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HomeMy WebLinkAboutMiscellaneous - 230 GRANVILLE LANE 4/30/2018 230 GRANVILLE LANE 210i106.c-0080-0000.0 e CAMn FILE# NA A S TITLE V INSPECTION gr-D, Dean G. Luscomb H & Sons ��' , 0,�n1l P.O. Box 135 Rp N N Middleton, MA 01949 978-774-4065 Licensed Plumber# 20285 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNERS NAME_, o h h Q C I e-rY)e-r) PROPERTY ADDRESS o 3 0 &.cavwcue- L CZr)e DATE OF INSPECTION A b e l / 0, 0017 NAME OF INSPECTOR�� (,�_ -� L u.s c b m b QUALITY IS NUMBER ONE TO US Commonwealth of Massachusetts N W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 April 10, 2017 required for p every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. 0® Important: A. General Information `' When filling out forms on the computer, use 1. Inspector: only the tab key to move your Dean G. Luscomb II QUO�QP4�� cursor-do not Name of Inspector �r use the return key. Dean G. Luscomb II &Sons NO Company Name — 288 Maple Street IL Company Address Middleton MA 01949 ' P7 City/Town State Zip Code 978-774-4065 S1848 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 urther Evaluation by the Local Approving Authority e April 10, 2017 Insp tor's Signature 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•3/13 Title 5 Official Inspection Forth: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 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10, 2017 required for p every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: ChecoB, C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins.3/13 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 ^M 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10 2017 required for P , 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 1� to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will u 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 Othe 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 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is required for North Andover MA 01845 April 10, 2017 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ' ❑ The system has a septic tank and soil absorption.system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D System Failure Criteria a 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 El ® 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•3/13 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 230 Granville Lane Property Address Donna Clements _ Owner Owner's Name information is North Andover MA 01845 April 10 2017 required for P every 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) targe Systems: To be considered a large system the system must serve a facility with a Best flow of 10,000 gpd to 15,000 gpd. For large system , u must indicate either"yes"or"no"to each of the owing, in addition to the questions in Section D. Yes No ❑ ❑ the system is within et of a surface drinking water supply ❑ ❑ the syste ' within 200 feet o tributary to a surface drinking water supply ❑ ❑ system is located in a nitrogen se ' 've area (Interim Wellhead Protection Area—IWPA) ora mapped Zone II of a pu i water supply well If you ha answered "yes"to any question in Section E the system is c idered a significant threat, or an ered "yes" in Section D above the large system has failed. The own e r operator of any large system considered a significant threat under Section E or failed under Section D II upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the a riate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �w 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Ar10 required for _ April , 2017 every 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) ® ❑ 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-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 230 Granville Lane Vin, .p�`ev Property Address Donna Clements Owner Owners Name information is North Andover MA 01845 Ar10 required for April , 2017 every page. City(rown State Zip Code Date of Inspection D. System Information Description: owner and town Number of current residents: 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 1"j- i►G./ -- Detail: or Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Esta i nt: Design flow(based on 310 C 5.203): Gallons per day ipid)-�°'- _ Basis of design flow(seats/persons/sq.ft., et Grease trap present? ❑ Yes ❑ No Industrial waste holding to esent? ❑ Yes ❑ No Non-sanita a discharged to the Title 5 system? Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10, 2017 required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) La of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Last pumped approx 2 months ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: Zero — gallons How was quantity pumped determined? -- Reason for pumping: No need at this time 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•3113 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is required for North Andover MA 01845 April 10 2017 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: System is from 2014 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): / Depth below grade: 20"Leet Material of construction: ® 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.): Main line and joints are in good condition. Septic Tank(locate on site plan): i D 8 WIC" 49k Depth below grade: �t�� �� feet -7;— nrG.Gf.�..- U Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Precast rectangular concrete- 1000 gallons If tank is mea, t &. years Is ager�firmAr�n - I icate of Compliance? (attach a copy of certificate) a No Dimensions: 4'deep x 6' wide x 8' long - 1000 ga Sludge depth: 1" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Suosurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 230 Granville Lane, Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10 2017 required for _ — — p � _ every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 28" Distance from top of sludge to bottom of outlet tee or baffle -- Scum thickness 1" -- Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? by measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank and baffle are in very good shape. The solids are light and do not require pumping at this time. The liquid is running at it's correct working heigth. Grease Trap(locate on site plan): Dep elow grade: feet — Material of co truction: El concrete metal ❑ fiberglass ❑ polyethyl ❑ other(explain): Dimensions: '� --- - Scum thickness ! — -- Distance from top of scum,te"top of outlet tee or baffle Distance from b. 'm of scum to bottom of outlet tee or baffle --- Date o st pumping: ------ -- Date + t51ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disgrosal System•Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is required for North Andover _ MA 01845 April 10, 2017 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Com is(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels a ated to outlet invert, evidence of leakage, etc.): Ti ht or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth b w grade: -- `l Material of con uction: ^ V ❑ concrete metal ❑ fiberglass ❑ polyethylene other(explain): Dimensions: Capacity: — gallo Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Ala in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condit' of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes Q No t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10 2017 required for p , every page. CityT town 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 Zero 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.): The d-box is 16"x 16"and is 4' below grade. The d-box is in very good shape. mp Chamber(locate on site plan): V Pumps in wo i order: ❑ Yes ❑ No' V Alarms in working order: ❑ Yes ® No* Comments(note condition of pump cha r, condition of pud afi ppurtenances, etc.): ..rte . * 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: / SAS was located by asbuilt drawings. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments OiM 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 required for April 10, 2017 every 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.- 1 - 10' x80' -- ® leaching fields number, dimensions: - ❑ 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.): The SAS is in good condition. There are no signs of ponding or breakout. esspools (cesspool must be pumped as part of inspection) (locate on site plan): Number a onfiguration Depth—top of liquid to i t invert Depth of solids layer — Depth of scum layer Dimensions of cesspool Materials of construc ieri I— — ---- Indication,of groundwater inflow ElYes ❑ No r�r t51ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syste •Page 13 of 17 • Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10, 2017 required for P every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) tornmeat5 note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Pr locate on site plan): Materials of con tion: Dimensions Depth of solids Comments (note condition of soil, signs of hydra ure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 230 Granville Lane Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 April 10, 2017 required for _ Pi 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 AkT:: D e-C_ $f�D .230 G-�n�rlk Z",_ Al. 4,tWo W J C k Lec.�f�►h F��l of X10 r t L E O [ Y I I e. I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 230 Granville Lane Property Address Donna Clements _ Owner Owner's Name information is North Andover MA 01845 Aril 10, 2017 _ required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface waterlQ� nt iv ® Check cellar P6-y /,/,4 dap UA ® Shallow wells lu(m Estimated depth to high ground water: 5.166' 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: 5/23/01 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Permit, proposed, asbuilt and previous title v from 12/17/03 on file. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole# 1 showed ESHWT at 62". Test hole#2 showed ESHWT at 72". By B. Dufresne Merrimack Eng. Services 5/23/01. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Granville Lane _ Property Address Donna Clements Owner Owner's Name information is North Andover MA 01845 Aril 10 2017 required for p every 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 White-Applicant Yellow-flea" ---- i + f�10RT1/, • 7 8'1 9 p Town of North Andover ;'•�:,;o:: �' HEALTH DEPARTMENT ,SSACNust4 CHECK#: -2333 DATE: LOCATION: 23 O 6j/a,I� H/O NAME: ��/1�e/77�S CONTRACTOR NAME:Aan 6.L5C044 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ O Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report �Q SS $SQ ❑ Other. (Indicate) $ Heal t Initials White-Applicant Yellow-Health Pink-Treasurer WLDI ES UHr4AY o i9l' GcrT��c�-Rork �� DoT IJOtE� T�i� P�..•-� �r bI.A�► R A �, E p e -E 7r. 4%(";, eH , sT I,, A ztioo" E ,0 5 A.w*, E t e VOmOJ CF -r'4 R GOHPo+�tira tti. sex 2 Lill _ LH r� M gOARQ OF� T �� r �� it l l�✓� 1. 1 �v e+ / br `Ear �' " Z % u 1 Sol AS PLAN Of DISpMAL SYSTEM SUBSURFACE LOCATED IN 00 r2 H D FOR D AS PREPARE KORAV06 CIVIL Na.37752 DATE: I -C21 SCALE: I MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 66 PARK SSREET • ANDOVER. MASSACHUSETTS 01810 TEL (617 475-3555. 373'STII COMMONWEALTH OF MASSACHUSETTS WTIr EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a d DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 Nor-A RAVer TITLE OFFICIAL INSPECTION FORM-NOT FOR VO LUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RM CERTIFICATION Property Address:230 V1 I Owner's Name: - C)rl r - Owner's Address: ST N F Vi ' N t- rcw BOARD O Name of Inspector: " 2 1 Pe (please print) Company Name: Windriver Environmental Mailing Address: 561 Main Street Hudson MAO 1749 -- -�-�" .•` w Telephone Number:978-562-4500 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information below is true,accurate and complete as of the time of the inspection.The inspection was reported-. training and experience in the proper function and maintenance of on site sewage disposal systems.I am a D approved system inspector pursuant to Section 15.340 of Title S(31t CMR a disposal Performed ed based on my EP )• The system. Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature:]I"— I t I/ Date: kat- O The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of es sent to the Health or DEP)within 30 days of completing this inspection. If the system is a shared s s gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional offic o he DEP.The original should be sent to the system owner and copies y tem or has a design flow of 10,000 authority. p buyer, if applicable,and the approvingt Notes and Comments 5e0_6 m Yn Pump I +arik ,�Ieq�/E ****This report only describes conditions at the time of inspection and under the conditions of use a time. This inspection does not address how the system will perform in the future under the same or conditions of use. t that different Title 5 Inspection Form 6/15/200() Page 2 of I I tT w ' OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO PART A RM CERTIFICATION (continued) Property Address: 1' G�i�t�l/1 f I� Owner: i Date of Inspection: i; / 3 Inspection Summary:y Checkl./�B,C,D or E/AL__AWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the fail ure criteria 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below described in 310 CMR Comments: i B• System Conditionally Passes: One or more system co repaired.The system, upon cmponents as described in the"Conditional Pass"section need to b ompletion of the replacement or repair,as approved by the Board of e replaced Health, will pass. Answer yes,no or not determined(Y,N,ND)in the explain. for the following statements. If"not determined"please The septic tank is metal and over 20 years old*or the septic tank(whether meta unsound,exhibits substantial infiltration or exfiltration or tank failure is iass ins existing tank is replaced with a complying septic t. 1 System m will not)is structurally *A metal septic tank will pass inspection if it is of Compliance structurally sound,not leaking and if a Certificate tank as approved by the Board mminent. inspection if the rs old is available. Health. indicating that the tank is less than 20 yea ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken orp obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: x Page 3 of']I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A M 2�. CERTIFICATION(continued) Property Address: _CJ 1 �e Owner: - }– Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determ is failing to protect public health,safety or the environment. ine If the system 1• System will pass unless Board of Health determines in a30 that the system isnot functioning in ccordance with 310 CMR 15. 3(1)(b)a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water esspnnl or. nriyv is within c .... .._..., 0 feet of.a her .,,,. , .getated ".f-tland 2• System will fail unless the Board of Health(and Public Water Supplier,if any)de termines 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 p tank and SAS and the SAS is within a Zone I of aubli — The system has a septic tank and SAS and the SAS is within 50 feet of a ry at c water supply. P e 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, bacteria and volatile organic compounds indicates that the well is free from pollution from that facili the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 for coliform failure criteria are triggered.A copy of the analysis must be attached to this form.ppm,provided that no other ty and 3. Other: Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 230 �a7V1' Owner: )A Date of Inspection: Jf 03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X, 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 X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X1,W1.6,01 dfrnth in rPccn.�nl .. il;ast day w ; ol'Ime is less ",u Required pumping more than_ 4 times in the last year NOT due to obstructed pipe(s). Number Of times pumped clogged or ob 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. X Any portion of a cesspool or privy is within a Zone 1 of a public well. LC Any portion of a cesspool or privy is within 50 feet of a private water supply well. �C Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) t yv (Yes/No)The system fails.I have determined that one or more of the above failure as described in 310 CMR 15.303, therefore the system fails.The system owner shoulderia contactt st 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 gpd. flow of 10,000 gpd to 15,000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 15.304.The system owner should contact the appropriate regional office of the Department. 310 CMR t Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO PART B RM CHECKLIST Property Address: �Vi l Owner or Date of Inspection: '7 Check if the followin have been done. You must indicate " es"or"no"as to each of the fol 7- lowm 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 ? tic ed In 1XIO.P period ,X-- Have large volumes of water been introduced to the system recently or as part of this Y ins pecdon . A- - Were as built p Tans of the system obtained"and exam (If they y were not available note as N/A) X — Was the facility or dwelling inspected for signs of sewage back up? ,X- Was the site inspected for signs of break out? — A- Were all system components,excluding the SAS, located on site? -- )�J6ox n�p�'l� Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition g of the baffles or tees, material of construction,dimensions,depth of liquid,depth of slud a and d Was the facility owner(and occupants if different from owner)provided q,ith epth of scum ? X ..— 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 Ye determined based ased o o n. — Existing information.For example,a plan at the Board of Health. -L — Determined in the field �f an . ( y of the failure criteria related to Part C is at issue a pproximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of I I f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TS PART C SYSTEM INFORMATION Property Address:,7_3 �jr- �`IL, 48- Owner: s O1J h . G O �1✓ Date of Inspection: / RESIDENTIAL, FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): Ylp�(ifyes separate inspection required] Laundry system inspected(yes or no): quied) Seasonal use: (yes or no):LU Water meter readings, if available(las et 2 years usage,.ys _,„;;�_.):�� g (gpd)): Last date of occupancy:.I f COMMERCIAL/INDUST—R AL Type of establishment: Design flow(based on 310 MR 15.203): — Basis of design flow(seats persons/sgft,etc): Grease trap present(yes no):_ Industrial waste holdin tank present Non-sanitary waste di harged to the Title 5 sy toes or n Water meter reading , if available: Y Last date of occup cy/use: OTHER(describ Pumping Records GENERAL INFORMATION Source of information: Was system pumped aspart of the ins ec on If yes, volume Pumped:um d: gMons--HO'/ q was p (Yes o no): S uanti Reason for pumping: „� Y pumped determined? �S(J 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 obtained from system owner) approval _Tight tank —Attach a copy of the DEP a (to be _Other(describe): Approximate age of 111 .Tppents,date installed(if known)and source of information: Were sewage odors detected when arriving at the site (yes or no): t Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Ej� J � Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: ` Materials of construction: cast iron _40 PVC Distance from private water supply well or suction line:other(explain): Co nts 4on c n ition ofjoints, ventin evide ce of leakageet .): iSo�r o � , - en c SEPTIC TANK: 50ocate on site plan) (, J 0v4161"C'ove - t� Yom✓,!T- v �Z�� t�z�; � � Depth below grade: g Matecial of construction: —other(explain) X concrete_metal_fiberglass_polyethylene If tank is metal list age: Is age confirmed by a Certificate of Compliance certificate) P (yes or no Dimensions: v��X ) _(attach a copy of Sludge depth: J " Distance from top of sludge to bottom Scum thickness:IQ" of outlet tee or baffle: Distance from top of scum to top of-outlet tee or baffle: Distance from bottom of scum to bottom of outlet to or baffle: How were dimensions determined: I'll u I Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural elated to outlet inv rt,evidence of leak ge,etc. 1) integrity,liquid levels e, GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:—c Crete_metal_fiberg ss (explain): _polyethylene_.oth r Dimensions: Scum thickness: Distance from top of scu o top of outlet tee or bafflum to bottom of outlet to Distance from bottom of cor ba _ Date of last pumping: � Comments(on pumpirecommendations,inlet a d rt, evidence of leakage,et ): o1�t tee or baffle Condit* n,structural integrity, liquid levels as related to outlet in Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Property Addressr:,2' SYSTEM INFORMATION(continued) ©r'' A t vet- Owner: Date of Inspection: ! -3 TIGHT or HOLDING TANK: (tank must beum p p at time of inspecbion- )(loca onsite plan) Depth below grade: Material of construction: onerete metal fiberglass, polyethyle other(explain): Dimensions: Capacity: gallons Design Flow: gallons/d � "arrri nronn n:r. Alarm level: Alarm in workin ovd Date of last pumping: (Yes or no): Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet in 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,an evidence lea age in�o or out f b x,et .): y ence of Vei egr - PUMP CHAMBER: (lo ate on site plan) Pumps in working order es or no): Alarms in working ord (yes or no): Comments(note con tion of pump chamber,condition pumps and appurtenances tc.): Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,�' SYSTEM INFORMATION(continued) Property-A�Jddress: �—{.J , v;" le Lavx Owner: V1S l- r0 Ver Date of Inspection: �� y SOIL ABSORPTION SYSTEM(SAS): locate on site plan,excavation not required If SAS not located explain why: Type leaching chambers 'number: I Ver O� leaching galleries,number: — leaching trenches,number,length: — leaching fields,number,dimensions: overflow cesspool,number: innovativelalternative system Type/name of technology: ' Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of etc c vegetation, CESSPOOLS: (cesspool must be pumpedfpa� e ion)(locate on site plan) Number and configu/inflow Depth—top of liquid in Depth of solids layer: Depth of scum layer: Dimensions of cesspo Materials of construct Indication of groundws or no): Comments(note condition of soil,signs of hydraf ponding,/nditfijon etation,etc.): PRIVY: (locate on si. plan) Materials of construction- Dimensions: Depth of solids: Comments(note condi ion of soil-,signs of hydra lic failure, level of ponding,co clition of vegetation,g ,etc.): Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOL UNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMNTS PART C SYSTEM INFORMATION(continued) Property Address:ZW &�"l,�,✓1V1 it V) Owner: ��V ~ ever Date of Inspection: bZ ' SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. �'pDi41 - 00) { Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSES MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTfEM INFORMATION(continued) Property Address: : -� f ►��fl l ►ale Owner: 5,6 Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water J feet Plracp„�,{irarA�..hP,.►,1 n l-1 f,�„r:-n: . �at:o Obtained from system design plans on record-If checked,date of design k Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: g Plan reviewed: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must descri¢¢e- how you established the high ground water elevation: l�lo ` ✓� l c h C.Tr 0 %� L ( ect�t L bvl `4 Lai TAS a+y��'•�Z3o � l \ r_lz�y F+EW IN T AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN Oor2TH AQ00V6¢ 6 2AWVIL.A►�E: AS PREPARED FOR LISA Dj rrV DATE: - 1-7 �M � l Dto� SCALE: 1 0 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER. MASSACHUSETTS 01810 or TEL (617) 473-3551 i. TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/02/01 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by John Shaw at 230 Granville 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 I /-Zb/ E;4 FIV- C'nmoutpr H:Pwd%xarP C»Iizaara.Iytvointary�1t Pciaaas fiRir1e Ti" 9-onnect Edit Ternaual Help . WATER BILLING HISTORY 3170055-STORY, JON-,& KAREN METER #1: 317 0055 --------------------- 230 GRAN ILL LN # CYCLE SERVICE PRIOR CURRENT SE WATER SEWER FEES TOTAL E f 200310:23}SWI 1 2000-13 10/01/1999 3683 3794 163 444.94 0.00 0.00 444,94 2 2000-23 01/05/2000 3794 3834 40 109.20 0_00 0-00 109.20 3 2000-33 63/29/2000 3834 3855 21 57.33 0-00 0.00 57.33 4 2000-43 96/13/2000 3855 3879 24 65.52 0.00 0.00 65.52. 5 2001-13 09/22/2000 3879 3962 83 226.59 0-00 11.06 237.54 ,.. M 6 2001-23 12/29/2800 3962 3989 27 73.71 0_00 11.80 84.71 7 2081-33 03/29/2601 3989 4014 25 68.25 0.00 11.00 79.25 8 2001-43 07/18/2081 4048 4048 0 0.90 0.00 11 .00 11.88 c[---] F. 9 2002-13 89/13/2001 4048 4126 78 257.62 0.80 5.55 263_17 T10 2002-23 01/16/2002 4126 4191 65 190.79 0.00 5.55 196.34 X11 2002-33 84/03/2802 4191 4211 20 49.40 0.00 5.55 54.95 s12 2002-43 06/10/2882 4211 4234 k 23 60.17 0.00 5.55 65.72 I13 2002-3F 07/17/2001 4014 4048 1' 34 92.82 0.00 35.08 127.82 14 2803-13 09/11/2002 4234 4371 1137 87.94 0.00 5.97 493.99 7.15 2083-23 12/12/2002 4371 4395 1, 24 61.38 0.00 5.97 67.3510ftware and r16 2803-33 03/12/2003 4395 4416 t 21 S1.40 0.00 5.97 57.37 departments. 07 2083-43 06/11/2003 4416 4435 19 45.22 0.00 5.97 51.19 nlike to spend 18 2084-13 09/17/2003 4435 4492 t S7 174.44 0.00 7-42 181 .86. J. sREUIEW CHOICE # or <ENTER> MORE HISTORY: _ entifyou 1) The type of desktop applications in use and your level of comfort with performance,utilization and support. Examples of desktop applications are word processing, database, spreadsheet, e-mail,Internet, etc. 2) Printer utilization. 3) Data storage-what types of data is stored on local PC drives and what data is stored on network servers. Start ; Tnbax- Microsoft 0... Telnet- 1Q.1.71.55 0 FW: Computer Hard.... , I: _10:26 A Ni -- - . . - _ 1 Into PrintKPOR)Vizminn 9 1 a ICU Pr_O '7 F'L AN Ot t. AN! ') + Cf_1dl1I Y" 7.iAU r_)M-- l_LINC; Is L C ,3U G R A N Vi L-L.E-- L A N�_ ON +-++ c,t:cel arvc� ns I rov, ORT�t-i AN(70VE=_rte', MA � r 1 UA , (3 Y': N C7_ SUI I IVAN A L F:_M S 1—RLL_ 7 \ "FN D vu_v 11FRN, MA 01801 a 416�Ei 1 ', /13/2000 SC AI f=_ "— .40' ,A .ss 0A LOT AREA=43.848 S.f-_��� r-_ P/T +z �L i D_& «A OX Q1lNC �11-3 irp8p -� r�'ti F'IT '2. r 1r SeH n -c tDOSRAIC MOO! ! O .3p f N 71 "50:40"W S.E3. " F N D F N D F G R A N Vt I lT E (50' WIDE—PUBLIC) !___A tV E Commonwealth of Massachusetts City/Town of System Pumping Record AUG 2C Z010 4ty v �v Form 4 T D� ANDOVER EPHp,�TMENT DEP has provided this form for use by local Boards of Health. Other f , u e information must be,substantially the same as that provided here. Before using this form, check with your local Board of Health tQ 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 Locatio.eeft�of ight side of house, Left front of house, Right front of house, Left rear of house;- ' Left rear of building. Right rear of building. Address Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Stat ip Code Telephone Number B. Pumping Record ! _ Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Cond' 'on�System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location wh contents were disposed: L. w Waste Water Signa re iff Ht uler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of a System Pumping Record SEP 0 S 2009 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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: of hou Right side of house, Left front of house, Right front of house, Left rear of house, Right rear of house. Address City/Town State Cl Zip Code 2. System Owner: Name Address(if different from location) Cityfrown Stat:,, � l Zi Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 0� If yes, was it cleaned? ❑ Yes ❑ No 5. Condition oftC n 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Locat'pn4oere contents were disposed: G.L. .D Lowell Waste Water S' n ur of Haulr Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts ' ;;�: � City/Town of �� System Pumping Record AUG 1 S 2008 Form 4 TOWN OF NORTH ANDOVER a� R HEALTH DEPART VENT 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 Important: When filling out 1. SyStYl Location- forms on the 1{,1 \� ,•-jib computer, use only the tab key Address .� "" , `� to move your �GCNvv cursor-do not Cityfrown State Zip Code use the return key. 2. System Owner: VQ G Name 1,0 ren, Address(if different from location) CitylTown State � � ,Zig.Codg, Telephone Number B. Pumping Record 1. Date of Pumping ✓ 2. Quantity Pumped: p g Date Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condit' n o��ste�V� L,4., 6. Syste Pumped By: l Name Vehicle License Number bp��Ik— CJS Company 7. Location re contents were sed: . 7)11c —( r Signaturplur Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Form 4 -- System Pumping Record f Commonweakh of Massachusetss Massachusetts System Pumoing Record System Owner System Location Type: Emergency Routine Cesspool: No Yes Septic tank: No Yes ©� Date of Pumping: Quantity Pumped: /000 Gallons System Pumped By: Wind Ow Environmental, LLC k/ permit#: Contents transferred to: O��� " g0 � r n q r Contents Disposed at: Date: I;V- 03 Pumper signature: Condition of System/Other Comments Dep Approved Form - 12/07/95 La U- i TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/02/01 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by John Shaw at 230 Granville 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 �of� �6-P, Iti 1 TE,vii OF f6ffH ANDOV2R/ BOARD OF HFALTH AS-BUILT CHECKLIST _ 2 5 2001 LOT NUMBER, STREET NAME ✓/ ASSESSORS MAP& PARCEL NUMBER `✓ LOT LINES & LOCATION OF DWELLINGS LOCATIONS& DIMENSIONS OF SYSTEM, . Na TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA f LOCATIONS OF DEEP HOLES& PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION NA. LOCATIONS OF WELLS,DRAINS, WATERCOURSES / WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP &SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The dersigned hereby certify that the Sewage Disposal System( ) constructed; ( if repaired: by---- located y located at2j ? -�42d�)U was installed in conformance with the North And ver Board of Health approved plan, System Design Permit 92ldated O j 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: Engineer Representative Final inspection date: 8-7_—e / Engineer Representative Installer-: �� � Lic.#: Date: a <K C� / a Design Engineer: Date: . Tc ;'�~ 2 5 2001 �� �"� � �,�S � , i �a � � ������ 0 Q �, ss 9�;�/� � acs J #. • wardian Date: Date Vaccine administe Date on VIS: ' I Vaccine lot num er: )OVER BOARD OF PiEALT t CHARLES STREET 8/00 1 ANDOVER,MA 01845 RECEIVED APR 0 9 2001 Medicare 0 o J.C. Town of North Andover, Massachusetts Form No.3 NORTH BOARD OF HEALTH • l� A DISPOSAL WORKS CONSTRUCTION PERMIT Sg�ICHUSE Applicant N)KIA E ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. �l`J CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. .f ok tt-- & BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: "7 Q / CURRENT INSTALLER'S LICENSE# LOCATION: 0'30 6,-c /lam ,ve LICENSED INSTALLER: SIGNATURE TELEPHONE# 5;-L7 S <9!S 7y// CHECK ONE:: REPAIR: v NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $160.00 Fee Attached? Yes t/ No Foundation As-Built? Yes No 'VA Floor Plans? Yes No IYA Approval _ J 7GC. Date: 71W1011 TOW BOARD OF HEALDTti JUL '� s� Town of North Andover °f N°RT#j 'I'V0 .° Office of the Health Department Community Development and Services Division �o 27 Charles Street 4`° = 41 North Andover, Massachusetts 01845 "SS"CHU Sandra Starr Telephone(978)688-9540 Health Directof- Fax(978)688-9542 July 3, 2001 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 Re: 230 Granville Lane Dear Bill: This is to notify you that the revised plans dated 6/12/01 for 230 Granville Lane have been approved. The following local variances have been granted: 1. Separation to ground water from 4 feet to 3.5 feet. 2. Less than 900 feet minimum 800 square feet allowed. If you have any questions,P lease 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: Duffy File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNINTG 688-9535 FORM 9B - LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts 1t�o,�rJ� 4Nbo j� , Massachusetts LOCAL UPGRADE APPROVAL BRID PURSUANT-TO 310 CMR JS.444 & 1S.AAC Facility/system owner: Name: � J Address: �9/CAN V16& o' Address of facility OJ?M-/-- Type of facility: residential L--'institutional _ commercial _ school _ design flow per 310 CMR 15.203 Z�le) gpd q70'- System designer: Name 1'l,,�^6P_,01j4 4 Address ,�,6 �/�,�,� WA)tVUSC Phone No. Local Upgrade Approval granted for: reduction in setback(s) (specify) perc rate of 30-60 min./inch (specify rate) reduction in SAS area of up to 25 7 (specify % reduction & size of SAS) -,,-Xreduction in separation between 1' '(}Iq '� 7�D 3- �; J� !�'I P SAS & high groundwater (specify reduction &perc rate) relocation of a well (explain) List local-variances granted (no DEP approval required per 310 CMR 45.412(4)) List variances granted requiring DEP approval Board of Health Approval of proposed upgrade ,/ �---- IA16X, W /-fid/, Name Title Signature City/town Date THE SYSTEM OWNER OR OPERATOR SHALL PROVIDE A COPY OF THIS LOCAL UPGRADE APPROVAL TO THE APPROPRIATE REGIONAL OFFICE OF THE DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF WATER POLLUTION CONTROL UPON ISSUANCE BY THE LOCAL APPROVING AUTHORITY & BEFORE COMMENCEMENT OF CONSTRUCTION. M ArrttoM FORM-u=»s NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm(a,netway.com Date: June 12, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/014 230 Granville Ln Assessors Map 106C,Parcel 80 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated May 23, 2001,by Merrimack Engineering Services, Inc. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the following is addressed: 1) Add"replace existing tees"at septic tank detail. 2) Use 113.4 for water table elevation. The highest ground grade within the leaching area is 119.4+/-. — 3) Need a local variance request for less than 900 sf. of area(NA 9.01 (1)) add to plan and variance request form. 4) Identify water line as either pressure or suction. 5) Profile of system shall be drawn to scale, with existing and proposed ground grades– 220(4)(0),NA 8.02C. 6) Provide a note stating existence of wetlands within 150 ft. of system. 7) Provide a note stating no tributaries within 325 ft., no reservoirs within 400 ft.,no tributaries to reservoirs within 200 ft., and no drains within 50 ft. to the system. 8) Increase length of leaching system 6 ft. to allow for 2 ft. level and D-Box. 9) Add 5 ft. over dig to end section and profile. 10)Provide ground elevation at existing septic tank and elevation of deck. Add to variance request permission to maintain existing use of septic tank. 11)Add note regarding distance to private wells. 12)Provide actual slope from septic tank to D-Box. 13)Indicate solid pipe on interconnection of distribution pipe. Respectfully, John L. Noonan, P.L.S.-P.E. &office/forms/tonarev014 Land Surveyors Civil Engineers Environmental Planners NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 nA Email:. nmAnetway.com f �9 Date Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 17170/ 611,f- 7- /Z 3a 4,r11*v y> e.,e.-c::- c--Ad Assessors Mapz6?,,c,Parcel T Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated .-moi it z 3, i v, It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the following is addressed: � e %� 5 A-7— s&-Y' ri e- 1-.x..1 K= O�rat t � IOU 7— �c/�T• �-�,.- P7/ �_ �tet•A- C-- JS L.�3 S j�� ✓ 9Cc7 Q � �i3z �i✓/f �� ��� APP 7-0 Respectfully, 6 v e- T John L. Noonan, P.L.S.-P.E. G:office/forms/tonarev j��rn�-, c ar 1 f'� -� sem- 7 Land Surveyors Civil Engineers Environmental Planners � v� G*//7w e n.0 fQ o)t--r ter, N ci i7�G.7 t N 5 fig/r ooyl i r..� SGS 7 7 7 /t a� r- 7 Imo/ C- Po-eQ F1 C- 70 •tel elm X e7/-- S /�' 75C f7l< S 7'/ v r ,7 CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS N&M Job 1770/ �/ fit' The following is a checklist that incorporates all Title 5 and local regulations for septic plans. � /9�v7tsJr's� c/L Name of Applicant:X,',17 4°-a 7"-f &4/7,fY C-�i,Name of Designer: Plan Date:^of / Z-1 'ZQQ/Revision Date: Date of Review: C Property Address: -Z 3 o Glf yevyi- 4-t Map:lao --- Lot: ' BOH Reviewer: c14— NOON /f E✓ Type of Plan(new<rva Number of Bedrooms in -Or s: gpd)Garbage Disposal Allowed: f l� General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK emblem N/A Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) Legal boundaries of the facility being served-220(4)(a) Names of abutter 1= - NA 8.02j /74x-v 7- Number of bedrooms,design calcs.,-NA 8.02i E� Name&address of record owner&applicant- NA 8.02k Name&address of designer-NA 8.021 Holder and location of all easements-220(4)(b) �- Date plan drawn&any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) All distances on site plan-NA 8.03a-c Elevation of proposed driveway-NA 8.02t Lam, Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system' c .reserve ew const.)-220(4)(e) 4�T.vv Limits of excavation of leach area on sitepl�a NA 8.02z Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) �- Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) c-� Date(s)of soil testing-220(4)(h)&(i) . Existing grade elevation of each deep hole-220(4)(h) v Elevation of percolation tests-N.A. 8.02n Name of approving authority representative-220(4)(h)&(i) Name of soil evaluator-220(4)0) �- Soil logs and perc test logs match BOH records Locations waterli ains,and subsurface utilities-220(4)(m) ,,,-,-r7 L Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n) /►,� T C Complete profile of the system to scale-220(4)(o),NA 8.02c 3V l c Cross section of leaching facility-NA 8.02w (Not to scale) Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) Original R.S./P.E.stamp,signature&date-220(1)&(2) If P.E.,discipline specified within stamp. MGL C. 112 s. 81M sfc.supplies(w/in 400'),pub.wells(w/in 250'),pvt.wells(w/in 150')-220(4)( Location of watercourses,wetlands,wells,etc. w/in 150'of system-NA 8.02r PW�etland disclaimer-NA 8.02s S plan reference&certification required(prop line setbacks)-220(3) T s Plan contains designer's certification statement j' �- Use approvals/standards checked for UA system-DEP docs., A 2 v �P rarate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) erc rate>60 MPI-must use modified tight tank or 1/A technology-245(4) Proposed system qualifies as"shared"system-002(definitions) Z--"'Flow is over 2,000 gpd-No R.S.allowed-220(1) Design flow was set in accordance with code-203 y Existing system location and note on proper abandonment-354 Leaching facility at le a over Flood elevation—NA 9.05 All piping Sch 40 minimum=X10.01 '—Basement floor minimum 1' above groundwater elevation—NA 5.04 Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan-220(4)(h) o� All deep holes and peres shown,including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(i) ✓ Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: ground elevation el. acceptable soil el. Leach facilitv invert el. ground water el. refusal el. !/ bottom of leach facility el. thickness of acceptable soil �^ before&after soil R&R separation to groundwater separation to refusal _ soil class perc rate loading rate septic tank below g.w.table / (yes or no) pump tank below g.w.table =_' (Yes or no) l.f in fill -255(1) Setback Distances(Given in feet) 15.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility Property line 10 10 G✓ Cellar wall 10 20 2 3 Inground pool 10 20 C-91-ab foundation 10 10 Deck n footings,etc. 5 10 Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib.To Surface Water supply 325 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 �O Drains(wat.supply/trib.) 50 100 v Drains(intercept g.w.) 25 50 �. Foundation drains 10 20 / Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) - Pipe cast iron or Sch 40 PVC-NA 11.02 Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) Pipe laid on continuous grade in straight line-222(7)@ — Cleanouts precede all changes in alignment and grade-222(8) e----�-Cleanout provided every 100 feet-222(8) rr Manhole at any 90 degree alignment change-222(8) �T— Invert elevation at building: Invert elevation at septic tank: Length of run: �' Slope: (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) 3 Septic Tank ~? OK Problem N/A Tank is accessible-228(3) No structures above c-=�26&( Tank c commodate both primary&reserve-NA 9.04 %of flow(required -=provided given. 1500 min.)-220(4)(f)&223)(1)(a) 2-3"drop from' to outlet-227(5) Minimum liquid depth-223(2) 3"a' ace above tees/baffles(minimum)-227(4) " u space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6"above flow line-227(1) Inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(mo r deeper tanks)-227(6) Gas baffle installed on outlet-322p4)-:— Access 2Access manhole cover abo enter of tank&each tee(except 2 compart)228(2) 3-20"manholes-22 1 childproof,24" iser/manhole Win 6"of final grade if<1000gpd-228(2) Inlet and o t tees on center line-227(1�s* is non-nati Soil co action below tank specified(ifve)-221(2) 6" <=3/4"stone beneath tank spec' d-221(2)&22 8(1) /tl gpd AND not a single .dwell.must be 2 tks or 2 comp.-223(1)(b) Ifecifies disposal mu e 2 tanks in series or 2 compart.tank-223(1)(c) Bcalcs.require ' tank at or below water table-221(8) Tatertight-2 (1) 9" er over (minimum)-228(1) Hading n.)-H-20 if traffic-226(3) Tnk =36"below grade-221(7) A ' g to tank(if applies)in accordance with-229 Ttet to keep old system in service during install if possible Distribution Box(Check here if not present: ) OK P�coblem N/A Inlet elevation: �--- �— Outlet elevation: r"-- �, 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6" sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b)'- Outlet 32(3)(b)'-Outlet pipes laid level for first 2 ft.-232(3)(c) Pipe Sch 40-NA 10.01 ' Number of outlets: Number of laterals: Size of outlets: Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a), r'`17.q % Soil compaction below distribution box specified(if soil is non-native)-221(2) 6" of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36"below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8) 7PU (Check here if esent: ) Volume specified: 22a()(r) Pump on elevation- _�220(4)(r) Pump off elevation: 220(4)(r) Alarm on ele n: 220(4)(r) Num cyverycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box) inimum 2"deliline to d-box if gravity-254(1)(c) 4 r >� 5 Pressure dosed l.f.if owe 2,000 gpd-254(1)(a)&254(2)(a) Cycles per d consistent with chamber volume-23 1 Vol alculations include flowback volume-2') 1(2) our storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4 "sol'ds(minimum)-231(7) Pump controls speci e6220(4)(r) Alarm equipme pecified-231(2) Alarmis i ilding and powered on separate circuit from pump-2') 1(9) Pump uence correct(off-lead on-lag on-clan-n on)- 31(8) P performance curves included-220(4)(r) anual operating switch-NA 12.01 Check valve,bleeder hole-NA 12.01 1 childproof,24"riser/manhole t mal grade-2'31(5), Soil compaction beneath p chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone bene chmbr.specified-221(2)&228(1), Buoyancy calcula ' s if chamber is at or below water table-221(8)@ 9"of cover ov chamber(minimum)-228(1) H- 10 load' g(min.)-H-20 if traffic-226(')), Cham is watertight-221 (1) Top of chamber<=36"below grade-221(7) Leaching Facility(general-complete-for all designs) OK Problem NIA 50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) �—'No vehicle or imperv.area above 11.unless unavoidable-240(7);NA 13.02 Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) G� 9"cover over peastone-240(9) !'Reserve area provided(new construction)-248(1) e--Reserve 4'from primary leach area—NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w.-212(a)&(b) V 4'(down to 2'with variance or I/A-upgrades only)of natural soil under 11 — `" GW separation is adjusted to highest existing_grade if facility cuts into a hillside �J 1C' Pipe slope minimum of 0.005 -251(9) L--- Require 5'removal and replacement if in fill-255(5) I_--- Top of leach facility<=36"below grade-221(7) C-- Final grade over 11 minimum 0.02 ft/ft-240(10) T Surface&subsurface drainage away from 11-240(1 1)&245(5) -- � Minimum design flow 440 gpd without deed restriction—NA 13.01 �— 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) Impermeable barrier if<3:1 slope or< 15 feet to—3:1slope-255(2) fir= Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E.-255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret.wall-255(2)(g) C— Perc test(s)done in most restrictive layer- 104(2) Perc test 4'below leaching elevation—NA 7.06 Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4"diameter except for dosed system—NA 14.04 each lines capped,vented,or connected together-251(9) Pressure dosing guidance followed if pressure distribution-254(2)(c), pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) 5 w 6 C Leaching Trenches(Check h if not present: OK Problem N/A- Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): Width of trenches(2'min.,4'max.): -251 (1)(b) " Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50' 1 (11) Trenches follow contour ' s-251(2) Trench spacing 3 t' s effective width or depth minimum-251 (1)(d) In fill or res between trenches, 10' min.-NA 14.01& 14.03 Avail each area given(Min.500 s.f.)-NA 9.01(2) Bottom=L x W —x# - s.f. Sidewall=L x D x# - s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR = g/day Effective area is>=desi ow of facility being served 2"of 1/8"- 1/2"2x ed peastone.-247(2) Trench depth /4"to 1 1/2"double washed stone-247(1) Leach Fields(Check here if not present: 1 OK Problem N/A Number of fields: (need dosing chamber if> 1,231 (1)) Length(100'max.): -252(2)(b) �- Width: Total area:L x W = s.f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe-NA 15.01 Effective leach area given Loading factor: ��- Effective area=total area s.f x LTAR = g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) G" 6'line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(f) Between 6"and 12"of 3/4- 1 1/2"stone beneath field-252(2)(g)&247(2) ��- 2"of 1/8"-1/2"2x washed peastone.-247(2) Final Grading OK Problem N/A �i- Slope over leach area minimum of 0.02 feet/foot-240(10) Grading shall divert drainage away from leach area-240(l 1) u Grading slopes away from dwelling 5/24/01 f:/office/forms/tonackltr.doc 6 LVI11 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 FAX(978)475-1448 •E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: y 2 o I RE: p TM: 11269 G TL: Q`j0 OWNER(NAME& ADDRESS) irE► �£ zr� _►2�FFA Members of the Board: An upgrade sewage disposal system plan dated: has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. 1) ( S• ZM& V Krim-E c.— or-r ICY FrL r_C TNS' SA-_ 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne cd �,- -/ ��0 OV dot• � � „�z, •, � � t,� � . 0/01 /0'U !/ INSPECTION CHECKLIST FOR SEPTIC SYSTEMS �= I�"S -. + + ►t C rn ' Yes NO is s A. Bottom of BedJZ 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. Comments: Y , B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimi m 10'to leaching facility 4. W,#Ii;eets specifications of plahi'- r� Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cern 5. Slope min' .01 or 1/8"per foot minimum 6. Pipe pr `rly set on compact firm base �- 7. Pi aid on continuous grade in straigtrie 8. leanouts precede all change in-WitEnent and grade Manholes at any 900 ch 10. 10'minimum offsetTo water line Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum ' 3. Gas baffle present on outlet 4. Manhole to grade ` 5. Manholes over center and each tee (� ! , a � 6. 3-20"manholes t4' :�''" 7. Inlet tee minimum 12"under invert - If ' /r c1 8. Outlet tee minimum 14"under invert , 9. Outlet line cemented f'! , 71 �- - r f/ �'��► T 10. Air space 3"above tees /"_'�z� 11. 2"-3"drop from inlet to outlet 12. Pipe set 13. Compact base with 6"of%"crushed stone under tank 14. Tank is watertight Comments: 7 _t r v Yes NO E. Pump Chamber 1. If separate from tank,compact base wi J 6"of 1/4"stone underneath 2. Minimum 2"pipe to d-box if ty system 3. 20"access manhole 4. Tank level y 5. Watertight 6. Tank sizeees with plan specification 7. Manhole`o grade ... 8. Cl rvalve and bleeder hole presence-d.'l-" � 9. farm in building on-separate circuit' larm functions 11. Manual operating switch 12. Pump delivers liquid to d-box Comments: F. Distribution Box 1. D-box level f 2. Minimum 0.IT'(2")drop from inlet to outlet J r 3. Minimum 6"sump 1-3, r ' 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box 6. Box is watertight G - 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe is - Comments: '/� �'i✓ G. Soil Absorption system 1. All stone double-washed-3/4"- 1 '/2" [� -pea stone Bucket test done? 2. Minimum 2"of pea stone above distribution lines 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together tf�" 5. Grading meets 3:1 slope 6. Minimum of 9"of fill graded over system 7. Toe of slope stops minimum 5'from edge of property; if not,then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max.length 100') 3. Wid �ches agree with plan-Minimum 2';maximum-4'. 4. present if<50 feet or specified = ' 5 is between trenches min' and maximum of 6' 6. Minimum distance betwe. enches 10' 7. Pipe slope�esbelow 5 or 6"per 100' 8. Depth ooutlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: 1. Leach Field �- 1. Maximum length of field 100' r� 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipe 6'maximum ,� i— •` `� 4. Pipes connected at end 5. Separation between adjacent fields 10'minimum �- 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet piii ' �_ 2. co 3. Sits ofbetween 12"and 48wide�= Access manholes on aaeh pit' 5. Pipes cemented hydraulic cement Comments: ' K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond Wind2 FMS-Noonan&McDowell,Inc. I Fle Edit Tools Data Maintain Process View Report GOO Windows Help J IN Project: 1770 - 7 1r? Office of Health Department 27 Charles Street,—No.Andover, - — Billing Group ID: 031 Billing Type: Fixed Fee Billing Fee: 150.00{' Card ID: ToNA _ f Classification I GLAccounts Billing Messages Alerts _ _ Main , Billing Info Contract Info l J l Staffing I Activities ssign To -- Proposal Number: 'Department: °t Contract Number: Contract Work Start Date: Expected Finish Date: I 1 _�J f Use Government Invoice Style Description: Survey engineering services required for septic system inspection. Installer: John Shaw 978.474.8088 Pager,978.815.7411 Cell Applicant: Lisa Duffy 230 Granville Lane i 1� Save Close �—Notes... iSaved. ;start Quicklaunch M 0 011;10 AM Project Request Record Town of North Andover Date: Client Id:ToNA Card Id:ToNA Client/Company Name:Board of Health Card Type-Client Contact Name: Ms. Sandra Starr Phone:_978-688-9540 Title:Director Fax: 978-688-9542 Address: 27 Charles Street Email: Notes: Town: North Andover State: MA Zip Code: 01845 Other contacts if applicable:ie Engine /�stalle 7 Name: coo S f/ip !<t/ Phone: 9 A0�Z Title: Fax: Address: Email: C L L Notes: Town: State: Zip Code: Project: Project ld: 1770 Project Title: Town of North Andover.Board of Health (JOB NO) (PROJECT NAME&STREET ADDRESS) Manager:NOW Billing Group: Billing Code:Fixed Fee Contract Info..Project Description for each billing group BG/ Applicant 0 SA Assessors Map Lot Street Z 7d Type of service s•L----e,7-i��t� S Z7��� Office/forms/jbrqutona MERRIMACK ENGINEERING SERVICES INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS Lq 1 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: RE: 'Z o C`��i�.ry J�"'e, L.t, TM: (C69 G TL: OWNER(NAME& ADDRESS) r2y-*ErA-1- �£ 6W &A0I>A 124 FF-r Members of the Board: An upgrade sewage disposal system plan dated: has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. I) ( S. ZQzt V e-k-T-1cA L- OFF-5 6y Ff I-"P-C TOc SA45 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES Ljj1&-- ^~'"y William Dufresne cd MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: (n•2. —C�( r.1: RE: 7i� C-. v! LLE C.�J, 2 9 2001 TM: TL: 00 OWNER(NAME& ADDRESS) Members of the Board: An upgrade sewage disposal system plan dated: has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. 1) k2A, l-cA- u4 F t PLP L45 1Oytzt) I c29se(-Oca 5P 06T 2) 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES A William Dufresne cd No Jun- 19-01 04:46P P.03 NOONAN & Me DOWELL, INC. 25 Bridge Street; Suite 6, Billerica, MA 01821-1023 Voice(978)667-9736 Fax (978) 671-9565 Email: mn647,rictway ct�n't Date: June 12, 2001 Town of North Andover J' Offiw of the Health Department Community Development iuid Services Division 27 Charles Street North Andover, MA 01845 RL: Subsurface Sewage Disposal System Plan Review, 1770/014 230 franville Ln Asse5SQrs 1Vfap 106C, Parcel 80 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated May 23, 2001,by Merrimack F ngineering Services,inc. it is our opinion that the proposed design will meet the requirements oCTitie 5 and the. North Andover Board of Health "By-Laws"if the fol lowing is addressed: �dd"replace existing tees"at septic tank detail. 2) Use 113.4 1'or water table elevation. The highest ground grade within the lcach.ing area is JUS � 1194 +/ �eed a local variance request for less than 900 sf, of area(NA 9.01 (1)) add to plan and variance request form. k11V Identify waterline as either pressure or suctran. Profile of system shall be drawn to scale, with existing and proposed ground grades 220(4)(0),NA 8.020. Provide a note stating existence of wetlands within i so Il. or system, Provide a note stating no tributaries within 325 It, no reservoirs within 4(1(3 fl.,no iributarics to reservoirs within 200 ft.,and no drains within 50 ft. to the system. increase length of leaching system 6 ft. to allow for 2 ft. level and D-Box. 17i �-JrS ) Add 5 [t. over dig to end section and profile. W 'oI Provide ground elevation at existing septic tank and elevation of deck. Add to variarce `cQ equest permission to maintain existing use of septic tank. t11�vl� SLi dd note regarding dislaticc to private wells. 7122 �f rovide actual slope from septic tank to D-Box. lndicate solid pipe on interconnection ol'distrihution pipe. y 114, Respectfully, . John L. Noonan, P.L.S.-P.E. G:u(fiCc%rix msR�nxrc�t)I 4 Land Surveyors Civil Engineers Enviroutncntal Planners Location: Zr � t :fin owner's Narne: Map/Parcel'— „ F_ _ Address: (a VIA")I L Ltw, Installer: Tel R• "�� New(siso) Repair 1. Date: `�" ?'"� Wetlands Zone If Soil Symbol (-'a Soil 1Qam%� Soil Class 12j Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil ColorSoil hiottlin; % Gravel,Stones,etc: Fwt I��� (O'er f�� �� ���"' � O�'�i`l�6ir '^ �•i�'tjhGJ� t ?� ✓� JSP ZtSYslt<e M•r 'IV IQ 0 tL t �flir�� W Parent Material �{ "1.• - Depth to Bedro&&�standing Water in the Hole*__: V4eepin,from Pit FaceF,sgM;4V f V, 41, P144-OP U4 F51,• 10y l u 0 V t I-V410LA* Parent Material �(.LU Depth to Bedrock standing Water in the Hole.-. Weeping from Pit Facet` ESgMy: Date Percolation Tests Observation Hole Depth of Perc ( " Start Pre-soak ;1 Time at 12" Time at 9 711 5Z ; Time at 6" Time(9"-6") ..Rate Minach 01 Performed Br. Witnessed By: , i I � Llt4 0 L4 TIC N I iilvl= ;=� i I IME I Ilyl_ I I i CERTIFIED PLOT PLAN OF LAND I CERTIFY THE DWELLING IS LOCATED 230 GRANMLLE LANE ON THE GROUND AS SHOWN. NORTH ANDOVER, MA �zNOF PREPARED BY: `� JOHN D. SULLIVAN III, P.E. \ r I-P• Na. 193 R. SALEM STREET FND S VAN WOBURN, MA 01801 ° 4 (781) 935--9143 �. AL DATE: 11/13/2000 SCALE: 1"=40' \ '11° li(13(ZbDD 250, �No�• \ ul off, N� LOT AREA=43,848 S.F. Y \ LSC pr 71.02' \ o-gox ,0 �r /pc 1 .r 0 �0�•� .� ('i l SrpnC k2 23 \ 17, rAAF� Y WOOD , J 86.66' 1.P. SE53.33' 2.42' 163.66' L--87.00 S/N x.30 S.B: N71*50'40"W S.B. FND FND ~` FND G R A N V I L L E (50' ono.E—Pusuc) LANE T0018 ZZZ2SLV9L6 IVA MPT 11HI TO/99/P0 t: 1 i n=.,i !y `^� «f S f•' � � I I + t I I I SEPTIC PLAN SUBMITTAL FORM LOCATION: ZIO Gr.A-k)y 1 LLE L-Aoe 4 1140.eU NEW PLANS: S 6�- 0/Plan ✓ REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: 'YES/ NO DATE: DESIGN ENGINEER: AcV, 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. TOWN OE NORTH ANDOVER/ BOARD OF HEALTH � JUN 2M1 Town of North Andover, Massachusetts Form No.2 f NORTh BOARD OF HEALTH 3?p�4 4v � k.06 I O � , w A DESIGN APPROVAL FOR ds"c"USE< SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No.—/04:2,_ AV Site Location a d Reference Plans and Specs rmQGAzloox. �U&' i�A9101 ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH elk Fee Site System Permit No. MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: 5"7-05�a RE: v C`AAN Ji l.l. L-?, TM: 126 G TL: gj0 OWNER(NAME& ADDRESS) �£ EU, zAo-eia--t ou FFA' Nv. OOWr2c V Members of the Board: An upgrade sewage disposal system plan dated: has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. 1) �. V L' v(�;;F-5t"r Fier-t -T-0c 2 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES cjj&-- Qzl� William Dufresne cd Location:_ owner's Name: 21 Map/Parcel• 9/ _ Address: vh Installer. Tel N: ;^1 New(siso) Repair Date: '2° �''0 Wetlands ZoneII'r' Soil Symbol C..-M Soil 1Qame Soil ClassL� Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil Color Soil hiottling % Gravel,Stones,etc: tv 44. 96 re JV0 sq 4 bs 5 Parent Material �1 �►�.•d Depth to Bedrock.-fit Standina.Water in the Hole: =W epin;from Pit Face ' : ESHGNV. 7r'' 10o-01 A0 5 I Y3 C V, r-,IA" ' 116. 4 4, ku, 10Yit,41w pk4w,, urs /8014 002- F5 V toy& G Pj,4-r;P51 v� V OL,& 1- 113 04'.wa, r-E- y(//L I Lw'� s 0.0 Parent Material �/ Depth to Bedrocl:�Standing Nater in the Holr. "` W"pin;from Pit Face" ESHGXY: Date Percolation Tests Observation Hole r "I Depth of Pere " Start Pre-soak: Time at 12" 1 Time at 9" 1 it 5Z.- Time at 6' Time(9"-6") Rate Min/Inch Performed Br. Pj• (j. � f Witnessed By: �, 1 / IF 1 I Cq �i (/) IL I c--b ill U • 1II Ill III (:1 -. Q I 1 I 1 _ <1" _ v) ,... i), it t -l• (1�; i�l - I 1-- < UJ LJJ LIJ UJ Ut ll.l �� ll.l 111 LIJ lJ.l ttl - - - •� ll) Z � Z i CERTIFIED PLOT PLAN OF LAND I CERTIFY THE DWELLING IS LOCATED 230 GRANVILLE LANE ON THE GROUND AS SHOWN, NORTH ANDOVER, MA zNOF� ti PREPARED BY. \ JOHN D. SULLIVAN 111, P.E. r I.P. Na. 193 R. SALEM STREET FND s WOBURN, MA 01801 o a (781) 935--9143 A`� DATE: 11/13/2000 SCALE: 1"=40' cbJo VL \�0\ pQ .. r LOT AREA ,8 iN �M 48 S.F. \ �. LEApitArc pr � � 71.02' \ 40, °' X ,. Prr 'h c o NaLmrc � \ Yp K'DOD O X30 .O J 86.66' I.P. 61.36' SE 53.33' ' R=255.00 R`g2.426# 163.66' r L 00 7 S/N 1'30 S.B. N71850'40"W 5.8. FND FND FND G R A N V I L L E (50' IMDe—Pueuc) LANE T00O ZUSSO8L6 %dd CONT 11E,L TO/9Z/V0 t 'i•�ted' {'`9���,� ..-4 �¢ � f �•"- i � I LIle + ILL i —r I h- Town of North Andover, Massachusetts Form No. 1 N QRTH BOARD OF HEALTH Q� 19 Q �goo41,11�11-- ^' " APPLICATION FOR SITE TESTING/INSPECTION 7 RATED PPP '(5 �SSACHUSE� i i Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Commonwealth of Massachusetts I " - , Massachusetts System Pumping Record System Owner System Location 6 Date of Pumping: Quantity Pumped: /Ov9allons Cesspool: No [.]/ Yes [] Septic Tank: No [] Yes [� System Pumped by: Tarw" saaqww License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: r- Frank C. Gelknas and Associates Engineerss &Architects Q�L[EUTEQ (OF URUZEUTU North Andover Office Park NORTH ANDOVER, MASS. 01845 DATE JOB NO. Phone 687.1483 ATTENTIO RE: TO GENTLEMEN: / WE ARE SENDING YOU M1 Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPT ON J 3 J �"_t J,-klh THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. 101gle 7? J 9 Anne 4zd �o 14,,,� �j le(, �A . BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE:24—t? 1 LOCATION OF SOIL TESTS: Assessor's map & parcel number. 1 ©<1 C- Q�0 OWNER:—&00�tC KW;,(Qt Il TEL. NO.: U ADDRESS:_ Lt,t- Looe ENGINEER: W9414 k&cj:�- TEL. NO.: 4-X-'X555 CERTIFIED SOIL EVALUATOR: YI L-t-,�U ��f� Int nf_dAiWVf land: residential subdivision, single family home, commercial e c/ Un loped to testing APR 2 7rvation Commission Approval: - - THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: APR 2 7 2001 1. Proof of land ownership (Tax bill,deed, or letter from ovine 1mrtU1111Y 2. Plot plan 3. Fee of E275.00 per lot forenv 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 plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1'-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing sol.1 evaluation forms shall be submitted. 'CERTIFIED PLOT PLAN OF LAND I CERTIFY THE DWELLING IS LOCATED 230 GRANVILLE LANE ON THE GROUND AS SHOWN. NORTH ANDOVER, MA \ �LZNOF PREPARED BY: I.P. Na. JOHN D. SULLIVAN III, P.E. \\ r s i1N FND 193 R. SALEM STREET WOBURN, MA 01801 o a (781) 935--9143 DATE: 11/13/2000 SCALE: 1"=40' 0. i \ cp 40, LOT AREA=43,848 S.F. ��c Pir 71.oz' ')-BOX Luqlft Pir o t Ato A02• h s? r ikspc \ 4 ry�0 � G z ��II \ J \ �r G �z�o 'oma 86.66' 1.P. 61.36, 53.33' SE ' R=255.0 R�2.42' 163.66' r ��� O S/N x.30 S,B. N71650'40"W F,B, FND FND ND G R A N V I L L E_ (50' WDE—Pueuc) L AN E TOO 01 ZZZ99L68L6 %d3 CONT 11H.L TO/9Z/60 FI. P , i IZ- Location: ` �i �,,, i. Owner's Name: Map/Parcel•_ tretfq Address: 017el Installer. Tel uR.. - ��Y New(siao) Repair r tt Date: Wetlands " " Zone II Soil Symbol (—,'I't Soil Same6uFp E±y0 Soil Class nn r7 Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Terture Soil Color Soil Mottling % Gravel,Stones, etc: 0 ,1-a-o'L�a K Parent Material 1r Depth to Bedrock16tandin;Nyater in the Hole: : Weepin;from Pit Face V, Jiro 116 14, IV Iw, t,. f�vf� -�- pk4ofo Fe FIA-1;4t V 93 V t Ff?.40LA, ;Zeei Cf. Parent Material Depth to Bedrocl: Standin.a Water in the Hole. ""` WinE` p .as from Pit Face"" ESHGW: Date Percolation Tests Observation Hole r Depth of Perc Start Pre-soak 21;1 Time at 12" ( e Time at 9" 5Z- -------- Time at 6" Time(9"-6") ( ..Rate Min/Inch ..- Performed BN- OU, Witnessed By: �. r -` 3 r, i O C,^.7 i 0 fel: aaf� COL".i ION TEST .= ` I ItiIE L..�i ....Lir.(\. �. \ �i--'.l I..__� .. "I''�.=_ Inc I INS= :=. 1 � C e i T I IVi E I E . I I IM T; .`. I I !" TUE .; CERTIFIED PLOT PLAN OF L�gND I CERTIFY THE DWELLING IS LOCATED 230 GRANVILLE LANE ON THE GROUND AS SHOWN, NORTH ANDOVER, MA �zNoF PREPARED BY: \ `�' JOHN D. SULLIVAN III, P.E. r I.P. i NO. 193 R. SALEM STREET FND s LN WOBURN, MA 01801 4 (781) 935--9143 ?s\ �` sioeAtE DATE: 11/13/2000 SCALE: 1 40' 40 LOT AREA=43,848 S.F.±� LCA�1Nc P1 t 71.02' Pt r 5 177$8 T�k42 c \ Y � . p Doaaw J 86.66' I.P. 81.317' SE 53.33' � R=255.0; 2.42'R� 00 163.66' � .. L��. S •30 S.B: N71650'40"W FND S .B. FND FND G R A N V I L L E_ (so' wiD.E-Pusuc) LANE TOOln ZZZ99L69L6 Xd3 MtT 11H.L TO/9Z/t0 I i ti A %\ Coo 1 ` t A L c T ' 1_ NY P-LP-F- QST QF ��aE: A 5 � U � �-r ti P1P� NTQ 7A&4V _ — — I pF rANU�- \L P.LFL N'O.D.E5oX = - ,',,LV-P.iP-QuT Q.aQX av LN IQ G � Q PA-TE-- r }�' F RA�� GC G (�E �ir.►A.S vGOn ES Q�� AN DCS/�� cj-T- �y o ArJ CaO�lE� I i •� 1 i1� 1 1 � + l � -��, ������L� d '�