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Home My WebLink AboutMiscellaneous - 230 GRAY STREET 4/30/2018 50 .Gray Street j �I I i i w .f Commonwealth of Massachusetts ug a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for V61un4ry Assessments 230 Gray Street Property Address Sandra Han Owner Owners Name information is required for North Andover MA 01845 1/21/2016 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. Important: A. General Information When filling out forms on the JAN 2 5 2016 computer,use 1. Inspector: only the tab key -TOWN OF OCR-,F,AMDOVER !ER to move your Neil J. Bateson HEALTH ELPART7,'ENT cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address P Y Andover MA 01810 Citylrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N eds Further Evaluation by the Local Approving Authority 1/21/2016 Insp s ignature 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 Form:Subsurface Sewage Disposal System•Page 1 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.' Form-Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for North Andover MA 01845 1/21/2016 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found an information which indicates that an of the failure criteria described Y Y in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After filling holes over leach area with sand&cutting down tree over leach pipe septic system now passes Title 5 Inspection. I i 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 Y that the tank is less than 20 ears old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ` Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments " 230 Gray Street Property Address Sandra Han Owner Owner's Name .information is North Andover MA 01845 1/11/2016 required for every page. Cityfrown State Zip Code Date of Inspection `t Inspection results must be submitted on this form. Inspection forms may not be altered in alrR:_ '. way. Please see completeness chgcklist at the end of the form. Important:WhenA. General Information = filling out forms on the computer, use only the tab 1. Inspector: AN r key to move your �d'�nl Q "'d ; cursor-do not Neil J. Bateson use the return Name of Inspector g �` key m i � Bateson Enterprises Inc. p �y Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 _S 1 15 Telephone Number License Number B. Certification certify that I have personally inspected the sewage di:.nnsal system at this address and that the .r;. information reported below is true, accurate arr}.: ompl;,;�� s of the time of the inspection. The insp[Y`` was performed based on my training and experience in the proper function and maintenance of on fi sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 c,' Title 5(310 CMR 15.000).The system: ❑ Passes Z Conditi.c„ally Passes ❑ .Fails ❑ NeeFurth r Evaluation by the Local Approving Authority i 1/11/2016 rz Ins r Signatu Date The system inspector shall submit a ccoy of this ins ection report to the Approving Authority (13c"'., of Health or DEP)within 30 days of completing this inspection. If the system is a shared system " has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the = k report to the appropriate regional office of the DEP. The original should be sent to the system ov r x and copies sent to the buyer, if applicable, and the r'nnroving authority. *""'This report only describes conditions at the time of inspection and under the conditions o; :r?r=i. at that time. This inspection does not address how the system will perform in the future u ".M the same or different conditions of use. 1; t5ins•3113 Title,5 Official Inspection Form:Subsurface Sewage Disposal System-Page' Li 'I + ' Comfttonwealth of Massachuseds Title 5 Official. Inspection Form a Subsurface Sewage Disposal System Form-Not fc„ , )luntary Assessments 14, 230 Gray Street Property Address" .Sandra Han Owner Owner's Name informfor every information is required North Andover MA 01845 1/11/2016 --- .. page. City/Town ,tate Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information viihich indicates,that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. An failure criteria not of evaluated are indicated below. o C mments: F..: B) System Conditionally Passes: ..,. ® One or more system components as described in the"Conditional Pass" section need to bay. replaced or repaired. The system, upon completion of the replacement or repair, as the Board of Health, will pass. Check the box.for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is stru unsound, exhibits substantial infiltration or exfiltration o-tank failure is imminent. System will ps'� d inspection if the existing tank is replaced with a compl •ing septic tank as approved by the Boar, Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate't' Compliance indicating that the tank is less thai 120 years old is available. ❑ Y ® N ❑ ND(Explain below): . t5ins•3/13 Title 5 ufi.icial Inspection Form:Subsurface Sewage Disposal System•Pape ' Commonwealth of Massachusetts Title - official inspection Form Subsurface Sewage Disposal System form -Not for Voluntary Assessments f 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 page. own CitylrState Zip Code Date of Inspection . J t': B. Certification (cont.) , y ,}vi ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health apl pumps/alarms are repaired. B) System Conditionally Passes(cont.): :; ❑ Observation of sewage backup or break out or high static water level in the distribution to broken or obstructedpipe(s�or due to a broken, settled or uneven distribution box. Sys r pass inspection if(with appro•,-a,l 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 L] Y ® N ❑ ND (Explain below) ❑ The system required pumping more than 4 times a year due to broken or obstructedp p I e(; ' Commonwealth of Massachusetts Ui Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for\./ luntary Assessments k 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 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 heaV,S,Qe, safety and environment: r ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is withii;'< 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone 1.of a public w�Y ..; supply. Jt: ❑ The system has a septic tank and SAS and tho SAS is within 50 feet of a private wata 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 supp:' well**. Method used to.determine distance: 'Pi 1 f r **This system passes if the well water analysis, per,,rmed at a DEP certified laboratory, for tN1 ; ��f,4 s coliform bacteria indicates absent and the present-a cA ammonianitrogen and nitrate nitrogen i p°= to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analy',.,=} be attached to this form. L: 3. Other: Fill holes over leach trench# 1 with clean sand &remove tree on d-box&pipe for leach tree;., .: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded c � clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an ovE, or clogged SAS or cesspool ❑ ® Liquid depth i,_,cesspool is less Phan 6" below invert or available volume than '/z day flow �.. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•P; j, (1i ' i ' 4 ' 4 L � { , I I Commonwealth of Massachusetts 'title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F ' 1 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 i required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 1 Yes No Required pumping more the- times in the last year NOT due to clog`s" ❑ ® obstructed pipe(s). Number of times pumped: -El z �: Any portion of the SAS cesspool or privy is below high ground water,,,: Any portion of cesspool or privy..;s within 100 feet of a surface waters::`,-; ` El ® tributary to a surface water supply. ❑ ® Any portion of a cesspool c%r 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 N; s ❑ 0 Any portion of a cesspool or pri',:ry is less than 100 feet but greater tha, t, from a private water supply well with no acceptable water quality analj'n, system vises if the well water analysis, Y p y , performed at a DEP cerl��; ,,;^;, tix,� laboratory, for fecal coliform bacteria indicates absent and the pr3,4 of ammonia nitrogen and nitrate nitrogen is equal to or less than ris;,;;,ss,,>; ` provided that no other failure criteria are triggered. A copy of the and chain of custody must be attached to this form.] ❑ ® The system is a cesspool s.;•Nt;;g a facility with a design flow of 2000g,�"._-;�:. 10,000gpd. _ ❑ ® The system fails. I have determined that one or more of the above criteria exist as described in 3-10 CMR 15.303, therefore the system fa'-,,,' system owner should contact the Board of Health to determine what w`:; necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility wit l design flow of 10,000 gpd to 15,000 gpd. .For large systems, you must indicate either"yes".or"no"to each of the following, in addition questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply 11 ❑ the system is within 200 feet of a tributary to a surface drinking water ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Pr(r�,.;r`;°:; Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section. F_ the system is considered a significai4 31 <<' or answered"yes" in Section D above the large system has failed. The owner or operator of;= y' system considered a significant threat under Section E or failed under Section D shall upgrac,} -°;- ' system in accordance with 310 CMR 15.304. The system owner should contact the appropria' regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• *� .�. 'A�/� Y .d �r I��e ��I .. 1 l wo1l�• Ua,,. 3 4 1 ' Commonwealth of Massachusetts i Title 5 Official InspectUi Form Subsurface Sewage Disposal System Form -Not for�'taoluntary Assessments F .1- 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover Wk 01845 1/11/2016 required for every page. City/Town ' State Zip Code Date of Inspection C. Checklist Check if the following have beep,done.You must indicate "yes" or"no" as to each of the fc Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board ❑ E Were any of the system cor.-,� .ants pumped out in the previous two val'= 't ❑ ® Has the system received nor ql flows in the previous two week period` P El ® Have large volumes of water� ee,i introduced to the system recently or this inspection? ® ❑ Were as built plans of the.system obtained and examined?.(If they wer�w available note as N/A) ® ❑ Was the facility or dweVing inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all syv9m components, excluding the SAS, located on site? } ® ❑ Were the septic tank manholes uncovered, opened, and the interior of i, s inspected for the condition of the baffles or tees, material of constructio'� 1 dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and oc..;:,i;ants if different from owner)provided information on the proper maintenance of subsurface sewage disposal :-- The size and location of the Soil Absorption System(SAS)on the s` been determined based on: ® ❑ Existing information. For examp,c, a plan at the Board of Health. ® ❑ Determined in the field (if anv of the.failure.criteria.related to Part C is as" approximation of distance is unacceptable)[310 CMR.15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 `.1 t5ins•3113 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal system• r , '�'. ' Commonwealth of MassacMsetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information North Andover MA 01845 1/11/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: 4". Number of current residents: ,,- Does residence have a garbage grinder? ❑ YR� , Is laundry on a separate sewage system?(Include laundry system inspection a a :information in this report.) ❑ YX' ?' ' Laundry system inspected? Seasonal use? ❑ YI .INC, Water meter readings, if available(last 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Y ` � , Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): ,i Grease trap present? ❑ Yt I Industrial waste holding tank presant? ❑ YE Non-sanitary waste discharged to the Title 5 system? ❑ Ye t tR Water meter readings, if available: ' t5ins•3113 hl:! Title!Official Inspection Form:Subsurface Sewage Disposal Syster, Commonwealth of Massachusetts - Title Official .knspection Form Subsurface Sewage Disposal C ;:tern Form-Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han _ Owner owner's Name information is required.for every North Andover MA 01845 1111/2016 --- page. Cfty/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date C. Other(describe below): General Information Pumping Records: Source of information: P°':;r�ed two years ago, owner 1 Was system pumped as pa-t of the inspection? Z Yes C 1f yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, dist,i�ution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy i 'Y ❑ Shared system (yes or no) (if yes, attach previous inspection records, If ac+�� ❑ Innovative/Alternative technology. Attach a copy of the current operation maintenance contract(to be obtained from system owner)and a copy of I,;`rII inspection of the I/A system by system operator under contract 1 f ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(desc*it i.;. l5ins 3113 Title 5 Oficial Inspection Form:Subsurface Sewage Dis oral S D P yste,a -IJ'II� 5 A l. �'+, � _ l d ,p r 'C Commonwealth of Massachusetts TitleOfficial InspecUon Form `s Subsurface Sewage Disposal System Form- Nc!for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every page. Cityftown State Zip Code Date of Inspection r D. System Information (cont.) Approximate age of all components, date instal!�a(if known)and source of information: $' 10 years old, 11/16/2005, as built plan Were sewage odors detected when arriving at the si"a? ❑ Yes b-1 Building Sewer(locate on site plan): Depth below grade: 1.3 feet Material of construction: ❑ cast iron ® 40 PVL ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): .4".PVC through wall,3" PVC.in house , no lef '":�.visible. Septic.Tank(locate on site.plan): Depth below grade: 0.3 t feet Material of construction: E concrete ❑ metai ❑fiberglas 3 ❑ polyethylene ` ❑ oths .• : If tank is metal, list age: years Is age confirmed by a Certif tate of Compliance? (attach a copy of certificate) El Yes Dimensions: 10' x 5'x 4' Sludge depth: 4.1 1:51ns-3/13 T o Oficial inspection Form:Subsurface Sewage Disposal Syster `,�..+ aM Commonwealth of Massachusetts w u -Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F r ' 230 Gray Street Property Address Sandra Han +_ Owner owner's Name information is required for every North Andover MA 01845 1/11/2016 - - -• page. City/Town state;;'. Zip Code Date of Inspection D. System Information �,..ont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" 411 Scum thickness 81' Distance from top of scum to top of outlet tee or baffle V Distance from bottom of scum to bottom of outlet t, or baffle 11" How were dimensions determined? Tape measure Comments.(on pumping recommendations, iniet.and outlet.tee or baffle condition, struct( ' liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee Depth of liquid at outlet invert. No :<s leakage. Inlet cover&outi•a;cover has metal cove 2"deep. _ __. . Grease Trap(locate on ske plan): Depth below grade: feet Material of construction: ❑concrete ❑ mr�t :: ❑fiberglass ❑ polyethylene ❑otf - ' Dimensions: Scum thickness Distance from top of scum to top of outlet tee or bafqF i { Distance from bottom of scum to bottom of outlet tee' or baffle Date of last pumping: Date ;.: i � I 5ins•3113 title E official Inspection Form:Subsurface Sewage Disposal Systc 11I�,..Ii�JL z_I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every _ page. City/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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. No evidence of leakage. No evidence of carryover. D-box had root invasion from tree right up against box. Remove roots from D-box. Tree should be removed. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Chamber ok. Pump ok. Floats ok. Alarm has.both audible&visual. "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every _. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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.): Soil ok. Vegetation ok. No sign of ponding to surface. Three trenches of infiltator chambers, six chambers per trench. Some one dug holes over trench# 1. Holes needs to be filled in with clean sand. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for every -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 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 fo€`Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is North Andover MA 01845 1/11/2016 required for 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. Cheek one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t 0 1 NG� a o P o � T az rig t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1/11/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Check cellar ® Shallow wells Estimated depth to high ground water: 4 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: 8/16/2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design Plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Deport Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts r Title-5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Gray Street Property Address Sandra Han Owner Owner's Name information is required for every North Andover MA 01845 1111/2016 page. Cityrrown State _ Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 :�L- Commonwealth of Massachusetts CRY/Town of . �b System Pumping-Record Form 4 DEP has provided this form for use-by local Boards of Health. Other forms may -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: Left/Right front of hou , L / ig rea o hou eft/right side of house, Left/ Right side of building, Left/Right front oft Ing, Left rear of building, Under deck Address Cityfrown state Zip Code 2. System Owner. Name' Address(if different from location) Cltylrown • State ^ Z�n.Code ; Telephone Number B. Pumping ,record 1. Date of Pumping pate ;:eptic . Qua Pumped: Gallons } 3. Type-of system: E3Cesspool(s) Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yep No If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: kkl 1j, .� 6: System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Ina Company 7. Locati contents-were disposed: Ca•_ Q Lowell Waste Water Sign a Haul Date ` t5formCdoc•06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 1/13/2016 2:26:47 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-107.D-0129=0000.0 Parcel Id 22684 230 GRAY STREET SANDRA HAN 34 HARWICH ROAD CHESTNUT HILL MA 02467 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.31 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until SANDRA HAN Owner 34 HARWICH ROAD CHESTNUT HILL MA 02467 STELLA,MARY Previous Customer Inactive 10/1/2005 C/O JANET M. KLISKA,TR 180 GRAY STREET NORTH ANDOVER,MA 01845 LITCHFIELD CO. Previous Customer Inactive 12/7/2005 26 RAY AVENUE' BURLINGTON, MA 01803 TONG HAN Previous Customer Inactive 7/29/2011 34 HARWICH ROAD CHESTNUT HILL,MA 02467 CYNTHIA LIU Previous Customer Inactive 8/17/2012 34 HARWICH ROAD CHESTNUT HILL,MA 02467 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17708.0-230 GRAY STREET Last Billing Date 11/13/2015 1090515 01 Cycle 01 Active UB Services Maint. Account No. 1090515 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/1 WTR WATER 01 ALL METER SIZE 41.80 1/1 UB Meter Maintenance Account No. 1090515 Serial No Status Location Brand Type Size YTD Cons 32421970 a Active 00 b Badger w Water 0.63 0.63 1740 Date Reading Code Consumpticn Posted Date Variance 10/22/2015 2086 aActual 11 11/20/2015 -17% 7/24/2015 2075 a Actual 13 8/14/2015 -1% 4/27/2015 2062 a Actual 13 5/19/2015 -8% 1/30/2015 2049 aActual 16 2/20/2015 -87% 10/24/2014 2033 aActua1 117 11/14/2014 -19% 7/25/2014 1916 a Actual 146 8/13/2014 590% 4/24/2014 1770 a Actual 20 5/15/2014 5% 1/27/2014 1750 aActual 21 2/14/2014 -92% 10/23/2013 1729 aActual 252 11/18/2013 972% 7/23/2013 1477 a Actual 23 8/15/2013 14% 4/24/2013 1454 a Actual 20 5/20/2013 17% 1/25/2013 1434 aActual 18 2/13/2013 -92% 10/23/2012 1416 aActual 222 11/9/2012 285% i I ' Town of North Andover L-' of No RTN ,ti Office of the Health Department Community Development and Services Division ' 400 OSGOOD STREET North Andover,Massachusetts 01845 sACHUS Susan Y. Sawver, REHSJRS 978.688.9540-Phone Public Health Director 978.688.8476-Fax fwRV g7ICX rM OT C091M)G r ONCE As of: November 22, 2005 This is to cert that the individual subsurface disposal system was Fully Constructed by Charles Todd At Lot 5, aha, 230 Gray Street NorthAndover, 911A 01845 alas been installed in accordance with the provisions of Title v of the State Sanitary Code and with the North Andover Board of ifealth regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. clic ele E. Grant Tu6licWealth Inspector (ii)ARD t.)1 \PPFA(S 633�)9�I [3U11.UINCi 688')�l5 CONSI:RVA FION 638-95,3,.0 HFAL I'I 1688-95 40 PLANNING 638-9:35 0 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'SS4CMt!`��t Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SEPTIC SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: Lot 5 Gray Street MAP: LOT:_ INSTALLER: Charlie Todd DESIGNER: Joe Serwatka PLAN DATE: Last Revised 8/1/05, Received on 9/21/05 BOH APPROVAL DATE ON PLAN: 10/6/05 INSPECTIONS DATE OF BED BOTTOM INSPECTION: 11/4/05—Michele Grant DATE OF FINAL CONSTRUCTION INSPECTION: 11/17/05 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE 1. GRAVITY DISTRIBUTION...❑ 2. PRESSURE DISTRIBUTION...❑ 3. PRESSURE DOSING...rx-1 4. HOLDING TANK...❑ 5. ADVANCED TREATMENT...❑ 6. OTHER...El PUMP SYSTEM COMPONENT SUMMARY FROM PLAN 1. GALLON TANK= 2500 2. LOADING OF SEPTIC TANK= H-20 3. GALLON PUMP CHAMBER = 2500 4. LOADING OF PUMP CHAMBER = 5. TYPE OF SAS = Standard Infiltrator Chambers 6. DIMENSIONS AND DETAILS OF SAS: 47.5 x 43.5 Comments: There is a new benchmark. I marked it on the Plan. I asked the Installer to can the engineer regarding the new benchmark. Installer stated benchmark confirmed,but I did not verify- arm Page 1 of 4 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS Ol 845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SITE CONDITIONS 1. Existing septic tank properly abandoned...❑ 2. Internal plumbing all to one building sewer...O 3. Topography not appreciably altered...❑x SEPTIC TANK 1. Bottom of tank hole has 6" stone base...❑x 2. Weep hole plugged...❑ 3. Tank has been installed (H-20) Tank Size: 2,500 Monolithic ...0 4. Water tightness of tank has been achieved (Visual)...❑ 5. Inlet tee installed,under access port...❑x 6. Outlet tee (gas baffle or effluent filter) installed,under access port...D 7. Cover to within 6" of final grade installed over one access port,must be over outlet of tank if effluent filter is present- Inches of Tank...❑ 8. Hydraulic cement around inlet&outlet...ED Comments: There are new benchmarks. I asked the installer to make sure he removes larger rock out of the bed bottom. Polylok effluent filter installed. PUMP CHAMBER 1. Bottom of tank hole has 6" stone base...❑ 2. Weep hole plugged hl ...❑ 3. Pump Chamber Installed Gallons; (H-10 or H-20) (Monolithic or 2 piece) (circle) 4. Inlet tee installed,under access port...0 5. Pump(s) installed on stable base...O 6. Alarm Float Working...ED 7. Pump On/Off Float Working...❑x 8. Total # of Floats... 3 9. Drain hole in pressure line...❑ 10. Cover to within 6" of final grade installed over one access port...❑ 11. Water tightness of tank has been achieved—Visual or Vacuum Test or Water held for 24 hours (circle) 12. Hydraulic cement around inlet&outlet...0 Comments: Combo septic tank/pump chamber. No weep hole in line. Confirm at final grade. Page 2 of 4 TOWN OF NORTH ANDOVER t NORTi�, Office of COMMUNITY DEVELOPMENT AND SERVICES .t a ,+ ...•s O HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01 845 �'ss'C U t� Susan Y. Sawyer,REHSIRS 978.688.9540—Phone Public Health Director 978.688.8476—FAX I D-BOX 1. Installed on stable stone base...0 2. Inlet tee (if pumped or >0.08'/foot)... ❑x 3. Hydraulic cement around inlet&outlets...❑x 4. Observed even distribution...❑x 5. Speed levelers provided (not required)...❑ Comments: SOIL ABSORPTION SYSTEM 1. Bottom of SAS excavated down to C Soil Layer, as provided on plan...❑x 2. Size of SAS excavated as per plan...D * 3. Title 5 sand installed,if specified on plan...❑x 4. Gravel-less disposal systems: type,number and location as per plan...❑x 5. Elevations of laterals installed as on approved plan...0 6. 40 Mil HDPE barriers installed...❑ 7. Retaining wall (boulder / concrete / timber / block) ...❑ 8. Final cover as per plan ...❑ Comments: . PRESSURE DISTRIBUTION 1. # of Inches in Manifold 2. Laterals installed with end sweeps; Size: Material: 3. Squirt Test: Feet in height 4. Equal distribution to all laterals 5. Orifice size inch as per plan Comments: CONTROL PANEL 1. Alarm&Pump are on separate circuits...❑ 2. Alarm sounds when float is tripped...O 3. Location of control panel: 4. Rated for exterior if placed outside...❑ Comments: NOTE: ALARM & PUMP ON SAME CIRCUIT. VERIFY AT FINAL Page 3 of 4 0 0 TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �,SSgCNUs t Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS 1. Benchmark: 200.19 2. Rod at Benchmark: 3.20 3. Height of Instrument: _203.39 INVERT ON DESIGN INVERT PLAN ELEVATION Building Sewer OUT 199.96 199.65 Septic Tank IN 199.75 199.24 Septic Tank OUT 199.50 198.98 Distribution Box IN 208.95 D-Box OUT Manifold 208.73 Lateral 1 HIGH 208.80 209.16 Lateral 1 Inv 208.71 208.69 Lateral 2 HIGH 207.20 207.54 Lateral 2 Inv 207.11 207.09 Lateral 3 HIGH 205.60 205.99 Lateral 3 Inv 205.51 205.53 Page 4 of 4 Grant, Michele To: DelleChiaie, Pamela Subject: Lot 5 Gray st Hi Pam, I will go out to Lot 5 Gray street, tomorrow at about 10:30am to do a Final Grade. Thanks Michele 1 Page 1 of 1 DelleChiaie, Pamela From: Andy McBrearty [amcbrearty@millriverconsulting.com] �q Sent: Tuesday, November 22, 2005 10:19 AM 0 1 To: DelleChiaie, Pamela Subject: Re: Lot 5, aka� Gray Street ff) .000 Had two issues with 20 Gray Street- 1)pump wiring was wrong (only one breaker,pump & alarm on same circuit) and 2) no weep hole in pressure line... I believe you are aware of the wiring, and the Town electrician has been out there. Inspection report included. -andy DelleChiaie, Pamela wrote: Charlie Todd requesting a Final Grade. How did they do yesterday on the Final Const.?? gas/R¢0Aads, PaIR044 2901M I Ai¢ Health Department Assistant Town of North Andover 400 Osgood Street North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax http:.// toymofnorthandover.com healthdept@townofnorthandover.com v ( � f ) 6 �/ �� ds --- N6VIcQ, 11/22/2005 TOWN OF NORTH ANDOVER t NORTi , Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET • �, .-.,::.:.. , NORTH ANDOVER, MASSACHUSETTS 0 184 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SEPTIC SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: Lot 5 Gray Street MAP: LOT:_ INSTALLER: Charlie Todd DESIGNER: Joe Serwatka PLAN DATE: Last Revised 8/1/05, Received on 9/21/05 BOH APPROVAL DATE ON PLAN: 10/6/05 INSPECTIONS DATE OF BED BOTTOM INSPECTION: 11/4/05—Michele Grant DATE OF FINAL CONSTRUCTION INSPECTION: 11/17/05 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE 1. GRAVITY DISTRIBUTION...O 2. PRESSURE DISTRIBUTION...❑ 3. PRESSURE DOSING...ON 4. HOLDING TANK...❑ 5. ADVANCED TREATMENT...❑ 6. OTHER...D PUMP SYSTEM COMPONENT SUMMARY FROM PLAN 1. GALLON TANK = 2500 2. LOADING OF SEPTIC TANK = H-20 3. GALLON PUMP CHAMBER= 2500 4. LOADING OF PUMP CHAMBER = 5. TYPE OF SAS = Standard Infiltrator Chambers 6. DIMENSIONS AND DETAILS OF SAS: 47.5 x 43.5 Comments: There is a new benchmark. I marked it on the Plan. I asked the Installer to call the engineer regarding the new benchmark. Installer stated benchmark confirmed, but I did not verify- arm Page 1 of 4 i TOWN OF NORTH ANDOVER O NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �cHu CHU s Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SITE CONDITIONS 1. Existing septic tank properly abandoned...❑ 2. Internal plumbing all to one building sewer...❑x 3. Topography not appreciably altered...M SEPTIC TANK 1. Bottom of tank hole has 6" stone base...rx-1 2. Weep hole plugged...❑ 3. Tank has been installed (H-20) Tank Size: 2,500 Monolithic ...❑x 4. Water tightness of tank has been achieved (Visual)...❑ 5. Inlet tee installed, under access port...0 6. Outlet tee (gas baffle or effluent filter) installed,under access port...❑x 7. Cover to within 6" of final grade installed over one access port,must be over outlet of tank if effluent filter is present- Inches of Tank...❑ 8. Hydraulic cement around inlet& outlet...❑x Comments: There are new benchmarks. I asked the installer to make sure he removes larger rock out of the bed bottom. Polylok effluent filter installed. PUMP CHAMBER 1. Bottom of tank hole has 6" stone base...❑ 2. Weep hole plugged...❑ 3. Pump Chamber Installed Gallons; (H-10 or H-20) (Monolithic or 2 piece) (circle) 4. Inlet tee installed,under access port...❑x 5. Pump(s) installed on stable base...❑x 6. Alarm Float Working...❑x 7. Pump On/Off Float Working...❑x 8. Total # of Floats...—3 9. Drain hole in pressure line...❑ 10. Cover to within 6" of final grade installed over one access port...❑ 11. Water tightness of tank has been achieved—Visual or Vacuum Test or Water held for 24 hours (circle) 12. Hydraulic cement around inlet&outlet...0 Comments: Combo septic tank/pump chamber. No weep hole in line. Confirm at final grade. Page 2 of 4 C ti TOWN OF NORTH ANDOVER O NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES Frceb�.�o'6 HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �CNUSe Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX 1. Installed on stable stone base...❑x 2. Inlet tee (if pumped or >0.08'/foot)... O 3. Hydraulic cement around inlet&outlets...❑x 4. Observed even distribution...ON 5. Speed levelers provided (not required)...❑ Comments: SOIL ABSORPTION SYSTEM 1. Bottom of SAS excavated down to C Soil Layer, as provided on plan...❑x 2. Size of SAS excavated as per plan...❑x * 3. Title 5 sand installed,if specified on plan...❑x 4. Gravel-less disposal systems: type,number and location as per plan...❑x 5. Elevations of laterals installed as on approved plan...❑x 6. 40 Mil HDPE barriers installed...❑ 7. Retaining wall (boulder / concrete / timber / block) ...❑ 8. Final cover as per plan ...❑ Comments: . PRESSURE DISTRIBUTION 1. # of Inches in Manifold 2. Laterals installed with end sweeps; Size: Material: 3. Squirt Test: Feet in height 4. Equal distribution to all laterals 5. Orifice size inch as per plan Comments: CONTROL PANEL 1. Alarm&Pump are on separate circuits...❑ 2. Alarm sounds when float is tripped...❑x 3. Location of control panel: 4. Rated for exterior if placed outside...❑ Comments: NOTE: ALARM & PUMP ON SAME CIRCUIT. VERIFY AT FINAL Page 3 of 4 I QTOWN OF NORTH ANDOVER O MOR,H f Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT A 400 OSGOOD STREET ,,p NORTH ANDOVER, MASSACHUSETTS 01845 9Ss�cHuSet Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS 1. Benchmark: 200.19 2. Rod at Benchmark: 3.20 3. Height of Instrument: _203.39 INVERT ON DESIGN INVERT PLAN ELEVATION Building Sewer OUT 199.96 199.65 Septic Tank IN 199.75 199.24 Septic Tank OUT 199.50 198.98 Distribution Box IN 208.95 D-Box OUT Manifold 208.73 Lateral 1 HIGH 208.80 209.16 Lateral 1 Inv 208.71 208.69 Lateral 2 HIGH 207.20 207.54 Lateral 2 Inv 207.11 207.09 Lateral 3 HIGH 205.60 205.99 Lateral 3 Inv 205.51 205.53 Page 4 of 4 0 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, November 21, 2005 3:23 PM To: Grant, Michele Subject: Lot 5 Gray Street-Charlie Todd Michele, Please schedule a time to do a Final Grade at above. Charlie will be in tomorrow to sign-off on the certification forms. Once those two items are done, I can issue a COC. Thanks. BBsf Iegalds, pAAwIOea neeeeesfafe Health Department Assistant Town of North Andover 400 Osgood Street North Andover,MA o1845 978.688.9540-Phone 978.688.8476-Fax http://www.townofnor-thandover.com healthdept@townofnorthandover.com I 1 I DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, November 15, 2005 2:54 PM To: 'Daniel Ottenheimer(E-mail)'; 'Lisa LeVasseur(E-mail)'; 'McBrearty Andrew(E-mail)' Subject: FW: Lot 5 Gray Street- Bottom of Bed Inspection from 11/4/05 Importance: High Please schedule a final inspection: 508.962.0311 with Charlie Todd. Thanks. -----Original Message----- From: DelleChiaie,Pamela Sent: Wednesday, November 09,2005 2:39 PM To: 'Daniel Ottenheimer(E-mail)';'Lisa LeVasseur(E-mail)'; 'McBrearty Andrew(E-mail)' Subject: Lot 5 Gray Street-Bottom of Bed Inspection from 11/4/05 Importance: High Hi, Here it is. Will be ready for a Final sometime next week. Will let you know. Is CONSTR INSP.- Lot 5 Gray Stree... 86$f R¢gl101r$, Pwtiy¢ew D¢l�8¢L�lfiwi¢ Health Department Assistant Town of North Andover 400 Osgood Street North Andover,MA o1845 978.688.9540-Phone 978.688.8476-Fax http://www.townoftiorthandover.com healthdept@townofnorthandover.com I 1 a O DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, November 09, 2005 2:39 PM To: 'Daniel Ottenheimer(E-mail)'; 'Lisa LeVasseur(E-mail)'; 'McBrearty Andrew(E-mail)' Subject: Lot 5 Gray Street- Bottom of Bed Inspection from 11/4/05 Importance: High Hi, Here it is. Will be ready for a Final sometime next week. Will let you know. CONSTR INSP.-Lot 5 Gray Stree... BasiRagwfds, PMw10144 DaBBaG7lfiWO Health Department Assistant Town of North Andover 400 Osgood Street North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com I a TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET ` " +' NORTH ANDOVER, MASSACHUSETTS Ol 845 �'Ss'CM„5 S� Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476—FAX SEPTIC SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: Lot 5 Gray Street MAP: LOT:_ INSTALLER: Charlie Todd DESIGNER: Joe Serwatka PLAN DATE: Last Revised 8/1/05, Received on 9/21/05 BOH APPROVAL DATE ON PLAN: 10/6/05 INSPECTIONS DATE OF BED BOTTOM INSPECTION: 11/4/05-Michele Grant DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE 1. GRAVITY DISTRIBUTION...❑ 2. PRESSURE DISTRIBUTION...❑ 3. PRESSURE DOSING...❑ 4. HOLDING TANK...❑ 5. ADVANCED TREATMENT...❑ 6. OTHER...IF] PUMP SYSTEM COMPONENT SUMMARY FROM PLAN 1. GALLON TANK = 2500 2. LOADING OF SEPTIC TANK = 3. GALLON PUMP CHAMBER = 2550 4. LOADING OF PUMP CHAMBER = i 5. TYPE OF SAS = Infiltrator 6. DIMENSIONS AND DETAILS OF SAS: 47.5 x 43.5 Comments: There is a new benchmark. I marked it on the Plan. I asked the Installer to call the engineer regarding the new benchmark. Page I of 4 i TOWN OF NORTH ANDOVER t NoerM 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'ss ACMUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SITE CONDITIONS 1. Existing septic tank properly abandoned...❑ 2. Internal plumbing all to one building sewer...❑ 3. • Topography not appreciably altered...❑ SEPTIC TANK 1. Bottom of tank hole has 6" stone base...❑x 2. Weep hole plugged...❑ 3. Tank has been installed (H-10 or H-20) Tank Size: 1,000; 1,500; Other Monolithic or 2 piece (circle)...❑ 4. Water tightness of tank has been achieved (Visual)...❑ 5. Inlet tee installed,under access port...❑ 6. Outlet tee (gas baffle or effluent filter) installed,under access port...❑ 7. Cover to within 6" of final grade installed over one access port,must be over outlet of tank if effluent filter is present- Inches of Tank...❑ 8. Hydraulic cement around inlet&outlet...❑ Comments: There are new benchmarks. I asked the installer to make sure he removes larger rock out of the bed bottom. PUMP CHAMBER 1. Bottom of tank hole has 6" stone base...❑ j 2. Weep hole plugged...❑ 3. Pump Chamber Installed Gallons; (H-10 or H-20) (Monolithic or 2 piece) (circle) 4. Inlet tee installed,under access port...❑ 5. Pump(s) installed on stable base...❑ 6. Alarm Float Working...❑ 7. Pump On/Off Float Working...❑ 8. Total # of Floats... 9. Drain hole in pressure line...❑ 10. Cover to within 6" of final grade installed over one access port...❑ 11. Water tightness of tank has been achieved—Visual or Vacuum Test or Water held for 24 hours (circle) 12. Hydraulic cement around inlet& outlet...❑ Comments: Page 2 of 4 0 TOWN OF NORTH ANDOVER 0 NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES F b 9 HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss"CH„s Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX 1. Installed on stable stone base...❑ 2. Inlet tee (if pumped or >0.08'/foot)...❑ 3. Hydraulic cement around inlet&outlets...❑ 4. Observed even distribution...❑ 5. Speed levelers provided (not required)...❑ Comments: SOIL ABSORPTION SYSTEM 1. Bottom of SAS excavated down to C Soil Layer,as provided on plan...❑x 2. Size of SAS excavated as per plan...❑x * 3. Title 5 sand installed,if specified on plan...❑ 4. `/4-1/2" double washed stone installed...❑ 5. 1/8- 1/2" (pea stone) double washed stone installed...❑ 6. Laterals installed and ends connected to header (and vented if impervious material above) ...❑ 7. Orifices @ 5 &7 o'clock positions...❑ 8. Gravel-less disposal systems: type, number and location as per plan...❑ 9. Elevations of laterals installed as on approved plan...❑ 10. 40 Mil HDPE barriers installed...❑ 11. Retaining wall (boulder / concrete / timber / block) ...❑ 12. Final cover as per plan ...❑ Comments: *Trenches shifted a couple of feet on North side due to mistake on tree location. PRESSURE DISTRIBUTION 1. # of Inches in Manifold 2. Laterals installed with end sweeps; Size: Material: 3. Squirt Test: Feet in height 4. Equal distribution to all laterals 5. Orifice size inch as per plan Comments: CONTROL PANEL 1. Alarm&Pump are on separate circuits...❑ 2. Alarm sounds when float is tripped...❑ 3. Location of control panel: 4. Rated for exterior if placed outside...❑ Comments: Page 3 of 4 TOWN OF NORTH ANDOVER MCRTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET • �, ...�,::�.�,�� +no NORTH ANDOVER, MASSACHUSETTS 01845 �ssACHU`��t Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS 1. Benchmark: 2. Rod at Benchmark: 3. Height of Instrument: INVERT ON DESIGN INVERT PLAN ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 Inv Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Page 4 of 4 I Z 0 TOWN OF NORTH ANDOVER O pORT1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT =400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��sS wcHuse Susan Y. Sawyer;RENS/RS 978.688.9540—Phone Public Health Dir�ctor 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: Ll� EMAP:_ LOT: INSTALLER: 1 DESIGNER: PLAN DATE: BOH APPROVAL ATE ON PLAN: a DATE OF BED BOTTOM INSPECTI N: [ e 4 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION 1" PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 07)_ LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = � 7 7, LOADING OF PUN4P MBER� TYPE OF SAS DIMENSIONS AN;D TAILS OF SAS: Yom'f--5 CL, v1 V►�� 1 ��n a �` CJ—ISch - was SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Page 1 of 4 TOWN OF NORTH ANDOVER O NORT1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT - 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 s�cMuse Susan Y. Sawyer, RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under accessp ort ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: Ice- lfca R-a&Z- a2k� 6 PUMP CHAMB ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: Page 2 of 4 0 TOWN OF NORTH ANDOVER O NORrh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET �, r NORTH ANDOVER, MASSACHUSETTS 01845 �,�5, <� S�CNUSE Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) El cover as per plan Comments: PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: Page 3 of 4 O TOWN OF NORTH ANDOVER O gORTM 40 Office of COMMUNITY DEVELOPMENT AND SERVICES 3?�°`' � ��AL HEALTH DEPARTMENT p 400 OSGOOD STREET "•^, , ,r.' NORTH ANDOVER, MASSACHUSETTS 01845 �'�s' <� S^CMU4t Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV a.TOP OF PIPE INVERT ELEVATION I Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 '1 Commonwealth of Massachusetts Map-Block-Lot "0 107.D-0128- Board of Health Permit No > �+Z North Andover BHP-2005-0702 P.I. FEE �Su,c".;SES F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted Charles Todd to(Construct)an Individual Sewage Disposal System. at No 230 GRAY STREET LOT 5 as shown on the application for Disposal Works Construction Permit No. BHP-2005-070 Dated October 25,2005 Issue On: Oct-25-2005 Board of Health ............................................................................................................................................................................... Commonwealth of Massachusetts L� �� •," Map-Block-Lot G` Board of Health 107.D-0128- � D North Andover Certificate of Compliance14 .y THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Construct) 1-/ 6 by Charles Todd - Installer at No 230 GRAY STREET LOT 5 J has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the(i application for Disposal Works Construction Permit No. BHP-2005-070 Dated October 25,2005 Printed On: Oct-25-2005 Board of Health INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the Da property at 44-t- S 6CY S� relative to the application �T c ^ of dated �h)'oS" for plans by and dated 9111 ®Cr with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi d Licensed Septic Installer Date: I 6182 t� - Dat--........ ... ... NOR7M o�t,�.o�•�/� 3? e•,� .- .;• o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING IssA � 5� CNU This certifies that ................ .. .......fir.'........................ . ......... i has permission to perform .......... ......... ..`!,�, �-'1............. wiring in the building of..... � .. ...... 7✓ at........a 30 /��;' �.�.......................... .North Andover,Mass. /S Lic.No/� l D 2 y �-�" � rt Fee................... . ..... ..... . ................. .. ........:..... ..::�': .... .... ELECTRICAL INSPECTOR Check # 229 VVV ' TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT : - 400 OSGOOD STREET •--x-- -' NORTH ANDOVER, MASSACHUSETTS 01845 'SS"CHUSES Susan Y. Sawyer 978.688.9540—Phone Public Health Director 978.688.9542—FAX October 6,2005 Litchfield Company 126 Cambridge Street Burlington,MA 01803 RE: Subsurface Sewage Disposal System Plan for Lot 5 Gray Street,Map 107D,subdivision of Parcel 6,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property.These plans,dated August 1,2005,have been approved for a five(5)bedroom,maximum 1I- room home.Note that page 2 is showing new pump information and is dated September 17,2005. As stated in the previous approval,the design has been approved for use in the construction of a new onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover.Please note the condition#2 below. This approval is subject to the following conditions: 1. Title V regulation section 102C—requires 2 deep hole observation tests in the primary and secondary disposal areas.Lot 2 primary and secondary areas only have 2 deep hole tests. According to agreements between the BOH representative and the engineer,the onsite decision was made to reduce the required number of tests for each system. In this case,due to the lack of soil information on the south side of the system,this plan approval conditions that upon construction,if the BOH inspector finds that soil conditions vary within the boundary of the system,he/she may require a confirming test hole prior to allowing the installer to move forward with the stem construction. P g system 2. The issuance of the disposal works construction permit is contingent upon the receipt of a foundation as built of the dwelling. The as-built must be in a scale of 1"=20`. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 5. This system is designed to pump to a distribution box.Please note that the electrical inspector regularly requires an external shut off within site of the pump.Please have the electrician contact the inspector for details on this issue.It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance i• . .{�� . �, C�' 6. As per the Engineering notes,before construction,the pump and electrical box must be approved by the engineer. The health department is now withholding the installation permit until the electrical permit has been issued. Please provide proof upon application by the installer. The Health Department may be reached at 978-688-9540 with any questions you might have. Sira ly, san Y. Sawyer, H S blic Health Director cc: Joe Serwatka,P.E. GOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET ' °4 •-• NORTH ANDOVER, MASSACHUSETTS 01.845 Susan Y. Sawyer 978.688.9540—Phone Public Health Director 978.688.9542—FAX October 6,2005 Litchfield Company 126 Cambridge Street Burlington,MA 01803 RE: Subsurface Sewage Disposal System Plan for Lot 5 Gray Street,Map 107D,subdivision of Parcel 6,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property.These plans,dated August 1,2005,have been approved for a five(5)bedroom,maximum 1I- room home.Note that page 2 is showing new pump information and is dated September 17,2005. As stated in the previous approval,the design has been approved for use in the construction of a new onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover.Please note the condition#2 below. This approval is subject to the following conditions: 1. Title V regulation section 102C—requires 2 deep hole observation tests in the primary and secondary disposal areas.Lot 2 primary and secondary areas only have 2 deep hole tests. According to agreements between the BOH representative and the engineer,the onsite decision was made to reduce the required number of tests for each system.In this case,due to the lack of soil information on the south side of the system,this plan approval conditions that upon construction,if the BOH inspector finds that soil conditions vary within the boundary of the system,he/she may require a confirming test hole prior to allowing the installer to move forward with the system construction. 2. The issuance of the disposal works construction permit is contingent upon the receipt of a foundation as-built of the dwelling.The as built must be in a scale of 1"=20`. 3. H site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicants septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 5. This system is designed to pump to a distribution box.Please note that the electrical inspector regularly requires an external shut off within site of the pump.Please have the electrician contact the inspector for details on this issue. It is the responsibility of the applicant and/or the applicants septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance i 6. As per the Engin&ffng notes,before construction,the pump and e�al box must be approved by the engineer. The health department is now withholding the installation permit until the electrical permit has been issued.Please provide proof upon application by the installer. The Health Department may be reached at 978-688-9540 with any questions you might have. rb y, . Sawyer, H ealth Director cc: Joe Serwatka,P.E. D i FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTIO APPLICANT C-:1r �!' - � C P NE LOCATION: Assessor's Map Number 4 D aD PARCEL d SUBDIVISION LOT(S) STREET �x�AV b'3^ ST. NUMBER OFFICIAL USE ONLY VE TIO TOWN 3: CNSERVATION ADMINISTRATOR DATE APPROVED ' DATE REJECTED COMMENTS . roIC TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS I FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED ✓ SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS L�'' ca c day.`t`�� 47 e,., j PUBLIC WORKS-SEWER/WATER CONNECTIONS /r �✓—�—d 5 DRIVEWAY PERMIT FIFE DEPARTMENT i�W��y. ' Dieu t` \1 � l C /,rJ%io!�,,�r . RECEIVED BY BUILDING INSPECTOR DATE Reviad YIY7 Jm —� ro��°oT eg o Applicati t?''ror Septic Disposal Sys d. o- °� TODAY'S DATE -Construction Permit — TOWN OF ------ �.4� NORTH ANDOVER, MA 01845 250.00_Full o # o9pQ aS�•r. EK`� 125.00 omponent SNCHUS Important: ApplicatioD is hereby made fora permit to: When filling out Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return key. A. Facility Information rab Address or Lot# yy a ® � City/Town 2.-* PE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name \- Address(if different from above) Mint SS Wnsta"lUerinformation State Zip Code Telephone Number 3. 6K I C Name. Name of Company _ Address C City/Town tate �- le d Telephone Number(Cell P please) 4. Designer Information losaOn -I- Name Name of Company po Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 �oRr� Application or Septic Disposal System TODAY'S DATE Construction Permit - TO`XN OF $ 250.00-Full Repair ORTH ANDOVER + MA 01845 $125.00 -Component SSACHU$ PAGE 2OF2 A. Facility Information continued.... 5. Type of Buildina:LVResidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issu d by this Board of He h. . _0 Name - Date Applicat* n Approved B ifBoard of Health Representative).• NDate Application Disapproved for th following reasons: For Office Use Only: / L Fee Attached? Yes✓ No 2. Project Manager Obligation Form Attached? Yes No 3. Pump System? If so,Attach copy of Electrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes V'_/ No (Same scale as approved plan) 5. Floor Plans? (new construction only): Yesz No Application for Disposal System Construction Permit•Page 2 of 2 0 0 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT « 400 OSGOOD STREET "}�� •� " NORTH ANDOVER, MASSACHUSETTS 01845 CHUs�� Susan Y. Sawyer 978.688.9540—Phone Public Health Director 978.688.9542—FAX August 22,2005 Litchfield Company 126 Cambridge Street Burlington,MA 01803 RE: Subsurface Sewage Disposal System Plan for Lot 5 Gray Street,Map 107D,subdivision of Parcel 6,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property.These plans,dated August 1,2005,have been approved for a five(5)bedroom,maximum 1I- room home. As stated in the previous approval,the design has been approved for use in the construction of a new onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover.Please note the condition#2 below. This approval is subject to the following conditions: 1. Title V regulation section 102C—requires 2 deep hole observation tests in the primary and secondary disposal areas.Lot 2 primary and secondary areas only have 2 deep hole tests.According to agreements between the BOH representative and the engineer,the onsite decision was made to reduce the required number of tests for each system. In this case,due to the lack of soil information on the south side of the system,this plan approval conditions that upon construction,if the BOH inspector finds that soil conditions vary within the boundary of the system,he/she may require a confirming test hole prior to allowing the installer to move forward with the system construction. 2. The issuance of the disposal works construction permit is contingent upon the receipt of a foundation as built of the dwelling. The as built must be in a scale of 1"=20`. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned.requirements. 5. This system is designed to pump to a distribution box.Please note that the electrical inspector regularly requires an external shut off within site of the pump.Please have the electrician contact the inspector for details on this issue.It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, September 15, 2004 10:21 AM To: amcbrearty@miliriverconsulting.com; 'Pamela Delle hiaie'; Susan Sawyer Subject: Gray Street Lot 5 Sue and Pam, Attachedis plan review for Gray Street Lot 5. Dan Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com ,I 'I I 9/16/2004 Co%rola/ 13,0 5'I3i4�� 1311s�� 9 I 14 3 fififi 603, 879, 96 96 - I� IF -��I II I =� II lHI _ n1 ��bo�wf•+fl i TP I � II II I o ( II I v loll 14'0" 121011 I4'0 - R7 DD r 1 a T 1 Metal Drrp Edge -------------------------------------- ----------------------------- Ice 4 Water Shield ; O i I O C-4 o �Gompobite Roofing I � �U I � 1IRidge vent(UP.) i C-4I �� I 1 ' 'i i ♦ 1 ------------------i' , ,' ♦♦ r , --------------- %----------------- * r'91i2 /12♦� - - - - 1'Sl�tes; �i6u 5�bn * Ail dimensions to be field verified and changes made accordingly. $ veriFy Window and poor Rough Openings with Manufacturer Specifications. . •, loo f i 8 Val - 1,01 �j 4 When this drawing is 11 x ll, it is the scale as indicated. * Drawing print out date: 10/25/04 i 0010171271 $123/4 11 810" 1614'12 g 1 14 3 Oroffih99 /Y�7 61511 9 11t z 5113 31411 8163/4" 5,C3 I / II 603. 879. 9696 2'10" X 3'SY2" 1 11 .�� 5 9'/411 X 515/211 -- - - 594 35Y 2 C - ---- -------- - 11 II 11 II � O = $" x 12" II II II •� 11 L.� Tub - ha1F walll Bed r m 04 M 5a t}� r - _f� II 11 I I II I \N 214" _.. .. 21411 ... 3,011 61�u • O — 61011 413t/ s11 ,�, CP 1 O cN-. NINN S O 1 x 66 van, _ � I �^ s, ---------- o Gl, n v cv 11 Z -2111 261�n 1611 I V O 1 I At=lKcass 0 6 O =N 11 1Full doun Ste O O 0 1t roulated 4'5Y 9 4'6'/4" 3',¢" 3'bt/4" 3'10" 2 - 2011 - N 3 ' 2 0 �I^11 Post Post 1811 2 -2'011 C O o M Bedroom it 1 = 1 11 ------ j� = z P CIA JZa 60,01, 61 IDiNCS 310111411 3911 5'O° 5'>j3/4 n s T- open to <r Y v Y Y Bed r oom 0 2 Below Bedroom $3 2'11 1" X 5'S 2" 2'11 2".X 5'S 2" O i Post Post 2'11Y2" X 5'5'x" 2`11'/2" X 5'5V2"v 2'11'/21 X 5'5/2" 2'11'/2" X 5V/2" Segmental IF -_ 1 Window o 2 5,-411 x 6'411 cn IC! 410" S011 4'0" 31gn 61611 3'gu 610u 610 319u 6161' 3'9n lo 14'0" 12'011 U. 1410" . . 161011 40'0" 56'O" IVOIES: 1- - 2 39 3/16" 1'D" All dimensions to be field verified and changes made accordingly. Verify Window and poor Rough Openings with Manufacturer Specifications. Tempered Glazing shall be installed at all windows located near tubs and whirpools. Any glazing located closer than 113" to the floor. Living area sq . F t _ , 3�� t Smoke detectors per electrical code - locations to be verified per other 110 ,> * When this drawing is 11 x 11, it is the scale as indicated. In O J e r / CJ t a i r Area g q , f t . * Drawing print out date: 02/22/05 �J (P'3 3/4 22'V1,411 �16�211 „ O ® !'raftlr� Nil 16' 11 51^11 51011 51�3�411 4141,411 10111 TC311 31011 16�211 603,8 79. 9696 VN _ F--Deck > 11 41 2'1011 3'5/2 Post 3'611 X 3'6"csmnt ® 211/1 X 515/211 -_ I — -55 .,�.,� 1 .'' n 60 x68 � I 11 I O � � I1 r Vie•. ,y� til Zero-clearance Post _ `9 direct vent $rea�Cf ast Ki tchen wall ® Study ,N �U I Actual cabiket lajout X fireplace �yVn Op =n C, IS 0 C ,. x O - �. oat 21611 1. " Option 3 6 28 = II � = N N $ O p Decorative Column tw/e ---- 41211 411 31411 3'0/2 13 ost "` cl _ - _ Fami l y =- Half Wall Pos 2 2, O 80 _ _ n O Post 4'0" —C,4 - C (Ghalrrall,shadow boxes ,n – – – a dentil moulding F X o in living room only) _ I 3/ '1 O 1410" �118L4" 31811 14'334 O 4 _ ' V ' / I VII 1 ,,11 Open a 2iI2 X552 2ils X55a _ L IV i n z _ n i ng o ;; f=oyer UP 1 9 j 1 14R 11 2'4/2 &J/2 '41/2 cq 211Y' X 5'5Y' 2'111/2 X 5'S1/2° 2111,12" X 551/2 2'p1/2" X 5'51/1' 1 Post p 1211 o Cl oat O 2 1 81011 4'011 41011 61011 41011 61011 - - - - - - 1011 41011 61011 41011 01 4 O 141011 14'0" 12'0" —10 16'011 40'0° Nous= * All dimensions to be field verified and changes made accordingly. ns. L 2 3Q Q t , Qr F n 3/16" = 1'O" * Verify Window and Door Rough Openings with Manufacturer 5pecificatior i r a } Q •, * Tempered Glazing shall be installed at all windows located near tubs and whirpoois. Any glazing located closer than 18" to the floor. L. iv i ng area sq , f t 540 * 6moke detectors per electrical code - locations to be verified per other . x 111�eN +Hta /+►9111tY1/1 in 11 v 1-1 1+ to +hA ar_alo? AA ir1r11r_MAtel. >X Drawing r rint out date: 02/22/05 r by �J % �'6�� 33'6" CDI017%aI ,Dr�Ftir�� Yl`r 603.B 79, 9696 5 C3 2'i°'� x 3'5'�s" _ 3'5/2'1 _ ------------------------------------------ --- ------- ---------------------------------------------------------- -- ' Full 2 x 6 stud wall ' p 5a seme n t w/ frostwall 4' ' � -� 4 Concrete Slab ' = 4 Basement Slab min. below grade f - .F ; O Slope for drainage Option= Fibermesh and rebar ; o ° ; 4" / Lally column = per builders discretion o o 1-0" dia. cont. pier �� ' ' ; x 3'6" x 3'6" x 1'3" dp, ftg. „ 3 1/2 ��dia. Laily��Column� i 1 a 3 1/2 dia. Lall Column (2 each) w/2 6 s x IT' d Ft = 4/ 4 04 bot, ea, way y 'q' p' g' ' C' S O" 8'33%" �,'2�/4" With Z 6 x 4 6 x 13 dp. Footing ( 6 req d ) r - -- _ � g31460 5'4/2 69 /4 68 , It— C14 - --�-- o AA_ir. - LS ° 3 1/2" dia. Lally Column ? 1'O" dia. concrete pier LVL Beam '-- (point load) int load) Z'6" sq, x 1'3" dp. Ft'g. (See Framing LVL Beam ; �, Top of Fdn ' bottom 4'0" below grade plans) (See Framing plans) ' ' ---- Ref, EL(-) 5'-6" Splices located over ' m , �� x Garage Finish columns and staggered 2 x 6 Kneewall o ' p 5/S" type - X =0 4"(min) Step down into Garage on 10" cont, wall ; v ; �4— ogypsum wallboard on Frostwall w/ footin on era a side — 20 minute fire door (min) g m �--------------------------g---g- 6.. W x 6" DP x 9" H ; o 7 4 below grade O Concrete. Foundation' ; ------------ --- ---------- --- 1 Shim beam with steel 10" � 4" _ :-_ shims or hard brick�,O„ S �,0„ ,��'� with dampprooFing i min. O To of Fdn (Step Footing) (2 Req d) _ ' n Ref. El.(-) 4'-9" LL - - _ -T- -_ 4 Slab 5 tepdow n - - -- --- ------------------------ 11 (3) •--- ' ' ---- O ---------------------------- + ' d, 4'-0' 4''0' _ , ' ----------------- 4 SOSO14'0" 12'0" 01, 14'0" ho,0° 40'0.. 01 Q ' 56,0 01� L - 238 : FoundB t ion Pl 8n 3/16" = 1'0" Step Footing * All dimensions to be Field verified and changes made accordingly. * Verify window and door rough openings with manufacturer specifications. * Under Slab Vapor Barrier to have 6" (min) overlapping points, $ Concrete Slab Control Joint spacing @ 30 ft. (max.) * Provide a minimum of 4 operable windows for every 1,500 sq. Ft. Garage area sq . f t . = 914 * 5ite- conditions shall determine the need for foundation drainage, basement area sq , fta ��06 � 0 Damberoofina shall be aeelted from ton of footing to finish grade. , 1 _� TOWN OF NORTH ANDg7 °f ►ORT{{ Office of COMMUNITY DEVELOPMEN i�AND SERVICES Fa •'y° '�O�p HEALTH DEPARTMENT . . ,41015 400 OSGOOD STREET "'�°• - �-• NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss�cMuS 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:bealthdept@,townoffiorthandover.com WEBSITE:http://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(constructed; ( ) repaired; (Print Name) � ( located at t ✓e - - /� (Installation Address) was installed in conformance with the North Andover Board of Health approved plan, originally dated l l'/ and last Revised on 1 0 `i , with a design flow of 5'150 , O 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(Signature) And-Print Name Final inspection date: Engineer Representative(Signature) And-Print Name Installer: (Signature) Date: And-Print Name Engineer: (Signature) Date: I ( 1 RECEIN:� And-Print Name —W. (2-9,3-0 NOV 18 2005 oHEALTH DEPARTMENT i , FORM SOIL EVALUATOR FOR . 1 Paas 2 or 3 Location Address or Lot ialo. /. 6e,A-,y 177 0/0 7 1q-"wavk=r-- On-site Review _ Deep Hole Number ✓ Date: A..Z 1/�L Time: Weather G 4-e- 2 Go Location (identify on site plan) Land Use W 0 o 0 9 Slope M Surface Stones ^/A^Acr 'Ta 4 04- Vegetation Landform Position on landscape (sketch on the back) ! Distances from: Open Water Body feet. Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet 'Other - I I DEEP OBSERVATION HOLE LOGS i Depth from Soil Horizon Sol Texture Sol Color Sort pts Surface)Inches) (USDA) lMunsell) Mottling (Structure.Stones.Boulders,Consistency, % Graven /4 ' Z ,Z 8 7 syr 7s'-�s -;Zp/s Parent Materiat(geologic) Depth to Groundwater: Standing Water in the)tole: Weeping from Pit face: 2/Q Estimated Seasonal High Ground water: ~ DE!APPRON-M FORM-12/07195 BOARD OF HEALTH 4�1aTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 2 -1�ir�0 2 MAP & PARCEL: /O 7 P S 10 LOCATION OF SOIL TESTS: /Y9 4nr'�e',4cNiED P44 V. OWNER: —MA A i Ly &I S T E c.._C_.4 TEL. NO.: 6o 93 – 0 3 3 3 ADDRESS: 1(0 2 �IEI Y �iT , 1J • ENGINEER: 2c,�� CERTIFIED SOIL EVALUATOR: e - Intended Use of Land: esi ential Su ivision Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: X In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting:test) 2. Plot plan & Location of Testi-ng 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) 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. ��y�Q{o-.P� 6. Within 45 days of testing, a scaled plan (no smaller than I"-100') shall r of Health showing the location of all tests (including aborted tests). g0A 7. Within 60 days of testing soil evaluation forms shall be submitted. t Please Do Not Write Below This Line . N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: fi Town of 1,,irth Andover', Massachusetts _ Form No. 1 NOR,M A BOARD OF HEALTH 7�St LED �6�64, V /�/ / P w✓ �� L 19 4 °°°•°°°w° APPLICATION FOR SITE TESTING/INSPECTION QDgATED'pP �y �9SSACHUSE� Applicant— _ ::27-6ZZ4 NAME ADDRESS TELEPHONE z Site Location 7 4� Engineer A 'i NAME ADDRESS TELEPHONE Test/Inspection Date and Time _ CHAIRMAN,BOARD OF HEALTH Fee Test No. f S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I I I