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Parcel ID :210/107.A-0131-0000.0 FY:2010 Community: North Andover
SKETCH
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PHOTO
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344 RALEIGH TAVERN LANE
Location: 344 RALEIGH TAVERN LANE
Owner Name: WALSH, MICHAEL P
MARY E MC LAUGHLIN
Owner Address: 344 RALEIGH TAVERN LANE
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 7 - 7 Land Area: 1.04 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 2298 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 493,900 519,900
Building Value: 268,000 294,800
Land Value: 225,900 225,100
Market Land Value: 225,900
Chapter Land Value:
J
http://csc-ma.us/PROPAPP/display.do?linkld=1519436&town=NandoverPubAcc 9/27/2010
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... Btu' TRUST
,-NOTE** THIS PLAN & CERTIFICATION IS NOT
A WARRANTY, OF THE SUBSURFACE DISPOSAL
SYSTEM. IT IS A RECORD OF THE LOCATION
AND ELEVATION OF THE EXISTING SYSTEM
COMPONENTS.
_LT 4G.ilas�
THE SEPTIC TANK WAS INSTALLED CLOSER TO
THE EXISTING GARAGE DUE TO LEDGE BEING
ENCOUNTERED.
RALEIGH TAVERN LANE
AS BUILT PLAN
OF
X7-40 � 7 2010 SUBSURFACE DISPOSAL SYSTEM
TOWN OF NORTH ANDOVER LOCATED IN
HEALTH DEPARTMENT NORTH ANDOVER, MASS. /344 RALEIGH TAVERN LANE
AS PREPARED FOR
MIKE WALSH TM: 107A
DATE: 9-23-10 TL: 131
SCALE: 1"=40'
0 20 40 80
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
North Andover Health Department
Community Development Division
CFRTIFICATE OF COMPLIANCE
As of:
September 28, 2010
This is to certify that the individual subsurface disposal system received a
Satisfactory Inspection of the:
Repa.%r/Replacetnent of th&camplet&
Septic.1 v4p0WV SySte W
'By:
344 Rale giv rawerw La*wl
Map .107A Lotl31
NortivAnd over, MA 0.1845
The Issuance of this certificate shall not be construed as a guarantee that the
system will function satisfactorily.
�t
us�an Y. Sawyer
Public Health Director
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
6 NORTH ,,••
O�,stlEo IQ�-r0
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PUBLIC HEALTH DEPARTMENT
Community Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 344. Raleigh Tavern Lane MAP: 107A LOT: 131
INSTALLER: Todd Bateson
DESIGNER: Vladimir Nemchenok
PLAN DATE: 8/12/10
BOH APPROVAL DATE ON PLAN: 8/26/10
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION: 9/21/10
DATE OF FINAL GRADE INSPECTION: glar7I I 0
SITE CONDITIONS
Comments:
SEPTIC TANK
NA Contractor reports any changes to design plan
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
❑ Building sewer in continuous grade, on compacted
firm base
❑ Cleanouts per plan
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ gallon tank has been installed
loading
❑ Monolithic tank construction
❑ Water tightness of tank has been achieved by
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Inspection Form June 2008
No
ti
o 11'
�t
�•D coc.uiwewaw . 1•
PUBLIC HEALTH DEPARTMENT
Community Development Division
testing
❑ Inlet tee installed, centered under access port
❑ Outlet tee installed, centered under access port (gas
baffle/effluent filter)
❑ inch cover to within 6" of final grade installed
over one access port
❑ Hydraulic cement around inlet & outlet
Comments:
DISTRIBUTION -BOX
® Installed on stable stone base
® H-20 D -Box
® Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
Z Speed levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM (General)
Bottom of SAS excavated down to C soil layer, as
provided on plan
® Size of SAS excavated as per plan
® Title 5 sand installed, if specified on plan
® 40 Mil HDPE barrier installed
® Laterals installed and ends connected to header (and
vented if impervious material above)
® Elevations of laterals and chambers installed as on
approved plan
NA Retaining wall (boulder / concrete / timber/ block)
❑ Final cover as per plan
Comments:
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Inspection Form June 2008
�'D_ COtMitlwKK , 1'
PUBLIC HEALTH DEPARTMENT
Community Development Division
SOIL ABSORPTION SYSTEM (Gravel -less Chambers)
® Brand and Model of Chamber: Standard Quick 4 LP
Infiltrator Chambers
® Number of chambers per row: 7
® Number of rows (trenches): 6
Comments: Total Chambers = 42
BM = 100.00
H R = 2.24
HI = 102.24
SYSTEM ELEVATIONS
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Inspection Form June 2008
ROD ELEVATION
AS -BLT INVERT ELEV
DESIGN INVERT ELEV
Benchmark
2.24
Building Sewer OUT
Septic Tank IN
Septic Tank OUT
Distribution Box IN
12.86
89.03
89.00
Distribution Box OUT
13.04
88.85
88.83
Lateral 1-6 TOP
13.10
Lateral 1-6 INVERT
88.79
88.78
Bottom of Bed/Chamber
13.79
88.50
88.50
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Inspection Form June 2008
r►ORTH
O�,st�eo �6 q�0
O
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland
bylaws
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Inspection Form lune 2008
Tank
SAS Sewer
®
Property line
10
10 --
®
Cellar wall
10
20 --
®
Inground pool
10
20 --
®
Slab foundation
10
10 --
®
Deck, on footings, etc
5
10 --
Waterline
10
10 101
®
Private drinking well
75
1002 50
®
Irrigation well
75
100
®
Surface Water
25
50
®
Bordering Vegetated Wetland ,
Salt Marsh, Inland / Coastal Bank'
75
100
®
Wetlands bordering surface
water supply or trib. (in Watershed)
150
150
®
Trib. to surface water supply
325
325
®
Public well
400
400
®
Interim Wellhead Prot. Area
®
Reservoirs
400
400
®
Drains (wat. supply/trib.)
50
100
®
Drains (intercept g.w.)
25
50
®
Drains (Other) Foundation
10 (5)
20 (10)
®
Drywells
20
25
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland
bylaws
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Inspection Form lune 2008
►A
1aw111 � Y 1110
Date: 7//0111o�, 0,v//, i
Address:
L LOAMED?
SEEDED?
❑ COVER PER PLAN?
Other:
Commonwealth of Massachusetts Map-Block-Lot
107.A0131
-----------------------
y� Board of Health Permit No
a BHP -2010-0721
i North Andover ----------------------
'r " FEE
°..� .... P.I.
�
$250.00
F.I.
�SSACMtl�E1
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Todd -Bateson
----------------------------------------------------------------------------------------------------
to (Repair) an Individual Sewage Disposal System.
atNo - 344 RALEIGH TAVERN LANE ---------------------------------------------------------------------------------------------------
----------------
as shown on the application for Disposal Works Construction Permit No. BHP -2010-072 Dated __ September 15, 2010
--- ---------
Issued
- - Issued On Sep -15-2010
Board of Health
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
1
ICS
Application for Septic Disposal System
Construction Permit -TOWN OF
$qORTH ANDOVER. MA. 01845
Application is hereby made for a permit to:
❑ Construct a new on-site sewage disposal system*
epair or replace an existing on-site sewage disposal system*
❑ Repair or replace an existing system component — What?
A. Facility Information
3r/_Y iZaA v 2A"
Address or Lot #
City/Town p..
2.- *TYPE OF SEPTIC SYSTEM*:
❑ Pump ❑ Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
TODAY'S DATE
$ 250.00 — Full Repair
$925.00 - Component
❑ Conventional System (pipe and stone system)
nfiitrator or BiodifFuser (Gravel -Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D -Box Present) S.A.S.
2. Owner Information
Name
MSL- 7dF t/ 441,
Address (if different from above))
City/Town
3. Installer Information
Name
1,14 0/ y AIS_
State Zip Code
Telephone Number
Name of Comp ON ENTERPRISES, INC.
L 111 ARGILLA ROAD
Address gy p
City/Town State Zip Code
/. = J!' o 3
Telephone Number (Cell Phone # if possible please)
4. Designer Information
Name Name of Company
Address
Cityrrown
/Llo- o - rel
State . Zip Code
%5—Tecf, � ;�- q95--
Telephone
lephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
j°RTS Application for Septic Disposal System
TODAY'S DATE
pConstruction Permit TOWN OF
-'* ORTH ANDOVER MA 01845 $.250.00 -Full Repair
$125.00 - Component
PAGE 2OF2
A. Facility. Information continued....
5. Type of Building: Piizesidential Dwelling or ❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore -described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certificate of Compliance has
been issued his Board of Health.
Name Date
Application roved By: oard of Health Representative)
Nam / Date
Application Disapproved for & following reasons:
For Office Use Only:
L
Fee Attached.
YesZ
No
2.
ProjectManager Obligation Form Attached.
Yes ✓
No
3.
Pump System? Ifso; Attach copy ofElectrical Permit
Yes_
No
4.
Foundation As -Built. (new construction ronly);Ye
No
(Same scale as approved plan)
5.
Floor Plans? (new construction only).
Yes_
No
Application for.Disposal System Construction Permit , Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
(Address of septic system) For plans by �d ►'.�.tr r C Nr��:�tC2� ie�►
(Engineer) J
Relative to theapplication of / ty-�,Q rev
(Installer's name) And dated
ngina ate .
Dated %11-%--w
o ay s ate
With revisions dated
(Last revised date)
I understand the following obligations for management of this project:
1. As the installer, I am .obligated to obtain all permits and Board of Health approved plans prior to
performing any work on a site. I must have the approved plans and the permit on site when any work is
being done.
2. As the installer, .I.mustcall for any and allinspections: If homeowner, contractor, project manager, or any
other person not associated with my company schedules an inspection and the system is not ready, then
item three shall. be. applicable.
3. ` As the installer, I anti 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 accordant
a. Bottom of Bed - Generally, this is the first (1S� inspection unless..there is aretaining wall, which
should be done.first. The installer must request the inspection but does not have to be present. .
b. Final: Construction. Inspection — Engineer must first do thein inspection for elevations; ties, etc.
As -built of verbal OK (or e-mail to: hcalthdel2t@towr-ofnor.thandover.co .from the engineer mu.st
be submitted to .the Board of Health, afterwhich installer .calls for an inspection time. Installer must
be present for this. inspection. With a pump system, all electrical work.must be ready and able to
cause pump to work and alarm to function..
c. Final Grade —Installer must request 4nspection when all grading is complete: Installer does not
have to be on-site.
4. As the installer, I understand that only I may perform the work (other than :simple excavation) and I am required
to complete the installation of the system. identified in the, attached application for installation:.I further
understand that work done by others unlicensed .to installsetics stems in North Andover can constitute
reasons for denial of the system and/or'revocation orsuspension of my license to operate in the Town of
North Andover significant fines to all persons involved are also possible
5. .As the .installer, I understand that I must be on-site during the.perforniance of the following construction
steps:
a. Determination that .the proper elevation of the excavation has been reached
b. Inspection of the sand and stone to be used.
c. Final inspection by Board ofHealth staff or consultant.
d. Installation., of tank, D -Box, pipes, stone, vent, pump chamber, retaihiv wall and other
components.
6. As the installer, I understand that Lam sole
1v res onsible for the installation of the s stem as er the
approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve
me of this obligation.
TOWN OF NORTH ANDOVER Permit Number
NORTH ANDOVER, MASSACHUSETTS 01845
Date issued
Expiration Date
Jackie's Law — Permit Application
Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant 0,940 e4- ies .-,
Phone Cell
Street Address
City/Town
MA
ZIP
/�
a/,Vg-/v
Name of Excavator (if different from applicant)
Phone Cell
Street Address
City/Town
MA
ZIP
Name of Owner(s) of Property
��,� Gv�-!sem
Phone Cell
Street Address 3'Y`fL"�,}v.
City/Town
MA
JZIP
Other Contact
Permit Fee ReceivedNo Yes
Description, location and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to
be laid in proposed trench (eg; pipes/cable lines etc..) Please use reverse side if additional space is needed.
c9 f /Z-ldu 5
Insurance Certificate #/: q P
Name and Contact Information of Insurer: Ni -cLi
Dig Safe #:
f® tau o2 w
Name of Competent Person (as defined by 520 CMR 7,02):
Massachusetts Hoisting License # / ;l ,0EF ®-2 3
BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE
AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE
WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO
WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. C. $2A, 520 CMR 7.00 et seg., AND ANY
APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT
AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL
COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW.
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TU APPLY FOR THE PERMIT AND
THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND
ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY
THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK
FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND
REGULATIONS GOVERING SUCH WORK.
THE UNDERSIGNED APPLICANT, OWNERAND EXCAVATOR AGREE JOINTLY AND.SEVERALLy
TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY
THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED
THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE
LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO. ASSURE COMPLIANCE
THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC
WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH
INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY By
THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS
AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES
RESULTING FROM .OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY
PERSON .OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT.
APPLIC GNATURE
DATE
EXCAVATOR SIGNATURE (rF DIFFERENT)
DATE
OWNER'S S'I.G�iNAT/URE (IF DIFFERENT)
W DATE:
2lPage
CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq.
(as amended)
By signing the application, the applicant understands and agrees to comply with the following:
No trench may. be excavated unless the requirements of sections 40 through 40D of chapter 82, and any
accompanying regulations, have been met and this permit is invalid unless and until said requirements
have been complied with by the excavator applying for the permit including, but not limited to, the
establishment of a valid excavation number with the underground plant damage prevention system as
said system is defined in section 76D of chapter 164 (DIG SAFE);
ii.
Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the
General Laws, an excavator shall not leave any open trench unattended without first making every
reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said
open trench unattended. Excavators should consult regulations promulgated by the Department of
Public Safety in order to familiarize themselves with the recognized safety hazards associated with
excavations and open trenches and the procedures required or recommended by said department in
order to make every reasonable effort to eliminate said safety hazards which may include covering,
barricading or otherwise protecting open trenches from accidental entry.
Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety
standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR
1926.650 et.seq., entitled Subpart P "Excavations".
iv.
vi.
Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment
subject to chapter 146 shall only employ individuals licensed to operate said equipment by the
Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed
operator before any excavation is commenced;
By applying for, accepting and signing this permit, the applicant hereby attests to the following: (1) that
they have read and understands the regulations promulgated by the Department of Public Safety with
regard to construction related excavations and trench safety; (2) that he has read and understands the
federal safety standards promulgated by the Occupational Safety and Health Administration on
excavations: 29 CMR 1926.650 et.seq., entitled Subpart P "Excavations" as well as any other
excavation requirements established by this municipality; and (3) that he is aware of and has, with
regard to the proposed trench excavation on private property or proposed excavation of a city or town
public way that forms the basis of the permit application, complied with the requirements of sections 40-
40D of chapter 82A.
This permit shall be posted in plain view on the site of the trench.
For additional information please visit the Department of Public Safety's website at www,mass.gov/dns
3 1 P a g e
Summary of Excavation and Trench Safety Regulation (520 CMR 14.00 et seq.)
This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L.c.82A and does not
include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A, go to wwwlmass.gov/dps
Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety, jointly with the Division of Occupational Safety,
drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of
Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a
trench made for a construction -related purpose on public or private land or rights-of-way. All municipalities must
establish a local permitting authority for the purpose of issuing permits for trenches within their municipality.
Trenches on land owned or controlled by a public (state) agency requires a permit to be issued by that public agency
unless otherwise designated.
In addition to the permitting requirements mandated by statute, the trench safety regulations require that all
excavators, whether public or private, take specific precautions to protect the general public and prevent unauthorized
access to unattended trenches. Accordingly, unattended trenches must be covered, barricaded or backfilled. Covers
must be road plates at least %1' thick or equivalent; barricades must be fences at least 6' high with no openings greater
than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators
may choose to attend trenches at all times, for instance by hiring a police detail, security guard or other attendant who
will be present during times when the trench will be unattended by the excavator.
The regulations further provide that local permitting authorities, the Department of Public Safety, or the Division of
Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury; the failure
to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The
trench shall remain shutdown until re -inspected and authorized to re -open provided, however, the excavators shall
have the right to appeal an immediate shutdown. Permitting authorities are further authorized to suspend or revoke a
permit following a hearing. Excavators may also be subject to administrative frees issued by the Department of
Public Safety for identified violations.
Summary of 1926 CFR Subpart P -OSHA Excavation Standard
This is a worker protection standard, and is designed to protect employees who are working inside a trench. This
summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational
purposes only and does not constitute an official interpretation by OSHA of their regulations, and may not include all
aspects of the standard.
For further information or a full copy of the standard go to www.osha.aov.
Trench Definition per the OSHA standard:
o An excavation made below the surface of the ground, narrow in relation to its length.
o In general, the depth is greater than the width; but the width of the trench is not greater than fifteen
feet.
Protective Systems to prevent soil wall collapse are always required in trenches deeper than 5', and are also
required in trenches less than 5' deep when the competent person determines that a hazard exists. Protection
options include:
o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices, the
equipment manufacturer's tabulated data, or designed by a registered professional engineer.
o Shielding (Trench Boxes). Trench boxes must be used in accordance with the equipment
manufacturer's tabulated data, or a registered professional engineer.
o Sloping or Benching. In Type C soils (what is most typically encountered) the excavation must
extend horizontally 1 '/ feet for every foot of trench depth on both sides, 1 foot for Type B soils,
and % foot for Type A soils.
o A registered professional engineer must design protective systems for all excavations greater than
20' in depth.
continued
4 1 P a g e
• Ladders must be used in trenches deeper than 4'.
o Ladders must be inside the trench with workers at all times, and located within 25' of unobstructed
lateral travel for every worker in the trench.
o Ladders must extend 3' above the top of the trench so workers can safely get onto and off ofthe
ladder.
• Inspections of every trench worksite are required:
o Prior to the start of each shift, and again when there is a change in conditions such as a rainstorm.
o Inspections must be conducted by the competent person (see below).
• Competent Person(s) is:
o C ale (i.e., trained and knowledgeable) in identifying existing and predictable hazards in the
trench, and other working conditions which may pose a hazard to workers, and
othAu orized by management to take necessary corrective action to eliminate the hazards. Employees
must be removed. from hazardous areas until the hazard has been corrected.
•
Underground Utilities must be:
o Identified prior to opening the excavation (e.g., contact Dig Safe).
o Located by safe and acceptable means while excavating.
o Protected, supported, or removed once exposed.
• Spolls must be kept back a minimum of 2' from the edge of the trench.
• Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep
heavy equipment and heavy material as far back from the edge of the trench as possible.
• Stability of Adjacent Structures:
o Where the stability of adjacent structures is endangered by creation of the trench, they must be
underpinned, braced; or otherwise supported.
o Sidewalks, pavements, etc. shall not be undermined unless a support system or other method of
protection is provided.
• Protection from water accumulation hazards:
o It is not allowable -for employees to work in trenches with accumulated water. If water control such
as pumping is used to prevent water accumulation, this must be monitored by the competent person.
o If the trench interrupts natural drainage of surface water, ditches, dikes or other means must be used
to prevent this water from entering the excavation..
• Additional Requirements:
o For mobile equipment operated near the edge of the trench, a warning system such as barricades or
stop logs must be used.
o Employees are not permitted to work underneath Ioads. Operators may not remain in vehicles
being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6).
o Employees must wear high -visibility clothing in traffic work zones.
o Air monitoring must be conducted in trenches deeper than 4' if the potential for a hazardous
atmosphere exists. If a hazardous atmosphere is found to exist (e.g., 02 <19.5% or >23.5%, 20%
LEL; specific chemical hazard), adequate protections shall be taken such as ventilation of the space.
o. Walkways are required where employees must crossover the trench. Walkways with guardrails
must be provided for crossing over trenches > 6' deep.
o Employees must be protected from loose rock or soil through prot
protective barricades. ections such as scaling or
5 1 P a g e
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES Z'
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ;�;»�• tr'+
NORTH ANDOVER, MASSACHUSETTS 01845 "Sso%
978.688.9540 — Phone
Susan Y. Sawyer, RENS/RS 978.688.8476-- FAX
Public Health Director E-MAIL: healthdet)t@townofiiorthaatdover.com
WEBSITE: ihttp://www.townofiiorthandover.coni
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: g- ("i O AU'I 0
TOWN OF NORTH GNOiVE
Site Location: A4 Lo • 1H947—Hip PAR ANT
Engineer;
New Plan
review only)
Revised Plans?Yes $75/Plan Check #
Site Evaluation Forms Included? Yes ✓ No
ibmission and one re -
Local Upgrade Form Included? Yes No
Telephone #.-M 70 �"� "' �l`� ✓" Fax 4-7 15 44
T
r _
Homeowner am- ��
Name: l
OFFICE USE ONLY
When the submi ion is complete (including check):
➢ Date stamp plans and letter
➢ Complete and attach Receipt
➢ Copy File; Forward to Consultant
➢ Enter on Log Sheet and Database
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Commonwealth of Massachusetts
City/Town of
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
A. Site Information
Contact Person (if different from Owner) Telephorfe Number "
B. Test Results
Observation Hole #
Depth of Pere
Start Pre -Soak
End Pre -Soak
Time at 12°
Time at 9"
Time at 6"
Time (9"-6°)
Rate (Min./inch)
Comments:
BY.
,�o�, t -t
Date � Time
�p it
E�;Iy
11 �37
t 4*7
Test Passed:
Test Failed:
V 1eq-5
Zip Code
Date Time
Test Passed: ❑
Test Failed:_ ❑
t5form12.doc- 06/03 Perc Test • Page t of 1
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
IL ff
Commonwealth of Massachusetts
City/Town of
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
A. Site Information
Cs=
5tre W 0 eSS Of L -V9 A i P0-Va9 HA,
Ckyftown T State Zip Code
67
Contact Person Of different from owner)elep rfieNumber
B. Test Results
0-1-1 p I kdo 4"
Time (9"-6")
Rate (Min./inch)
Comments:
Test Passed:
Test Failed:
Date Time
Test Passed: ❑
Test Failed: _ ❑
t5form12.doc- 08/03 Pere Test • Page 1 of 1
Data
TimObservation
Hole #
F I
Depth of Pere
tt
I
Start Pre -Soak
21 i
End Pre -Soak
741
Time at 12"
7
Time at 9"
Time at 6"
Time (9"-6")
Rate (Min./inch)
Comments:
Test Passed:
Test Failed:
Date Time
Test Passed: ❑
Test Failed: _ ❑
t5form12.doc- 08/03 Pere Test • Page 1 of 1
Bill Dufresne
Merrimack Engineering Services, Inc.
•66 Park Street
-Andover, MA 01810
•(978) 475-3555 Ext. 20
• 907 Ocean Blvd.
• Hampton, NH 03842
• Cell: (978) 502-6206
Fax: (978) 475-1448
Email: brdufresne@comcast.net
LETTER OF TRANSMITTAL
TO: Susan sawyer
DATE: 8-24-10
Board of Health
RE: 344 Raleigh Tavern Lane
NO.
DESCRIPTION
3
Revised
8-20-10
WE ARE SENDING YOU: ( ) PRINTS
(x ) PLANS ( ) SPECIFICATIONS ( )COPY OF LETTER
COPIES
DATE
NO.
DESCRIPTION
3
Revised
8-20-10
Upgrade Plan of Subsurface Sewage Disposal System
THESE ARE TRANSMITTED as checked below
(x ) FOR APPROVAL ( ) FOR YOUR USE ( ) AS REQUESTED
( ) FOR REVIEW AND COMMENT ( ) APPROVED AS SUBMITTED ( ) RESUBMITTED
REMARKS
Revised to address all 5 comments in your review letter
North Andover Health Department
Community Development Division
August 19, 2010
Vladimir Nemchenok
Merrimack Engineering Services
66 Park Street
Andover, MA 01810
Re: 344 Raleigh Tavern Lane Man 107A, Lot 128
Dear Mr. Nemchenok:
The proposed wastewater system design plan for the above site dated August 12, 2010 and received on August 13,
2010 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The
specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each
item.
1. The scaled profile should be no less than 1"=2' vertical (NA 3.2).
2. Please provide a statement identifying whether the property is within or not within the Lake Cochichwick
watershed (NA 3.2).
3. Please indicate the brand and model number of the DEP approved effluent filter proposed. Also indicate
the required annual maintenance (3 10 CMR 15.227(7)).
4. The graphic profile indicates that magnetic tape will be provided or a riser above the distribution box be
installed. Magnetic tape cannot be substituted for providing a riser above the distribution box if the cover is
greater than 9 inches below finish grade. Please specify a riser above the distribution box will be required if
the cover is greater than 9 inches below finish grade (3 10 CMR 15.232(3)).
5. An eighty finish grade contour is required to meet the 3:1 slope (3 10 CMR 15.255(2)).
Please feel free to contact the office with any questions you may have. We look forward to working with you to
obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure
protection of public health and the environment of North Andover.
Si
ncere
wyer, REHS/RS
Public Health Director
cc: Mike Walsh
File
1600 Osgood Street HEALTH DEPARTMENT
Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com
North Andover, MA 01845 Phone: 978.688.9540
Page 1 of 1
Fax: 978.688.8476
OF NORry qti
S�� OOG O
COPY
9SSACHUS��
North Andover Health Department
(ommunity Development Division
August 26, 2010
Mike Walsh
344 Raleigh Tavern Lane
North Andover, MA 01845
RE: Septic System Design approval for 344 Raleigh Tavern Lane, map 107A lot 131
Dear Mr. Walsh,
The North Andover Board of Health has completed the review of the septic system design plans
for the above referenced property, submitted on your behalf by Merrimack Engineering Services
dated August 12, 2010, last revised August 20, 2010 and received August 24, 2010. This plan
has been approved.
The design has been approved for use in the fully compliant construction of an onsite septic
system for a 4 -bedroom house (maximum 9 -room). In accordance with state subsurface disposal
regulations plans shall expire three years from the date approved unless construction on the lot
has begun. During this time, a licensed septic system installer must obtain a permit and complete
this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of
North Andover.
The previously issued disposal works construction permit has been rendered void. The contractor
must apply and receive the current approved plan. There will be no charge for this since no
inspections had occurred. Please notify your contractor.
This approval is subject to the following conditions:
1. If site conditions are found in the field to be different from those indicated on the design plan
and/or soil evaluation, the originally issued Disposal System Construction Permit is void,
installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit.
2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic
system installer or other representative to ensure that all other state and municipal
requirements are met. These may include review by the Conservation Commission, Zoning
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
�F
344 Raleigh Tavern Lane — Septic Plan Approval August 26, 2010
Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector.
The issuance of a Disposal System Construction Permit shall not construe or imply
compliance with any of the aforementioned requirement.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
may have.
Sincere
S san Y. Sawyer, REHS/RS
Public Health Director
Cc: Vladimir Nemchenck, Merrimack Engineering Services
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
DelleChiaie, Pamela
From:
Sawyer, Susan
Sent:
Monday, September 20, 2010 2:14 PM
To:
'Marianne Peters'; 'rburley@miliriverconsulting.com'
Cc:
DelleChiaie, Pamela
Subject:
upcoming systems
FYI for Mill River,
Bottom of Beds were done at 344 Raleigh Tavern Lane and 545 Johnson Street; Friday and today. The sand is
going in as we speak.
The systems should be built this week.
Just thought you may want to know.
We will let you know when the engineers call us ready for inspections.
Susan
-----Original Message -----
From: Randy Burley [mailto:rburley@millriverconsulting.com]
Sent: Monday, September 20, 2010 1:17 PM
To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan
Subject: Emailing: 215 Old Cart Way NA soils.pdf
Please find attached the soil testing witnesse this morning witb Bill Dufrense.
The testing is for a replacement system. The soil between the two deep holes was consistent; a loamy sand
which perc'ed at 2 min./in.
Feel free to contact me with any questions.
Randy Burley
215 Old Cart Way NA soils.pdf
Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of
file attachments. Check your e-mail security settings to determine how attachments are handled.
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal
offices and officials are public records. For more information please refer to:
http://www.sec.state.ma.us/pre/Sreidx.htm.
Please consider the environment before printing this email.
DelleChiaie, Pamela
From: Dan Ottenheimer [info@millriverconsulting.com]
Sent: Tuesday, September 21, 2010 2:08 PM
To: Sawyer, Susan; DelleChiaie, Pamela; Grant, Michele
Cc: 'Marianne Peters'; 'Randy Burley'; 'Isaac Rowe'
Subject: construction inspection, 344 Raleigh Tavern Road
Folks,
We got a call from the installer Todd Bateson about this job. He said he knew that he was jumping slightly around protocol
because the designer had not yet been out to certify things but he wanted to give us a heads up that he was nearing
completion on the installation. I also knew, as did he, that we had Isaac in town today to witness a soil test and requested
if we could complete the construction inspection today.
So, just so you know, we are undertaking that effort now. I know this is not the usual flow of information but with the
schedule we have on tap this week, and with someone being in town already, I needed to make it happen today in order
to preserve sanity (whatever we have left) on our side. If there are problems with this please let me know and we'll work
something out.
Dan
>m i- R River
cons u It i ng<
Civil [nginellring # Envirann ent4i Periftittrng.
mumltipli E:tvirommCelisl MV.7101 co""filtin:
Daniel Ottenheimer, President
Mill River Consulting, Inc.
6 Sargent Street
Gloucester, MA 01930-2719
978-282-0014
fax: 978-282-1318
www.millriverconsultinR.com
danogmillriverconsulting com
Member: Yankee Onsite Wastewater Association, Massachusetts Environmental Health Association, Cape Ann Chamber
of Commerce, Gloucester Rotary Club, New England Water Environment Association, Cape Ann Referral Group
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more
information please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
fs
•
'r
' TOWN OF NORTH ANDOVER F KORTk ,
O tea° ,a NO
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT 10FO
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36°
NORTH ANDOVER, MASSACHUSETTS 01845 1SSACHU`ES
Susan Y. Sawyer, REHS, RSi�978.688.9540 - Phone
Public Health Director �,�� 978.688.8476 - FAX
r r healthdept(a,townofnorthandover.com
`{ U www.townofnorthandover.com
ER
APPLICATION FOR SO WNPA -r 45 -T
is�r���n��rl�r
DATE: %- 2 O - /O MAP & PARCEL: 07 A 75,'
LOCATION OF SOIL TESTS: / 4 &M 14H! A tjer-*
OWNER: �1r-C 1_ 11 I.S 1.4 Contact #: (/ `- t " �5
A��.,1 F Contact #: L"�t ((
APPLICANT: � J� � i �7 Z � � ?T T -
ADDRESS:
ENGINEER: , Xne rru g /64- 1L( Contact #: �7%y75 � �� -20
CERTIFIED SOIL EVALUATOR: P /l I T- D lGSt�
Intended Use of Land: Residential Subdivision Si Eamity Ho a Commercial
Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
➢ 8.511 x 11 "Plot plan & Location of Testing (please indicate test pit sites on the plan)
➢ 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 $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests)..
➢ Within 6� da g soil evaluation forms shall be su ' ed��
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date: '
-2j--2
Signature of Conservation Agent:^t` n
Date back to Health Department: (stamp in):
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Inleresl at ine rate or 7474 per annum "i accrue SEE HE=VERSE 51DE FOH IMPOH TAN I INFUHMAf IU4i!a„
on overdue payments from the due date until
payment is made. THE COMMONWEALTH OF
>, Make Checks Payable To: I
Town of North Andover ' °'�' If N 14 -kA d
Fiscal Year 2010 1st Quarter
Preliminary Real Estate Tax Bill
Office of Collector of Taxes
Jennifer Yarid, Treasurer/Collector
WALSH, MICHAEL P
MARY E MC LAUGHLIN
344 RALEIGH TAVERN LANE
NORTH ANDOVER, MA
000001-007157
Your Preliminary Tax for the fiscal year
beginning July 1, 2009 and ending June 30,
2010 on the parcel of real estate described
below is as follows:
PROPERTY DESCRIPTION
344 RALEIGH TAVERN LANE
Class Code 101
Land Area 1.04
Map -Lot -Plot 210-10TA-0131-0000.0
Book/Page 43161289
Assessed owner as of January 1, 2009:
WALSH, MICHAEL P
MARY E MC LAUGHLIN
344 RALEIGH TAVERN LANE
NORTH ANDOVER, MA
Your Preliminary Tax for the fiscal year
beginning July 1, 2009 and ending June 30,
2010 on the parcel of real estate described
below is as follows:
Town o o n over
Collector of Taxes
P.O. Box 184
Medford, MA 02155-0002
Office Hours:
M -F 8:30am - 4:30pm
TAX COLLECTOR: 978-688-9550
ASSESSOR: 978-688-9566
I Please use the enclosed lokbox envelope to
expedite your payment. This will assist us in
processing your payments more efficiently. The Tax
Collector's Office is located at 120 Main Street.
Town of North Andover
Fiscal Year 20101st Quarter
Preliminary Real Estate Tax Bill
Jennifer Yarid, Collector of Taxes
*418811111*
1111111 VIII VIII VIII VIII VIII VIII VIII 11111 II11 IIII
1st Quarter Payment
Keep This Portion For Your Receipt
_ Bill No.
1 8156
Preliminary Tax
$3,130.50
Exempt/Abatement
$0.00
I Subtotal
$3,130.50
2nd Qtr. Due 11/2/2009
$1,565.24
1st Qtr. Due 8/3/2009
$1,565.26
Payments Made
$0.00
Amount Due
$1,565.26
8/3/2009
$1,565.26
Interest at the rate of 14% per annum will accrue
on overdue payments from the due date until
payment is made.
0418817,111207,0000000000000000000000100008156000000],56520507,8
PROPERTY DESCRIPTION j
344 RALEIGH TAVERN LANE
Class Code 101
1
I Land Area 1.04
I Map -Lot -Plot 210-107.A-0131-0000.0 ,
Book/Page 4316/289
Assessed owner as of January 1, 2009:
WALSH, MICHAEL P
MARY E MC LAUGHLIN
344 RALEIGH TAVERN LANE
NORTH ANDOVER, MA
Town of North Andover
Fiscal Year 20101st Quarter
Preliminary Real Estate Tax Bill
Jennifer Yarid, Collector of Taxes
*418811111*
111111 [1111 VIII VIII 1111111111111[111111111111111 IIII
1st Quarter Payment
Return This Portion With Your Payment
Bill No.
1 8156
Preliminary Tax
$3,130.50
Exempt/Abatement
$0.00
Subtotal
$3,130.50
2nd Qtr. Due 11/2/2009
$1,565.24
1st Qtr. Due 8/3/2009
$1,565.26
Payments Made
$0.00
Amount Due
$1,565.26
$/3/2009
DelleChiaie, Pamela
From: Isaac Rowe [irowe@millriverconsulting.com]
Sent: Wednesday, August 11, 2010 5:07 PM
To: 'Daniel Ottenheimer'; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters';
DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan
Subject: 344 Raleigh Tavern Lane
Attachments: 344 Raleigh Tavern Lane - Soil Testing Results 8-11-10.pdf
Susan,
Please find the soil testing results for the above referenced property. This is a repair of a failed system.
Please let me know if you have any questions.
Thank you,
Isaac
Isaac M. Rowe, R.S.
Project Manager
Mill River Consulting
6 Sargent Street
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APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I he y m k ,appl' ation for a permit for a sewage disposal installation at
z�. «�. I will install this system in ac-
cordance with alp the laws of a Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 196 until 10 feet pre-
ceding the septic tank, wher the grade shall not exceed 2%6. I will install a con-
crete septic tank of�� in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of _ _q 6-6 lineal (square) feet of effective absorption area.
The pipes will be laid on a 6 inch layer ,of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
Z 6 the line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE -71
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE f/ -/ y - -7/
Signature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE
Signature of Inspecting Officer
Percolation Test �d
Garbage Grinder
1 Y(
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
f
'y-- 71
5,7y
1. NAME S ill �7 4id�L'%� eAl DATE
2. ADDRESS�`ece LOT NO. TEL. 4'-X5-
3. NO. OF BEDROOMS DEN YES NO
4. GARBAGE GRINDER YES NO All'
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
I- r
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE llfl7 /71
NAME OF APPLICANT Old North Andover Realty Trust
LOCATION Lot #h Raleigh Tavern
Addr ss of lot no,
BUILDING: Dwelling x Other
SYSTEM: New X Repair
GENERAL DESCRIPTION OF LAND high
SUBSOIL: Clays Gravel Sand
PERCOLATION TEST 10 minutes per inch,
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK 1025_gallon capacity.
LEACH FIELD 300 lineal feet of drain pipe,
2'1 gravel bed
William J. Driscoll, Engineer
Board of Health
