HomeMy WebLinkAboutMiscellaneous - 285 REA STREET 4/30/2018 (2)K)
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PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CE_Dr,,.rr-LIFICATE OF
COMPLIANCE
As of: 1/16/14
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Complete Repair and Construction of an
On -Site Sewage Disposal System
By: Todd Bateson
At:
285 Rea Street
Map 38 Lot 118
? North Andover, MA 01845
The Issuan 6eqf this certificate shall not be construed as a guarantee that the system will function satisfactorily.
SIAS9 Sawyer
F(ublic Health
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978,688.8476 Web www.townofnorthandover.com
N-16-2014 07:50 FROM:BATESON ENTERPRISES 9784755451 TO:9786888476 P.1/1
PUBLIC HEALTH DEPARTNU-r
(OfUlaunitV D&Vsj*p.,,j Divisloll
TOWN OF NORIW ANDOVER
SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIVICATrON
The undersigned bereby cerfiry Ukat the Scmge posal S lem)f
I ?is constructed; ( )repaired;
By:—
arint Ame) — ------------
Located at: 20� T� L�
�; frl V, -
Onstallati drcis—)— " — -- - —
Was installed In conformance with the North Andovcr 130ard or Yealth approved plan, originally dated
and last revised oil . ) 0// With a design flow of
ge"OnS Per day- The 1`11111CHAIS USed were in conrormanco with those specified on the
approved plan-, the system was installed in accordance with the Provisions of 3 10, CMR IS -000, Title 5 and imal
regulations, and the rinal grading agrees substantially with the 31PProved plan.
the A.9 -built which has been submitted to the Board of Health.
BottoM of Bad Inspection Date. It 13
L�-3
'�VX4VN1'4'10<j-
A nd - Print Name
r1inal Construction inspection Date:—U, oom
T611') P, I rfJWAPJ��
And - Print Name
lrkstallcr-._�4 — - -0)
Enginer
is U=MtCIY represented on.
0 pil
f,
Date: J- /& - /Y
And - Print Narno
And - Print Nante
1600 Osgood Street, North Andover, Massachusetts 01945
Phone 978.688.9540 Fox 978.688,8476 Web hitp://www.townafnarthondover.coi"
Received Time Jan.16- 2014 7:16PM No,0377
dw Cz
North Andover Health Department
(ommunity Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 285 Rea St. MAP: 038.0 LOT: 0118
INSTALLER: Todd Bateson
DESIGNER: Sullivan Engineering
PLAN DATE: 9/23/13 (Rev. 10/15/13)
BOH APPROVAL DATE ON PLAN: 10/17/13
INSPECTIONS
TANK INSPECTION: 11/12/13
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION: 11/15/13
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
Comments:
SEPTIC TANK
N/A Contractor reports any changes to design plan
Existing septic tank properly abandoned
Internal plumbing all to one building sewer
Topography not appreciably altered
Z Building sewer in continuous grade, on
compacted firm base
X Cleanouts per plan
X Bottom of tank hole has 6" stone base
X Weep hole plugged
X 1500 gallon tank has been installed
H-10 loading
X Monolithic tank construction
Water tightness of tank has been achieved by
visual testing
Z Inlet tee installed, centered under access port
dr
Z Outlet tee installed, centered under access port
(gas baffle)
Z 24" inch cover to within 6" of finish grade
installed over inlet and outlet
X Hydraulic cement around inlet & outlet
Comments: 10'from house
DISTRIBUTION -BOX
Z installed on stable stone base
Z H-20 D -Box
N/A Inlet tee (if pumped or >0.08'/foot)
Z Hydraulic cement around inlet & outlets
Z Observed even distribution
Z Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM (General)
X Bottom of SAS excavated down to C soil layer,
as provided on plan
X Size of SAS excavated as per plan
X Title 5 sand installed, if specified on plan
Z 40 Mil HIDPE barrier installed
Z Laterals installed and ends connected to
header (and vented if impervious material
above)
Z Elevations of laterals and chambers installed as on
approved plan
N/A Retaining wall (boulder / concrete / timber/ block)
Ej Final cover as per plan
Comments: 10' front house 14.3xl 2 left side 24.3xl 8.4 right side / plus over dig
SOIL ABSORPTION SYSTEM (Gravel -less Chambers)
Z Brand and Model of Chamber: Standard Quick
4 Low Profile Infiltrator Chambers
Z Number of chambers per row: 10
Z Number of rows (trenches): 5
Comments: Total Chambers = 50
Ob I .
FINAL GRADE
Loamed
Seeded
Cover per plan
Comments:
DOCUMENTS NEEDED
Certification of Installation Form submitted
By engineer and signed and dated by
��r/ngineer and installer
As-Built Plan
4b , . -
BM = 103.14
HR= 6.86
HI = 110.00
SYSTEM ELEVATIONS
ROD
ELEVATION
AS -BLT INVERT
ELEV
DESIGN INVERT
ELEV
Benchmark
Building Sewer OUT
7.16
102.49
102.58
Septic Tank IN
7.33
102.32
102.38
Septic Tank OUT
7.66
101.99
102.13
Distribution Box IN
8.93
100.72
100.61
Distribution Box OUT
9.10
100.55
100.44
Lateral 1 TOP
9.28
Lateral 1 INVERT
100.37
100.38
Lateral 2 TOP
9.27
Lateral 2 INVERT
100.38
100.38
Lateral 3 TOP
9.28
Lateral 3 INVERT
100.37
100.38
Lateral 4 TOP
9.27
Lateral 4 INVERT
100.38
100.38
Lateral 5 TOP
9.28
Lateral 5 INVERT
100.37
100.38
Top of Chamber
Bottom of Bed/Chamber
9.88
100.12
100.10
Aft _ --,a,
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
E
1 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 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA
wetland bylaws
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
1001 50
Irrigation well
75
100
Surface Water
25
50
Bordering Vegetated Wetland
Salt Marsh, Inland / Coastal Bank 3
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
E
1 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 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA
wetland bylaws
Commonwealth of Massachusetts
BOARD OF HEALTH
North Andover
P.I.
Map -Block -Lot
038.00118
-----------------------
Permit No
BHP -2013-1022
-----------------------
FEE
$250.00
-----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted -Todd-Bateson ------------------------------------------------------------------------------------------
to (Construct) an Individual Sewage Disposal System.
atNo-2-8-5-REASTREET --------------------------------------------------------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. -BIB-1P--.0l3-:--J'Q-2--) Dated,_,Ni�v!p�er06,2013
I'U -- - ---------------
-----------------------------------------------------------------
Issued On: Nov -06-2013 BOARD OF BEALTH
-------------------------------------------------------------------------------
10H.'H
C H!:
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
01__�
vs"
Application for Septic Disposal System
Construction Permit -TOWN OF
NORTH ANDOVER, MA 01845
Application is hereby made for a permit to:
EI Construct a new on-site sewage disposal system*
Elkepair or replace an existing on-site sewage disposal system*
E] Repair or replace an existing system component — What?
A. Facility Information
-5 ZO,4
Address or Lot #
1"V-eg- A4
City/Town
TODAY'S DATE
$ 250.00 - Full Repair
$125.00 - Component
NOV Ub 2013
2.- -TYPE OF SEPM SYSTEW: TOWN OF NORI H ANDOVER
> [I Pump 5;�Gravity (choose one) I HEALTH DEPARTMENT
***If pump system, attach copy of electrical permit to application"*
> M C9pventional System (pipe and stone system)
> Plonfiltrator or Biddiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.)
> E] Pressure Distribution S.A.S. (No D -Box)
> [] Pressure Dosed (D -Box Present) S.A.S.
> El Does the system require an effluent filter? Yes No
If yes, does plan specify make and model of filter? YES = (no further info. needed)
NO = (installer must specify brand of filter before DINC issuance)
What is the Make? "at is the Model?
2. Owner Information
Name
Address (if different from above)
r
City/Town State Zip Code
—38/Vt2�
Telephone Number
3. Installer Information
Name U Name of CompM51 t- ON ENTERPRISES, INC.
111 ARGILLA ROAD
Address L ANIDQVER�
Ad A�
City/Town
4. Desianer Information
State Zip Code
q'� Ly
Telephone Nurhber (Cell Phone #if possible please)
SU.)j1'V,4AJ _,EV9,'�VAaA41q
Name Name of Company
�A
Address
— N�> �FDJ R,+ iM?
07ty/Town — _a /
State q�� 3S Zip Code
t7 I
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit - Page 1 of 2
cza
d
Application for Septic Disposal System
Construction Permit -TOWN OF
NORTH ANDOVER, MA 01845
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building Dre's-idential Dwelling or E]Commercial
B. Agreement
TODAYS DATE
$ 250.00 - Full Repair
$125.00 - Component
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. I understand that until a final Certificate of Compliance has been issued by
this Board of H Ith the installed system is not approved.
L
Name Date
Application Approved By: (Board of Health Representative)
Name
Application Disapproved for the following reasons:
For Office Use Only:
Date
L
FeeAttached?
Yes
No
2.
Project Manager ObEgation Form Attacbed?
Yes
No
I
Pump S
- Xstem? If so. Attacb copv of Electrical Permit
Yes
No
4.
Reviewed approval ktter, aBpaperwork received?
Yes
No
Missing..
5 FoundadonAs-BuW (new construction only): Yes No
(Same scale as approvedplan)
6 Floo.-PlansP (new construction only): Yes No
Application for Disposal System Construction Permit - Page 2 of 2
SEPTIC.Sy -'OBLIGATIONS
STF
,M..jNSTALLEp.p.ROjF_CT �VNAG�MENT.
for the tic systein,16t.the-property it:
As the North Andover ficOnsed i�ist'lllOt .c6nstme,tiq forthe sep,
(Ad e .. st oiseptic system)
Relative to the.tipplication of
,.For . pilans by (Engineer)
AAd dated
(Urigmal I e
Dated With revisions dated
(Ioday's date.) �Last revised date)
I understand the following obligations fof mgnagement of -this P.roject:
1. A . s the installer, I amobligated to obtain. all pemuts and Bbard offlealth apptoved plans: piol to
petfomzng any -work on a site.. I must e s and the peftnit-on site when M'work is
Q%
biink
2. As th� intta;let, 0 -for. and id -inspections; If hornOwnek, contractorproject mauager, or any
any iny . st . heMe . s -an inspecaon and the systeiii is not ready, I then
other personnot associatedwith MY COMP
item three- sW bp'.stpplicable-
z#-q= i oe*su�.woik.-comple�id-ptioi.to the.applicable inipections -as
As thp iRStift�- 1"afi cd to. have.th-
jnclic�ted belowi, T g . ftdgfttan l6fion: of the- iteins in, acc6idanc
a.' Boil= -Grenerdl� -is u.. ss�� ere is a.retonin *all, which.
bf -.9, the -unld' 'th
this
shptildbe�-do���.t- nejwt&rfjtuptt�quw.-.the ��=46a but 46.6s.hothave to bepte.s6nt.-
6�ecti &A ln*xtion for elevations,des,,etc.
":t Iftust 00, t6t
(Or to. from the eqOp& must
S-� o !*
ii�i* t-verWbk-* e -ma -11 townofiUWhandoyer,�Ojn�
be iti�niitt�--d-to-.the.Board-ofl-Iealth tte -..v Mstialldrcalls for a�' must
a Z. n iiisp*ectipn tize. 'Instffl6r
electlical
bepresent. for tl*.inspecti6n, W.ith-ap" sys�t� -,��fl6nwt'be read� and able to
=P
caus Opiin�p - t6 -v�ark aAd�alartii't'oi fimetion. .
din 'is'coipplete.- -InstaRerdoes' n . ot
C, FinAl�Gt-Ado—,ThgtaUer=ustrequqt. spectiontvhefi -gra g,'..*..
hkv�e to be onrifte.
4. As -the inst4a; I un�l that only 113 . Iq iitd6ral the voik(other than iiVle excavafiox) and'I AtA -reqi�red
6.msta ittzi��ed' lbwion� f6r. ihstAflation.: *1 Awhe
to complete tli. 40.6n of the s7ste.m identified in th.,. Vp
North And=L'sig�i6can*t �nes to
uh At'' '""d
5.. At th�.instiuer,,I_ �,derstand th' ce -of the" -following co krtcfion
e -on�ute, urink 0 -perffixnian ns
stepis:
a.' Dct��&ado'd that. the -ro efevadon of the crearationhas beenreached, -
A Ljuspeei(= of the "sand aMpsZoi�e, -to he used.
c, Finalins by Board ofUealkh staffor cons t,
Pecdo" UAW
d Instaffadan of t=k
D -Bar
.,pipes, stone, vent, chamber
P=P retaiviffg w2ff and othet
components.
rA
d
Licease Septic. Installer. Date�
Undersip6d
k. I X$.
R E C E I � I
Printed: October 21, 2013 @ 11:39:06
Essex North Registry
M. Paul Iannuccillo
Reg i st er
Trans#: 25572 Oper:DELIAL
J RAMOS
Book: 13673 Page: 210 instg: 301414
Ctl#: 29 Rec:10-21-2013 13 11:39:06a
NAND 2K REA ST
DOC DESCRIPTION TRANS AMT
-----------
NOTICE
Surcharge CPA $20.100 /20.00
50.00 recording fee 5C.00
5.00 TECH FEE �.00
Total fees: 75.00
*** Total charges: 75.00
CASH PMT PAYMENT -CASH 75.00
Ir
1367:3 :5 r, 4- __ 4-
-3 — 2 1 — 2 3 --7- 3
R RECEIVED
ECE'VED
Notice of Alternative Sewage Disposal System OCT
M.G.L. c. 21A, § 13 and 310 CMR.15.0287(10) OCT 22 2013
T
his N tice to be recorded and/or flied for reelstration in the chain of title of the Property serve b%& [VeANE)OVEF
wa
El
E�p
P JJTm T
Ve geoDisposal System ("Alternative System7).l E ARTMENT
EN
NAME(S) OF OWNER OF P�O
,��Ra SERVED BY ALTERN TEM:
0-0 A/Ar� ;�.VT
ADDRESS OF PROPERTY SERVED) BY ALTERNADYE SYSTEM:
2,61
TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and
complete each that applies]:
Deed recorded with the Registry of Deeds in Book Page /2-'7
Certificate of Title No. issued by the Land Registration Office of the Redstry District
Source of title other than by deed
[If Alternative System Owner(s) is other than Property Owner(s), complete the following:]
Alternative System Owner Name: h 4, 4
Alternative System Owner Address: I r /Y'j
WHEREAS, Section 15.280 of Title 5 of the State Environmental Code ("Approval of
Alternative Systems"), provides for the Massachusetts Department of Environmental Protection (the
"Department") to approve or certify, as appropriate, all proposals to construct, upgrade or replace on-site
sewage disposal systems using alternative systems;
WHEREAS, owners and/or operators of approved or certified alternative systems are subject to
general conditions, as specified in Section 15.287 of Title 5 of the State Environmental Code, 310 CMR
15.287, and may be subject to special conditions, as specified in the Department's approvals or
certifications; such general and special conditions potentially including, without limitation, requirements
relating to the use of trained operators, periodic inspections, maintenance, saT�Yhik; reporting apd/or.,.
recordkeeping;
WHEREAS, Section 15.287(l 0) of Title 5 of the State Environmental;Code,.3 10 CMR.
15.287(10), requires that "prior to obtaining a Certificate of Compliance for T
upgraded system, the system owner shall record in the chain of title for the property served by the
alternative system in the Registry of Deeds and/or Land Registration Office, as applicable, a Notice
disclosing both the existence of the alternative on-site system and the Department's approval of the
system. The system owner shall also provide evidence of such recording to the local Approving
Authority [J" and
WHEREAS, the Property is served by an alternative sewage disposal system.
NOW, THEREFORE, Notice of an alternative sewage disposal system is hereby given for the
above -referenced Property, as follows:
1. Existence. An alternative system has been installed as a new or upgraded alternative sewage disposal
system, on or adjacent to the Property, and serves the Property. The trade name and model number(s) of
the alternative system are as follows:
Trade name of technology.
Manufacturer Name:
Model number(s):
Page I of 2
V IS.
__? 7-, 20
2. ApprovalICertification. OnA0`>_. Z_ ) ;3". fdatel, the Department, pursuant to its authority
under the section of Title 5 as specified below, approved or certified the tec-bnol sed ' the above -
\<2, '/ Z, JTrausmittal Number
referenced alternative system, under MassDEP Transmittal Number./ --_,n7`1u
of approval or certification].
[Check one of the following, as applicable:]
Approved for remedial use under 310 CMR 15-284
Approved for piloting under 3 10 CMR 15.2 8 5
Provisionally approved under 3 10 CMR t 5.286
Certified for general use under 3 10 CNIR 15.288
A copy of the Department's Approval/Certification is available from the Department in person or on-
line at the Department's website: http:A/www.mass.,gov/dep.
WITNESS the execution hereof under seal this I-* day of 20 /.�? made by
the above-named Alternative System Owner(s).
[Alternative System Owner(s)l
Print Name(s): AM4MO14. A04W
r-,wy —, ss COMMONWEALTH OF MASSACHUSETTS
On this jj�day of 0C,/&h9-/ , 20 U, before me, the undersigned notary public, personally
appeared A M*PA A44405- (name of document signer), proved to me through satisfactory
evidence of identification, which were A444)41 L -&S 1,jC&Te_ , to be the person whose name is
signed on the preceding or attached document, knoMdg d 'to me that (he) (she) signed it
voluntarily for its stated purpose.
and seal o
-------------------- ----------------------------------------- 71, -----------------------------
[Complete the following Property Owner(s) Consent if Alternative System Owner sjsWtl�an
Owner(s):l
CONSENTED TO:
ss
On this
appeared _
lProperty Owner(s)j
Print Name(s):
Date:
COMMONWEALTH OF MASSACHUSETTS
day of 1 20—, before me, the undersigned notary public, personally
(name of document signer), proved to me through satisfactory
evidence of identification, which were , to be the person whose name is
signed on the preceding or attached document, and acknowledged to me that (he) (she) 3igned it
voluntarily for its stated purpose.
(official signature and seal of notary)
Upon recording, return to:
[Name and address of Property Owner(s)]
AN,�,vpM Page 2 of 2
2,9� 4IFil- 57-.
//L/P/z a 4 Al 4 0 Pir,01
Sullivan Engineering Group, LLC
Civil EnuineeTs & Land De velopment Consultants
October 15, 2013
Town of North Andover
Board of Health
Re: 285 Rea Street, North Andover
Certification for Alternative Soil Absorption System
Quick4 Plus Standard LP (Infiltrator)
Board of Health;
RECEIVED
OCT Z-2 2013
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Joseph & Amanda Ramos, owner of 285 Rea Street, provides the following certification in accordance with
Section 11(18) of "Standard Conditions for Alternative Soil Absorption Systems with General Use
Certification and/or Approved for Remedial Use':
1) The owner has been provided a copy of the Title 5 I/A technology approval, the Owners Manual, and
the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and
conditions.
2) The owner agrees to provide a Deed Notice for the "Alternative Sewage Disposal System". Proof of
the recorded deed notice will be submitted to the Board of Health.
3) The owner agrees to fulfill his responsibilities to provide written notification of the Approval to an new
Owner, as required by 3 10 CMR 15.287(5).
4) The design does not provide for the use of garbage grinders and the owner understands this.
5) Whether or not covered by warranty, the System Owner understands the requirement to repair, replace,
modify or take any other action as required by the Department or the Local Approving Authority
(LAA), if the Department or the LAA determines the System to be failing to protect public health and
safety and the environment, as defined in 3 10 CMR 15.3 03.
Print Owners Name:
/,/)//-7 11-3
Date:
Owners Signature:
22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352-787 1 -Phone — 978 352-7871 - Fax
------------- - I L-
rf Q�6
I-ED,1
flj2copy
North Andover Health Department
(ommunity Development Division
October 17, 2013
Joseph and Amanda Ramos
285 Rea Street
North Andover, MA 0 1845
Re: Subsurface Sewalle Disposal System Plan for 285 Rea Street, Map 38, Lot 118
Dear Homeowners:
The proposed wastewater system design plan, for the above site, dated September 23, 2013 with
a final revision dated October 15, 2013, received on October 17, 2013 has been approved.
The design has been approved for use in the construction of a fully compliant upgraded onsite
septic system, designed for a 5-bedroorn (maximum 11- room) home. This plan is good for 2 -
years from the date of the failed Title V Inspection, conducted by a licensed state inspector on
July 26, 2013, however in this case the owner has agreed to have this system installed as soon as
possible.
During this time, a licensed septic system installer must obtain a pennit and complete this work;
all paperwork including the "Deed Notice" etc. must be submitted; and a Certificate of
Compliance be endorsed by the installer, designer and the Town of North Andover or the plan
approval will be voided.
This approval is also subject to the following conditions:
1 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(l)).
2. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and
municipal requirements are met. These may include review by the Conservation
Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector
and/or Electrical Inspector. The issuance of a Disposal System Construction Permit
Page I of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035
North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476
4r 1 0
285 Rea Street October 17, 201 3 )
shall not construe and/or imply compliance with any of the aforementioned
requirements.
3. Prior to a Certificate of Compliance is issued, proof of the following shall be
submitted to the Health Office.
a. "Deed Notice". As a reminder, since the Infiltrator Chamber system is proposed
as an alternative soil absorption system the "Standard Conditions for Alternative
Soil Absorption Systems with General Use Certification and/or Approved for
Remedial Use" will apply. Please provide the following as required by the
approval conditions Section 11(l 8):
- certification by the Designer that the design conforms to the Approval, any Company
Design Guidance, and 3 10 CMR 15.000; and
- a certification, signed by the Owner of record for the property to be served by the
Technology, stating that the property Owner:
1. has been provided a copy of the Title 5 I/A technology Approval, the Owner's Manual,
and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms
and conditions;
2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his
responsibilities to provide a Deed Notice as required by 3 10 CMR 15.287(l 0) and the
Approval;
3. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his
responsibilities to provide written notification of the Approval to any new Owner, as required
by 3 10 CMR 15.2 8 7(5);
4. if the design does not provide for the use of garbage grinders, the restriction is understood
and accepted; and
5. whether or not covered by a warranty, the System Owner understands the requirement to
repair, replace, modify or take any other action as required by the Department or the LAA, if
the Department or the LAA determines the System to be failing to protect public health and
safety and the environment, as defined in 3 10 CMR 15.3 03.
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.
Since Y,
SE4i Y. Sa er, HS/RS
ell, Public He th D* ector
Encl. N Andover Installer's list
cc: Jack Sullivan, PE
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035
North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476
I
UD
CUSTOM BUILDING GBO,
Board of Health
North Andover, MA
Q 2013
.) L I
S'P
TOVYN OF NIORTH ANDOVER
V; E ALT H DE P A R1 MI E NT -
9/12/13
We would like to be included on the meeting agenda of the Board of Health scheduled for 9/26/13, to
discuss the progress and intent of the Septic Design being done for 285 Rea St. We would also like to
discuss the feasibility of getting BOH approval for a building permit contingent on installing the approved
system, prior to the system actually being installed.
We are currently in the middle of one portion of the work at 285 Rea St., with a second large portion of
the work needing a permit to continue. The new septic system is being sized to accommodate the new
work and room count.
Thank you for your consideration.
Matt Bendle
Project Manager
508-265-3844
4
The Rivervalk Cornplex, 360 NA:,,ohack Sir-eci, #5, Lavvze! 01,71.3 T9,78,989, cm?ln 1:973.939-94'
09/26/2013 11:54 FAX
Dear Board of Health,
As you aware, we have submitted the septic system upgrade plans for 285 Rea
Street, designed by John Sullivan, the for approval by the Town of North Andover
Health Department. We kindly request that the Health Department accept this
letter of agreement in regards to the septic system repair at 285 Rea Street.
The following are the reasons for our request;
0 We are committed to completing the septic system upgrade as soon as it
is approved. We are a family of five and it is of the utmost importance to have a
fully functioning septic system as soon as possible. We are of the understanding
that septic installations cannot occur between Nov. 30 the March Ist of each
year. Thus, we are hopeful to have it Installed by the November deadline & this
is our goal. We are 100% ready to move forward once approved.
We are planning on receiving bids on the septic system upgrade and will
be securing a contractor soon. if weather permits, we would install the system
before winter and heavy snow coverage. If not, at worst case we will complete
the installation of the septic system no later than March -April 2014.
Thank you,
jav/' ZOE---
Amanda & Joseph Ramo
PAW,
October 15, 2013
Town of North Andover Health Dept.
c/o Susan Sawyer
1600 Osgood Street, Suite 2035
North Andover, MA 0 1845
Re: Revised Septic Plans
285 Rea Street
Ms. Sawyer;
Sullivan Engineering Group, LLC
Civil Engineers & Land Development Consultants
RW E t. 011,-, E, I if " = D
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Enclosed are three (3) sets of the revised Septic Plans for the above referenced property.
The following changes/revisions were made based on the review letter;
1) Abutter names have been added to the plan
2) The existing leaching pits have been added to the plan and a note that they shall be abandoned in-
place.
3) Note on excavation of C -layer extending 6" into native material has been removed.
4) Cross Section of Infiltrator field has been revised accordingly.
5) Design analysis properly identifies system as "infiltrator" now.
6) Wetland delineator and date of delineation has been added to the plan.
If you should have any questions or comments please feel free to contact me.
Very
Cc: North Andover Conservation Commission
22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352 -7871 -Phone — 978 352-7871 - Fax
North Andover
On -Site Wastewater System Design Plan Review Checklist
The following checklist incorporates Title 5 and local regulationsfor septic plans
Property Address: Z X -5 -S -r Map: 3Y Lot:
Name of Applicant: -f- 12 NwaNeposfDesigner:
f
Plan Date: 911 Revision Date:
Date received: at BOH
Staff Reviewer: !!� . !S .
Number of Bedrooms in Assessor's Records:
Garbage Disposal Allowed: FIYES FINO
at MRC
Date of Reviewt Type of Plan: E] new S upgrade
Number of Bedrooms in Design: — ( — gpd)
General Information: NA = North Andover Design Standards Other numbers refer to Title 5
R YES 0 NO Is the lot in the Lake Cochichewick Watershed? NA 3.2 (Requires Alternative Treatment)
OK Problem N/A
Street number and map/lot - 220(4)
P-11
_1Z.
Site Plan:
Names of abutters from recent tax map - NA 3.2
Name & address of record owner & applicant - NA 3.2
Name & address of designer - NA 3.2
Maximum scale of 1 "=20' for profile and component details - 220(4)
Locus plan - 220(4) (Not to scale)
Date(s) of soil testing - 220(4)
Name of approving authority representative - 220(4)(h)(i)
Name & GeFtifiGatien numbe of soil evaluator - 220(4)0)
Complete profile of the system - 220(4)
Complete scaled profile of the system no less than V=2' vertical and V=20'
horizontal - NA 3.2
Cross section of leaching facility - NA 3.2 (Not to scale)
Note listing all variance requests with proper citations - 220(4)
Local upgrade approval request form submitted & noted on plan - 403(l)
Original R.S./P.E. stamp, signature & date on one copy - 220(2)
Use approvals / standards checked for I/A system - DEP docs.
System is in Nitrogen Sensitive Area? - 214 & 215
Loading rate <= 440gpd/acre (new construction) - 214
Perc rate - check loading rate (differs w & w/o pressure dist) 242
Perc rate > 60 MPI - use modified tight tank or 11A techn. at 0. 15 L TAR - 245(4)
Proposed system qualifies as "shared" system - 002 (definitions)
Flow is over2,000 gpd -No, R.S, P.E. required -220
Number of bedrooms with design calcs -220(4) y
Design flow was set in accordance with code - 203
Notation that all piping shall be minimum Schedule 40 PVC - NA 3.2
Design notation regarding garbage grinder
OK roblem N/A
Maximum scale of 1 "=40' for plot plan - 220(4)
Holder and location of all easements - 220(4)(b)
All dwellings and buildings, existing and proposed - 220(4)(c)
Page I of 10 (Revised May 2013)
North Andover e- ?
On -Site Wastewater System Design Plan Review Checklist r
wbolq
Location of all existing or proposed impervious areas - 220(4)(d)
Legal boundaries of the facility being served - 220(4)(a)
Lot area and dimensions — NA 3.2
Location and dims of the system (incl. reserve area for new const.) - 220(4)(e)
All distances on site plan from all tanks, primary/reserve SAS to: NA 3.2
Subsurface, interceptor & foundation drains
Catch basins
Property lines
dwellings or other structures
Private water supply or irrig.1tion wells
Watercourses or wetlands
North arrow - 220(4)(g)
Existing and proposed contours - 220(4)(g)
2 ft contour intervals existing and proposed — NA 3.2
Locations and logs of deep holes - 220(4)(h)
Locations and logs of percolation tests - 220(4)(i)
Statement identifying property is within or not within Watershed of Lake
Cochichewick — NA 3.2
Locations of waterlines, drains, and subsurface utilities - 220(4)(m)
Location of benchmark(s) within 50-75 feet of facility - 220(4)(q)
Show all watercourses, wetlands, drains, wells within 150' of system — NA 3.2
Within 400' of system if in Watershed of Lake Cochichewick
A note or chart listing all T5 variances, LUA, BOH variances — NA 3.2
Design shall specify all components of system and model/brands — NA 3.2
Notation all concrete tanks <2500 gallons shall be monolithic — NA 3.2
Notation all concrete d -boxes beLLZO loading — NA 3.2
Notation operation & maintenance contract is required if I/A tech. used — NA 3.2
Following statement required: NA 3.2
I � ify �the locations, elevations and ties shown on this plan result from an actual survey made on the ground.
Signature of Designer
Date
Existing system location and note on proper abandonment —354 & NA 3.2
Sensitive receptors within 100' shown beyond setback —220(4)(1)
Magnetic marking tape indicated —221
Setback Distances (given in feet) 15.211 (NA 3.9)
OK Problem N/A
' Suction line 222(2)
Septic, Pump or Treatment Tank
Property line
10
Cellar wall
10
In -ground pool
10
Slab foundation
10
Deck, on footings, etc
5
Waterline
10
Private drinking wel 12
50
Leach Facility Sewer
10
20
20
10
10
10 101
1001 50
Page 2 of 10 (Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
Irrigation well
5040 100-2-5 50
Surface Water
25 50
Bordering Vegetated Wetland
Salt Marsh, Inland / Coastal Bank 4
7525 10050
Wetlands bordering surface
water Supply or trib. (in Watershed)
1502-5 150 5Q
Trib to Surface Water supply
325 2 -GG 325-200
Public well
400 400
Interim Wellhead Prot. Area
not > 440 g/acre/d (new const. only — 15.214)
Reservoirs
400 400
Drains (wat. supply/trib.)
50 100
Drains (intercept g.w.)
25 50
Drains (Other)
5 10
Drywells
10 25
Downhill slope or barrier wall
15'to 3:1 slope w/o barrier
o --For new construction location and elevation
of foundation drain (or note) — NA 3.2
Surface supplies(w/in 400'), pub wells(w/in
400'), private wells(w/in 1 00')-220(4)(k)
RLS plan reference & certification (if property line setback variance) - 220(3)
Components on lot or easement for
grading (upgrades only) - 211
Local Upgrade Approval Hierarchy:
Note that the goal for a septic system design is FULL compliance wherever feasible as set forth in 310 CMR 15.404(l), Where full compliance is not possible, allowed to
reduce setback to following (405) w10 abutter notification unless property line or neighboring private water supply setback (with ua' the first preference, and "i" being LAST
preference :)
a) property line but not w/in 10' of another SAS - need survey if w/in 5'
b) cellar wall, pool, or slab; up to 72" cover with venting and H-20; tank liquid depth to 3'
c) Up to 25% reduction in size of SAS
d) Relocate private well if septic system failed because of this criteria
e) Setbacks to BVIN's
Setbacks to surface waters, salt marsh, inland and coastal banks, vernal pools, leaching CB's, dry wells, or surface or subsurface drains not leading to water
supplies
g) Setback to water lines, private wells (not <50'), water supplies and tribs. and drains leading to the same (not <100')
h) Reduce required separation to g.w. (1301-1 must set GW, 3 or 4' only (depending on perc rate), <2000 gpd flow, no increase in flow or square footage, no
reduction to SAS size, setbacks to wells, BVIN's, wetlands, surface. waters, salt marsh, coastal bank, vernal pool, water line, water supplies or tribs./drains).
i) Sieve analysis in lieu of percolation test
j) Tank inlet or outlet <12" to ESHGW with watertight connections and watertight tank
k) Perform only one deep observation hole per disposal area
Building Sewe
OK Problem N/A
Grease trap required for certain uses (check 230 for details)
Pipe diameter listed (4" minimum) - 222(l)
Pipe schedule listed - 222(3)
Sch 40 PVC — NA 3.2
Watertight joints specified - 222(3) & (4),
Pipe laid on compact, firm base - 222(5)
Pipe laid on continuous grade in straight line - 222(7)
Cleanouts precede all changes in alignment and grade - 222(8)
Cleanout provided every 100 feet — 222(8)
2 New construction allowed up to 440 gallons/day/acre when on a private well pursuant to 15.214(2).
4 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws
Page 3 of 10 (Revised May 2013)
bt-t- t-- V 1 tu.�-
North Andover
On -Site Wastewater System Design Plan Review Checklist
Manhole at any 90 degree alignment change - 222(8)
Invert elevation at building:
Invert elevation at septic tank:
Length of run: / P /
Slope: 4r (minimum of 0.01 - 0.02 desired) - 222(6)
Septic Tank: septic tank below g.w. table 'E']"yes El no El assumed C" 1 C05 C -S.
- - >
No tank allowed in a velocity zone or on a coastal beach, barrier beach, dune, or in KJE'late9d'flyoodway (213)
OK Problem N/A
tank is larger than 2500 gallons and not monolithic it must be vacuum tested (NA 4.5)
Tank is accessible - 228(3)
200% of flow (required & provided given, 1500 min.) - 220(4)(f) & 223(l)(a)
2"(min)-3"(max) drop from inlet to outlet - 227(5)
Minimum of 4' liquid depth - 223(2) or LUA
3" air space above tees/baffles (minimum) - 227(4) Aeo 4 .14
9" air space above flow line (minimum) - 227(4) e3
Tees are located under manhole - 227(l) 0 P.
Inlet and outlet tees on center line - 227(l)
Tees extend 6" above flow line - 227(l)
Inlet tee extends 10" below flow line (minimum) - 227(6)
Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6)
Gas baffle installed on outlet - 227(4)
Effluent filter
Brand and model approved by DEP
Filter type/name noted on manhole covers.
Riser with manhole cover at grade placed over filter- 227(7)
Annual filter maintenance specified - 227(7)
Access manhole cover above center of tank & each tee (except 2 compart) -228(2)
3-20" manholes specified - 228(2)
1 childproof 20" riser/manhole Win 6" of final grade if <1000gpd- 221 & 228(2)
2 childproof 20" risers over inlet & outlet tees to*81;k final grade if
Greater than 1000 gpd -221,228(2)
Soil compaction below tank specified (if soil is non-native) - 221(2)
6" of <= 11/2" stone beneathotank specified - 221(2) & 228(l)
If > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. - 223(l)(b)
If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(l)(c)
Buoyancy calculations required if tank at or below water table - 221(8)
Notation as to tank water tightness - 221 (1)
V', Inlet & Outlet >12" above ESHGW - 227(5) or LUA
9" of cover over tank (minimum) - 228(l)
Top of tank <=36" bAkYV`§ra'd6-- 22
H-10 loading (min.)�H-20 if traffic - 226(3)
:if ti
All pumping to tank (i )4R-aee�nce vVi-th - 229
Tight Tan (Check here if not present: F-1 ) tank below g.w. table 11 yes 11 no 11 assume
Note: No tight tan allowed in a velocity zone or on a coastal beach, barrier beach, dune, or in a regulated
allowed in a �e,
floodway (213)
OK Problem N/A
5 0
c
00% of design flow or 2000 gallons provided - 260(2)(a)
0" manholes - 228(2)
Soi ompaction below tank specified (if soil is non-native) - 221(2)
Page 4 of 10 (Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
/2'
of <= 1 1
6" of <=11/2"stone beneath tank specified - 221(2) & 228(l),
C
uoyancy calculations required if tank is at or below water table - 221(8)
% to tank water tightness — 221 (1)
N tion as
9" of ver over tank (minimum) - 228(l)
Top of t <=36" below grade - 221(7)
H-10 loadinN k -20 if traffic - 226(3)
t�,(min ) i,H
All pumpinc 0 n f applies) in accordance with — 229
Equipped �ith a ' dio a ' nd vi ' s ' u'al alarm set at 3/5 tank cap — 260(2)(c)
AN alarm set at 3/ ank capacity — 260(2)(b)
ocus
Alarm signal to I N nned 24 hours per day if deemed necessary— 260 (2)(c)
Tank is set to keep old s in service during install if possible
Min. 1-24" frame w/cover at fini d grade — 260 (2)(f)
Year round access for pumping — 260 (2)(g)
Odor control provided if required — 260(2)(k)
Inlet >12" above ESHGW — 227(5) or LUA
Distribution Box Check here if not present:
OK Problem N/A
Inlet elevation: L Ji
Outlet elevation:
0.17' drop from inlet to outlet (minimum) - 232(3)(b)
6" sump (minimum) - 232(3)(e)
All outlets at same elevation (notation) - 232(3)(b)
Outlet pipes laid level for first 2 ft. (notation) - 232(3)(c)
Inlet baffle/tee min. 1 " over outlet invert for all d -boxes when pumped or slope
greaterthan .� �_
____S9+comip-a-cTion below distribution box s 1 soil is non-native) - 221(2)
6" Of <= 2 n ution box specified - 221(2)
Box is watertight (notation) - 221 (1)
D -Box is H-20 — NA 3.2
Top of chamber <=36" below grade - 221(7)
Riser to Mthi, i-& of f I grade if greater than 9" of cover - 232(3), 221(13), 228(l)
Pump Chamber (Check here if not present: F] )
Pump chamber below ground water table El yes [:1 no R assume
OK Problem N/A
Volume specified: - 220(4)(r)
p off elevation: - 220(4)(r)
Pum n elevation: - 220(4)(r)
Alarm 0 vation: - 220(4)(r)
Numbei of c s per day specified by designer - 220(4)(r), 254(1)5
Minimum 2" deliv line from d -box to SAS if gravity - 254(l)(c)
Cycles per day is con . ent with chamber volume - 231(3)
Volume calculations ind lowback volume - 231(2)
24 hour storage capacit, abo
y abov ump on elevation - 231(2)
Dual alternating pumps with valves' ystem serves >2 dwelling units -231(6)
High water alarm is in building and po d on separate circuit from pump - 231(9)
Pump sequence correct (off -lead on -lag on larm on) - 231(8)
Pump performance curves included - 220(4)(
Pump can provide flow needed against calculat d head - 220(4)(r)
5 Encourage more than I cycle per day.
Page 5.of 10 (Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
1 childproof, 24" riser/manhole at final grade - 231(5)
N5oiI0 on beneath pump chamber specified (if soil is non-native) - 221(2)
fC:517VsCttoine beneath chamber specified - 221(2) & 228(l)
cu'al
Buo cy calculations if chamber is at or below water table - 221(8)
C!mb is watertight (notation) - 221(l)
Top of cha er:536" below grade - 221(7)
H- 10 lo2ing i .) - H-20 if traffic (notation) - 226(3)
Inlet & Outlet >12" above ESHGW — 227(5) or LUA
Effluent filter provided before or inside pump chamber — 231 (10)
On-site Soil and Groundwater Review
OK Problem N/A
Proper deep observation hole logs on plan - 220(4)(h)
Soil evaluation forms 11 &12 submitted within 60 days of field work - 018(2)
Existing grade elevation of each deep hole - 220(4)(h)
Soil evaluation/perc test results on current DEP forms 11 & 12 — NA 2.3
If soil evaluation conducted on new lot, all test pits & perc tests located on
scaled site plan. Tie distances from permanent structures — NA 2.4
Proper percolation test log - 220(4)(i)
16— Ample deep observation holes in primary disposal area (minimum 2) - 102(2)
Ample deep observation holes in secondary disposal area (minimum 2) - 102(2)
Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4)
Perc test(s) done in most restrictive layer - 104(2)
Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n)
soil class all_
perc rate A 0
loading rate (LTAR) �-P (check pressure distribution rates in 242)
Critical Des�qn Parameter Cakulations
Test Pit Numbers- I -> IL4-
Elevation at grade
a. top acceptable soil el. ale /X;. /S
b. el. 2Y
3L. 272 V�
C. naturally occurring soil depth
?:Pt El no> 4' naturalsoil? 240(l)
El if NO, variance (repair & I/A) 415(l)
/% reAu 3 awl
Page 6 of 10 (Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
Critical Design Parameter Calculations icontinued)
a. bottom of leach facility elev
b. ground water elevation C)
C. separation to groundwater (a -b).
?Iles F1 no > 4' (5' in sands) ground water sep? - 212(a) & (b)
a. top acceptable soil el.
b. breakout el.
tfy—e—s nno 5' over dig required? — 255(l)
nyes Flno if "yes" specs for fill provided?
Leaching Facility
(Complete for all designs except fight tanks)
OK Problem N/A
fC;,,Y 4�,Yl- 4L C -
SAS size calculations provided 220(4)(f)
50% larger if garbage disposal - 240(4)
SAS size >= required size
Trenches to be used whenever possible 240(6)
No vehiGle aG vpv. aFea above l.f. WRIess unavoidable 240(7)
Vented ffif und 5 GOV F 241 (1)
Vented through same pipes as distribution system - 241 (1)(a)
Vent protected from precipitation/animal entry - 241 (1)(b)
Vent is placed beyond traffic or impervious area - 241 (1)(c)
All lines connected to vent - 241 (1)(d)
9" cover over pea stone or filter fabric - 240(9)
Reserve area provided (new construction) - 248(l)
GW separation is adjusted to highest existing grade if facility cuts into a hillside
Pipe slope minimum of 0.005 - 251(9)
Fill material specs provided — 255(3)
Top of leach facility <= 36" below grade - 221(7)
Final grade over leach field at a minimum 0.02 ft/ft -240(l 0)
Surface & subsurface drainage away from leach field - 240(l 1) & 245(3)
Grading slopes away from dwelling
Inspection port specified in SAS — 240(13)
Pressure distribution provided if multiple SAS — 254(2)
Class I I I or IV cannot use bed or field — 249(4)
L--- 3/8"-5/8" orifices specified (gravity system) - 251(8)
Toe of fill slope stops 5' from property line or swale installed - 255(2)
3:1 slope where grading required - 255(2)
Impermeable barrier if < 3:1 slope or < 15 feet to 3:1 slope - 255(2)
Retaining wall stamped by P.E. - 255(2)(b)
Top of retaining wall/barrier >= top of pea stone elevation (breakout) - 255(2)(f)
10' offset from edge of leach facility to edge of ret. wall - 255(2)(e)
cz L-7 ��Cl/ G
Page 7 of 10 (Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
Leaching Facility (continued)
Leach ',es PVC S40 NA 3.2
P ssul
re losing guidance followed if pressure distribution - 254(2)(c
Orifice pacing< 5'
r
Dosevo me 5x- 10x void volume of leach lines
e
Pump vold e includes Dose Volume + Drain Back Volume
Squirt heigh on plan (min 25).
Pressure required over 2,000 gpd or with I/A remedial use - 231 (1)
Infiltrator Chambers (Check here if not present: F� )
OK Problem N/A Model of Infiltrat r Chambers
Design flow= YZ .0
gpd
Loading rate Lv gpd/sf
Required leaching area =.S5 gpd / f4mVapd/sf 914-,+-"7
Chamber area = Y. 7 3 sf/If x ft = 4" sf/chamber
Chambers required = - sf sf/chamber = 5 �f chambers
Provided leaching area = 5 &-' chambers x V., sf/chamber sf
Rows Jf- x Chambers/row 1*P = %C;l total # chambers
Capacity provided = sf x gpd/sf = _ gpd
Capacity provided is >= design flow of facility being served
Leach Fields (Check here if not present: F -I )
OK Problem N/A
Number of fields: (need dosing chamber if >1) - 231 (1))
Length (100' max.): - 252 (2)(b)
idth:
To rea: L x W - S.f.
Effectiv ach area given total of S.f.
Loa factor:
Effective ea = total area s.f. x LTAR g/day
Effective are . s >= design flow of facility being served
Minimum of two distribu lines - 252(2)(a)
6' line separation (max.) - 2 2)(d)
4' maximum separation from e of field to line - 252(2)(e)
10' minimum separation betwee a * ent leach fields - 252(2)(f)
Between 6" and 12" of 3/4 - 1 1/2" ston neath field - 252(2)(g) & 247(2)
Ends of distribution lines tied together with s lid pipe - 251(9)
2"of 1/8"-1/2" 2x washed pea stone or filter fabric - 247(2)
Leaching Trenches Check here if not present:
OK Problem N/A
Number of trenches:
Depth of trenches (max eff. 2'):
Width of trenches (2' min., 3' max.):
Length of trenches (100' max.): _
Page 8 of 10
feet - 247(l)
feet - 251 (1)(b)
feet - 251 (1)(a)
(Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
Trenches are vented (when > 50') - 251 (11)
Trenches follow contour lines - 251(2)
Trench spacing 3 times effective width or depth, 2 times width if reserve area
n specified between trenches- 251 (1)(d)
Avai le leach area given
ottom = L x W x # S.f.
S ewall = L - x D x # x 2 S.f.
Effec-tiv: ch area given
Loa i g factor:
Effecti area = total area s.f. x LTAR - g/day
Effective rea is >= design flow of facility being served
2" of 1/8"-1/2" 2x ashed pea stone - 247(2)
%" to 11/2" double w hed stone from bottom of SAS to distribution lines
or filter fabric - 247(l
Non -Traditional Dispersal Systems (Check here if not present:
OK Problem N/A
Dispersal ystern approved for use in Massachusetts
Loading rat&"� rectly applied
Page 9 of 10 (Revised May 2013)
North Andover
On -Site Wastewater System Design Plan Review Checklist
Notify Health Department that the Following is/are Necessary:
Approvals:
Health Department, no LUA
Health Department, w/ LUA
F1 Board of Health, local regulation variance
Board of Health, w/ LUA
Board of Health, Title 5 variance
DEP, Title 5 variance
E] DEP holding tank
WT --Notice of Intent (NOI) forms from Conservation Commission
Other:
r_1 Draft maintenance agreement with hauler for tight tank
OK Problem N/A
Method and frequency of removal specified — 260 (2)(d)
Location and method of content removal — 260 (2)(e)
n Deed Restriction regarding # bedrooms or presence of a particular technology that requires a notice be
placed on the deed
F] Draft maintenance Agreement (Pressure Distribution delivery to SAS requires this)
F1 Proper License
F1 with class 2 WWTP operator for Advanced treatment
El Licensed installer or hauler (or above) for simple Pressure Distribution
F1 Minimum 2 -year term
El Quarterly scheduled maintenance for PD only, semi-annual for I/A with Remedial Use
F-1 Check pressure distribution if part of design
See NA regulations chapter 6 for maintenance contract requirements
Page 10 of 10 (Revised May 2013)
North Andover Health Department
(ommunity Development Division
October 9, 2013
John Sullivan, P.E.
22 Mount Vernon Road
Boxford, MA 01921 acopy
Re: Subsurface Sewage Disposal System Plan for 285 Rea Street, Map 38 lot 118
Dear Mr. Sullivan,
The proposed wastewater system design plan for the above site dated September 23, 2013 and
received on September 24, 2013 has been reviewed. Unfortunately, the plan cannot be approved
until the following minor items are corrected. The specific section in Title 5:'3 10 CMR 15.000,
or North Andover regulation that is not met by this design follows each item.
I Did not locate abutters' names. Please provide the names of abutters from recent tax map
(NA 8.020)).
2. Existing system is not located on the plan view on page I and note for abandonment may
need to include notes for the leaching area if needed. .354 & NA 3.2
3. Clarification of note regarding excavation into the "C" layer on page 1. This was a
previous NA requirement. Not sure if the engineer is proposing this for local or state
requirements. Unless a state requirement this is not needed
4. Field Cross Section notes appear to be from another plan it notes; "Cultec units" and data.
Filter fabricmirafi. enclosure; 5 foot separations etc. Please review and change to reflect
this design. Please correct.
5. Design Analysis notes Cultec units on last line. Please correct to "infiltrator"
6. Please note wetland delineator.
Plan notes "Deed Notice". As a reminder, since the Infiltrator Chamber system is proposed as an
alternative soil absorption system the "Standard Conditions for Alternative Soil
Absorption Systems with General Use Certification and/or Approved for Remedial Use"
will apply. Please provide the following as required by the approval conditions Section
II(l 8):
North Andover Health Department, 1600 Osgood Street, Suite 20' )5, Page I of 2
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
285 Rea Street October 7, 2013
- certification by the Designer that the design conforms to the Approval, any Company
Design Guidance, and 3 10 CMR 15.000; and
a certification, signed by the Owner of record for the property to be served by the
Technology, stating that the property Owner:
I . has been provided a copy of the Title 5 I/A technology Approval, the Owner's Manual,
and the Operation and Maintenance Manual, and the Owner agrees to comply with all
terms and conditions;
2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his
responsibilities to provide a Deed Notice as required by 3 10 CMR 15.287(l 0) and the
Approval;
3. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his
responsibilities to provide written notification of the Approval to any new Owner, as
required by 3 10 CMR 15.287(5);
4. if the design does not provide for the use of garbage grinders, the restriction is understood
and accepted; and
5. whether or not covered by a warranty, the System Owner understands the requirement to
repair, replace, modify or take any other action as required by the Department or the
LAA, if the Department or the LAA determines the System to be failing to protect public
health and safety and the environment, as defined in 3 10 CMR 15.3 03.
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.
YSincer
S anY:Z erREHSIRS
Public Health Director
cc: Property Owner
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 20' )5,
Noi th Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476
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4
TOWN OF NORTH ANDOVER
Office of COMMUNITV DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1601) OSGOOD STIIEET; SUITE. 2035
NORTH ANDOVER, MASSACHUSETTS 01845
Susan V. Sawyer, REHS, RS
Public Health Director
APPLICATION FOR SOIL TESTS
DATE:August 28, 2013
978.68,9.9540 - Plione
978.688.847o - FA X
\\ \\ \Q1 mino filorthandover.com
MAP & PARCEL:Map 38 Lot 118
LOCATION OF SOIL TESTS: 285 Rea Street
0 W N ER: Joseph Ramos Contact
APPLICANT: (Same)
Contact
ADDRESS: 285ReaStreet North Andover, MA01845
ENGINEER: Jack Sullivan
Contact#: 978-352-7871
CERTIFIED SOIL, EVALUATOR: Jack Sullivan SE#: 2378
Intended Use of I -and: Residential Subdivision (�Si�ingleFan�iilyHom�e Commercial
Is This: Repai r 'resting: Undeveloped Lot'resting:_ Upgrade for Addition: Y,
In the Lake Cochichewick Watershed? Yes X
No
THE FOLLOWING MUST HE INCLUDED WITH THIS FORM
Proof of land ownership (Tax bill, or letter fronn owner permitting test)
> 8.5"x I LZX�Plan & Location of TesthuY-(PjejjSe ht(ficalf" le-vt Vlt sites Oil file P11111
> Fee pr±25t00)kr lot for new construction. This covers the minimum two deep holes and
"EIVED
sp U '3 Z 0 13
TOWN OF NORTH ANDOVER
HEALTH nEPARTMENT
two PmetsW tests required for each disposal area. Fee of $360.00 per lot for repairs or uylgades.
GENERAL INFORMATION
Only Certified Soil Evaluators may perform deep bole inspections.
3;o Only Mass. Registered Sanitarians, and Professional Engineers can design septic plans.
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 BOI I
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 I "-1001) 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 Commissiolt Approvill Date:
Signature of Cottservation Agent:_ 0
Date back to Health Department. fttainp in):
I-,� I - - - -
c�,`'�J ,
10
-�lj
A.
low
VVC/1
VA.
4-�7
Sullivan Engineering Group, LLC
Cj vil EngineeTs & Land De velopmen t Consultan ts
August 28, 2013
Re: Owner Permission for Soil Testing
285 Rea Street, North Andover
Board of Health;
I give Sullivan Engineering Group, LLC and the Town of North Andover Board of Health (or designee)
permission to conduct soil testing on the property for the purposes of a new subsurface soil absorption system.
Sincerely,
Azle,- X
Joseph Ramo M4"
Owner — 285 i�treet, North Andover
R E C t I_V_E_ �D
SEP 0 3 2013
TOWN OF NORTH ANDOVER
__!fEALTH DEPARThAchrr
22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352-787 1 -Phone — 978 352-7871 - Fax
<6
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property Address
�MAN;)!a 4 pl, M a IS
Ow ner Ow nerV Na me
information is z -7
required for ever
.y I A r"a 4 Z'
page. City[Tow n State Zip Code Date of Inspection
Inspection results must be submitted on thi s form. Inspection form s may not aneRECEWED
way. Please see completeness checklist at the end of the form.
Important: When
filling out f orms;
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
� MAO
;X
A. General Information
Inspect6r:
V,.:, lx- L
Name of Inspector
Cornpany Name
i i .15— 4 P, \j e a, � � \ t S —I -
Cornpan Address
City[Town E7 -7 1�7
9-7 >
Telephone Number
B. Certification
JUL 3 0 2013
OF NORTH ANDOVER
I ��, A 0, j 1� le)
tate o e
S 1 -'2 - -3 2,1
License Number
I certify that I have personally inspected the sewage disposal system at this acl�;R�s and that t he
t i spection. - l_he I ns ped ion
information reported below is true, accurate and complete as of the time of
P -O" -S-?—e-I - I
was performed based on my training and experience in the proper functio0and maintenance of on sit
0
:�r P
-u
sewage disposal systems. I am a DEP approved system inspect ua nt to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
El Passes [I Conditionally Passes Fails
0 Needs Vurther Evaluation by thejLocal Approving Authority
'-7
13
Insp6ctor's Signature Date
The system inspector shall sul5mit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10, 000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at -that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins - 3113 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System - Page I of 17
. I . 4W
�L\l Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property Address
P,
Ow ner Ow ner's Name ....7
inf ormation is D
required f or every
page. CityfTow n State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
0 1 have not found any information which indicates that any of the faflure criteria described
in 310 CMR 15.303 or in 310 CM R 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
13) System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
El Y El N D ND (Explain below):
t5ins - 3/13 Title 5 Official Ins pection Fam: Subsurface Sewage Disposal System s Page 2 of 17
X
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
In
Property AddrETss
DN ner DN ner's Na n -e A
inf orn-ation is
required for every -7- 13
page. City/Town S�te_ Zip Code Date of Inspecti.on
B. Certification (cont.)
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
'El 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):
EJ broken pipe(s) are replaced El Y [I N El ND (Explain below):
El obstruction is removed 0 Y 0 N 0 ND (Explain below):
D distribution box is leveled or replaced [I Y 0 N El ND (Explain below):
El 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):
El broken pipe(s) are replaced El Y El N El ND (Explain below):
EJ obstruction is removed El Y El N El ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
0 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 envronment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(l)(b) that the system is not functioning in a mannerwhich will protect public health,
safety and the environment:
El Cesspool or privy is within 50 feet of a surface water
El Cesspool or privy is within 50 feet of a bordering vegetated -wetland or a salt marsh
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17
IyE
.m,7
mil
IL"i'l
No.
Cw ner
information is
required f or every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property Ad s
eKf's
Cwner's Name
CityrTown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
0 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.
El 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure crite� a are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
EJ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
0 Static liquid level in the distr�ibution box above outlet invert due to an overloaded
or clogged SAS or cesspool
0 El Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17
�C
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
SI -
Property ress
Cw ner Cw.ner's Narre
inf ormation is
I—, D 0 -Q 1-1Z
required for every I.;
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes. No
Req uired pumpi ng mo re than 4 times in the last year NOT due to clogg ed or
obstructed pipe(s). Number of times pumped:
El R
Any portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
E] 2
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
D Fv-1
The system is a cesspool serving a facility with a design flow of 2000gpd-
10, 00 Og pd.
D
The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM R 15.303, therefore the system fails. The
/X
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the
questions in Section D.
Yes No
the system is within 400 feet of a surface drinking water supply
11 El the system is within 200 feet of a tributary to a -surface drinking water supply
D El the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area — IWPA) or a mapped Zone 11 of a public water supply well . .
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304, The system owner should contact the appropriate
regional office of the Department.
t5ins - 3/13 Title 5 Official Inspection F orm: Subsurface Sewage Disposal System - Page 5 of 17
A
Ow ner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
Owner's Na rrie
7 13
City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or "no" as to each of the following-,
Yes
No
ner ccupant, or Board of Health
Pumping information was provided by thet4;�
Z��
Were any of the system components pumped but in the previciLta two weeks?
A k A'j PACCOL
Has the system received no al flows in the previous two week period?
LcALY 76irl--r -I'- I t, — 1:3
Z/
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
5��
El
Was the site inspected for signs of break out?
El
Were all system components, excluding the SAS, located on site?
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of s cum?
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:
Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure crite�a related to Part C is at issue
approximation of distance is unacceptable) (310 CM R 15.302(5))
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual,.
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms):
14
t5ins - 3/13 Tifle 5 Official Inspection Formi Subsurface Sewage Disposal S�stern - Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property AdIJY�s
�<
O,v ner Cw ner's Name
information is
required f or every t!' -7 - 13
page. CityrFow n State Zip Code Date of Inspection
D. System Information
Description -r -
L
Number of current residents:
t5ins - 3113
Does residence have a garbage grinder? /Yes El No
Is laundry on a separate sewage system? (include laundry system inspection 0 Yes [Re"'No
information in this report.)
Laundry system inspected? El Yes El No
Seasonaluse? El Yes VNo
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
Last date of occupancy:
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Gallons per day (gpd)
El Yes El No
L�; r ij
Date
11 Yes [I No
1:1 Yes El No
Non -sanitary waste discharged to the Title 5 system? Yes EJ No
Water meter readings, if available:
Title50fficiial Inspection Form: Subsurface Sewage Disposal System- Page 7 of 17
Cw ner
information is
required f or every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Addrr2ss
Y, 'n"
Owner's Name
– Ill IN N I-V V -C iL _hk -7— 1
CityfTown, State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
General Information
Pumping Records:
---f — I ,
t (-,— 13 Cj rre.,i-t-
Date
Source of information: 0 oo Ij t
Was system pumped as part of the inspection? Yes
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
gallons
Type of System:
Septic tank, dist ribution box, soil absorption system
11 Single cesspool
El Overflow cesspool
El Privy
E] Shared system (yes or no) (if yes, attach previous inspection records, if any)
El Innovative/Altemative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
Tight tank. Attach a copy of the DEP approval.
El Other (clescri be):
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System -Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5.
Property
Cvv ner Owner's Na rre
information is
required for every 1,,�b f -T
page. OityiTown
D. System Information (cont.)
State Zip Code Date of Inspection
Approximate age of all components, date installed (if known) and source of information-.
30 v (,,4 oc, s
Were sewage odors detected when arriving at the site? El Yes A�<o
Building Sewer (locate on site plan).- ig
Dept In bel ow g ra de: f eet
Material of construction:
M/cast iron 0 40 PVC El other (explain):
Distance from private water supply well or suction, line: f eet j1 I
Corn m ents (on co ndi ti o n of j oi nts, vent i n g, e \4 d enc e of I e ak ag e, etc.):
1, — hn C,
kJ1 6, Sic�)j 5 �- �c -4 It lic f- 141
LL
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
2-'c'oncrete El metal
6 o inj C; a �_
r-',
-14-
f eet
El fiberglass 0 polyethylene 0 other (explain)
If tank is -metal, list age: years
I's age confirmed by a Certificate of Compliance? (attach a copy ofcertificate) 11 Yes El No
Dimensions:
Sludge depth-
t5ins - 3113 Title 5 Official Ins pectionForm: Subsurface Sewage Disposal System -Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
izt vl_
Property Address,-�
Cw ner Cvv ner's Name
information is
required f or every _Nc, �-T�t Kj IN e,
page. City[Town State Zip Code
t5i ns - 3113
D. System Information (cont.)
i-7
Date of Inspection
Septic Tank (cont.) C."
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? i r
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
Dept In bel ow g ra de:
Material of construction:
El concrete 0 metal
f eet
0 fiberglass El polyethylene El 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
n.f. f Inc+ "m in
I, V �1 r)�+.
Titie50fficial InspertionForm Subsurlac;e SewageDisposal System, Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Is
Property Addres� ,
14 M05
CW ner Cw ner's Na rne
inforn-lation is
required for evN t,-�)DLI Q C,(L 7 �'3
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material -of construction:
El concrete El metal El fiberglass
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
gallons
EJ polyethylene 0 other (explain):
gallons per day
E Yes El No
Alarm in working order: El Yes El No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract (required). Is copy attached? 0 Yes . El No
t5i ns - 3113 Tifie 5 Official Ins pection F orm: Subsurface Sewage Disposal System - Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property Address-)
Ow ner Owner's Na me
information is -7 -A&
required for every I, -s rEL
page. City/Tow n State Zip Code Date of Inspection
D, System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet in�ert j C
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.):
oc,y I -S F I o C-, o'e'n
To Til4r'�
Pump Chamber (locate on site plan):
Pumps in working order: El Yes El No*
Alarms in working order El Yes El No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
If,pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
/Axns, 0�, Pi Ts
0 P) e, ir,;�
06,j -f- O.C) -e rJ -e 0 —160,0.ej) r iz-
W
t-Nns - 3/13 Title 5 official Inspe-cfion F orm: Subsurface Sewage Disposal Syste m - Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
Property Addres S-)
K �) 1 -1-1
Ow ner Owner's Name
inf ormation is
required for every 14 i�l �nl A 1\1� 0 d,
page. City/Tow n
D. System Information (cont.)
Type
leachin.g pits
leaching chambers
E]
leaching galleries
El
leaching trenches
El
leaching fields
11 overflow cesspool
El innovative/altemative system
111(� -7
State Zip Code Date of Inspection
number:
number:
number:
number, length:
number, dimensions:
number
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow
t5ins - 3/13
Yes No
Title 5 Official Ins pection Form: Subsurface Sewage Disposal System -Page 13 of 17
M
Ow ner
information is
required for every
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
s,
Property AddrgN
I
K P� In
Owner's Na me,
CitylTown C State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.): �,/s Tt ol t N Hyeh-4101,,�, F-i2i,kirt-
- 1) 1,'� �_Ix t- 16c 0'e
r r
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins - 3113 Title 5 Official Ins pec bon Form: Subsurl ace Sewage Disposal System -Page 14 of 17
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins - 3113 Title 5 Official Ins pec bon Form: Subsurl ace Sewage Disposal System -Page 14 of 17
MM
Ow ner
information is
required f or every
page.
—,& C
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
C', �-T� fL
Owner's Name
1,�� W. C'%z-
City/Town State Zip Code Date of Inspection
D. System Information (cont.).
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
Fs,/hand-sketch in the area below
F� rir�i%Aiinn qttnr.hPH -.pnPiratelv
-e CL
C)
C I
F171
t5ins - 3/13 Title 5 Official Ins pec bon Form Subsurface Sewage Disposal System -Page 15 of 17
C
Ci
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
C', �-T� fL
Owner's Name
1,�� W. C'%z-
City/Town State Zip Code Date of Inspection
D. System Information (cont.).
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
Fs,/hand-sketch in the area below
F� rir�i%Aiinn qttnr.hPH -.pnPiratelv
-e CL
C)
C I
F171
t5ins - 3/13 Title 5 Official Ins pec bon Form Subsurface Sewage Disposal System -Page 15 of 17
<r
,N Commonwealth of Massachusetts
Title 5 Official Inspection Form
W Subsurface Sewage Disposal System Form Not for Voluntary Assessments
5— Kit �4 S iI,
Property Add`RP� I -r\ 0S
Ow ner Owner's Name
information is
required f or every -7
page. City[Tow n State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
El Check Slope
Surface water iZ c� o J-(. E
Check cellar
0 Shallow wells
Estimated depth to high ground water:
Please indicate all methods used to determine the high ground water elevation:
[I Obtained from system design plans on record
If checked, date of design plan reviewed: Date
Observed site (abutting prop erty/obse rvation hole within 150 feet of SAS)
EJ Checked with local Board of Health - explain:
11 Checked with local excavators, installers - (attach documentation)
El Accessed USGS database- explain:
You must describe how you established the high ground water elevation. -
s P
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins - 3113 Title 5 Official Ins pec bon Form: Subsurface Sewage Disposal System -Page 16 of 17
N
rA
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Addfe�ss
L� A 0-� -; 5
Cw ner CIA,,ner's Narre
information is
req u ired f or every 0 C t-13 D e) \j 'C rL
page. City/Town State Zip Code Datb of inspection
E. Report Completeness Checklist
[2,, Inspection Summary: A, B, C, D, or E checked
El Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
E9 S ystem Information — Estimated depth t"igh groundwater
-1�b 2--e- �j �,� -� C', C- fj C W S, -,.z � �( 01 T
Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5i ns - 3113 Title 50fficial Ins pection Form: Subsurface Sewage Disposal System -Page 17 of 17
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENviRONMENTAL PROTECTION
RECEIVED
APR 11 2005
TOWN OF NORTH ANDOVER
TITLE 5 HEALTH DEPARTMENT
OFFICIAL INSPECTION FORM - NOT FOI;� �NTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 285 Rea Street -
North Andover�-
Owner's Name: -Peter North -
Owner's Address: 285 Rea Street -
North Andover, MA 01845_
Date of Inspection: 3/23/2005
Name of Inspector: -Neff J. Bateson -
Company Name: -Bateson Enterprises Inc._
Mailing Address: -111 Argifla Road
- Andover, Ma. Kim—
Telephone Number: _( 978 ) 475-4786_
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 fimction and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Inspector's Signature: Date: 3/23/2005
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
DER 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 I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 285 Rea Street
North Andover—
Owner: — North—
Date of Inspection: 3/23/2005
Inspection Summary: Check AM,CD or E / ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described
in 3 10 CMR 15.303 or in 3 10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,
will pass.
Answer yes, no or not determined (YNND) in the for the following statements. If "not determined7 please
explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank "I pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box
due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass
inspection if (with approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).
The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 285 Rea Street —
— North Andover—
Owner: — North—
Date of Inspection: 3/23/2005
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require ftuther 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(l)(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 I 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 I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 285 Res Street —
North Andover—
Owner: — North—
Date of Inspection: 3/23/2005
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 Ustem component due to overloaded or -clogged SAS or cesspool
—No-- Discharge or ponding of effluent to the surfitce 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 V2day flow.
—No— Required pumping more than 4 times in the last Year NOT due to clogged or obstructed pipe(s).
Number of times pumped
No Any portion of the SAS, cesspool or privy is below high ground water elevation.
—No� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
—No— Any portion of a cesspool or privy is within a Zone I 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.]
__Nq_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described
in 3 10 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to
determine what will be necessary to correct the failure
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either "yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped
Zone 11 of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
Page5 ofll
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 285 Rea Street –
– North AndoveF__
Owner: North
Date of in-spectio–n: 3t23/2005
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
–Yes– — Pumping information was provided by the owner, occupant, or Board of Health
— –No– Were any of the system components pumped out in the previous two weeks ?
–Yes– — Has the system received normal flows in the previous two week period ?
— –No– Have large volumes of water been introduced to the system recently or as part of this inspection ?
–Yes– — Were as built plans of the system obtained and examined?
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
conditio� of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum ?
–Yes– — Was the facility owner (and occupants if different from owner) provided with information on the
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes no
–Yes– — Existing information.
–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 I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 285 Rea Street –
– North Andovej�_
Owner: North
Date of Inspection: 3/23/2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): 4 Number of bedrooms (actual): 5
DESIGN flow based on 3 10 CKH-Cl 5.203 (for example: 110 gpd x of gedrooms): 440
Number of current residents:
Does residence have a garbage grmder (yes or no): –Yes–
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 readings: –Yes, 457985Ft3
Sump pump (yes or no): –No–
Last date of occupancy: –Current–
COMMERCIAL/INDUSTRUL
Type of establishment: _ _
Design flow (based on 3 10 CMR 15.203): ___gpd
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: –Pumped three years ago, owner_
Was system pumped as part of the inspection (yes or no): –Yes–
If yes, volume pumped: _1000_gallons -- How was quantity pumped determined? –Measured tank–
Reason for pumping: –Inspect tank & baffles—
TYPE OF SYSTEM
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: Jank original, pits
installed 7/3/1989, as built plan _
Were sewage odors detected when arriving at the site (yes or no): –No--
Page 7 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 285 Rea Street
North Andovir_
Owner: — North—
Date of Inspection: 3t23/2005
BUILDING SEWER — X — (locate on site plan)
Depth below grade: —24"
Materials of construction: X cast iron X 40 PVC other
Distance from private water Wply well or �uc�ion line: —
Comments (on condition ofjoints, venting, evidence of leakage, etc.)
No leaks visible—
SEPTIC TANKS: —X
—4" Cast iron tbru wall, 3" PVC in house.
Depth below grade: _12"_
Material of construction: X— concrete — metal —fiberglass .. polyethylene
__other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of
certificate)
Dimensions: Tx 5' x 4'—
Sludge depth- — 6"—
Distance from top of sludge to bottom of outlet tee or baffle: —26" —
Scum thickness: —4"
Distance from top of scum to top of outlet tee or baffle: —8" —
Distance from bottom of scum to bottom of outlet tee or baffle: —12"
How were dimensions determined: -Tape Measure—
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.)— Pumped septic tank. Inlet baffle ok. Outlet baffle ok. Depth
of liquid at outlet invert. No evidence of leakage. _
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 I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 285 Rea Street –
— North Andover—
Owner: North
Date of in-spectio–n: 3/23/2005
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 of liquid level above outlet invert: –0"—
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): – D -box level & distribution equal. No evidence of leakage. Evidence of
carryover, pumped d -box to clean. –
PUNIP CHAMEBER: (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 I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 285 Rea Street –
North Andover
Owner: – North–
Date of Inspection: 3/23/2005
SOIL ABSORPTION SYSTEM (SAS): —X— (locate on site plan, excavation not required)
If SAS not located explain why:
Type
–X– leaching pits, number: –2–
leaching chambers, number:
leaching galleries, number:
leaching trenches, munber, length:
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): _ Camera pits thru outlets in d -box, liquids not up to inverts. No sign of pouding to surface. Pit # 1 is H-
20 loading._
CESSPOOLS: _ (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: _ _
Depth – top of liquid to inlet invert:
Depth of 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 I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 285 Rea Street —
— North Andover—
Owner: North
Date of Inspection: 3t23/2005
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.
• to Tank = 14'
• to D -Box = 18'6"
Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 285 Rea Street —
— North Andover—
Owner: — North—
Date of Inspection: 3/23/2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water —>61
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: 4/3/1976
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: — Old design plan, no water 6.75'
deep._
Summary Record Card generated on 3/24/2005 11:42:33 AM by Lisa Warren
Town of North Andover
Tax Map # 210-038.0-0118-0000.0
285 REA STREET
NORTH, PETER
285 REA STREET
N. ANDOVER, MA
01845
Class 101 Single Family
Size Total 1. 14 Acres
FY 2005
UB Mailing Index
NamelAddress Type Loan Number
NORTH, PETER Payor
285 REA STREET
N. ANDOVER, MA
01845
UB Account Maint.
Property Type
Active/Inact. From
Account No Cycle
Occupant Name
Active/inactive
Bldg Id. 7886.0 - 285 REA ST
Last Billing Date 3/9/2005
2100518 02 Cycle 02
Active
UB Services Maint.
Service Code
Rate
Charge
Multiplier/Users
MISCFEE ADMIN FEE
0.635/8
7.82
1 /
WTR WATER
01 ALL METER SIZE 62.71
/1
UB Meter Maintenance
Serial No Status
Location
Brand
Type Size
0022305407 a Active
ENC F.RT.
?
w Water 0.630.63
Date Reading
Code
Consumption
Posted Date
2/22/2005 4571
a Actual
22
3/15/2005
11/17/2004 4549
a Actual
21
12/17/2004
8/12/2004 4528
a Actual
19
9/20/2004
5/18/2004 4509
a Actual
24
6/14/2004
Page 1
1 Residential
Until
YTD Cons
0
Variance
5%
-2%
-16%
13%
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Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTE"FJSES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
I 11 Argilla Road Andover, Mass. 0 18 10
Title 5 Inspection Report
Property Address: 285 Rea Street, North Andover
Owner: North
Date of Inspection: 3/23/2005
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.
Nei YJ.Jteson
Bateson Enterprises, Inc.
56
PR
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