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Miscellaneous - 338 BERRY STREET 4/30/2018
�=3 h 1' , NII It M a I I z C o � o 0 U .QT+ 00 O 00 "O L v G> O y; U O 40 r+ I I C 0 U p 0 O X r+ y o � OI O O L= b a A � _ I a s c i O y T M. O 00 O,O. O ° y'00 O' O ci z x M o 7 p L p C> O L m I 0 U X o � L= b O C CO _ a c O O x M N 7 p p C> O y m C O LZ a •� 3 c\ �o s a d UO m � 3 w C cCC ew N 00 3 c M C ° N y U00 CIOY rn o c •° •° 0 3 a o C v) t N c y U w O >. �• W) O 3 > ° a v " c U° a Y ° aj o Q 47 ° a 1>1 � d E N o cn o ti > =_ ., a a.5 ej cc°' Q C* a U U a a Q a a°i m ° a J� a yY O ai y Y OU M c m 0 O N N N y N — —C,oo U oo r �° � (3-01 r 0 0 0 M O z N �m Q LL Nz C1] � o 9 OBJ � a0i i � o Q � � I O 1 O O N It O C� (I"", /A, N O y C d C O C CL ti C y O O U z z v� n on in o, CC N ON N r r 00 6 N O N c 7S V Itt 7 R V 7 O O O Z O O O N N N CL 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 1. System Location: Left / Right front of house, Left / Right rear of hous. LLe lg ide of hous , Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck 2. Address City/Town state System Owner.�- Name Aaaress (rt aitterent from location) City/Town ' B. Pumping Record 1. Date'of Pumping 3. Type of system,- [I ystem: ❑ Other (describe): Zip Code ApR 14 2014 HEALTH state��� � de Telephone Number —4-17-/� Daft 2. Quantity Pumped: Cesspool(s) eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition f stem: ,( . � ' n�• "� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Lofcati®�re contents were disposed: Waste Water F5821 Vehicle License Number L—f— r7----( — e Date t5fomi4.doc• 06103 System Pumping Record • Page 1 of 1 TOWN OF SYSTEM PUMPING RECORD DATE: 5-A-03 SYSTEM OWNER & ADDRESS �r h4 2 3 2003 SYSTEM LOCATION (example: left front of house) �� C\3 "� j 6 Vcs DATE OF PUMPING: "()2D QUANTITY PUMPED: (O 00 ^ GALLONS CESSPOOL: NO YES S DTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: t5form4.doc• 06/03 Commonwealth of Massachusetts 70FNORTH ® City/Town of System Pumping Record 13 Form 4 DOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, u e 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 1. System Location: Left / Right front of house, Left / Right rear of house righ i e o ous .Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address---' City/Town State Zip Code 2. System Owner. Name Aaaress (It anterent from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Kj,c-\c)U-4j- LA 1-1v�3 Date State Zip Code Telephone Number 2. Quantity Pumped: Gallons Cesspool(s) ' eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [ -90 If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locationhere contents were disposed: Lowell Waste Water �r ule Date System Pumping Recons • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record 2010 Form 4 ' M TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health ovotber approving authority. A. Facility Information 1. System Locati : Leftside of , Right side of house, Left front of house, Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address CitylTown 2. System Owner: KUq Name Address (it different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): aa_� — State Zip Code T Telephone Number Date 2. Quantity Pumped: Cesspool(s) �epticTank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes LSO If yes, was it cleaned? ❑ Yes ❑ No 5. Conditio of stem: V 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatigo m4 ert)contents were disposed: L.S.D Signature F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record JUN - 8 2009 Form 4 -- - TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other form LTH DE RTMEN7 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. System Location: Left front, left re ,left side of s Right front, right rear, right side of house. forms on the computer, use only the tab key to move your Address V �' J cursor - do not use the return City/Town State Zi Code P key. 2. System Owner: r Name Address (if different from location) City/Town State, ode Telephone Number B. Pumping Record 1. Date of Pumping2. Quary p nti Pumped: Date Gallons 3. Type of system: 8 Cesspool(s) Septic Tank Tight Tank Other (describe): 4. Effluent Tee Filter present? E] Yes No If yes, was it cleaned? Ll Yes 0 No 5. Conditioo of System- no 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. LocatiojiwhKe contents were disposed: I.L.S.D >�4— Lowell Waste Water Water F 5821 Vehicle License Number of H4ut6r Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts UCity/Town of System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use thereturn key. IGS E�J r.rr —:y1 APR 2 5 2006 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. The Syt+ sHEALTH G`F_PARTlti1ENT be submitted to the local Board of Health or other approving authority. . A. Facility Information 1. Syst Location: g C � Addres - / u / City/Town State 2. System Owner:'PJA__jp,. Name Address (if different from location) Cityrrown Zip Code State Zip C' de Telephone Number B. Pumping Record 1. Date of Pum in p g Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight.Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes RIO If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 11 vv�pax' ( xt�w-ktA-M)' 6. System Pupped By N — ame �7 Vehicle License Number Company 7. Locati where contents were disposed: Signature f auler Date http://www.mass.gov/dep/`Water/approvals/t5forms.htm#inspect t5form4.doc• 06103 System Pumping Record • Page 1 of 1 st Town of North Andover Office of the Health Department o? +`b° Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 �'Ss�cHus Susan Y. Sawyer, REHS/ RS Public Health Director 978.688.9540 - Phone 978.688.9542 - Fax C'�E12�1'IFICA7E O�F'C09l�f�LIA�VCE As of: ,duly 23, 2004 ,his is to cert that the individual subsurface disposal system rep airecC(X) — (FuCCSystem 6y James Currier at 338 Berry Street North Andover, 911,4 01845 has been instatCed in accordance with the provisions of Titfe V of the State Sanitary Code and with the North Andover Board ofifeatth regulations. 7fie issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Si san T Sawyer, 1RE.li Eu6tic Yfeatth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN*OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (Xj repaired; by . _ JAMES H. CURRIER ii RAM^ 131 Forest Street .� .located at 3 � _,��E OWMA O JM � �^�I r was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# , plan dated with a design flow of gallons per day. The materials used were m conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 3 l0 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: 7f �vfo .y Final inspection date: _A4* d Installe Engine Engineer Re resentative Engineer Representative #PZ -4v (� O OO Date: Z fJ Date: LO d RECEIVED AUG 2 3 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Page 1 of 1 Sawyer, Susan From: Dan Ottenheimer [info@milldverconsulbng.com] Sent: Tuesday, July 13, 2004 7:16 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 338 Berry Street Sue and Pam, We met at 338 Berry Street with New England Engineering Services this afternoon. We checked all the survey work they completed. It turns out that the benchmark is correct at elevation 100.00 but that on the plan where they labeled the house sill at 112.00, it wasn't that at all (the sill is actually about 9" off from 112.00). That was the source of our confusion when we did the final inspection with Currier. I have spoken with Currier to let him know that he is ok to backfill. Inspection report coming along to you shortly. Dan 0 Daniel Gttenheimer, President Mill River Consulting Septic System Management Services 2 Blackbum Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.miltriverconsulting.com info@millriverconsulting.com 7/14/2004 Page 1 of 1 .i Dellechiaie, Pam From: Andrew McBrearty[amcbrearty@millriverconsulting.com] Sent: Monday, July 12, 2004 11:46 AM To: pdellechiaie@townofnorthandover.com; Sawyer, Susan Cc: 'Daniel Ottenheimer (E-mail)' Subject: Re: 191 Granville Lane - Final Inspection Request Hi Pam & Sue, I have setup for a Final for Granville for 7:00 tomorrow (Tuesday) morning. I also have two soil tests that NEES will be performing on 69 Laconia Cir tomorrow as well. After the Laconia test, we will be headin o 338 Berry St to v rift' the Benchmark elevation. We have also scheduled a perc test with Joe Fuchs(sp?) for 70 Wesley St on Aug 5th. Hope you had a good weekend. -andy Pamela DelleChiaie wrote: Please schedule a Final Inspection for above and arrange with John Soucy: 603.216.7175 or 978.683.5709. Steve from NEES also called and said that the As Built is okay. Any questions, call NEES at 978.686.1768. Thank you! Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development & Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover. com Tel. 978-688-9540 Fax 978-688-9542 IM] 7/12/2004 Page 1 of 1 C 0 Dellechiaie, Pam From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Friday, July 02, 2004 4:29 PM To: pdellechiaie@townofnorthandover.com; 'McBrearty Andrew (E-mail)' Cc: Susan Sawyer Subject: RE: Final Inspection Request - 338 Berry Street I just spoke with Jack, he said the designer has not been out yet. I told him to make sure designer calls your office after he is all set with everything and then I will be able to shoot out and check everything out. Dan 0 Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsOing corn info@millriverconsultinR.com -----Original Message ----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] Sent: Friday, July 02, 2004 1:41 PM To: 'Daniel Ottenheimer (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Sawyer, Susan Subject: Final Inspection Request - 338 Berry Street Importance: High Request from Jack @ Currier Const. for a Final Inspection. Please call him at 978.423.6870 to make those arrangements. Thank you. Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development & Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover.com Tel. 978-688-9540 Fax 978-688-9542 7/6/2004 1 %ORT#1 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT4000 27 CHARLES STREET # C �• Oq NORTH ANDOVER, MASSACHUSETTS 01845M9s ,, - 0 SACHUSE Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax DanielOttenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: 1.800.377.3044 or Date: Phone: jl ?� 978.282.0014 t� / Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick .them up as requested. Address: Please call 978-688-9540 for assistance with any questions. hank you. Cc: File - Address HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Jun 30 2004 12:06pm Last 30 Transactions Date Time Type Identification Duration Pages Result Jun 28 3:25pm Fax Sent 89786889556 0:42 1 OK Jun 28 3:32pm Received 978 688 9556 0:18 1 OK Jun 28 3:51pm Fax Sent 89786876045 0:30 2 OK Jun 28 4:1 bpm Received 9787747816 1:41 5 OK Jun 28 4:19pm Fax Sent 819782820012 2:22 3 OK Jun 28 5:24pm Received 0:28 3 OK Jun 29 9:16am Received 978 794 0107 1:30 2 OK Jun 29 9:22am Fax Sent 816173382200 0:00 0 No answer Jun 29 9:25am Fax Sent 81673380122 0:36 0 Error 388 Jun 29 9:29am Received 9783529872 1:04 2 OK Jun 29 9:38am Fax Sent 814135846697 1:30 3 OK Jun 29 9:5 lam Received 978 688 9556 0:31 2 OK Jun 29 10:09am Received 9784701017 0:50 6 OK Jun 29 11:04am Received 0:21 2 OK Jun 29 11:10am Fax Sent 89786889556 1:13 2 OK Jun 29 11:52am Received 7813401674 0:30 1 OK Jun 29 12:33pm Received 0:45 1 OK Jun 29 12:56pm Received 9786238359 0:18 1 OK Jun 29 1:38pm Received 5:11 3 OK Jun 29 2:50pm Fax Sent 89786889556 3:33 6 OK Jun 29 3:14pm Received 9789233619 0:28 3 OK Jun 29 3:54pm Received 0:38 0 No fax Jun 29 4:38pm Fax Sent 89786889556 1:20 2 OK Jun 29 6:19pm Received 6179267854 0:27 1 OK Jun 30 8:36am Fax Sent 89787947546 0:31 2 OK Jun 30 8:43am Received FAX 0:31 1 OK Jun 30 8:55am Fax Sent 89786836895 0:00 0 No answer Jun 30 8:58am Fax Sent 89786836595 0:00 0 No answer Jun 30 10:36am Received 1:31 6 OK Jun 30 11:44am Fax Sent 819782820012 8:58. 12 OK TOWN OF NORTH ANDOVER ct poRrh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS:338 Berry Street MAP: 108C LOT: 15 INSTALLER: James Currier DESIGNER: Richard Tangard� PLAN DATE: revised 9/10/03 BOH APPROVAL DATE ON PLAN: 9/24/03 DATE OF BED BOTTOM INSPECTION: June 28, 2004 Susan Sawyer DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION yes PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS Comments: ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Page 1 of 4 kl-./ \--1I TOWN OF NORTH ANDOVER °� NORrM Office of COMMUNITY DEVELOPMENT AND SERVICES F s A HEALTH DEPARTMENT . . 27 CHARLES STREET + NORTH ANDOVER MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK Did not check tank on BOB insp. PIs. do on final. ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed Comments: PUMP CHAMBER Comments: (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ 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 ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Page 2 of 4 TOWN OF NORTH ANDOVER °� NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 3? •'`��� �Oo� F ' 9 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM 94 9 Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to C soil layer, as provided on plan La boulder found on insD in NW area of bottom of SAS. Req removal ReinsD OK Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-11/2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder I concrete / timber/ block) Final cover as per plan 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 Page 3 of 4 6 0 Town of North Andover �/,:::9; �/ Health Department Date: ..s-- Location: (Indicate Address, if Residential, or Name of Business) Check #: x/aA Twe of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ a—peptic Disposal Works Construction G� (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ " ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) � 2 Health Agent Initials i White - Applicant Yellow - Health Pink - Treasurer Jun 21 04 08:40a NORTH RNDOVER 9786889542 TOWN OF NORTH ANDOVER o, V16HTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT , . 27 CHARLES STREET • �. ' NORTH ANDOVER, NLASSACHUSP_TTS 01845 Susan Y. Sawyer, RENS/RS Public Health Director 978.688,9540 — Phone 978.684,9542 — FAX healthdepKn)townol'northanclover,com www.toamornorthandover.coni APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 6' / �_' 1 /© Lt LOCATION LICENSED INSTALLER NATME:� Jamas L (ye0' !� PLEASE PRINT P.1 SIGNATURE: TELEPHONE# 2,29 %2 6 qS` N' CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $250.00 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As -Built? Yes No_,z Floor Plans? Yes No_z�__ Approval of Health Agent ,. -z.. Date: % A,! CGS �f i` Jun 21 04 M 40a NORTH ANDOVER 9786889542 INSTALLER PROJECT' MANAGEMENT OBLIGATIONS As the North Andover licensed instal ler for the construction of the septic system for the property at � � � � relaafive to the application of ted for Tans by and dated with revisions dated I understand the following obligations for management of this project: I . As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wait 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 vertral OK from eaaince:r must be submitted to Board of Health, atter 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 Oradc — Installer must request inspection when all grading is complete. Does not have to be on site;. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all parsons 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 he used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-hox, 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 obliaation. Undersign icensed Septic Installer 2' Date: 6 Disposal Works Construction Permit # p.2 f1 f1 TOWN OF NORTH ANDOVER Ot µORTM Office of COMMUNITY DEVELOPMENT AND SERVICES 3 `'90 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director ADDRESS: 338 Berry Street MAP: INSTALLER: James Currier Const DESIGNER: NEES PLAN DATE: 9/10/2003 BOH APPROVAL DATE ON PLAN: 9124/2003 DATE OF BED BOTTOM INSPECTION: Iq, Z DATE OF FINAL CONSTRUCTION INSPECTION: 7/7/2004 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Gravity Distribution COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = n/a LOADING OF PUMP CHAMBER = n/a TYPE OF SAS = Trenches x2 DIMENSIONS AND DETAILS OF SAS: 4'x 65'w/ 5' overdig SITE CONDITIONS 978.688.9540 — Phone 978.688.9542 — FAX LOT: ❑Existing septic tank properly abandoned ®Internal plumbing all to one building sewer ZTopography not appreciably altered Comments: Need to verify that old septic tank is crushed and filled. Plumbing for new addition, not hooked to tank yet. Verified all plumbing to one sewer. Page 1 of 3 f� f1 TOWN OF NORTH ANDOVER Naar„ Office of COMMUNITY DEVELOPMENT AND SERVICES F? •'�� '`.•`��p HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845ACHU MUS Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base N Weep hole plugged N 1500 gallon tank has been installed H-10 loading 2 -Piece 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 ❑ 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: Inlet tee to be installed. Plans call for 3 risers to 6" of grade - none installed yet. D -BOX N Installed on stable stone base N Inlet tee (if pumped or >0.08'tfoot) N Hydraulic cement around inlet & outlets ❑ Observed even distribution N Speed levelers provided (not required) Comments: No water on site to verify even distribution - to be checked at final grade inspection. Page 2 of 3 �1 ,J TOWN OF NORTH ANDOVER µoRrq Office of COMMUNITY DEVELOPMENT AND SERVICES 3 °•`"�° `��°� HEALTH DEPARTMENT . . 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �� s "°'�� Susan Y. Sawyer, REHSJRS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX 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 '/" double washed stone installed ® 1/8-1/2" (peastone) double washed stone installed Z laterals installed and ends connected to header (and vented if impervious material above) ® Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: Trench 1 (Closest to building) was 2' short (63) Question arose regarding accuracy of Benchmark Elevation of 100.0'. Returned to site on 7113/04 with Ben Osgood, New England Engineering Service, performed an investigation. It was determined that sill elevation of 112.00 shown on plan was not correct, but benchmark elevation of 100.00 shown on plan was correct. Elevations of system are satisfactory. SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 8.00 Height of Instrument: 108.00 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 102.76 103.28 Septic Tank IN 102.50 102.77 Septic Tank OUT 102.25 102.49 Distribution Box IN 101.50 101.47 Distribution Box OUT 101.33 101.26 Lateral 1 HIGH 101.23 101.29 Lateral 1 LOW 100.90 100.94 Lateral 2 HIGH 99.04 99.11 Lateral 2 LOW 98.71 98.71 Page 3 of 3 � FORIUI U - LQT RELL�SS /��— � — FORK► . . MI r cTIONS: This form is used to verify that all necessary approvals/permits B , . s and Departments having jurisdiction have been obtained. the applicant and/or landowner from compliance with an aiicabfehor does not re; p Y pp quiremeni APPLICANT FILLS OUT THIS APPLICANT 1 (�69 Jf LOCATION: Assessor's Map Number C SUBDIVISION �. STREET (Y 1 ' <�- CONSERVATION TOWN PLANNER COMMENTS n�arrGl.I UM—MCALTH COMMENTS J v„ -------"OFFICIAL USE ONL TOWN AGENTS: DATE APPROVED DATE REJECTED f� PHONE— 5� - PARCEL—� LOT (S) / ST. NUMBER -3U DATE APPROVED DATE REJECTED DATE APPROVE[ DATE REJECTED UAI t APPROVED. DATE- REJECTED ycy,y AN S�— be- o AA17A �A I PUBLIC WORKS - SEWER/WATER DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm �— e TOWN OF NORTH ANDOVER HEALTTI DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Heidi Griffin Acting Health Director FAX Telephone (978) 688-9540 FAX (978) 688-9542 Benjamin C. Osgood, Jr., EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 978-685-1099 Pages: Fax: 978-686-1768 Date: 4.1 Phone: Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: Z��e- A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Xc: Address File Chrono File TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 C►,USkt Heidi Griffin 978.688.9540 — Phone Acting Health Director 978.688.9542 — FAX September 24, 2003 Sonja & Gerard Murphy 338 Berry Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 338 Berry Street, Map 108C, Lot 15, North Andover, Massachusetts Dear Mr. & Mrs. Murphy, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated September 10, 2003 and received by this office on September 12, 2003. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. The time period for which this plan is valid may be reduced by the North Andover Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. 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 (3 10 CMR 15.020(1)). 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 and/or imply compliance with any of the aforementioned requirements. IIJ Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Heidi Griffin, Acting Health Director encl: List of licensed septic system installers cc: File _ New England Engineering Services — �% Page 1 of 1 DelleChiaie, Pamela From: Lagrasse, Brian Sent: Friday, September 26, 20031:06 PM To: DelleChiaie, Pamela Subject: FW: 338 Berry Street Plan Approval Letter did we send out an approval letter yet? -----Original Message ----- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Wednesday, September 24, 2003 3:40 PM To: Heidi Griffin; blagrasse@townofnorthandover.com; pdellechiaie@townofnorthandover.com Subject: 338 Berry Street Plan Approval Letter Heidi, Brian and Pam, Attached please find the approval letter for the septic design at #338 Berry Street. I did not have a standard letter which the Town used for such occasions so I borrowed what we have been using in Gloucester. Feel free to edit it if you see fit. You'll notice the letter: 1 Is addressed to the property owners 2 References the property and its map and lot 3 References a few key points to remember including the length the plan is valid, the need to obtain a Certificate of Compliance and what to do if something in the field is different from the plan. 4 Closes on a positive note. I was not sure who to have as the signer so please change as you see fit I'd suggest including a list of the licensed septic installers as an enclosure so the property owner can shop around, or at least knows who might be available for construction. Let us know if you have any questions. Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 info@milldverconsuIting.com 9/26/2003 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Heidi Griffin Acting Health Director September 24, 2003 Sonja & Gerard Murphy 338 Berry Street North Andover, MA 01845 978.688.9540 — Phone 978.688.9542 — FAX RE: Subsurface Sewage Disposal System Plan for 338 Berry Street, Map 108C, Lot 15, North Andover, Massachusetts Dear Mr. & Mrs. Murphy, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated September 10, 2003 and received by this office on September 12, 2003. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. The time period for which this plan is valid may be reduced by the North Andover Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. This approval is subject to the following conditions: If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 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 and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Heidi Griffin, Acting Health Director encl: List of licensed septic system installers cc: File New England Engineering Services _ Page 1 of 1 Pamela DelleChiaie From: "Dan Ottenheimer' <info@milldverconsulting.com> To: "'Pamela DelleChiaie"'<pdellechiaie@townofnorthandover.com> Cc: "'Heidi Griffin"'<hgdffin@townofnorthandover.com>; "'Brian LaGrasse"' <blag rasse@townofnorthandover.com> Sent: Wednesday, September 17, 2003 9:43 AM Subject: RE: 338 Berry Street - Status of 2nd Plan Review - H/O Request This should be completed within one week from today, possibly sooner. Dan Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 info@miliriverconsulting.com -----Original Message ----- From: Pamela DelleChiaie[mailto:pdellechiaie@townofnorthandover.com] Sent: Wednesday, September 17, 2003 9:15 AM To: Dan Ottenheimer Cc: Heidi Griffin; Brian LaGrasse Subject: 338 Berry Street - Status of 2nd Plan Review - H/O Request Hi Dan, Received a call from Sonja Murphy re: status of 2nd design plans for 338 Berry Street. They also have a Form U in through building for a building permit that was rejected on 8/1 due to the status of the septic. This homeowner is very proactive on checking status. Can you call and just let me know where its at? The 2nd plans have not been with you that long, but the h/o (my shorthand for homeowner) is anxious. Thanks so much Dan, Pam :) 9/17/2003 TOWN OF NORTH ANDOVE BOARD OF HEALTH 9 Location Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit �$ Dumpster Permit Burial Permit $ z 9 /-, 1*41 Swimming Pool Permit a4$ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ offal/Trash Hauler $ Other $ Health Agent White - Applicant Yellow - Dept. Pink - Treasurer SEPTIC PLAN SUBMITTALS M 1 t LOCATION: �?� �r Map &Parcel NEW PLANS: YES $225.00/Plan Check #: REVISED PLANS: YES $ 60.00/Plan � Check #: SITE EVALUATION FORMS INCLUDED: YES LOCAL UPGRADE FORM INCLUDED: YES NO DATE: Z C� 'S DATE TO CONSULTANT: DESIGN ENGINEER: Telephone #: Gla6-1/76 8 When the submission is complete (including check), date stamp plans, COPY for Conservation, and place in existing file with green Design Approval form. ///Ce 16:5&- 1 lk NEW ENGLAND ENGINEERING SERVICES INC North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 338 Berry Street, North Andover, Septic system design Dear Sir or Madam: September 11, 2003 Tovin, OF FORTH ANDD' -"FF This letter and the enclosed plans are being submitted to address the comments in a letter dated August 22, 2003. Each item is addressed as follows. 1. Observed groundwater depths have been added to the soil logs on the plan. 2. Note 8 has been revised to indicate that an additional benchmark shall be set by the engineer prior to construction. 3. Note 9 has been revised to indicate that the existing septic tank shall be pumped crushed and removed. 4. Typically only two deep holes have been required in trench systems where the reserve area is located between the primary disposal area. The requirement is considered as being met by the fact that the deep holes overlap both the primary and the reserve areas. 5. Buoyancy calculations have been added to the plans. The calculations have been done for the worst case scenario of the tank being totally submerged. The tank has been lowered to provide 18" of cover to overcome the buoyant force. 6. The septic tank is specified as being a supplied by Shea Concrete. Their tanks are certified to meet the specifications of Title 5. 15.226 which specifies that the materials be watertight. Further, a butyl resin seal is specified for the joint between the top of the tank and the bottom Note 10 of the plan specifies that all pipe penetrations in the tank shall be sealed with hydraulic cement which is a waterproof material. 7. Spot grades are shown in the area of the system. These grades .indicate that the slope over the system meets the 2% minimum slope required. Sincerely, -_ C 2dir., Benjamin C. EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 uw PLASTIC PIPE SEAL 4" DIA INLET 4'-7" v PLAN VIEW 1" TAPER 4" TOP (6" H-20) LIQUID LEVEL SEE NOTE 5 3" SHEA 4" SECTION VIEW NOTES: 1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS. 2. CONSTRUCTION OF SEPTIC TANK CONFORMS WITH DEP TITLE 5 REGS, 310 CMR, SECTION 15.226. 3. ALL REINFORCEMENT PER ASTM C1227-93. 4. TEES AND GAS BAFFLE SOLD SEPARATELY. 5. TONGUE & GROOVE JOINT SEALED WITH BUTYLE RESIN. 6. ALSO AVAILABLE IN H-20 LOADING. i . .1"a 5'-2" PLASTIC PIPE SEAL 4" DIA OUTLET 50OO (5-10" H-20) WEIGHT ITEM NO. TK -1000 STANDARD 8.765 TK -1000H H-20 9,785# � q NEW ENGLAND CONCRETE PRODUCTS INC. SEPTIC TANK 1000 GALLON WILMINGTON, MA (978) 658-2645 -- AMESBURY, MA (978) 388-1509 PAGE B1.1 NOTTINGHAM, NH (603) 942-5668 1i t TOWN OF NORTH ANDOVER' J HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Starr, R.S., C.H.O. Public Health Director Benjamin C. Osgood, Jr., EIT To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 From: Pamela # 978-685-1099 Pages: ,� Fax: 49 Telephone (978) 688-9540 FAX (978) 688-9542 978-686-1768 Date: � �% Phone: Af Septic Plan Response CC: Sandra 5tarr, R.S., C.H.O. Re: Health Director ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from Sandra Starr regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Xc: Address File Chrono File r �J HP Fax'K1220xi Last Transaction Date Time Type Aug 27 12:25pm Fax Sent Identification 89786851099 Log for NORTH ANDOVER 9786889542 Aug 27 2003 12:28pm Duration Pages Result 1:34 2 OK .J Town of North Andover Office of the Health Department 0 Community Development and Services Division 27 Charles street '' x North Andover, Massachusetts 01845 'ssu►ws1 Sandra Starr Public Health Director August 22, 2003 Richard C. Tangard, P.E. New England Engineering Servics, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 338 Berry Street Dear Mr. Tangard: Telephone (978) 688-9540 Fax (978) 688-9542 The proposed septic system design plans for the above site dated July 25, 2003 have been reviewed and have been found to have technical deficiencies that must be addressed prior to the plan approval. They are as follows: 1. Observed ground water is missing from the logs on the plan. (3 10 CMR 15.220(4)(n)). 2. The benchmark is located 150' from the tank. (3 10 CMR 15.220(4)(q)). 3. There needs to be a note regarding the proper abandonment of the existing septic tank (3 10 CMR 15.354). 4. There are only two deep holes and one perc test. Four deep holes and two perc tests are required since there is a primary and a reserve area (3 10 CMR 15.102(2) and 15.104(4)). 5. Buoyancy calculations for the septic tank are required since there is no ground water data in the area of the tank. ESHGW is located 40" below grade in the area of the leach trenches. (310 CMR 15.221(8)). 6. A note is required stating how the septic tank will be made watertight. (3 10 CMR 15.221(1)). 7. Grading shall divert drainage away from the leach area (3 10 CMR 15.240(11)). Please call the office if you have any questions. Sincerely, B ' l aGrasse, Health Inspector cc: Homeowner CD&S Dir. BOARD OF APPEALS 688-9541 BUILDNG 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 r l Page 1 of 1 Pamela DelleChiaie From: "Dan Ottenheimer' <info@milldverconsulting.com> To:<blagrasse@townofnorthandover.com>;<pdellechiaie@townofnorthandover.com> Sent: Tuesday; August 26, 2003 7:22 PM Attach: Berry#338 Plan Review Letter.doc Subject: Plan Review Attached please find plan review for Berry Street. Wasn't sure how you wanted to close the letter so you can edit that as you see fit. Dan Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 info@millriverconsulfing.com 9/8/2003 MORTq O ,SSACHUSEt Town of North Andover, Ma zhusetts BOARD OF HEALTH DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM A p p I i c a n t Site Location ���•PiP� Reference Plans and Specs DESIGN Form No. 2 19 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee�� CHAIRMAN, BOARD OF HEALTH Site System Permit No. TOWN OF NOATH ANDOVE BOARD OF HEALTH Location - Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ i Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ ods %1 a1Ui 5. 611� Health Agent White - Applicant Yellow - Dept. Pink - Treasurer NEW ENGLAND ENGINEERING SERVICES lk INC Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 338 Berry Street, North Andover, Septic system design Dear Sandra: June 28, 2003 i� 2 8 ?CD3 Enclosed are the following documents concerning the above referenced property. 1. 5 sets of septic system design plans, one with an original stamp. 2. Application for approval. 3. Soil evaluator sheets. 4. Check to cover the approval fee. This plan.is being submitted for approval. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, Benjamin C. Osgid,Jr., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 SEPTIC PLAN SUBMITTALS ~J LOCATION: Map & Parcello8c 1 S NEW PLANS: $225.00/Plan ✓ Check #: REVISED PLANS: YES $ 60.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO DATE: 7T `3 1 0 3 DATE TO CONSULTANT: DESIGN ENGINEER:--696Nce2�T elephone #: 9 7 8, 17( 9 When the submission is complete (including check), date stamp plans, COPY for Conservation, and place in existing file with green Design Approval form. No. � F 1 � z i FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: & 1361c, Commonwealth of Massachusetts Noa-w ANPo, tA- , Massachusetts Soil Suitability Assessment for On-site Seware Disposal gerr�+n�iN C. �s�oo9 ,j/t- Date: 6/30%3 ............... PerformedBy:........................................................................................... ............... Witnessed By:...... ..... .......SgA........................................................................ ............ ...... ........ ._.._ Location Address or 3 3 v & G IZ a _, 5-1a6'6—, Owrcr's Namc. 5 [7 NTi� z Gj-a�� /1a�2P�ry Lot J Address, and 7 n 0 l2?N AA) n 0,1E (Z A' A Tcleplwrc / ,a 3 L JG `J S 12 e e i /vo 2.7H AA/o o,Ie2, 44A- 0189,r Iew construction ❑ Repair 0 Office Review Published Soil Survey Available: No ❑ Yes Cbl Year Published (q ......._.......... Publication Scale 1 . ►,?.�1. Soil Map Unit Drainage Class WELL DRAt_NE Soil Limitations _. . ..........�' Surficial Geologic Report Available: No 14 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform .................................................................................................................................................................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No El Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal ®Normal ❑Belc=v Normal Other References Reviewed: DEP APPROVED FORM - 12/07/95 r�----:.....__.....__.._.. ..................................... AlJ�r...................... 1071 DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Muruell) 'Mottling (Structure, Stones, Boulders, Consistency, % Gravel) ^4 /45s, V c , r-WiP0 %E ,1411ss� i�h,`gBlE S7S -MINIMUM Vr L FIVLCJ ncuvulcv n• ���••• • •• v�� �•�• ^•-• • - Parent Material (geologic) )93L; n1 0A1 L_ DepthtoBedrock: % l t2)-5 Depth to Groundwater: Standing Water in the Hole: /y cJ •` Weeping from Pit Face: Q� k Estimated Seasonal High Ground Water: 1 DEP APPROVED FORM - 12/07/95 FORM 11 -:SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 233 2� b r 1212i 5 tZ E4 I ,U - �}ti' D Ov�✓� On. -site Review Deep Hole NumberDate:::..�'`..� �/`�3 Time:..Weather SON 7 Location (identify on site plan) :. .:..:::: Ear...:f2E/1-.,.:.....:..:::.:::.:.:.::::.:::..... :::....:.::::..:::.:...:.:..:::..::::..:......:.::.....:. Land Use Slope M Surface Stones Vegetation:.::..:..:.:L .K/... :.::. ::::..::...::::..::.:::,:........::.:...... Landform...:::.:..:..lhvllN.E:.. ...:::..::... ....:...... ...:..:.:.:..:..::..:....;...:...:::...::.:::..:.... Position on landscape (sketch on the back) ...:... -::- --- - .:: -- • :. :. - - - Distances from: Open Water Body .>SbJ feet Drainage way 6_ feet Possible.Wet. Area _ /S' ... feet Property Line ... 5....:. feet Drinking Water Well .:! .::. feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Muruell) 'Mottling (Structure, Stones, Boulders, Consistency, % Gravel) ^4 /45s, V c , r-WiP0 %E ,1411ss� i�h,`gBlE S7S -MINIMUM Vr L FIVLCJ ncuvulcv n• ���••• • •• v�� �•�• ^•-• • - Parent Material (geologic) )93L; n1 0A1 L_ DepthtoBedrock: % l t2)-5 Depth to Groundwater: Standing Water in the Hole: /y cJ •` Weeping from Pit Face: Q� k Estimated Seasonal High Ground Water: 1 DEP APPROVED FORM - 12/07/95 FOM n - SOIL EVALUATOR FOWN1 Page 2 of 3 Location Address or Lot No. 33 v 3e Rtz!* S-) 4-e —/1, IV007Y A-4)-0ojef- On-site Review Deep Hole Number T? Z Date:. 61.3P1� Time:. A2:'./.? Weather Location (identify on site plan)�..:::::.r!�.. Land Use.......)2GRS:!R-e-� :i7fl:4. Slope (%) S... Surface Stones : NaN,�5- ..- -,b 6`' Vegetation :...�-w�`! Landform ....:.....::.,✓�:DizfL'iNE . .:... ....... .... ..,. Position on landscape (sketch on the back) Distances from: Open Water Body jS00 feet Drainage way feet Possible Wet Area /,5--P.. feet Property Line ../s.... feet Drinking Water Well :/ . feet Other ...::...:: DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) 3/y niJrb Y77, r 2, 33 �� �. �� /OYIZ ,33-1/ ,y�,4s;sluc" �2iA.8GE /o R -� y 10%.G-2Av rrc � /v% C�BBS LSM MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic) R-9& -7)ON -7-14- ` DepthtoBedrock: q/ Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: yo,"C Estimated Seasonal High Ground Water: DEP APPROVED FORh1 . 12/07/95 FORM 11 - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. 338 sT2tCT ND R-. T/ AA1.D6(,t5i2 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ Depth weeping from side of observation hole .............. inches Depth to soil mottles ..:..'::: inches a. Ground water adjustment ................... feet Index Well Numb.er .................. Reading Date ................... Index well level ........... Adjustment factor Adjusted ground water level .... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ,9Es If not, what is the depth of naturally occurring pervious material? Certification aEo I certify that on /ggS (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date DEP APPROVED FORM - 12107/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. 33 o 8 fe b71aCE r- ivaiz:-1W ^/j -D C(/L COMMONWEALTH OF MASSACHUSETTS )V') Ell-( pr ao,JC2, Massachusetts Percolation Test# Date::...........:.�0 ` 3c� `a 3 Time:, Observation Hole # -77 Depth of Perc �i 7 Start Pre-soak 119;/g End Pre-soak `v 33 Time at 12" Time at 9" /v'�'�9 Time at 6" Time (9"-6") 2 Rate Min./Inch % r►m i r► f uv G i-/ Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed © Site Failed ❑ .................................................................................:........................................_.__........_......._ Performed By:i �r,U ,—RC s on 2 Witnessed By: ��fly (� b -o Comments: a. DEP APPROVED FORM - 12107/95 Town of k,.:rtth Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH Q�tt`ED ib �� ��� /D Vt-1 46 Q APPLICATION FOR SITE TESTING/INSPECTION Applicant—` /��J�/�J��` / ��— ✓`✓'��Do�� NAME / / ADDRESS TELEPHONE Site Location Cq S,77 Engineer NAME ADDRESS TELEPHONE Te /Insp ction Date and Time CHAIRMAN, BOARD OF HEALTH Fee ©� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North -Andover, Massachusetts / Form No. 1 NORTH A BOARD OF HEALTH " 3�Orytt`ED 6�•yOL r ��� /D���� Q APPLICATION FOR SITE TESTING/INSPECTION p°RATED PPa` '�y SSACHUSV. Applicant Site Location Engineer t- '. 4F—; Test/Inspection Date and Time Fee ©o A '—�1 ADDRESS TELEPHONE 30 CHAIRMAN, BOARD OF HEALTH q.r� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. r -TOWN OF NORTH ANDOVER BOARD OF HEALTH Location 3�w , Permit ;# 61<�`,�S Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ Health Agent t1hite - Applicant Yellow - Dept. Pink - Treasurer DATE: BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP & PARCEL: LOCATION OF SOIL TESTS: .33'0 1a RRj s—r2 F0 7 OWNER: TEL. NO.: q78 - ss — o a,s 7 ADDRESS: 3'07c�2(lW ENGINEER: 100 Ea�(rL.4Na �. � ,,� ¢� ; nn TEL. NO.:—q Z 8 17 � 4� CERTIFIED SOIL EVALUATOR: �J /L v Intended use of land: Residential Subdivision mangle Family Home) Commercial Is This: Repair testing_ Undeveloped lot testing In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $200.00 per lot for repairs or y2 rg ades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2: Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. .4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: /d Check Amount: 02619Check Date: U � CO � O n 00 O N N w Q` p LL- F--- W UJz OcnN f Zp�of pz� Q oo �_w Q Q 0 ry V) W_O,X O 26' a w i-- 8: 7 \� y w.Z 53.8'' l Y w.l r� 03 I U> I U') ZUwM I m� Mo N XDoo O Of W O N Z !_ ,05l8 w (f)F- z 6a 06 oz `oz T BERRY (VARIABLE' WIDTH) sTREE o� >Q Q Lij DATE: +�3 BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP do PARCEL: LOCATION OF SOIL TESTS: 16f� R lz�j 5;F12 F z OWNER: �50K4 TEL. NO.: qz8 - ss 7 - 0 a S 7 ADDRESS:32��c g- ST ENGINEER: 10e— E+�C, ���� k , �.�e TEL. NO.: 1-18 CERTIFIED SOIL EVALUATOR: b"e-1, Intended use of land: Res; rRepair — Repaipair testing In the Lake Cochichewick Watei THE FOLLOWING MUST B: 1: Proof of land ownership 2. Plot plan 3. Fee of $425.00 per lot for n required for each disposal a GENERAL INFORMATION Tk5 1-5 cd( SCS.+ 0 Commercial holes and two 1, sq�j percolation tests 1. Only Certified Soil Evaluators may pertorm deep hole inspections. 2: Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Bel w This Line N.A. Conservation Commission Approval: O Date Received: �' /G Check Amount: o2� 0_4DCheck Date: ' I r �J DATE: ted BOARD OF HEALTH �J NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP & PARCEL: LOCATION OF SOIL TESTS: J&Q R iZuj Sr R F 77t— ..OWNER: t. OWNER: �5c,TEL. NO.: qZ,9 -,5S ADDRESS:3j c iZ(Lw sT dt a l X,, Z).:). ENGINEER: 10 G— TEL. NO.: 1-78 CERTIFIED SOIL EVALUATOR: fit-1�9 d-� �J 2 A I-, Intended use of land: Residential Subdivision mgle Family H meo Commercial .Is This: Repair testing_ Undeveloped lot testing -In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $200.00 per lot for repairs or up ades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least -two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Bej9.w This Line N.A. Conservation Commission Approval: !' D Date Received: /d 5 Check Amount: 0249 a� Check Date: X /D,� O 0 Uw ka vi NCO t� O N o N N w Q= . > w cn O C) / G 4 N .� z( U Oc J Uig \ W 00 Q Q Oo �Fm Q s� aaa amu' M 12' .Z 53.8' I IrQ> �� II ca001 wU LL y N w n o) oZ 6$'S0� _ Z ,05 l8 , 0 oz =Z 1 STREE BERRY (VARIABLE WIDTH) LLJ o� >Q Q Wo\�o 4 _ 30_03 gg, 0 C,A,7-101\1. SOL' ��Ji i ;V Vzo ,-OL i ION i ST .= ` L4 77 I plc TIME IE� O IC- , C. -A. �Nlc E luap!sa/d 018S -LLL (8091 XV4 siugnly •V iLagoa 617610 VW 'uOIQIPP!W > pooa aI!49uawa0 91 991Z -d56(805) ANYdWOJ N011J3dSNl 9WOH d lv-y-� �NI'M1MEW01103dSWI QA" *,SUNSPACE FOR PROFESSIONAL HOME INSPECTION (508)9S4-2166 FREE FOLLOW-UP PHONE CONSULTATION PPOEESSIOML HOME INSPECTICft Qualifications: • Graduate Northeastern University Building Design d Management Program Certificate of Professional Achievement Real Estate Inspections • Graduate of New England Fuel Institute • licensed Oil Burner Technician • B.S. Tufts University • licensed Title V Septic Inspector \ J Complete Home Inspection: Card Grounds Gros Electrical Structured r'ior Kitchen • Exterior • Basement d Gawispace Roof Plumbing • Heating d Air Conditioning Testing Services: • Water • Termite • Radon Lead Septic Inspection: Complete Title V Inspection. Preliminary results given at time of inspection. Written results ASAP. • licensed • Wependent Ethical 14 Date....... ............ ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that e-.....I.•Q•J........... has permission to perform ... ........... 1� wiring in the building of ........................ .... t .... . ........................................... at �g ..... ........ ............ , North Andover, Mass. Fee /....... -7'5-�f ....... Lic. . .... . .......................... ELECTRICAL INSPECTOR Check # 5 418 TRE COM WONWF•AUHOFMASSACHUSETIS Office Use only i _ DEPAR73ffi 1'OFKMUCS4FM Permit No. Jr7`� a —1� P BOAROOFFMPREVEMONRBGULARONSSrag]2.ii" Occupancy & Fees Checked 1f� 1f APPLICATIONFOR PERMUTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH 1MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date S D Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ?,F-iZ 2 ,A/- 14, Owner or Tenant a -e y/ . - - Owner's Addresses - &lew—�- Is this permit in conjunction with a building permit: Yes 0 No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service AmpsT%.7 d 56volts Overhead ® Underground No. of Meters New ServiceJ0 Amps /Z4 olts Overhead ©Underground No. of Meters loe Number of Feeders and. Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixaures t Swimming Pool Above M Below Generators KVA round zround No. of Receptacle Outlets a� No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges / No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total t Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal _ Othe No. of Dryers Heating Devices KW � Connections ED No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- 41, C— ? 11M=C -- ?11M=C R>ralcrtlolhecegluanertsdMmxhuMGenaWLaws IhmaaaitLi*T1yykwmxePdLy tcixftCotr;i&- �ls Coraaoriatrialegxvabt YES � nNO I?Ave&bmi1edva6dpmofefmwlD he0ffiX YESri El ff}whavectl d(vdYES,pleasehic*fttH)eof by Li rawbox IlVSCJRANCE 1 BOND D O mM 0 (Pl w specit'y) �� /' d 7 EgkaGalDale VaiteofFJahicalWodc $ WO&IDStNtL"Cf h�spec ionD&Regttesmd Final Signedunder peow.. FIRMNAME LimmNo. ' vr�/ % Signaoae LioatseNo S� �� AIL Tel.No. Signature or Owner or Agent FM7 Masswiluselis Crerlaal Laws y a✓ Telephone No. PERMIT FEE $ THECOMMONWEAI.MOFMAS94CHUSE77S Office Use /only 7 m DF.RIUMENTOFMMIK"SAMY Permit No. BOAROOFFMPREVENNMNREIGUTAHONS5Vag]ZiD ' Occupancy & Fees Checked APPUCA77ONFOR PERMITTO PERFORM ELECTRICAL, WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH TOE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date S D Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number)- ,E /z QLI 12 Owner or Tenant a "cam' • " Owner's Address_ Is this permit in conjunction with a building permit: Yes [4 No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service fe ir-) Amps4.1v2 Volts t Overhead121 1:3 Underground No. of Meters New Service Amps/Zcf, -Volts Overhead® Underground 1:3 No. of Meters Number of Feeders and Ampacity, Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ' round itround No. of Receptacle Outlets c3eD No. of Oil Burners No. bf Emergency Lighting Battery Units 1. of Switch Outlets 1. No. of Gas Burners f— of Ranges / No. of Air Cond. Total Tons FIRE ALARMS No. of Heat Total Total b. of Disposals No. of Detection and Pumps Tons KW Initiating Devices No. of Sounding Devices b. of Dishwashers Space Area Heating KW No. of Self Contained of Dryers Detection/Sounding Devices Local Municipal Heating Devices KW o. of Water Heaters KW Connections No. of No. of Sions Bailasis o. Hydro Massage Tubs I No. of Motors Total HP ;CovelaW PUtumIDthe ta4u=McfMamhtsetlsGmEgL3ws umil-itthifiyhmweR*yhd&lgCo Ti* Crnaageorts&ftw lapNViat zmadvadidpioofofsatremdrOftmp YES riT IF)m 'NCE BOND MMR (Please Spetdty) No. of Zones a Other ValrecfEla kW Wade $ hts mbmD*Rgxsbd Rao RIA LimmNa Sigrmn Limmm S— V'& Busff=Tel.Nb n-/ J V(I-115'�" J/',� AIL TelNa FRANCEWAIVER,IamawmdutheL=wdoesmtdr eovsageorits ats1aruewivalu =smamedbvMamduseftCetmATAwc Ke cn dis pemit appkadm waives this requ'WWt ane) Owner 1:1 Agent 17 signature of Owner or gen Telephone No. PERMIT FEE $ % /�� come 2 5 l k� TcNfrli : G Fi rVr�"D�D �'0 2 /htc/Zo k4t� GS +Ccr w.� niD i woR k i w - — gopv �°t► wE"/� d -7-6s- Commonwealth of Massachusetts City/Town of System Pumping Record a` 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 usi ,n.;Z you local Board of Health to determine the form they use. The System Pumping rdd t the local Board of Health or other approving authority. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rdun A. Facility Information TOHEA0TH 0EPAR M � TSR 1. System Lo tion• �„ (� Address �-�- Ciiy/rown State Zip Code 2. System Owner. �1 !J � Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State,,�., NDCodp,Telephone Number Date 2. Quantity Pumped Cesspool(s) ErSeptic Tank 4. Effluent Tee Filter present? ❑ Yes ❑-t4o 5. Condition of Ds(�-� V-A� 6. System P mped By Name Company 7. Location ntentsre ;7- 1A g�� // - Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 'so t� C4,zS Fss'-�- ( Vehicle License Number Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 WILLIAM F. WELD (jOVCM07 ARGEO PAUL CELLUCCI Lt. Govemor COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 61i-292-5500 Ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 338 V • A10- 0' Address of Owner: Date of Inspection: ® Q 7 of different) Name of Inspector: /¢G,4XVA), S 1 am a DEP approved s stem inspector ursuant to Section 15.340 of Title 3 (310 CMR 15.000) Company Name: A/SPX f NS AFer N d/�C+ Mailing Address: Gen/v Al %4 VtgVf Telephone Number: ATG 13199 t R� DS mtar` DAVID B. STRUMS Commissioner CERTIFICATION STATEMENT I certify that 1 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 disposa! systems. The system: Passes _ Conditionalh, Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: Zzlt I The SN,stem Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SY TEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes, no, or not determined (Y, N, or ND). 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 conforming septic tank as approved by the Board of Health. (reviaad 04/25/97) Paye 1 of 10 DEP on the World Wide Web http/vwwrmgmetsmte.rna.us/deP Pnnted on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r' ?GCERTIFICATION (continued) Property Address: 370 SY Owner: Date of Inspection: QX/9/17 B] SYSTEM CONDITIONALLY PASSES (continued) 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled 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 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER I WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) 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 to 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 soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil 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 04/25/97) Page 2 of 10 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 338 St Owner: . Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following- I have determined that the system violates one or more of the following failure criteria as defined 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 Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution boa above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flov,. 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy, is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well w& no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copv 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" as 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 II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Saga 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3 IV g S Owner: Date of Inspection: /$ 97 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. •. _ 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub -Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (rovimed 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' Sfi SYSTEM INFORMATION Property Address: L� Owner: r G %A-U� Date of Inspection: �/�/977 FLOW CONDITIONS RESIDENTIAL• Design flow: _g.p.dJbedroom for S.A.S. Number of bedrooms: Number of current residents: Z -- Garbage g,rder (yes or no):.;irs) Laundry corrected to system (yes or no):� Seasonal use lyes or no):/VQ ^•' '. (� Water meter readings, if av ilable (last two (2) year usage (gpd): � W 6 L L Sump Pump (yes or no):� Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day 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 pate of o:cupanc,: OTHER: (Describe; _ Last date of occupancy. GENERAL INFORMATION PUMPING REC9RDSagd so rce of informati�: System pumped `A part of irKpection: (yes of no) -V© If yes, volume pumped: Gallons Reason for pumping Tl(P�OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: aAkA, VIV-510�.� 0 A Sewage odors detected when arriving at the site: (yes or no)� (revised 04/25/97) Daps 5 of 10 I— \ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION (continued) t Property Address: 338 Xr Owner: , Date of Inspection: BUILDING SEWER: �� (Locate on site plan) Depth below grade: Material of construction: _ cast iron _ 40 PVC _ other (explain) Distance from private water supply well or suction lire Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grader ID 0 Material of construction: oncrete _metal _Fiberglass _Polyethylene —other(explain) if tank is metal, Inst age _ Is age confirmed by Certificate of Compliance _ (Yes/No) Dimensions: 61 14 X". / 11e�� Q/1/ Sludge depth: It Distance from top of slydge to bottom of outlet tee or baffler Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: / I Distance from bottom of scum to bond of outlet tee or filer How dimensions were determined: Comments: (recommendation for pumping, condit��f inlet and outlet tees or ba s, dept of liquid I vel ' relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: fvpr (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: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address-&.39.A Owner: Date of Inspection: �SeQ TIGHT OR HOLDING TANKA/Rank 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: gallons Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: inose if IRvel and .distribution is equal evidepce of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:! A)A— (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) page 7 of 10 W SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_,& (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: (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: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) NPRIVY. _A_ (locate on site plan) Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page ! of 10 Dimensions: 7 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) �_ Property Address: a - a? dmv S-/ Owner: We J%e C44 Ze�K Date of Inspection: a -/r/ dy y/r /d, 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) pn2c r+ I7L:-- (revised 04/25/97) Page 9 of 10 t /1%7- To Property Address: 338 Owner: Date of Inspection: Depth to Groundwater`Feet ay 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' SYSTEM INFORMATION (continued) Please indicate all the methods used to determine High Groundwater Elevation: /V,4,Obtained from Design Plans on record li Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data r Describe in your own words how you established the High Groundwater Elevation. Must be completed) ,/ �� % �� u�eo-ar �oY► r� /1b a�Q �W — 3 a5- � 4� 7 ct - (revised 04/25/97) Page 10 of 10 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS 338 gax� S' SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: — �QUANTITY PUMPED l 24GALLONS CESSPOOL: NO S YE SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE �MERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) <� CONTENTS TRANSFERRED TO: CL'- 0 WELL DATABASE � l ADDRESS:�'� AGE OF W-ElLL: WELL D T i E,R: W—ELL WELL LOCATION: e ---WELL PERMIT DATE: DEP IH OF W : TYPE OF WELL: a_ DRILLED b. DLIG c. UNR OWN - TYPE OF WATER BEARING ROCK- _ WATER ANALYSIS DAT- -GH NfA GANESE:. Y_J N HIGEIRON Y N OTS CGN *A INANTS� Y N Lj + ; C/ 717= DATABA EE. ,a ADDRESS: S 13 ./'� �; / ► AGE OF WELL: _ -S 'ti 4= DRILLER'u- - ..WELL PERMIT,: J O WELL LOCATION: ��'� �% �t�) c � �=/ t``•`•v` WELL PERMIT DATE: _5 - c. - `� L DEP i H OF WELL: TYPE OF WELL: tea. DRILL b. UG c. U-N�'\iOWN TYPE OF WATER BEARLi iG ROCK: ^� WATER A'+ALYSIS DATE: � T_� HIGH MANGANESE: Y N HIGH IRON: Y N OTHER CONTANEL ,4" TS: Y N IL Commonwealth of Massachusetts City/Town of RECEIVES System Pumping Record Form 4 NOV 15 2011 1M sve` TOWN OF NORTH AyDOOwith DEP has provided this form for use by local Boards of Health. Other orrp Ane lrr�? r binformation must be substantially the same as that provided here. Be 67 tyour 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 1. System Location: Left/ Right front of house, Left/ Right rear of houseright side of house, Left/ Right side of building, l qft / Right front,of building, Left / Right rear of building, Under deck Address Cityrrown 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Other (describe) State Zip Code State Zip Code KSM - a 'a II Teleph umber Date' 1� 2. Quantity Pumped: Gallon ❑ Cesspool(s) V'S"eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ESI/No 5. Condition of System: w► a 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatiowhere contents were disposed: G.L S.Q Lowell Waste Water If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number �(' 9 -II Date t5form4.doce 06/03 System Pumping Record • Page 1 of 1