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HomeMy WebLinkAboutMiscellaneous - 300 GRANVILLE LANE 4/30/2018 300 GRANVILLE LANE 210/106-A-0035-0000.0 J t� J Arn.E P-O'u MTAY :9 300 Granville Lane N. Andover, MA. 01845 Main Floor ezc.Fc•..Ra s" . 4. .. errr. A h' :�{ 04 RA?ryF.?44? 15iA r'.' •s7 n ,t . A. • a y � UVA 511.6.1 • :,SA`TER BEG�CY.X? . i i 300 Granville Lane N. Andover, MA. 01845 2nd Floor i I - WORKSHOP x 24'3!' y t: k` _ BASEMENT h 37' 9" X 26° � f Rre 300 Granville Lane N. Andover, MA. 01845 Basement 300 j' • 5��'fGED�7�s` • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 5/16/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of tank By: Joseph Watson At: 300 Granville Lane Map 106.A Lot 0035 North Andover, MA 01845 The Issuance/of this c rtificate shall not be construed as a guarantee that the system will function satisfactorily. Brian J. aGrasse Public Health Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department [ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 300 Granville Lane MAP: 106.A LOT: 0035 INSTALLER: Joseph Watson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS [� Contractor reports any changes to design plan Et��,,�,!Existing septic tank properly abandoned nternal plumbing all to one building sewer Topography not appreciably altered Comments: SEPTIC TANK Building sewer in continuous grade, on compacted firm base Cleanouts per plan Bottom of tank hole has 6" stone base -5 Weep hole plugged 1500 gallon tank has been installed H-10 loading M olithic tank construction [� ater tightness of tank has been achieved by visual testing Inlet tee installed, centered under access port � M,J Ll�• �.s f Jsf��l�l Outlet tee installed, cente d under access (gas baffle/effluent filter) At le-j( rt�S [� inch cover to withi " installed over one access port Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: z y fi �w r� �w r 4 t 41 Ir ) r+aiy yt � r M .s� ,;gip • <.t ""'mss" . Commonwealth of Massachusetts Map-Block-Lot - 106.A0035 BOARD OF HEALTH - nit-- Penmit No North Andover BHP-2016-0140 ----------------------- FEE $175.00 ---- ------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted JOSEPH WATSON --------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 300 GRANVILLE LANE as shown on the application for Disposal Works Construction Permit No. BHP-2016-014 Dated May 09,2016 Issued On:May-09-2016 -_- ----------------- ------------- ' j - ------------------------------ BOARD OF HEALTH •a t A � . • KT,..n, Application for Septic Disposal System l� TOKAYt DATE Construction Permit — TOWN OF NORTH ANDOVER, MA 01845 $2s oo-comRepair Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms the computer,use �7epair air or replace an existing on-site sewage disposal system* `J only the tab key or replace an existing system component—what? ��k ` to move your IV cursor-do not use the return A. Facility Information key. 1J� Address or Lot# 1a6 City/Town MAY U 9 2016 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ❑Gravity(choose one) TOWN OF NORTH ANDOVER ***If pump system, attach copy of electrical permit to application*** HEALTH DEPARTMENT ➢ ❑Conventional System(pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑Does the system require an effluent filter? Yes No If yes, does plan specify make and model of Filter? YES=(no further info.needed) installer must specify brand of Filter before DWC issuance) What is the Make? What is the Model. /don 2. Owner_Info mation Name yK.C� Address(if diffe nt from above) City/Town State Zip Code 917�- L ;1. / — Email address Telephone Number 3. -Installer Information, Name Name of Compan Address � -et/� Ci own _-©F^ _ C Z State Zip Code ('[ C Telephone Number(Cell Phone#ifpossible please) a. Designer Information_ Name 4 Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) �J Application for Disposal System Construction Permit•Page 1 of 2 t R • � °ti •. Application for Septic Disposal System Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $250.00-Full Repair $125.00-Component PAGE 2OF2 A. Facility Information continued.... s. Type of Building: esidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of NOVV Andover. I understand that until a final Certificate of Compliance has been issued by this oard of Health,the installed system is not approved. � 6 N e Date RpplicatipFlprori BB' rd of Health Representative) Name/ Date Appli ation Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No Z. Project Manager Obligation Attached. Yes No 3. Pump System? If so,Attach co ofE tical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Sys te s" Yes No Handout. 4. Reviewed approval letter, all paperwork received. Yes No Missing. 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) 6. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 3V OAL (address of septic system) For plans by pp i , /(/ L� C/ L£��G ngmeer) Relative to thea lication of (Installer's name) And dated rigina ate Dated /",; 6 o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans p1lor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (VS inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdep gtownofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board 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: (2 w (Today's Date) flx f� S Ov ( ame— int) jhme , Signe 0d) FILE# Nf AndaQ'415 TITLE V INSPECTION RECEIVE® 4qlq2� MAR 0 3 2016 Dean G. Luscomb H & Sons TOWN OF NORTH ANDOVER P.O. Box 135 HEALTH DEPARTMENT. Middleton, MA 01949 978-774-4065 Licensed Plumber # 20285 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNERS NAME J-2 V e M Q S D n PROPERTY ADDRESS 3 0 D C) r a rn rc I La n e Irl . /l n d r) l r- MA DATE OF INSPECTION r Q rV (� 1 NAME OF INSPECTOR n C QUALITY IS NUMBER ONE TO US Commonwealth of Massachusetts t - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for rY every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information RECEIVED forms on the R6f� �+ computer,use 1. Inspector: only the tab key MAR 0 3 2016 to move your Dean G. Luscomb II cursor-do not Name of Inspector TOWN OF NORTH ANDOVER use the return key. Dean G. Luscomb II &Sons HEALTH DEPARTMENT Company Name P.O. Box 135 Company Address Middleton MA 01949 City/Town State Zip Code 978-774-4065 S1848 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ui't� r February 24, 2015 Inspector's Signature v Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 01 300 Granville Lane Property Address Mason Owner Owner's Name information is rY N Andover MA 01845 February 24 2016 required for , every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check ,B D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by S 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. ❑ Y ❑ N ❑ ND (Explain below).- is elow):is le&kl A, a6 &-& se'avi )P- 7ZAr, ljv.,ve, �v Lie- ry-pl Al ac- 4epa7p<_d t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,M ,•''r 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ElY [IN ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further&4aWQon is Required by the Board of Health: ❑ Conditions exist which ire further evaluation by the Board of Health in o tyto determine if the system is failing to protec blic health, safety or the enviro 1. System will pass unless Board o ealth de roes in accordance with 310 CMR 15.303(1)(b)that the system is not functi. in a manner which will protect public health, safety and the environment: ❑ Cesspool or„p6 is within 50 feet of a surface water ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. City/Town 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: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a rivate water supplywell". P 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 criteria 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 ❑ ® Backup of sewage into facility or system component due to overloaded or �- clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments w„ 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping.more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. D ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the f wing, in addition to the questions in Sectio D. Yes No `! � ❑ ❑ the system ithin 400 feet a surface drinking water supply ❑ ❑ the system is withi feet of a tributary to a surface drinking water supply f ❑ ❑ the system i, cated in a nitr en sensitive area(Interim Wellhead Protection Area—I A)or a mapped Zone =thesy ic water supply well If you have answered" s"to any question in Section Em is considered a significant threat, or answered"yes" i Section D above the large system has failed. The owner or operator of any large system cons* ed a significant threat under Section E or failed under Secn D shall upgrade the system i ccordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ► Commonwealth of Massachusetts W Title 5 Official Inspection Form a Sunsurface Sewage Disposal System Form - Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not ® ❑ available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 god t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 300 Granville Lane Property Address Mason Owner Owner's Name information is ry N Andover MA 01845 February 24 required for , 2016 every page. City/Town State Zip Code Date of Inspection D. System Information Description: owner and town Number of current residents: 3 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) El Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 79-1- .1 Detail: Sump pump? ❑ Yes Z No Last date of occupancy: currentDate C mercial/Industrial Flow Conditions: Type of Es shment: Design flow(based on CMR 15.203): Gallon r day(gpd) Basis of design flow(seats/persons etc.): Grease trap present? 1,,1.1__ ­ ❑ Yes ❑ No Industrial waste hol ' ank present? ❑ Yes ❑ No Non-sanita waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for rY every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date,of occupancy/use: Date Other(describe below . --,__ General Information Pumping Records: l� Source of information: �—V�� a Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 61,01 uN� 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)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. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System is from 1983-33 years old Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 25" / Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 15"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Precast rectangular concrete- 1500 gallons If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'x5'x10' - 1500 gallons Sludge depth: 4" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'' 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34 Scum thickness 4 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle uc�/piw►9f ��fEG How were dimensions determined? by measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): �i, rahnrl SPP--©k Z e ileJow OUbr-w,r„J Grease Trap(locate on site plan): Depth grade: feet UMaterial of constructs El concrete El metal �E] fiberglass olyethylene ❑ other(explain). Dimensions: Scum thickness Distance from top of m to top of outlet tee or baffle Distance fr ottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 300 Granville Lane Property Address Mason Owner Owner's Name information is required for N Andover MA 01845 February24, 2016 every page. City/Town State Zip Code Date of Inspection D.�System Information (cont.) Commen on pumping recommendations, inlet and outlet tee or baffle conditiQ,4- ral integrity, liquid levels as reiated tto outlet invert, evidence of leakage, etc` ;, - -" Tight Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth belo rade: V Material of constru 'on.- ❑ concrete ❑ tal El fiberglass ❑ polyet ene ED other(explain): Dimensions: Capacity: Z gallons Design Flow: gallons per day Alarm present: Yes ❑ No Alarm level: Alarm i orking order: ❑ Yes ❑ No Date of last pumping: Date Comments(corgolion of alarm and float switches, etc.): f " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for rY every page. Cityrrown 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 invert Zero 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.): The d-box is 20"x 17" and is 12" below grade. The d-box is in very good shape with no signs of any problems. D-box has a 20"x 20"cover. P Chamber(locate on site plan): h Pumps in wor rder: ❑ Yes ❑ No* U Alarms in working order: es ❑ No* Comments (note condition of pump chamber, c tion mps and appurtenances, etc.): F� * 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: SAS was located by proposed drawing and d-box location. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 • . Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ''V 300 Granville Lane Property Address Mason Owner Owner's Name information is required for N Andover MA 01845 February24, 2016 every page. City.?own State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: — L, ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 25'x 40' ❑ 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.): The SAS is in good condition. There are no signs of ponding or breakout. esspools (cesspool must be pumped as part of inspection) (locate on site plan): Number an nfiguration - V Depth—top of liquid to in vert / Depth of solids layer Depth of scum layer Dimensions of cesspo Materials ofxonstruction ./e Indication of groundwater inflow ❑ Yes ❑ t t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 • Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „ 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for rY every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, conditio egetation, mar.,.. P 'v (locate on site plan): �l Materials of c ruction: V Dimensions Depth of solids Comments (note condition of soil, signs of hydr (lure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. Cityrrown 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: ® hand-sketch in the area below ❑ drawing attached separately � 6-F--s 12. 3 41 G � � �� 3�q� �� �oX G6v � AsW yzr �u �m�T�k Gia = Rio �° .A 00 �\ d � Me� �y t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'V 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope Sem'°, ® Surface water /,et, [AA ® Check cellar 2)`-Y �v �u AAA p u►� ® Shallow wells P 0 Estimated depth to high ground water: 8'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/17/79 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Permit and proposed on file. ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: The basement is 8' below grade with no sump pump. ojw g1S117gi SLS Ak G(,Jzk ' 9 t 13-6. Ir 40 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 •� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 300 Granville Lane Property Address Mason Owner Owner's Name information is N Andover MA 01845 February 24, 2016 required for ry every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 �HSS SyS�E viA.)CO 3 T ,,• f �l. j 1111 .1 V At ' " Q +�y ! nt {� {� Pi „� .11 y 1 ��; ; �yj � � tj� .fYi d.•� } .•'..td� S. .�. \J Rk Y`l « OF x t . d A .t;d � '` `3, 'y` xn • .,f� W�.L "'a=.tba �y`. cs d Q (� � L ry� Y�.� � � �s r �•3'ix`� o ��- �' 4s i �ti��i+���'�� `� k � #,�• , � r a � .�� �• 4� yam` r�;` 'm _ r> Iv r 2 0 t d, ♦.t �1F 1r tip per. �� r t � r •1. � ry .y «<<<< yu ( y -. z+ f X.r t� .!N a ,_,s.- � Y ,h�t�1 .. ..�� `•t `� •,: ,:. .' t .'t'' t 'r t f �. !i � ��y,rSS..t .'.'�' 9{,rN Y•k r 2 '� Vi f� ^ ' '�'. v-•Y k,y < +` ,R l `Gs � x�s�1r S �� t .a. ,t k / J ,�.,. K t• f T +� Y0, '3 '* r + Y i ' _ a � .� >.s..,+ •,_ _.. +�wi.,.--z+_.b-... v- ...��� .a •�r,...w+.6,�.� «•--.•r'•,�r+ ,'�.�'e� _ V All ;f 1 Jv- In 8 Y � 1 � P `lc.�c•51 � .,L� D ��o s + , 'y t+�v .-� v y a � t ,^ to •. "�-$-j'� � t_' e S..©�� �4 t �h...� �,;. a ��..r 1 � i, a' N` y� IW Av tgq get L Y �. i. � r�Yr:t r*S<'.b�f.;ni*Z;� �`� '�'•.�.�� 'k 7,:1v. K'Y �f x I � i' a� '"'`�� � r � �f Y t �xS i a•'e• .t° "ti:. 1 , lh.�� �►a S a � t 1 v r v� • w 1 4 Y :J.^ � AA ¢ r .4'F S`� Fr �R a r 5*' .L4 , i ..._,� `� , • • r � rte, +a �� J f f i.j Fr/.!�/�,� . —e'- #- .� �.! � • � , 1 .rid F� � �, f �, c I' %46AN �. I � V Form No. 3 Town of North Andover, Massachusetts BOARD OF HEALTH .. f AORTH L O aiiUmmajift F P DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSE Applicant NAME / ADD N SS TELEPHOE Site Location CSL Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. • '`J c FAIR AN, BOARD OF HEALTH J/ �d D.W.C. No. r � Fee , � D 2,1 I � : Town of North Andover Of t NOR TM 11 OFFICE OF 3a �` ! 6'6 O L COMMUNITY DEVELOPMENT AND SERVICES A 146 Main Street qOo P.. North Andover, Massachusetts 01845 SSACHUS'* TOWN OF NORTH ANDOVER BOARD OF HEALTH July 29, 1996 CERTIFICATE OF COMPLIANCE This is to certify that the repairs to the D-box and the crushed pipes in the individual subsurface disposal system located at 300 Granville Road, North Andover by the licensed installer, John Divincenzo, have been been made in accordance with the provisions of TITLE S of the State Sanitary Code and with local Board of Health regulations. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY. Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover HaRTH OFFICE OF a°,t<" COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street - North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9SSACHUSEt Director August 2, 1996 Dear Mr. Lawless: Enclosed is the Certificate of Compliance for the repairs which were recently done to your septic system at 300 Granville Lane. When I was inspecting these repairs I noted that your leaching area is in a wooded area and that there are a number of trees growing on the existing leach area. To protect the leaching area of your septic system, these trees must be cut and the area over the leach area kept cleared. Grass may be grown over the system,but there can be no trees, shrubs, etc. because of their root structures. Please remove the existing trees and growth as soon as possible. Sincerely, xft—'z-z Sandra Starr,R. S. Health Administrator cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688.9535 I I mbsurface Desijn Check List Page 2 FAIL OK LeachLng Pits eaching pits are preferred where the installation is possible I Reg 11.2 qb c ations of leaching area-m�-nimum 500 sq ft 11.4 spac 11.10 surface a 2% 11.11 cover mat al21lc2t x4" spl padtee at elbow no bends in pipe .f� d-box to pipe Leaching Reg 15.1 a) no greater�t� 20 nd.nutes/inch area-minimum 900 sq ft 15.4 c construction of field 15.8 d) surface drainage 2 % 3.7 e) 201 from cellar wall or inground irAr dng pool Leachin ftezche i Reg 14.1 a) calculations A,_ons n_ _eaching area-min 500 eq ft 14.3 b) spacing-4 f min 6 ft with reserve between 14.4 c) dimension 11 .6 Id) contra on 14.7 e) stone 14.10 f) surf ce drainage 2% Downhill Vtop e a) 'slLope Xx = Ito be shown) b) y/x 150 = (to be shown) s Reg 9.1 a) app val 9.6 b) s d-by power *%-,arrl� of Feil.h ?earth „ndrrar,Mass SUBSURFACE DMOSRL DFST GN CHECK LIST LOT APPROVED DATE DISAPPROVED DATE Provided: 7� Reasons: �`— k)0U,'j5 40S JUST W9A/ Title V FAIL CK Reg 2.5 The submitted plan must show as a minim=.. the lot to be served-area,dfinensions lot #,abutters location and log deep observation hoes-distance to ti s location and results percolation tests-distance to ties design calculations & calculations showing required leaching area location and dimensions of system-including reserve area existing and proposed contours (g) location any wet areas within loot of sewage disposal system or disclairer-check wetlands mapping (h) surface and subsurface drains within 100+ of sewage disposal C � system or disclaimer (i) location any drainage easements within 100, of sewage disposal system or disr.airar-Planning Board files (j) knom sources of winter supply within 2001 of sewage disposal system or disclaimer Z(fc),location of any proposed well to serve lot-1001 from leaching facility location of water lines on property-10I from leaching facility location of benchmark iveways garbage disposals P) no PVC to be used in construction (q) profile of system-elevations of basement, plu-mb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and other elevations maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Sc tic Tanks capac t es- 50% of flow, water table, tees, depth of tees, access, pumping (b) cleanout c) 101 from cellar wall or ingrnund swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes a) -slope greater 0.08 Reg 10.41 b) sump