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Home My WebLink AboutMiscellaneous - 287 DALE STREET 4/30/20185 r mo im 'MM TOWN OF NORTH ANDOVER SYSTEM PUMPING RECOR-D 7 /elz— ,-t� �TENl OWNE R & ADDRESS (: �A, SYSTEM LOCATION (ex2mple: left front of house) r ro e" -t L).\,! C OF PUMPINC:-9-9? -0-1. QUANTITY PUMPED15vo C, i� L L()'�,, , .i..,)SPOOL: NO --�YES SEPTIC TANK: NO YES ,'�ATURE OF SERVICE: ROUTINE --� EMERCENCY uH��FRV,;\TIONS: COOD CONDITION HFAVY CREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER -) � ��'l LM P U M 1) C D B Y: �- U�IMFNTS: � U N' I I'll � A N S F E I Z I � ED TO: FULL TO COVEk BAFFLE'S IN I)L,ACI,' LEACHFIELD RUNBACK -LOODED --F — Oj�HER (EXPLAIN) fl 71 DelleChlaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Monday, June 28, 2004 8:36 AM To: Susan Sawyer; amcbrearty@mifiriverconsulting.com; 'Pamela Dellechiaie' Subject: 287 Dale Street Page I of I Sue and Pam, Attached please find the soil test results for 287 Dale Street. Found lots of fill but 4' of good soil beneath. Perc rate of 10 mpi. Dan F] Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, NIA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsultin corn 6/28/2004 Page I of I DelleChlaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, June 01, 2004 9:06 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: soil test Sue and Pam, We have scheduled 287 Dale Street with Merrimack Engineering for 6/24 at 9:30 a.m. Dan F -I Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com 6/l/2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688;9540 - Phone Public Health Director 978.688.9542 - Fax IMA V461 Daniel Ottenheimer To: Mill River Consulting 978.282.0012 Fam From: Pamela Pages: & 1.800.377.3044 or Date: Phone: 978.282.0014 151JI/ Request for Soil Testing or CC: Re: Septic Plan Review 0 Urgent x For Review El Please Comment 11 Please Reply 0 Please Recycle 0 Comments: Septic Plan Review Soil TesL-��':�OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address alw— BOARD OF HEAL<) 01TrH A�*-;�Ll NORTH ANDOVER, MASS. 01845-r`��-�--9F 978-688-9540 APPLICATION FOR SOIL TESTS DATE: MAP & PARCEL: LOCATION OF SOIL TESTS: OWNER: 1-1 L9 t2A r -E—:: ,7 L TEL. NO.(770) -7!jz4-16,��e ADDRESS: L7A-L-j5 4;7T -"0-T ENGINEER: 10C -601k6 TEL. NO.:(ue/ CERTIFIED SOIL EVALUATOR: Intended use of land: Ptesidential Subdivision �Single � �yHo Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed ?. 9 No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.0 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION I . Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. 'Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: OF juN 15 ri M�A,Y. 11.2004 1 : IOPM Al 0,11MONY CAKE NU. 110 F. 2 MORMAGE INSPECIMN PLAN AT 287 DALE SrREFT NOR 7-H A NDO VER, 41A. NO. ESSEX REGISMY- OF DEEDS.' SK. 2626 PG. 136 PLAN NO. 8763 cE RrIFIED TO.'RRS r BANKERS MORMAGE SERVICES, INC. SCALE.' /% 60' DAM'SEPMMOER /0, IM Fox DR41N LOr 4. CASENIENT' 44o525 Mit CA MIS ISNOTA PRoPERry suRvEy, DO NOr USE THISPLAN rO E=ABUSH PROPERrY LtArS OR ro 9'RgcrANY STRUCrURE. 2)pRoPERry LINES ARE DCrErRMINED FROM COMPILED INFORMArION TO 19E USFD AOR NORTOAGE PURPOSM O&r CERrIFICAMNS.' BASED ON MY KNOWLEDOE, NFORMArION AND BrUCF, Hrws Y cERrlr Y THA r TW PERMANMr SrRU.0 7URES INDICA rED ARE LOCArED ON THE ORWND APPROXIMATELY AS SHOWN AND ARE CONFORMINO rO rHE ZONING SErBACK RfQU1RfMCA1;r$ OF ME APPLIC48LE mumapAury WHEN comsmucro ON wy?E�xgmpr PeR mAssAcHusrm A XNERAL LAW cHAPrER 40A, SEMON 7, AND HA rRE mucruRt skow is sQr LOCA M IN A FL 0 OD HAZA RD ZONE PER FEW?& EAER&MY Af4AAAVAWAWXYW' COMMUN17'Y NO, 250098 EFFEC77VEDArE.'08-02-93 - ZONE* x JOHN ABAGIS 8 ASSOCIAMi PROFESSIONAL LAND SURVEYORS 137 CHANDLER ROAD, AND OVER, MA, (978) 688-4899 A llftoQ � A =4 0 (OADLic fvw. U7009 Z/z A flARION INUAl 'V 11144n 9VI Wdg(:Zl tflnZ 'WAIW > OTHER: (Indicate) Health Agent, Initials 079 White - Applicant Yellow - Health Pink - Treasurer Town of North Andover Health Department /Date-., 7 Location: 4�7� 4"?, Z" - (Indicate Address, if Residential, or Name of Business) Check #: Type of Permit or License: (Circle) > A�imal $ > Dumpster $ > Food Service - Type. $ > Funera I Directors $ > Massage Establishment $ > Massage Practice $ > Offal (Septic) Hauler $ > Recreational Camp > SEPTIC PERMITS: 4._�<Itic - Soil Testing U Septic - Design Approval $ 0 Septic Disposal Works Construction (DWC) Ll Septic Disposal Works Installers (DWI) $ > Sun tanning $ > Swimming Pool $ > Tobacco�. $ > TrashlSolid Waste Hauler > Well Construction > OTHER: (Indicate) Health Agent, Initials 079 White - Applicant Yellow - Health Pink - Treasurer 0 BOARD OF HEALTIO NORTH ANDOVER,- MASS. 1 978-688-9540 APPLICATION FOR SOILI. DATE: e�i—iq,o4 MAP & PARCEL: LOCATION OF SOIL TESTS: TOWN Fal mAY 2 � I ?nn I OWNER: L -i k9 r2.A, e�!A r* L-E—� TEL. NO.(q7O)'7!14-16.:2e ADDRESS: Z -f77 L74L-j:;; 4, -T -"E5 --r ENGINEER: TEL. NO.:(-TZ'0/ CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? 6) No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.0 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1 . Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians; and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: VA -Y, J 3w.2 0 0 4 1 : I OPM ATT-"-\TlM0THY CAGLE NO, 770 P. 2 u . 0 MOR MAGE INSPEC . r/ON PLAN, AT 287 DALE SrREFT NORM ANDOVER, MA. NO, ESSEX REGISMY- OF DEM.' SK. 2626 PG. 136 PLA N NO. 8763 CE RrIFIED TOMRS r BANKERS MORMAGE SERVICESt INC, SCALE.' /"460' DA M' SEP rEMBER /Ol IM NO res : # MIS ISNOTA PRopeRry suRvEr, Do Nor usE rHISPLAN W EsmsusH PRoPERry LIAes oR ro inecr ANY STRUCrURE ,P)pRoPERry LINES ARE DMRMIAIED FROM COMPILED INFOAMArION rO t9E* MD FOR NORTOAGE PURPOSE$ OALY. 9 - CER WICA rIONS.' -Wvf�� VA SED ON M Y KNO K EDOEj INFORMA WN A ND '9'F'IEF HERES Y CER r/tr Y rHA r ME PERMA NEW SrRUC FURES" INIDICA rED ARE LOWED ON THE O&W APPROXIMATELY AS ShOWN AND ARE CONFORMINO rO rHE ZONING SEWACK REQUIR&REWS OF ME APPLICABLE 'W"'V'C PAJ 'ry wHEN coNsmucm oft mAY?EpEmpr PeR mgsAousim L A r H GENERA" A W CHA P TER 4 OA, SEC rION 7, AND AW THE S TRUC rURE SHO WN IS NQ 7 LOWED INA FLOOD HAZARD ZONE PERFEDMALEAER&rNCYAi4N4GVAWAZWYW.'I commuNlry No 25oom EFFECIWDATE'06-02-93 - ZONE."y JOHN ABAGIS 8 ASSOCIAMSo PROFESSIONAL LAND SURVEYORS 137 CHANDLZR ROAD, A ND 0 VER, MA, (978) Sef-4899 ~-r%.rkomrvf i toAma; fvw. U7001V Z/z A tigplom INVAM 'V W44n 9VI U91:Z1 tflnZ 'WARW HP Fax K1220xi Log for NORTH ANDOVER 9786889542 May 25 2004 11:4 lam Last 30 Transactions Date Time To -e- Identification Duratio Pages Resul May 21 11:40am Received 1:19 2 OK May 21 12: lOpm Received 6866616 3:30 7 OK May 21 12:47pm Received to all employees 0:42 1 OK May 21 12:57pm Received 19786829064 0:23 2 OK May 21 1:42pm Fax Sent 819786838829 0:41 1 OK May 21 2:54pm Received 0:29 1 OK May 22 2:43pm Received 1486876808 0:39 1 OK May 24 8:45am . Fax Sent 89786641713 1:12 1 OK May 24 9:45am Fax Sent 816173380122 2:14 10 OK May 24 9:55am Fax Sent 816033290150 3:38 4 OK May 24 9:59am Received 0:42 1 OK May 24 10:38am Fax Sent 819784700217 0:32 2 OK May 24 10:47am Received 9786876616 1:09 6 OK May 24 10:48am Received 9786876616 1:09 6 OK May 24 11:13am Fax Sent 819783731185 0:28 1 OK May 24 2:05pm Received FCS Marketing 0:25 1 OK May 24 3:00pm Fax Sent 89786885717 1:03 3 OK May 24 3:12pm Received 0:38 0 No fax May 24 4:27pm Received 6038831902 0:48 2 OK May 25 9:08am Received 0:38 0 No fax May 25 10:20am Received 603-659-0418 1:43 6 OK May 25 10:26am Fax Sent 819785899671 1:55 3 OK May 25 10:35am Fax Sent 89786866094 1:05 2 OK May 25 10:45am Fax Sent 816177231710 0:38 0 Error 420 May 25 10:49am Fax Sent 89786863086 0:52 2 OK May 25 10:54am Fax Sent 816177231710 0:33 2 OK May 25 11:15am May 25 11:31am Received Fax Sent 978-6U-9556 -'K —i!820012 x; 978 �-�97�84 0:37 2:51 3:07 --OK- 4 Op 4_� May 25 11:34am Fax Sent -51A48' May 25 11:39am Fax Sent 817813347052 0:47 2 OK TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHU Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax FAX Daniel Ottenheirner To: Mill River Consulting From: Pamela F2X: 978.282.0012 Pages: & 1.800.377.3044 or Date: Phone: 978.282.0014 —4--, '51 j /-,) '/// Request for Soil Testing or CC: Re: Septic Plan Review 0 Urgent x For Review 0 Please Comment 0 Please Reply El Please Recycle :Comments: eptic Plan Review Soil Test e,14T�HER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested Address: E El I EIM 'Eoi� Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address Town of North Andover Health Department Date: Location-' (Indicate Address, if Residential, or Name of Business) Check#: (��& / Tvpe of Permit or License: (Circle) > Animal $ > Dumpster $ > Food Service - Type. $ > Funeral Directors $ > Massage Establishment $ > Massage Practice $ > Offal (Septic) Hauler $ > Recreational Camp > SEP77C PERMITS: El Septic - Soil Testing $ al_-,,�tic - Design Approval $ Ll Septic Disposal Works Construction (DWO $ L3 Septic Disposal Works Installers (DWI) $ > - Sun tanning > -Swimming Pool $ > Tobacco $ > TrasWSolid Waste Hauler $ > Well Construction $ > OTHER. (Indicate) Xy Health Agent Initials 146 White - Applicant Yellow - Health Pink - Treasurer I Town of North- Andover HEALTH DEPARTMENT 27 Charles Street North Andover, MA 01945 97&698.9540 heafthft 0ampnothorthandover-com DATE OF SUBMISSION: SITELOCATION: Zj0:Z___ ENGINEER: ag-al L/ jgfz'.� c_ L)461 N RECEIVED JUL 12 2004 N oj� jju!� i M ANDOVER :ALTH DEPARTMENT NEW PLANS: YES L,-" $22-5.00/Plan L,,-' Check#: 76 (Includes.1w" '" and one Re -Review Only) REVISED PLANS YES $ 75.00/Plan Check 4:_ SITE EVALUATION FORMS INCLUDED: (5s) LOCAL UPGRADE FORM INCLUDED: YES Te lephone A: 6-W)) '79 q, [6<20 Fax E-mail: ROMEOWNERNAME: OYF7C SE 0XLY EU When the submission is complete (inclu&ng check): 1. Date siamp plans and kner 2. _Complde and attach Receipt 3. Copy File, Forward to Consultant 4. Enter on Log Shed and Database % � r NO ff) /U061 I Location: 7^0 owneT's Num L-4, M st �P,,/Pnr6l: -f�j TnStntler. En Tel# -*_Z4-1/"_ NewMNL.Repair Date:--&- �I%J 'WetludILI_a9'ZOneIL_—_Soll Symbol 5Qj._$oUWitme_C Son clus Deep Observation Role Logs .. Elc%iLdon . Depth Soil HWzon Soil Testure Soil tolor SOD MOtfling. % Gmyel, Stones, etc.. ]77 w 41 . 0106 � '... _.w 11(01 0 - I 1� �. L"., 1 IMPOZO 1 — I ��44500 § va, =_Sgeeftg W'%Ur 'A the Hdet�weeping frout ft rSp e F -rat Mae" 4-4 Date 'Pemolation Tests Observation Role#. Depth of Pere Stan Pre -502k. Time at 121t Time at 9" Time at 6" Time (.g"- 6,,)- -Rate Mn/Inch -- - I Ln I PP-rformed B Vritnessed Br. A k9e .4 K -OJ - — M 71 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARL-E-S-STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 Heidi Griffin Corninunity Developinent Director Acting Health Director FAX Bill Dufresne From: Pamela To: MERRIMACK ENGINEERING 66 PARK STREET Andover, MA 01810 (978) 688-9540 - Phone (979) 688-9542 - Fax Fa)c 978-475-1448 Pages: I 978-475-3555 Date: Phone: �/ Re. Septic Plan Response CC: 0 Urgent x For Review 0 Please Comment 0 Please Reply 0 Please Recycle 0 Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Homeowner HP Fax K1220xi I og for NORTH ANDOVER 9786889542 I -al 23 2004 4:41pm Last Transaction Date Time Jul 23 4:37pm Type Identification Fax Sent 89784751448 Duration Pigess Result :23 4 OK TOWN OF NORTH ANDOVER 01WTH Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director July 21, 2004 Timothy Cagle 287 Dale Street North Andover, MA 0 1845 978.688.9540 — Phone 978.688.9542 — FAX healthdept@townofnorthandover.coni http://www.townofnorthandover.com RE: Subsurface Sewage Disposal System Plan for 287 Dale Street, Map 64, Lot 15, North Andover, Massachusetts Dear Mr. Cagle, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by Merrimack Engineering dated July 6, 2004 and received by this office on July 12, 2004. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. This approval is subject to the following conditions: I . Regarding the reuse of the septic tank: Since the original building seUer and septic tank are proposed to be re -used, please note that the designer and health inspector are to confirm compliance with regulatory standards prior to or at the time of construction and that lack of compliance will require a replacement building sewer and/or septic tank. 2. 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)). 3. 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 shall not construe and/or imply compliance with any of the aforementioned requirements. 4. The plan does not call for installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use, if you choose to install one. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, S Sus n I i Y 3 u n Y. Sawyer, REHS/ lic Health Director encl: List of licensed septic system installers cc: file Merrimack Engineering Services rII Page I of I Dellechiaie, Pam From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Thursday, July 22, 2004 3:09 PIVI To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 287 Dale St Sue and Pam, Attached please find approval letter for 287 Dale Street. Dan consulting`,---,, Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info 'Uq&).miililiriivercqn5ulting.com 7/23/2004 Dec. 10, 82 F-JJOM: So- Se-wazje Disoosa'- Svstem, T111is is to certif-." :-,ac nave -�--speczed -uclion materials cf said disposal system at loi 4 -D-aJ-e--S±x-eet— North Andover, Mass. OF The grades and construction material ' �" 'c ' in IdRARb af i ed my plans and specifications dated Oct. 27 1 ant lt Dec. 10 9 8-2— - KAMINSKI No. 29031 f :-,eg.Prof . . . . . . . . -,,Sa'nit -,an Richar ski FAIL C: I SFJ>TIC SISTEH INSTAIIATICts CHIrIK LIST 91 I ReagDnst fut LOT [EXCAVATIN OK FAIL 1. Distance To: a. Wetlands b. Drains c. Won G LL A5-1 4" 2. Water Line Location 3- No PVC Pipe Septic Tank a*.. -Tess --Length & To clean -,Out Covers - b. Cement Pipe to Tank -- on Both Sides of Unk 5. DistriWtion Box a. Covers & Box - No Cracks b. A21 Lines Flowing Equal AMOuats c. No Back Flow 6.. Leach Field or Trench a. Dimensions b. Stone Depth c Capped Ends d: Clem Double Washed Stone Leach Pits a. Dimen 0 b. Sto Depth ce ash Pads d Tees a CmMt pipe to Pit Both Sides f. Clean Double'Washed Stone 8. No Garbage Disposal 9. Tinal Grading Inspection -- 10. Barricading Covered -%ystem 11. As Built Sabnitted a. Lot Location b. Dimmsions of SYstem c. Location with Regard -to Pere Test d. Elevations eo* Water Table ,� I . of F,"3 -1-'.h APPROM DATE Provided! ZVI' SUBSURME DI�-IOSAI DFMG' CHMK LIST 2�L_ -L%;- I DISAPPROM DATE Reasons: LOT # 4 VD --UC- nT� Title V nn CrI Reg 2.5 e subidtted plan must show as a minim=: the lot to be served-area..dimensions lot #.,abutterB I/ location and log deep observation Mes-distance to ties location and results percolation tests -distance to ties design calculations & calculations showing required leaching area e location and dimensions of system -including reserve area existing and proposed contours g) location any vat areas within 1001 of sewage disposal system or . disclaimer -check wetlands mapping evage disposal h) surface and subsurface drains within 1001 of 0 6 system or disclaimer J) location any drainage easements -Athin U)01 of sewage disposal ,(/ system or disclairar-Planning Board files J) knom sources of water supply witbin 2001 of sewage disposal system or disclaimer k location of any proposed well to serve lot -1001 from leaching facilit location of water lines on property -101 from leaching facility rlocation of benchmark n)/ driveways garbage disposals no PVC to be used in construction pipe,, septic tank., q) profile of system -elevations of basement.. plumb distribution box inlets and outlets., distribution field piping and ther elevations r maxb= ground water elevation in area serwage disposal system plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such -plans Reg 6 Septic Tanks a) capacities -15D% of flow., water tablej, tees., depth of tees., accessj pumping cleanout, v lot from cella wall or inground swimming pool Z Fd)) 251 from subsurface drains Reg 10. 2 Reg 10.4 Distribution Boxes slope greater than 0.08 SUIMP a, face Dc�=.J= Chtck Li3t f a V_ e I FAn I CE Pa7s 2 Leaching Pits Leaching Pits are preferred 'where the installation is Possible a) calculations of hing area-minimzxm 500 sq ft al ations of b) spacing c) surface e 2% ma d) cover ma. al - 12 ri n P e) 2-sx2l splash pad f) tee t elbow en B i nil) e frc g) ends in pipe from d -box to pipe ,,,'Leaching Fields m=utes/inch gr EF - eater than 20 area -minimum 900 qq ft construction of field surface drainage 2 % e) 20# from cellar wall or inground swimming pool Leaching TV c a) cilculatIon eaching area -min 500 sq ft b) spacing --4,--f t min 6 ft with reserve between C) dimen d) cons ction e) a e f) farce drainage 2% Dow3hil 1 Slope ,a) slope y7x- =_rto be shown) �b) 7/x X 150 - (to be shown) :a) approval 'b) Stand -b7 power U O -r � '�: I - L - z --- 4:L- v E: L S VA -r 1 0 r-.4 5. . 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P -^CF- D I s t:;,o �5A L, SY5T am F:7 ZA.(=",&r--Y 5 Acr- A L- e I " = 4 C) ' Poo., -r e -, I Z / 1 0 / 8 Z- Y.A r -I I V�j sy-I I (:z-7F-L-ltj 1-7—= r's rl F— a �2_ 5 4 A, v&-- H I -r E C- -T- s -4 CE:. 1 '411, r -I F—= p-, lep-r t-4 4=). - Oc�k- " E,--> 4:>N,/ F— Town of North Andover Health Department Date: Location: 4:!qg�� (Indicate Address, if Residential, or Name of Business) Check #: �3 �� Type of Permit or License: (Circle) > Animal $ > Dumpster $ > Food Service - Type. $ > Funeral Directors $ > Massage Establishment $ > Massage Practice $ > Offal (Septic) Hauler $- > Recreational Camp $ > SEPTIC PERMITS: 0 Septic - Soil Testing Q Septic - Design Approval &9rtic 0 Disposal Works Construction (DWQ $ L3 Septic Disposal Works Installers (DWI) $ > Sun tanning $ > Swimming Pool $ > Tobacco $ > TrashlSolid Waste Hauler $- > Well Construction $ > OTHER: (Indicate) L 166 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 10 � A 0 N TOWN OF NORTH ANDOVER 7 Office of COMMUNITY DEVELOPMENT AND SERVICES 0 0 "1 HEALTH DEPARTMENT 27 CHARLES STREET -AX NORTH ANDOVER, MASSACHUSETTS 01.845 C" Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 — Phone 978.688.9542 — FAX healthdept@townofnorthatidover.coni www.townofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:__7 30 6`1 LOCATION: -7 4241e 51 LICENSED INSTALLER NAME: PLEASE PRINT A7 U SIGNATURE: TELEPHONE# 92.5 � CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. Fee Attached? Project Manager Obligation From Attached? Foundation As -Built? Floor Plans? Approval of Health Yes No Yes No Yes Yes No D a t e: 0 14�9 W INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic systernfor the ------- I proverty at e!!�qle St relative to the appElcation of_;76;,�,��dated /'O�/ for plans by and dated with revisions dated I understand the following obligations for management of this project: I . As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) , Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Disposal Works Construction Permit # Commonwealth of Massachusetts Map -Block -Lot 064.0- 0015 - Board Of Health Permit No North Andover BHP -2004-0554 P.I. FEE F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted John Shaw to (Repair) an Individual Sewage Disposal System. at No 287 DALE STREET as shown on the application for Disposal Works Construction Permit No. BHP -2004-055 Dated July 30, 2004 Issued On: Jul -30-2004 Board Of Health Commonwealth of Massachusetts Map -Block -Lot 064.0- 0015 - Board Of Health North Andover Certificate of Compliance THIS IS TO CERT1FY, That the Individual Sewage DisposaLSystcay �Repair) by John Shaw -Tnstaller at No 287 DALE STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2004-055 Dated July 30, 2004 Printed On: Jul -30-2004 Board Of Health Lol Lol U Clear Day Page I of I Dellechiaie, Pamela From: Pamela DelleChiaie [pdellechiaie@townofnorthandover.com] on behalf of Dellechiaie, Pamela Sent: Friday, August 13, 2004 10:06 AM To: 'Daniel Oftenheimer (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Sawyer, Susan Subject: 287 Dale Street - Final Inspection Request Importance: High Sensitivity: Private Hi, John Shaw called this a.m., and Bill Dufresne called last night to say that 287 Dale Street is ready for a Final Inspection. Can you arrange this with John Shaw of Wildwood Excavation: 978.815.7411? Thank you. Pamela DelleChiaie, Health Dept Assistant Town of North Andover Community Development & Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover com Tel. 978-688-9540 Fax 978-688-9542 8/13/2004 TOWN OF NORTH ANDOVER 0 Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Cow Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 - FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: MAP: LOT: -2 INSTALLER: ��6t �4� DESIGNER: PL N DATE: BOH APPROVAL DATE ON PLAN: DATE OF BED BOTTOM INSPECTION: V -1W -e -J1 DATE OF FINAL CONSTRUCTION INSPECTIdN: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION -K PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK LOADING OF SEPTIC TANK GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER TYPE OF SAS = -,P� -e-1 S DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS El Existing septic tank properly abandoned El Internal plumbing all to one building sewer Comments: /F Topography not appreciably altered Page 1 of 2 Page 2 of 2 TOWN OF NORTH ANDOVER ORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 C s Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK El Bottom of tank hole has 6" stone base Weep hole plugged gallon tank has been installed (H-1 0 or H-20) (monolithic or 2 piece) Water tightness of tank has been achieved '---,(Visual or Vacuum Test or Water held for 24hrs) El kettee installed, under access port El outlet te 4,gas baffle or effluent filter) installed, under access por� inch cover �to w tl,,',n 6" of final grade installed over C one access port, m jst bLver outlet of tank if effluent filter is present El Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER Bottom of tank hole has 6" stone base Weep hole plugged gallon Pump Chamber installed H-1 0 or H-20) (monolithic or 2 piece) El inlet tee installed, under access port El Pump(s) installed on stable base Alarm float)Vorking Pump On/Off \flbat working El Drain hole in pressure line El inch cover to wi\thin 6" of final grade installed over one access port El Watertightness of tank has been achieved Visual or Vacuum Te �t or Water held for 24 hrs Hydraulic cement around inlei\�'outlet Comments: Page 2 of 2 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARI.ES STREET NORTH ANDOVER, MASSACHUSETTS 01845 - Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - FAX D -BOX 1 0 N Comments: SOIL ABSORPTION SYSTEM AlIv., y )Rr Comments: PRESSURE DISTRIBUTION El El Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to C_ soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 '/2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan inch manifold laterals installed with end sweeps size: material: Squirt test ft in height Equal distribution to all laterals orifice size inch as per plan Page 3 of 3 TOWN OF NORTH ANDOVER ORT11 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARIES STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 CHU Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX CONTROLPANEL El Alarm & Pump are on separate circuits El Alarm sounds when float is tripped El Location of control panel: El Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV @ TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D -Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 Clear Day Page I of I Dellechiaie, Pamela From, Dan Ottenheimer [info@millriverconsulting.com] Sent: Sunday, August 15, 2004 10:50 AM To: pdellechiaie@townofnorthandover.com Subject: RE: 287 Dale Street- Final Inspection Request Sensitivity: Private All set for Monday (8/16) morning at 8:00.. Dan ".Mill River.-, consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultiniz.com LnfQ@.millriverconsul!Lng.com ----- Original Message ----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] Sent: Friday, August 13, 2004 10:06 AM To: 'Daniel Ottenheimer (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Sawyer, Susan Subject: 287 Dale Street - Final Inspection Request Importance: High Sensitivity: Private Hi, John Shaw called this a.m., and Bill Dufresne called last night to say that 287 Dale Street is ready for a Final Inspection. Can you arrange this with John Shaw of Wildwood Excavation: 978.815.7411 ? Thank you. Pamela DelleChiaie, Health Dept Assistant Town of North Andover Community Development & Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnoithandovercom Tel. 978-688-9540 Fax 978-688-9542 8/23/2004 0 j r---Nj D ER 0"' 4-f -TO%NN Ur 04 'H ANA t OR 0EALT ()EPA -p' TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION Th d igned hereby certify that the Sewage Disposal System constructed-, (r( ers repaired: by_ jojo located at M2 2&Lz e;'JJ-LE E -r was installed in conformance with the North Andover -Board of Health approved plan, System Design Permit � �!� , dated 7 -2-S _0 I , with an approved design flow of�� gallons per day. The materials used we're in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 3 10 CNM 15. 000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: b_� Final inspection date: e- iz--o4 Installer: Design Engineer: Engineer RepresYntative fz - C:�') "4 , � Engineer RepreseLiative Date: Date: ALOI/ kit Engineer RepresYntative fz - C:�') "4 , � Engineer RepreseLiative Date: Date: ALOI/ Page I of I Dellechiaie, Pamela From: Dan Oftenheimer [info@millriverconsulting.com] Sent: Wednesday, August 18, 2004 9:17 AM To: Susan Sawyer; amcbrearty@millriverconsuIting.com; 'Pamela Dellechiaie' Subject: 287 Dale Street Sue and Pam, Attached please find the inspection report for 287 Dale Street. No problems were identified once we had our own survey equipment at the site. No charge for second day of the inspection. Dan consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 .ww.w...m.illriverconsultin2.com info@ ing.com xmillriverconsulti. I 8/23/2004 61, 0 0 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET Riga NORTH ANDOVER, MASSACHUSETTS 0 1845 C .. Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - FAX ADDRESS: 287 Dale St MAP:64 LOT: 15 INSTALLER: John Shaw, Wildwood DESIGNER: Merrimac PLAN DATE: 7/12/2004 BOH APPROVAL DATE ON PLAN: 7/17/2004 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 8/16/2004 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Gravity Distribution COMPONENT SUMMARY FROM PLAN GALLON TANK = existing 1500 LOADING OF SEPTIC TANK = n/a GALLON PUMP CHAMBER = n/a LOADING OF PUMP CHAMBER TYPE OF SAS = Field DIMENSIONS AND DETAILS OF SAS: 50 x 15 SITE CONDITIONS Comments: Existing tank being reused DExisting septic tank properly abandoned DInternal plumbing all to one building sewer ZTopography not appreciably altered Page 1 of 1 0 1 0 TOWN OF NORTH ANDOVER RT" Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 CHU Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - FAX SEPTIC TANK Bottom of tank hole has 6" stone base Weep hole plugged F 1 1500 gallon tank has been installed H-10loading Monolithic construction Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) F-1 Inlet tee installed, centered under access port Outlet tee (gas baffle or effluent filter) installed, centered under access port 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Comments: Tank re -used. 1,500 gallon. Outlet baffle knocked out and replaced with Tee and gas baffle D -BOX Z Installed on stable stone base E] 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: Page 2 of 2 0 0 TOWN OF NORTH ANDOVER Th Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 C U Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SOIL ABSORPTION SYSTEM F-1 Bottom of SAS excavated down to soil layer, as provided on plan Z Size of SAS excavated as per plan Z Title 5 sand installed, if specified on plan F� 3/4-1 Y2" double washed stone installed Z 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Z Orifices @ 5 & 7 o'clock positions E] Gravelless disposal systems: type, number and location as per plan Z Elevations of laterals installed as on approved plan F-1 40 Mil'HDPE barrier installed F-1 Retaining wall (boulder / concrete / timber/ block) F� Final cover as per plan Comments: Page 3 of 3 0 0 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 1.62 Height of Instrument: 101.62. INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 96.70+/- Not Accessible Septic Tank IN 96.40+/- Not Accessible Septic Tank OUT 96.20+/- 95.55 Distribution Box IN 92.35 92.44 Distribution Box OUT 92.18 92.26 Manifold Lateral 1 HIGH 92.15 92.20 Lateral 1 LOW 91-90 91.98 Lateral 2 HIGH 92.15 92.19 Lateral 2 LOW 91-90 91.95 Lateral 3 HIGH 92.15 92.18 Lateral 3 LOW 91-90 91.98 Page 4 of 4 Q Ljo.r6., I'S JOT A off" 4119%ri, A CL409-0 VP 1'49 La.*rvW A�40 ClAvAenoLl PF -ri.4r, C�trTIWA *f9lvl-f e.0Hf0WLkr,V. 12 ftA 1044- 6 MOM RECEIVED AUG 1 9 2004 TOWN UF NORTH ANDOVER HEALTH DEPARTMENT AS BUI LT PLAN OF .RFACE DjSpoSAL SYSTEM Q1 szqt 1. WCATED IN �j . 0 V.-r�4 A �4 nov 157�' AS PREPARED FOR --ri t-1 4�'�C'm DATE: SCALE: I 2*1 P4 L,15- .0� AIN 015 I'Fl 6,Lf .1%, 16 MERRIMACK* ENGINEERING SERVICES, INC. IPROFESSIONAL ENGINEERS 0 LAND SURVEYORS * PLANNERS " PARK STREET 0 ANDOVFX MAWACHUSETTS 01gla or JEL 1617) 473.3W. 373-5721 I 101 101 'maow MT "T. Q Ljo.r6., I'S JOT A off" 4119%ri, A CL409-0 VP 1'49 La.*rvW A�40 ClAvAenoLl PF -ri.4r, C�trTIWA *f9lvl-f e.0Hf0WLkr,V. 12 ftA 1044- 6 MOM RECEIVED AUG 1 9 2004 TOWN UF NORTH ANDOVER HEALTH DEPARTMENT AS BUI LT PLAN OF .RFACE DjSpoSAL SYSTEM Q1 szqt 1. WCATED IN �j . 0 V.-r�4 A �4 nov 157�' AS PREPARED FOR --ri t-1 4�'�C'm DATE: SCALE: I 2*1 P4 L,15- .0� AIN 015 I'Fl 6,Lf .1%, 16 MERRIMACK* ENGINEERING SERVICES, INC. IPROFESSIONAL ENGINEERS 0 LAND SURVEYORS * PLANNERS " PARK STREET 0 ANDOVFX MAWACHUSETTS 01gla or JEL 1617) 473.3W. 373-5721 I 101 101 t Mj a\ 1. 1 tn izi E & a oo ONO U t t Mj 0 ca E 8 �R E Q 0 00 C> 9 .,t C> z LE z LL) 0 m t, .L:6 y > ca� (71 00 00 00 Z Q (D C� C) IW C> CD P U. L� E� ". " L� 0 0 0 z z z C> c) CD C) p rq rq 6 6 75 75 C4 kn rn <D kn In 1*1 9 9 9 IT -Ir -e C�l CD <D C> C� <D C� C� C�4 S CL w CR 06 Q. -Z 00 Cl Cl (D (y 9 z E cL E U 7� 0 0 E CL 0 0 C> C> C'4 V) a\ 1. 1 izi E & a t 0 ca E 8 �R E Q 0 00 C> 9 .,t C> z LE z LL) 0 m t, .L:6 y > ca� (71 00 00 00 Z Q (D C� C) IW C> CD P U. L� E� ". " L� 0 0 0 z z z C> c) CD C) p rq rq 6 6 75 75 C4 kn rn <D kn In 1*1 9 9 9 IT -Ir -e C�l CD <D C> C� <D C� C� C�4 S CL w CR 06 Q. -Z 00 Cl Cl (D (y 9 z E cL E U 7� 0 0 E CL 0 0 C> C> C'4 V) �0 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North AnJover, Massachusetts 01845 Susan Y. Sawyer, REHS/ RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE August 20, 2004 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by John Shaw at 287 Dale Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Zis 7� San Y. Sawye 7,RE / RS Public Health Director BOARD OF APPEALS 688-9541 BLJII-DING688-9545 CONSERVATION688-9530 HEALTH688-9540 PL.ANNINCY688-9535