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HomeMy WebLinkAboutMiscellaneous - 245 OLD CART WAY 4/30/2018WATER SUPPLY: TOWN j WELL WELL PERMIT DRILLER • WELL TESTS: CHEMICAL DATE APPROVED BACTERIA I DATE APPROVED...____._____,_____, BACTERIA II DATE APPROVED. COMMENTS: \� FORM U APPROVAL: APPROVAL 10 ISSUE( NO DATE ISSUED . / BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAIDS NO WELL CONSTRUCTION APPROVAL S. NO SEPTIC SYSTEM CONSTRUCTION APPROVAL _CYE NO ..OTHER . YES NO ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO DATE: ��%_ _BY: _ ';.•,...� SEPTI( S_Y_S�E.M_�N.�I9.4L.A_�C�_QN. . ;,. ,IS THE INSTALLER LICENSED? YE NO TYPE OF CONSTRUCTION: C NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW ---(YES,, NO CONDITIONS OF.APPROVAL YC� NO (FROM FORM U) ".ISSUANCE OF DWC PERMIT `. YES NO DWC PERMIT NO. INSTALLER: -1k BEGIN INSPECTION S NO: ..EXCAVATION,INSPECTION: NEEDED: PASSED BY CONSTRUCTION INSPECTION: NEEDED: - AS BUILT PLAN SATISFACTORY: YES:, APPROVA4. TO BACKFILL: DATE:�i ���/� By �� y FINAL .GRADING APPROVAL: )ATE BY�..�_ FINAL CONSTRUCTION APPROVAL: DATE:'G��BY '��� D-3oX EX15-r/1vG -_ .G.SoO . Go/iLG..dnJ %�- s rrA,/ e -A L7 Al v w A Y /„ EASE rl w, Z06/3 .r, / 5,0 r SND 60L L) E'e05EM6N7' E w). i Via_ /k� e_ (/_R s rrA,/ e -A L7 Al v w A Y /„ EASE rl w, Z06/3 .r, / 5,0 r SND 60L L) E'e05EM6N7' AS BUILT PLAN of SUBSURFACE DISPOSAL SYSTEM LOCATEDIN 4/ dg - AS PREPARED FOR OL / DATE :SEP iEMiS,ez 115i99s SCALE MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (sae) 475.3555, 373.5721 E w). i Via_ /k� e_ (/_R --/N p 0-i3a/.=01.76Z iN@2i3..3�- //V_169. AS BUILT PLAN of SUBSURFACE DISPOSAL SYSTEM LOCATEDIN 4/ dg - AS PREPARED FOR OL / DATE :SEP iEMiS,ez 115i99s SCALE MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (sae) 475.3555, 373.5721 �E-X-6ZIAL4 E X/5 r/NG_ i� oa c'9Z-C-0 30 fps fro � 4 �.Q„ /7 �v S%in/G i 6A0, Q LnZLO.g7 i A,1 0 E 5 F n -16 -AJ a �y -�3 Sa''iJn 6u)Lil" E,Q5EMEAI7 . / __X 4�Q1_;5c y40 P//G Z/b.7/ rr ,• r, " „ I' r r r, //V_✓C� lc /NO/ rr r. rr rr � Ir l� it AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOC�A//�T/�ED IN/ AS PREPARED FOR -1 EDS/ DATE: g9s SCALE' i"=AVI MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. loop 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 • TEL. (Sae) 475-3555, 373-5721 COMMONWEALTH OF MASSACHUSET'T'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _245 Old Cart Way_ _North Andover_ Owner's Name: _Chris & Karen Pepoli Owner's Address: _245 Old Cart Way_ North Andover, MA 01845_ Date of Inspection: _11/23/2002_ Name of Inspector: _Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: 111 Argilla Road_ Andover, Ma. 01810_ Telephone Number: _( 978 ) 4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: _X Passes Conditionally Passes Neel Further Evaluation by the Local Approving Authority Fail fit( I , PaAz�_ Inspector's Signature:Date: _11/23/2002_ 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. Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 245 Old Cart Way_ _North Andover_ Owner: Pepoli Date of Inspection: _11/23/2002_ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: _X 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): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 245 Old Cart Way_ North Andover — Owner: Pepoli Date of Inspection: _11/23/2002_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: — Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well's*. Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 245 Old Cart Way_ _North Andover— Owner: Pepoli Date of Inspection: _11/23/2002_ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _No Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _No_ Any portion of the SAS, cesspool or privy is below high ground water elevation. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No) 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. You must indicate either `yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply _ _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _245 Old Cart Way_ North Andover — Owner: Pepoli Date of Inspection: _11/23/2002_ Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes — Pumping information was provided by the owner, occupant, or Board of Health No_ Were any of the system components pumped out in the previous two weeks ? Yes _ Has the system received normal flows in the previous two week period ? _No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes_ _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ? Yes_ _ Was the site inspected for signs of break out ? _Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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 ? _Yes_ _ 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: Yes no Yes — Existing information. For example, a plan at the Board of Health. _No Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 245 Old Cart Way_ _North Andover– Owner: Pepoli Date of Inspection: 11/23/2002_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): —4— DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): _660 Number of current residents: Does residence have a garbage grinder (yes or no): _No_ Is laundry on a separate sewage system (yes or no): No_ [if yes separate inspection required] Laundry system inspected (yes or no): Seasonal use: (yes or no): _No Water meter readings: Yes_ Sump pump (yes or no): _No_ Last date of occupancy: _Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: _Pumped two years ago, owner_ Was system pumped as part of the inspection (yes or no) _Yes_ If yes, volume pumped: _1500�gallons -- How was quantity pumped determined? _Measured tank Reason for pumping: _Inspect tank & tees TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval _ Other (describe): Approximate age of all components, date installed (if known) and source of information: _7 Years old. September 15,1995. As built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 245 Old Cart Way_ _North Andover_ Owner: Pepoli Date of Inspection: _11/23/2002_ BUILDING SEWER (locate on site plan) X Depth below grade: 24" Materials of construction: _cast iron —X-40 PVC _other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): _4" PVC thru wall to septic tank. 3" PVC in house, no leaks. SEPTIC TANK: X locate on site plan) Depth below grade: _12"_ Material of construction: _X concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 10' x 5' x 4' Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: _15" How were dimensions determined: _Subtract scum & sludge depth to tee length. _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee & outlet tee ok. No evidence of leakage. Depth of liquid at outlet invert _ GREASE TRAP: _(locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _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 baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 245 Old Cart Way_ _North Andover— Owner: Pepoli Date of Inspection: 11/23/2002_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _0_ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box cover broken, replaced same. D -box level & distribution equal. No evidence of leakage. Evidence of carryover, pumped d -bog to clean. _ PUMP CHAMBER: (locate on site plan) 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.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 245 Old Cart Way_ North Andover_ Owner: Pepoli Date of Inspection: _11/23/2002_ SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: X_ leaching trenches, number, length: 3 trenches 72' long_ leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _Soil Ok. Vegetation ok. No sign of ponding to surface. CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _245 Old Cart Way_ _North Andover_ Owner: Pepoli Date of Inspection: _11/23/2002_ 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. A to Tank = 34'3" A to D -Boz = 40'8" B to Tank = 61'7" B to D -Boz = 65' Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 245 Old Cart Way_ North Andover– Owner: Pepoli Date of Inspection: _11/23/2002_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _4.5— feet Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: _9/28/1992_ 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: As per design plan 11 - --�' .3 -' 17 AA 'I I ' 0 �5 �� J -D 1 -5 1 U N 111 A,% OU % r-rl U1 " 0 m C2 Cl 111 Ln V) un UA OI PLM41 J "'I LALr1 4— r, q— U*i LM V) Vi Ln U*) CL L J -j LA 0 Wh 014 Ch LLJ 7 QIP.0 m C2 Cl 111 Ln V) un UA OI PLM41 LALr1 4— r, q— U*i LM V) Vi Ln U*) LLJ :' `)t 661 W Gh LIJ Lri r� w*, cr- 94 N 1c N U.� LU . . . . . . . c 0 cc OLnPLAONO.-000000 Lu is V1 1 W, 10 Ln Ln r,- I*. cc IM w w cm 'con T- T- CD Lij N m P� Y- Ln r, r- T, T- 9- UN LU CL C14 C.) L.0 IN LA N P.- -0 m N m r� r. LA r* T- T - O.7 LU a. II 0 Lu C> 0. QC> 0 L3 r- r- N N N N N N N N N N N N N. = Cj - T- TN I LLJ Lo I Z4 1, %, %% I-- T- C6 u-, N 9- N Lm P.- r- m Lr) t� C { j_.� I ©TOOOr OOOTOOOr Lid T- r, r, T, L-Uj C6 ol rl I TL r, rl cl, IN II, , N N cnIn I C3 = C2 C2 = CD = = = = C= 0 = cm w C2 0 0d C14 N Q I . ........ .. . 2 rr) LO fi Com; Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 245 Old Cart Way Owner: Pepoli Date of Inspection: 11/23/2002 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. 4Ba NNei n Bateson Enterprises, Inc. NORTry Oa+tete ,a'�40 A ;,SSACHUSEt� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant TestNo r I► • • L /_ _ S• r j __e Reference Plans and Specs. Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee bo. 0U CHAIRMAN, BOARD OF HEALTH Site System Permit No. 1� P Applic Town of North Andover, Massachusetts Form No. 1 IRT1i qBOARD OF HEALTH ED 97 -1977 APPLICATION FOR SITE TESTING/INSPECTION G/ Site Location Z,1)T 45 �0Ld C�X7- Engineer /Y�—&/)I/9G1C NAME ADDRESS TELEPHONE Test/Inspection Date and Time r CHAIRMAN, BOARD OF HEALTH Fee /o• Test No. &v S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH 19 APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee ' j CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Tom of N 4 ' SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: 4 QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: (; -Cs0, OR N oft t) rA cz D J o Z J H z a z � 1� � v Q {rs PQCf) r C7 a GO —cz(�� v U CD o Q =>- v w co co c w o w" a r G0 G �..� W � o Gc CO x w w v z i v v cn a D J ca %J llO zm � •d o o qp O CICE O y Z ui Vi atom -z tit d R 4 �/.•� CO �s mpg co �. � � � zCD V C� E a CO OL CD (.C.3 CM r m c N � Ma CID cm H rF14 .� .der •_ �t p �, U .s y m ac .00 _ l :mom m_ V N O i �� cmv•�Z o � � Q W c a LA - COD H m wCD .mc LL •N m W O C O 1i. .J �--, N •Q L Z F�.. = m N 0 W b- V m V Of �... �•� n W Scc ,��H ' O Q.m � o � Q , CD z E LL co Q G o GO ca %J llO zm � •d o o qp O CICE O y Z ui Vi atom -z tit d R 4 �/.•� CO �s mpg co �. � � � zCD V C� E a CO OL CD (.C.3 CM r m c N � Ma CID cm H rF14 .� .der •_ �t p �, U .s y m ac .00 _ l :mom m_ V N O i �� cmv•�Z o � � Q W c a LA - COD H m wCD .mc LL •N m W O C O 1i. .J �--, N •Q L Z F�.. = m N 0 W b- V m V Of �... �•� n W Scc ,��H ' O Q.m � o � Q , CD z E LL co Q G VLU Z Q Cl - CD =>- co co c F— F— w 'a Q CO y 'E m m Lu z i CL co ~ _••• UO m O i co CDCJ G O L cc o Q Q �Q y C � OR L C J v J� z .Q o oJ LL c Z zCD V r -L_ y C C � CL y C-0 F— G z z � w a_ C/) 9 I NORTH '9 0 t�-E� 16it �Q vo �o L m 'Q COCM,C.Ew,cx AA "H OA?ATED AP \y ,EC �SSAcHUS' i,- . APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY: 404 /3 Old O` .;l 6y DATE REQUEST FILED/READY FOR INSPECTION: Z CLOSING DATE ON PROPERTY: ;li ` f FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED. ALL WORK AND SIGN -OFFS MUST BE COLLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED: BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext23 January 28, 1994 White Birch Construction 733 Turnpike Street, #336 North Andover, MA 01845 Re: Lot #13 Old Cart Way Dear Ed: This letter is to confirm that the North Andover Board of Health, at their meeting on January 27, 1994, granted a variance to North Andover Regulation 2.14(4) minimum design rate to allow the design of the septic system on this lot to be based on 150 gallons per day per bedroom. If you have any questions, please feel free to call me at the Health Office. Sincerely, Sandra Starr, R.S. Health Agent SS/cj p cc: Karen Nelson, Director, Planning & Comm. Dev. File P BOARD OF HEALTH Mr. Les Godin Merrimack Engineering 66 Park Street Andover, MA 01810 Dear Les: 120 MAIN STREET NORTH ANDOVER, MASS. 01845 March 16, 1995 TEL. 682-6483 Ext23 This is to confirm that on February 23, 1995, the North Andover Board of Health granted a variance to Lot #13 Old Cart Way to permit the construction of the leaching area twenty-five (25) feet instead of thirty-five (35) feet to the foundation drain. If you have any questions, please do not hesitate to call the Health Office at 688-9540. Thank you for your cooperation. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp 1 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (508) 475-3555, 373-5721 • FAX (508) 475-1448 February 21, 1995 Town of North Andover Board of Health Town Hall - 120 Main Street North Andover, MA 01845 RE: Lot 13 Old Cart Way Wagon Wheel Estates Dear Board Members: 1 X, On behalf or our client, Christopher Pepoli, we herein request a Variance to Town of North Andover Board of Health Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, Reg. 4.18 "Distances" so that a subsurface disposal system may be constructed 25 feet distant from foundation drains as opposed to 35 feet, as required, for the subject lot. The installation of foundation drains is a general requirement of the Town of North Andover Building Department, however, please note that the cellar floor elevation is above the seasonal high water table in this case, therefore, no sewage infiltration into the foundation drains should occur. Please schedule this item for the next available meeting of the Board of Health and feel free to contact me at this office should you have any questions or comments. Very truly yours, MERRIMACK ENGINEERING SERVICES L Les Godin Project Manager cd - - - ------------- - - ---------- ---- 42 9r1 Ulf -- CL �',a 17 Leo PLAN REVIEW CHECKLIST �r/ © b ADDRESS ��.- J7L/� (�� C ��/%l��i�ENGINEER P9 GENERAL 3 COPIESy STAMP C--' LOCUS 4--� NORTH ARROW e--- SCALE "--- CONTOURS—L-., am' CONTOURS PROFILE C---- SECTION BENCHMARK'0ei SOIL & PERC INFO ELEVATIONS "'--/ WETS. DISCLAIMER WELLS & WETLANDS ✓ WATERSHED?�M DRIVEWAY�-� (Elev.) WATER LINE FDN DRAIN SCH40 TESTS CURRENT? / q8( 6,,e, i�e6 soi/ G haw er 2/Qv. @ enh o F I��e - e rc. -�00- SEPTIC TANK MIN 1500G. C--' .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR i-' MANHOLE TO GRADE [ice ELEV c-- GW d ,f D -BOX SIZE 7 # LINES� FIRST 2' LEVEL STATEMENT '-"-- INLET ` /S J� - OUTLET ,�-%S3�b _ 17 ( 2" OR .17 FT) TEE REQ' D? AD LEACHING RESERVE AREA &,,-41 FROM PRIMARY? &,-'1001 TO WETLANDS L,-' 2% SLOPE 100' TO WELLS `--- 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW 325' TO SURFACE H2O SUPP L,-- 4' PERM. SOIL BELOW FACILITY MIN 12" COVERZ/'- FILL? x(25' if above natural elev; 10'' below) BREAKOUT MET? --- TRENCHES TRENCHES MIN 660 gpdSLOPE (min .005 or 6"/1001) ✓ >3' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D ,(MIN 61) t/ IS RESERVE BETWEEN TRENCHES? ✓ IN FILL?t/ MUST BE 10' MIN. ✓" 4" PEA STONE? ,�/ BOT X LDNG a-1" 2+ SIDE 43'�- X LDNG TOT 0�j G �O (L x W x #) (G/ft ) (DxLx2x#) FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or ,landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT : � ), J � 61A -u - t VrP - SCJ..(. L4 Phone G I, i - 667 73 LOCATION: Assessor's Map Number P rl Parcel Subdivision /10/0 t� l.L4 i, ::t? �/ CUC L G���`° � Lot (s) Street St. Number ************************Official Use Only************************ RECOMMENDA PNS OF TO AGE , Date Approved / onserva ion Admini trator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food Inspector -Health ,A Septic Inspector -Health Date Approved Date Rejected Date Approved Date Rejected Comments X?1V 1 ti J) !!55 b-5 C 0 ti S T.C'Cil T /O fL� ✓/ Public Works - sewer/water connections - driveway permit V Fire Department Received by Building Inspector Date WHITE BIRCH CONSTRUCTION, INC. 733 Turnpike Street, #336 North Andover MA 01845 Tel: (603) 889-1186 Fax: (603) 595-2824 January 20, 1994 Ms. Sandy Starr No. Andover Board of Health Town Hall Main Street No. Andover MA 01845 RE: Lot #13 Wagon Wheel Estates North Andover, MA Dear Sandy: Pursuant to our last conversation regarding Lot #13 in the Wagon Wheel Subdivision, I would like to formally request that I be put on the agenda of the January 27, 1994 Board of Health meeting of the purpose of requesting a variance to the North Andover Regulation 2.14(4) regarding minimum design rate. Very truly yours, �J Edward W. Huminick EWH:kah "•,~O\ 9.^ . p BOARD OF HEALTH January 22, 1993 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 JAN 2 5 1333 Les Godin 4fiENICE SAti?tiGS BAPIK Merrimack Engineering Services, Inc. 66 Park Street Andover, MA 01810 Dear Les: This is to confirm that at the Board of Health meeting held on January 21, 1993, the Board granted variances to North Andover regulations: 2.14-4, minimum design flow for single family dwellings, for Lots 1 and 18 Old Cart Way; 17.03, spacing between leach trenches for Lots 8, 10, 11, and 14 Old Cart Way; 4.18 distance to a catch basin for Lot 5 Old Cart Way; 4.14 to allow a twenty minute design rate. With these variances, all current lots on Old Cart Way have been approved, specifically, Lots 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 21. If you have any questions, please do not hesitate to call. Sincerely, Sandy Starr BOARD OF MINUTES JANUARY HEALTH 21, 1993 Dr. MacMillan called the meeting to order at 7:35 p.m. MEMBERS PRESENT: Francis P. MacMillan, M.D., Chairman, John S. Rizza, D.M.D., Gayton Osgood, Sandy Starr, Health Agent, Allison C. Conboy, Health Administrator and Karen Nelson, Director, Planning & Community Development. OLD CART WAY LOTS # 1 8 10 11 14 18 - LOCAL VARIANCES Mr, Les Godin, Engineer came before the Board to request variances to the Town of North Andover's Regulations on Subsurface Disposal of Sanitary Sewage - Wagon Wheel Estates, Lots #1, 8, 10, 11, 14, 18 as follows: Lots #1 & 18: Regulation 2.14-4 so that the leaching systems may be designed for a minimum design flow of 495 gallons/day as opposed to 660 gallons per day as required. Lots #8, 10, 11 14• Regulation 17.03 so that leaching trenches may be spaced 9 feet apart as opposed to 10 feet apart as required. Mr. Godin stated in his letter that subsurface disposal systems plans for these lots had been previously approved by the Board of Health under regulations adopted September 27, 1984, but have since expired. Mr. Godin stated that the plans have been otherwise revised to met current regulations adopted March 21, 1992 by the Board of Health. These variances are necessary to accommodate the substantially larger leaching areas required by current regulations. Ms. Starr stated that she does not have a problem with this and suggests that a variance be granted. Mr. Osgood sees no problem. On a motion by Dr. Rizza, seconded by Mr. Osgood, the Board voted unanimously to grant variances to Lots #1, 8, 10, 11, 14, 18 on Old Cart Way as stated in the letter dated January 4, 1993. Ms. Starr also requested that the houses that are being changed to three bedrooms be noted on the deed. BOB LEYLAND INTERN - DISCUSSION - UPDATE ON SEPTIC SYSTEM DATA BASE AND 1992 QUESTIONNAIRE• Bob Leyland, Intern for the Conservation Commission and the Board of Health was present and a lengthy discussion ensued in regards to the update on septic system data base and the 1992 questionnaire. Mr. Leyland stated that approximately 448 DATE h2- Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # APPLICANT 5 S --h /NSe1 ADDRESS ENGINEER YCRRI/1115fC/<- DATE RECEIVED lak l& ASSESSOR'S MAP /6 7S PARCEL # a % LOT # STREET c D Ate_ ADDRESS PLAN DATE 9/�810� REVISION DATE CONDITIONS OF APPROVAL:—/) ADD T G 50/t, TESrs @._evb Of GEi�Ch1 IRE - ,AEf,'C /�L5Ci ) ELEV OF FQN . DRP il11 f �ac/�nati�5 lqz APPROVED l a,31 G,�C-��� �r© 6011., DISAPPROVED 6)eN� �Y/��'/ANGC • ST�IGTL j/ T/TLE �� vs/ . It L -o -r- ZoT NaI�TH AU DOVEI,� + MA, A�PUCOJ, D154FPP4 UED R�ASoNs P(AtJ 04iE 5EPTI c SY sTEM Cotjgjno�J5 Dw� SC�--I C SysTEM 1 � SiiO ll�T+oiu ,�--X4v4T(O^J )tiSPE6T(O&1 DArE I Q5PF�rloA) 4 PP13OVEp Q SS U r=4►L- FI PE FROA-\ �iO� rc) TA 0 t� Ll Fig S`D `O FOIL QJ/3TC I Nsi�cr.�c; 4WITIOMAL 1) sJYbc, i tj5 �, may) DISAPt )�o\j&D DArC R�Oso NS •, FML VPIZVALD,o-r