HomeMy WebLinkAboutMiscellaneous - 234 BRADFORD STREET 4/30/2018 (2) 234 BRADFORD STREET '9t
- 210/061.0-0045-0000.0
f
/2 Lot & Streets Map/Parcel MSG/
CONST UCTION APPROVAL
Has plan review fee been paid:(YES NO Permit#
Plan Approval: Date: 919Z Approved by:
ry
Designer: o' 1) U/i«°g54,6— Plan Date:
//90h
Conditions:
Water Supply: Town Well
Well Permit: Driller:
Well Tests: Chemical Date Approved
Bacteria I Date Approved
Bacteria II Date Approved
Plumbing Sign-Off: Wiring Sign-off:
Comments:
Form "U" Approval: Approval to Issue: YES NO
Date Issued By:
Conditions:
Final Approval:
All Permits Paid? YES NO
Well Construction Approval? S ---
_ - _-____NO
Septic System Construction Approval? E_� NO
Certification? S NO
Other? YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
SEPTIC SYSTEM INSTALLATION
CONDITIONS:
Is the installer licensed? �$__ NO __
Type of Construction: NEW REPAIR
New Construction: Certified Plot Plan Review YES NO
Floor Plan Review YES NO
Conditions of Approval from Form U YES NO
Issuance of DWC permit: AYES NO
DWC Permit Paid? S NO
DWC Permit# //off Installer: Jo �v� pcJc
Begin Inspection: YES NO
Excavation Inspection:
Needed:
Passed:
Construction Ibisp ection:
Needed:
s Built Pla Satisfactory:
YES: ,�
Approval of Backfill: Date: /0 J cr 1 7 By
Final Grading Approval: Date: C . 9 7 By:
Final Construction Approval: Date: 11 By: /
Certificate of pP
Compliance: Approval: Date:
P
i
t
c� o,r) o o o o r) QPoo00n000 00
Commonwealth of Massachusetts
u City/Town of North % 'n(-�doec
0
System Pumping umping Rec®rd
Form 4
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 folm they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab
key to move your Address
cursor- not N �� r) ®�1
use the return Ma
key. City/Town _
State Zip Code
2. System Owner:
Name
renrn
Address(if different from location)
N. Reading
W Cityrrown State — -
Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping
Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) 'CJ Septic Tank
❑ Tight Tank El Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ;2-*N* o If yes, was it cleaned?
❑ Yes ❑ No
5. Condition of System:
6. System P meed By:
qr 1 AA
Name Q�3
vehicle License Number �v
Stewart's Septic Service A�ppvER
Company TOW AOT"v�FPARTt�iENT
7. Location where contents were disposed:
Stewart' :- -treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of H. uler Date
Signa o_, of Receiving Facility Date
t5form4.doc•03/06
System Pumping Record•Page 1 of 1
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COMMONWEALTH OF MASSACHUSETTS
_ - EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER,STREET,BOSTON MA 02108 (617)192-5500
T13UD'Y CORE
Secretary
ARGEO PAUL CELLUCCI DAVID?B.STRUM
Governor I ICommissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -
PART A
CERTIFICATION
Property Address- - no� �� me of Owner _Tcl_q_
(
�JG zjV-rl._ Address of Owner: 1 L-C�1AA�
Date of Inspection:
Name of inspector:(Please M-0
I am a DEP ved system pursuant to Section 15.340 of rift 5(310 CMR 15.000)
Company Name: GLx - V <, t,
MatTing Address: t ` x- fie 0►$1 G,2
Telephone
Number:
i
CERTIFICATION STATEMENT .
I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below Is trice,eCeutate
and complete as of the time of inspection. The inspection was performed based on my training and exporlenee in the proper function and -
maintenance of on-site sewage disposal systems. The system:
_ Passes
Conditionally Passes_.
_ Nee valuation By the Local Approving Authority
7faI
Irmpector'
s
Signature:
Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)withii thirty{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 acid the IiVkem bwrter _
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should bb beth to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
�
BOARD OF FiEF,LTi-( i
a �
IJUL ®2 1999
revised 9/2/98 Pagelottt .
42 Printed on Recycled Paper
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A^= ..
CER I
Property Address: ° �If cagikj�!�-r\ q— . 001
Owner:
Date of Inspection:
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
i have not found any information which indicates that any of the failure conditions described in 310 CMR 15:303 eidst. 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 iepaired. .The system;upon
completion of the replacement or repair,as approved by the Board of Health,will pass,
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. it"not determinlid";tlxpialn why not
_ The septic tank is metal,unless the owner or bperator has ptovided the`system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installEd within twenty(20)jieais ptioi to thb diito bf the IftObtiah,or
the septic tank, whether or not metal,is cracked,structurally unsound,shows silbstaiitiai infiilthWon lir 4kfiitrltti6n,+ofrtenk,
failure is imminent. The system will pass inspection If the existing septic tank is tep(aced with iy IEoltitpltiinj.siptic terdc.isa
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken o►abstnicttd pipets)
or due to a broken, settled or uneven distribution box. The'system will pass inspection if(with doprovai of the Board of
Health).
broken pipets)are replaced
obstruction Is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipets). The sysie ii Will pass .
inspection if(with approval of the Board of Health):
broken pipets)are replaced
obstruction is removed
revised 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTiFICATiON(confiriuedl
property Address:Owner:
Date
Date of Inspection:
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine it the system is failing to protect the
public health,safety and the environment.
11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 18-30111I 1ib1 T1iAT 01511EM
ONMIlEll T:
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SALTY AND,'Y�iE ENVIR
_ Cesspool or privy Is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a soft marsh:
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH IAND PUBLIC WATER SUPPLIER,IF ANY)W" Mi IMtS THAT THE S'IV6110 19 .
FUNCTWMG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENNIROMiMNENT'
_ The 'system has a septic tank and soil absorption system(SAS)brit)the SAS is v 10dri 100 Leet of 6 W11rftb6 watdf supply or
tributary to a surface water supply. d
The system has a septic tank and soil absorption system and the 5AS is within a Zone I of a pubiib viiatef wopli{iSieli:
_ The system has a septic tank and soil absorption system britt the SAS is witixn 50 feet of a pinnate WM61'aupplli
_ Well.
_ The system has a septic tank and soil absorption system fired the SAS is Ibss thiih 100 fast bort Sb fMet bt niton6'*6011 a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic 66mpounda indicates'feat the .
well is free from pollution from that facility and the presence of ammonia nitrogen fiind nitrate nitrogen Is equill tit of less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
i
revised 9/,2/98 hge3ofIt
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATKIN(aont-mued)
Property Address: ]
Owner:-�it'�T�
Date of Inspection: �D. SYSTEM F!J":
You mus ate either"Yes" or "No" to each of the following-
1 have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303: The basis for this
determination is identified below. The
Board of Health should be contacted to determine what will be nec+bssary to'CWtect the feilure.
Yes ` x�7c-ka'
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the grouted of surface waters due to an overloaded br dogged 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 112 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets):
T Number of times pumped_.
_ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. .
Any portion of a 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 I 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 lessAhan 100 feet but greater than 60 feet from a private water supply Wali with ho
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of wall wi-star analysis for
coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen:
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow or 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist.,
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 Proteabri kes=ISI{iPM or 6 ToOpM 1dfle it of a pubfic
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMh 15:304(2). Please consult the locai`regiona(
office of the Department for further infor nation.
revised 9,,2/98 Page4otii
i
SUBSURFACE SEWAGE DISPOSAL SYSTM INSPEC 11011i PORMN
PART B
CHECKLIST
u
Property Address:
Owner:
Date of Inspection: 6
Check if the following have been done: You must indicate either"Yes"or"No" as to each of the following:
Yes
Pumping information was provided by the owner,occupant,or Board of Health.
None of the system components have been pumped for at least two weeks and the-system has i"hieciiW t 4ibftid flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
_ _ g built plans have been obtained and examined. Note if they are not available with NIA.
I,I'I
The facility or dwelling was inspected for signs of sewage back-up.
Vwsystem does not receive non-sanitary or industrial waste flow.
a-site was inspected for signs of breakout.
All ystem components, excluding the Soil Absorption System,have been located on the site.
The septic tank manholes were uncovered,opened,and the interior of the septio tank was inspected for condition of beffles
or tees, material of construction,dimensions,depth of liquid, depth of sludge,depth of scum.
Tfr&size and location of the Soil Absorption System on the site has been determined Based on: _
ting information. For example, Plan at B.O.H.
Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distahed IS unacc6pteble).
115.302(3)(b)1
L The facility owner(and occupants, if different from owner)were provided with information on the proper meinten6nce of
SubSurface Disposal Systems. -
r
i
revised 9/2/98 pagesotit
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
1 j SYSTEM iNFORMATiON
Property Address: Aa�`Y �� �' �
Owner: ---�
Date of Inspection: `G �•-
C�w FLOW CONDITIONS
RESIDENTIAL:
Design flow: p.d./be r o
Number of bedroom (des' Number of bedrooms(actual):
Total DESIGN flow
Number of current residents:
Garbage grinder(yes or no):W0
Laundry(separate system) (yes or no):�Jo: If yes,separate.inspection required
Laundry system inspecte (ties or no)
Seasonal use(yes or no►:_tt11
Water meter readings,if svoilable(last two year's usage(gpd):
Sump Pump(yes or no): N'{rk
ccu anc :
Last date of o p y ..SJ
COM MERCIAUINDUSTR W L:
Type of establishment:
Design flow: qpd ( Based on 15.203)
Basis of design flow
Grease trap present:lyes or no)_
Industrial Waste Holding Tank present:lyes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection:(yes or no)ttp
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF S
eptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPRO TE AGE�;I components, date installed(if known)and source of information:
Sewage odors detected when arriving at the site:(yes or no)Ab
I
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION( "
Property Address.:d
Owner: ,
Date of inspection: •���
BUILDING SEWER: V c
(Locate on site plan
1
Depth below grade:
Material of constructi ���asl iron 40 PVC_other(gxplaiv�
1l� LYLS�a/vim-u�tJ�:7t R1�J \t'
Distance from private water supply well or suction line
Diameter
Comments:(condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK:_
(locate on site plant
1�
Depth below grade: t
1 Fiberglass lass Pol eth ene other(explain)
t meta Y Yt _.
of construction:
oncre e _ 9
Material _
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
'
Dimensions•
Sludge depth:
Distance from top osludge to bottom of outlet tee or baffle: a W
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to botto of at tee or baffle: t �'r"�tl��"" t�� •
How dimensions were determined:_ �`" 5�'►�„”�' ''�' S V '' .
Comments:
(recommendation for pumpin c n on f in t and outle tees or baffles,de of li id) I in at1g6' et in"eft,s#Itt iftli
evi a of leakage,etc 1
a v
GREASE TRAP•
(locate on site plan)
Depth below grade:^ e
Material of construction:_concrete_metal_Fiberglas's Polyethylene_other(explain)
Dimensions
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or befflei
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid ievel in tell t(oh t6 butief inverts strlitaiira)integt#ty,
evidence of leakage,etc.)
revised ed 9 -2 9 7 f11 o
Pee
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(eontinusidl
Property Address
� � Q��
C
: ��
�1'
Owner:
Date of hrspectian.�� '��
qq
TIGHT OR HOLDING TANKWNW (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade:_
Material of construction: concrete metal_Fiberglass_Polyethylene_othar(expiain)
Dimensions
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes_ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
�I
L
BOX: �
DISTRIBUTION _
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
Tie if le el and distribution is a al,evidenc of solids carryover,6 ce leakage i to or out 'f box,etc.) ' ' '
�QVQ..0
enc e
�Q>W- ��
.— ,
PUMP CHAMBER:_ .�1 —SkDk-"�•
(locate on site plan) ^J
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc:)
iz
9
revised 9/2/98 Page sof it
1.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM/NFOR(M�AJT�I/M(oor0weA
Property Addlress:} a�_ 4 V)XQ.9kAt_K,\-
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits,number:_
leaching chambers,number-
leaching
umberleaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Alternative system:
Name of Technology:
Comments:
(not ndj' n of soil, signs of hydraulic failure,lev I of ponding damp soil,conditi n of ve station,eta)
c;� .
CAIci
,
kP
r
CESSPOO S:—011W
(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(cesspool must be pumped as part of inspection) -
Comments:
(note condition of soil,signs of hydraulic failure,level of pondjng,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.)
s . .
revised 9/2/98 09ge9ot11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION llcm irwed)
Property AddreA: D34_
Owner:
Date of Inspection: �a
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into hous 1
Qq
s ,
A`7 �t
36
Id'.
revised 92/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(confirs"
Property
Owner:
Date of Inspection:
NRCS Report name
Soil Type_ -
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 5011114-
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
served Site(Abutting P roperty!:-bbservation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
it , c� e , co- v
� by � �
A0 � �
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revised 9/2/98 Page 11 of 11
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Tel: (978)475.4786
Fax:(978)4755451
BATESON ENTERPRISES; INC
Excavating-Water& sewer Lines-Septic Systems&Pumping Service
111 Argilla Road Andover,Mass.01810
Title 5 Inspection Report
Property Address: 3q.
{ �
Owner: G�
Date of Inspection: L C,; �Q
My report contained herein does not constitute a guarantee of future usage and.."
the functionality of the existing septic system. Such repott issued hadwitli is McPely
based upon my observations,and I hereby disclaim any further+aeration of gout ' :' `
current septic system.
Neil'!, Bateson
Bateson Enterprises;Lnc '
q,
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Thursday, July 29, 2010 2:46 PM
To: 'linda.richardsl @comcast.net'
Subject: I.R. -234&246 Bradford Street- North Andover
Importance: High
I.R. -Septic/Health I.R. -Septic/Health
File-23... File-24...
Hello Mr. Richards,
Attached you will find paperwork from the Health Dept. files of 234 Bradford Street, your property, as well as
your neighbor's information at 246 Bradford Street.
There were no certified plot plans to speak of in either the Health or Building files. To be sure of where the
exact lot lines are located, you should contact an engineer at a surveying company to have an official survey
done of your property. The Zoning Administrator is unable to provide a definitive answer to your question
regarding your neighbor's fence and where it should be or not be without the proper information from an
official survey. The attached information is for your reference, and contains all of your Septic As Built
information if you need it.
You may also want to check the registry of deeds online to see if they have an official copy of your plot plan.
Their website is: www.lawrencedeeds.com. If I find it for you in the meantime, I will e-mail it to you. Good
luck!
&a
Pamela DelleChiaie
Administrative Assistant I Community Development I Health Department
Town of North Andover
1600 Osgood Street I Bldg 20 1 Suite 2-36
North Andover,MA o1845
ph: 978-688-9540
fax: 978-688-8476
"We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous
1
DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Thursday, July 29, 2010 2:28 PM
To: DelleChiaie, Pamela
Subject: I.R. -Septic/Health File-234 Bradford Street
Attachments: 20100729142812393.pdf
This E-mail was sent from "RNPOA428C" (Aficio MP C5000).
Scan Date: 07.29.2010 14:28:12 (-0400)
Queries to: noreplyktownofnorthandover.com
i
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TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
11/5/99
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired (X )
by
John Soucy
at
234 Bradford Street
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 as described in the Design
Approval Site System Permit# 1099 dated 9/20/99.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
i
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed; { repaired;
by
located at `Z��`j PJI r2Ur� I rL�GT
was iustalled m conformance with the North Andover Board of Health approved plan,System
Design Permit# /D dated— ' .a with an approved design flow of.
gallons per day. The materials used were in eonforniance with those specified on the approved
plan;the system wa&installed in accordance with the provisions of 310 CMR 15.000,Title 5 and
local regulations, and the final grading agrees substaraially with the approved plan. All work is
-accurately rapr d on the built which has been submitted to the Board of Health.
Installer: P o Lie.#: — Date:
Design E eer: _ Date:
K
No.97`M
9 �
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Form No•3
dr } Massachusetts
I�, 'dM't€t �''_ � k ,f Town of North Andover,
3tF`` rkit rrtt "E ' BOARD OF HEALTH f
19
_-
..}� 2, dot e,,J.. t � !,',• 3? a^,. s O� `
4t,1 s9` IT� pi l it 1 i• f
-.. j k r t• „;. -- • DISPOSAL WORKS CONSTRUCTION PERMIT -
t r ra LYy S{ { ` s ...'1. •yq ...a...•�t'h -
< li V:;"i7 tp: SSACHUS
ppyr•c s•
TELEPHONE
Applicant DRESS
NA
"
Site Location
L
an Individual Soil Absorption
or Repair
hereby granted to Construct ( ) �• ,
Permission Is h Y Approval S.S. No.
Disposal System as shown on the'Design pP
SewageP
CHAIRMAN,BOARD OF HEALTH
• 4
D.W.C. No. //a171r
Fee
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APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
I
DATE: CURRENT INSTALLER'S LICENSEM
LOCATION: 3 CQ(Q b2c� � "V
LICENSED INSTAL R: v I,-
SIGNATURE:-
..SIGNATURE: TEL HONE#
CHECK ONE:
REPAIR: ,/ NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes 'V No
Foundation As-Built? Yes No
Floor Plans? Yes No
Approval Date: d/ �
F',OARD OF HEALTH
S_r 281999
AS-BUIL'[' CIIECKL.IST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES& DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES& PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
-/ TOP OF FDN ELEVATION
-/ LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150' OF SYSTEM
✓ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
STAMP& SIGNATURE
_ IMPERVIOUS AREAS -DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION &ELEVATION OF BENCHMARK USED
LOCUS PLAN
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
pk� (example: left front of house)
3�� �-�
o �
DATE OF PUMPING: `7 QUANTITY PUMPED r S�y GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
TGvVil
BOARD OF PEALTH_"-,
COMMENTS: 1 , ,
i
CONTENTS TRANSFERRED TO:
Town of North Andover °t NORTH ,
OFFICE OF 3a yt<` °' ti
COMMUNITY DEVELOPMENT AND SERVICES °
27 Charles Street 9
North Andover,Massachusetts 01845 "SSgCFMUs�`�y
WILLIAM J. SCOTT
Director
(978)688-9531 Fax (978)688-9542
September 24, 1999
Bill Dufresne
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: 234 Bradford Street
Dear Bill:
This is to confirm you that on September 23,.1999 at their regularly scheduled meeting
the North Andover Board of Health considered variances requested for the repair of a
septic system at 234 Bradford Street. The following variance was granted by a vote of
the Board.
Local upgrade approval for off-set from the soil absorption system to the seasonal water
table from 4 feet to 3 feet.
With this variance the plans have been approved.
Please feel free to call the Health Department at 978-688-9540 if you have any questions
concerning this action.
Sincerely,
Sandra Starr, R.S.
Health Administrator `.
cc: Muhammed Alai Taftl
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
MERRIMACK ENGINEERING SERVICES, INC,
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
LVI 1 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com
September 14, 1999
Ms. Sandra Starr
Director of Public Health
27 Charles Street
North Andover, MA 01845
RE: 234 Bradford Street
Septic Upgrade
Dear Ms. Starr:
This office has prepared a subsurface sewage disposal system plan for the above referenced
site. As noted on the plan, the design requires a local upgrade approval for off-set from the
soil absorption system to the seasonal water table.
On behalf of our client, we respectfully request this matter be placed on your next available
meeting agenda for consideration by the Board.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
Project Manager
cd
SEPTIC PLAN SUBMITTAL FORM
LOCATION: Z'*� 2I/J �T►z�E'�
NEW PLANS: $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: NO
DATE:
DESIGN ENGINEER: H fmy_,iHAek-
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 Port Engineering.
When the submission is all in place,route to the Health Secretary.
CK
Town of North Andover °t 40RTH
OFFICE OF oa �'"`c °�tio0
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
,IAM J.SCOTT North Andover,Massachusetts 01845 �9SSAcEHusE`�y
Director
78)688-9531 Fax(978)688-9542
September 15, 1999
William Dufresne
Merrimack Engineering
66 Park Street
Andover, MA 01810
RE: 234 Bradford Street
Dear Mr. Dufresne:
This is to inform you that the proposed plans for the repair of the septic system located at
234 Bradford Street,North Andover,have been disapproved for the following reasons:
/Vent is shown on D-box instead of connecting ends of the distribution lines. (310
CMR 15.241(1)(d)).
tw//
not listed. (NA 8.02j)
calculations for septic tank missing. (3 10 CMR 15.221(8)),
Please remember that revisions require a$60.00 submittal fee. If you have any
questions, please feel free to contact the office at the number below.
Sincerely,
Sandra Starr,R.S.
Health Administrator
Cc: M. Alaltaptl
File
Sep-LO-99 08:05A Paul D. Turbide, PE/PLS 508-465-0313 P.03
September 10, 1999
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MA 01845
RE: Title V review for 234 Bradford Street
Dear Sandra,
Enclosed find the"Checklist for North Andover Septic System Plans" for the above-
mentioned site. The following is a list of all the `Problem' areas and deficiencies Port
Engineering has found.
❑ The vent is shown on the design plans as connecting to the dbox. 310 CMR
i 15.241(1 xd) requires that the end of each distribution line in a trench be connected
to the vent. Nothing in the regulations states that a vent can be connected to the
dbox. Therefore the vent should be switched to connect to the ends of the trench
distribution laterals.
o Abutters must be shown on the plan. NA 8.02j
o Buoyancy calcs for the septic tank must be shown. 310 CMR 221(8)
If you have any questions or comments please feel free to contact me.
Sincerely
Carlton A. Brown, PE/PLS
Brad ford 234.doc
011T
ENGINEERING
Civil Engineers&
Land Surveyors
One Harris Street
Tewburypurl,NIA
01950
(978)465.8394
I
f
f
PAGE 1 OF 5
Commonwealth of Massachusetts
Application for Local Upgrade Approval
Title 5, 310 CMR 15.000
DEP Approved form required by 310 CMR 15.403(1)
To a submittted to Local &wroving Authority/Board of Health: For the upgrade of a failed or
nonconforming system with a design flow of <10,000 gpd, where full compliance, as defined in
310 CMR 15.404(1), is not feasible.
To be submitter to DEP: For the upgrade of a failed or nonconforming system with a design flow
of 10,000 up to 15,000 gpd and/or for upgrade of a state or federal facility, where full
compliance, as defined in 310 CMR 15.404(1), is'not feasible.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the
addition of new design flow to a cesspool
nstrante�d on �ccordan addition
ethenew design
the 978 Code or 310
existing approved capacity of a system
CMR 15.000.
1) Facility/system owner
Name_ ► WWAi-L" eV AL �-
Address _ II &Zww aftz L'OW E 11-7
Phone #
Address of facility_Z� O ky � �' -
2) Applicant'(if different from above)
Name
Address
Phone #
3) Type of facile
_ esidential _commercial _school
_ institutional
(Specify) _ RAF oo
r 21999
DEP APPROVED FORM-ulnas __
PAGE 2 OF 5
4) Type of existing system
_priv cess ool(s) conventional system
Y p
Other (describe)
Type of soil absorption system (trenches, chambers, pits,etc.)
5) Design flow based on 310 CMR 15.203
a) Design flow of existing system LWfpd 1/1,19 41r(7
Approved? yes approval date
no why?
b) Design flow of proposed upgraded system� gpd
c) Design flow of facility_�� gpd
6) Proposed upgde of existing system is
a) Voluntary
Required by order, letter, etc. (attach copy)
Required following inspection required by 310 CMR 15.301 (provide date
inspection form was submitted to the approving authority) (date)
b) .Describe the proposed upgrade to the system
c) Which of the following are applicable to the proposed upgrade?
r� Reduction of setback(s) (list setbacks to be reduced with proposed setback distances)
Percolation rate of 30-60 minutes per.inch (state actual pert rate)
DIP APPROVED FORM-1210 M
PAGE 3 OF 5
JVg Up to 25% reduction in subsurface disposal area design requirements (state required
& proposed size)
A Relocation of water supply well (identify well, describe relocation)
c� Reduction of required separation between bottom of SAS & high groundwater
(specify proposed reduction & perc rate) V & 31 A(gyp,/ .
_ Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the
Code)
System upgrades that cannot be performed in accordance with 310 CMR 15.404 &
15.405, or in full compliance with the requirements of 310-CMR 15.000, require a
variance pursuant to 310 CMR 15.410-15.417.
7) If the proposed upgrade involves.a reduction in the required separation between the bottom
of the soil absorption system-and the.high groundwater elevation, an Approved Soil
Evaluator must determine the-high ground water elevation pursuant to 310 CMR
15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority:
Distance from soil absorption system to high groundwater
7 feet
As determined by:
Evaluator's name u b K Nz-►Z
Evaluator's signs
Date of evaluation
DEP Arr OVW FORM-tVnns
PAGE 4 OF 5
8) Notice to Abutters
No application for upgrade approval in which the setback from property lines or a
private water supply well is reduced shall be complete until the applicant has
notified all abutters whose property or well is affected by certified mail at least ten
days before the Board of Health meeting at which the upgrade approval will be on
the agenda. Such notice shall include the date, time and place where the upgrade
approval will be discussed.
If the Department is the approving authority,
then such notice to abutters must be
completed prior to the date of submission of the application to the Department.
The notices to abutters shall include a copy of the completed application form and
shall reference the standards set forth in 310 CMR 15.402 through 15.405.
List of affected Abutters:
Abutter Name Date notified
Address
Abutter Name Date notified
Address
Abutter Name Date notified
Address
Abutter Name Date notified
Address
9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each
section must be completed):
a) an upgraded system in full compliance with 310 CMR 15.000 is not feasible:
IA' b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible:
DSP APPROVED FORM-11/01HS
PAGE S OF 5
i c) a shared system is not feasible:
d) connection to a sewer is not feasible:
10) An application for a disposal system construction permit, including all required attachments
(e.g. plans & specifications, site evaluat forms), must accompany this application. Is the
DSCP application attached? _yes_no
11) Certification
"I, the facility owner, certify under penalty of law that this document and all
attachments, to the best of my knowledge and belief, are true, accurate, and
complete. I am aware that there may be significant consequences for submitting
false information, including, but not limited to, penalties or fine and/or
imprisonment for knowing violations."
Facility owner's signature Date
I-�1D k-1 rk 1.102 A
Print Name
j,j, VU FYI is /M KVI(A M ACZ-- �i Ni�7
Name of.preparer Date
Telephone # & address of preparer
NOTE: Title S. 310 CMR 15.403(4), requires,the system owner or operator to submit to the
Department a copy of the local upgrade approval upon issuance by the Board of Health and prior
to commencement of construction.
OFr APPROVED FORM-12/17195
FORM 11 - SOIL EVALUATOR F0R111
Page 1 j
i
No.................................
Commonwealth of Massachusetts
Massachusetts
SuMility Assess ent for On-site Sewage. Disposal
_.
Performed By: ...........
Witnessed By:...x. ::. : .....�.......: -:.. .... ::. :.::::::: ........:. :..:::::..........._............:................._" . .�.
toarlo.Andra.ar (e� ✓�rud��'LQ ST olr.er's w.a /L(OL �� �"L'�'G�,f�TL
Loi f lX ,Tdqbm
New Construction ❑ Repair ❑
Office Review
Published Soil Survey Available: No ❑ Yes E
y .
Year Published Publication Scale/-!?!^� Soil Map Unit.....0..6
Drainage Class .....C...... Soil Limitationss,...................................................................:..........LrG��aQr
Surficial Geologic Report Available: No ted Yes ❑
Year Published .................. Publication Scale ......
GeologicMaterial (Map Unit) ..................................................................................................................................
Landform ................................................................................................_.................................................................................................................
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑ Yes - -aLa�
Ell/ Yes fc 141�tr RS
Within 500 year flood boundary No _-
Within 100 year flood boundaryNo Er"
Yes ❑ - Z 1993
Wetland Area: --—'
National Wetland Inventory Map (map unit)......................................... ..................-.........................................
Wetlands Conservancy Program Map (map unit).................................................................._.....__....._..........
Current Water Resource Conditions (USGS): Month ` .
Range : Above Normal ❑ Normal ❑ Below Normal
Other References Reviewed:
' MRAi 11 - SOR, EVALUATOR FORM
Pegs Z
On-site Review '
Deep Hole Number Time-.A0-.Akjw Weather
_ ._.
Location(Identify on alto plant
Land Use ��.. � _ _ _ _. Slops 1161 �� Surface Stones .... rix .......__.._.�7--;•--_w-_.._----
Vegetation r_N.._.............�_...............
landform --�- �-~----
position.on landscape (akotch on the back) �`'��_m
Distances from: '
Open Water Body Zl-c feet Drainege way...l�'_. feat,
possible Wat Areela�`_ feet Property Una,_. feet
Drinking Water Well.7LW—'-. feet Other-• -•••--•-• •--- ��
DEEP SERVAMON ROLE WG
pepth�r a6urfaw 6oN ttorimn SoM Tia a S�oM 6oN I Aattlln0 (gds. .�t4Aafad
ofaW
dip
kwAl-5 51
yC
04
parent Material(geologic( _- = ...- -.--..- .- _.----.._.__............ Depth to Badrook:
uenth tg Groundwater: Standing Water In the Hole: Weeping from Pit Face: ` -
1
Estimated Seasonal High Ground Water: ��•
FORM It - SOIL. EVALUATOR FORM
Page Z
nn..ri�p R�v�.f�W •
Deep Hole Number Weather _ &ki
Location (Identify on site plenl
Slope(961 �®"�-;- Surface Stonea
Land Ues
Vegetation
form
Positionon landscape (sketch on the back) --- ` _s' -- ~»~N~------------------— N-~- - ----__.
Olstanoes from: '
Open Water Body 4 • feet Drainage feet,
Possible Wet Area -7.1 V feet Property Una , fast
Drinking Water Wal -leu_`_.. feet Other ----•••---•-•••»--• --
paPq�, a6urfaa SoY Hoti:on 6oM �• SO 681 1AatdlnO t U—NO 0,5 .Qo�Man.
Gnw
f
dtvaw
Parent Material Igeologicl »--- -_- - --- --- -...»»........._............ Depth to Bedrock: --
nth to Groundwater. Standing Water In the Hole: D-2'�.- eeping from Pit Face:
Estimated Seasonal High Ground Water: ....
i
FORM 11 - SOIL EVALUATOR FORM
Page 3
ne/n inadm for SeMM Hkh Waver Table
Method used:
❑ Depth observed standing In observation hole.. . --. Inches
❑ Depth weeping from side of-observation hole ._ ... Inches
1.�
Depth to soil motiles ��`-• (nahee4-
❑ Ground water adjustment --• feet
Index Well Number
Reading.Date Index well level_ .. ....
Adjustment factor Adjusted ground water level _........
Denth of Naturally Occurring Pervious Materiel
Does at least four feet of naturally occurring pervious material exist in.all areas
+ observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
I certify that on (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experienca
described in 310 CMR 16.017.
Signature
FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test
Date: .---2' Tune: ..............................-.
Observation Hole # P
7
Depth of Pare t,
Start Pre-soak
End Pre-soak
Time at 12" .
Time at 9"
Time at 6"
Time l9
Rate Min./Inch
Site Passed L7 Site Failed ❑
Performed By:
Witnessed By: PL,
Comments: ..................
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BOARD OF HEALTH TEL. 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE:
LOCATION OF SOIL TESTS. t*4
Assessor's map & parcel number. t
OWNER: 1 ydaldi.-inn ALArTAMtTEL. NO.:. (51(,) 39
ADDRESS:_I It 61cWi--1G'YL.0 Lae. /Gomer--�,�se� _ r�.Y. I1'72-5�
ENGINEER: HE TEL. NO.: ZS �S
CERTIFIED SOIL EVALUATOR: az, LU ou FIZE�tie
Int se o and: r idential subdivision, single family home, commercial
pair testi Undeveloped lot testing
onservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of 1276.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of$75,00 per lot for
repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
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 soil evaluation forms shall be submitted. r;
JUL 1 21999 ,
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
LQR byto !2 A t• I will install this system in ac-
cordance with all the laws of the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of /0-00 64L in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of lineal (square) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/41' (dia. ) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
the line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE
Sig ture of Ap icant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Signature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE
Signature of Inspecting Officer
Percolation Test 7 M/g&Ate
Garbage Grinder 0
BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS
SEWAGE DISPOSAL
DATE 'YID (,
NAME OF APPLICANT �jk_q-o-&
LOCATION
Addres f, of lot no,
BUILDING: Dwelling Other
SYSTEM: New K. Repair
GENERAL DESCRIPTION OF LAND
SUBSOIL: Clay X GzAvel Sand
PERCOLATION TEST minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK gallon capacity,
LEACH FIELD— lineal feet of drain pipes
William J. Dri 4coll , Engineer
Board of Health
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
? 3ephc sik
ate'
47
1. NAME i ds e. P �aY�/}G/Q [. �C DATE l!/-3ze-r
T
2. ADDRESS r 1 LOT NO. TEL.
3. NO. OF BEDROOMS 3 DEN YES NO l
4. GARBAGE GRINDER YES NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I he eb make pplicati.on for a permit for a sewage disposal installation at
&Iellc 6,7t I will install this system in ac-
cordance with all the la of the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1/ until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of f in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and 1d in a series of trenches, the bottom of which will pro-
vide a minimum of /V lineal (square) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
tile line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE
ignature of pplicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Signat a of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE
\Iva
L -J1
Signature o Inspecting Off* er
�I d
Percolation Test
Garbage Grinder
Town of North Andover, Massachusetts Form No.2
f NORTH BOARD OF HEALTH
L,�27o
°----• DESIGN APPROVAL FOR
ss"C"USEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
• Applicant Test No.
: Site Location
• Reference Plans and Specs.
• 'ENGINEER DESIGN DAVE
: 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
Fee 0��� Site System Permit No.
Address -Q&D r-•j2n Title of File page of
Date File Open: Date file closed:
Doc Document/Action Title Date ofRefer to other Purpose of Document/Action and notes
action Document/ docurnent/
Num. Action Department
Board of Appeals — Board of Health — Planaing Board _ Conservation Commission — Boilding Departrner
G
f
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
Af ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
v TIES TO LOT LINES & DWELLNG, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
t% LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
L'
LOCATIONS OF WELLS, DR-ANS, WATERCOURSES
W/N 150' OF SYSTEM
LOCATION_ OF WATER,-GAS ELECTRIC LINES CABLE
(/ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
STAi%, P & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCIItiLARI USED
f/ LOCUS PL:��1
Town of North Andover, Massachusetts Form No. 1
NORT1q BOARD OF HEALTH 4
O
APPLICATION FOR SITE TESTING/INSPECTION
7q A�gATED PPP�.�GJ
SSACHUS�
Applicant F v
NAME ADDRESS TELEPHONE
Site Location
Engineer
AME ADDRESS TELEPHONE
Test/Inspection Date and Time
�-7 CHAIRMAN,BOARD OF HEALTH
Fee Test No. (?/f
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
6,' 0 19 r
o m
oR APPLICATION FOR SITE TESTING/INSPECTION
��SSACHUs���y
Applicant •
NAME ADDRESS TELEPHONE
Site Location
-.T
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.
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555.373-5721 •FAX(978)475-14d8•E-MAIL;mgrreng@W,Gom
September 14, 1999
Ms. Sandra Starr
Director of Public Health
27 Charles Street
North Andover,MA 01845
RE: 234 Bradford Street
Septic Upgrade
Dear Ms. Starr:
This office has prepared a subsurface sewage disposal system plan for the above referenced
site. As noted on the pian,the design requires a local upgrade approval for offset from the
soil absorption system to the seasonal water table.
On behalf of our client, we respectfully request this matter be placed on your next available
meeting agenda for consideration by the Board.
Very truly yours,
MBRRIMACK ENGINEERING SERVICES
William Dufresne
Project Manager
cd
i
i
i
Town of North Andover a N0RTH ,
OFFICE OF �a o�'" °0
COMMUNITY DEVELOPMENT AND SERVICES A
Y Y
27 Charles Street x a
North Andover, Massachusetts 01845 �9SsncHuSE�<y
WILLIAM J. SCOTT
Director
(978)688-9531 Fax(978)688-9542
September 15, 1999
William Dufresne
Merrimack Engineering
66 Park Street
Andover,MA 01810
RE: 234 Bradford Street
Dear Mr. Dufresne:
This is to inform you that the proposed plans for the repair of the septic system located at
234 Bradford,Street,North Andover, have been disapproved for the following reasons:
• Vent is shown on D-box instead of connecting ends of the distribution lines. (310
CMR 15.241(1)(d)).
• Abutters not listed. (NA 8.02j)
• Bouyancy calculations for septic tank missing. (310 CMR 15.221(8)).
Please remember that revisions require a$60.00 submittal fee. If you have any
questions,please feel free to contact the office at the number below.
Sincerely,
Sandra Starr,R.S.
Health Administrator
Cc: M. AlaltaP tl
File
i
I
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
. ' Q PAGE 1 OF 5
Commonwealth of Massachusetts
Application for Local Un ade Dar�oval
Title 5, 310 CMR 15.000
DEP Approved form required by 310 CMR 15.403(1)
To be submitted to Local Awroving Authority/Board of Health: For the upgrade of a failed or
nonconforming system with a design flow of <10,000 gpd, where full compliance, as defined in
310 CMR 15.404(1), is not feasible.
To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design flow
and/or for upgrade of a state or federal facility, where full
u to
15 000 Pg
of 10,000 p �
R W -� feasible.
' nce as
defined
in 310 CMR 15.404(1), is'not feasn
�compina ,
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the
addition of new design flow to a cesspool or privy or the addition of new design flow above the
existing approved capacity of a system constructed in accordance with either the 1978 Code or 310
CMR 15.000.
1) Facility/system owner
Name_ WIVQA-r40 CQ *L*il `�-
Address _ II C Le'a Nl akz L.*We e4""n^ejreQ,�( t I
Phone #
Address of facility Z?�t gwx7ef ^N 62al ev,
2) Applicant-(if different from above)
Name
Address
Phone #
3) Type of facility
t,Aidential —commercial _ school
_ institutional
(Specify)
�TC
eC °
ci=, —9 1999
DEP AMOVED FORM-UMM
A
PAGE 2 OF 5
4) Type of existing system
ool
cess s) ✓conventional system
_envy P (
Other (describe)
Type of soil absorption system (trenches, chambers, pits,etc.)
5) Design flow based on 310 CMR 15.203
a) Design flow of existing system mot pd Zig Ore
Approved? _yes approval date
no why?
b) Design flow of proposed upgraded system 1l;�& gpd
c) Design flow of facility gPd
6) Proposed upg de of existing system is
a) Voluntary
Required by order, letter, etc. (attach copy)
Required following inspection required by 310 CMR 15.301 (provide date
inspection form was submitted to the approving authority) (date)
b) .Describe the proposed upgrade to the system
c) Which of the following are applicable to the proposed upgrade?
q Reduction of setback(s) (list setbacks to be reduced with proposed setback distances)
Percolation rate of 30-60 minutes per.inch (state actual pert rate)
DEP APMOVM WORM•IIM195
PAGE 3 OF 5
Up to 25% reduction in subsurface disposal area design requirements (state required
& proposed size)
� Relocation of water supply well (identify well, describe relocation)
c/ Reduction of required separation between bottom of SAS & high groundwater
(specify proposed reduction & perc rate) '
_ Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the
Code)
System upgrades that cannot be performed in accordance with 310 CMR 15.404 &
15.405, or in full compliance with the requirements of 310-CMR 15.000, require a
variance pursuant to 310 CMR 15.410-15.417.
7) If the proposed upgrade involves.a reduction in the required separation between the bottom
of the soil absorption system-and the.high groundwater elevation, an Approved Soil
Evaluator must determine the.high ground water elevation pursuant to 310 CMR
15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority:
Distance from soil absorption system to high groundwater
�_feet
As determined by:
Evaluator's name 1
Evaluator's signs
Date of evaluation -2,2:, —
DEP A"ROVM FORM-1210195
PAGE 4 OF 5
8) Notice to Abutters
No application for upgrade approval in which the setback from property lines or a
private water supply well is reduced shall be complete until the applicant has
notified all abutters whose property or well is affected by certified mail at least ten
days before the Board of Health meeting at which the upgrade approval will be on
the agenda. Such notice shall include the date, time and place where the upgrade
approval will be discussed.
If the Department is the approving authority, then such notice to abutters must be
completed prior to the date of submission of the application to the Department.
The notices to abutters shall include a copy of the completed application form and
shall reference the standards set forth in 310 CMR 15.402 through 15.405.
List of affected Abutters:
Abutter Name Date notified
Address
Abutter Name Date notified
Address
Abutter Name Date notified
Address
Abutter Name Date notified
Address
9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each
section must be completed):
#Aa) an upgraded system in full compliance with 310 CMR 15.000 is not feasible:
k* b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible:
DEP APPROVED FORM-0071"
PAGE 5 OF 5
i c) a shared system is not feasible:
d) connection to a sewer is not feasible:
10) An application for a disposal system construction permit, including all required attachments
(e.g. plans & specifications, site evaluat forms), must accompany this application. Is the
DSCP application attached? _yes_no
11) Certification
"I, the facility owner, certify under penalty of law that this document and all
attachments, to the best of my knowledge and belief, are true, accurate, and
complete. I am aware that there may be significant consequences for submitting
false information, including, but not limited to, penalties or fine and/or
imprisonment for knowing violations."
V lllYz4 LZ, �,3-liy�
Facility owner's signs re Date
�-� k4At-1 t-l 02 Atm
Print Name
-FA L,L. r2uFrOO VIS /NKN64MiN ib
Name of.preparer Date
AK
Telephone # & address of preparer
NOTE: Title 5, 310 CMR 15.403(4), requires.the system owner or operator to submit to the
Department a copy of the local upgrade approval upon issuance by the Board of Health and prior
to commencement of construction.
D"AeeaovW VoLM-iunns
BOARD OF HEALTH TEL. 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE: ?—�
LOCATION OF SOIL TESTS: Z-*4 0962rc402
Assessor's map & parcel number. t
OWNER: - fla3,di-1 , , - 15`t3`
ADDRESS:_11 Ca L6QHe1z6 Liar. ti -Y, l 17Z�
ENGINEER: Wert, 1 h-� TEL. NO.:
CERTIFIED SOIL EVALUATOR: i LL- r2u rwze
Int se o and: r sidentlal subdivision, single family home, commercial
pair testi i/ Undeveloped lot testing
onservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of 1275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of$75.00 per lot for
repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
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 soil evaluation forms shall be submitted.
12 JV
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