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HomeMy WebLinkAboutMiscellaneous - 31 GRAY STREET 4/30/2018 (2) 31 GRAY STREET 210/107.6-0052-0000.0 phti UPC 13730 No. C�tl?�-�k �1� HASTINGS. Alp i 1 t%ORTH I kJ P 6, 0 yy Co CMeiSfwlC[n V7' Al-Ap ss4c PUBLIC HEALTH DEPARTMENT Community Developmpqi Bivision k0-Fq(T-FF-[C OT -1031'rT')jl(,-,TAjcV(Y As of-. Aprifl 7 2007 rlh,.,is to certify that the individuafsu6suif-ace dispos'af system receiveda ,MJIS"(,Y]'0W(fJ,9VSqT-(—YTl0Xqf the: TuffSeptic System Repair �y: Todddateson At. 31 Gray Street forth - Andover, 9Y/4 0184.5 The lssuawce of this cerhfi.cale shaff n.ol, fie construed as a guarantee that the sY., m tewiff fimictioli,sat4factonfiy. Susaii. T- 5a-tf)yer-'-' Tufificlfeafth 4Xrector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688,9540 Fox 978.688.8476 Web www.townofoovthandover.com f�t3RTk q p iRt oto aw 1`O —fy R Arr TOVvw u, ivvt<tH ANDOVER PUBLIC HEALTH DEPARTMENT L HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undeerrsiiggned hereby certify that the Sewage,,Disposal System( )constructed;(�)repaired; By: /��� 131 TE s o/V (Print Name) Located at: 31 &2)9 7 S / ?ILS"j (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated �)I MAS/ 2006 and last revised on i A ,with a design flow of 1 1 q 1;0gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: /Z L5 Q r // p gin4Representative e Signature) \-Vl Ity�( l t And—Print Name Final Construction Inspection Date: t' /3/0 b gineer (Signature) Ke-via K. &esaLL, And—Print Name Installer: OV (Signature) Date: OF gsS And—Print Name � •o Enginer: (Signature) Date: ` o B S L _, CIVIL v D c t 3941G / KFVIA/ Ago FFG/STEQ�� �SSIONAL EAnd—Print Name I 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com N.Andover Health Department facshfle ftwsirfiU To: Kevin Borselb ax: 800 866-1471 From:m: Susan sawyer,Health Director Date• R'Y 5/2/2007 Re: 31 Gray Street Pages: 2 CC: ❑Urgent ❑For Review ❑Please Comment ❑Please Reply ❑Plus Regde Mr.Bomselfi, Please find the attached checklist for the As-built submitted for 31 Gray Street.I have checked off the missing items that North AndoWs local regulations require. The ties ora schedule of ties must be on the As-built to the center of the tank and D-Box. 1 was also unable to locate the BM used,l would appreciate it if is then:that you highlight it for me.All other item necessary were identified.I appreciate your cooperation with this matter and look forward to closing this project. Thank you . . . . . . . . . . . . . . . . . . . . . . . . . . . . AS-BUILT CHECKLIST LOT NUMBER, STREET NAME V ASSESSORS MAP.& PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS +/ LOCATIONS &DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM ✓ TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK &D-BOX ORIGINAL STAMP & SIGNATURE i IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED BORSELLI ENGINEERING & DEVELOPMENT, INC. 110 WINN STREET,Suite 209 WOBURN, MA 0 180 1 (781) 937-9947 (800)866-1471 (fax) 06 July 2007 North Andover Health Department 1600 Osgood Street RECEIVED Building 20, Suite 2-36 2007 North Andover, MA 01845 JUL 17 Attn: Michelle Grant T�HEALLTH DEPARTMOF NORTH ENANDOVER Subject: Septic System Repair 31 Gray Street Revised AS-BUILT Plan submission Dear Ms. Grant: Please find attached three (3) copies of the REVISED "As-Built"plan for the subject project. Based on your comments, we made the following changes: 1. Noted that the top of the foundation was utilized as a vertical bench mark. 2. Inserted dimension ties from the corners of the structure to the d-box and the septic tank. If you have any questions or comments regarding this submission, please do not hesitate to contact this office. Sincerely, 1 in R. Borselli, PE Borselli Engineering & Development, Inc. CC: Bill Penny—Andover Renovations, Inc. - 1 - 4�x BORSELLI ENGINEERING & DEVELOPMENT, INC. 110 WINN STREET,Suite 209 WOBURN, MA 01801 (f (781)937-9947 (800)866 1471 (fax) 03 April 2007 s North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 Attn: Michelle Grant APR — 9 2007 NORTH Subject: Septic System Repair TO HEWN ALTHOF DE ARTMENTER 31 Gray Street AS-BUILT Plan submission Dear Ms. Grant: Please find attached three (3) copies of the "As-Built"plan for the subject project as well as a partially filled out"Certificate of Compliance". I would like to apologize as this as-built was completed some time ago, however, apparently they were not forwarded to your office due to an administrative problem. If you have any questions or comments regarding this submission,please do not hesitate to contact this office. Sincerely , c 1 - evin R. Borse i, PE ��i/�jc,-✓ Borselh Engineering & Development, Inc. CC: Bill Penny—Andover Renovations, Inc. � Wa/ Commonwealth of Massachusetts W City/Town of NORTH ANDOVER Certificate of Compliance Form 3 H SV DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On-Site Sewage Disposal System Important: When filling out ❑ Construction of a new system forms on the ® Repair or replacement of an existing system computer, use ❑ Repair or replacement of an existing system component only the tab key to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): use the return key. DSCP Number DSCP Date CHARLES JENKINS Facility Owner 31 GRAY STREET Street Address or Lot# N. ANDOVER MA 0 City/Town State Zip Code Designer Information: KEVIN R. BORSELLI BORSELLI ENGINEERING & DEV., INC. Name Name of Company 04/03/07 Si Date Installer Information: Name Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: NO GARBAGE DISPOSAL The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. N. ANDOVER BOARD OF HEALTH Approving Authority Signature Date t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1 NORTF4 Otr tt`�o 60,4 rao q�'O qq COCMKW Wtw`y r ��SSgcNus���y j 9 PUBLIC HEALTH DEPARTMENT � fommunity Development Division 7' L ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 31 Gray Street MAP: LOT: INSTALLER: Bateson Enterprises DESIGNER: Kevin Borselli PLAN DATE: May 31, 2006 BOH APPROVAL DATE ON PLAN: November 20, 2006 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 12/11/06 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofoorthandover.com 14ORT14 O �t�eo $6'9N0 0 O Lig► H � � � � eya �► w-O9 c"K. WKM 7' SSgCNUs� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ❑ 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: Septic tank dropped slightly to incorporate additional sewer waste pipe not shown on plan. Still maintained 1% slope from septic tank out to D-box in. 12-11-06. DISTRIBUTION-BOX ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: Rubber seals used in place of hydraulic cement. 12-11-06. SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Infiltrator Standard ® Number of chambers per row—12— Z Number of rows (trenches) 5 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com t10RTF4 O��Steo 86t9tiO 0 y 0 e" y T O COLNICM Kw 1 T SsgC Hus���y PUBLIC HEALTH DEPARTMENT Community Development Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT ELEV. Distribution Box IN 95.82 95.77 Distribution Box OUT 95.66 95.60 Building Sewer Out#1 98.27 Building Sewer Out#2 96.78 Septic Tank In #1 96.66 96.75 Septic Tank In #2 96.65 96.75 Septic Tank Out 96.34 96.50 Lateral 1 INV 95.41 95.41 Lateral 1 TOP Lateral 2 INV 95.41 95.41 Lateral 2 TOP Lateral 3 INV 95.41 95.41 Lateral 3 TOP Lateral 4 INV 95.39 95.41 Lateral 4 TOP Lateral 5 INV 95.39 95.41 Lateral 5 TOP 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com NORTH q O M t O COCMC IWKM y1. �.9 AERATED SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com Y FINAL GRADE INSPECTION Date: Address: I o/ LOAMED? SEEDED? f ❑ COVE PER PLAN? Other: i y NORTH 1 Commonwealth of Massachusetts Map-Block-Lot 3?°�•��'° '•.�oo� 107.B-0052- Board of Health ° p Permit No + . BHP-2006-0739 North Andover --------------_- -- P.I. FEE ts34cwust� F.I. $250.00 ---------------------- p Dis osal Works Construction Permit Permission is hereby granted Todd-Bate-son ----- ---------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. I at No 31 GRAY STREET as shown on the application for Disposal Works Construction Permit No. 13HP-20067073 Dated November 20,2006 __________________UFOUL L ____-____-___--_j Issued On:Nov-20-2006 --------------------------------------------------------------------------------- wORTk Map-Block-Lot °f,,,�° ..,y° Commonwealth of Massachusetts p- r • 0 107.6-0052- j a Board of Health ----------------------- j • North Andover #sACHUCertificate of pliance s�cwust ! THIS IS TO CERTIFY, ndividual Sewage Disposal System (Repair) by Todd Bateson --- gdd� ------ ----- - ------------------------------------------------------------------------------------- Installer j at No 31 GRAY ET -- - ----------- ------------------------------------------------------------------------------------------------------------------------- has been ins ed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the applic n for Disposal IS Construction Permit No. BHP-2006-073 Dated November 20 2006 - ---------------------- j Board of Health �rintedOn:Apr-18-2007 Of "';T",ti Commonwealth of Massachusetts Map-Block-Lot '" °o� 107.13-0052- a Board of Health Permit No j North Andover -BHP------ - 2006-0739 �;� FEE ss4cmust $250.00 Disposal Works Construction Permit I p Permission is hereby granted Todd Bateson - - ------------ - ----------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 31 GRAY STREET - - --------------------------------------------------------------------------------------------------------------------- j as shown on the application for Disposal Works Construction Permit No. BHP-2006-073 Dated November 20,2006 - - -- -------------- --- --- --- -- ----------------- --------------------------- j Issued On:Nov-20-2006 Board of Health rh Applicatioi )r Septic Disposal S st ° TODAY'S DATE r2 � Construction Permit, - TO" ( = ' NORTH ANMA 01845 $ 250-00- DOVER,s,�••.:, .00 Component SSwCNUs� Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use [�epair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Information key. ra Address or Lot# CitylTown d Vj e 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump 2,10ravity (choose one) ***If pump system,attach copy of electrical permit to application*** ❑ 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)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information Name Address(if different from above) City/Town— --- -- - State Zip Code – ------ Telephone Numiber 3. Installer Information Name Name 9Ac§bN E Address Andover, L"gA 0181.0 --.- - City/Town State Zip Code re Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 u R of °k�� 1a Application for Septic Disposal Svstem %Construction Permit - TOVN OF TODAY'S DATE , $250.00 ORTH ANDOVERMA 01845 -Full Repair $125.00 -Component PAGE 2 OF 2 A. Facility Information continued.... 5. 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 North Andov and not to place the system in operation until a Certificate of Compliance has been iss y this Board of Health. o r - //- t7-�� Na Date Application Approved By: (Board of Health Representative) c Name Date Application Disapproved for the following reasons: .For Office Use Only: / 1. Fee Attached? Yes✓ No 2. Project'ect Mana er Obligation Form Attached? Yes r/ No g g — — / 3. PumpSystem? If so,Attach copy of Electrical Permit Yes— No 4. Foundation As-Built?(new construction ronly):/;s s o_ (Same scale as appro�rd plan) S. Floor Plans?(new construction only): — No— r. . . .. a ~r SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: -3 l C v y sl (Address of septic system) For plans by Ste- ` Zj, ,,02F_4'I (Engineer) Relative to the application of a it S,N (Installer's name) And dated nguia ate Dated 1 f — ( � — O(o G, j _ �y 1 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 prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without 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 firstt(1S) 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: healdidept@townofnorthandover.co 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 simile excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank,D-Box,pipes, stone, vent,pump chamber,retaining wall and other components. 6. As the installer. I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor,or any other persons shall absolve me of this obligation. j Undersigned Licensed Septic Installer: d (Today's Date) (Name—Print) a e—Signe r1ORTH O��,%.1 D 06 q'1O OL O C Oy O.p COCMICW WKII V^ �9SSgcwuS PUBLIC HEALTH DEPARTMENT (ommunity Development Division November 21,2006 Susan Cronin-Jenkins 31 Gray Street North Andover,MA 01845 RE: Septic System Design 31 Gray Street,North Andover Map 107B,Lot 52 Dear Homeowner, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property,submitted on your behalf by Borselli Engineering,dated,May 31,2006,last revision date November 6,2006 and received November 20,2006. The design has been approved for use in the construction of an onsite septic system. The 550 gal/day,5-bedroom (i l-room maximum)design has been approved for use in the construction of a fully compliant,Title V,subsurface disposal system.This approval is valid for two years from the date of the approval in accordance with current local regulations and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance be endorsed by the installer,designer and the Town of North Andover. This approval is 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. 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 shall not construe or imply compliance with any of the aforementioned requirement Your effort to provide a properly functioning septic system for your dwelling is appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sine ely, z - se Y. Sawy S/RS Public Health Director Encl: list of licensed septic system installers Cc: Borselli Engineering 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTH +► moo' yf ��SSwcHus t Health Department June 20, 2006 Kevin Borselli, P.E. Borselli Engineering, Inc. 110 Winn Street, Suite 209 Woburn, MA 01801 Re: Wastewater Treatment and Dispersal System Plan for 31 Gray Street Dear Mr. Borselli: The proposed wastewater system design plans for the above site dated May 31, 2006 and received on June 5, 2006 have been reviewed. Unfortunately, they cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Please indicate the tax map and lot number for the parcel—220 2. Please indicate the abutters to the parcel from the most recent tax map—NA 8.02 3. Please indicate the presence or absence of water supplies and tributaries thereto within the setbacks distances indicated in the regulations -220 4. Please indicate the presence or absence of wetland resource areas within the setback distances indicated in the regulations—NA 8.02 5. Please indicate the basement floor elevation with respect to the ground water elevation —NA 5.04 6. Please indicate the location of the current or proposed areas for driving and their relationship to tank,piping or soil absorption sstem design—220 7. Please provide distances from the septic tank and soil absorption system to the dwelling and property line -NA 8.03 8. Please indicate the location of water lines, foundation drains and subsurface utilities. It also appears that the water line and sewer line are crossing (though they are not labeled),please provide appropriate construction details—220 9. Please provide a benchmark which is within 75' of the proposed construction area- 220 10. Please describe the method to be used to abandon the existing on-site wastewater system—354 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 11. Please clarify the distance between the dwelling and the proposed primary(septic)tank on the site plan 12. Please indicate that the building sewer is to have watertight joints, to be laid on a compact and firm base, and is to be laid on continuous grade in a straight line—222 13. Please provide buoyancy calculations for the tank—221 14. Please indicate the minimum and maximum cover allowed over the primary (septic) tank and the distribution box—228 15. Please specify the loading of the distribution box to be used—226 16. Please indicate that the distribution box is to have all outlets at the same elevation— 232 17. Please provide the elevation of the percolation test—NA 8.02 18. Please provide a swale where the grading is close to the property boundary—251 19. It does not appear breakout requirements are maintained. Please adjust the design or provide for a barrier or some other mechanism to meet this standard—255 20. Please clarify Construction Note 13 as it is unclear what the reference to gravel fill is, and if that applies to this project 21. Trenches are to be used as the soil absorption system mechanism whenever possible. Please use trenches in this instance or explain why they cannot be utilized- 240 22. This design is proposed for new construction(current house is 4 bedrooms and design is for 5 bedrooms). Accordingly,the design must meet all standards for new construction including the design of a primary and reserve soil absorption system. This has not been provided on this design 23. Use of gravel-less chambers for new construction requires a demonstration that the site can accommodate a conventional soil absorption system, and only then can gravel-less chambers be utilized. Please demonstrate compliance with this standard. You may choose to use a separate drawing or detail if that would assist with depicting items more clearly- (see approval letter for Infiltrator-brand gravel-less chambers) Additionally,you might wish to consider specifying an effluent filter in the primary(septic)tank. 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. Sincerel usan Y. Sawyer, REHS/RS Public Health Director cc: Owner File BORSELLI ENGINEERING & DEVELOPMENT, INC. 110 WIN STREET, Suite 209 WODURN, MA 0 180 1 (781)937-9947 (800)866-1471 (fax) 19 September 2006 North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 Attn: Sudan Y. Sawyer, REHS/RS RECEIVED Public Health Director Subject: Septic System Repair SEP 19 2006 31 Gray Street TOWN OF NORTH ANDOVER Drawing Revisions HEALTH DEPARTMENT Dear Ms. Sawyer: Please find attached three (3) copies of a revised Wastewater Treatment and Dispersal System Plans as well as buoyancy calculations for the subject project as requested. In addition, the following are responses (by line item) to your letter dated 20 June 2006: . The assessors map and parcel has been denoted on the site plan. �2. The abutter's names have been denoted on the site plan. /3. Note #10 has been added to the general notes section of the site plan to address this requirement. �4. Note #11 has been added to the general notes section of the site plan to address this requirement. J 5. The proposed TOC, Slab, and ESHW elevations have been added to the site plan for the 7 proposed addition. �� L 6. The existing driveway has been added to the site plan. /7. The dimensional offsets for the system components to the property lines have been added to the site plan. 8. The existing water line location has been added to the plan. The plan shows a proposed re- located water line. It is not known at this point, which measure (re-locating the water line, or ' V constructing both sewer and water pipes as class 150 pressure and testing) is more cost effective. It should be noted here, that although it is called out on the plan for re-location, the latter is an acceptable means, and should not require additional plan revisions. 9. A benchmark has been added to the site plan. -10. A note has been added to the site plan describing the method to abandoning the existing system. v11. The dimensional offset from the proposed septic tank to the existing foundation ahs been added to the plan. 12. Note #17 has been added to the construction notes section of the site plan to address this requirement. 13. Attached find buoyancy calculations for the proposed septic tank. J14. The minimum and maximum cover requirements for the septic tank and D-Box have been added to the system profile. - 1 - �. The D-box loading requirement has been added to the system profile. X16. The distribution box has outlet elevation requirements as listed in the schedule of elevations. No revisions necessary. 17. The elevation of the percolation test has been added to the percolation test log. :/i8. A swale has been added to the site plan. 19. Although breakout measures were obtained previously, the system was re-configured to eliminate grading along the adjacent property line. /20. The area requiring gravel fill is often referred to"the over dig"as the requirements of gravel fill meeting 310 CMR 15.255 is commonly known as "septic sand." 21. Trench configuration on this lot is not possible due to the limited site available to construct such a system. Trench systems require a separation distance of 2 times the height or width of the trench, whichever is greater. A trench system requires a larger footprint, which cannot be accommodated on this lot. 22. It was the understanding of this office that the nature of this project was to repair a failed septic '? system. A reserve area has been added to the plan, additional soil testing (if required) can be administered at the time of construction of the leaching facility. 23. The area required for a conventional system has been shown at the end of the proposed leaching 1 system demonstrating that one can be built. If you have any questions or comments regarding this submission, please do not hesitate to contact this office. Sincerely, K vin R. Borse i, PE- Borselli Engineering & Development, Inc. CC: Bill Penny—Andover Renovations, Inc. 31 GRAY STREET - 2- 9/19/2006 s T, Bouyancy Calculations for Shea Model TK-1500 Std Single Compartment Septic Tank Assumptions : Cover over tank c:= 0.75ft Unit weight of soil ys:= 100 Ib ft3 Existing ground elevation at tank location7- eg:= 98 ESHW Elevation= ew:= 93.17ft Bot tank elevation = st:= 92.0ft Height of Groundwater on side of tank= h:= ew—st h= 1.17 ft Given : Weight of Empty Tank w:= 116701bLECE1V1=r Unit weight of water yw:= 62.4 fb SEP 1 0 ,ti Lenght of tank 1:= 10.5ft TOWN ;ER FIE vT Width of tank b:= 5.7ft Bouyant force acting on tank : Total vertical force acting downward : Volume of water displaced by tank: Volume of Soil over Tank: V:= 1•b•h V=70.025ft3 Vs:= c•b•1 Vs=44.888ft3 Bouyant force acting on tank: Weight of soil acting on tank: B:= V.yw B =4.37 x 103 lb Ws:= YS-VS Ws=4.489 x 103lb Total Upward Force Total Downward Force U:= B U=4.37x 103 lb D:= Ws+w D= 1.616x 104lb , HOf � Since D is Greater than U; Tank will not experience heaving. ��``A�� Ass�oy o KEVIN R. � Factor of safety for heaving= FS:= D FS=3.698BoCIVIL Li 1 394 Fs OVAL J BORSELLI ENGINEERING & DEVELOPMENT, INC. 110 WINN STREET, Suite 209 WOBURN, MAO 1501 (781)937-9947 (800)866-1471 (fax) 17 November 2006 North Andover Health Department RFC PLD 1600 Osgood Street Building 20, Suite 2-36 NOV 2 0 2006 North Andover, MA 01845 TOWN Or '4uKri1 ANDOVER Attn: Michelle Grant HEALTH DEPARTMENT Subject: Septic System Repair 31 Gray Street Drawing Revisions#2, with additional test-hole information Dear Ms. Grant: Please find attached three (3) copies of a revised Wastewater Treatment and Dispersal System Plans which incorporate the additional test-hole information we obtained on-site on October 31, 2006. I apologize for the delay in this submission. If you have any questions or comments regarding this submission, please do not hesitate to contact this office. Sincerely, M. Bvin R. Borselli, PE orselli Engineering & Development, Inc. CC: Bill Penny—Andover Renovations, Inc. - 1 - TOWN OF NORTH:ANDOVER OeµORTp 1 4�y1O ° 1'O Office of COMMUNITY DEVELOPMENT AND SERVICES 0- HEALTH HEALTH DEPARTMENT IV -%WWMWI 400 OSGOOD STREET "s�°* • `�' °RAtt° NORTH ANDOVER, MASSACHUSETTS 01845 ITS C" Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX October 11,2006 Boroselli Engineering and Develpoment,Inc Kevin Borselli,PE 110 Winn Street,Suite 209 Woburn,MA 01801 RE: Subsurface Sewage Disposal System Plan for 31 Gray Street Dear Mr.Boreselli: The proposed septic system design plans and your letter of response to the previous denial letter,for the above site, dated September 6,2006 and received on September 19,2006 have been reviewed. All items except one have been corrected satisfactorily. As the application stated this soil testing was for an addition.The addition exceeds the current size of the existing subsurface disposal system.This increase is not a repair,rather the increase requires it to meet all aspects of"new construction".Unfortunately,without the proper testing within the area of the reserve the plan cannot be approved. Please feel free to contact the office with any questions you may have. This has been an ongoing project.The homeowner was given the permission to proceed with their addition without the prior approval of this plan.This was a gesture in good faith In kind,it is expected that the plan for this"new construction"will meet all standards of Tide V. We will be as flexible as possible and will not charge an additional fee as your original fee covered the testing. Please contact this office as soon as possible.We look forward to working with you to obtain a septic system that will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Since , Y. Sawyer,REHS� Public Health Director Cc: owner file 31 Gray Street-Need Form 11 ' submitted with plan- RCN Network webmail - Msg Page 1 of 1 From: 'DelleChiaie, Pamela' Sent: Mon Jun 5 11:04 <pdellechiaie@townofnorthandover.com> To: <bill@andoverrenovation.com> Priority: Normal Cc: <ashienkins@comcast.net>, 'Sawyer, Susan' &I ... Subject: 31 Gray Street- Need Form 11 to be submitted with plan Bill, As you are listed as the contact person for the septic work on this property, I am acknowledging that I have received the payment for the plan review and 3rd copy of plan this morning. However, I have not received the Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal. I also left you a voice mail regarding this. Please submit a copy of that to me asap so that I may forward your plan to be reviewed. Thank you. Best Regards, Pamela DelleChiaie Health Department Assistant RECEIVED Town of North Andover 1600 Osgood Street JUN - 9 2006 Building 20,Suite 2-36 North Andover,MA o1845 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 978.688.9540-Phone 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com From: 'DelleChiaie, Pamela' <pdellechiaie@townofnorthandover.com> - 31 Gray Street - Need Form 11 to be submitted with plan https://webmail.rcnnetworks.net/mail/reademail.pl?id=cur/1149519728.H78950P25959.mai... 6/6/2006 Grant, Michele From: Cronin-Jenkins, Susan M [SMJENKINS@BICS.BWH.HARVARD.EDU] Sent: Friday, June 16, 2006 9:26 AM To: Grant, Michele Subject: Jenkins 31 gray st I sent a fax this morning documented we agree to replace the septic system as discussed yesterday. I will send the original via mail. Thanks again for facilitating the building permit. Let me know if you need anything else. Have a nice weekend. 1 Grant, Michele From: Cronin-Jenkins, Susan M [SMJENKINS@BICS.BWH.HARVARD.EDU] Sent: Wednesday, June 21, 2006 12:55 PM To: Grant, Michele Subject: RE: Jenkins 31 gray st To: Michelle Grant From: Susan Cronin-Jenkins RE: Commitment agreement, new septic system 31 Gray St. Date: 6/21/06 Per our phone conversation this AM, I agree to replace my existing septic system within three months of start of construction renovation. This will be per North Andover engineering requirements. Thank you in advance, Susan Cronin-Jenkins Gly , rt 5 V 14 S OT 1� s a✓'.✓C 0C C_CNv a A,& u ;6-0 i June 27, 2006 North Andover Health Department 1600 Osgood St. North Andover,MA 01845 Dear Michele Grant, I, Susan Cronin-Jenkins, owner of 31 Gray St.North Andover, MA 01845 agree to replace my existing septic system within three months of an approved engineering soil absorption system. This will be per North Andover engineering requirements. I understand we are allowed to move forward with the building application and begin construction in conjunction of approved SAS plan. Thank y , Susan Cronin ns 31 Gray St. North Andover,MA 01845 978-682-0523 DONNA M.WEDGE .__ �-? NOTARY PUELfC COUVIONWEALTH OF MAF; ""ETTS My Comm.Expires Au .;,209 06/16/06 09:26 FAX 617 726 5144 PLANNING/CONSTR MG$ 10002 A r• June 15, 2006 To Whom It May Concern: I, Susan Cronin-Jenkins,owner of property 31 Gray St.North Andover,MA agree to replace the septic system per engineering plans. Thank you in advance Susan Cronin-Jenkins yV 4-'f01- 6jf�? ol-17 2c) z1 ���� FILE COMMENTS Name: Susan Cronin-Jenkins and Charles Jenkins Comments: Commitment agreement Date: 6-26-2006 On June 21St, 2006 Susan Jenkins called wondering if Mill River had approved their Septic Plan. The plan was submitted to the Health Dept on June 12. The package was not Complete. We had been waiting for additional missing information from the Engineer so as we could send the design to Mill River. The homeowners have had a very difficult time with the Contractor—William Penny from Andover Renovations out of Andover, MA. On June 23, 2006 we received 31 Gray Street's denial letter, but due to the hardship,we are allowing Susan Cronin-Jenkins, the homeowner to proceed the building permit. Mrs. Jenkins is to write a letter that will oe notaE izeu Dv aiU111ial vv-62c. witieti will state tuat lite notttetowtier wtit do all hilt is ilskett UV iiia. i lav isa.siaiza iiet,iui iaaia.iai. FORM U - LOT RELEASE FUHM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** . APPLICANT / Pte/ ��'iv�cr/o�'�1cSy+ �o��C'vlt PHONE-191 W,11,aw% pP.�►�Y , P��. litc . LOCATION: Assessor's Map Number [o"I PARCEL SUBDIVISION LOT(S) STREET �7� ✓tel ST. NUMBERL *****************************************OFFICIAL USE ONLY*********************************** €' EVA AT OWN�LA S: COTION ADMINISTRAT DATE APPROVED DATE REJECTED t COMMENTS M / j� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS MP ELT R� IEAL DATE APPROVED l DATE REJECTED WLI PE TOR-HE T TE APPROVED" 1` af<01% � - -� c DATE REJECTED COMMENTS ` 3 C)le- PUBLIC WORKS-SEWER/WATER CONNE TION /r U_r�e'<_��, ; , T-� RIVEWAY PERMIT FIRE DEPARTMENT ] 147 rt i 1 d 1 RECEIVED BY BUILDING INSPECTOR DATE `evised 9\97 jmJo f=ORM U .- LOT RELEASE FC .M INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from QpardG and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT � � � �"` �^ Aja��J�QYIs; PHONE-19( W 11\1a016 p�„►..�y , P�e�. IVIc . LOCATION: Assessor's Map Number 10713 PARCEL 57- SUBDIVISION LOT(S) STREET ?7` d✓tel • ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** f f E MM AT OWI S: CON ERVATION ADMINISTRAT DATE APPROVED DATE REJECTED COMMENTSGAYif At a TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED I G. COMMENTS ,,��11��. �i �/ /� i'7��c � % .3• �c C7� -_ '�U" ff'Ul�7�n 'tr�� , AUL PUBLIC WORKS-SEWERMAT R CONNECTION r `l , T-S R VEWAY`PERMITLL FIRE DEPARTMENT J RECEIVED BY BUILDING INSPECTOR DATE Revised 919117 jm �Y 11,e /7` ( 15 11--7 1-7 S U c�c . ,30 c�-i7- _ c �� 0 6 00 '�awcnuN Town of North Andover Invoice No. 10/30/2006 1600 Osgood Street Bill To Borselli Engineering Building 20;Suite 2-36 Address Attn: Kevin Borselli North Andover,MA 01845 110 Winn Street,Suite 209 978.688.9540-Phone Woburn,MA 01801 Web Site- www.townofnorthandover.com Phone 781.937.9947 E-Mail- Fax 800.866.1471 healthdeptCciltownofnorthandover.com E-Mail 978.688.8476-Fax Deposit Received $0.00 Invoice Subtotal $50.00 Due upon receipt Tax Rate Invoice Total Total Amount Due $50.00 Amount Paid r�sf '31 Gray Street-Missed Septic Inspection with Health 10/25/2006 -Inspector _$50.00' I -Received by: Signature: Print Name: - 1 + - - ---y _..}. _Subtotal $50.00 Taxi $0.00 I Total _ $50.00 Thanks for letting us serve you! TOWN OF NORTH ANDOVER t Office of COMMUNITY DEVELOPMENT AND SERVICES �. HEALTH DEPARTMENT 400 OSGOOD STREET o, `L NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES Inspection Date: 2/2/06 LOCATION INFORMATION ADDRESS: 31 Gray Street MAP: LOT: INSTALLER: Neil Bateson DESIGNER: PLAN DATE: February 13, 2006 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 []Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: Re: Title 5 Reports: 1St— please see passing Title 5 done by Michael Gracia. 2nd — Done by Bateson —was a conditional pass. Neil feels there will be a water table issue. He found water in the trenches. SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port Wastewater System Documentation—Feb 2006 Page 1 of 6 • TOWN OF NORTH ANDOVER tµORTol Office of COMMUNITY DEVELOPMENT AND SERVICES �?�'`�2D F _ 9 HEALTH DEPARTMENT 400 OSGOOD STREET " � 07 .twinwt.`4 NORTH ANDOVER, MASSACHUSETTS 01845 ��Ss"„CHU Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ❑ 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: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 • TOWN OF NORTH ANDOVER NORrN Office of COMMUNITY DEVELOPMENT AND SERVICES ��• -t • op HEALTH DEPARTMENT 41 400 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845 ��ss"C„,,; Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX No Installed on stable stone base Inlet tee (if pumped or >0.087foot) Hydraulic cement around inlet & outlets x Observed even distribution x Speed levelers provided (not required) Comments: This d-box was replaced during a Title 5 inspection by Michael Gracia of Wilminton. Michael does not have a license to install in North Andover. SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: This system should have been a conditional pass. Neil Bateson is doing another Title 5. Wastewater System Documentation—Feb 2006 Page 3 of 6 • TOWN OF NORTH ANDOVER °t NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES ,r?•`` ^��°�� 10 9 HEALTH DEPARTMENT 400 OSGOOD STREET 4�•, . , +' NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss�c U Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 4 of 6 TOWN OF NORTH ANDOVER Ot NORTN 7 Office of COMMUNITY DEVELOPMENT AND SERVICES � p HEALTH DEPARTMENT 400 OSGOOD STREET • ° . . . NORTH ANDOVER MASSACHUSETTS 01845 �Ss tt�' ,«ws Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains(wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains(Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 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 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVEROf NORTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT � 400 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility information 1. Facility Information Owner Name 2 I &2Ay STfif7- Map/Lot Street Address=�Jn� � City/rown V� State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade Repair ❑ 2. Published Soil Survey available? Yes No ❑ If yes: /�� Year Published Publication Scale Soil Map Unit C ANM04I E/A)6 Z v L O ff— 3 Tb R Put .�Rr s Soil Name Soil limitations 3. Surflcial Geological Report available? Yes ❑ No I If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes Pg No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map 1/ Wetlands Conservancy Program Map Map Unit Name Map Unit Name DFP Form 11 Sail Suitability Assessment for On-Site Sewage Disposal•Page 1 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions.(USGS) /O 160& Range: Above Normal ❑ Normal ❑ Below Normal ❑ Month/Year 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number:. _ O jS1 10b 8.30 Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan) Ste- S/I-;;r S/ -;;rPLAO 77P,P, -'�S 2. Land Use: 'f prx Y.W0 3 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) ruG(J�'i/�.._ Vegetation ' Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 2(ID� Drainage Way 20 '�_ Possible Wet Area 2a I- feet feet feet Property Line 2 Drinking Water Well Other feet fe 4. Parent Material: r :l�1l _ri L L Unsuitable Materials Present: Yes ❑ No ❑ if Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ BedrocA 5. Groundwater Observed: Yes No ❑ �! If Yes: Depth Weeping from Pit �`- Depth Standing Water in Hole -74 _ Estimated Depth to High Groundwater: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 2 of 7 �y Commonwealth of Massachusetts City/Town of lull Form 11 - Soil Suitability Assessment for On-Site Sewage Disp-1 Inches �.!�� levation Deep Observation Hole Number: _ Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other (in) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones LLio y s /� - V.4 ki Ik �/ �1, o*41f% D, 1 c 2/ Y �� L 5510 137 374 3 1at � � s.L Zai 7S -�t Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site S&,Aoge D po�s�•Page 3 of 7 Commonwealth of Massachusetts Cityfrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: 1b A/ Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) 2. Land Use: i (e.g.w odland,agr' ultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way — Possible Wet Area - feej feet feet Property Line Drinking Water Well _ Other --" feet feet 4. Parent Material: GII&AIL Unsuitable Materials Present: Yes ❑ No 7 If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes 0 No ❑ L f If Yes: Depth Weeping from Pit Depth Standing Water in Hole_ '413 Estimated Depth to High Groundwater: 1914 76,171 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 4 of 7 Commonwealth of Massachusetts C ity/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F ,r Deep Observation Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (in') Depth Color Percent Gravel Cobbles &Stones Z.0 00 , v 3 S7 I* G S / Additional Notes 4j . DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 5 of 7 l Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: Depth observed standing water in observation hole A. B. inches inches EP Depth weeping from side of observation hole A. B. ` inch Inith Depth to soil redoximorphic features (mottles) A. ?-� B.- �- �] inches Groundwater adjustment (USGS methodology) A.inches B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturall occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes F No ❑ b. If yes, at what depth was it observed? Upper boundary: Z 7 Lower boundary: __ 7S inches inches F. Certification I certify that I am currently appro a Departm nt of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has ee erformed by c tent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the resu of soil evaluati s ' ated in the attached Soil Evalua ion Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Ic Is // r 0 Signature of So` ator Date Typed or Printed Name of Soil Evaluator `Date of S it Evalua or Exam MIG��LU� Ir9i�� Al- / RxLcz<� Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 6 of 7 Commonwealth of Massachusetts C ityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Y Use this sheet for field diagrams: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal -Page 7 of 7 SOIL SURVEY OF ESSEX COUNTY, MASSACHUSETTS, NORTHERN PART 31 Gray Street f h W n dl�U i Viae m `s s` S@ttS sex R < * 10 Ile k y ^v x; k x� ` +t Meters Feet 0 15 30 60 0 45 90 180 270 360 USDA Naturai Resources Web Soil Survey 1.1 10/30/2006 Conservation Service National Cooperative Soil Survey Page 1 of 3 SOIL SURVEY OF ESSEX COUNTY, MASSACHUSETTS, NORTHERN PART 31 Gray Street MAP LEGEND MAP INFORMATION �] Soil Map Units 0 Cities Source of Map: Natural Resources Conservation Service Detailed Counties Web Soil Survey URL: http://websoilsurvey.nres.usda.gov Detailed States Interstate Highways Coordinate System: UTM Zone 19 Roads Soil Survey Area: Essex County, Massachusetts, Northern —i—� Rails Part water _ Spatial Version of Data: 2 Hydrography Soil Map Compilation Scale: 1:15840 Oceans AYAYA10 Escarpment,bedrock v~~~. Escarpment,non-bedrock --^--A- Gulley muumuw Levee .......... Slope V Blowout to Borrow Pit Sit Clay Spot ♦ Depression,closed = Eroded Spot X Gravel Pit Gravelly Spot ti Gulley Lava Flow 9 LarKMIl Map comprised of aerial images photographed on these dates: 4k Marsh or Swamp 4/3/1995 ® Miscellaneous water I/ Rock Outcrop + Saline Spot Sandy Spot 3� Slide or Slip 0 Sinkhole fif Sodic Spot � Spoil area The orthophoto or other base map on which the soil lines were compiled and o Stony spot digitized probably differs from the background imagery displayed on these maps. As a result,some minor shifting of map unit boundaries may be evident M Ve'y Stony Spot e Perennial Water USDA Nsturat Resoerces t wet Spot Web Soil Survey 1.1 10/30/2005 Comervatiou Service National Cooperative Soil Survey Page 2 of 3 Soil Survey of Essex County,Massachusetts,Northem Part 31 Gray Street Map Unit Legend Summary Essex County, Massachusetts,Northern Part Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI S lA Swansea muck,0 to 1 0.5 1.8 percent slopes 52A Freetown muck,0 to 1 3.0 10.7 percent slopes 421B Canton fine sandy loam,3 to 12.9 45.5 8 percent slopes,very stony 421C Canton fine sandy loam,8 to 7.9 27.8 15 percent slopes,very stony 711C Charlton-Rock 4.0 14.2 outcrop-Hollis complex.,8 to 15 percent slopes USDA Natural Resources Web Soil Survey 1.1 10/30/2006 il�Conservation Service National Cooperative Soil Survey Page 3 of 3 RECEIVED Commonwealth of Massachusetts CJUN - 9 2006 City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage DisposalTOWN OF NORTH ANDOVER HEALTH DEPARTMENT y� DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information .�. r�Sf�tJ C_P_a1.J/A)-- Owner Name _,, ter. r,k !` t_ .,,. Map/Lot Street Address ._ Citylrown State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair 2. Published Soil Survey available? Yes ❑ No ❑ If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ❑ If yes: Year Published Publication Scale Map Unit tW Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes No ❑ Within the 100 year flood boundary? Yes ❑ No �] Within the 500 year flood boundary? Yes ❑ No Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 7 Commonwealth of Massachusetts City/Town of i Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) _,-�/0 _ Range: . Above Normal ❑ Normal ❑ Below Normal Month/Year 7. Other references reviewed: ,1,s r y i C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: -7-P 7 -111410(, Date Time Weather / 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan) L` -- 2. Land Use: � �1u G �p S (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) S. Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way A11A Possible Wet Area ?1%Jh111 feet feet feet Property Line 'Z''. Drinking Water Well Other feet feet 4. Parent Material: comflyc,l 7_1z_L Unsuitable Materials Present: Yes ❑ No❑ If Yes: Disturbed Soil[] Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes No ❑ If Yes: Depth Weeping from Pit ? Depth Standing Water in Hole Estimated Depth to High Groundwater: � ?�\ ',( 1 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal dt inches elevation Deep Observation Hole Number: T/ 115,(_ ` Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Depth (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones tLi' sq Additional NotesAr r ,:�r t 5 �� tJff L l-.'`rte .b DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal I uv� §_ C. On-Site Review (Cont.) Deep Observation Hole Number: Date Time Weather / 1. Location Ground Elevation at Surface of Hole Location(Identify on Plan ) " }gym 2. Land Use: (e.g.woodland,agricultural field,vacant lot,etc.) Surtace Stones Slope(%) Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way Possible Wet Area feet feet feet Property Line Drinking Water Well Other feet feet 4. Parent Material: Unsuitable Materials Present: Yes [] No❑ If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock[] Bedrock 5. Groundwater Observed: Yes No ❑ If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: r U, inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal wFol Deep Observation Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other (In) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones WVM p Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches Depth to soil redoximorphic features (mottles) A. r,;'O B. inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of natural) occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes No❑ b. If yes, at what depth was it observed? Upper boundary: i?- Lower boundary: .. inches inches F. Certification I certify that I have passed the it ev tuator examination*approved by the Department of Environmental Protection and that the above analysis was performe y me con " nt with the required training, expertise and experience described in 310 CMR 15.017. signfitw4 o Soil Evaluat8r Date , ' R.S., ///O f Typed or Printed Name of Soil Evaluator *Date of goil Evaluator Exam Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal* Page 6 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet for field diagrams: L /V DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 7 of 7 � Commonwealth of Massachusetts --- City/Town of Percolation Test Form 12 Yr Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on the computer,use 5US F�^ J t.,l i s only the tab key Owner Name to move yourf" cursor-do not �� (3'-r� � use the return Street Address or Lot# key. /V, t a'. Ahe Citylrown octate Zip Code Contact Person(if different from Owner) Telephone Number I B. Test Results Date Time Date Time Observation Hole# Depth of Perc Start Pre-Soak l ' Z 0 End Pre-Soak Time at 12° Time at 9° / Time at 6" 12y'L`° 6 Time(9°-6") I Rate(Min./Inch) 27 ISR if Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Y+m✓l P:. .✓Asa Sss�"r Witnessed By: + Comments: 0 _* M* 7,z � t5form12.doc-06/03 C = z m Perc Test•Page 1 of 1 Uo t m D= CC z o M Cn v DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, June 05, 2006 11:05 AM To: 'bill@andoverrenovation.com' Cc: 'ashjenkins@comcast.net'; Sawyer, Susan Subject: 31 Gray Street- Need Form 11 to be submitted with plan Bill, As you are listed as the contact person for the septic work on this property, I am acknowledging that I have received the payment for the plan review and 3rd copy of plan this morning. However, I have not received the Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal. I also left you a voice mail regarding this. Please submit a copy of that to me asap so that I may forward your plan to be reviewed. Thank you. AAW Ragwl-ds, pa/*10B4 Da"1040 fiwi¢ Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover,MA o1845 978.688.9540-Phone 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 1 J" - TOWN OF NORTH ANDOVER f riORTt,1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT y � 400 OSGOOD STREET +CC. =• NORTH ANDOVER,MASSACHUSETTS 01845 ss,C" Susan Y. Saw-ver,RENS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthde t(n;townofnorthai-ove.r.---- —. `��,w•.townofiiorthandover.com i�Nz APPLICATION FOR SOIL TESTS MAR 3 1 2006 DATE: 3 A9 lo MAP&PARCEL: TOVI IN(;F LOCATION OF SOIL TESTS: Gra•, �h✓���- OWNER: Su Sat) CI-0 %n — eiys�lhS Contact#: 91 G 6%7-, 053.3 APPLICANT: `�;,,je, c,PA^�AµS Contact 4: 1T9 (EISZ 0✓51, ADDRESS: 3t (5 4c t ENGINEER: XEVJAJ &QSF-SFContact 4: 781-737--9747 CERTIFIED SOIL EVALUATOR: KEV1AJ &RSELLI Intended Use of Land: Residential SubdivisionSingle Family Home ' Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No_V THE FOLLOWING MUST BE INCLUDED WITH THIS FORM i Proof of land ownership(Tax bill,or letter from owner permitting test) Y $.S"x Il"Piot plan&Location of Testing(please indicate test pit sites on the clan) Fee of$125.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION > Only Certified Soil Evaluators may perform deep hole inspections. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. y 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. y Full payment will be required for all additional tests within two weeks of testing. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). > Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval Date.- Signature ate.Signature of'Conservation Agent. Date back io Health Department: (stamp in): 03/28/06 16:49 FAX 617 726 A149 Z001/001 Q3/28/2006 16:33 7819321 ANDOVER RENOVATI, PAGE 02 Susan Cro»in-Jenkins 31, Gray Street North Andover,MA 01845 March 28,2006 To whom it may concem: Thus letter serves as notice to the Health.Department of the Town of North Andover that 1, Susan Cronin-Jenkins is the owner of record of the property and house located at 31 Gray Street. And furthermore authorize Kevin Borselli to conduct a soil test on said property for the purpose of upgrading our septic system. Sincere , Susan Cronin-Jenkins I �Ay N 5 BT4{9 Z LOT AREA S. 45,131 S.F..* ti $w F yl t TP HOUSE 19. 5 s�s. PRELIMINARY 6x p„ 31 GRAY STREET o fto NORTH ANDOVER, MASS. SCALE: Ill = 60' DECEMBER 6, 2005 Prqmmd By EDWARD J. FARRELL PROFESSIONAL LAND SURVEYOR d 110 WINN STREET— SUITE 203 — WOBURN, MA. .W (781)-933-9012 Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Monday, April 03, 2006 3:44 PM To: DelleChiaie, Pamela; Grant, Michele; Sawyer, Susan; Andrew McBrearty; Lisa Kozel LeVasseur; Dan Ottenheimer; Marianne Peters Subject: Soil Test; 31 Gray St, April 6th @ 1:00 The soil evaluation for 31 Gray Street has been scheduled to April 6th at 1:00 with Kevin Borselli (this will be right after the 102 Penni Lane one, which is why that was rescheduled, so that 2 could be done in 1 day). Please call if you have any questions. Marianne 978/282-0014 4/4/2006 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, April 06, 2006 8:26 AM To: amcbrearty@millriverconsulting.com; Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 31 Gray Street(supposed to be today); postponed Kevin Borselli cannot have a backhoe @ 31 Gray Street at 1:00 today, so we are postponing this; will advise as to when it's rescheduled. Marianne 0 Daniel Ottenheimer,President Mill River Consulting,Inc. 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 dano@millriverconsulting.com 4/12/2006 ,r TOWN OF NORTH ANDOVER O�MORTF1 Office of COMMUNITY DEVELOPMENT AND SERVICES H F HEALTH DEPARTMENT .• 400 OSGOOD STREET -:�:•. 4 r NORTH ANDOVER, MASSACHUSETTS 01845 �'SS4CHU 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdeptAtownofnorthandover.com WEBSITE:hqp://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM RECEIV D Date of Submission: (,, _ 2__o6 JUN — 5 2006 l7'9�U cG�. 1 Site Location: TOWN OF NORTH ANDOVER ?v( �jY' �+�'. 110 . �-tn�..tC�X /VI Q HEALTH DEPARTMENT Engineer: �o,r sc tri e�v H New Plans? Yes_ / _$225/Plan Check# (includes 1" submission and one re- review only) Revised Plans? Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No Telephone#: '7$l 131 3q0S Fax#: _1q( cl,3Z 104 E-mail: bt�� n2 Oc�oJry r���tn oro��1 Cmc Homeowner Name: ��cN►��.. f ���&1 DSV3 5 a v� cS c� ��V►S }Ply s to cDo"��/7 OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ _ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Delledhiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Monday, April 24, 2006 1:39 PM To: Andrew McBrearty; Dar, Gttenheimer; Lisa Kozel LeVasseur; Marianne Peters; Grant, Michele; DelieChiaie, Pamela; Sawyer, Susan Subject: Soil Test Results; 31 Gray Street image002.jpg Soil Results-31 Gray St-Ap... Attached please find the soil test results from 31 Gray Street done on April 14th with Kevin Borselli. Please call if you have any questions. Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx 1 1 Location W st Ga.&_ vT, 14 Date L Location �Ir Project 1 Client +< vtir.+ Q,eeS �t„�.'* G�yer+,��e+�a Project 1 ae�YQ,9 VOL- glkRem WresuSf� +AJ+ ! 1 err I ' Ss"Gw"r C>" 11LQ-Ea 16c s7�i fpm S4� - _4E�w s 'pr -1 5ue�f• `t$� Sl MN •ri, r_ •-rp-z f , A, FIm • Y T . -2 • s 0101 6e W rm�m a MOINES NOWNE HIS 1■� OWEEN .n SEE 010 HIM �� �■ ONE0 now ■� OEM [Nonni ROME �- MEMO 0 SmEnimilm NEVA Mai I KNEES IMES Hal ■.yrs ■■nUNN ■nnni sr ■ n ri r ■■s■WE n ■ .� s■■�a no SEE �. �uarra �■ ■ SIN 44 a«►Do.Location 3t Gam►• 'rvwwr Mv6R Date � oa � Location „ Project!Client K�d`�+ �es�5��,� �„ Protect Boar. Q� �©�5& ruggsar�► 8K" i Csrs ��,►to• f 1 f Fat,vJc.�c�tCty,ysnsy,�P•M)- •,• i - s:ai,wales,•M+r�h►s�•S.�.r►cuar5,'�eNt di I S�►r�F. `1$• to 20���roy5.--i rdi85 tt:3 t2�5li _ +�o�• ice' I Z't +�1 MIN MPI • 'TP-?- I a R. � ' saa�w't 58 � •A, 't$ c?t. rt ro Ya NZ SXM .44 •res.I 1 I I tg - OD G V S Z•s Y101 y saME " >�senP.oc,l< aer-vs^i-e I I I 1 a 1 � . _--------- - — -7 L �. .m A-%-'gm= Iwo H�WAR e ■ , � � WAS d MU IBM s� ��n�i ��ini .nm n■ nen. ■i ra TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ' 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 3'33s";�H„gt Susan Y. Sawyer, REHS;'RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ( v LOCATION INFORMATION Cf ADDRES MAP: LOT:_ INSTALLER: DESIGNER: PLAN DATE: '/dy BOH APPROVAL DATE ON PLAN: INSPECTIONS o� TANK INSPECTION: _ I'�i �J (✓1rZ DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE 1. GRAVITY DISTRIBUTION...❑ 2. PRESSURE DISTRIBUTION...❑ 3. PRESSURE DOSING...❑ 4. HOLDING TANK...❑ 5. ADVANCED TREATMENT...❑ 6. OTHER...❑ PUMP SYSTEM COMPONENT SUMMARY FROM PLAN 1. GALLON TANK= 2. LOADING OF SEPTIC TANK = 3. GALLON PUMP CHAMBER = 4. LOADING OF PUMP CHAMBER = 5. TYPE OF SAS = 6. DIMENSIONS AND DETAILS OF SAS: Comments: 1 1 Page 1 of 4 �)A�A If �_ TOWN OF NORTH ANDOVER tµORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ^GNUS Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SITE CONDITIONS 1. Existing septic tank properly abandoned...❑ 2. Internal plumbing all to one building sewer...❑ 3. Topography not appreciably altered...❑ SEPTIC TANK 1. Bottom of tank hole has 6" stone base...❑ 2. Weep hole plugged...❑ 3. Tank has been installed (H-20) Tank Size: 1,500 2-piece ...❑ - H-40 4. Water tightness of tank has been achieved (Visual)... ❑ 5. Inlet tee installed,under access port...❑ 6. Outlet tee (gas baffle or effluent filter) installed,under access port...❑ 7. Cover to within 6" of final grade installed over one access port,must be over outlet of tank if effluent filter is present- Inches of Tank...❑ 8. Hydraulic cement around inlet&outlet...❑ ****Comments: **** PUMP CHAMBER—n/a 1. Bottom of tank hole has 6" stone base...❑ 2. Weep hole plugged...❑ 3. Pump Chamber Installed_Combo tank Gallons; (H-20) (Monolithic) 4. Inlet tee installed,under access port...❑ 5. Pump(s) installed on stable base...❑ 6. Alarm Float Working...❑ 7. Pump On/Off Float Working...❑ 8. Total # of Floats... 9. Drain hole in pressure line...❑ 10. Cover to within 6" of final grade installed over one access port...❑ 11. Water tightness of tank has been achieved—Visual or Vacuum Test or Water held for 24 hours (circle) 12. Hydraulic cement around inlet& outlet...❑ Comments: Page 2 of 4 • TOWN OF NORTH ANDOVER NORTH t 1 � O Sia• ,• ,{. Office of COMMUNITY DEVELOPMENT AND SERVICES or•'`� °� HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845Ss us Susan Y. Sawyer, REHS;RS 978.688.9540-Phone Public Health Director o v 978.688.8476-FAX �j D-BOX �//� DI 11. Installed on stable stone base...❑ i ` O 5 - ( (,� S VPIGS2. Inlet tee (if pumped or >0.08'/foot)... ❑ _ I \ ^ 3. Hydraulic cement around inlet,_&/°utlets...❑ � (��'( ot_ 1 \`� l V t S pecC 4. Observed even distribution...Od bcJ t VCh�_ C-L ca�1 0- 5. 1 5. Speed levelers provided (not required)... u Comments: N(} V`P OL t'&e r S�P_ 40 SOIL ABSORPTION SYSTEM 1 v-) N � 'er- 1. - 1. Bottom of SAS excavated down to C Soil Layer, as provided on plan...❑x 2. Size of SAS excavated as per plan...❑ 3. Title 5 sand installed,if specified on plan...❑ 4. 3/4-1 1/2" double washed stone installed...❑ 5. 1/8-1/2" (peastone) double washed stone installed 6. Laterals installed and ends connected to header (and vented if impervious material above) 7. Gravel-less disposal systems: type,number and location as per plan.........❑ 8. Elevations of laterals installed as on approved plan...❑ 9. 40 Mil HDPE barriers installed...❑ 10. Retaining wall (boulder / concrete / timber / block) ...❑ 11. Final cover as per plan ...❑ *****Comments: ***** CONTROL PANEL 1. Alarm&Pump are on separate circuits...❑ 2. Alarm sounds when float is tripped......❑ 3. Location of control panel: 4. Rated for exterior if placed outside...❑ Comments: Pkj-vJ L ka_vj� n cA— Page 3 of 4 • ` . TOWN OF NORTH ANDOVER NORTfi 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845ACHU CHU g Susan Y. Sawyer. REHS;RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS 1. Benchmark: 2. Rod at Benchmark: 3. Height of Instrument: INVERT ON DESIGN INVERT PLAN ELEVATION Building Sewer OUT 199.96 199.65 Septic Tank IN 199.75 199.24 Septic Tank OUT 199.50 198.98 Distribution Box IN 208.95 D-Box OUT Manifold 208.73 Lateral 1 HIGH 208.80 209.16 Lateral 1 Inv 208.71 208.69 Lateral 2 HIGH 207.20 207.54 Lateral 2 Inv 207.11 207.09 Lateral 3 HIGH 205.60 205.99 Lateral 3 Inv 205.51 205.53 Page 4 of 4 I 4 COMMONWEALTH OF MASSACHUSETTS M EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > DEPARTMENT OF ENVIRONMENTAL PROTECTION c C—C- d F V ��i1,o1v� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 31 Gray Street_ —North Andover_ Owner's Name:_Charles Jenkins_ Owner's Address: 31 Gray Street _North Andover,Ma 01845_ Date of Inspection:2/2/2006_ Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:J978)475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported was performed based on m below is true,accurate and complete as of the time of the inspection.The inspection p y of n site sewage disposal systems.I am a DEP ion and maintenance o trainingand experience in the proper fund g P Y P P P approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes X Conditionally Passes Needs Further Evaluation by the Local Approving Authority F 'S�s Inspector's Signature: Date: 2/2/2006_ IV The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different pe Y conditions of use. 'Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 Gray Street _North Andover_ Owner:_Jenkins_ Date of Inspection:_2/2/2006_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: X One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain.Inlet baffle in septic tank.Outlet pipe to d-box&reinstall d-box to code. N The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N 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: N 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: I 'Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Gray Street_ _North Andover Owner:_Jenkins Date of Inspection:—2/=006— C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ Thestem has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a sy eP � surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance_ "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 'Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 Gray Street_ _North Andover— Owner:_Jenkins_ Date of Inspection: 2/2/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`�no"to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is''/z day flow. No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. No Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 'Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 Gray Street_ _North Andover_ Owner:_Jenkins_ Date of Inspection:_2/2/2006 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? N/A _ Were as built plans of the system obtained and examined? Yes Was the facility or dwelling inspected for signs of sewage back up? Yes _ Was the site inspected for signs of break out? Yes _ Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? 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.Old Title 5 Inspection _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distanceis unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 Gray Street_ _North Andover– Owner:_Jenkins Date of Inspection: 2/2/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_N/A_ Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203 N/A Number of current residents:_5 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): N o_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no):_No_ Water meter reading: Yes_ Sump pump(yes or no): No Last date of occupancy: — Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):____gpd Basis of design flow(seats/persons/sgft,etc.):_ Grease trap present(yes or no):_.__ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available:— Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 1/12/2006,owner_ Was system pumped as part of the inspection(yes or no):–No_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: _ TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool_Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other describe Approximate age of all components,date installed(if known)and source of information: Unknown_ Were sewage odors detected when arriving at the site(yes or no):_No 'Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Gray Street _North Andover_ Owner:_Jenkins_ Date of Inspection:_2/2/2006_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_15" Materials of construction: X cast iron _40 PVC—X—other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _4"Cast iron thru wall,1 1/2"Cooper pipe in house,no leaks visible. SEPTIC TANKS: X Depth below grade: 3"_ 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: 6'x 4'_ Sludge depth: 0"_ Distance from top of sludge to bottom of outlet tee or baffle:_27"_ Scum thickness:_0" 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:_21"_ How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition structural integrity,gr ty,li quid levels as related to outlet invert,evidence of leakage,etc._Inlet baffle corroded off.Outlet tee ok.Depth at outlet invert.No evidence of tank leaking. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 'Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Gray Street _North Andover Owner:_Jenkins_ Date of Inspection: 2/2/2006_ 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 BOXES: Depth below grade _10"_ 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-bog not level&distribution equal,has flow levelers.No evidence of carryover.No evidence of leakage.Others installed new d-bog out a permit from B.O.H.Camera pipe from septic tank to d-bog.Camera indicates liquid flow but not into d-bog,pipe leaking out.Water is notice below d-boa. PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):__-_ Alarm in working order(yes or no):____ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 'Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Gray Street _North Andover-- Owner: ndover_Owner•_Jenkins_ Date of Inspection: 2/2/2006_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type _ leaching pits,number:_ leaching chambers,number: leaching galleries,number: _X leaching trenches,number,length: 3 trenches 25'long_ _ leaching field,number,dimensions: overflow cesspool,number: innovativetalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil oL No sign of ponding to surface,liquid above invert of leach pipes 5'from d-box._ CESSPOOLS: Number and configuration: Depth–top of liquid to inlet invert:_ Depth of sludge layer:— Depth of scum layer:_ Dimensions of cesspool:— Materials of construction: Indication of groundwater inflow(yes or no):_ Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_ PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 'Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Gray Street _North Andover Owner:_Jenkins_ Date of Inspection: 2/2/2006_ 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. Garage Driveway House ® ® D- ® Boz Septic Tank A to Inlet=6' A to Center=T6" A to Outlet=10 A to D-Boz=4016" B to Inlet=17'9" B to Center=17'4" B to Outlet=17'3" B to D-Boz=33'1" ' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 Gray Street _ _North Andover— Owner:_Jenkins Date of Inspection: 2/2/2006_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _>6'_ Please indicate(check)all methods used to determine the high ground water elevation: _ Obtained from system design plans on record-If checked,date of design plan reviewed:_ 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) X Accessed USGS database-explain: Essex County Soil Map_ You must describe how you established the high ground water elevation: Essex County Soil Map,Sheet#36, Canton Soil,Water>6'deep._ Sol 73 fit :m' CL J-k ti1w~1Li-flit-4 - ' Ct1J N�SoQCA-7Q {l AWNS-+ ." 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Wo I�i } T !i11S Y @ y ♦J I ..•j wt 1 g a ('St 0'+LJ W id a' Q-Q CL C13•-i t/3 a l_ ^ y 1 S �,�u Vit. Q,e� t•�• tl " L ."ATF C ��"�x` I�+✓� TTj Q k r +y d.F E. rp C Q � 11■bleeA■1 � a �.� „• •� _�: ace�..„,� s..., _- M 8 v�r " $ S i Summary Record Card gene m 2/22006 1:05:09 PM by Elaine Barclay Page 1 •° Tow. . of North Andover. Tax Map # 210-107.6-0052-0000.0 31 GRAY STREET JENKINS, SUSAN CRONIN 31 GRAY STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.04 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until JENKINS, SUSAN CRONIN Payor 31 GRAY STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13702.0- 31 GRAY STREET Last Billing Date 11/2/2005 1090380 01 Cycle 01 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER 01 ALL METER SIZE 75.46 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16748930 a Active ERT ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 1/30/2006 448 a Actual 22 2% 10/26/2005 426 a Actual 22 11/9/2005 -13% 7/20/2005 404 a Actual 23 8/10/2005 22% 4/22/2005 381 a Actual 17 5/13/2005 -6% 2/1/2005 364 a Actual 22 2/15/2005 7% 10/27/2004 342 a Actual 18 11/15/2004 -19% 8/3/2004 324 a Actual 23 8/25/2004 38% 5/7/2004 301 a Actual 18 6/8/2004 -15% 2/2/2004 283 a Actual 23 2/2.4/2004 0% 10/22/2003 260 n New Meter 0 10/22/2003 0% Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report i Property Address: 31 Gray Street, North Andover Owner: Jenkins Date of Inspection: 2/2/2006 a guarantee of future usage and the functionality of the existing My report contained herein does not constitute g g y g septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. c Neil J. B eson Bateson Enterprises, Inc. C:UMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION JAN 3 0 2006 ` TOWN ur N6R7H ANDOVER TITLE 5 HEALTH DEPARTMENT` ' OFFICIAL INSPECTION FORM,,:-NOT FOR VOLUNTARY ASSESSMENTS,1;, },,;,,. ` SUBSURFACE SEWAGE DISPO i ,PART CERTIFICATION Property Address: 'r 0 dr V A AjD o I/ Owner's Name: y,Owner's Address: �-RtM 4- y � y� Date of Inspection:�`l 26 40 Name of Inspector(PleaPt) /G L ;':company Name:; ': R,4Q/9- BR–AWO& `° Melling Addr`esel° , .21 ,%N/itJ67'Zrt r �1� '' lira • '}`< Telephone Number.r c79' ASY 7797 .�- �.wti -i. v rCERTIFICATIOI��STATEMENT €�'° 4-1, 4 s I certify that I have,personally,hn'pected the sewage disposal s em at s address and th the infotmatiod ieported _ Foelow ls:true,accurate and cotmplete,as of the time of the inspection.The inspection was performed oasedoiWiv �l,it *Yt .a tttatttmg and expertence�ttt the proper function and maintenance of on site sewage disposal syster��anlatl7El' ' rk. `�approv�ed,system inspector pursuant to;Section 15.340 of Title 5(3 10 CMR 15.000). The system ;� � ;- r w A Passes _� ! ZY ra Conditionally Passesr� Needs Further Evaluation by the Local Approving Authonty�t _t 1 ,* .' { Fails X FS br k {jzf( ci 1 t}art � f.., 1 J� ' ��eit• s D 1�:tWl•t��t` $Inspector's Signature: Date: t Y, d1 H , .` r}�� ,zs'7' aM1 '✓ S.`�' '� Y }+F r>t j,.C. •''tF r j ',•� ,� 11 4?.�s'S4FiF riot;'7 '�*k Fr* The system inspector shall submit a copy this inspection report to the Approving'Authonty(8,oW ofHeatt�t'ots¢4 � T2s► ;DEP)within 30Aays of completing this inspection.If the system is a shared system or has a design tlowjoht. j 0$ t r Y � �, �`; •gpd'or greater,the inspector and the,system owner shall submit the report to the appropriate regtonal,offieofti t orlgmal should be seni to the system owner and copies sent to the buyer if applicablean�dilie .I.455.'N xt al1tl10ri 7-,Notes and Comments r, j s:a '. i S 7 �f ,//,��•S i a fi r' c -. x. � vw�-��+ ' >1•`7� r t' t,� 1 �,:ii° t 4�. ?' '��y �,CC>* r.s. e 'f,:t.¢ySi �{�`r �s� it � �jh 1 j h'� ; f a .. - 4�n's�^ t *;! '•s„� }.'li,€ r i , �`'"tg „`.. ..w`kts�`i ems''{a r y y �. >-. �•. `.� .''. ,!' .,J'p -r w. .,..r• r'� i>.y<, ,4* *Thls"feport only describes conditions at the time of in and under the conditions`ofds t r k ' tine Thli 6ipecdon does not address how the system will perform in the future under the 3sme of etltilleredt 'rte c iditions of u3e. �4rl.' prt r 4 � i111 rvr' e t sk 5?a�Jitle 5 Inspection Form' 6/15/2000: page 1 >; Pa g6;2 11 ` t < �' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSE x,,,�'' . -> • � t SSMENTS� , ` ;SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMS {` .. . - PART A CERTIFICATION (continue(l) •Sa Property Address: 6AA4 S7 1 1`:. OWnet' ,SF .aDhte of Inspection: D ' ,.Inspection Su+mmaryc Check A,B,C,D or E/ALI" complete all of Section D t , ► :# t iI.# A..,:- 4, Vf ' X5.3 have not found any information which indicates that any of the failure criteria described in 310 CMR or in 3,10 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. ' .Comments: 3. System Conditionally Pass { �? 1 O e or more system components as described in the"Conditional Pass"section need to be re lac I1 Y P P .,a o � repalred,The system,upon completion of the replacement or repair,as approved by the Board of Heayylth,w111'p' sj�y,. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not>detetmined".pleas Z explain j p j ', •' `T y'r/.l ytA r�{�itltf sic tl��t��013,ji-Ai I' r . ')CG i f q {}, } �+F� p IT1 i" r.rtp•.,n 7F f y>,+,1�"tj . . {t.Esf/n`Thb se tic� 'i§metal atfl�'over;20 years old*or the septic tank(whether metal or not)is sMicturay- sf r#. K{• >. t ,> x:ui ?tinsoftn tell bits su�stahttal infil{ration or•exfiltration or tank�failure is imminent.System willli',pass,tns echo r' K / 'M1 � ie. S' �' i • ¢ exfi16 tanit Is replirC'ed:WtM complying septic tank`as approved by the Board of Health.' _ metal septic tank Will pass inspection if it is structurally sound,not leaking and if a Certificate of.Coinpliance, ` c �{ indicAliitg thatthe tatilcFis less than 20 years old is available. .. . All. ' t 45 ��:ND explain' 40bseNation of sewage backup or break out or high static water level in the distribution box due to broken: `�' i'obstructed p#pe(s),o`due to,a brokett,settled or uneven distribution box.System will pass inspection' k ;�}=�aPptoval of Board of Health)' • 1 � i br� "r�irlixfrstit3}vf�• it,txbroken pipe(s)are replaced t30t t"lS wr>t'1 hAlOA �,;obstruction is removed-• ,n r•Ifr »fi ►• ,T v �t, t ` i�tl �s AfM.,0 j `.+�40istribution box is leveled or replaced gin: ��t01 "+N pit iSill rf, �4it j+jLtl 't� •ir,�terl.: u�` ji � ��qy���NDe piatni1�i , E I 7 i•��y�!r � x.�r (• Ra.�,""( h3, � e �r`Y'�r !r Ff t G. f 1i. '.. } tin+.. M �7•{ t !'.,� ry'{,t+f. '<>,N a4-, h' d i' -•• - .,:! ''tj* �- >� 1v�f rv,^ :' The system required pumping more than 4 times a year due to broken or obstructed pipes) The+s w} pass ldspection'if(with approval of the,Board of Health): broken pipe(s)are replaced " , r •, P, obstruction is removed f i.=•:' �r t 4„ eI ,t f)r V*4 q��boill ..7,,F 116L-. ��.�ti�tq�'r,': i. .. - �f:{n�1{�7�� �' j ♦ t� � �1�'X�J>'g"��i'At'"t� �:.t`.+r�.t -+1F.Ith;rftri •° - y.,, "t`' ft`��J�•�r Y '+ �y {�,.;^�''�'!'� . t1 6$f'sa �'..4�/.�� S ��J � �' 1 .. ,�t •" � 3 1. .drx� ? '5' I 01 Page.3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: V l . _Fr; . ��--�^��� ' Owner: J Flfl1014 j Date`of Inspection: # tic 106 C. ..Further Evaluation is Required by the Board of,Health: ' ; � F < Conditions exist which require further evaluation by the Board of Health in order to determine if the system,_ ' ,'' ►`i its failing to protect public health,safety or the envirottmFnt. • r )1 'System.will pass unless Board of Health determines in accordance with 310 CMR 15.3036)(b)that the s ,system lspot;functioning in a manner which will protect public health,safety and the envlronment:�i '►,. ; �� _ CesspooI,or privy is within 50 feet of a surface water ; . . V", 1Ct L1r• �t �� r. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh r •�, •,k •,JAS•;, ,�� .,,.. t , -46 Vii . ,�r t};, ►Birt'" r} +: i' 'rri •ti: � f .•il,,- ' "�' t�Y � - '. .�t1,R'tfr�,'"A ('•;�,.ryre �a...t ,.,.�• f! ,;'i .r r •?SStI,' �r tl.. �. < .. 4i . , LoSystem will fail unless the Board of Health(and Public Water Supplier,if any)determines-that a ,�� isysteni Is Nfictioning Wa`manner that protects the public health,safety and environment:` # } ttr �y tt.: , + , x .:r ?ti � i ( j :,lr,f,jr.it'{•r�'4l'411..ti•A .�..,.�7 i "Y`!' t r{£y,:tl ' r`_�,�The system hasPa septic tank•and soil absorption system(SAS)and the SAS is within IQO feet of a,, •_t rf, 3_ surface aterlsupply or tributary,to a surface water supply. �. �� �t �'a'4�►G i�% a. ,1 � y 'Y' �1 4. i k [T:���K r ,�i.. �tOe system has a septic tank andrSAS and the SAS is within a Zone 1 of a public water Supply.l. 4 '��� `�,��y,�Ai'}9,�tlt�tt,.�.,��Yr�t�'�f{+�ir;3a(�1:�;��3y�•�a .�,,, :• %+ti t>,r�t tkS�tl'��;i�' �*5'r`�'•�QS' ti +The system has a septic tank and SAS and the SAS is within 50 feet of a private water suppiy�well. 4 `F`' r i ' � r .��Zw'..a�' a.,; t ..,.';,..•, The system has.a septic,tank and SAS and the SAS is less than 100 feet but 50 feet or more from l gate ter su 1 well**'Method used to determine distance a r'' fc r pp Ys _ ,... i +c ''i•r� i,,_•,',r •t,;>yY T s'r *►f �:,{',� �� r. a,,. ► ti r` w r **Tlus$ystetn passes`if the well water analysis,performed at a DEP certified laboratory,:for coliform bacteria and'volattle organic;compounds indicates that the well is free from pollution�6om tha facility the pits, of ammonia pit rogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no'b t F s �fatltue cntena are triggered yA copy of the analysis must be attached to this form.,^J {Y :g sai 1► y�� �` A i i ��•.. �i . j 1 j. ` Yy ..a li�' , • . Vit'►r N, SC+E II 1�,, '^�, � ••� F�=S`'i � r., .:.A QF t+r:►fi �rH � i •t<''��F :a-a'��# �'.ya ..a j' � y,,,,�,� �e' }} ,.. � _. Ft t t :.,�• � ; + ' � {���.���'°��#� r:i�;'i? !f j't•r Ji;}`� � �f` ,. r t,.ir t*��.l� 'a��.r,. F¢, r{, T tr ;;.. y'.:.t 'i` Y ", a�•3 T * r _, 7. fes,,J?i � � " t�+�rz �� r�{K •. � &,c �o ir'� ��}"� 'y�:�r,,�Wp�'S t<7 r����t}i�'d�,C`0{�+�'�j�:Te�u,i�y'r�° '.� y • •r. i'" '�i��T/'�'��#*� . �.r`pa.+:. . k�� �`� #, •.:b'�,�1kr►�3!IU.� 7�3f.'���r,�Q� ?j ` ,"(: 3''}.stir ,,,�'�``4R!•t'y'�t` '1 �Fq•• f��fye,-:��ylliD:M,V'H � ,�,',,le � `��' ar �;�rri�!'• ;�#,� ,{'t , .;try.vu `•frf?tf!'3,i3 ��� •'� +ski 14 3 1{ tib} J � F�sF'Sf, M i Jr..• �- ' a ' Page i4` • y .. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CE11TIFICATION(continucd) 1 Property Address: v1Q 'Owneri` �7ss 4 ,int 'Date of Inspection: } D �System Failure.Criteria applicable to all systems: You, us indicate`yes'.-',or"no"oto each of the follIng for all inspections: Yes No, .. 10acku of sewage Into,facility ors stem component due to overloaded or clogged SAS oi6ss 1 tiDischarge,,onponding,of effluent t the surface of the ground or surface Ovate d ue to ad'overloaded k ,cogged 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 invertor available volume is less than%:day,flowL r Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes) Number,; s r'};•oftitnes pumped" rptA E , t { ;Any portion,ofthe 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" ' :�' .. �d3wateraupplytii*a, -�� ; . .t .w . ,. tt+st tlt•. t����•; �.�;, ' 'Any portion of a cesspool or privy is within a Zone 1 of a public well, :,Any.por`tion.of a cesspool or privy is within 50 feet of a private water supply well .�.• °�°►r►Y P . `` < ortion.rof,a cesspoolor privy is less than 100 feet but greater than•50 feet•from a timate water "t�: n ; P• r p q quality Y i Y p y r supplywell with no licca table water uali analysis. This system asses if the well Witte anal i k§ rr :!!performed ita DEP.certified laboratory,for coliform bacteria and volatile organic compounds ^W' indicates4l at_thi-,Well is Tree from pollution from that facility and the presence of ardbonia » in and nitrate nitrogen is equal to or less than 5 ppm,provided that no other,failure criteria 't.,�� r4I are triggere&A copy'of the analysis must be attached to this form.] j0p;1 < 0 hes stem fails:I have'detetmined that one or more of the above failure criteriafexist \! / y 6 d bed in 310 CMR-15.3031therefore the system fails.The system owner should contact the Baard'' , x ' r .. Y Y Health•to determine what will be necessary to correct the failure. «1' '. r 4'�• � `�'';t??'aj l!I(�'!yF..�:'ii '�i ?,�`..-"•! .tat. .�t,. `..'�t?}',}y.`_ �. �'`�,� Wi`t c k'�°r `°t _ k �yy,rye .�h{N[7 ( yr'• ty tri` S`_a w � ' ti.� ; im ,"; E` I.arge•Systems:aa#i a`v) r 4 1 s ttr .t ,To be considered a larges stem the system must serve a facility with a design flow of 10,000gp8 to 15;000 t�� ,: 6Pd3ry' l� ''.: �.•� "' i.:ti:, :, :. '. +s °� �her f'•�,� . ... • ,Yot�'must•indtcate either••`yes ,orr"no•to each of the following: (The'following criteria apply to large systems in addition to the criteria above) iv �e ^n0 Xf` r Se• 1 ,.C� a - A` r �the system is within400`feet,ofa surface drinking water supply ,. „„ t"l r �•�k ' r,�l• i i r a system is within 200 feet of a tributary to a surface drinking water supply, `...�.Y'� Cats F�.a+rwM•....t •'Ya'i+aai«.r•... `{.. :.'_ ya'.i ,the systedf is located'in'a nitrogen sensitive area(Interim Wellhead Protection Area IWPN�or a " tR `Zo3ie II of i' pubIie water supply well �• r �...• , T �.Ary t*X._ 'i I4 bu have;a s'were' yes,to any question in Section E the system is considered a significant threat, an r fi"yel�tIt SecE on D;above the large system has failed.The owner or operator of any large.system considered 3 . stgn�ficantAiteat tinder Section E or failed under Section D shall upgrade the system in accordance witit`_310 C ' , } 15304,41e system owner should contact the appropriate regional office of the Department. . 11} ♦ Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Amon- r Owners" /� / ;.➢ 4,f# Date of Inspection: • � •r~rt:tf 'rr :gym Check if the following have been done.You must indicate"yes"or"no"as to each of the following:, Ila t'1 'Yes ' NO Pumping information was provided by the owner,occupant,or Board of Health 't'wtsosf� e1;, Were any of the system components pumped out in the previous two weeks 7 >. ., " -. �:rj,;,•' �;dray 4�3t„�,ti #' ! Has the system received normal flows in the previous two week period? " a► Sip 44 $#.b it 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) ?> t, s . .at • . zti 1"�.}i:D'!tr• �3I{..92�� %:.,�„�,r_ �,� ' Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? ltF7 Y ; *4 f fr-."Were all system components,excluding the SAS,located on site 7 { r •Were.the septic tank manholes uncovered,opened,and the interior of the tank inspected for.the con r •- ,r, •'.•, of; a bales`ortees�`material_of construction,dimensions,depth of liquid,depth of stud a and dPtl'of sctiin° _,_-,,Was the facility owner(and occupants if different from owner)provided with information on the fro maintenance of subsurface sewage disposal systems 71#�� r • f t The size location of the Soil Absorption System(SAS)on the site has been detetnittled}basel >Ti. ;a , . kk jExistmg information f For example,a plan at the Board of Health. r�;ter. ' l ila•,« t' `r _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation o unacceptable)(31d`CMR'15.302(3)(b)]r. ' 4, �r., 't ;y'.., 'N•{ 't�lt'�3#I•r �plj�t.4114f t �t1 , '.� : 1 t r�'•11t'j��t�.,F�t �r, t..�. ✓ ,_ w1 k+T �f 4 sL PV. ��/` AI V I'LL �W y i{,. •Y' Jt _.,i3y!.'�4.t' , �• ` 4� r . • _;.. y, {v v.l,. 3 t ti F� ��: � s Page 6 of 11 _ :OFFICIAL;INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i -� PART C SYSTEM INFORMATION Property Address• ' v .fie_ 3 •."rF • - - Owner. *1 FUNt _ __ � •t.vx ! Date.ofInspection• FLOW COh(DITIONS w RESIDENTIAL, ; Number of bedrooms(design):i ,` •Number of bedrooms(actual): b��fGN•�low based on 310 CMRJ 5.203(for example: 110 gpd x#of bedrooms): '' F es. -,:Number of curfent residents: , `'a , . ?Doesresidence have a garbage grind (yes r no : `t �� Is`liimdry on a separate sewageasyste es o no . [if yes separate inspection required] }y Lailttdry system inspected(yes or;no). two- 0 �`r t Seasonal use;(yes,or o r.ti' • , '� Wafer meter.reading , ava'fable(last 2 years usage(gpd)):�e2 fk� ' a�+ 1�ate pump(yes orno): �'of occupancy:, COMMERCIAL/INDUSTRIAL /V � _ ,, � ' �' � �'•' , �' Deslgn�floW(based;on 310 CMR 15.203): d .: gp i . lir ws of desiepow(seats/persons/sgR,etc.): x iGre�se trap present,(yesor-no)!. r ;Ind6trial�waste holding tank present(yes or no):i b•.;,� r� r Nori sani40:waste discharged to the Title 5 system(yes or no): �' WAter inetefreadings,'ifavailable: > Lastz"date�ofoccupancy/use: '" = fio �irj .t F. t .lir• of � k. �i:- °GENERAL INFORMATION �Pdmping Records t-a D• r tttit* vK= #, [ y ; source of information. @ICAO! ✓NO ' � ,`Wal;Tsysterf"pumped as part of the inspection(yes no): _ `i;tIf yes,volume puiriped'• allons--How was i umped determined? Reason.�fol pumpmgt t'r.l, 7 .'��sY jC � } +,Y� G't��. i.i ,i.tf i S"4r•..a3f? yi�r��M:i t �' 'I'lt E OF SYSTEM w r kr# 4 "ft . Septic tanl sAistribution'box,,soil absorption system �,}Singleicesspool ` s,� �'•: 5: +e }!„ � � r .. K*Overtlow,ces olid r Y 4 i e►: ,;,Shared system(yes or no)(if yes attach previous inspection records,if any) F - "Innovatly..e/Altemativetechnology,Attach a copy of the current operation and maintenance contract.(to obtained ffoin system`owner) L , � i tank x , Attach a dopy of the DEP approval x r Other(descnbe): w , ' r +� t�' 7ka r t is du}.! .,k r rApproxtmate.age of all com ne date' stalled 'f own) d source of information: w4 c Were sewage odorjf etected when arriving at the site(yes o o): , ..{` Jr° 'iii' .f t.y�:. •k. . - •��tr tj� Z'�`��' T a kj Page.7 of 11 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS'r . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continucd) Property Address: l Date of Inspection: . + 1 r= BUILDING SEWER(locate on site plan) I`` 14i t 1Dt2` • ' ° .i, Depth below Bade: } I'd If;;lsU Materials'ofconstruction;'` cast iron !40 PVC_other(explain): :�;-: ,Aft F -r Distance from rivate,water.su I well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): „_< <p►2tcmrf l r t'v't!i'tr23t X +, SEPTIC TANK:_(locate on site plan) ' x'"•Depth below.grade: MatenaCofconstruction; concrete_metal_fiberglass_polyethylene d other(explain) ' Y If tank is metal list ege:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy t cettificate).= ,� i Dunenstons �` � 'Y 'r�tl r• ��,�"?„ Y'”k{. �`'�*' -,7 Sludge depth: ► — �� _ 1 • ry ,3 , ", i 4 •Distance;f rom top of sl a to bottom of outlet tee or baffle: 4 ` j.Sciigithkidiss� ',nig .r^I'r °tTt Ed+1 2i{• }t� it' I, {�11?ffr ,=i s �' Pa'fq � t 1 t31 t{ ,-� Dt3taitce from top of scum to top of outlet tee or baffle: r " `} Distanceifrom bottoin:of scum to bottom.of.outlet tee or baffle: �',r'_`x `'•�° l • .HoWt�were dimensions determined:.,' . SU/'`v,� �N '� 4 q < -� �" .._` 'J � t...wr,.:.. F•t 4T't b �.. ; rti f ' Commeftb:(dh pumping recommendations inlet and outlet tee or baffle condi n structural integrity liquid levels ► K Ifi4D AtAptj W/J ' as he ated to`outlet-i/nyv-errt,,,evidence of leakage,�e�tc.): �i N1S �) ° d. S;pe �U M/N1 �I//Itrd/7[ S ,f,4r.;•kl' .. � t� /3-t!! , /f-•.%/�I•a `!���'�� �.rarh.r !!!J �.a qd+- �A�, t t.4 E . EASE TRAP. _(locate onsite plan)--o: Cl fi «A 1 p _ -n .3\,. ...f,h�..•a.,.� .': .}-. ... ., - J -.may j cFi` C•,1,`j./.',,,?�� 5, Y r, n Depth below grade.. ` ,Material ofconstruction `concrete . metal fiberglass__polyethylene_other :' 1 t 1r .�Gtt � � tri ��` ' 'r SCWiithlokness:., _; ', ; {" � D�steaceA�otn top of scum to, of outlet tee or baffle: c D9'a C"e fro�"'bott�m�of sc'tiiri fo bottom of outlet tee or baffle: Date of last:pumputg:k Comments'(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrityrliquid i as "laced)o outlet in tit,&evidence of leakage,etc.): K": x t S j � �:•tt� k r � A. ♦ ' .�F AA�7'Gx`R �Ni"A `• ,LY.Y tom, 4 T .. .t_•.Y:t r•t!• � ,y,r.V:f,r�a� �.. t`tt; :+'�F•l. A. Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART C SYSTEM'INFORMATION(continucd) PropertyAddress:` =r i DO O!K A' ..-:,;Owner:,. Date of Inspection:A. ,. .. :TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate onsite plan) .Depth below-grade: wiW tit,it"t- Material of construction: concrete metal fiberglass ___polyethylene other(explain): �* .Dimensions: :,i,,s„''r r )Rlnlrrtty t; r ,K r �-dapacity: gallon Design Flow: gallons/day ` A arm present(yes or no): rAlartri lever Alarm in working order es or no): :,Date'of last pumping: M Comments condition of alarm and float switches etc. : ` 7 6. I � r .r .y�•ir\i��Z s (DISTRIBUTION BOX: i(if present must be opened)(locate on site plan) ,a'at}imeiL „,.. (;• `-'},. � .1•Deptlitof liquid level above outlet invert: t6)r A'T '7All6/Z7 :Comments(nott?ifbox is level and distribution to outlets equal,any evidence of solids carryover,any evtdeQcgofw; �” Sew ge.into r out of box etc, , 1 .Y 'it � � � •.. 1A A ��}T, i t r ,•1'11ry ., ��}n�i�t�e`4���'Fi [r �. - ?Rl���#:.�il[thiif•1�����r-�f" {r i�1 '..' .' ;I,!tib .�4�.1�s�7��'.• y�, 'f Y �t .t r { •' �u�i .': '�� -.,, • :T r •. , .x r tis#it+.f�7rt 13'� t,�r 1;.�. PUMP CHAMBER. (locate:on site plan) 4" j Imps in work& order(yes or no); Alarms in'working order.(yes or no): . `f ,Comments(note condition of pump chamber,condition of pumps and appurtenances,etc): •*zr 5+� J� _ ryyu i p �1' '�� ��, '� r,t ?.7e.. f wr'y i' •AI i`f..Sµ��']2.. � �.r5 • r rt _: �t Y t'. l ^i 3 'S`15 r r f,R•�L.i tirti..^c 1�i�yt�ff�>'f7P1"1t F#�•' <° • ... v ..'iii. i�•n '.5 - i "t ;t���t��•'��e� �'f a: F•n� 141.' t- � ;{r+r �w t1j, 131!� �,y, i J� I}f a ':�r )i` ;�. :I1.i•i (t�#jt�lfyid#(j c'I k; ' 'r •`�'k�� fr �., i,;d_ ':°�, " �•' .. i r r t••ky9 r=i IJi:'l lr�. • '�� -� .-,,,•'�a k 2}h.r •r,,,L.��. y;" y:'... .I .. :'-i.«. j' + `L ' 4 � v f1. r ps Lt'S'(t ✓ , ��.�� -?`;-- ,;r,.,,,.yy .;c- •}-.!.�� a •�4+r+:: a� �f .t w Z # 1 - f r- � ••� i , i •' h. , . `Page 9 of 11 y OFFICIAL:INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS•,ki SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: A a `. ��"2� , _ t` I Owner:' ' Date of Inspection: SOIL'ABSORPTION SYSTEM(SAS): (loc_ate on site plan,excavation not required) If SAS not located`explain why: Type o " :leaching pits,number: , teaching chambers,number: leaching galleries,number. leaching trenches,number,length: L• .Y: leaching fields,,.number,dimensions:77 u "overflow.cesspool,number: iMovative/altemative"system Type/name of technology: r 't. Comments(note*condition'of soil,signs of hydraulic failure,level of ponding,damp soil,condition of.vegetation,` r^ �. �4 etcc De r►/'� t ? ., CESSPOOLS: :(cesspool must be pumped as part of inspection)(locate on site plan) t ._, ass='.. T; a Number and configuration: f, t''Dep th-top `of liquid to inlet invert: Y '� ,',;;Depth of solids layer. s, �Deptli of scum layer•.. t D6riensions of cess v,i poo: 3, � "=tMaterials-of constructions v Y _Y ,yq4 r.r4 e i Indtcati' df groundwater inflow(yes.or no): Cotzltnents note condition of soil 1'si ns of hydraulic failure level of ponding,condition of ve etatio etc. : 4 � ;hk 4'.' .tr - ..�� itis,, �f� K ik.S+L : •,*..�t.i ✓� 3L h i 1).i , n a `PRIVY `LLLVocate on site plan), Materials of construction' i { Dip tfi of Qlds` Comments note condition of soil si o hydraulic rr �� zs( ,i gns f by c failure,level of ponding,condition of vegetation,etc,): # {`{r'�t�H,.� y���'1 "��»4f r..~ •• • r }r.y r �,i.,��••X- r. 9 ;;, ( rk. !.:' ... a ' ••_i s-vii a.'. '5 l?age°l0.of.l 1 .",OFFICIAL':INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS+ j SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (rontinuril) -Property Address: 31 '<. Date of Inspection: 't 'SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a'sketch of the sewage disposal system including ties to at least two permanent reference landmarks or p-,_-A,;?{;1 benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. i j, 3 rA ' e) r ,t . :�A��.. t t``'• e^ + r ^ •�� �' in=ASF. + ���� � ,.���1�.�s,'. 1�. . 24,N-0...,,. i �4 - ' y 'y� 1 �40 R.r. 'fie�� ,7 s,� � 5, . � � � ;� A''� .° �gV ✓�M{ r,r v7 t•'.i # ( . +1 (J+3! � 1 e ox 4vJ tY 7i� rY{*aVa.�S�lt+tltti :,rt . t,flt s 3 r ¢ t Aa {4 a �4�t t F1Y...• -0H' ., !kw r..j... i;�y��r{l7� ��� i. F "}k.y �t .i pat ` " fit#� •�Y 1 +� t� � r , t. J.,. , � - '� �{•+-;�`''�''�,1""` i�, X11 .�'�^ ✓�';�_1� C AN 1 ..t•tp d 10 r rs,. •�� .d W. � ., i.,F� y'rkdo!if t'- f '` 3,�. E::::T ,.4:P.age.11,of 11' ' l f. n' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continual) Property.Address: CS Owner: Date of Inspection: 06 SITE'EXAM' r Slope po,�. Surface water✓// 'Check'cellar ••+Shallow'wells r. z `Estimated depth to ground water _Ir feet ' Please'indicate(check)all methods used to determine the high ground water elevation: I-ILObtained from system design plans on record-if checked,date of design plan reviewed: 73va •.� .t�, Observed site(abutting property/observation hole within 150 feet of SAS) x" !Checked.with local Board of Health-explain: ' r aCheckedwith local.excavators,installers-(attach documentation) Accessed USGS database-explain: i You must describe howyolu established the high gro nd w terreelev ion: J t i , f . .� .i �lE tt+-� �S 4G c tillr �A�tJt QGA�� i + at2 ' }., ) i•:. 111111 I :: J f 1 y, wb4. t ug 4't. �j'f`� •'I.I v"'� 'rte •Mr ,, � � •.���� y f •rf/-.di �� ow . s,}l:'`. 5 ,yw.E Ya A tes.. te 50 c O e M£' � 1 Ae ago4 v4 V rJ/ co At +� , ar�'}r� '� T ,�z'�,r 4��. .` J.r�r•( Jt- reW�°►.r"R,V" Oit i I rl YcC) r ` YG �d JTk /au /Olt' Y Jan :ar 6 ; =. i. 3K, P. 1 y Summary Record Caro ge, ad on 1130;2006 10:48:47 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-107.B-0052-0000.0 31 CRAY STREET JENKINS, SUSAN CRONIN Gf ;SL< ' 1 l• / 31 GRAY STREET tt N. ANDOVER, MA 01845 Class 101 Single :"&m0y Property Type 1 Residential Size Total 1.04 Acres FY 2006___ UB Mailiny_indax Name/Address Type Loan Number Active/inact. From Until JENKINS, SUSAN CRONIN Payor 31 GRAY STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13702.0-31 GRAY STREET Last Billing Date 11/212005 1090380 01 Cycle 01 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 if WTR WATER 01 ALL METER SIZE: 75.46 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16748930 a Active ERT ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 10/26/2005 426 a Actual 22 1119!2005 -13% 7/20/2005 404 a Actual 23 8/10/2005 22% 4/22/2005 381 a Actual 17 5/13/2005 -6% 2/1/2005 364 a Actual 22 2115/2005 Igo 10/27/2004 342 a Actual 18 11/15/2004 -19% 813/2004 324 a Actual 23 8125/2004 38% 517!2004 301 a Actual 18 618/2004 -15% 21212004 283 a Actual 23 2/24/2004 0% 10/22/2003 260 in New Meter 0 10/22/2003 0%