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Miscellaneous - 22 RALEIGH TAVERN LANE 4/30/2018 (2)
22 RALEIGH WERN LANE Lane 210/107.A-01040000.0 V " t -. i NOTICE OF VARIANCE/DEED RESTRICTION 1 � Pursuant to 310 CMR 15.000 Title 5, and as a condition of the North Andover Board of Health Design Approval For Soil Absorption Sewage Disposal System Permit # 1118, dated June 2, 2000, notice is hereby given that real estate located at 22 Raleigh Tavern Lane,North Andover, Massachusetts, as described in a deed from James M. Beveridge and Sally R. Beveridge to Joseph M. Harb and Theresa E. Harb, dated May 2, 1977, and recorded in the Essex County Registry of Deeds in Book 1307 and Page 96, is the subject of a variance under 310 CMR 15.405(1)(i) from the Town of North Andover to permit the separation to groundwater to be 3 feet instead of 4. Said variance limits any increase in the design flow of the building and limits the maximum number of bedrooms to three. This variance is within the jurisdiction of the North Andover Board of Health. °°® Signed and sealed this 6th day of June, 2000. seph A Harb f heresa E. Harb �_ COMMONWEALTH OF MASSACHUSETTS Essex, ss. June 6, 2000 Then personally appeared the above named Joseph M. Harb and Theresa E. Harb and acknowledged the foregoing instrument to be their free act and deed, before me, / Robert D. Harb-Notary Public My Commission Expires: 12/22/06 ooti-har f � 1 JUx' 6 r . � ESSEX NORTH REGISTRY OF DEEDS LAWRENCE., MASS. air-o0o A TRUE COPY: ATTE REGIS? R OF OEM K, Lot & Street �o�} ����c,�'Z ZlVel-1) lZa Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# /// Plan Approval: Date: &le-106 Approved by: Designer: 0) , DU rf,& n e Plan Date: Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Dafe Approved Bacteria I Date Approve Bacteria 11 Date Approved ' Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO 19 Qo^ m Pm bo ny z . ds tow-e>5 , FINAL BOARD OF HEALTH APPROVAL: Q�rectan ¢ le4GA DATE: 3, P f4 210 APPROVED BY: • `/• no pert_ 70 'J'j cc f i SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEWAIR New Construction: Certified Plot Plan Review YES -0 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: NO Excavation Inspection: Needed: Passed: kl/7,109 / / -, 7 - ---- By: -;7 L// - - Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: �i O� By: Final Grading Approval: Date: p By: _ Final Construction Approval: Date: ABy: Certificate of Compliance: Approval: Date: 2b �v Commonwealth of Massachusetts Title, 5 Official Inspection Form )z;lrs Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �l ✓ 22 Raleigh Tavem Lane ( 91 Property Address OA ,!A Priva Ravindran p Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information RECEIVED When filling out forms on the computer,use 1. Inspector: AUG 2 4 2015 � - only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector ` Use the return HEALTH DEPARTMENT key. Bateson Enterprises Inc. Company Name VQ 111 Argilla Road Company Address Andover MA 01810 reua City/Town State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification 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 8/20/2015 Inspect is glignatureU 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 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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•Pape 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane ,p Property Address Pdva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavem Lane Property Address Pdva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is.less than 6" below invert or available volume is less than %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence Of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone li of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown 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) ® ❑ 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallonsper day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Tittle 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped Jan. 2015,owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Pdva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 15 years old, 6-23-2000, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.8 feet Material of construction: 0 cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet .Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast Iron through wall, 3"Cast Iron in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 0.3 feet Material of construction: ® concrete ❑ metal ❑ 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 5'x 4' Sludge depth: 1" t5ins•3113 Title 5 Official Inspection Form:Subsurfaoe Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavem Lane Property Address Pdva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown 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 32" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser to grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owners Name information is North Andover required for MA 01845 8/20/2015 every 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 El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: 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 A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every 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 0 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.): D-box level&distribution equal, has flow equalizers. No evidence of leakage. No evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . ' 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owners Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown 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: 1 bed 30'x 34' ❑ 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.): Soil Ok.Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must.be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name information is required for North Andover MA 01845 8/20/2015 every page. Cityrrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Pdva Ravindran Owner Owner's Name information is North Andover required for MA 01845 8/20/2015 every page.. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately tD,(\v 144" Q,<30'f3a8`t t 3u 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 22 Raleigh Tavem Lane Property Address Priva Ravindran Owner Owner's Name information fo is North Andover required for MA 01845 8/20/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 3 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: 3-17-2000 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan test pit data. Local approval for 3'separation Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official ' lnspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 22 Raleigh Tavern Lane Property Address Priva Ravindran Owner Owner's Name formation is North Andover required for MA 01845 8/20/2015 every page. Cityrrown 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 Summary Record Card generated on 8113/2015 2:48:05 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-107.A-0104-0000.0 Parcel Id 17929 22 RALEIGH TAVERN LANE THIRUMAL THANIGAIVELAN 22 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zonin93 1 Residential Size Total 1.03 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until THIRUMAL THANIGAIVELAN Owner 22 RALEIGH TAVERN LANE NORTH ANDOVER,MA 01845 COURNOYER,ERIN Previous Customer Inactive 6/26/2007 22 RALEIGH TAVERN LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14209.0-22 RALEIGH TAVERN LANE Last Billing Date 6/4/2015 2100205 02 Cycle 02 Active UB Services Maint. Account No.2100205 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 72.20 /1 UB Meter Maintenance Account No.2100205 Serial No Status Location Brand Type Size YTD Cons 33530246 a Active ERT HH b Badger w Water 0.63 0.63 629 Date Reading Code Consumption Posted Date Variance 8/4/2015 733 a Actual 23 18% 5/4/2015 710 a Actual 19 6/22/2015 -19% 2/3/2015 691 a Actual 24 3/20/2015 -15% 11/3/2014 667 aActual 29 12/15/2014 13% 8/1/2014 638 a Actual 24 9/11/2014 _3% 5/5/2014 614 a Actual 25 6/12/2014 33% 2/4/2014 589 a Actual 20 3/17/2014 -21% 10/31/2013 569 aActual 24 12/20/2013 28% 8/1/2013 545 aActual 19 9/18/2013 -5% 5/1/2013 526 aActual 18 6/18/2013 3% 2/7/2013 508 a Actual 21 3/13/2013 -15% 10/30/2012 487 a Actual 22 12/13/2012 -16% 8/2/2012 465 a Actual 27 9/26/2012 39% 5/2/2012 438 a Actual 19 6/20/2012 -24% 2/2/2012 419 a Actual 26 3/14/2012 6% 11/1/2011 393 aActual 24 12/15/2011 28% 8/2/2011 369 a Actual 19 9/14/2011 0% 5/2/2011 350 a Actual 18 6/13/2011 _24% 2/4/2011 332 a Actual 26 3/15/2011 0% 4 11/1/2010 306 aActual 35 12/13/2010 -30% 8/3/2010 271 a Actual 24 9/13/2010 19% 5/3!2010 247 a Actual 28 6/9/2010 _7% 2/1/2010 219 aActual 30 3/11/2010 88% 11/2/2009 189 aActual 16 12/11/2009 _19% 8/3/2009 173 aActual 19 9/11/2009 13% 5/7/2009 154 a Actual 18 6/16/2009 45% Commonwealth of Massachusetts City/Town of System Pumping-Record r- 23,201 .W Form 4 To' <..,_...._ 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.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location• eft Righ# ont of Nous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Righ on of building, Left/Right rear of building, Under deck Address City/Town V l State Zip Code V 2. System Owner. ` � � � Name c—\ Address(if different from location) Citylrown State Z' Code Telephone Number 3 Il B. Pumping Record 1. Date of Pumping D 2. Quantity Pumped: � Gallons 3. Type of system. ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas 9-146' If yes,was it cleaned? ❑ Yes ❑ No. 5. Condition of Shystem, c ., 6. System Pumped By: Neil.Bateson F5821 Name Vehicle Uoense Number Bateson Enterprises Inc Company 7. Location where contents were disposed: d L S.- Lowell Waste Water Sign ji-taulerV Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 t ,�3 1 1,6,. Y !) i i t • t s F t,x� t��i�r�e r��^�.i �t ;IFt I. �;22as u r�k � tf c r ' r fi��. t•t xiro°Tt i�tY t}ri��v a ��{+3,.�Y��, l N}.1,9 Ai Sit lr,x Y A 1 r Fcs. Vis.,. /;ti 1;3t &tx oAf! �, #tt1t,�` •r�H�si„�llrtt��_ f i _ r !' rt$}�� t r ' 1 - r ! m k -!r t fy r r :Y•iY Cr �� } t Y �a,.s '} u ! t e }tt N� db f �tif!� " e '4+�'�'``• 3I. – .� !! Y tai)t }.11t ti t� ! i�.is }x• $}ii{Ltt y, ii rit 'j'XC i t' Z' OF 1 t ktkrt i t 17 t it r 1i t�yf.t } i r slit "�'�� --� 1zNQ � � T j, IF i a i t .•Aa lxtx r� 1 i:F t, � �!w 7 Y � I t#!( i A!r 4 u f N ri r-it �p — fh1 7 7 ✓�I J G��ipJ�/` tt i 's int°7 1h i! iia r t i,.` itf i+` ,� ni �---- t IR i t j I; t k i DIVERSIFIED CIVIL ENGINEERING March 8, 2000 Mr. Gayton Osgood, Chairman North Andover Board of Health Town Hall Annex 146 Main Street North Andover, MA 01845 Re: 22 Raleigh Tavern Road,North Andover,MA Sewage Disposal System Up-grade Dear Mr. Osgood: Please find attached to this letter two copies of the soils testing data and Particle Size Analysis for the above referenced property. A percolation test could not be conducted at the time of the soils testing on February 10, 2000 due to groundwater interference. As such, a soil sample was taken and sent to Geotechnical Services, Inc., Haverhill, MA for a Particle Size Analysis in conformance with DEP Policy BRP/DWM/PeP-P00-1, Title 5 Alternative to Percolation Testing Policy. As such, Please regard this letter as a formal request to grant the following variance. A variance is hereby requested from 310 CMR 15.104(4)to allow the use of a Particle Size Analysis to determine a percolation rate instead of the required percolation test per area. Based on the Particle Size Analysis, the soil type is a sandy loam, a class H soil. The on-site soil evaluation determined the soil to be uncompacted. Based on these criteria, an Effluent Loading Rate of 0.33 gpd/sf shall be utilized for the design of the soil absorption system. This loading rate corresponds to a percolation rate established in 310 CMR 15.242 of 30 minutes per inch. Soils testing conducted for the design of the original system in 1968 (attached herewith) obtained a percolation rate of 6 minutes per inch. We request to be placed on the North Andover Board of Health agenda for the next meeting to be held on Thursday,March 23, 2000 at 7:30 PM for your consideration of the variance requested. We will be in attendance to answer any questions the Board may have. Thank you for your time and fair consideration. Very Truly Yours, DIVERSIFIED CIVIL ENGINEERING Kirk FitzPatrick, E.I.T. Cc: Joseph& Theresa Harb, 22 Raleigh Tavern Road,North Andover, MA 01845 P.O. Box 890.359 Littleton Road,Westford, MA 01886 • Tel. (978) 692-0939 • FAX (978)692-5339 PARTICLE SIZE DISTRIBUTION TEST REPORT c S 100 90 111111 80 ' 0 , I ,. I; I I IIf' I III ! I! hi w I ! I I! 1 1! ! ! W g0 z i Z 50 w W 40 ! I If III II ! ! 30 ! � I it � it I , •��j I l i � i ! �1 N11 20 NV i I . T 10 1 I I 1 II 1 I 1 I I I I I I I I I i I ( �.:'• If 01 Soo 100 10 1 0.1 0.01 0.001 GRAIN SIZE-mm %+3" %GRAVEL %SAND `/.FINES CRS. FINE CRS. MEDIUM FINE SILT CLAY 0.0 0.0 20.7 23.8 8.9 18.7 20.2 7.7 SIEVE PERCENT SPEC! PASS? Soil Description SIZE FINER PERCENT (X=NO) coarse to fine SAND,some Gravel,some Silt,trace clay. 6 in. 100.0 USDA Clasification-Sandy loam 3 in. 100.0 2 in. 100. 1.5 in. 100.0 Atterberg Limits 1 in. 100.0 PL= LL= PI= .75 in. 100.0 5 in. 100.0 Coefficients 375#4n. 96.3 D 5.73 D 50 2.57 D 0.618 #8 58.1 #4 79.3 D853Q= 0.0880 15-=Dom0.0175 D10= 0.0097 #10 55.5 Cu- 265.22 Cc= 0.31 #16 53.6 #40 46.6 Classiflcation #50 43.2 USCS= SM AASHTO= A-2-4(0) #100 35.5 #200 27.9 Remarks #270 23.7 No specification given. * (no specification provided) Sample Ill L-173-00 Source of Sample: 22 Raleigh Thoreen Rd. Date: 3/6/00 . Location: N.Andover MA Elev./Depth: Client: Diversified Civil Engineering GEOTECHNICAL SERVICES, INC. Project: llarb Project No: 200203 Plate MAR 8 , FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. 000Sc� Date: Commonwealth of Massachusetts Massachusetts !Soil Suitability Assessment for On-site :Sewa a Disposal Performed By: Date: ..A.(. ...SfT•1�. ....... I.. It.:/ ....`...« li.«{_..._....�'T»��.TCjn TI[.�q......................... Witnessed By: ........... . ................. ............... La A&=,and N: �'y,..C�o•��Z� MP 7elghws/ ZZ TZ��EiyH T/-#ve�..� 171.14 ew Construction ❑ RepairJ 9,+_ 3?Z I Office Review Published Soil Survey Available: No ❑ Yes Year Published l.`tP�..l..... Publication Scale I' !a' .... Soil. Map unit #34,..._ _... Drainage Class wc'7A- -+ Soil Limitations ......... Surfcial Geologic Report Available: No ❑ Yes ❑ Year Published r...A....... Publication Scale , GeologicMaterial (Map Unit) .......................................................................................................................... ......_�..... -- Landform ............................................................................................................................................................................................................... Flood Insurance Rate Map: Z 1a> � � ' CP- � ' SU,-5 Z,-1`1-93 Above 500 year flood boundary No ❑Yes X Within 500 year flood boundary No 2 Yes ❑ Within 100 year flood boundary No 2Yes ❑ Wetland Area: - National Wetland Inventory Map (map unit) ................................................................................................... ........... Wetlands Conservancy Program Map (map unit) .........................................._._.........................._..............__.... Current Water Resource Conditions (USGS): Month Range :Above Normal []Normal ❑Beicw Normal ❑ Other References Reviewed: MAR —8 DF3 APPROVED FORM-12107195 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 2M On-site Review Deep Hole Number Date:' �/ �'� Time:.:9 Weather �5 v•—j Y Location (identify on site plan) `-� •A •l'u Land Use Slope M 3 X, Surface Stones Vegetation r Landform ,....... n..Z .�•�.� Position on landscape (sketch on the back) Distances from: Open Water Body ti/,4 feet Drainage way 5,-DI- feet Possible Wet Area ..i5d.t feet Property Line .SC047 feet Drinking Water Well 0,J119 feet Other :.........,........:..: :::. DEEP OBSERVATION HOLE '-OG� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones. Boulders, Consistency, % 0-4-x+' �I��— a ,.�p7 Sys �i- M<►,.,y E (,�l�^!� ►N��-o'x1 Ho�T Co�tt��' Parent Material(geologic) Ti t..i.. DepthtoBedrock: Np�� s� Depth to Groundwater: Standing Water in the Hole: /Ijcna^ J�5 Weeping from Pit Face: _ is Estimated Seasonal High Ground Water: DEP APPROVED FORM-1210719S t FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. La=t(i-i ,A�vM-� i , Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole.............:.... inches Depth weeping from side of observation hole.... ... inches ® Depth to soil mottles ..46...._ inches ❑ Ground water adjustment _....._......... feet t Index Well.Number .................. Reading Date ................. Index well level Adjustment factor ................... Adjusted ground water level .................................... ................ Deoth of Naturaliv Occurrino Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _YES If not, what is the depth of naturally occurring pervious material? Certification I certify that on 19t, (date) I have passed the soil evaluator examination approved by the De artment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Sianature 11;el c Date ' 8 ae DFP APPROVED FOMI.12/07/9S FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. 00030 Date: Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment,for On-site :Sewage Disposal .._ -.... Date: 2�/o`Q. ... -� Performed B ..cr��......�.�...�.�+ �... ..._......._.......... ,rgn4,c..-r ,,.�......:.!�r-r� ,-,..z...t... ', t _....> �..�s�.,�.1 ..._.............._. Witnessed By: .......... . _......- L2Z 1zR y oacwn Addrus« r...�� •H /R VC�?..J �. Loc/ AdCress.W /op Tcic,ras, . ZZ TL/��ciyK TRve T2 . New Construction ❑ Repair J <1. 32Z I Office Review Published Soil Survey Available: No ❑ Yes Year Published 19tQ).J.... Publication Scale 1 .... Soil klap unit # ..._ _... Drainage Class �,,.�c�.a im Soil Limitations Vie ....rP.t;.�. �,...Seo.,.,......P..�7�c!���i4�r ......... Surfcial Geologic Report Available: No ❑ Yes ❑ .Year Published Publication Scale r... ....�. GeologicMaterial (Map unit) .......................................................................................................................... ......_�... -- Landform ................................................................................................................................................................................................................ Flood Insurance Rate Map: Z�� � � �'�' (r-Cv'�) :Su,-,;F Z., /-93 Above 500 year flood boundary No ❑Yes X Within 500 year flood boundary No ©Yes ❑ Within 100 year flood boundary No 2Yes ❑ Wetland Area: - National Wetland Inventory Map (map unit) .................................................................................. .............._............. Wetlands Conservancy Program Map (map unit) ........................................._._...................................... _.__.... Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belcw Normal ❑ Other References Reviewed: DEP APPROVED FORM-12107195 FORM 11 - SOIL EVALUATOR FOR(1I Page 2 of 3 Location Address or Lot leo. �� i-Gt4H Ti°►ye�� fes. On-site Review Deep Hole Number-7R...,-2_.A_ Date: Time:: .'(``AM Weather • ,L rte.,.:. ��- . ,.t1!...:......::..:. .....:.::..:. .....:.::......... ..:... .::. Location (identify on site plan) Land Use Slope M 7— Surface Stones . F_. ..... . Vegetation �iZ/�1. ::. -:n:,.,. . . :... .: . :.:.:,.:..,.. .. .:... ... .. . Landform .:.:.. . .: ; ./.�.l, :..., Position on landscape (sketch on the back) ^T?T'94-/trL-_-, .S��H Distances from: Open Water Body N1R feet Drainage way s' feet Possible Wet Area .�'t- . feet Property Line feet Drinking Water Well 6H feet Other :..:.:..:_.... .....:.: :.: DEEP OBSERVATION HOLE LOG ?1-I - 2A Depth from fSoilorizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,G au/ldders, Consistency, 0/6 121,111-g''IC LES ffdfffff 15 AT EVERY PRUF Parent Material (geologic) Tf--t-- DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: u _ Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORA1 Page 2 of 3 Location Address or Lot 140. On-site Review ori Time:.: . /.SRA'1 Weather �u��y. 3Z". Deep Hole Number .:..Z Date: -��Q�. .� Location (identify on site plan) . �.....:::.::::....�.�-c,y..�. .. 1.��Lz...N..::.::. .....::....:. .....:.::,.:...... Slope M Surface Stones . Land Use Vegetation - Landform egetation Landform Position on landscape (sketch on the back) ze 44 Distances from: Open Water Body r✓IA feet Drainage way 5f:>4- feet Possible Wet Area .SO:7t. feet Property Line feet Drinking Water Well feet Other :..:.....:,...........: :..: DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones. BouldGravelers, Consistency, % 5 j'U M1= �. A EEA LO (►V) E/hKY PROPOSED DISPOSAL AREA MINIMUM U11' f Parent Material (geologic)_ T Lt.-- DepthtoBedrock: w Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12107!95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. ;7-'2— 7; Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole.................. inches ❑ Depth weeping from side of observation hole.......... ..... inches ® Depth to soil mottles . fin__ inches ❑ Ground water adjustment ................ feet .Index Well Number .................. Reading Date .................. Index well level ........_.. Adjustment factor ................... Adjusted ground water level .................................... ................ Depth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? y&-- If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the soil evaluator examination approved by the Deprartrbent of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Sianature Date ora DEP APPROVEDFOPM-1210719S 7F H— BeHaS: 7D J Ch,ckennq Rd 5D-7E Ec.es!lla.D, 5M. H(7 Co-P�- '7D Bezon! 6C Christian Way 4H E �e $T.'�--- Be Keley Rd 7F Church 6C ........ Berry 7.81-M E Ig D, 8ll Clarendon 5D Ht; 7H Beverly 6C FalloXh BE �zL vClark 4BC 1`4mu, 7j 5:!I Be—Rd 7F Coa,.hmans La 5F F A, 7E lz.looc -L Bixby Av 5D C000lesione C,, 6E Fa Pic! GO Inns Cu IN Due Ridge Rd 5H RC Dr 3DE Farr. 7'L 4, M Blueberry Hill La 7G e Ipswich 7E 0 Colgate Or 5C Fern'rof;C,, 3G 1101--3.d�Id '-, Bonny La 3D Columbia Rd 5C F2��,,e.Av F17E living Fd 5C Booth 7G Commonwealth Av 7C Fe cod 7C Jay Ad 7G Concord 5D Fes, 13 Je'ierson 7-.Z,� `vox Ord Copley Cir 6E Fns 6C Je;:,d Lit Rd K, T Colud 7E Flagship Dr 8H Jerald Fit 41, Sec- (fc^ It Pace Z1 'GL Fo,es-�5K-N Jetwood 7� Courl 6E Fos;Rd 7E Joa-e D, 5V F00 le, 34J Johnny Cakef 7j ounam r 5D Johnson 6cF.'-i Fox Hit Rd 5EF F;anc�s 6C Johnson Gr t; EJ v ONI,-L-�?p DEER Me Kara Or 7G vp Franklin 6D Kenwood 7C 0 French Farm Rd 3C Kieran Rd 61, 0 Fuller Rd 1i K.noston 7E.8-, F AY A.. Meadow Rd 5j K,11�10ge Rd 5, 5 Furber Av SC Laconia C,, M Garden 6CLacy, 4M WINTE Gibson C1 7.80 Uiavelte Av 5,1 ��REEN DR. G��bet 6C Lancaster R.- z.5,ij &U Gilman La 7j Lexington 5D to Glen RC 6F Leyden 7E G,encres!Dr 3G Leycon 8cG cl) Glenwood 7C Liberty 5N Grafton 7E Lincoln 6D Granville La 6K Lincten Av 6,70 z Grapevine Act 5H Lisa La 7G Little Rd 6C 'JEST W A Y3T1% Longwood Av 717 0 Lorraine Av 7EF D Los:Pond La 31 Lyman Rd 6C Lyons Way 7Lt,4 '9"?/(TIFDGES Magnolia Rd 6D 1\1 D V E -A ;,NCASTER C RIDGE lk i, �O0gv�P,5 I. - ;j C ANOX-S < ceod,, P0, ItFD ILHAD $T ES LA.RD. Z c,;XL E M I ST )COACH DR.. -7 r B ,11SH EASY 3. IC,—ST r- N LE—LA A'47 N SA El, jo ltNNe- A 1ONfLA) ` 4 / � T "lid w( w IAN UU 0 1fose ..t, P CD Middleton :1) ,,,Dso�p PE, See Map on Page 219-21 10 10 TUCKER RM RD. Boston 0 Z O CN 03 J2ST - Cn vk1l H CK LA C) cl) UniversalO Publishing Co., Inc. Andover SAL le p on Page 34-35 H J K LSE, Ifil 11[flirt t C91 1191 Ittlilt I[Ff I f9ftE Err E F Frrrp FF.Prrrrrprir.r. ------------- --------------- °r '� \ ,;\ \: - ,�-•i�( I�<,.� ���o) /`-, j1 :ma•. p �I � �,I��-�'Df�i� •�' o os{ � r l/. 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Turbide, PE PLS 978-465-0313 P.03 ............ _ - _ A. { i In ' 1 a o f r a • k i H ' i • �r �''� ` �► rr rp r n CUM 1�Lr�` ' '^ �►� ' it7i1�N71® • f I i - y► J / ? r • r . _ • 1 Feb-10-00 05: 11P Paul D. Turbide, PE/PLS 978-465-0313 P.01 Facsimile Cover Sheet To: SANDRA STARR Company: NORTH ANDOVER BOH Phone: 978-688-9540 Fax: 978-688-9542 From: Carlton A. Brown Company: Port Engineering Associates, Inc. Phone: (978) 465-8594 Fax: (978) 465-0313 Date Feb 10, 2000 Pages Including This Cover Page: 5 Comments: Sandy, Enclosed are the perc results for 22 Raleigh Tavern and 146 Olympic. Note that for 22 Raleigh Tavern, the groundwater was in the C layer and thus a percolation test could not be performed. The C layer was a sandy loam almost to a loamy sand but was saturated. The soil is not firm and had a mushy consistancy when the backhoe cast the soil into the pile. I have personally performed dewatered tests, and it is my opinion that this site would not be conducive to dewatering because the soil is not firm. Kirk Fitzpatrick took a representative sample to have a certified soils lab analyze the soil to estimate a percolation rate as per the DEP written guidelines entitled Guidance on Maximum Feasible Compliance. Call me if you have any questions or comments an this. There was also a stump that had been buried and which was dug up in TH-2, however there was the same soil under the stump as in the rest of TH-1 and TH-2. My recommendation would be that any stumps(if there are any more)must be removed and proper fill replaced. Thanks, Carlton NORTH ANDOVER BOARD OF HEALTH AUTHORIZATION FOR SOIL TESTS LOCATION ENGINEER TEL# PAID DATE TO PORT 22 Raleigh Tavern Lane Kirk Fitzpatrick 978-686-4200 Yes February 1,2000 Peter Parent Carlton, This is a repair and the Board of Health wants you to assess the weather and ground conditions and do the testing when it's appropriate in the best interests of the septic system. Call if you have any questions. Sandy FAX TO: Port Engineering, Carlton Brown Fax#: 978465-0313 FROM: North Andover Board of Health, Sandy Starr Tel. # 978-688-9540 TB test was submitted, conditional upon the pertinent establishment passing inspection. Gayton Osgood proposed that in the future the licensing of massage therapists should be done administratively. This was discussed and the following action taken. On a motion by Dr. MacMillan, seconded by Gayton Osgood, the Board voted to have the Health Administrator license massage therapists in the future. Dr. MacMillan will review the medical histories and candidates will be required to appear before the Board only if there is a problem. RECOMMENDATION OF THE ANIMAL INSPECTOR Ms. Starr stated that she had spoken to Dr. Atwood and he is insterested in being reappointed Animal Inspector. On a motion by Dr. MacMillan, seconded by Gayton Osgood,the Board voted to recommend the reappointment of Dr. Atwood as Town Animal Inspector. 1591 OSGOOD STREET- DISCUSSION Ms. Starr updated the Board on the recent correspondence from the owner's representative, Thomas Phalen,Jr., concerning the installation of a grease trap at 1591 Osgood Street. Discussion ensued. The Board requested that a letter be sent to Mr. Chris Adams, owner of the property, stating that the previous vote of the Board of Health on January 27, 1999 concerning the installation of a grease trap stands as voted, that DEP concurs, that a plan will be required for the grease trap installation, and that if variances for technical issues only are required, then the owner should come to the Board. BOARD OF HEALTH ACTION PLAN There was some discussion concerning the draft of the action plan prepared by SIS. Starr. The Board expr1z; Upraise for-he draft and recommended that the plan be completed and reviewed, after which it could be submitted to the Town Manager. ADJOURNMENT On a motion by Dr. MacMillan, seconded by Gayton Osgood,the Board voted unanimously to admurn the meeting at 7.45 P.M. J January 5 , 2000 Board of Health 27 Charles Street North Andover, 01845 Dear Members of The Board We, the undersigned, own property at 22 Raleigh Tavern Lane,North Andover. It is a single family home located in a residential neighborhood. We have been living at this address for the past 21 years. The home is thirty years old and we are the subsequent owners. The original septic system was installed at the time the home was built (records show 1969). We have had Diversified Engineering look at the system as well as Bateson Enterprises Inc. Neil Bateson has pumped out this system once a year since we purchased the property. Both have stated it would not pass Title V because of the wet and saturated area surrounding the leatchfield which is an indication that the system is failing. Please be aware that several of our neighbors have sold within the past two years and have had to replace their systems. In the event of a future sale of our home, we feel replacement of our system would be inevitable, therefore, we would like to start the proceedings as soon as possible. Due to the above-mentioned reasons, we request to be placed on the agenda for the next meeting scheduled for Thursday, January 27"' at 7:00 pm to discuss seeking a variance on the local regulation pertaining to soil testing at 22 Raleigh Tavern Lane. Thank you in advance for your consideration of our request. Sincerely, 'YqP4,141, ' # Joseph M. Harb 1h/ rb JMH:TEH cc: Peter Parent Diversified Engineering i JAN 6 ?C�0 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 6/26/00 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by Todd Bateson at 22 Raleigh Tavern Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector e NORTh Town Of North Andover ►°.3? •� '�•� °p William J. Scott Community Development & Services 27 Charles Street Director * (978) 688-9531 -==�•�,'''' North Andover, Massachusetts 01845 cHus�� Fax 978-688-9542 May 4, 2000 Joseph Harb Board of 22 Raleigh Tavern Lane Appeals North Andover, MA 01845 (978) 688-9541 Re: Variances for 22 Raleigh Tavern Lane Building Department Dear Mr. Harb: (978) 688-9545 This letter is to confirm that at their regularly scheduled meeting on April 27, Conservation 2000, the North Andover Board of Health granted the following variances for the Department septic system repair at the above referenced property: (978) 688-9530 1. A variance under 310 CMR 15.405(1)(i) to permit the separation to Health groundwater to be 3 feet instead of 4 feet. Department 2. A variance from 310 CMR 15.104(4)to allow the use of the Particle Size (978) 688-9540 Analysis to determine the percolation rate. Public Health Please note that a restriction is required to be placed on the deed to limit Nurse expansion of the dwelling because of the size of the septic stem and variance (978) 688-9543 P g P Y number one. If you have any questions regarding this letter, please call the office Planning at 978-688-9540. Department (978) 688-9535 Sincerely, Sandra Starr,R.S., C.H.O. Health Director Cc: W. Dufresne DEP File Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTH c� r_fl &ORTH • 3: a R.`.. ..e L O 9 F .•' DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHUStit Applicant ADDRESS TELEPHONE • NAME - /�� Site Location onstruct or CRepair ( Individual Soil Absorption Permission is hereby granted to ( Sewage Disposal System as shown on the Design Approval S.S. No. HAIRM N, BOARD OF HEALTH D.W.C. No. Fee INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at C C� VA4 - relative to the application of P60J dated 0 for plans by14rr,7"O-J ,&&I and dated with revisions dated I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed—generally first inspection unless there is a retaining wail which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my.company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation-or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi a Licensed Septic Installer i y Date: COMMONWEALTH OF MASSACHUSETTS A F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS � d 6EPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional Office v0 ARGEO PAUL CELLUCCI BOB DURAND Governor Secretary JANE SWIFT LAUREN A.LISS Lieutenant Governor � Commissioner May 23, 2000 Joseph&Theresa Harb 22 Raleigh Tavern Lane North Andover, MA 01845 RE: APPROVAL OF VARIANCE GRANTED BY BOARD OF HEALTH(BRPWP59b) 22 Raleigh Tavern Lane, North Andover(15-Shawsheen) DEP Transmittal No.31003558 Dear M/M Harb: The Metropolitan Boston-Northeast Regional Office of the Department of Environmental Protection has received and reviewed your application for approval of sanitary sewage variances pursuant to 310 CMR 15.410 and 310 CMR 15.412 with the above transmittal number. The application contained written notification, dated May 4,2000, that the North Andover Health Department had approved variance to the following provisions of the State Environmental Code: ■ 310 CMR 15.212, as it relates to the separation of the bottom of the soil absorption system (SAS)from the estimated high groundwater level; and ■ 310 CMR 15.104, as it relates to performing a percolation test at the proposed site of the SAS. Accompanying the application were plans consisting of one(1)sheet titled as follows: Title: Upgrade Plan of Subsurface Sewage Disposal System Location: 22 Raleigh Tavern Lane Municipality: North Andover Applicant: Joseph&Theresa Harb Designer. Daniel Koravos, P.E. No. 37752 Date(Last Revision): March 17, 2000(May 9, 2000) An engineer of the Department reviewed the plans and the accompanying data, and it is opinion of the Department that the plans are in compliance except for the following Title 5 provisions: ■ 310 CMR 15.212, as it relates to the separation of the bottom of the soil absorption system (SAS)from the estimated high groundwater level[Three(3)feet of separation between the SAS and estimated high groundwater, instead of the required four(4)feet, is proposed for this site.]. 310 CMR 15.104,as it relates to performing a percolation test[The soil conditions, especially high groundwater, on the site preclude percolation testing. A sieve analysis was performed and This information is available in alternate format by calling our ADA Coordinator at(617)574-6572. 205A Lowell St. Wilmington,MA 01887 . Phone(978)661-7600 . Fax(978)661-7615 . TTD#(978)661-7679 Printed on Recycled Paper the most conservative long term acceptance rate(LTAR)for the class of soil was used to calculate the SAS.]. As part of its approval, the Department will require that the following conditions be complied with by the applicant and all subsequent owners or this approval be rendered null and void: ■ Prior to construction, the applicant must obtain a Disposal System Construction Permit(DSCP) from the North Andover Health Department. ■ Title 5 of the State Environmental Code requires two deep observation holes be tested in the area of the SAS. A second deep observation hole test shall be performed in the area of the SAS at the time of construction. A copy of the soil log shall be forwarded to the Department. If soil conditions are found to vary from those previously encountered, construction shall cease and the North Andover Health Department shall be notified. • The system is not designed to accommodate a garbage disposal. As such, one should not be installed or used at this dwelling. ■ It is the responsibility of the applicants to assure that the approved plans are available at the site during construction. The special conditions, outlined above, in no way should be viewed as superseding any conditions imposed by the North Andover Health Department. The above conditions are meant to supplement any other conditions imposed upon the facility. It is the opinion of the Department that the requirements for the granting of variances as specified at 310 CMR 15.412 has been satisfied.The enforcement of the provisions of the Code from which variance is being sought would do manifest injustice and the applicants have proved to the Department's satisfaction that the same degree of environmental protection required under Title 5 can be achieved without strict application of the subject provisions. The following paragraph outlines the Department's findings relative to manifest injustice and equal environmental protection as they relate to the variances, granted by the North Andover Health Department,which the Department hereby approves. The site is limited by high groundwater. Because of this, a percolation test could not be performed. The Department has granted variance from the percolation testing only for upgrades of existing systems with high groundwater conditions. In these cases and with a variance, a sieve analysis may be used as an alternate method to estimate the percolation rate of the soil. The SAS was designed using the most conservative LTAR from the soil type determined through sieve analysis and verified by the soil evaluation. The variance,from the separation of the SAS to the high groundwater from four feet to three feet, could not be granted under local upgrade approval (LUA) because of the request for a variance from the percolation testing. The upgrade of the existing failed system provides.for better treatment of the effluent by using the full design area of the SAS and that no other variance nor increase in flow is sought. Based on this information,the Department has concluded that to deny this variance would be manifestly unjust and that the applicant has provided equal environmental protection. This Permit is an action of the Department. Any person aggrieved by this action may request an Adjudicatory Hearing. A request for a hearing must be made in writing and postmarked within twenty-one (21)days of the Permit issuance date. Under 310 CMR 1.01(6)(b), the request must state clearly and concisely the facts,which are the grounds for the request, and the relief sought. The Hearing request along with a valid check payable to the Commonwealth of Massachusetts in the amount of one hundred dollars($100.00)must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 Y The request will'be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town(or municipal agency), county, or district of the Commonwealth of Massachusetts, or a municipal housing authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file,together with the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. If you have any questions or additional information is required, please contact George A. Kretas at (978)661-7744. Sincerely, Madelyn Moms Deputy Regional Director Bureau of Resource Protection mm/gak cc: -Sandra Starr, R.S., Health Department, 27 Charles Street, North Andover, MA 01845 Daniel Koravos, Merrimack Engineering Services, Inc., 66 Park Street,Andover, MA 01810 -BRPMastewater Management Program/Title 5 Section/Boston PARTICLE SIZE DISTRIBUTION TEST REI'Ow too t = � � : F all I I I I 70 r� 60I ! 1 I I r { to 500 70 t011 0.01 0.001 GRAIN SIZE-mm %GRAVEL %SAND WINES CRS. FBVE IWEDIUAR FINE SILT CLAY 0.0 0.0 20.7 1 23.8 1 8.9,A 18.7 20.2 7.7 SIEVE PERCENT OPEC.* PASS? Sol)Description SIZE FINER PERCENT "0) cearse to fine SAND,some Gravel,some Silt,trace clay. 3 in. 100.0 USDA Claslficadon-Sandy loam z im 100.0 1.5 irt. 100.0 Atterbero Limits .75 In. 100.0 PL= LL= P!= .3 in. 100.0 Coe loots .375 in. 95.3 ___tBS #4 79.3 D85- 10480, .73 ' D fip= 2.37 D5p= 11.613 #16 3.6 ��22 01 30173 D�p. t 1.0097 #40 46.6 Classification #050 43.2 USCS= SM AASHTO= A-24 D) 5.5 #200 27.9 Remarks 0270 23.7 No specification given. ' (fro spcxihcadal Provided) Sample No.: L-173-00 Source of Sample: 22 Raleigh Thorsen Rd, bate: 3/6100 Location: N.Andover MA ElevMepth: Client: Diversified CIA Engineetitilg GEOTECHNICAL SERVICES, INC. Project: Ifarb Project No: 200203 Plate FORM 11 •SOIL EVALUATOR FORM Page 1 of 3 NO. .400zX1 i Da;e: Commonwealth of Massachusetts �✓. /9A__'r_)0vM , Massachusetts foil Suitability Assessment,ioorr On-site :Se Performed By: , Z l .. . .r.>�.�..�.:r. Date: � , i% Witnessed By: ,. . .. r-.. r. .....1 . �,x �??a ...iT, r ....�.._....._... .M....... ..... L=M Ad& .« 2z 1Z"q r...a iy'r 7-. ver..j 7'w. lz�G f la. A&Amc w ZZ Rz6"w04 7AvrzP_.) �. fl'ex".rz,A;/4 New conSLructlon ❑ Repair Offfilice Review Published Scil Survey Available: No Cl Yes 9 Year Published f.` .►..._. Publication Scale 1, i — Soil Map Unit , moo... .... , MdL1�r./'71cLY , Drainage Cla<S �,r�s�.D +?f-+ Soil Limitations �1A .....-rPB.w�J...Si.o........:'?�`t.tirw2y..._...._.. Surficial Geologic Report Available: No ❑ Yes Year Published Publication Scale , ...._ Geologic Material (Map Unit) ...... Larndfotzn ................. ._ ....:..,..........._._......_.... ................_......... .....................__............................._._.....:........ .................. ..... ._...... Flood Insurance Rate Map: t � ��-�� Above 500 year flood boundary No ❑Yes © tip K Within 500 year flood boundary No Oyes Cl Within 100 year flood boundary No 2Yes ❑ Wedand Area: . National Wetland inventory Map(map unit) ... ..... .......................... ............. __:......_... Wetlands Conscrv=cy Progrartz Map(map unit) Current Water Resource Conditions(USGSx Month Range :Above Normal ❑Normal ❑Bcicw Normal ❑ Other References Reviewed: Do AP1'MOVm YORM-lima$ FORM 11 - SOIL EVALUATOR FORM Page Z of 3 Location Address or Lot No. 27 Zai-fr-114,u TAyiez..2 s•. On-site Review Deep Hole Number Date:z, 047> Time:.,9,i�AM Weather u�.-+•�y r3� Location (identify on site plan) S. - , r+R r ...... .n< fl..w�.•. ... w .,.. .,,.,..w....... Lend Use ...._Y.f ..?...„.. ..... Slope M 3%- Surface Stones . .. w•. . . Vegetation TIAL*. .,.........:. . . w . Land! .:.: . :.. . Position on landscape (sketch on the back) ,5ma:r ^T'r =K&TLP( Distances from: Open Water Body N/4 feet Drainage way Sc5` feet Possible Wet Area ...50-.* feet Property Line ... 'r feet Drinking Water Well .0.09 Net Other �....•.•.•. ..•� DEEP OBSERVATION HOLE :.OG* Depth from $oil Horizon Soil Texture Soil Color Soil OoFu r Surface(lncheS) tUSDA) (Munseal Monfng (Structure,Stonea,Goulrav ij► s, Consistency. % fq �. �.., ..�- 'p 1`��•rig�A - ©' + f Lt— ►� 5Pl,.�coy �5�4 Moo,.,ra yL-Yeo 7 G�taY 46 1 LO RM 4$I MASSivarJ �iZ on X, Parent Material tgeabgiol �r s.. OevthwIledrock:_ g*pth t�Gro_undwater: standing Water in the Hole:_ /VC?,�F Weeping trop►Pit face: Estimated sewon&I Hio Ground wstar. t, . DEP A"ROVED TOM-12107JOS FORM 11 - SOIL hVA.'XATOR F0ILN1 Page 3 of 3 Location Address or Lot No, ? a►`� ,H -rr.�y , betermination r easonal i Water Ta ie Method Used: ❑ Depth observed-standing in bbservation hole taches Depth weeping from side of observation hole.... .. inches Depth to sail mottles ..�#&_ inches ❑ Ground water adjustment.-...,..... - feet Index Well Number .............. Reading Oate - .._.._...... Index well level ......_ Adjustment factor ................... Adjusted ground water level ................................. . Death of Naturaliv Occurring Pervious Material Does at least four feet of naturally occurring pervious material .exi.it in all areas observed throughout the area proposed for the soil absorption system? 7grr If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) 1 have passed the soil eva!uato examination approved by the Deoarttnent of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise ajad experience described in 3 Y0 CMR 15.017. Signature �l�.. - Date 31fl16g _ nr�►�oti�v raw►t•�uor�ss FORM 11 - SOIL EVALUATOR FORrvi Page I of 3 No. ocaa_� Date: Ro Commonwealth of Massachusetts �✓. 19�bov , Massachusetts Soil Suitabilitv_.A sessment for On-site .Sews DiW.M1 Performed By: ....... Date: Z 1iK-114? Witnessed By: .....,... ........ ......... .. M... L�.oa AO@gs a -2z RA L e ly ov T-AV-V,.,i T�, lac f A�lpl.Ylf . lU; �.�n4,r�Z� MA Tdwml . ZZ 72/9--E1414 -rAv-r,,..j 7-r.. tom..., /' ew construction ❑ Repair ' 3� Once Revic Published Soil Survey Available: No ❑ yes Year Publishedt t ?i(...- Publication Scale J' ;:534-c>... Soil lkla? Unit ��..._ .... Ds'aina;e Glass wt,.a w ;+ Soil Limitations �tJl3X ,.... J°� >~, 'y...��a�,i.....r''E;t�I P���4dT ........ Sutficial Geologic Report Available:No ❑ yes ❑ Year Published Publication Scale . . GeologicMaterial Map Lmt� ..............,........,......,...,..............w.............................................._............ ......_�,.....�..� Landform Flood Insurance Rate Map; Z a-'x' vmTM`A Above 500 year flood boundary No ❑Yes ��� X Within 500 year flood boundary No . yes ❑ Within 100 year flood boundary No Byes ❑ Wetland Area: - National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) �.... _... _-.._,.....--- Current Water Resource Conditions(USGS): Month �.W. Range:Above Normal ❑Normal ❑Belcw Normal ❑ Other Refercnces Reviewed: DET AMOvm FORM•1u01»s FORM I I - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. ZZ Z4L a(QM MnWm�_ Onsite Review Deep Hole Nulnber'V_tM . Date: Time: -ISR Weather Location (identify on site plan) SCIE-_.AOITA4GA—f� ., land Use ...••• . Slope Z Surface Stones . 1 ... . .. Vegetation r..l,�iZFt �.,...,.., . .. �..,M_.. . . �,,.....w... ...,M. .. . . . , . Landform Position on landscape (sketch'on the back) ..-151M ATTRGMD. Distances from: Open Water Body N/R feet Drainage wayfeet Possible Wet Area .SO* . feet Property Line _1567 feet Drinking Water Weil :AIM feet . Other ....r.. DEEP OBSERVATION HOLE LOG* Depth from Soi(Horizon Soil Texture Soil Color Sod Othe r Surface(Inches) (Munseili Mottling {Structure.Stones,G ulld{yrs.Consistenoy� % !J^-'?(A? ��^ 9Car 4+ SA►-rfl'`J �Sfif Ml3t/1/(4 /YI�S�rvLr� �'�,rR$I,.L LOAM Parent Material(geologic) Roth to Gran water: Standing Water in the Role: Weeping from Pit Faeel ` Estimated Seasonal High Ground Water: DFP AtFROV1rD FORNt•I2 WAS FO&M I I • SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot too. '7? i—gfc�N `i-vEr-t..r km On-site Review Deep Hole Number'L-Yz'ZA Date: 4A.. 9,> Time..:Y'/.SAw Weather .�a.,..�y. 37-'. Location {identify on site plane 5 ..�. '+'>- .rf . .. r..�..,,...:. _�� .,..,..,��.:..... Land Use —..14 — Slope M . . Surface Stones Vegetation7Z/9�4��,,......., .. .. .. ::..... �..........._..._..... . ...,.. Landform Mo. .rM.� _... . ... .,... Position on landscape {sketch on the back} Distances from: Open Water Body A,//r9 feet Drainage way + feet Possible Wet Area .SO7*. feet Property Line .,970:4.- feet Drinking Water Well .N/R feet Other ... ., DEEP OBSERVATION HOLE LOW -rt/ - Z's Depth from Soil Horizon SoilTexture SoR USDA) Munsell mottling (Structure,Stones,Bou lers,Consistency, % Surface(inches) Color Soil Gravt.q r `�L� f7•0 �.. 5FI-joy 0-15/4 r►'IA',5,v�, VMA1st..6J4, LoRM ti+o - coniP,W--r MA Parent Mater(aI(9eolo9icl_ DepthtoSedrock:_ Depth ig Groundwater: Standing Water in the Hole: Weeping from Ph Face._ Estimated Seasonal fth Ground Water: vr2c OMA DEP APPROVED F0101-131671" FORM It - SOIL EVA,�UATOR FORM Page 3 of 3 Location Address or Lo! No. ? Determination for Seasonal High Tahir Method Used; ❑ Depth observed standing in observation hale..•..........:.... inches Depth weeping from side of observation hole........ ..... inches Depth to soil mottles .ate_ inches ❑ Ground water adjustment_..._.._..... feet Index Well Number ............... Reading Date _..,........... Index well levet Adjustment factor Adjusted ground water level ..................... . Death of Naturally.0ccurrinofIrvioWs Material Does at least four feet of naturally occurring pervious material exi:;t in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on tdate) I have passed the soil evaluator examination approved by the D-97arttent of Environmental Protection and that the a 3ove analysis was performed by me consistent with the required training, expertise ar d experience described in 310 CMR 1 5,017, Signature Date 3/9'/A-5 DEP AQP MIM FORM-I MMS a MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS ip pp 1 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com April 13, 2000 Mr. Gayton Osgood, Chairman Town of North Andover Board of Health 27 Charles Street North Andover, MA 01845 RE: 22 Raleigh Tavern Lane- Sewage Disposal System Upgrade Dear Mr. Chairman and Members of the Board: Please find attached soil evaluation data by Diversified Civil Engineering and Particle Size Analysis performed by Geotechnical Services, inc. for soils taken from the above referenced site. Our office has been retained to complete the sewage disposal upgrade design for the site. On behalf of our client, Joseph and Theresa Harb, we hereby request a Variance from 310CMR 15.104(4)to allow the use of the Particle Size Analysis to determine a percolation rate instead of the required percolation test per area. The Particle Size Analysis determined the soil type to be sandy loam, a Class II soil, as such we propose to use an effluent loading rate of 0.33 gpd/s.f. We request this mater be placed on the Board of Health Agenda for April 27, 2000 for consideration of this Variance request. A representative from Merrimack Engineering Services will be present to answer any questions you may have. We thank you for your consideration of this matter. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd Att. (2) cc: Mr. Joseph Harb SEPTIC PLAN SUBMITTAL FORM LOCATION: _ 7a-uU e -^ L � NEW PLANS: S $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: NO DATE: ''/ �O DESIGN ENGINEER: DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Part Engineering. When the submission is all in place,route to the Health Secretary. a 'VC APRT $ TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION T� ersignede hereby certify that the Sewage Disposal System ( ) constructed; ( repaired: by Ol) /�l's�7 /J located at Z7i YULE! lq�u 41 k9. was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # 1// dated_G — 7— Jo-- , with an approved 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: X/ En ine r ep sentative Final inspection d e: � —v� Engineer Re resentative X Installer: Lic.#: Date: Design Engineer: GV�.�/� �j�UL—� Date: . �w