Date Method (GPM) (hrs & min) /(Ft. BGS) , (hrs & min) (Ft. BGS)
Date Measured
Ground Surface (FT)
14. PERMANENT PUMP (IF AVAILABLE) _
15. NAMEJADDRFSS OF PUMP INSTALLATION;COMPANY
Pump Description uvpS; - 75, �(304feilir e, Horsepower z'
y„" 0UL-;l1S eo a1C•
Z AA ,
Pump Intake Depth (ft) Nominal Pump Capacity — (gpm)
16. COMMENTS
17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this report is complete and)con: to the best of my knowledge.
Driller:` L� ��S Supervising Driller Signature:' Registration #:�
b r � _ q
Firm:Date: Rig Permit #:
NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
BOARD OF HEALTH COPY
08/14/2003 11;26 978692,0023
66 LITTLETON ROAD, WESTFORD, MA 01866
{ Report Number 75761
r
' Client:
j".
THORSTENSEN LAB
PAGE 01
(978) 692-8396 FAX(978)692-0023 1.800 -649 -TEST
Report Date: 8/14/03
Sample Information:
Joseph Casey
Lot 66 Turnpike Rd.
65 Federal St.
N. Andover MA
W ihuington MA 01887
Sampled by: CM Rollins
Certificate
Date Received: 8/12/03 Date Sampled: 8/12/03
-of Aml,Ysis
TesPara m.etcT
EPA Limit
Results
Units
Total Coliform (P)
0
# 10
perI00ml
Fecal ColifornV B.coh (P)
Absent
# Present
per100m1
Calcium
Not Spec.
115
mg/L
s'
Copper (S)
1.3
0.03
mg/L
Iron (S)
0.3
# 1.7
mg/L
Magnesium
Not Spec.
11.7
mg/L
Manganese (S)
0.05
0.05
mg/L
Potassium
Not Spec.
3.1
mg/L
Sodium
See Note
82.8
mg/L
i
Alkalinity (S)
Not Spee.
103
mg/L.
Ammonia -N
Not Spec.
<0.03
mg/L
j
Chloride (S)
250
# 358
mg/L
Chlorine
Not Spec.
<0.02
mg/L
Color (S)
15
# 150
CPU
ConductrvtY i
No Spec.
Not l�
550
umhos/cm
Hardness
Not Spec.
335
mg/L
9
Nitrate -N (P)
10
0.73
mg/L
Nitrite -N (P)
1
<0.01
mg/L,
Odor
3
0
TON
pH (S)
6.5-8.5
7.7
SU
Sulphate (S)
250
19.3
mg/L
Turbidity
Not Spec.
37
NTU
Sediment
pos/neg
neg
Legends:
(P)=Primary EPA Standard, (S) -Secondary EPA Standard, #Exceeds EPA Limit,
TNTC=Too Numerous to Count, *=Background
Bacteria Noted,' = Exceeds Advisory Limit
Sodium Advisory Limits, Mass. --20, NH -250.
This water sample as submitted, has failed one or more
primary EPA standards as denoted by the
# sign, and is considered UNSAFE for
human consumption.
Massachusetts Certification # MA048
Michael P. Carlson, for
Thorstensen Laboratory Inc.
f .
08/19/2003 09:18 9786920023
AM
66 LITTLETON ROAD, WESTFORD, MA 01$86
Report Number 75889
Client:
Joseph Casey
65 Federal St
Wl1.Tn1ua.gtoll MA 01887
Sampled by: C.M. Rollins Date Received: 8/15/03
ertifi
Ccate of AiWysjs
THORSTENSEN LAE
PAGE 01
(978) 692-8395 FAX(978)692-0023 1.800 -649 -TEST
Report Date: 8/18/03
Sample Information:
Lot 66 Turnpike Rd
N. Andover, MA
Date Sampled: 8/14/03
Test Pztra!7teter EPA Limit RuQi Units
Iotal. Coli.l'onn (P) 0 0 per 100ml
Fecal Coliform (P) Absent Absent per 100ml
'6 -coli Absent Absent per100m1
This Water sample as submitted, meets all State, Local and Federal (EPA) requir=ents for Coliform Bacteria.
Massachusetts Certification # MA048
// 6 4;
- /' &I le", �
Michael P. Carlson, for
Thorstensen Laboratory Inc.
Zn7
Town of North Andover
Office of the Health Department
Community Development and Services Division
William J. Scott, Division Director
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
December 12, 2000
Joseph Serwatka
31 Kendrick Street
Lawrence, MA 01841
Re: Lot 66 Turnpike Street
Dear Joseph:
Telephone (978) 688-9540
Fax(978)688-9542
This is to notify you that the revised plans dated 12/8/00 for the new construction of Lot
66 Turnpike Street have been approved.
If you have any questions, please do not hesitate to call the Board of Health Office at
978-688-9540.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
SS/smc
cc: Casey
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
� QD
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