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HomeMy WebLinkAboutMiscellaneous - 314 REA STREET 4/30/2018 (2) 'J ' . I` �� ���-��n _ � ■. W r.0 ;-� � _, �. -- f r Lot & Street 8/ Map/Parcel �� I CONSTRUCTION APPROVAL Has plan review fee been paid: ES NO Permit# Ufa Plan Approval: Date: �Iee Approved by: i� Designer: lnv-i�',15ot Plan Date: Conditions: Water Suply: . Tow_-_ cif Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved :�::���������� Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YE NO �0 �r,°r' U,*��S FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: i R w SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? NO Type of Construction: NEW P I New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U Y NO Issuance of DWC permit: NO DWC Permit Paid? NO DWC Permit# q45 Installer: e Begin Inspection: NO Excavation Inspection: — Needed: Passed: g` By: ✓�-���Z' Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: V D1 By: Final Construction Approval: Date: 2 By: Certificate of Compliance: A� 1: �� z� 0-,i -Bafa;_�� C( 1�V MM TWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRON CTION 5�. b ,. JUN 2 5 2008 TOWN OF NORTH ANDOVER L /0 HEALTH DEPARTMENT TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 314 Rea Street_ _North Andover_ Owner's Name:_Sean Connolly Owner's Address:_314 Rea Street _North Andover,MA 01845_ Date of Inspection:_6/7/2008 Name of Inspector:_Neil J.Bateson_ Company Name:_Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,MA 01810_ Telephone Number:_(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP 7 approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F Inspector's Signature:411f Date: 6/7/2008 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 V 1 i Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_314 Rea Street_ _North Andover— Owner:_Connolly_ Date of Inspection:_6/7/2008_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements. 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: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_314 Rea Street_ _ North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require q further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: No— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — _No— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No_ Liquid depth in cesspool is less than 6"below invert or available volume is'/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No_ Any portion of a cesspool or privy is within a Zone I of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone I1 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ Pumping information was provided by the owner,occupant,or Board of Health No_ Were any of the system components pumped out in the previous two weeks? _Yes_ Has the system received normal flows in the previous two week period? _No_ Have large volumes of water been introduced to the system recently or as part of this inspection? _Yes_ _ Were as built plans of the system obtained and examined? _Yes_ — Was the facility or dwelling inspected for signs of sewage back up? _Yes_ _ Was the site inspected for signs of break out? Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the 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. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_440_ Number of current residents:_4_ Does residence have a garbage grinder(yes or no):_Yes_ Is laundry on a separate sewage system(yes or no):_No_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no):_No_ Water meter 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 March 08,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank_ Reason for pumping: _Inspect tank&tees_ 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 7 years old,9/17/2001,as built plan._ Were sewage odors detected when arriving at the site(yes or no):_No_ Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_18"_ Materials of construction: __ cast iron _40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _ SEPTIC TANK: X Depth below grade:_6"_ Material of construction:_X concrete____metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):`(attach a copy of certificate) Dimensions: 10' x 5'x 4' Sludge depth:_2"_ Distance from top of sludge to bottom of outlet tee or baffle: 25"_ Scum thickness:_4"_ Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17"_ How were dimensions determined:_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc._Pumped septic tank.Inlet tee ok.Outlet tee ok. Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_314 Rea Street_ North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX X Depth below grade _18"_ Depth of liquid level above outlet invert:_0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.) _D-box level&distribution equal.No evidence of leakage.Evidence of carryover,pumped d-box to clean._ 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.): _ Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type _Leaching pits,number: _ Leaching chambers,number: Leaching galleries,number: _Leaching trench,number,length:— _X_ Leaching field,number,dimensions: _1 field 25'x 36'_ Overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok.No sign of ponding to surface._ 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.): Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building Porch FF A 1 Septic House Driveway Tank B Water 2 Meter C A to 1=13'3" D-Box Ato2=16'5" Bto1 =26' B to 2=20'5" B to D-Box=47'6" C to D-Box=57'1" Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_314 Rea Street_ _North Andover_ Owner:_Connolly_ Date of Inspection:_6/7/2008 SITE EXAM Slope_No_ Surface water_No_ Check cellar _Yes_ Shallow wells No Estimated depth to ground water _3'_ Please indicate(check)all methods used to determine the high ground water elevation: _X Obtained from system design plans on record-If checked,date of design plan reviewed:_3/11/2000_ ^Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:__ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: _ You must describe how you established the high ground water elevation:_As per design plan_ Title 5 Inspection Form 6/15/2000 11 Summary Record Card generated on 6/6/2008 3:02:55 PM by Lisa Evans Page 1 Town of North Andover Tax Map # 210-038.0-0123-0000.0 Parcel Id 11124 314 REA STREET CONNOLLY, SEAN J & LAUREN J Since Jan 2004 314 REA STREET NORTH ANDOVER, MA _ 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.65 Acres FY 2008 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until CONNOLLY, LAUREN&SEAN Payor 314 RAE ST NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13968.0-314 REA STREET Last Billing Date 3/5/2008 2100573 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7,82 1/ WTR WATER 01 ALL METER SIZE 50.26 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 0022305417 a Active ENC L w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 5/5/2008 3303 a Actual 12 _14% 2/4/2008 3291 a Actual 14 3/14/2008 -50% 11/5/2007 3277 a Actual 28 1/15/2008 52% 8/6/2007 3249 a Actual 18 9/14/2007 -12% 5/9/2007 3231 a Actual 16 6/22/2007 91% 2/28/2007 3215 m Manual estimate 14 3/23/2007 _37% 11/3/2006 3201 a Actual 14 12/22/2006 11% 8/21/2006 3187 a Actual 15 9/13/2006 -8% 5/25/2006 3172 a Actual 20 6/20/2006 19% 2/6/2006 3152 a Actual 14 3/13/2006 _7% 11/8/2005 3138 a Actual 15 12/14/2005 1% 8/10/2005 3123 a Actual 15 9/12/2005 -1% 5/11/2005 3108 a Actual 13 6/8/2005 600 2/22/2005 3095 a Actual 15 3/15/2005 8% 11/17/2004 3080 a Actual 15 12/17/2004 -11%0 8/12/2004 3065 a Actual 15 9/20/2004 5/18/2004 3050 a Actual 15 6/14/2004 183% 2/17/2004 3035 a Actual 6 4/16/2004 0% 11/6/2003 3029 n New Meter 0 11/6/2003 0% Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health.Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. Syst m Location: forrns on the computer,use only the tab key Address tcomoveove ours 3 i L` Rem, use the return State Code key. � 2. System Owner. Name 1�1 Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes D-No- If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: s. " Pte\ Nj Name r- Vehicle License Number Company 7. Location where contents were disposed: C) Sign Sign au Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 y r Tel: (978)475-4786 Fax: (978)475-5451 BATESON ENTERPRISES, INC. Excavating-Water& Sewer Lines-Septic Systems& Pumping Service 111 Argilla Road Andover,Mass. 01810 Title 5 Inspection Report Property Address: 314 Rea Street, North Andover Owner: Connolly Date of Inspection: 6/7/2008 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises,Inc. Town of North Andover Office of the Health Department 0 Community Development and Services Division + , 27 Charles Street ' North Andover, Massachusetts 01.845 a��s c KCHu� Sandra Starr Telephone(978)688-9540 Public Health Director Fax 97$ 688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 03/25/02 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by Mike Reilly at 314 Rea Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations, The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. ArjanLaGras Board of Health Inspector BOARD OF APPEALS 688.9541 BUILDING 688-9545 CONSERVATION 688-9534 IM-AL-171-1689-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The u dersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired: by— K-E qv- 1/ 7f l;3 r located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# , dated with an approved design flow of 4440 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: -C�?� Engineer Representative Final inspection date:__ Engineer Repres ntative Installer: Lic.#: Date: ) I.g_(I I Design Engineer: yax �--� Date: . OF Ail' e_ f Nps 8 � 7� AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDIN@-RES -kVT� 1-� TIES TO E4'LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM �a� ll TOP OF FDN ELEVATION ' q/ C/ LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABJ,E DISTANCES FROM CORNERS OF HOUSE TO CENTER OF / TANK & D-BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW LOCATION &ELEVATIONS OF BENCHMARK USED AS-BUILT CHECKLIST LOTNUMBER, STREET NAME ASSESSORS MAP& PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, ✓ 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 v IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED 1. 1�.OF Np i �OARD0FE�jy .... Nov 8 , 2001 it N&M Job number 1770/ Q TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Site: '`/- If s T Final Date: Installer: �,$" 4S— �yi �< 2 t �Lr Tel:, �9� Date Yes No Initials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments: (Use back of sheet for diagrams.) B. Retaining Wall 1. Wall height an�wadthas specified 2. Waterproofed 3. Wall�m�m�imum 10'to leaching facility 4. Wall meets specifications of plan Commei ts: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe . _ �- 3. Inlet t6 tank cemented 4. Slope minimum 0.01 or 1/8"per foot minimum 5. Pipe properly set on compact firm base 6. Pipe laid on continuous grade in straight line 7. Cleanouts precede all change in alignment and grade 8. Manholes at any 90°change 9. 10'minimum offset to water line Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum — ✓ 3. Gas baffle present on outlet 4. Manhole to w/in 6"of grade 5. Manholes over center and each tee 6. 3-20"manholes 7. Outlet line cemented 8. 2 3 drop from inlet to outlet 9. Pipe set _ 10. Compact base with 6"of 3/"crushed stone under tank 11. Tank is watertight 12. Tees 12"off side of tank p 182001 N&M Job number 1770/ � Comments: Date Yes No Initials E. Pump Chamber 1. If separate from tank,compact-base with 6"of/4"stone underneath 2. Minimum 2"pipe to d- if gravity system 3. 20"access7manho4. Tank leve5. Watertt 6. Tank,�'agrees with plan specification :- 7. Marfhole to grade A 8 heck valve and bleeder hole pr t Alarm in building on separat ircuit C 10. Alarm functions � 11. Manual operating switch 12. Pump delivers liquid to d-box ` Comments: F. Distribution Box 1. D-box level 2. Minimum 0.IT'(2")drop from inlet to outlet 3. Minimum 6"sump - - 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe 9. First 2'from.box laid level Comme ts: .t t "00 /y G. Soil Absorption system 1. All stone double-washed-3/a"- 1 '/2" Gt-c�i�v,tea -pea stone Bucket test done? ---4—.— , �//¢� � 'PIP,A042. Minimum 2"of pea stone above distribution lines 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together V. 5. Toe of slope stops minimum 5' from edge of property; �-- 5a. if not, then swale. Comments: N&M Job number 1770/ w Date Yes No Initials H. Leach Trenches I. Minimum 2 trenches 2. Length of trenches agrees plan. (Max. length 100') 3. Width of trenches a s with plan Minimum 2';maxim -4'. 4. Vent present if> feet or specified 5. Minimum ance between trenches 10' 6. Pipe sl a minimum 0.005 or 6"per 10 ' 7. D of trenches below outl try minimum of 6". 8. ipes set on stable base. �--- Comments: ' J r I I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipes 6'maximum ...-� 4. Pipes connected at end&vent end raised 5. Separation between adjacent fields 10'minimum 6. Pipes set on stable base _ 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 4� Comments: " HIG fj S — By L T GZ A: To - T> l3ok ��1 Y N��� 77�� i•ti e�� l.�o�r J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete —� 3. Sidewall between 12" 8"wide 4. Access manhol each pit 5. Pipes ce ed with hydraulic cement 6. Comments: �,�,..•• K. Final Grade I. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 6. Grading meets 3:1 slope 7. Minimum of 9" of fill graded over system Town of North Andover, Massachusetts Form No.3 Of tNORT^,�O BOARD OF HEALTH e p �,'°•,T��'"� DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSEt • Applicants Q NAMEADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair L,,�/an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. '4- HAIR N, BOARD HEALTH s7 Fee. D.W.C. No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: = LICENSED INSTALLER: P, Rzi k SIGNATURE: eA� TELEPHONE# CHECK ONE: REPAIR: ✓ NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS—BUILT. JUN Z001 Administrative Use Only r- $160.00 Fee Attached? Yes �'� No Foundation As-Built? Yes No Floor Plans? Yes No Approval Dater G� INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at �``-�� � ``�" relative to the application of - dated for plans by r1 C�d dated I-Szf ) with revisions dated I k-G -©(Q I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved: 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Disposal Works Construction ermit# 49,36 MERRIMACK ENGINEERING SERVICES INC. v Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE JOB No. (508) 475-3555 ATTENTIONt �jJ �/�Fax (508) 475-14488]]] TO �'/�"'V wf RE: WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION W&O - `ate 1 c- THESE ARE TRANSMITTED as checked below: ❑l� For approval ❑ Approved as submitted El Resubmit copies for approval IU�or your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS Q t oaf) rvmio 4' Irl 1142 H tL12 '0lj COPY TOj SIGNED: '2, If enclosures are not as noted,kindly notify us at once. , F• Fid b� ,Cz4rLl�, ;7 i . N 5�j�a o � L 1 I r I III I . . _ � �, •�"'_ ���-�+_I %�►�J��.,i.,ria O-Ati r� f t%ORTII TOWN OF NORTH ANDOVER 3?;.<, `D HEALTH DEPARTMENT p Y 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ,s TACH Sandra Starr Telephone(978) 688-9540 Public Health Director FAX(978) 688-9542 December 11, 2001 RE: 314 Rea Street,North Andover septic system To Whom It May Concern: The construction of the septic system repair at 314 Rea Street,North Andover was installed according to the approved design plan and should operate as intended, providing that regular pumping of the septic tank and water conservation practices are maintained. A variance was given for separation to ground water from the minimum four feet to three feet. The system was installed 2.9 feet above groundwater which condition should not affect its operation, but an additional variance was given for this separation distance. Consequently this system does not conform to the letter with current Title 5 regulations, but as stated above, will function properly if maintained. Sandra Starr, R.S., C.H.O. Public Health Director 1� r., CJf�ece(fb2�le,Jw� a !�/�e5 )r . �e oc� o� 1� elvo •rK �`�� y.4 vip ��;a,'�. „�.. *�..8 y moi✓ ��._ .. —( \ . �, y � �,� � .�..w e tic•»�� '`''` s� ,� �.,'�-�.y+,.� �" >, ..,.__ _ , 52 ED6 c v F ; r , J \G' �ir,r1Y, E��g T• { o V015 LL, f a M r iG 1 LlJ 1 SX �I2,L �ji�, 42� � I r a� ilL Town of North Andover F HORTF� O tt�oo ;°Ati Office of the Health Department 0? Community Development and Services Division William J.Scott,Division Director 9q 27 Charles Street ��SSaCHU Sandra Starr P � )978 hone North Andover,Massachusetts 01845 Tele 688-9540 Health Director Fax(978)688-9542 November 16, 2000 William Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 Re: 314 Rea Street Dear Bill: This is to notify you that waivers have been granted to allow the installation of septic leach area not less than 50 feet to a wetland and to vary the depth to ground water to 3 feet instead of 4 feet. Please inform your client that with the second waiver there can be no additional rooms added to the dwelling until it is tied-in to sewer. With the waiver to these variances, the plans for the repair of the septic system at 314 Rea Street are approved. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Health Director SS/smc cc: Alvarez File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 of NORTH ' Town Of North Andover 4Lt0 4• �� ar •` °_ . '• o� William J. Scott s A Community Development & Services « 27 Charles Street Director(978)688-9531 North Andover, Massachusetts 01845 1gSACHU`�Et Fax 978-688-9542 November 6, 2000 Board of Appeals Bill Dufresne (978) 688-9541 Merrimack Engineering 66 Park Street Building Andover, MA 01810 Department (978) 688-9545 Re: 314 Rea Street Conservation Dear Bill: Department (978) 688-9530 This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as followed: Health Department (978)688-95401. Distance to wetland not shown as required b NA 8.03 c. mooN ' 45 S c n) ,ct-r— �c� O J Public Health 2, Minimum cover of 9 inches over septic tank is not specified as required by Nurse 310 CMR 228(l). (978) 688-9543 Planning J3. Elevation of perc test not provided as required by NA 8.02 n. Department (978) 688-9535 /4. Location and elevation of Deep Observation Holes (including aborted tests) are not shown as required by NA 8.02 n. The Designer shows one observation hole while NABOH records show that three were excavated. If you have any questions, please do not hesitate to call the Board of Health Office. 'i Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Alvarez file Nov-06-00 . 11 :38A Paul D. Turbide, PE/PLS 978-465-0313 P.02 October 30, 2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 RE: Title V review for SDS upgrade at 314 Rea Street Dear Sandra, Enclosed find our review of the"Checklist for North Andover Septic System Plans' for the septic system upgrade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. ❑ Distance to wetland not shown as required by NA 8.03 c. o Minimum cover of 9 inches over septic tank is not specified as required by 310 CMR 228 (1). ❑ Elevation of perc test not provided as required by NA 8.02 n ❑ Location and elevation of Deep Observation Holes(including aborted tests)are not shown as required by NA 8.02 n. The Designer shows one observation hole while NABOH records show that three were excavated. Ifou have anquestions y y or comments please feel free to contact me. ere Paul D. Turbide,PE/PLS P01?TILI ENGINEERING Civil Engineers& Lend Surveyors One Harris Street Newburypurt,MA 01950 (978)465-8594 \\Server MABti1nSBAREA STREET 314.DOC MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: RE: 714 P f-A -51TkleE-r- TM: TL: OWNER(NAME& ADDRESS) G Members of the Board: An upgrade sewage disposal system plan dated: has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. 2) 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, 2 MERRIMACK ENGINEERING SERVICES William Dufresne cd Location: Owner'sName: Map/ParceL•_ Tw 2q TL 1Z--5, Address: / � a7 ���j dA Installer: Tei#r " S�Z- lew silo( ) Re Date:�j=?j �•-c Wetlands�ne H Soil Symbol Soil lQame J�=� y t-t� oil Class Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil Color Soil hiottling % Gravel,Stones,etc: C,YM ZXI " c 4 172w ���'t': 7`�Y��//G, '�Ni l'Lut 5s c-moi 1(2YW-,yJ �ililrr-int- a Parent Material Depth to Bedrock Standing Water in the Hole• Q/_•s • �v a weeping from Pit Face T� �HG%V: Parent Material , Depth to Bedrock Standing eater in the Hole: Weeping from Pit Face EMGIV. Date Percolation Tests Observation Hole."- 2o* Depth of Perc I Start Pre-soak: Time at 12" Time at 9" Z: Time at 6" ( !p Time(911-6") Rate Min/Inch rA Performed By_ /� Q� V Witnessed Bir �f � SEPTIC PLAN SUBMIT'T'AL FORM LOCATION: fG/ PC6 4- SM F 7� NEW PLANS: S $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: S NO DATE: DESIGN ENGINEER: DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary, 20 SEPTIC PLAN SUBMITTAL FORM LOCATION: �} NEW PLANS: YES $125.00/Plan REVISED PLANS: _. $ 60.00/Plan L. SITE EVALUATION FORMS INCLUDED: YES NO DATE: //ZZO /0 DESIGN ENGINEER: , DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. f Town of North Andover, Massachusetts Form No,z NORTh BOARD OF HEALTH •_�. O (} O c F • 11"• a i ' "-- DESIGN APPROVAL FOR ss'CHUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. 7 � Site Location • Reference Plans and Specs. ENGI EERD GN DATE Permission is granted for an individual soil absorption sewage disposal sys em to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. lcg .d L Page 1 of 5 9A-APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving AuthoriVBoard of Health: For the upgrade of a failed or non-conforming system with a design flow of<10,000 gpd, where full compliance, as defined in 310•CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non-conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: litWLVrr AI.�/V2,0-1, Address: 6Ma �v® OvX. &&-Z, APO , AV, &'q-7O3 Phone#: (4r) Address of facility: 3t q v2-OrA z�-vtc- 2) Applicant(if different from above) Name: GJ4p-te. . Address: Phone#: 3) T e of Facility: `Z esidential Commercial School Institutional (Specify) Page 2 of 5 4) Type of Existing System: _privy cesspools) conventional system other(describe) 1 `$L Tr�l1� `-.7" y�L.-L r-c j Type of soil absorption system (trenches, chambers, pits, etc.)_ e: C �� 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system e4-f-'40 gpd Approved: es Approval date: no Why: b) Design flow of proposed upgraded system pd Why Ljr�W c) Design flow of facility44�2 gpd 6) Proposed pgrade of existing system is: a) Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: rC&a�Lj c) Which of the following are applicable to the proposed upgrade? ArA Reduction of setback(s)(list setbacks to be reduced with proposed setback distances) NA Percolation rate of 30-60 minutes per inch(state actual perc rate) ►/rA Up to 25%reduction in subsurface disposal area design requirements(state required& proposed size) /Relocation of water supply well(identify well, describe relocation fZCt.cx 2t� o R r-4 tv Fi2oN1 5 S 7"�r� `Reduction of required separation between bottom of SAS & q p high groundwater(specify proposed reduction&perc rate) Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met(specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: l AM-tz- Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback fromroPettY lines or a p private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date,time and place where the upgrade approval will be discussed. If the department is the approving authority,then such notice to abutters must be completedrior to the date of submission of the application to the department. P pp p nt. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. Page 4 of 5 List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1),is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. /A c) A shared system is not feasible. I.- I d) Connection to a sewer is not feasible. 0A- Nava 10)An application for a disposal system construction permit,including all required attachments (e.g. plans & specifications,site evaluation forms), must accompany this application. Is the DSCP application attached? yes ono r Page 5 of 5 11)Certification 1, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility Owner's Signature Date Print Name Name of Preparer Date Telephone No. &Address of Areparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. Town of North Andover NORTFt Office of the Conservation Department Community Development and Services Division49 William J. Scott Division Director 27 Charles Street �9SSwCH S t�h North Andover,Massachusetts97 01845 Telephone Brian LaGrasse p ( 8)688-9530 Interim Conservation Fax(978)688-9542 Administrator November 16, 2000 To: Robert Nicetta, Building Commissioner Alison Lescarbeau, Chairman, Planning Board William Sullivan, Chairman, ZBA From: Brian LaGrasse, Interim Conservation Administrator At our Conservation Commission meeting held on November 15, 2000 the following decisions were approved: 242-1044 428 Winter Street This NOI was for the construction of a replacement septic system and associated grading within the Buffer Zone of a BVW. The Order of Conditions was approved as drafted for this project. 242-1046 314 Rea Street This NOI was also for the construction of a replacement septic system and associated grading within the Buffer Zone of a BVW. The Order of Conditions was approved as drafted for this project. 242-1049 659 Forest Street The Order of Conditions was approved as drafted for this NOI which was for the construction of a septic system and associated grading within the Buffer Zone of a BVW. 242-1047 212 Haymeadow Road This NOI was for the construction of a replacement of a failing septic system and associated grading within the Buffer Zone of a BVW. The Order of Conditions was approved as drafted for this project. If you would like a copy of the Order of Conditions please contact the Conservation Department. CC: Scott Masse, Chairman, Conservation Commission /Heidi Griffin, Town Planner ,./Sandra Starr, Board of Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLEUWNG 688-9535 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH O �s�eo ib�ti0 R °°° °w°��� APPLICATION FOR SITE TESTING/INSPECTION ��SSACHU$ 5 Applicant _E�'�� NAME ADDRESS TELEPHONE Site Locationl Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time L-3 26!511--) l'6 f sa CHAIRMAN, HEALTH Fee Test No. c� S.S. Permit No.-d3,7 -D.W.C. No. C.C. Date Plbg. Permit No. r BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS �_ _ DATE: � 0-0 _ LOCATION OF SOIL TESTS: Assessor's map & parcel number. /z 3 OWNER:_ ern elf d7 r/ .- TEL. NO.: ADDRESS:-ZiE5 l t,UGt till- dk4 �,,�,�o�, a1�P/0 ENGINEER:--Adr& 4Ge TEL. NO.: 'V 7S— S <- zo CERTIFIED SOIL EVALUATOR: r 124,Aw,g-r 1)Z-� Intended use of land�sidential subdivision, single family home, commercial Repair testing ✓ Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 1275.OQ per lot forep w construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75,00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. APR 2 0 7-50 .tiffs/�I �•,�� �T ►= r �U . J. (77.17 I r-TTpq 1=0 Set to �s rP T � i r _ r l�� I t 4 dl l 11) U �- ) q, L' Itl 111 �I- r � i I •�, � � til 1.1 �� Cj v1 Yvk��J III U i1) A: ll: >- Lj <l <I" <C 7 11, I- ('1 I I1. W U.1 U) UJ Ul H.I U �� ILI I11 LIJ I _>- Z Z �-> j u- M j- 1- 1- 1- u v � 10,20- y 1 v t COMMONWEALTH OF MASSACHUSETTS Clo EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMM OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)M5500 TRUDY COXE semvtm ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECi1M FORM PART A CERIB ATION Property Address:314 Rea Street,North Andover Name of Owner:Ernest Alvarez Address of Owner:CMR 460 Box 662,APO AE 09703 Date of Inspection:411512000 Name of Inspector:Neil J.Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number.(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes Conditionally Passes Needs Fu her Evaluation By the Local Approving Authority ails Inspector's Signature: Date:4/15/2000 The System Inspector shall s b it opy of i inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the ystem is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4115/2000 I INSPECTION SUMMARY: Check A, 8, C,or D. A.SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B.SYSTEM CONDITIONALLY PASSES: One or move 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. Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination in all instances.If"not determined",explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 912198 Page 2 of 11 it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4/15/2000 C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and sal absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.Method used to determine distance (approximation not valid). 3) OTHER revised 912198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) i Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4115/2000 D.SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: X I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. _X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _X_ Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. _X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E.LARGE SYSTEM FAILS- 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 912/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4/1512000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No _X Pumping information was provided by the owner, occupant,or Board of Health. _X_ None of the system components have been pumped for at least two weeks and the system has been receiving normal flog rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _X As built plans have been obtained and examined.Note if they are not available with NLA. _X The facility or dwelling was inspected for signs of sewage back-up. _X_ The system does not receive non-sanitary or industrial waste flow.The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. _X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X Existing information.For example,Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [I 5.302(3)(b)] _X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection: 411512000 FLOW CONDITIONS RESIDENTIAL: Designflow_N/A_ .g.p.d./bedroom. Number of bedrooms(design):-4_ Number of bedrooms(actual-4— Total actual4_Total DESIGN flow_N/A_ Number of current residents: Garbage grinder(yes or no):_Yes_ Laundry(separate system)(yes or no):_No If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes or no):–No_ Water meter readings.NIA Sump Pump(yes or no):_No Last date of occupancy: Current COMM ERCIALIINDUSTRIAL: Type of establishment: Design flow: gpd(Based on 15.203) Basis of design flaw 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information:Pumped last year,owner System pumped as part of inspection:(yes or no)_No_ If yes,volume pumped:_gallons 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information:24 Years old,7/31/1976,as built plan. Sewage odors detected when arriving at the site:(yes or no)_No_ revised 9/2/98 Page 6 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4/15/2000 BUILDING SEWER:X (Locate on site plan) Depth below grade:20" Material of construction_X cast iron_X 40 PVC _ other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"cast iron thru wall to septic tank.3"PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade:8" Material of construction:_X concrete_metal_Fiberglass_Polyethylene_other(explain) If tank is metal,list age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions:7'x 5'x 4' x 7.5=1000 gallons. Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness:2" 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:14" How dimensions were determined:Subtract scum&sludge depths to baffle length. Comments:Inlet&outlet baffle ok,no tees.Depth of liquid at outlet invert.No evidence of leakage. GREASE TRAP:None (locate on site plan) Depth below rade: � 9 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: revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4115/2000 TIGHT OR HOLDING TANK:_None_ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Material of construction: concrete_metal_Fiberglass Polyethylene_other(explain) Dimensions: Capacity: allons Design flow:_gallons/day Alarm present Alarm level: Alarm in working order:Yes_No Date of previous pumping: Comments: I DISTRIBUTION BOX.:_X_ (locate on site plan) Depth of liquid level above outlet invert:2" Comments:D-box level&distribution not equal.Evidence of carryover.No evidence of leakage. Water 2°above all inverts. PUMP CHAMBER:—None,gravity system_ (locate on site plan) Pumps in working order.(Yes or No) Alarms in working order(Yes or No) Comments: i i i i Revised 9/2/98 Page 8 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4/16/2000 I SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number.3 leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments:Soil ok.Vegetation ok.No sign of ponding to surface.Camera inside of all pits thru outlet pipes in D-box,all pits flooded above all inverts. Sign of hydraulic failure. CESSPOOLS: None (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: revised 912198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4/15/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Pit 3 E Pit 1 D- box B Porch House Driveway 2 1 A Water Meter A to 1 =8'1" Ato2= 14' A to D-Box=22' Btol = 16' Bto2=20' B to D-Box= 127' revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:314 Rea Street,North Andover Owner:Alvarez Date of Inspection:4/15/2000 NRCS Report name Sal Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells i Estimated Depth to Groundwater 3.75 Feet Please indicate all the methods used to determine High Groundwater Elevation: _X Obtained from Design Plans on record _X Observed Site(Abutting property,observation hole,basement sump etc.) _X—Determined from local conditions __k___Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed)As Per design plan. revised 912198 Page 11 of 11 i Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 314 Rea Street, North Andover Owner: Alvarez Date of Inspection: 4/15/2000 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic sstem. Neil J. Bateson Bateson Enterprises, Inc. • Bateson Enterprises Inc. 111 Argilla Road Andover MA 01810 (978) 475,4786 Invoice Ernest Alvarez Date: 04/20/2000 314 Rea St Inv# 1887 N. Andover MA 01845 Description Work Date Title 5 Inspection. 04/15/2000 Invoice Total: 300.00 Total Paid: 0.00 Total Due: 300.00 i T30 �...�.....�_. �, 162 r'? 7co � r 0 _ LO T i o 3 . 101 t �i I0o GAL 1 Z3` t� 'erTK. to Tom-L Y FA 13` � 1 t E'