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Miscellaneous - 24 MARIAN DRIVE 4/30/2018
i s � Lot & Street Miglo,, ) Del Map/Parcel CONSTRUCTION APPROVAL D Has plan review fee been paid: ^�S NO Permit# Plan Approval: Date: ° �<)1� Q))4 Approved by: �jliU Designer: J, :5 C"r_W r4i'll, Plan Date: /J�Z Conditions: Water Supply: Town Well Well Permit: \a Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved. Bacteria H Date Approved Plumbing Sign -Off: Comments: Wiring Sign -Off: Form "U" Approval: — - Approval to Issue: Floor Plans Date Issued y� Conditions: YES NO Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? (� NO Certification? YES NO Other YES NO As Built YES NO Any Variance Needed? NO 3 To Cv tt_.1 FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? Type of Construction: New Construction: Certified Plot Plan Review Floor Plan Review (iLD NO NEW CREPAIR YES NO YES NO Conditions of Approval from Form US NO Issuance of DWC permit: NO DWC Permit Paid? rE NO DWC Permit # 49&"l Installer: /Y! / ze-5 LC X DWC Date v /ass q 1 Begin Inspection: ('YE� NO Excavation Inspection: Needed: Construction Inspection: Needed: As Built Plan Satisfactory: - C-- ES _ NO �9/-47 Approval of Backfill: Date: By: Final Grading Approval: Date: By: i Final Construction Approval: Date: 711 laa By: Certificate of Compliance: Approval: 7// l4q Date: d North Andover,Board of Assessors Public Access J Page 1 of 1 �10RTM Of „t��o .e''•1•G s;CMug Click Seal To Retum Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial _4orth Andover Board of Assessors 796property Record Card 'n-- -I m .^fl In nn n AAGo noon n T)V.AAAO Location: 24 MARIAN DRIVE Owner Name: WESTPHALEN TR, EVA -MARIA WESTPHALEN NOMINEE TRUST Owner Address: 24 MARIAN DRIVE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6 - 6 Land Area: 1.01 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1500 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 354,200 382,000 Building Value: 145,500 151,100 Land Value: 208,700 230,900 Market and Value: 208,700 Chapter Land Value: LATEST SALE Price: 1 Sale 08/14/2001 Date: s Length Sale F-NO-CONVNIENT Grantor: EVE -MARIA WESTPHALEN Doc: Book: 06310 Paee: 0292 http://csc-ma.us/PROPAPP/display.do?linkld=1182203&town=NandoverPubAcc 12/16/2008 Commonwealth of Massachusetts City/Town of Nff4 WWA System Pumping Record Facility Information: System Location: 0n Address RECEIVED JUL `'4 9 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT catyi i own State Zip Code System Owner: Name: Adress (if different from location of pump) City/Town State Zip Code Telephone Number Pumping Record Date of in Pum p 0/// v Quantity Pumped Rallons Type of System %Septic Tank Grease Trap Other (what) System Pumped by: r_'&qLr h��'q & Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843 Location where contents were Signature of Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 OCT 0 2 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatio Right front of house, Left /Righ ear of hou_s , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Cityrrown 2. System Owner. Name Address (if different from location) City/Town /Vorm,&, fi,-x-_ State Zip Code Statez„' Code Telephone Number CJ ✓ y B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? es ❑ No. 5. Condition of System: PO 6. System Pumped By.- Neil y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: I` Lowell Waste Water Sign aHaule Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 e Commonwealth of Massachusetts City/Town of N,66)� 0, j �N System Pumping Record rC Facility Information: System Location Address City/Town System Owner Name - M R t2l AJ bK- tS� Adress (if different from location of pump) City/Town State RECEIVED NOV 18 2008 1 -OWN OF NORTH ANDOVER HEALTH DEPARTMENT O/� Zip Code State Zip Code 0175-(PSv 11a Telephone Number -------------- Pumping Record Date of Pumping 1Q '500U/ l dal -Quantity Pumped � � gallons Type of System )( Septic Tank -Grease Trap other (what System Pumped by:CJ0-L I 0 e ( Company: ROOTER -MAN 12 East Dracut Rd., Methuen, MA 01844 Location where contents were diposed: Signature of Hauler Date ' OEP.hei P Qy ded;hl,viorrn I,�( -60 00 e'.:O/T?I(IOd 10 lhB IOCBI 8O rC 1 ) 0001 808/Ci n fl C' oj,(n 0( Omof ap A, Facility 'in forrrl Io um pin Rekord 0818 o! Pumpinp 3. TYpa 91 eyslem;., �" C099�001(9) ' • � : Q - Ol�har (describ0� Emuanf T00 FIIIe(P(q)0nt? [' Yo9 [D No �f,,,f -. ' ...!�r%' ���••6"l`Co�dl�Jon'P(:9yj,�m;'.�.;`. 6 •� SY �l P��m ed 8 ,. ... - i��•,.i ;`4�1.;'l�l,ji� IY�� X11!• �� ';1' � � ' � S% 'r y,'.I�, r`` ,•%/ yn),17kol loc1n.f�ere'oorllenla'yrar.e dl�poseo: .. � �.: �' ., Illy,, �1.' S 1 �•:..;1 S�nt�wi 'mesa 8ov/ds.Jweler/epprpY8)V to rm5.P, mgIn3pacl �4 4111111�j�- S0POC Tens 71S^I Teri y0f11C10'.1Unif fele II , 5ocaUon: .•a C::.'4:,1 ' 00 SPI•. , . .� tM n /ivwn /Sysl0mOwnor, (If 4Vferenl rpm "u0n) TqnN) um pin Rekord 0818 o! Pumpinp 3. TYpa 91 eyslem;., �" C099�001(9) ' • � : Q - Ol�har (describ0� Emuanf T00 FIIIe(P(q)0nt? [' Yo9 [D No �f,,,f -. ' ...!�r%' ���••6"l`Co�dl�Jon'P(:9yj,�m;'.�.;`. 6 •� SY �l P��m ed 8 ,. ... - i��•,.i ;`4�1.;'l�l,ji� IY�� X11!• �� ';1' � � ' � S% 'r y,'.I�, r`` ,•%/ yn),17kol loc1n.f�ere'oorllenla'yrar.e dl�poseo: .. � �.: �' ., Illy,, �1.' S 1 �•:..;1 S�nt�wi 'mesa 8ov/ds.Jweler/epprpY8)V to rm5.P, mgIn3pacl �4 4111111�j�- S0POC Tens 71S^I Teri y0f11C10'.1Unif fele n.t.-..M"".'snrv... u • u: ..e -.T ,,.'y.a ayry .Yy.t - .u,n-n y 2..k,.r'� ,c -M1• -y i t f MORT4 1 0 'A - Town of North'Andover' `�'•�;; ;o �. �' HEALTH DEPARTMENT CHECK #:G DATE: LOCATION: H/O NAME: CONTRACTOR NAME: box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ TitTitll e,5 -Inspector $ M'- Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health . Pink -Treasurer Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. lel :t Con nonwealth ofr assachusetts Title 5 Official Inspection Fo Subsurface Sewage Disposal System Form - Not for Voluntary, 24 Marian Drive Property Address Eva Maria West Name L RECEIVaij ents FEB 2 4 2009 TOWN Uv ivURI'ri HEALTH DEPAI North Andover MA 01845 2/5/2009 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: James Wright Name of Inspector Aspen Environmental Services LLC Company Name 270 Lawrence Street t,;ompany Aaaress Methuen City/Town 978-681-5023 Telephone Number B. Certification MA State 2035 License Number 01844 Zip Code 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 MR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails Further Evaluation by the Local Approving Authority 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. 24 Marian Or No Andover Title V • 08106 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 24 Marian Drive Property Address Eva Maria Westphalen Owner Owner's Name information is required for North Andover MA 01845 2/5/2009 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If "not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): 0 0 broken pipe(s) are replaced obstruction is removed 24 Marian or No Andover Title V • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 24 Marian Drive t-roperry Aaaress Eva Maria Westphalen Owner's Name North Andover Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): MA 01845 2/5/2009 State Zip Code Date of Inspection ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pu�hif more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspec with approval of the Board of Health): ❑ broken pipes) are replaced ❑ obstr6ction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 fee a surface water ❑ Cesspool or privy is wi ' 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fall u s the Board of Health (and Public Water Supplier, if any) determines that t system is functioning in a manner that protects the public health, safety and env system ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 24 Marian or No Andover Title V • 06/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner's Name North Andover MA 01845 City/Town State Zip Code B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): 2/5/2009 Date of Inspection ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used used to determine distance: ** This system passes if the we�l,w'ater analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent andthe presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, providedfhat no other failure criteria are triggered. A copy of the analysis must be attached to this form, -°'r 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded ❑ �r clogged SAS or cesspool iquid depth in cesspool is less than 6" below invert or available volume is less /than '/2 day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 24 Marfan or No Andover Title V • 08/06 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System - Page 4 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner's Name North Andover MA 01845 City/Town State Zip Code B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 2/5/2009 Date of Inspection Yes No ❑ Ld Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is wit ' 0 feet of a surface drinking water supply ❑ ❑ the s m is within 200 feet of a tributary to a surface drinking water supply E]❑ ,,#fte system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you haveAfiswered "yes" to any question in Section E the system is considered a significant threat, or answer6d "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 24 Marian or No Andover Title V - 08/06 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive rropeny Address Eva Maria Westphalen Owner's Name North Andover Citylrown MA 01845 State Zip Code 2/5/2_009 Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Y;,_,,No ❑. Pumping information was provided by the owner, occupant, or Board of Health / ❑ Were any of the system components pumped out in the previous two weeks? L� ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) I,b'f Was the facility or dwelling inspected for signs of sewage back up? (� Was the site inspected for signs of break out? �❑ �❑ Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: L�' ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 24 Marian or No Andover Title V • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 15 . f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner Owner's Name Information is required for North Andover re uired for MA 01845 2/5/2009 every page. Citylrown state Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes 2 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 2"N'o Laundry system inspected? ❑ Yes 21"'N—o Seasonal use? ❑ Yes No Water meter readings, if available (last 2 years usage (gpd)): Yes Sump pump? 4 Yes ❑ No Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste dischargod-fo the Title 5 system? Water meter readings available: Last date oto&''' pancy/use: describe): Gallons per day (gpd) Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 24 Marian or No Andover Title V • 08/06 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner Owner's Name information is required for North Andover MA 01845 2/5/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont:) General Information Pumping Records: --- Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: gallons Type of System. 91 Septic tank, distribution box, soil absorption system ❑ Yes No ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No 24 Marian Dr No Andover Title V • 08M Tide 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner owners Name information is required for North Andover MA 01845 2/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑. cast iron 40 PVC ❑ other (explain): Distance from private water supply well or suction line: j� feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of. construction: concrete ❑ metal If tank is metal, list age: r/ feet ❑ fiberglass ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle S i Distance from bottom of scum to bottom of outlet tee or baffle 17,3 How were dimensions determined? 24 Marian or No Andover Title V • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 15 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner's Name North Andover MA 01845 2/5/2009 Cityl I own D. System Information (cont.) State Zip Code Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t -:-%y ( e - Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ Dimensions: Scum thickness Distance from top of Distance from top of outlet tee or baffle scum to bottom of outlet tee or baffle feet ❑ polyethylene ❑ other (explain): Date of last purr Ing: Date Comments ( pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid level.9/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 constructio . ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): 24 Marian or No Andover Title V • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 24 Marian Drive Property Address Eva Maria Westphalen Owner Owner's Name information is required for North Andover MA 01845 2/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: Comments (cond gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date alarm and float switches, etc.): ❑ Yes ❑ No * Attach,66py of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert �l/�-�i✓ 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.): Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: Yes ❑ No es ❑ No 24 Marian Or No Andover Title V • 08/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 15 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 24 Marian Drive Owner information is required for every page. vroperty Adaress Eva Maria Westphalen Owner's Name North Andover MA 01845 Citylrown State Zip Code D. System Information (cont.) 2/5/2009 Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): .ti d 24 Marian or No Andover Title V - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 15 Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ 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.): .ti d 24 Marian or No Andover Title V - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner Owner's Name information is required for North Andover MA 01845 2/5/2009 every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) 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 construatl`on Indication of undwater inflow ❑ Yes ❑ No Comme (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 cdition etc.): of soil, signs of hydraulic failure, level of ponding, condition of vegetation, 24 Marian Dr No Andover Title V • OSM title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive Property Address Eva Maria Westphalen Owner Owner's Name information is required for North Andover MA 01845 2/5/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 24 Marian or No Andover Idle V • 08/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Marian Drive rropeny Aadress Eva Maria Westphalen Owner Owner's Name informationis North Andover required wirfor for MA 01845 2/5/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: F 0 Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: 24 Marian Dr No Andover TRIe V • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 15 Jan '6, ;09 06: 313p Summary Record Card generated on 112612009 2:32:44 PM by Karen Hanlon Town of North Andover Tax Map # 210-107.C-0058-0000.0 Page t Parcel•Id 18342 24 MARIAN DRIVE WESTPHALEN, HEINZ 24 MARIAN DRIVE N. ANDOVER, MA 01845 Class 101 Single Family Size Total 1.01 Acres Property Type 1 Residential FY 2009 UB Mailing Index Name/Address WESTPHALEN, HEINZ Type Loan Number Active/Inact. From Until Payor 24 MARIAN DRIVE N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 13637.0 - 24 MARIAN DRIVE Occupant Name Active/inactive 1090315 01 Cycle 01 Last Billing Date 11/5/2008 Active UB Services Maint. Service Code MISCFEE ADMIN FEE Rate Charge Multiplier/Users WTR WATER 0.635/8 7,82 01 ALL METER SIZE 27.12 1/ !1 UB Meter Maintenance Serial No Status 16336440 a Active Location 00 Brand.., _ ,� Type Size YTD Cons Date Reading Code ;' Consumption w Water 0.63 0.63 Posted Date 19 10/23/2008 255 aActual 8 11/12/2008 Variance 7/22/2008 4/23/2008 247 236 a Actual 11 8/1512008 -30% 50% 1/28/2008 229 aActua!7 a Actual j/° 5/i 9/2008 12 10/24/2007 222 a Actual 7 i 6 2/19/2008 18% 7/19/2007 216 a Actual i 8 11116/2007 8/15/2007 -30% 4/19/2007 208 a Actual ; 9 5/21/2007 -22% 1/2912007 199 a Actual /2007 20% 10/25/2006 190 a Actual 9 1120622006 60° 7/27/2006 181 a Actual 7 8!1812006 24% 5/1/2006 1/31/2006 174 164 a Actual a Actual 5116/2006 -28 -28% 54% 10/26/2005 157 a Actual 15 2/19/2 05 -006 53% 7/20/2005 9 8/10/2005 55% 4/20/2005 133 a Actual ! 8 5/13/2005 4% 1/26/2005125 a Actual 8 2/15/2005 15% 10121/2004117 a Actual 9 11/15/2004 17 7122!2004 108 a Actual 8 8/25/2004 -6% 5/7/2004 100 a Actual 8 6/8!2004 25% 2/2/2004 92 a Actual 9 2/24/2004 4P 10/22/2003 83 n New Meter 0 10/22/2003 0 �o t TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 07/01/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired ( X ) by F.P. Reilly & Sons, Inc. at 24 Marian Drive 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 # dated. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION Th3/undersigned hereby certify that the Sewage Disposal System ( ) constructed; (�+//) repaired: by F. P f located at ��- b•rk�� l�tJ ���� was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved design flow ofr fl 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: �o�E Engineer Representative Final inspection date: (� `� °r 1 j. &&)�' Engineer Representative Installer: Date: Design Engineer: ADate:. F'1 6KKi H AC_1�_ C9Q. � P Z 05 PF' ' I NC' E -N b 1 NESS Arr- Ndj -F44 E 064160 9-061NEEe, \i FORM 12 - PERCOLATION TEST Location Address or Lot No. 2 ° -- em.�u COMMONWEALTH OF MASSACHUSETTS No. ,jtj D p v f5Imo, , Massachusetts Percolation Test` Date: Time: �, rt✓1 . Observation Hole # Depth of Perc // l Start Pre-soak End Pre-soak Time at 12" Time at 9" 5'44 4 Time at 6" Time (9"-6") Z OD >v Rate Min./Inch , * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed VT Site Failed ❑ DEP APPROVED FORM - 12/07/95 FOR -N1 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.�- On-site Review Deep Hole Number Date: /o — 20 Time: g /� , %, Weather 6D S�ti.v y Location (identity on site plan) Land Use f_j--UJ ti Slope (%1 �' Surface Stones T OWNVegetation n, AND Landform V P --U M LPosition on landscape (sketch on the back) Distances from: Open Water Body > 10 4 feet Drainage way 5 1 0d feet Possible Wet Area 7l00 feet Property Line 00 -t -feet Drinking Water Well 71 a 0 feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color S70.1— "o oil Other Surface (Inches) (USDA) (Munsell) Mottling -Structure, Stones, Boulders, Consistency, % Gravel) o -14- 4p r-56 )oYPO2 s� MINIMUM OF 2 HO Parent Material (geologicl T% L.(, DepdAoge&ock: %I Q Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: Z �� i . DFP APPROVED FORM • 1210719S FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACH 'SETT � M oRrH 61�poVER/ Massachusetts � nrr 4 �Ca$ ' r Percolation Test` L_ Date: %d _ ZD Time: Observation Hole l Depth of Perc 3G Start Pre-soak 0 End Pre-soak g ei> 4 Time at 12" // Q �y ��S�rI o°= 7 p Time at 9" Time at 6" o — o— I/=Z � Time (9"-6") /O�J� Rate Min./Inch J �J Minimum of 1 percolation test- must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ ......................... Performed By: Witnessed By. /2(� 2/ Comments: I DEP APPROVED FOR,%t . 12/07/95 DATE: 6" 1 0— q b LOCATION: ENGINEER: --2sgh-- BOH WITNESS: PERCOLATION TEST -#r BOTT i ONI DEPTH OF PIERC TEST. TIME OF SOAK: _ � � (,AL IE�s� I = minutes Icnc) TIME, -"IT 12" TIME AT c" TIME AT CVE,NIGHT SOr,K r TIME ST"RTED NES I D, -,'\Y SOAK: ,Y �,Ai IecS i Irl ie5 V o1 6 6 6 TIME/ -,I12, TIME AT S" , TIME A I .., Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 January 28, 1999 Eva -Maria Westphalen 24 Marian Drive North Andover, MA 01845 Dear Mrs. Westphalen: 27 Charles Street North Andover, Massachusetts 01845 Fax(978)688-9542 This letter is to inform you that, with the approval of the variance of 3' to groundwater approved by the Board of Health at their meeting on January 27, 1999, the proposed septic plans dated 11/23/98 for the repair of the system located at 24 Marian Drive have been approved. Please let me know if I can be of further service, or call the office with any questions you may have. Sincerely, Sandra Starr, R.S. Health Administrator Cc: W. Scott File ' -OARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Important: When filling out forms on the computer, use only the tab key to move your cursor . do not use the return key, r►on a Commonwealth of Massa setts City/Town of NORTH ANDOV MASSA K, System Pumping Record ,.Form 4 DEP has provided this form f b or use y local Boards of Health. The System Pumping Record mu; be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Address (—� Clty/Town_ �. State Zip Code 2. System Owner: Name Address (!I different from location) CItyTown State Zi Code Telephone Number :-Bumping Record {. 1. Date of Pumping I Type of system: ❑ ❑ Qtner (describe): Date - 2. Quantity Pumped: --150 ._- _._.... Gallons Cesspool(s) 2 Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes E3--N'o r 5. Condition of System: m Pumped By: j / I . A f , Company If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number 7. Location where contents were disposed: v Aw Si ature of fiau --- Date -- http://www,mas$;gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record • Page t of 107 Forest St. Middleton, MA 01949 (508) 774-2772 C J F ZI 4 - SYSTF111 PU111PNG Commonwealth of Massachusetts L' • vac , Massachusetts Sv�temPum��„�R,._.._V )\•stem D L( `Cncvs /V- Ayidouec � 09- 09 , 1-7 2 c/ N d a , 4 n bg7'-t:, ►roolvi ahs �$ 4; 9 AC.” ,K : Date of Pumping: y Quantit)' Pumped:-17'0gallons f 4 Cesspool: 1\o t Yes ❑ Septic Tank: No Yes S\[stem Pumped by- -_ Contents transferred to: UccccC Date o Inspector I )'c e. • License #: wt .;._, . W Z Inspector I )'c e. • wt 3+1•r ' W Z ( J. +s rs{ u �xJ • THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN 0i ' INDUSTRY • TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS Pko- �-f- V-�- (example: left front of house) St mC c 14��A�� DATE OF PUMPING: QUANTITY PUMPEDSCD GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: /,EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: Gr' L e _5-< b JUL ` 6 2001 13 OF NORTH ANDOVI-4 s M PtIMPING RECORI'�, SYS I'll -M OWNER & ADDRESS SYSTEM LOCATI rio /0 -DP. 0 V - ma - Pilo P-1-, DATE', OF FUNIPIN(j:, _,,QUAN'FI'FYIIUMPF RECEIVED AUG 0 9 2004 HEALTH DEP (t'-SSPOOL. NO. YE�i.. I / SefAic hubk: NO YE -S t -)F �J, V I C I�-� : jq)j�) t�N'j 'NCY LKIL FLOODED (.)BSER�'AIHON� (100D CONDITION FULLTO COVER, HFAVY GREASE BAFFLES IN Pt Ac ROOTS LEACHFIELD RUNBACK EXCESSIVL SOLIDS FLOODED SOLIT) CARRYOVER OTHE'R EXPLAIN sy"'leill pullipcd lh.� o? ('(,),MW,N I 4 I LN I'S IXAN'SHARIA) i 026 A1,11IS'l i10 Fo as S1. �G SOC P`a M.dttri► 01949 S%SPgE��` FORM 4 - SYSTEM PUMPING RECORD k &- Commonwealth of Massachusetts K _, Massachusetts System %mer Sy TOWN OF NORTH AN©OVER/ i Lion ;.; Date of Pumping:.. Li�� Quantity Pumped:/• j 00 gallons � Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes ®� System Pumped b} : License #: Contents transferred to: Date Inspector AS -BUILT CIIECkLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER ✓ _ LOT LINES & LOCATION OF DWELLINGS V % OE5160 LOCATION & DEMENSIONS OF SYSTEM, ���fNCLUD[NG 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 _AjA'_.,P"-CXfS-r--TOP OF FDN ELEVATION J,w,N 6 LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM t./-. LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE 10 ✓ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX L✓ STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. aEs�6 p�� NORTH ARROW (,cs►u07v�fFINAL CONTOURS AX!l Cmc �'" -Abrf / LOCATION & ELEVATION OF BENCHMARK USED sc-la, LOCUS PLAN vE%SilfafJ AZAN I Town of North Andover, Massachusetts BOARD OF HEALTH 19 —DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant �V/�-/✓i/9,t?JY� �E�j�Ojs1�}��c� Test No, Site Location Reference Plans and Specs. ENGINEER DESIGN DATE Permission is granted for an individual soil absoprtion sewage disposal system to be installed in accordance with regulations of the State and the Board of Health. BOARD OF HEALTH Fee r Site System Permit No. 98 - o'Z SEWAGE PUMP STATION DESIGN COMPUTATIONS OWNER & APPLICANT Single Family Dwelling 24 Marian Drive North Andover, MA 01845 Westphalen 24 Marian Drive North _ver, MA PLSH OF a4' JOSEPH v«�� SER DATE: 6/8/98 vr""W"- PUMPALS 19 f DESIGN DATA: PUMP: DESIGN FLOW SOIL CLASS PERC RATE FORCE MAIN DIA, HAZEN-WILLIAMS COEFF. 330 Gal/Day 2 40 Min/inch 2" SDR 21 PVC 150 MANUFACTURER: PEABODY-BARNES MODEL #: SE -411 HORSEPOWER: PUMP CHAMBER: STORAGE PRIMARY 330.0 gallons RESERVE 330.0 gallons VOL. IN PIPE RUN 0.0 gallons TOTAL 660.0 gallons DIMENSIONS LENGTH* 7.50 WIDTH* 4.50 DEPTH* 4,25 *INSIDE DIMENSIONS ELEVATIONS INLET INVERT 96.60 SUMP 92.35 OFF 93.10 ON 94.41 ALARM 95.29 STATIC HEAD: DBOX INLET ELEV. 100.10 FT PUMP OFF ELEV. 93.10 FT TOTAL STATIC HEAD 7.00 FT PUMP.XLS 0.4 i EQUIVALENT LENGTH: FRICTION LOSSES IN PUMP CHAMBER: 1 2"DIA 900 BEND 0 2"DIA 450 BEND 1 2"DIA CHECK VALVE 1 2"DIA GATE VALVE TOTAL LOSS b 1 21.0 FT FRICTION LOSSES IN PIPE RUN: 2 2"DIA 900 BEND 0 2"DIA 450 BEND 0 2"DIA 22.50 BEND 1 2"DIA TEE 40 LENGTH OF RUN FT MISC. PIPE 1.8 TOTALLOSS 0.63 b 1 66.0 AFT TOTAL EQUIV. LENGTH: SYSTEM CURVE: 5.0 FT 0.0 FT 14.0 FT 1.2 FT 202 FT 10.0 FT 0.0 FT 0.0 FT 12.0 FT 40.0 FT 4.0 FT 66.0 FT 87 FT Q V HF/100 HF Hs TDH GPM FPS FT FT FT FT 20 1.8 0.72 0.63 7 7.63 25 2.3 1.09 0.95 7 7.95 30 2.7 1.52 1.33 7 8.33 35 3.2 2.03 1.76 7 8.76 40 3.6 2.59 2.26 7 9.26 50 4.5 3.92 3.41 7 10.41 60 5.4 5.50 4.78 7 11.78 70 6.3 7.32 6.36 7 13.36 80 7.2 9.37 8.15 7 15.15 90 8.1 1-1.65 10.14 7 17.14 FROM ATTACHED PUMP CURVE: 50 gpm @ 12 TDH TIME ON: 6.6 minutes PUMP.XLS BARNES®SUBMERSIBLE NON -CLOG P Series: SE, Manual & Automatic PUMPS 1-112" Spherical Solids Handling Series: SEA HP 1750 RPM (SE411 & SE421) THE BELOW LISTINGS ARE FOR SE411, SE411A & SE421 ONLY. CIP® Canadian Standards Association File No. LR16567 UL Underwriters Laboratories Inc. File No. E142177 Description: SUBMERSIBLE NON -CLOG SEWAGE PUMP DESIGNED FOR TYPICAL RAW SEWAGE APPLICATIONS. Sample Specifications: Section 1 Pages 13-14. 1. KH N t PUMPS & SYSTEMS Bames Pumps, Inc. Distributor Sales & Service Dept. 420 Third Street/P.O. Box 603 Piqua, Ohio 45356-0603 Ph: (513) 773-2442 Fax: (513) 773-2238 Specifications DISCHARGE: LIQUID TEMPERATURE: VOLUTE: MOTOR HOUSING: SEAL PLATE: IMPELLER: Design. Material: SHAFT: SQUARE RINGS: HARDWARE: PAINT: SEAL: Design: Material. CABLE ENTRY: SPEED: UPPER BEARING: Design: Lubrication.- Load. ubrication:Load. LOWER BEARING: Design: Lubrication: Load. MOTOR: Design: Insulation: SINGLE PHASE: FLOAT: OPTIONAL EQUIPMENT: Bames Pumps, Inc - Bid -To -Spec & Project Sales 1485 Lexington Ave. Mansfield, Ohio 44907-2674 Ph: (419) 774-1511 Fax: (419) 774-1530 SECTION 1A PAGE 1 DATE 5/94 REPLACES 7/93 2" NPT, Vertical 104° F Continuous. Cast Iron, ASTM A-48 Class 30, Cast Iron -ASTM A-48, Class 30. Cast Iron ASTM A-48 Class 30, 2 Vane, Open, With Pump Out Vanes On Back Side. Dynamically Balanced, ISO G6.3. Zytel 70G43 Nylon, Glass Filled. 416 Stainless Steel. Buna-N 300 Series Stainless Steel. Air Dry Enamel. Single Mechanical, Oil -Filled Reservoir, Secondary Exclusion Seal. Rotating Face - Carbon Stationary Face - Ceramic Elastomer - Buna-N Hardware - 300 Series Stainless 15 ft. Cord w/Plug On 115 and 230 Volt, Pressure Grommet For Sealing And Strain Relief. 1750 RPM (Nominal). Sleeve Oil Radial Single Row, Ball Oil Radial & Thrust NEMA L Torque Curve. Completely Oil -Filled, Squirrel Cage Induction. Class A - Permanent Split Capacitor (PSC). Includes Overload Protection In Motor. Automatic Models. Wide Angle, Polypropylene, 15ft. Cable. SE411A & SE421A, Float w/Plug Attached To Discharge Piping, SE411AU & SE421AU Float Attached To Pump. ON and OFF Points are Adjustable. Seal Material, Additional Cable and Cast Iron Impeller. "MEMBER SECTION 1A PAGE 2 DATE 5194 REPLACESLli 7/93 SE411A & 421A SE411 &1 SE421 (Less Float) SE411AU & 421AU P'1 ' 120° Pumping 900 Differential . 16.00 4.00 120' 9.00 Pumping Differential 16.00 I 4.00 MODEL PART HP VOLT PH RPM NEMA NO. NO. (Nom) CODE 75 ;.32 --1 1.56 3.86 7.72 FULL LOCKED LOAD ROTOR AMPS AMPS CORD CORD CORD SIZE TYPE OD JC411 058701 0.4 115 1 1750 A 10.0 19.0 14/3 SE411A 082215 0.4 115 SJTOW-A 0.390 1 1750 A 10.0 19.0 14/3 SE411AU 093193 0.4 115 1 1750 A SJTOW-A 0.390 10.0 19.0 14/3 SE421 082089 0.4 230 1 1750 A 5.0 SJTOW-A 0.390 SE421A 093194 0.4 230 1 1750 A 5.0 9.5 14/3 SJTOW-A 0.390 9.5 14/3 SE421AU 093195 0.4 230 1 1750 q 5.0 SJTOW-A 0.390 9.5 14/3 SJTOW-A Mercury Switch on SE411A &Mechanical on SE421A, Cable 16/2, SJOW-A, 0.320 O.D., Piggy -Back Plug. Mechanical Switch (SE411AU & SE421AU), 0.390 Cable 14/2, SJOOW-A (UL), SJ IMPORTANT! OW (CSA), 0.370 0. D. 1) DONOI USE THIS PUMP TO PUMP FLAMMABLE LIQUIDS. 2.) THIS PUMP IS APPROPRIATE FOR LOCATIONS CLASSIFIED AS DIVISION II. 3.) THIS PUMP IS ftQ1 APPROVED FOR USE IN SWIMMING POOLS, RECREATIONAL WATER INSTALLATIONS,DECORATIVE FOUNTAINS OR ANY INSTALLATION WHERE HUMAN CONTACT WITH THE PUMPED FLUID IS COMMON WHILE THE PUMP IS RUNNING. 4.) PUMP CAN BE OPERATED DRY FOR EXTENDED PERIODS WITHOUT DAMAGE TO MOTOR AND/OR SEALS. CRANE PUMPS & SYSTEMS Barnes Pumps, Inc. Distributor Sales & Service Dept, Barnes amps, Inc. Bid Swfm 420 Third Street/P.O. Box 603 -To -Spec & Project Sales 1485 Lexington Ave. Piqua, Ohio 45356-0603 Ph: (513) Ohio453 6- Mansfield, Ohio 44907-2674 Fax: (513) 773-2238 4-1511 Fax: (4197774-153 Fax: (419)774-1530 MEMBER BARN ES® MERCURY LEVEL CONTROLS Pipe Mounted & Suspended Pipe Mounted: P/N's: 073613, 073615 & 073617 Suspended: P/N's: 073612, 073614 & 073616 u� CO CRANE PUMPS & SYSTEMS Barnes Pumps, Inc Distributor Sales & Service Dept 420 Third Street/P.O. Box 603 Piqua, Ohio 45356-0603 Ph: (513) 773-2442 Fax: (513) 773-2238 Specifications: CABLE: Material: Size: HOUSING: Material: Color: CLAMP: WEIGHT: TEMPERATURE RATING SWITCH: SWITCH RATING: Description: SECTION 6C PAGE 47 DATE 7/93 PL REACES 7/92 18-2 SJO W -A, 41 Strand x #34, 90°C .29 Dia. x (See Chart for Length) Polypropylene Normally Open - Blue Normally Closed - Red Adustable 1"-3" Stainless Steel with Polypropylene Saddle. (Models 073613, 073615 and 073617) Suspended, 2.25" Sph. lead weight with Adjustable stainless steel fittings (Models 073612, 073614 and 073616) 60°C Mercury, Narrow Angle, Horizontal 4.5A @ 115VAC RES 2.25A @ 230VAC RES The Mercury Level Controls are available in either a pipe mounted or suspended configuration with 25 to 200 feet of cable on P/N's 073612, 073613, 073614 & 073615; P/N 073616' with 15 feet '(use 073612, for longer lengths). P/N 073617 with 15 & 20 feet. They are pilot duty devices which control the function of motor load devices, such as contactors, motor starters, and power relays, to automatically cycle a pump or pumps. They can also be used for alarm signaling devices. Two Mercury Level Controls for a one pump operation; three for a two pump operation. If an alarm device is used, add another Level Control. LEVEL CONTROL SELECTION CHART Control Number Cord Length Type Installation Contacts 073612 25 to 200Ft. Suspended Open 073613 25 to 200Ft. Pipe Mounted Open 073614 25 to 200Ft. Suspended Closed 073615 25 to 200Ft. Pipe Mounted Closed 073616 '15Ft. Suspended Open 073617 15 & 20Ft. Pipe Mounted Open State cord length at time of ordering Barnes Pumps, Inc. Bid -To -Spec & Project Sales 1485 Lexington Ave. Mansfield, Ohio 44907-2674 Ph: (419) 774-1511 Fax: (419) 774-1530 SECTION 6C PAGE 48 DATE 7/93 REPLACES 7/92 4.50 encs ams, ruc. —2.88 TYPICAL SIMPLEX WIRING SCHEMATIC L1 L2 L OL11 ON L2 b OFF STARTER COIL AUXILIARY CONTACT TO MOTOR TYPICAL ALARM WIRING SCHEMATIC L1 120V 60HZ 1r L-�J ALARM CONTACT' (MINI -FLOAT) TYPICAL PIPE MOUNTED INSTALLATION: General Comments: 1. Never work in the sump with the power on. 2. Attach the Level Controls to the mounting pipe or the pump discharge pipe. The "off' float should be below the "on" float in a "pump out' application. 3. Arrange the Level Controls so they do not tangle or hang up. 4. Insert the hose clamp through the two slots in the pipe/cable clamp, circle the discharge pipe with the hose clamp, feed the end of the hose clamp through the screw and tighten. 5. Measuring the difference between mounting points given the "pump down" differential. Important Notes -Mercury Level Controls are pilot duty devices. They cannot be used to directly power pump motors. Also, do not use Mercury Level Controls in gasoline or other combustibles. Mercury level control are compatible with intrinsically safe relays. CRANE PUMPS & SYSTEMS Barnes Pumps, Inc. Bames Pumps, Inc. Distributor Sales & Service Dept. Bid -To -Spec & Project Sales 420 Third StreetlP.O. Box 603 1485 Lexington Ave. Piqua, Ohio 45356-0603 Mansfield, Ohio 44907-2674 Ph: (513) 773-2442 Ph: (419) 774-1511 Fax: (513) 773-2238 Fax: (419) 774-1530 SILENCE —Z3 E; 1 ALARM R i R1 2 AUDIBLE ALAR /MOUNTING OR DISCHARGE PIPE "ON" FLOAT DIFFERENTIAL PATER LEVELII "OFF" FLOAT 2 BARNES®ALARMS Wall Mounted PIN: 061486 FOR INDOOR USE ONLY. (90 PIN: 061487 FOR INDOOR USE ONLY. CRANE PUMPS & SYSTEMS Barnes Pumps, Inc Distributor Sales & Service Dept. 420 Third Street/P.O. Box 603 Piqua, Ohio 45356-0603 Ph: (513) 773-2442 Fax: (513) 773-2238 SECTION 6A PAGE 43 DATE 7/93 REPLACES 10/85 Specifications: 061486 High Water Alarm includes stainless steel wall plate with red jewel light and one mercury level control with 10 ft. of 18/2 cord. 2.75 0- 3.81 4.25 I O 2 HOLES FOR 6-32 x 1/4 SCREWS 061487 High Water Alarm (Solid State) includes stainless steel wall plate, audible and visual alarm with silencer button and one mercury level control with 10 ft. of 18/2 cord. 4.56 . � I ®— —o— I 3.28 4.50 --1.81 Barnes Pumps, Inc. Bid -To -Spec & Project Sales 1485 Lexington Ave. Mansfield, Ohio 44907-2674 Ph: (419) 774-1511 Fax: (419) 774-1530 w • JOB SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE Sra� F �.,vvwi uaoo-� A B C 1 } SEPTIC PLAN SUBMITTAL FORM LOCATION: q n a r^ , NVAn�6VEEt NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan CL SITE EVALUATION FORMS INCLUDED: YES NO DATE: Cl 2 2 I DESIGN ENGINEER: 7 4 �<Ct DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. ,10RTH Ottt.•o ;" ,�o 0 A X1,9 VS.�110 SS^CHUS� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 3 DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME�y ADDRESS TELEPHONE se��/ Site LocationP212, '//2/0 Dejbl -'i Permission is hereby granted to Construct ( ) or Repair (Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. VY6 Fee 7 CHAIRMAN, BOARD OF HEALTH D.W.C. No. _ 1661 TOWN OF NORTH ANDOVER/ BOARD OF HEALTH MAR 1 7 10=1`) APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT M DATE: 3111 sAck CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: J=. SIGNATURE: TELEPHONE# 4 q s- j CHECK ONE: REPAIR: r/ NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -Built? Floor Plans? Administrative Use Only Yes L--� No Yes No Yes No Approval _/" A&A Date: _3Ark_ SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: YES $125.00/Plan REVISED PLANS: YES C�6O..00 /PIan p SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGINEER- DATE NGINEERDATE 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. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 January 28, 1999 Eva -Maria Westphalen 24 Marian Drive North Andover, MA 01845 Dear Mrs. Westphalen: 27 Charles Street North Andover, Massachusetts 01845 L-1100 �T10 Fax(978)688-9542 This letter is to infonn you that, with the approval of the variance of 3' to groundwater approved by the Board of Health at their meeting on January 27, 1999, the proposed septic plans dated 11/23/98 for the repair of the system located at 24 Marian Drive have been approved. Please let me know if I can be of further service, or call the office with any questions you may have. Sincerely, Sandra Starr, R.S. Health Administrator Cc: W. Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 IF44AIIII, ct 0 0 DATE: O 1,- 0 yg LOCATION: ENGINES; BOH WITNESS: Q, PEF.CGL.^,T10N TEST* - <__ /Y .\r 5-1 t BOTT OM DEPTH OF PE -RC TEST, � TIME OF SOAK.: _ r .�-� (At IE�s 1�m irute= Icnc) TIME AT 2" �•Zt9 TIME AT c" T IME AT CvE=NICHT SOK TfiviE STA.RT_J 2: 2 (.-.t 1--- Niru es) 64Mf/ PFAso TIME A,TS" 64Mf/ lowf I./ 'IIJ )"V k �,i z; Vile °y 1 s E6 C Page 1 of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5,310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non -conforming 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 non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 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 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.. a UA� I`1 _ Name: n,a A - 0 1C l t>�— Address: z t4 w*%4 (Z -v A- ►•l No ..4 #-t v o u & (Z, Phone #: (0 1.7 Z Address of facility:5 A 2) Applicant (if different from above) Name: Address: Phone #: 3) Type of Facility: Residential Commercial School Institutional Specify) 101 4) Type of Existing System: _privy cesspools) other(describe) Page 2 of 5 jC conventional system Type of soil absorption system (trenches, chambers, pits, etc.) EI -ID 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system vN 6LNocwA, p Approved: _des Approval date: no Why: b) Design flow of proposed upgraded system j jLO gpd Why c) Design flow of facility gpd 6) Proposed upgrade of existing system is: a) X' Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: N 6 w s PT c -7-,4--" y Am A At c) Which of the following are applicable to the proposed upgrade? Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) Percolation rate of 30-60 minutes per inch (state actual perc rate) Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) Relocation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) C C Page 3 of 5 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 31 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)(1)(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: Evaluator's Signature: Date of evaluation: 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 9or well is affected by certified 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. Page 4 of 5 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: b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. ryOT ��- %LJ��% nlT�© 119 -nql S hu 5T.4-1%le ' . c) A shared system is not feasible. d) Connection to a sewer is not feasible. No T 4 rem- I CAB LC 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes no Page 5 of 5 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 Print Name Date Name of Preparer Date 51 ZEE&.) ap r.,K ezz • � LA- w4r--iyais, ti.'3 ,6 F15 Telephone No. & 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. c Town of North Andover, Massachusetts Form No. 1 ORTH BOARD OF HEALTH , ,l//"�J'[�, W A -j— 19 7C) a „••., , m a APPLICATION FOR SITE TESTING/INSPECTION Applicant X1/14- NAME ADDRESS TELEPHONE Site Location ::;1, 4- A)WIAA-) � Engineer Test/Inspection Date and Time A CHAIRMAN, BOARD OF HEALTH Fee �� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NpRTFj BOARD OF HEALTH - 19 o �' m APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location i Engineer jn . �'. NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH r r� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. "O—"TN BOARD OF HEALTH DATE: # W3° 8' 30 SCHOOL STREET TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS LOCATION OF SOIL TESTS: _ 2 �'VI,q �I tJ Assessor's map & parcel number: OWNER: tV,4 - 1,4 TEL. NO.: ADDRESS:- Z q W -g -r A -A) �jz , n • ;1j Apa V Eat ENGINEER: �. GjC—F— u�,4nril,4 TEL. NO.: G F3 CERTIFIED SOIL EVALUATOR: 14 Intended use of land: residential subdivision, single family home, commercial KV -P,41 t? THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) Plot plan 3. Fee of $175.00 per lot for new construction. This covers the minimum o deep holes and two percolation tests required for each disposal area. ee of $75.00er 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. i vci - M ari'q we -c4 r cAl en 21+ hcirriam DrI ve, Noy 4k AtnJOve-v) 10,0194 SF R VA T V A ASSOCIATES 31 I:kNID►21CK STR, L A WR k N CE 11\i �.! 01 Re; `our PraPasal vorn rebs', a 1 A� 1 -1 19 3- 1 -7- T 7 -- T Hereby au -k o r i Ze M r, � )Sep[') serva� (/ci "P, F Fo P e- rj brrn God 4cs r)3 01-7 V-ny s�'nGe6�2.1 y � &?� - a6-v,c Z -t.� f �4 , UP -0-2 .• � W P�� •%4t� a � '� ,� J ^�� � �•