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Home My WebLink AboutMiscellaneous - 259 GRANVILLE LANE 4/30/2018I North Andover Board of Assessors Public Access Page 1 of 1 rioRYy k K Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales . ni s s;X-7-M _76) M - Property Record Card Parcel ID: 210/106.A-0152-0000.0 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Click on Photo to Enlarge Location: 259 GRANVILLE LANE Owner Name: BURT, DAVID R JANET HUGHES BURT Owner Address: 259 GRANVILLE LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 1.24 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2240 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 550,600 585,200 Building Value: 340,100 352,400 Land Value: 210,500 232,800 Market Land Value: 210,500 Chapter Land Value: LATESTSALE Sale Price: 315,000 Sale Date: 04/13/1997 Arms Length Sale Code: Y -YES -VALID Grantor: OWEEFE, DENNIS Cert Doc: Book: 04729 Page: 0101 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&LinkId=1181166 1/17/2008 .,a' i TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT t 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORT14 A�M� 7k�M,ASSA,i--I41,-,KTTS 01845 4SS lCpuS�t Susan Y. Sawyer, RENS, RS Public health Director APPLICATION FOR DATE: 1- 11 " o {j AN 2 3 Z008 TOWN OF WORT H ANDOVER H FAL"11-! DEPARTMENT .688.9540 — Phone- .688.9476 hone.688.8476 —FAX .townofnorthandover.com MAP & PARCEL: 10 (,, A r/ I r l LOCATION OF SOIL TESTS: OWNER Contact APPLICANT:...... 9 1 �,�-- —b Contact ADDRESS: --- ENGINEER: ��— J V ontact #: /�� .— 3-55E57 — 20 CERTIFIED SOIL EVALUATOR _ �j(L,(� �j�Lpfk,��_ ' Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No Y THE FOLLOWING MUST .BE INCLUDED WITH THIS FORM ➢ Proof of land. ownership (Tax bill, or letter from owner permitting test) ➢ A5"x 11"Plot plan & Location of Tevftr (please indicate test nit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for re airs or uvargdes. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. i At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1 "A 00') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval D&-.-. l $ i Signature of Conservation AgentA!, uo u. 4w, ta '06 '„d /e cd, q, Date back to Health Department: (stamp in): IPK l F C_o✓d-s7��o✓i LNORrM Q`" a G , 6 q% COPY OR coc.uitiiwic• , 1• PUBLIC HEALTH DEPARTMENT (ommunity Development Division CE1��II�F'ICA7E Off' C091�1�1'LIA9VC�E As of: JuCy 16, 2009 9his is to cert that the individuaCsu6surface di sposaCsystem received a SATISIFACY ORTINS(ECTIOYof the: Wfpairlftllacement of Complete Septic System By: JoFin Soucy At: 259 Granviffe .Gane 911ap —106.,X; Parcel -152 North Andover, gw q 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. YSanar Pu6CuWealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r� w NORTii SSACHUSE PUBLIC HEALTH DEPARTMENT Community Development Division RECEIVED JUN 2 5 2009 TOWN OF NORTH TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (�epaired; By:. ® f� �_ vu G (Print Name) Located at: (i21 a "901 L t_f. , 49 (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated 2'2�`0(� and last revised on ��/� y' , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: _Un U f" Engineer Representative (Signature) And — Print Name Final Construction Inspection Dater Z— [ —00 And — Print Installer: l.� Engineer Representative (Sig ature) Xj Lit VLADIMIRL. ��J 0i -i 6J 20l_I LY NEMCHENOK `� ' And — Print Name Enginer: V ignature) Date: SS�QNAL EhG V L-A D 1 M I rc_ { 4 E H GI4 Eta And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web http://www.townofnorthandover.com Fi him L-- AS -BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, MTI -IUP 346 -RE -SERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARRO W , LOCATION & ELEVATIONS OF BENCHMARK USED AS -BUILT CHECKLIST i LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS ' LOCATIONS & DIMENSIONS OF SYSTEM, INCLU —MG-USF.RVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS Az ELEVATIONS OF DISPOSAL SYSTEM ? ' TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM ----- LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF . / TANK & D -BOX ORIGINAL STAMP &SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW '' LOCATION & ELEVATIONS OF BENCHMARK USED pORT#1 0-4-CLIo 161 0 o eee o *�q_ COCMIc.1CRCWKR � 1� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 259 Granville Lane INSTALLER: John Soucy DESIGNER: Vladimir Nemchenok PLAN DATE: 2/27/08 BOH APPROVAL DATE ON PLAN: 4/25/08 MAP: 106A LOT: 152 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 12/2/2008 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanout added during construction ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading monolithic construction ® Water tightness of tank has been achieved by Visual testing 4 ® Inlet tee installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTh J* PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over inlet and outlet access ports ® Hydraulic cement around inlet & outlet Comments: The existing building sewer line location was different than depicted on design plan, so a cleanout was added in order to get to the septic tank location. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ® 1000 gallon Pump Chamber installed ® H-10 loading 2 -piece construction) ® Inlet tee installed, centered under access port ® Pump installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ® Hydraulic cement around inlet & outlet Comments: Goulds pump installed. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: outside to next to front door ® Rated for exterior if placed outside ® NO - Alarm signal located inside 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 pORTR O�.1g1.t° 061 9tiO 6 OL O A� PUBLIC HEALTH DEPARTMENT (ommunity Development Division Comments: DISTRIBUTION -BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: 2" x 4" coupling located approx. 4' prior to d -box inlet. SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Infiltrator Chambers — Quick 4 ® Number of chambers per row: 11 ® Number of rows (trenches): 4 Comments: 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.com Inspection Form June 2008 t RTF+ PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS BM = 100.00 H R = 0.40 HI = 100.40 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 7.70 92.35 94.0 Septic Tank IN 8.88 91.17 91.00 Septic Tank OUT 9.23 90.82 90.75 Pump Chamber IN 9.32 90.73 90.70 Pump Chamber OUT 9.60 90.63 Distribution Box IN 7.40 92.65 92.47 Distribution Box OUT 7.59 92.46 92.30 Lateral 1 TOP 7.72 Lateral 1 INVERT 92.33 92.27 Lateral 2 TOP 7.72 Lateral 2 INVERT 92.33 92.27 Lateral 3 TOP 7.72 Lateral 3 INVERT 92.33 92.27 Lateral 4 TOP 7.72 Lateral 4 INVERT 92.33 92.27 BED BOTTOM ELEV. 8.77 91.63 91.60 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 o',sttec 16''NO0 i A -O COC.I CMIwKM, 04 Are 01, SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 DelleChiaie, Pamela From: Grant, Michele Sent: Friday, December 05, 2008 8:42 AM To: DelleChiaie, Pamela Subject: Granville Lane Hi Pam, John Sousy will be completed with Granville Lane by the end of the day — Today He will need a final grade DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Thursday, December 04, 2008 4:44 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 259 Granville Construction Inspection attached Attachments: 259 Granville Lane.pdf Attached please find the report for 259 Granville that was done yesterday. Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web: www.millriverconsultinng.com DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Monday, December 01, 2008 4:33 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 259 Granville inspection for 12/2 now moved to 12:30 We just moved the inspection with Soucy up to 12:30 rather than 1:30 due to a schedule conflict; sorry for the inconvenience. <outbind://37-00000000F5353D926F8C7242B15001AAC259AA8B84BA5100/cid:670275918@15072008-240C> Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web: www.millriverconsulting.com<http://www.millriverconsulting.com/> 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Monday, December 01, 2008 3:51 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 259 Granville Lane Inspection sched for Dec 2nd at 1:30 Importance: Low This inspection has been scheduled with John Soucy for 1:30 tomorrow, December 2nd. Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web: www.miUriverconsulting.com From: DelleChiaie, Pamela[mailto:pdellech@townofnorthandover.com] Sent: Monday, December 01, 2008 3:05 PM To: mpeters@millriverconsulting.com; dano@millriverconsulting.com Subject: FW: 259 Granville Lane Importance: Low Hello Mill River, Please schedule 259 Granville Lane with John Soucy at: 603.216.7175. Thank you. From: brdufresne@comcast.net [mailto:brdufresne@comcast.net] Sent: Monday, December 01, 2008 2:26 PM To: DelleChiaie, Pamela Subject: [BULK] 259 Granville Lane Importance: Low Pam System is ready for final inspection. John Soucy will be in touch to schedule thank you, Bill Dufresne I TOWN OF NORTH ANDOVER a NORTp 7 Office of COMMUNITY DEVELOPMENT AND SERVICES o o'y• HEALTH DEPARTMENT 4p 1600 OSGOOD STREET; Building 2-36 r NORTH ANDOVER, MASSACHUSETTS 01845TD t�� CHUS Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES )CATION INFORMATI, ADDRESS: INSTALLER: DESIGNER: PLAN DAT Z v BOH APPROVAL DATE ON PLAN INSPECTIONSa� �. T TANK INSPECTION:.`/ DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK LOT: []Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon tank has been installed H-10 loading Monolithic construction Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) Inlet tee installed, centered under access port Outlet tee (gas baffle or effluent filter) installed, centered under access port 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Wastewater System Documentation — Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER ,r Office of COMMUNITY DEVELOPMENT AND SERVICES o? •'; p �'• °°? HEALTH DEPARTMENT p 1600 OSGOOD STREET; Building 2-36 ",.. +' NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss;;CH,;; Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: Comments: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Wastewater System Documentation — Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER E aoRTN Office of COMMUNITY DEVELOPMENT AND SERVICES o?o'��.o '�'•�°off HEALTH DEPARTMENT to 1600 OSGOOD STREET; Building 2-36 • �, ..:�::.. ,.q �'4iIC NORTH ANDOVER, MASSACHUSETTS 01845 'Ss�C SEt Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX D -BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM R Bottom of SAS excavated down to V soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel -less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: Wastewate Sy em Wcumentation — Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER °E NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o? W; o��°°� HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �,SSACHUS t� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps Comments: CONTROLPANEL Comments: size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Wastewater System Documentation — Feb 2006 Page 4 of 6 Ir" r TOWN OF NORTH ANDOVER H°RTM Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �'ss"„CHU Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Wastewater System Documentation — Feb 2006 Page 5 of 6 Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- Waterline 10 10 10' ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other) Foundation 10 (5) 20 (10) ❑ Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Wastewater System Documentation — Feb 2006 Page 5 of 6 ,+' r TOWN OF NORTH ANDOVER MOR*H Office of COMMUNITY DEVELOPMENT AND SERVICES °•tS... ,.'ti°L r°- y � • a HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845'S.9 CHUStt Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX SYSTEM ELEVATIONS Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW INVERT ON DESIGN PLAN FIELD INVERT ELEV. Wastewater System Documentation — Feb 2006 Page 6 of 6 FINAL GRADE INSPECTION Address: LOAMED? SEEDED? ❑ COVER PER PLAN? Other: „oRry Commonwealth of Massachusetts Map -Block -Lot fly •,Oo .t�1�a� 106.A- 0152 - ----------------------- Board of Health Permit No � North AndoverBHP-2008-0-- 221 221 ---- :. ----P-20-- °;. •• P.I. FEE t.. �SAcwu`�Et F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted John Soucy to (Repair) an Individual Sewage Disposal System. at No259 GRANVILLE LANE ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. 13HP72008-0221 Dated .__November_ 17120-08 Issued On: Nov-18-2008 ---------------------------------------------------------- e ----------------------------------------------------------------- Board of Health NORTF, Application for Sepfiic Disposal System " 0' . �p Construction Permit - TOWN OF r ORTH ANDOVER, MA 01845 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rerun Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facili Information !'4VLV ciQ:) Addressor Lot # City/Town PE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) a TO y'S bATE $ 250.00 — Full Repair V $125.00 - Component ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information y 1R_ -� Name Address (if different from a ove)/lXJ[_J City/Town State' r� Zip Code Telep one Number 3. Installer Information e L�C LjJy Name Name of Company Addres 04 b?071 Cityrrown tate Zip Code Telepho a Number (Cell Phone #if possible please) 4. Desiciner Information Nam L - Name of Company Addresx; et a City/Town IMA b I (a Stale Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 -Jo�(,000' RT►,a,. Application for Septic Disposal System ft WOE pConstruction Permit -TOWN OF TO NORTH ANDOVER, MA 01845 $ 250.00 - Full Repair $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ,,�d � Name Date Approved : (Board of Health Representative) I/) _7 )P Date Disapproved for the following reasons: For Office Use Only: L Fee Attached. Yes ✓ No 2. Project Manager Obligation Form Attached. Yes v� No 3. Pump System? If so, Attach copv of Electrical Permit Yes No 4. Foundation As -Built. (new construction ronl : /� f; No Y) j — (Same scale as approved plan) / 5. Floor Plans? (new construction only): �I� Yes No Application for Disposal System Construction Permit • Page 2 of 2 1 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 12�GieV� V�J�J� (Address of septic system) Relative to the pplication of 1, nstaller's name) Dated 11 16/ /0�- oclay's date For plans b, - � � C6► (Engineer) And dated With revisions dated -/lIVo0? (Last revised I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without comuletion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or My company_ a. Bottom of Bed — Generally, this is the first (VS inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer:It,( (Today's D a e — rint —7aml Signe-cl)/ SUMMARY OF INVERTS SEWER ® FDTN. 92.44 6' OFF SEPTIC TANK IN 91.18 SEPTIC TANK OUT 90.85 PUMP TANK IN 90.82 DIST. BOX IN 92.65 4" DIST. BOX OUT 92.47 4" INV. IN CHAM. 92.35 BOTT. CHAM. 91.70 BUILDING TIES BLDG. CORNER A B C SEPTIC TANK IN 27.5 65.2 PUMP TANK 40.2 64.1 DIST. BOX 60.0 41.2 NOTE: THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS. RECEIVED 14, 12�14 IH OF k, JUL 0 8 2009 O VLADIMIR L � — �%� NEMCHENOK " TOWN OF NORTH ANDOVERa a i , HEALTH DEPARTMENT ca A j&afu ,�F STER�c�`' AS BUILT PLAN ss�aNAL�NG OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. /259 GRANVILLE LANE AS PREPARED FOR DAVID BURT TM: 106 A DATE: 12-1-08 TL: 152 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS. *LEACH FIELD IS 30 FT. FROM DWELLING. THE PROPOSED OFFSET WAS 32 FT. LA._ (54,064 S.F.) LEACH FIELD W/44 INFILTRATOR D -BOX ?` CHAMBERS.. OUT \ I- INSPECTION ?000 OT AL PORT Rt4t t PUMP TANK is, 's• "'.% a 1500 GAL SEPTIC TANK ca 141 /' / RECEIVED JUL 15 2009 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM • ,LOCATED IN NORTH ANDOVER, MASS./259 GRANVILLE LANE AS PREPARED FOR DAVID BURT TM: 106 A DATE: 12-1-08 TL: 152 SCALE: 1"=40' 0 20 ao so 11ERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SUMMARY OF INVERTS BUILDING BLDG. CORNER SEPTIC TANK IN PUMP TANK DIST. BOX TIES A B C 27.5 65.2 40.2 64.1 60.041, N THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS. SEWER 0 FDTN. 92.44 6' OFF SEPTIC TANK IN 91.18 SEPTIC TANK OUT 90.85 PUMP TANK IN 90.82 DIST. BOX IN 92.65 4" DIST. BOX OUT 92.47 4" INV. IN CHAM. 92.35 BOTT. CHAM. 91.70 LEACH FIELD W/44 INFILTRATOR CHAMBERS .�s VLADIMIR y i Al�q,,,. C, e 'v f 'G,ex,°-,ALT ��:!��`�•,�` AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. /259 GRANVILLE LANE AS PREPARED FOR DAVID BURT TM: 108 A DATE: 12-1-08 TL: 152 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS '01810 o -r ,C-:' L Z I A41 ft r 1-9 zAe, '-Al F qv---px,t7, ZZAA a -All E5 12 LLa--- s-SultvrAhc& oma f4 V - L syr is -All E5 12 LLa--- s-SultvrAhc& oma f4 V - S M E A D® No. SFP11SA UPC 68030 smead.com• Made in USA �'6crct'b ti Qr FA4a-- --7;-USED IN TWS POLM A %. COMMONWEALTH OF MASSACHUSETTS 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: _259 Granville Lane_ —North Andover_ Owner's Name: _David Burt Owner's Address: _259 Granville Lane _ _ North Andover, MA 01845_ Date of Inspection: _1/9/2008_ Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810 Telephone Number: _ (978) 475-4786_ RECEIVED JAN 1 1 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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: Passes X Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fail Inspector's Signature: ` Date: _1/9/2008 _ 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: _259 Granville Lane _ North Andover_ Owner: —Burt— Date BurtDate of Inspection: _1/9/2008 _ 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: X 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. _ Septic tank leaking & D -boa broken and filled with sand. Yes 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 No 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: No 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 exnlain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _259 Granville Lane _ North Andover_ Owner: _Burt Date of Inspection: _1/9/2008 _ 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". 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: _259 Granville Lane_ _ North Andover— Owner: _Burt Date of Inspection: _1/9/2008 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: 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''/z 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 _ 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. NoAny 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 II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 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: _259 Granville Lane _ _ North Andover _ Owner: _Burt Date of Inspection: _1/9/2008 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No No 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 ? No 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? 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 ? _ _No_ 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 _ No Existing information. _Yes_ _ 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: _259 Granville Lane_ _ North Andover– Owner: _Burt Date of Inspection: _1/9/2008 _ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 _600 Number of current residents: _0 Does residence have a garbage grinder (yes or no): (Ze� Is laundry on a separate sewage system (yes or no): No _ Laundry system inspected (yes or no): Seasonal use: (yes or no): _No_ Water meter reading: Yes_ Sump pump (yes or no): _No_ Last date of occupancy: _ Vacant two months_ CONEVIERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): ___Md Basis of design flow (seats/persons/sqft,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: _Unknown Was system pumped as part of the inspection (yes or no): _No_ If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: _ 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 _27 Years old, 9/4/1981_ 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: _259 Granville Lane_ _ North Andover _ Owner: _Burt Date of Inspection: _1/9/2008_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _6'_ Materials of construction: cast iron —40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ Unable to see piping, finished cellar SEPTIC TANK: X Depth below grade: _5' _ 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 0"_ Distance from top of sludge to bottom of outlet tee or baffle: _N/A _ Scum thickness: _0"_ Distance from top of scum to top of outlet tee or baffle: fflN/A_ N/A =Tank leaking Distance from bottom of scum to bottom of outlet tee or bae: N/A How were dimensions determined: _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. _Septic tank leaking out. Liquid level 2' below inlet pipe. _ 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: _259 Granville Lane _ _ North Andover— Owner: _Burt Date of Inspection: _1/9/2008_ 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 Depth below grade _6'_ 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 & d -box filled with sand. Unable to see piping._ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): Alarm 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: _259 Granville Lane _ _ North Andover– Owner: _Burt Date of Inspection: _1/8/2008_ 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: _ leaching trench, number, length: X leaching field, number, dimensions: _1 field 25' x 36'_ 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.):–Unable to measure leach lines, d -box filled with sand. Measurements for field width & length came off of as built plan. Vegetation covered in snow. No signs of ponding. _ CESSPOOLS: Number and configuration: _ Depth – top of liquid to inlet invert: Depth of sludge 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 Property Address: _259 Granville Lane _ _ North Andover_ Owner: _Burt Date of Inspection: _1/9/2008_ 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 Inlet --26'2" A to D -Boa = 39' B to Inlet = 24'8" B to D -Boz = 24'5" Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _259 Granville Lane _ _ North Andover_ Owner: _Burt_ Date of Inspection: _1/9/2008 _ SITE EXAM Slope _ Yes _ Surface water _ No _ Check cellar _ Dry _ Shallow wells No Estimated depth to ground water _ 41 _ 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: _5/12/1979_ 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: Jest pit data on design plan _ Class Size Total FY Summary Record Card generate6zn 1/9/200810:28:58 AM by Karen Hanlon Town of North Andover Tax Map # 210-106.A-0152-0000.0 259 GRANVILLE LANE BURT, DAVID & JANET 259 GRANVILLE LANE N. ANDOVER, MA 01845 101 Single Family Property Type 1.24 Acres 2008 UB Mailina Index Name/Address BURT, DAVID & JANET 259 GRANVILLE LANE N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17379.0 - 259 GRANVILLE LANE 3170049 03 Cycle 03 UB Services Maint. Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Type Loan Number Active/Inact. From Payor Occupant Name Active/Inactive Last Billing Date 10/3/2007 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/ 01 ALL METER SIZE 68.21 /1 Serial No Status Location Brand Type 0027912852 a Active ENC F.L. ? w Water Date Reading Code Consumption Posted Date 12/10/2007 3385 a Actual 0 9/4/2007 3385 a Actual 19 10/12/2007 6/14/2007 3366 a Actual 26 7/20/2007 3/15/2007 3340 a Actual 27 4/16/2007 12/6/2006 3313 a Actual 27 1/19/2007 9/8/2006 3286 a Actual 43 10/20/2006 6/12/2006 3243 a Actual 24 7/10/2006 3/6/2006 3219 a Actual 15 4/17/2006 12/21/2005 3204 a Actual 27 1/17/2006 9/14/2005 3177 a Actual 54 10/14/2005 6/9/2005 3123 a Actual 17 7/15/2005 3/18/2005 3106 a Actual 23 4/5/2005 12/9/2004 3083 a Actual 18 1/14/2005 9/15/2004 3065 a Actual 20 10/8/2004 6/10/2004 3045 a Actual 13 7/30/2004 4/12/2004 3032 a Actual 33 5/17/2004 12/5/2003 2999 n New Meter 0 12/5/2003 Size 0.63 0.63 Page 1 1 Residential Until YTD Cons 0 Variance -100% -19% 5% -10% -38% 100% 22% -27% -51% 172% -12% 10% 3% -6% -14% 0% 0% 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: 259 Granville Lane, North Andover Owner: Burt Date of Inspection: 1/8/2008 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. Neil4. Baton Bateson Enterprises, Inc. November 25, 1996 Septic Compliance, Inc. affilliate of Thomas E. Neve Assoc., Inc. North Andover Board of Health 146 Main Street North Andover, MA 01845 Attn: Sandra Starr Re: Sanitary Disposal System Inspection 259 Granville Lane - Dennis O'Keefe Dear Ms. Starr: TLY 2 In accordance with the Commonwealth of Massachusetts, Department of Environmental Protection, State Environmental Code (Title V), 310 CMR 15.301, paragraph 7, please find attached a "Subsurface Sewage Disposal System Inspection Form" for your records. If you have any questions regarding this report or any of its contents, please do not hesitate to contact this office. We thank you, in advance, for your continued cooperation in these matters. Very truly yours, SCO LIANCE YINC. Paul Cardone Certified Septic Inspector Attachment N.Andlet.sam • SYSTEM INSPECTORS • • SOIL EVALUATORS • • ENVIRONMENTAL ENGINEERS - 447 Old Boston Rd., US Route 1, Topsfield, MA 01983 Tel (508) 887-8586 Fax (508) 887-3480 Property Address: Septic Compliance, Inc. affilliate of Thomas E. Neve Assoc., Inc. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 259 Granville Ln. No. Andover, Ma. 01845 Address of Owner: Dennis O'Keefe (if different) Date of Inspection: November 15, 1996 Name of Inspector: Paul Cardone Company Name, Septic Compliance, Inc. Address and 447 Old Boston Road, Topsfield, MA 01983 Telephone Number: (508) 887-8586 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: XX Passes Conditionally Passes Needs further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: November 19, 1996 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. 1 • SYSTEM INSPECTORS • • SOIL EVALUATORS • • ENVIRONMENTAL ENGINEERS - 447 Old Boston Rd., US Route 1, Topsfield, MA 01983 Tel (508) 887-8586 Fax (508) 887-3480 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: XX I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y,N, or ND). Describe basis of determination in all instances. If "not determined", explain why. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four 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 2 SUBSURFACE SEWAGE"DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 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 the public health, safety and the environment. I) SYSTEM WILL PASS UNLESS THE BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. The system has a septic tank and soil absorption system and is within 100 feet to a surface supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 156, 1996 D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contact to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface water due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. In SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 D) SYSTEM FAILS (continued) 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exists: The system is within 400 feet of a surface drinking water supply. The system is within 200 feet of a tributary to a surface drinking water supply. The system is located in a nitrogen sensitive area (Interim Wellhead Protection Area [IWPA] or a mapped Zone II of a public water supply well). The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 259 Granville Ln. No. Andover, Ma. 91845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 Check if the following have been done: Y Pumping information was requested of the owner, occupant, and Board of Health. Y None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A Asbuilt plans have been obtained and examined. Note if they are not available with N/A. Y The facility or dwelling was inspected for signs of sewage back-up. Y The system does not receive non -sanitary or industrial waste flow. Y The site was inspected for signs of breakout. Y All system components, excluding the Soil Absorption System, have been located on the site. Y The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of SCUM. Y The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non -intrusive methods. Y The facility owner land occupants (if different from owner) were provided with information on the proper maintenance of Subsurface Disposal System. 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 FLOW CONDITIONS Design flow: 550 gallons Number of bedrooms: 5 Number of current residents: 3 Garbage grinder (yes or no): no Laundry connected to system (yes or no): yes Seasonal use (yes or no): no Water meter readings, if available: Last date of occupancy: occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: Grease trap present (yes or no): Industrial Waste Holding Tank present (yes or no): Non -sanitary waste discharged to the Title V system (yes or no). Water meter readings, if available: Last date of occupancy: OTHER (Describe): Last date of occupancy: 7 gallons/day SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 GENERAL INFORMATION PUMPING RECORDS and source of information: According to owner system is pumped every two or three years. System pumped as part of inspection (yes or no): yes If yes, volume pumped: 1500 gallons Reason for pumping: To check baffles, to check tank for leaks,to check structural integrity of the tank. TYPE OF SYSTEM XX Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or not) [If yes, attach previous inspection records, if any] Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 14 years of age 1982 owner The house was built in 1982. The system was never replaced. Sewage odors detected when arriving at the site (yes or no): no SEPTIC TANK: yes (locate on site plan) Depth below grade: Tank. itself is down 4' cover is brought up to grade. Material of construction: x concrete metal FRP Other (explain) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 Granville Ln. No.Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 Dimensions: 10' 6" x 6' 4" x 5' 4" Sludge Depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: F 10" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 5" Distance from bottom of scum to bottom of outlet tee or baffle: 1' 9" Comments: (recommendations for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) We recommend tank be pumped be once per year, baffles in very good condition, level good, structural integrity good, no evidence of leaks. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: none Concrete Metal FRP 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: 9 Other (Explain) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 Comments: (Recommendations for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: Dimensions: Capacity: Design flow: Alarm level: none Concrete Metal FRP gallons gallons/day Comments: (Condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: yes - down 5' (Locate on site plan) 10 Other (explain): SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 Depth of liquid level above outlet invert: none equal Comments: (Note if level and distribution is equal evidence of solids carryover, evidence of leakage into or out of box, etc.) level is good box level no signs of carryover no leaks apparent. PUMP CHAMBER: none/gravity (Locate on site plan) Pumps in working order (yes or no): Comments: (Note condition of pump chamber, condition of pumps and appurtenances, etc.) SOIL ABSORPTION SYSTEM (SAS): yes (Locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 Type: Leaching pits, number: Leaching chambers, number: Leaching galleries, number: Leaching trenches, number, length: Leaching fields, number, dimensions: Overflow cesspool, number: 1- field 20' x 40' Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) normal none none green grass CESSPOOLS: none (Locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of inspection): 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 Granville Ln. No. Andover, Ma. 01845 Owner: Dennis O'Keefe Date of Inspection: November 15, 1996 Comments (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: none (Locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 13 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks. Locate all wells within 100'. fRoNi Ac G.i soN .sept; � a4C :2.7'z- DEPTH TO GROUNDWATER Depth to groundwater: 76" no water observed feet Method of determination or approximation: Being a registered soil evaluator, seeing that I had to dig down T to the d -box, I continued down another 2'6". That is as far as my machine would go. I observed no groundwater. 14 <C- two n DEPTH TO GROUNDWATER Depth to groundwater: 76" no water observed feet Method of determination or approximation: Being a registered soil evaluator, seeing that I had to dig down T to the d -box, I continued down another 2'6". That is as far as my machine would go. I observed no groundwater. 14 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Address Certification Statement Paul Cardone Septic Compliance, Inc. 447 Boston Road, Topsfield, MA 01983 (508) 887-8586 I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the XX FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature: Date: November 19, 1996 Copies to: Board of Health Buyer (if applicable) Approving authority: r -S Health Department April 10, 2008 Mr. Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Septic System Design Plan for 259 Granville Lane - Map 106A, Lot 152, Subdivision Lot 22A Dear Mr. Dufresne: The proposed wastewater system design plan for the above site dated February 27, 2008 and received in our office on March 24, 2008 and has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover (NA) regulation that has not met by this design follows each item for your convenience. 1. Please provide a benchmark within 50-75 feet of the system (220(4)(q)) 2. Please adjust the design to provide for the minimum slope required for the building sewer (222(6)) l,° Please provide volume calculations which include the flow back volume for the pump chamber (231(2)) 4. Please provide a pump performance curve (220(4)(r)) 5. Please provide the correct number of deep observation holes in the disposal area or request a Local Upgrade Approval (102(2)) 6. Please use leach trenches or provide an explanation as to why trenches were not used (240(6)) 7. Please specify the final grade over the leach field to be a minimum of 0.02ft/ft (240(10)). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerell, usan Y. Sawyer,ZHS/RS� Public Health Director cc: Owner File 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 �' Commonwealth of Massachusetts City/Town of North Andover u Form 9A - Application for Local Upgrade Approval 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. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Idl Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information 1. Facility Name and Address: David Burt Residence Name 259 Granville Lane Street Address North Andover City/Town 2. Owner Name and Address (if different from above): David Burt Name Lutherville Timonium Citylrown 21093-7025 Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: 4 Bdrm. House 5. Type of Existing System: MA State 714 Hawkshead Road Street Address MD State (617) 717-4209 Telephone Number ❑ Commercial ❑ School 01845 Zip Code ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval- Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A — Application for Local Upgrade Approval ^M 5 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): 600 gpd 440 gpd 440 gpd ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Complete system, New 1500 gal. septic tank, 1000 gal. pump tank, 830 s.f. leach field with 44 Infiltrator chambers 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ft. min./inch ft. t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met— describe and specify sections of the Code: 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 groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name (type or print) Signature C. Explanation Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: Site conditions precluded 2 holes from being dug within the disposal area 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc • rev. 7106 Application for Local Upgrade Approval• Page 3 of 4 ti Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval �,M 5DEP 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. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. 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 deliberate violations." A��dxhl?r- Facility Owner's Signature David Burt Print Name Bill Dufresne/Merrimack Engineering Name of Preparer 66 Park Street Preparer's address MA / 01810 State/ZIP Code 4-16-08 Date 4-16-08 Date Andover City/Town (978) 475-3555 x-20 Telephone t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval, Page 4 of 4 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL info@merrimackengineedng.com April 14, 2008 Susan Sawyer Public Health Director 1600 Osgood Street Building 20 — Suite 2-36 North Andover, Ma 01845 RE: 259 Granville Lane Dear Ms. Sawyer, RECF1" " APR 2 2 [008 TOWN OF Nur, i t i ra,:vOVER HEALTH DEPARTMENT We are in receipt of your review letter dated 4-10-08 for the above referenced project. Item #1 refers to a benchmark which is clearly shown on the plan as the top of foundation and is within 50 -75 ft. of the system components. We are unclear as to the reviewers comment. Item # 2 refers to the minimum slope of the building sewer which is shown on the plan and does meet the minimum requirement and we are again confused as to the reviewers comment. Item #3 has been addressed and added to the plan. Item #4 has been addressed. See copy of pump performance curve submitted herewith. Item # 5 refers to the number of deep holes. Site conditions were such that holes were dug where possible. The location of the existing leach field precluded us from digging 2 holes which fall within the proposed s.a.s. Both holes represent consistent soil conditions and water tables and it is reasonable to assume that conditions are consistent within the area of the proposed system. It is unfortunate to require a Local Upgrade for this site when all the design requirements are met. Issuance of the L.U.A. is solely for number of test holes which could ultimately restrict the future use of the property however a completed L.U.A Application is submitted herewith. Perhaps a deep hole could be performed at time of excavation inspection so as to eliminate the need for a L.U.A. Item #6 refers to the use of trenches and as we have argued in the past, construction of trenches in this situation is less feasible as a field. Trenches would require a greater area and associated cost and would be constructed in fill and not function as the code intended. Lastly, item #7 refers to the final grade over the system. The typical end section specifies the grading requirements and the plan view shows the existing/proposed contours which also represent the grading requirements. Both comply with Title 5 and we are again confused as to the reviewers' comment. We have enclosed 3 copies of the revised plan and respectfully request that the design be approved as re -submitted. We appreciate your prompt attention to this matter. Very truly yours, MERRIMACK ENGINEERING SERVICES, INC. William Dufresne Project Manager MERRIMACK ENGINEERING SERVICES, INC. • 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 pORTH q O �t4lC �6• �/� �? �'� �� - a a OL yO y :0YY T T gyp_ cxwcw.wc« �• PUBLIC HEALTH DEPARTMENT Community Development Division April 25, 2008 David Burt 259 Granville Lane North Andover, MA 01845 Re: 259 Granville Lane, map 106A Lot 152, North Andover, Subsurface Disposal System Installation Dear Homeowner, The North Andover Board of Health has completed review of the onsite wastewater treatment and dispersal system design plans for the above referenced property submitted on your behalf by Merrimack Engineering Services dated April 24, 2008 and received by this office on April 22, 2008. The design has been approved for use in the construction of a replacement onsite wastewater system for a 4 -bedroom (maximum 9 -room home) This plan is valid for two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations, January 9, 2008. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health (BOH) may reduce the time period for which this plan is valid. This plan includes an approval of a local upgrade approval (LUA) for the variance to 310 CMR 15 102(2), requiring a minimum of two deep hole tests within the primary leaching area. With this LUA, the Health Department accepts that the soil characteristics are likely consistent within the system area even though it does not meet the minimum requirements set by Title V. No additional action is needed on this issue. Please also note upon second review that the initial reviewer was found mistaken on observations listed on the disapproval letter and noted as #1, #2 and #7. Please disregard these items. Item # 6 was addressed in the response letter for reasons given, which if listed on the plan would not have been challenged. The document submitted for #4 will be attached to the plan to provide information to the installer. This approval is subject to the following conditions: 1. The building sewer invert shall be checked prior to construction and the engineer shall be consulted if any adjustments are needed to the placement of the tank elevations. 2. Keep the attached Form 9b for your records 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com F A 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's designer, installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning onsite wastewater treatment and dispersal system for your property is greatly appreciated. The Health Department may be reached at 978-688- 9540 with any questions you might have. Sincerel :�"-- u Sawyer, S Public Health Director Cc: William Dufresne, Project Manager Vladimir Nemchenok, RE 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com When filling out fomes on the computer, use only the tab key to move your cursor - do not use the return key. Q Commonwealth of Massachusetts CitylTown of North Andover Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information 1. Facility Name and Address David Burt Name 259 Granville Lane Street Address North Andover MA 01845 Cityrrown State Zip Code 2. Owner Name and Address (d different from above): Name Street Address City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Design flow per 310 CMR 15.203 5. System Designer. state Telephone Number ❑ Commercial ❑ School 440 td Vladimir Nemchenok ®PE ElRS Name 66 Park Street Andover Address City rrown B. Approval 1. Local Upgrade Approval is granted for. ❑ Reduction in setback(s) — specify: ❑ Reduction in SAS area of up to 25%: MA 01810 State, ZiP SAS size, sq. ft. % reduction 259 Granville Lane 9b 4.25.08 • rev. 7106 Local Upgrade Approval• Page 1 of 2 Commonwealth of Massachusetts Cityf town of North Andover Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate rt. minAnch Depth to groundwater T ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a pert test List local variances granted not requiring DEP approval per 810 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Board of Health / Approving Authority Susan Sawyer, Health Director °f 25/08 Print or Type Name and Title Signe Date 259 Granville Lane 9b 4.25.08 • rev. 7/06 Looel Upgrade Approval, Page 2 of 2 LE40-Series 4/10 hp 2" Solids -Handling 2" Discharge Features: • Heavy cast iron construction • Vortex style impeller made of corrosion resistant high temperature polymer • Oil filled, thermally protected motor • Permanently lubricated bearings • All stainless steel fasteners and rotor shaft • 10' power cord with quick -disconnect design — standard (25' cords also available) • Mercury -free float with series (Piggy- back) plug on automatic models Model LE41 M 115V,12a, Manual (no switch) Model LE41A 115V., 12a, Automatic . er,rn{iwf roik+ PERFORMANCE CURVE 1550 RPM U.S. Gallons Per Minute CO. Certified Models Available C us LE50-Series 1/2 hp 2" Solids -Handling 2" Discharge Features: • Heavy cast iron construction with 2 -vane semi -open *HYTRELO impeller • Oil filled, thermally protected motor • Permanently lubricated bearings • All stainless steel fasteners • Stainless steel rotor shaft • 10' power cord with quick -disconnect design —standard (25' cords also available) • Mercury -free float with series (Piggy- back) plug on automatic models *HYTREL® is a registered trademark of DuPont Polymers Model LE51M 115V., 12a, Manual (no switch) Model LE51A 115V.,12a, Automatic Model LE52M 208-230V, 6.8a, Manual (no switch) Model LE52A 208-230V., 6.8a, Automatic PERFORMANCE CURVE 1725 RPM U.S. Gallons Per Minute LE70-Series 3/4 hp 2" Solids -Handling 2" or 3" Flanged Discharge Features: • Heavy cast iron construction • 2 -vane cast iron impeller • Oil filled, thermally protected motor • All stainless steel fasteners • Stainless steel rotor shaft • Single and 3-phase models • 10' power cord with quick -disconnect, standard on single-phase models (25' cords also available) • Mercury -free float with series (Piggy- back) plug on automatic models Model LE71M 115V.,12a, Manual (no switch) Model LE71A 115V., 12a, Automatic Model LE72M 208-230V., 6a, Manual (no switch) Model LE72A 208-2300, 6a, Automatic Also available in 208-230V. 3-phase, 440-480V. 3-phase, and 575V. 3-phase. PERFORMANCE CURVE 1725 RPM U.S. Gallons Per Minute 0I o y *-*me tNe OW The Commonwealth of Massachusetts�� Department of Public Safety o,o„p,, s fte crrawd WMM OF FM PREVENTION RW AAMONS. 527 CMA 12M 13M omm WHO APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK . M work to be pwtffrsad in socord*m with the MasaGwsatrs BOCWW Codec 527 CMR 12:W (KEM PPJNT' Mt fit( OR TYPE ALL WOF#AAT<K)N) Date' ! `'i City or Town of -1�10el;w To the of V*= The undersWed applies for a Parrott to perform the eieohcai worts desufl*d below. Loafjon{8bv*4 Owner ar Tenant Owr s Attcf m Is this Wrmit M wflh a bukWo permit: Yes ❑ No Ca' (Cheek Appropriate Box) Purpose of &AdkV c14<1--mi-4 <!YntOity Autlarix *m ft CIA." Aniipp . Atnpfi .� Zo l'' /1h Vaft Ow hwd a'Undgrd ❑ Nm of Me** � *d ❑ No of Mears Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING M r) z This certifies that C' � -� has permission to perform wiring in the building of .............4. �'.'.!<................................................ . at .......... a 5 ....�il� ......North Andover, Mass. Fee . ... Lic. No.l.�`�? ................ LECMICAL INSPECTo Check # �`�� ., 84 �r i N Vw haw chpoks YES, Oeaee iris the type of 00VWape by ch*Mrq fe iNBt pw= E 9—ow ❑ 0TWR ❑ Faaft Si e*h EsUmead Vdue of Ekx4e d work ti V*wk to Sled //-/ ,�7 ^ir S- w+daweperPIN ee of pa*W. p/,�Ce��. L E ALARMS No. of Zones of Dsrecdon and atinp owtoes Of Smmdit of ago necNon 000W WW aQLAIdwt YESEr NO ❑ (ExpMraon t� �'PrA " BUIL ` 1-54z 42-7V AddreeaJ�-vt ri' °" otAnUBM 49RAI1Ui M WANM t aIn awrrnithatthe tiouN.e the irnwanoe aaverape arils audearMiat hgiMnt as nr+m*W by Maaaachweft t3etstrai t.ew& and that my aiO wwre on** 13- -& epptioetim wdrw the rpuhement. owner ❑ Apent ❑ tPbaee --t -i one) (8**DA* of Owner or Awl) Telq*Ww "D. PEFOR FEES _ r .. a J � 'TOWN OF NORTH ANDOVER 1 NORTN 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 " NORTH ANDOVER, MASSACHUSETTS 01$45 - Susan Y..Sawyer, R.EfiS/RS 978.688.9540 Phone978.688.8476— FAX Public Health Director E-MAIL: healthdept@townofnorthandover com WEBSITE: http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission:_ r L e p Site Location:...,..:j Engineer:_ 0 f 22, j 1 pj, {rV� RECEIVED WN 2 ,' 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT New Plans? Yes ✓ $225/Plan Check #_(includes Ist submission and one re- review only) Revised Plans?Yes $75/Plan. Check # Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? AJC Yes No Telephone #:(A.-70) 4:;2!2- =z -'e5_ Fax #:jta E-mail: H f)jA Ei)4eA0 (` D r Homeowner Name: OFFICE USE ONLY When the submission is complete (including check): Date stamp plans and letter Complete and attach Receipt ___ 4,�Copy File; Forward to Consultant ____ _____Enter on Log Sheet and Database 1,0cntfion• t. (� pri�ncc's Name , �.,�t v t 12 a I'z - AF N ArLp/pamel:,,_-L t Laatnllrx Tel- D ate: `' WetlaadtZone II°- $OQ S�rnibp�tSoft Rome " SnD Clan D=p'-Observxdpa Bole Logs Elution Dgdk So11 HWZU Solt Team Sall Dolor Sol MoOng . % Gtx4 Stoney etc: -;, r!'Y`1 j + �LF.x.� PZ'M'{ `" Fi Irl p. atl►twtaid_ 'i`��,t.- _ ` ,a wow hta-xd. ' We Acormar*w —" Z'' '1o*, ` r" Wa 1p't"tM2dKwL r .1r.J .vq*MRAM*L---6bWWZ Wakrinayesdct__— VegftgkmmF.okE�[c►vi """` Parplation Tests Ob:emflan Haim Depth ofrar A, f A � Stat P"sk Ttmc at 12* T"uae at 9" Time at 6" Time (9 .Rate M�ch - Performed B�•: SMEAD No. SFP11SA UPC 68030 smead.com • Made in USA a4J �y _2 ti FIBER USED INTHIS PRODUCT UNE MEM S F I SOURCING RMEMQU OF THE SR PROGRAM W CERTIFlED SDURGNG W WSRPR.... I..RG