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HomeMy WebLinkAboutMiscellaneous - 38 FARNUM STREET 4/30/2018N J O' maw q co v D D z o � CO 90 p m m p m o �- Y FINAL GRADE INSPECTION Date: S /?�/7 Address: u--rOAMED? SEEDED? OVER PER PLAN? Other: s� North Andover Board of Assessors Public Access s• Nor+ry L ;i Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Town of Worth Andover, I%c)vx'd of Assessors, Parcel ID: 210/107.A-0088-0000.0 SKETCH. Click on Sketch to Enlarge Page 1 of 1 Property Record Card Community: North Andover PHOTO No - ur e ISI►! Location: 38 FARNUM STREET Owner Name: DIGIOVANNI JR, RAYMOND R KELLIE ANN BOUTS Owner Address: 38 FARNUM STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 1.09 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 2408 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 564,000 512,800 Building Value: 355,500 330,300 Land Value: 208,500 182,500 Market Land Value: 208,500 Chapter Land Value: LATESTSAL:E Sale Price: 310,000 Sale Date: 11/26/1998 Arms Length Sale Code: Y -YES -VALID Grantor: PATRICK CAHILL H Cert Doc: Book: 05254 Page: 0350 http://csc-ma.us/NandoverPubAce/jsp/Home.jsp?Page=3&Linkld=991506 4/19/2007 - w C2 o0 00 Iy! 16i LID Lo O N 8 f O I 0 O w N f@!,N• ,y• Lb Ia Ly6pc`6t6�i3O. CD ,y .6).0 O y, 2wois � a O c c i� � 4 f v I i 1 F -a2' i O o llc I� o a :O'OOp V �O �T C J m LLIw'-a OU�}Ny . @O -O I f`6 N N c riNL- O �j W' � i I Q`N Ln1 z O O! No 06 000 OBD M iU;a,. 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Please contact John Soucy to set up an inspection. Thank you Susan PS Pam is out today, call the office if you need to speak to anyone. 1 V or tt�eo ,6'•,VO O cx.u�newK. 1 'P �.Q AOgAT60 ��`i'(y PUBLIC HEALTH DEPARTMENT Community Development Division %CE127ITICATE OAF C014PLIA5VCE As of: 9VarcFi 20, 2008 rihis is to cert that the individuaCsu6surface disposafsystem received a . SA`IIS FACT0RT 19VSTECTIOY of the: CompCete Septic System 12epair/12epCacement By: ,john Soucy 38 Farnum Street Map 107..4; (Parcel88 North Andover, 5W,4 01845 The Issuance of, this certificate shaff not 6e construed as a guarantee that the system wdf function satisfactorily. usan TSdw ^ Pu6fic Yfeafth 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com •� i pORTq s i � • OqN , P ,Sswciauae'`� PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sew a e Disposal System (* constructed-, ( ) repaired-, By. SdUc 2 (Print Name) Located at: J 8 i �' &Vo JVTF (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated 0('T �� zood j -N 18 200 and last revised on with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on ---- - And — Print Name 1,600,0spodStreet -North Andover, Massachusetts 01845 Phone 978 688 .9540, ; Fax 978.688.8476 Web http://www.townofnorthandover.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, March 31, 2008 2:24 PM To: Sullivan Jack (E-mail) Subject: 38 Farnum Street - COC Hi Jack, For your files. The original COC will be mailed to the h/o today. Pam -----Original Message -- From: noreply@yourcopier.com [mai Ito: noreply@yourcopier.com] Sent: Monday, March 31, 2008 3:14 PM To: DelleChiaie, Pamela Subject: Message from KMBT_600 L1 SKMBT_600080331 14130.pdf KORfy, ��SSwCNU PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewa Disposal System (* constructed-, ( ) repaired-, By: SOVCYT ,f IIJM j,gVice (Print Name) Located at: 38 FA&t 1 ffiA�T (Installation Address) Was installed in// conformance with the North Andover Board of Health approved plan, originally dated OGT �� -Zoot and last revised on JAN /8 Z On with a design flow of J gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: MAY 3, 200 _ Engi ee ep esentatTe'ignature) A Arid — Print Name Final Construction Inspection Date:,/,,7A\/ 10y Zba7 JU4v And — Print N G Enginer: (Signature) gng4ee epresenta ive (Signature) Date: </I/ I0, Name And — Print Name 1,600,Nod Street; North -Andover, Massachusetts 01845 Phone 978.688.9540 Fax 918.688.8476 Web http://www.townofnorthandover.com Page 1 of 1 DelleChiaie, Pamela From: jacksu1153@comcast.net Sent: Thursday, March 06, 2008 1:47 PM To: DelleChiaie, Pamela Subject: re: 38 Farnum Street Hi Pam, I will be submitting the Septic As -Built plan for the above referenced property in the near future and was wondering if you had the dates on the bottom of bed inspection and the final construction inspection... This system was installed during the summer of 2007. Thanks. Jack Sullivan Sullivan Engineering Group, LLC 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 Phone + Fax 3/6/2008 Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants March 14, 2008 North Andover Health Department — Susan Sawyer 1600 Osgood Street Building 20; Suite 2-36 North Andover, MA 01845 Re: Request for COC — 38 Farnum Street, North Andover Ms. Sawyer; RECEIVED MAR 18 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT On behalf of the homeowners, Ray & Kellie DiGiovanni, I am requesting a COC for the septic installation at 3 8 Farnum Street. Attached for your review and approval; 1) Two (2) copies of the Septic As -Built Plan 2) A signed/dated Installation Certificate by myself and the installer (John Soucy) 3) A copy of the recorded Deed Restriction for this property limiting the number of bedrooms to 5. If you have any questions or need further clarification please feel free to contact me. Very Trulyl,Y urs, JJAM Jack Sullivan, P.E. Cc: Ray & Kellie DiGiovanni - Owners �v 22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352 -7871 -Phone — 978 352-7871 - Fax Bk 11098 P42252 5953 03-11-2008 a 02 = 21 p COVER SHEEN` TRIS IS THE FIRST PAGE OF THIS DOCUMENT DO;NOTREMOVE GRANTOR GRANTEE ADDRESS OF PROPERTY CITY/TOWN TYPE OF DOCUMENT _MEC- ASSIGNMENT TYPE ._ DEED 6D MORTGAGE NOTICE TYPE DISCHARGE SUBORDINATION AFFIDAVIT CERT TYPE DEC OF HOMESTEAD UCC TYPE DEC OF TRUST OTHERr'77`i . %ltr,�odaro� Nt.(A DESCRIft Essex North Registry of Deeds Robert F. Kelley, Register 354 Merrimack St. Suite 304 Lawrence, MA 01843 (978) 683-2745 wwwlawrencedeeds.com A c Bk 11098 P42252 5953 03-11-2008 a 02 = 21 p COVER SHEEN` TRIS IS THE FIRST PAGE OF THIS DOCUMENT DO;NOTREMOVE GRANTOR GRANTEE ADDRESS OF PROPERTY CITY/TOWN TYPE OF DOCUMENT _MEC- ASSIGNMENT TYPE ._ DEED 6D MORTGAGE NOTICE TYPE DISCHARGE SUBORDINATION AFFIDAVIT CERT TYPE DEC OF HOMESTEAD UCC TYPE DEC OF TRUST OTHERr'77`i . %ltr,�odaro� Nt.(A DESCRIft Essex North Registry of Deeds Robert F. Kelley, Register 354 Merrimack St. Suite 304 Lawrence, MA 01843 (978) 683-2745 wwwlawrencedeeds.com Bk 11098 Pg 253 #5953 CYE OfVARZL AYE/OEM %FMCZTON Pursuant to 310 CMR 15.000 Title 5, and as a condition of septic plan approval by the North Andover Board of Health, notice is hereby given that real estate located at. 38 Famum Street, North Andover, Massachusetts, (aka Assessor's Man 107A / Lot 14 as described in a deed from L" to DiGiovaM* dated NQ Myer 2-7, 1998 and recorded in the Essex County Registry of Deeds in Book M4 ad PaM350, and as document # 40539, is the subject of a variance from the Town of North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage A1.05 and C9,01(4). Said variance limits the maximum number of bedrooms at this dwelling to five (5) bedrooms. This restriction shall remain on the property until such time that the dwelling is connected to a municipal sanitary sewer system and the soil absorption system is properly abandoned This variance is within the jurisdiction of the North Andover Board of Health. Signed and sealed this day of Z&f�I , 2008. CO"094A1.GW0219W,#WM&ETtlS Essex, s.s. Date: /li�,@tH // , 2008 Then personally appeared the above-named 11 Yr -i Y AIi 4 , ealp- Aw lI QvnNA/ I and acknowledged the foregoing instrument to be his free act and deed, before me. Name Notary Public i RECEfvf AS -BUILT CHECKLIST f LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER V LOT LINES & LOCATION OF DWELLINGS OATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS S. FROM SEPTIC TANK } b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS MAR 1 8 2008 TOWN OFti1JliVER HEALTay ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES / WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Friday, March 14, 2008 9:41 AM To: DelleChiaie, Pamela Subject: RE: 38 Farnum inspection all done; done earlier today NO, HERE IT IS NOW.... OTHERWISE, I'LL FORGET. SORRY YOU NEVER GOT ONE. From: DelleChiaie, Pamela [ma iIto: pdellech@townofnorthandover.com] Sent: Friday, March 14, 2008 9:33 AM To: Marianne Peters Subject: RE: 38 Farnum inspection all done; done earlier today Importance: High Hi, This can wait till you come back .... but I never got a copy of the final construction in inspection on this one. Can you send it along? Thanks. -----Original Message ----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Thursday, May 10, 2007 1:18 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: 38 Farnum inspection all done; done earlier today Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsulting.com 3/14/2008 NORTHqLID 16 q "••60 o? 0 ' _ L At q 40 Are 6ATe 9SSAC HUSSY PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 38 Farnum Rd. MAP: LOT: INSTALLER: Soucy's Septic Service DESIGNER: Sullivan Engineering PLAN DATE: 10/1/06 rev. 1/18/07 BOH APPROVAL DATE ON PLAN: 2/12/07 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 5/10/07 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: The dwelling was found to have two exiting sewer waste pipes. SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoof northandover.corn 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8416 Web www.townofnorthandover.com r10RTli O A 4Lceeb '� - .. 'pA CocntMlwrcM ``r _ 0ACED PPP (� 9SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: No hydraulic cement, rubber boots were used on Fralo poly 1500 gallon septic'tank. 5/10/07 DISTRIBUTION -BOX ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8416 Web www.townofnorthandover.com f r1ORTh q O 1 ti 3��s, ° OL O 10 . T O4A LOC NIL nL wKM `y1` T DgATBD �9SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division SYSTEM ELEVATIONS CRITICAL SETBACK DISTANCES 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthandover.com i 1 I INVERT IN FIELD PLAN INVERT.ELEV. Building Sewer OUT 1 101.19 2 100.30 100.29 Septic Tank IN 1 99.93 2 99.94 100.19 Septic Tank OUT 99.67 99.94 Distribution Box IN 99.55 99.84 Distribution Box OUT 99.43 99.67 Lateral 1 INV 99.51 99.61 Lateral 2 INV 99.51 99.61 Lateral 3 INV . 99.51 99.61 Lateral 4 INV 99.51 99.61 CRITICAL SETBACK DISTANCES 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthandover.com i 1 I / .. .ttORT11 A . yy T O L11M 44 tochicriwc■ `♦. ORATED PPa .(5 9SSAC HUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 E] Public well 400 400 j ❑ 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) Z 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). s 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 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, March 14, 2008 9:33 AM To: 'Marianne Peters' Subject: RE: 38 Farnum inspection all done; done earlier today Importance: High Hi, This can wait till you come back .... but I never got a copy of the final construction in inspection on this one. Can you send it along? Thanks. -----Original Message ----- From: Marianne Peters[mailto:mpeters@millriverconsulting.com] Sent: Thursday, May 10, 2007 1:18 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: 38 Farnum inspection all done; done earlier today � I Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsUltina.com 3/14/2008 Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Thursday, May 10, 2007 1:18 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: 38 Farnum inspection all done; done earlier today Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx i www.millriverconsultina.com i Page 1 of 1 DelleChiaie, Pamela From: jacksu1153@comcast.net Sent: Thursday, March 06, 2008 1:47 PM To: DelleChiaie, Pamela Subject: re: 38 Farnum Street Hi Pam, I will be submitting the Septic As -Built plan for the above referenced property in the near future and was wondering if you had the dates on the bottom of bed inspection and the final construction inspection... This system was installed during the summer of 2007. Thanks. Jack Sullivan Sullivan Engineering Group, LLC 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 Phone + Fax 3/14/2008 6 Ce- :{ f "-cam*�. , Commonwealth of Massachusetts Map -Block -Lot �aov,••i° �.¢c°p 107.A-0088' Board of Health - -- - Permit No North Andover BHP-2oo7-ooss `w °.� ,..:» .. y • P.I. FEE 1Ss�CHU F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted John_ Soucy --------------------------------------------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. at No 38 FARNUM STREET as shown on the application for Disposal Works Construction Permit No. BHP -2007-006 Dated April 18, 2007 Issued On: Apr -18-2007 Lj Board of kalth ------ ----------------------------------------------------------- c. 4 f Commonwealth of Massachusetts Board of Health • North Andover °•-Top-�` Certificate of Compliance ,SSACHV THIS IS TO CERTIFY,That the Individual Sewage Disposal Syste by---John Soucy------------------------------------------------------ Map -Block -Lot 107.A- 0088 - ----------------------- at No 38 FARNUM STREET,s' ---------- ------------------------------------------------------------------------------------------------- has been installed in accordance wit>,esprovisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2007-006 Dated April 18,-2007 ----------------------------------------------------------------- Printed On: Apr 118-2007 Board of Health Of MORTol � 9 l Town of North Andover HEALTH DEPARTMENT ,SS�CHU�+E4 CHECK #: IrJ&—d DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal ❑ Body Art Establishment ❑ Body Art Practitioner ❑ Dumpster ❑ Food Service - Type: ❑ Funeral Directors ❑ Massage Establishment ❑ Massage Practice ❑ Offal (Septic) Hauler ❑ Recreational Camp ❑ Sun tanning ❑ Swimming Pool ❑ Tobacco ❑ Trash/Solid Waste Hauler ❑ Well Construction SEPTIC Systems: ❑ Septic - Soil Testing 11 Se�ptic�-Design Approval � Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ Title 5 Inspector ❑ Title 5 Report ❑ Other: (Indicate) $ P 2379 ' Health Agent Initials js. 1. White - Applicant Yellow - Health Pink -Treasurer „ORTN Application for Septic Disposal System tso eAN -Construction Permit -TOWN OF Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ rehun ORTH ANDOVER. MA Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* )rRepair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information 3 I bwa �•., �-� Address or Lot # /�1 L4,,x (�D v,z� City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump Icktravity (choose one) ***If pu p system, attach copy of electrical permit to application*** TODAY'S DATE $125.00 - Component ❑ Conventional System (pipe and stone system) Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner In !0 Name atL4- Address (if different from above) f e rA-ALQJV.”, City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company - 0,0 4 �`l b 0,�— L u S? Address IF City/Town L St Zi Code elepho Number (Cell Phone # if possible please) 4. Designer Information %V �(/✓t -rim ' v� Name Name of Company D—_ A Ey v vt -�" I /� ®A L44�l t2 is Addres ' ®k- �rV 04-f 6 �� 1 City//T wo nwo n L State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Of"ORTH Application for Septic Disposal System t,I­t-7—®7 t ao .°• �� C. TODAYS DATE pConstruction Permit— TOWN OF $ 250.00 - Full Repair ORTH ANDOVER, MA 01845 $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: VResidential 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 A over, and not to place the system in operation until a Certificate of Compliance has been 'sed by this Board Health. me Date Applicatiofi/Approved By: oard of Health Representative) Nam; Date Application Disapproved for the following reasons: For Office Use Only: L Fee Attached. YesV/ No I Project Manager Obligation Form Attached. Yes f/ No -3.1 ump S s� tem? Ifso, Attach copy of Electrical Permit Yes No 4.' Foundation As -Built?, (new construction ronly): Yes 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) Relative to the application of L� SOLA C (Installer's name) For plans by y4VjVCW (Engineer) And dated C) '-' 1 — 0(p nglna ate Dated 1-7 —4-, -7 (Ioday's ate) With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that reauestina an inspection, without completion of the items in accordance with Tide 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company a. Bottom of Bed — Generally, this is the first (ls� inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to'be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdeptntownofnorthandover.corn) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the a roved Tans. No instructions b the homeowner, general contractor, or an other persons shall absolve me of this obligation. 4 /J A Undersigned Licensed Septic Installer: (Today's Date) L�_�-7—©� a. e igne 10 r4rg- llki"'- {° A PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: EMAP: LOT: INSTALLER: "�/ . Sod C DESIGNER- PLAN DATE:j ��D BOH APPROVAL DATE ON PLAN: l INSPECTIONS �—� TANK INSPECTION: 5-7 -7DATE OF BED BOTTOM I SECTION: S�3�v7 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Fur Existing septic tank properly abandoned Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port t 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: DISTRIBUTION -BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.087foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com f NORTH q O �t%eo 06� Oto `T O LaML T/ �}_ CC[MKManta 1' PUBLIC HEALTH DEPARTMENT (ommunity Development Division SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ❑ Brand and Model of Chamber Infiltrator Quick 4 ❑ Number of chambers per row 9 ❑ Number of rows (trenches) 3 ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan Comments: CONTROL PANEL Comments: ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside ❑ Alarm signal located inside 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthandover.com J 0 ` O •wwc � PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 INV Lateral 1 TOP Lateral 2 INV Lateral 2 TOP Lateral 3 INV Lateral 3 TOP Lateral 4 INV Lateral 4 TOP 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com V rtORTN q ti 3� O eya q_ tecM�trNwKr . 1' 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 918.688.8416 Web www.townofnorthandover.com Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other) Foundation 10 (5) 20 (10) ❑ Drywells 20 25 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 918.688.8416 Web www.townofnorthandover.com TRANSMISSION VERIFICATION REPORT DATEJIME FAX NO.INAME DURATION PAGE{S} RESULT MODE North �# over klealt Depart, ent 1600 Osgood Street Building 20, Suite 2.36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fox e o overso - E-mail wwuu tawnoftro h tgver +rte . Website 02115 15:41 819783527871 00:01:07 06 OK STANDARD ECM TIME 02/15/2007 15:42 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 Letter of Transmittal Page o �... We erre sending yo atol;;0"f utter 0 plans a Other Mill in holow) These ar®trans fitted as checked below- ➢ arm+ ➢ L7*Aivmd& ➢ rCJ*A*" > ➢ ®�ar�,d►d�v�l ➢ );* 17m5"_ W**r WWW North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, INA 01845 978.688.9540 - Phone 978.688.8476 — Fox healthdegt@townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter of Transmittal [Page of TO:/ T. 4�Z�I_tJ c (OMPA �5? it Phone: RE: Fax: r� TO:/ DATE: I eq 7 4�Z�I_tJ c (OMPA �5? FROM: Pamela De IeChiaie, Health Department Assistant Phone: RE: Fax: r� We are sending your li-Geopy of Letter OPlans L7 Other ffi0/in below) These are trans fitted as checked below: ➢ dasA ➢ L7Av4 p vm i ➢ L7&V 6r * g2iVf r ➢ L7*AhFAZW ➢ ®raram iewanixn nmt ay VHd ➢ L7*R*&W ➢ DraryYarft ➢ L7SA7* qMWfbrafst. REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: 4S1 eu /61 •r�\ 4'O iOCNK QwKM � � �� PUBLIC HEALTH DEPARTMENT Community Development Division February 14, 2007 Ray and Kellie DiGiovanni 38 Farnum Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 38 Famum Street, Map 107A, lot 37, North Andover, Massachusetts Dear Mr. And Mrs. DiGiovanni, 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 Sullivan Engineering Group, LLC dated October 1, 2006, last revised January 18, 2007. The design has been approved for use in the construction of a replacement onsite septic system. This plan is good for 3 -years from the date of approval. 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. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. The following requests were approved at the Board of Health meeting held on February 12, 2007. 1. To allow the application for a Local Upgrade as requested, for a reduction in the separatio etween th oil absorption system and the high groundwater from the required feet to fq4feet. With the granting of this reduction, a deed restriction must be laced on the property, which limits the maximum number of bedrooms of this dwelling to five bedrooms. The applicant must submit proof of recording, prior to the issuance. of a Certificate of Compliance by the health department. (See attached example of a deed restriction) This restriction shall remain on the property until such time that the dwelling is connected to a municipal sanitary sewer system and the soil absorption system is properly abandoned. This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 2. 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)). 3. 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, Susan Y. Sawyer, REHS/[tS Public Health Director cc: John Sullivan, P.E. file /usan Sawyer, REHS/RS Public Health Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web wwwr,towrnofnorthandover.com It is the responsibility of the appCuant to record the required deed restriction per 310 C91R,15.000 Title 5. The following is a suAAested format, but the fzna(document should be approved 6 your attor►rek prior to recording. NO ICE Off' vA4ANCE /(DEED W 4UgW 7ON (Pursuant to 310 C9W R 15.000 Oitfe 5, and as a condkion of septic pian appro vaf 6y the North Andover Board of gfeaCth, notice is Fiere6y given that reafestate located at. North Andover, wassachusetts, (aka Assessor's 9Kap /Lot 1 as descri6ed in a deed from to dated . 20 and recorded in the Essex County Tsgistry of(Deeds in Book and (Page and as (Document # is the subject of a variance from the clown of NorthAndoverWinimum Wsquiremen tsfor the Su6surface (Disposal of Sanitary SewageA1.05 and C9.01(4� Saidva&nce Camits the maximum number of bedrooms at this dwelling to 6edrooms gWis variance is within the jurisdwtion of the NorthAndoverBoardofIfealth. Signedandsealed this (Property Owner(s)Signatures Esse.Z s.s day of 20 COMWOWEXW Off' JV1"AMVSE9Z (Date. . 20 Then personally appeared the above-named and acknowledged the foregoing instrument to 6e his/her/thek&e act and deed, before me. Name Notary (Pu6Cic 4 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 96 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Design flow per 310 CMR 15.203: 5. System Designer. 22 Mount Vernon Road Address B. Approval Telephone Number ❑ Commercial 550 gld John Sullivan ❑ School Name Boxford MA City/Town State, ZIP 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) - specify: ❑ Reduction in SAS area of up to 25%: 01845 Zip Code 7-401111111 IWW� SAS size, sq. ft. _ % reduction 38 Famum form 9b 2.12.07 • rev. 7106 Local Upgrade Approval- Page 1 of 2 A. Facility Information Irnportarrt: When filling out 1. Facility Name and Address forms on the computer, use Ray and Kellie DeGiovanni only the tab key Name to move your 38 Famum Street cursor - do not use the return Street Address key. North Andover MA CitylTown state 2. Owner" Name and Address (if different from above): Name Street Address City/Town State Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Design flow per 310 CMR 15.203: 5. System Designer. 22 Mount Vernon Road Address B. Approval Telephone Number ❑ Commercial 550 gld John Sullivan ❑ School Name Boxford MA City/Town State, ZIP 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) - specify: ❑ Reduction in SAS area of up to 25%: 01845 Zip Code 7-401111111 IWW� SAS size, sq. ft. _ % reduction 38 Famum form 9b 2.12.07 • rev. 7106 Local Upgrade Approval- Page 1 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval y Fon n 9B B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reducti1 on Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): ft. 11 min./inch 3 ft. ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a pert test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: N. Andover Board of Health j Approving Authority Susan Sawyer, Health Director February 13, 2007 Print or Type Name and Title j$ re - p 38 Famum form 9b 2.12.07 • rev. 7106 Local Upgrade Approval* Page 2 of 2 Of NORTH 1 H/O NAME: � � e5 0/ 0-! Vj 1I � J. 1 Op Town of North Andover of Permit or License: (Check box) M�'• ,SSACHUStS HEALTH DEPARTMENT CHECK 4:, ❑ LOCATION: v�/%'l//�� H/O NAME: � � e5 0/ 0-! Vj 1I � J. CONTRACTOR NAME: _ZAESIOWIA41 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster. $ ❑ Food Service - Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing Septic Approval $ -Design $� ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ i i 1829 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval M 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 5.404(1), is not feasible. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information 1. Facility Name and Address: Ray & Kellie DiGiovanni Name 38 Farnum Street Street Address North Andover MA City/Town State 2. Owner Name and Address (if different from above): Name City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional Street Address State Telephone Number ❑ Commercial ❑ School 01845 Zip Code 4. Describe Facility: Single Family Residential dwelling consisting of 5 bedrooms w/ a failed septics stem 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below): Local Upgrade Approval - 38 Famum Street, North Andover • rev. 5/02 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts CityfFown of Form 9A - Application for Local Upgrade Approval M ve 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. A. Facility Information (continued) 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Proposed Leaching Bed with Enviro-Septic Leaching Pipes 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): 550 gpd 550 gpd 550 gpd ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Replace existing 1000 gallon septic tank w/ a new 1500 gallon septic tank, dosing chamber, d -box and soil absorption field consisting of Enviro-Septic Leaching pipes. 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 2 (4 feet separation required, 2 feet requested) ft. Percolation rate 11 Depth to groundwater min./inch 2 (Allowed per Title 5 with Enviro-Septic system ft. Local Upgrade Approval - 38 Farnum Street, North Andover • rev. 5/02 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval M 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Other requirements of 310 CMR 15.000 that cannot be met —describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(� a soil evaluator must be a member or agent of the local approving authority. , /) I I High groundwater evaluation determined John D. Sullivan III Evaluator's Name (type or print) Sign b C. Explanation 7/14/06 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: An upgraded system in full compliance would require additional site grading and possibly a concrete retaining wall to deal with septic breakout. It would also involve clearing of a large wooded area for sufficient off -grading of the soil absorption area. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: The Enviro-Septic Leaching Pipe system is an alternative system which is approved for Remedial Use under Title 5. Title 5 allows a 2 foot separation (pending the Local Upgrade Approval) to the high groundwater table from the bottom of the underlying sand for this system based on the soil percolation rate (11 MPI) Local Upgrade Approval - 38 Famum Street, North Andover • rev. 5/02 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval 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. C. Explanation (continued) 3. A shared system is not feasible: A shared system is not feasible since the majority of the neighborhood is presently replacing failed septic systems. 4. Connection to a public sewer is not feasible: There is no municipal sewer available in this location 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Signature Rav DiGiovanni V Print Name John D. Sullivan III, RE Name of Preparer 22 Mount Vernon Road Preparers address MA 01921 State/ZIP Code Local Upgrade Approval - 38 Farnum Street, North Andover • rev. 5/02 10/3/06 Date 10/3/06 Date Boxford City/Town 978-352-7871 Telephone Application for Local Upgrade Approval* Page 4 of 4 COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL .AFFAIRS kip DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 MITT ROMNEY STEPHEN R. PRITCHARD Governor Secretary KERRY HEALEY ROBERT W. GOLLEDGE, Jr. Lieutenant Governor Commissioner APPROVAL POR REMEDIAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Presby Environmental, Inc. Route 117, PO Box 617 Sugar Hill, NH 03586 Trade name of technology and model: Presby Enviro-Septic Leaching System (Hereinafter called the "System"). The "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide" including schematic drawings of typical Systems, a technology checklist, and a System Installation Form are part of this Approval. Transmittal Number: W021550 Date of Issuance: November 21, 2005, Revised May 22, 2006 Date of Expiration: November 21, 2010 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental, Protection hereby issues this Approval to: Presby Environmental, Inc., Route 117, PO Box 617, Sugar Hill, NH 03586 (hereinafter "the Company"), approving the System described herein for Remedial Use in the Commonwealth of Massachusetts. Sale and use of the System are conditioned on compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. Glenn Haas, erector Date Division of Watershed Management Department of Environmental Protection This information is available in alternate format. Call Donald M. Gomes, ADA Coordinator at 617.556-1057. TDD Service -1-800-298-2207. DEP on the World Wide Web: http://www.mass.gov/dep 0� Printed on Recycled Paper Approval for Remedial Use - Presby Enviro-Septic Leaching System Page 2 of 8 1. Purpose The purpose of this approval is to allow Remedial Use of the System in Massachusetts with the necessary permits and approvals required by 310 CMR 15.000. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Approval for Remedial Use authorizes the use and installation of the System in Massachusetts. 3. The System may only be installed where conditions meet the criteria of 310 CMR 15.284(2). The System is an alternative system approved in accordance with 310 CMR 15.280 through 15.289 and is used to treat and dispose of wastewater. 4. This Approval for Remedial Use allows the use of the System where the local approving authority finds that the System is for upgrade of a failed, failing or nonconforming system. The Title 5 design flow for the facility must be less than 10,000 gallons pet day. . H. Design and Construction Standards 1. The System is a subsurface unit that replaces a soil absorption system (SAS) designed in accordance with -310 CMR 15.000. The System consists of an 11 5/8 -inch diameter corrugated, high-density plastic pipe with a 9.5 -inch interior diameter and a length of 10 feet. The exterior of the pipe has ridges on the peak of each corrugation. The pipe is perforated with eight holes equally distributed around its inner circumference. Each hole has a plastic skimmer extending inwards. The exterior of the pipe shall have a minimum of two layers of fabric. The inner layer shall be a thick layer of coarse, randomly oriented polypropylene fabric. The outer layer shall be a non -woven geo- textile polypropylene fabric. The pipe shall be installed in a concrete sand bed and _._surrounded on all,_sides by._a_minimum of six inches of sand. Depth to the high groundwater elevation shall be measured from the bottom of the sand underlying the pipe. 2. The System sand shall meet ASTM C-33. 3. Systems shall be installed with a differential venting for aeration and inspection at end of each run of pipe, section or serial bed and whenever the System is installed under impervious surfaces 4. The System shall be designed and installed using distribution boxes for inspection ports. The pipe between the distribution box and the System shall be installed at a minimum .slope of 0.02 feet/foot. Approval for Remedial Use Presby Enviro-Septic Leaching System Page 3 of 8 5. Serial distribution laterals shall be limited to no more than 500 gpd. Multi-level systems shall not be allowed. 6. The System shall be installed in a bed or field configuration, as defined in 310 CMR 15.252. The effective leaching area shall be the bottom area (length times width) of the field or bed as presented in the Company's "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide". 7. Effluent loading rates adjusted to reduce the soil absorption system by 40 percent shall be in accordance with 310 CMR 15.242. No System shall be installed with a leaching area of less than 400 square feet. 8. The System shall not require pressure distribution. 9. The System may be used in soils with a percolation rate of up to 90 minutes per inch (MPI). For soils with a percolation rate of 60 to 90 MPI, the effluent loading rate shall be 0.15 GPD/SF III. Allowable Soil Absorption System Design 1. Reduction of the Required Separation Distance to High Groundwater Elevation - An Applicant is eligible for a reduction in separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the SAS and the high groundwater elevation, where all of the following conditions are met. Accordingly, in approving design and installation of the System by a particular Applicant, the local approving authority may allow a reduction in the required separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of SAS and the high groundwater elevation, provided that all of the following conditions are met: --- _ --- A. A minimum two foot separation (in soils with a recorded percolation rate of more than two minutes per inch) or a minimum three foot separation (in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the sand underlying the SAS and the high groundwater elevation is maintained. R 7\Tn f„rthc�, rarh,�+inn thin Gr�Arifir rl in QPrtrnn TT (7) in the rPrniirPra Q A C ci�a is allowed. C. No reduction in the required four feet of naturally occurring pervious material is allowed unless the Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. Any such reduction must Approval for Kemediat Use Presby Enviro-Septic Leaching System Page 4 of 8 first be approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a reduction under a local upgrade approval in accordance with 310 CMR 15.405 (1) (a), (b), (f), (g), and (h). E. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from the local approving authority and then approval of the Department. 2. - Reduction of the Requirement for Four Feet of Naturally Occurring Pervious Material — An Applicant is eligible for a reduction in the required four feet of naturally occurring pervious material in an area of no less than two feet of naturally occurring pervious material, where all of the following conditions are met. Accordingly, in approving design and installation of the System by a particular Applicant, the local approving authority may allow a reduction in the required four feet of naturally occurring pervious material in an area with no less than two feet of naturally occurring pervious material, provided that all of the following conditions are met: A. The Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. B. No further reduction, than specified in Section 11(7), in the required SAS size is allowed. ------- C._No_r-educti.on_in__the_required_separation__(four_feet.-in_soils_with_a_recor_ded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of SAS and the high groundwater elevation is allowed unless such a reduction is first approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a I'euuCalUil uridt r a 1Ucd1 upgrux appIoval ill accurual ce whit 310 Ova 13.405 (1) (a), (b), (f), (g), and (h). E. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the Approval for Remedial Use Presby Enviro-Septic Leaching System Page 5 of 8 applicant first must obtain variance(s) from the local approving authority and then approval of the Department. III. General Conditions All provisions of 310 CMR 15.000 are applicable to the use of this System, the System owner and the Company, except those that are varied by the terms of this Approval. 2. All sample analysis must be conducted by an independent U.S. EPA or DEP approved testing laboratory, or a DEP approved independent university laboratory. It is a violation of this Approval to falsify any data collected, to omit any required data or to fail to submit any report required by such plan. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 4. In accordance with applicable law, the Department and the local approving authority may require the System owner to cease operation of the system and/or to take any other action as it deems necessary to protect public health, safety, welfare and the environment. 5. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sewer system. No System shall be installed, upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer, unless as allowed by 310 CMR 15.004. When a sanitary sewer connection becomes feasible, the facility served by the System shall be connected to the sewer, within 60 days of such feasibility, and the System shall be abandoned in compliance with 310 CMR 15.354, ----- - ----unless-a-later-time -is allowed, _in-writing,--by-.the-aPer-oving-authority.__-_ 6. Design, installation and operation shall be in strict conformance with the Company's DEP approved plans and specifications, 310 CMR 15.000 and this Approval. IV. Conditions Applicable to the System Owner The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non -sanitary sewage generated or used at the facility served by the JySteTil sClall IlOI C)C 1I11rUUUt eU 12110 the SySlenfi alid shall l7e lawtUlly alsposta. 2. The System owner shall at all times properly operate and maintain the on-site sewage disposal system. The System owner shall have the System inspected annually by an operator trained by the Company and shall submit the results of that inspection, on a technology checklist, to the local approving authority. Presby Enviro-Septic Leaching System Page 6 of S 3. The System owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 4. No System owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. 5. Prior to the issuance of a Certificate of Compliance for the System, the System owner shall record and/or register in the appropriate Registry of Deeds and/or Land Registration Office, a Notice disclosing both the existence of the alternative septic system subject to this Approval on the property and the Department's approval of the System. If the property subject to the Notice is unregistered land, the Notice shall be marginally referenced on the owner's deed to the property. Within 30 days of recording and/or registering the Notice, the System owner shall submit the following to the Department and the local approving authority: (i) a certified Registry copy of the Notice bearing the book and page/instrument number and/or document number; and (ii) if the property is unregistered land, a Registry copy of the owner's deed to the property, bearing the marginal reference. V. Conditions Applicable to the Company i. By January 315= of each year, the Company shall submit a report to the Department, signed by a corporate officer, general partner or Company owner that contains information on the System, for the previous calendar year. The report shall state: the number of units of the System sold for use in Massachusetts including the installation date and date of start-up during the previous year; the address of each installed System, the owner's name and address, the type of use (e.g. residential, commercial, school, institutional) and the design flow; and for all Systems installed since the date of issuance of this Approval, all known failures, malfunctions, and correctiv_e_actions taken and the address of each such event_ I The -Company shall notify the -Director of the Watershed Permitting Program at least . 30 days in advance of the proposed transfer of ownership of the technology for which this Approval issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless ` I, n*•nrl�mne+4 d^.tc.:.iirnr n*l,n D:.ra ««cnt n ,, Wit..:.^1; 3. The Company shall develop and submit to the Department: an operating manual, including information on substances that should not be discharged to the System and a recommended schedule for maintenance of the System essential to consistent ' Approval for Kemedial�Use Presby Enviro-Septic Leaching System Page 7 of 8 successful performance of the installed Systems within 60 days of the effective date of this Approval. 4. The Company shall make available, in print and electronic format, the referenced procedures in paragraphs 3 above to System owners, operators, designers and installers. 5. The Company shall institute and maintain a training program in the proper design, installation and inspection techniques of its System and provide a training course at least annually for prospective designers, installers and inspectors. The Company shall certify that installers and inspectors have completed the Company's training class, maintain a list of trained installers and inspectors, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. 6. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the receipt of that request. 7. The Company shall include copies of this Approval and the procedures in Section V (3) with each System that is sold. In any contract executed by the Company for distribution or re -sale of the System, the Company shall require the distributor or re- seller to provide each purchaser of the System with copies of this Approval and the procedures described in Section V (3). 8. The Company shall comply with 310 CMR 15.000 and all Department policies and guidance that apply and as they may be amended from time to time. 9. If the Company wishes to continue this Approval after its expiration date, the Company shall apply for and obtain a renewal of this Approval. The Company shall submit a renewal application at least 180 days before the expiration date of this Approval, unless written permission for a later date has been granted in writing by -- — -- the Department. This approval shall continue in force until the.Department_has acted. on the renewal application. VI. Conditions Applicable to Installers of the System Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. TT_ T.- «.,ll .. L 71 -. 11 +L (�.. t nv 1 tl T + 71 ., i n 1 .n +�n ? 1 ., fi n - ry laluauatvi utaaa.a♦ ini t.al! lana, S j u,C.— U-1- u., via.. ..alu coli .., I— va,..� .�,.i,���,-,,, _ J �iA, Company on installation of the System or the installation is overseen by a Company representative(s). 3. Installers shall complete the System Installation Form and forward a copy to the Company and the local approving authority. t Approval lur Ar-111ruld1 USG Presby Enviro-Septic Leaching System Page 8 of 8 4. The System installer shall provide the System owner and the local approving authority with a bill of lading certifying that the sand fill meets ASTM C-33. VII. Reporting 1. All notices and documents required to be submitted to the Department by this Approval shall be submitted to: Director Watershed Permitting Program Department of Environmental Protection One Winter Street - 6th floor Boston, Massachusetts 02108 VIII. Rights of the Department The Department may suspend, modify or revoke this Approval for cause, including, but not limited to, non-compliance with the terms of this Approval, non-payment .of the annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of .conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Approval and/or the System against the owner, or operator of the System and/or the Company. IX. Expiration Date 1. Notwithstanding the expiration date of this Certification, any System installed prior to the expiration date of this Certification, and approved, installed and maintained in compliance with this Certification (as it may be modified) and 310 CMR 15.000, may remain in use unless the Department, the local approving authority, or a court requires the System to be modified or removed, or requires discharges to the System to cease. W021550 a Q. N 0 0) 3 d N ! O L O m - cc d M •- 3 v� cc cc to A Se. _ t 0 O r O � � O E t L U U LL 1. i co 3to 10 oV n a IN o f C O � W m o � p � c o O YUta. 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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 Rav & Kellie DiGiovanni Owner Name 38 Famum Street Street Address or Lot # North Andover MA 01845 Citylrown state Tip Code 978-681-4775 Contact Person (if different from Owner) Telephone Number B. Test Results John D. Sullivan III, P.E. Test Performed By: Randy Burley, Consultant for North Andover BOH Witnessed By: Comments: Date r rme Test Passed: ❑ Test Failed: ❑ t5form12.doc- 06103 Perc Test - Page 1 of 1 7/14/06 9:30 a.m. Date Time Observation Hole # PT#1 Depth of Perc 45"-63" Start Pre -Soak 9:17 End Pre -Soak 9:32 Time at 12" 9:32 Time at 9" 9'54 Time at 6" 10:25 Time (9"-6") 31 Minutes Rate (Min./Inch) 11 MPI Test Passed: Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: Randy Burley, Consultant for North Andover BOH Witnessed By: Comments: Date r rme Test Passed: ❑ Test Failed: ❑ t5form12.doc- 06103 Perc Test - Page 1 of 1 Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants January 22, 2007 North Andover Health Department — Susan Sawyer E E Ez.D 1600 Osgood Street Building 20; Suite 2-36 JAN 2� North Andover, MA 01845 2007 TOWN OF NORTH ANDOVER Re: Revised Septic Plans — 38 Farnum Street HEALTH DEPARTMENT Ms. Sawyer; Enclosed are four (4) revised septic plans based on comments in your letter dated November 14, 2006 for 38 Farnum Street, North Andover. Specifically, the following revisions have been made; 1) The Enviro-Septic Leaching system has been eliminated from the design. 2) Cultec Contactor Field Drain C-4 units are proposed. _ 3) The interior plumbing at the foundation is proposed to be raised to eliminate the need for a Pump chamber. 4) A local upgrade approval is requested to allow for a 3 foot separation between the bottom of the cultec units and the seasonal high groundwater table. 5) A 1,500 gallon SepTech Poly Tank by Fralo Plastech is proposed as allowed by Title 5. 6) All notations referenced in the 11/14/06 letter have been added where applicable. If you have any questions or need further clarification please feel free to contact me. Very Truly urs, Jack Sullivan, P.E. 22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352 -7871 -Phone — 978352 -7871 -Fax Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 5.404(1), is not feasible. 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance .with either the 1978 Code or 310 CMR 15.000. A. Facility Information 1. Facility Name and Address: Ray & Kellie DiGiovanni Name 38 Farnum Street Street Address North Andover City/Town 2. Owner Name and Address (if different from above): Name City/Town Zip Code 3. Type of Facility (check all that apply): MA State Street Address State Telephone Number ® Residential ❑ Institutional ❑ Commercial ❑ School 01845 Zip Code 4. Describe Facility: Single Family Residential dwelling consisting of 5 bedrooms w/ a failed septic system 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below): 1000 Gallon septic tank, d -box, trenches Local Upgrade Approval - 38 Farnum Street, North Andover • rev. 5/02 Application for Local Upgrade Approval• Page 1 of 4 AORTN Town of North Andover 4 1,-*,, HEALTH DEPARTMENT CHECK #: LOCATION: H/O NAME: . ... ....... ,71% CONTRACTOR NAME: �,/ S, 0 Type of Permit or License: (Check box) 0 Animal $ 0 Body Art Establishment 'Is I 0 Body Aft Practitioner $ 0 Dumpster 0 Food Servici - Type. 1 $ 0 Funeral Directors $ 0 Massage Establishment 0 Massage Practice • Offal (Septic) Hauler • Recreational Camp $ 0 Sun tanning $ 0 Swimming Pool $ 13 Tobacco $ 13 Trash/Solid Waste Hauler $ 0 Well Construction $ SEPTIC Systems: 0 Septic - Soil Testing $ Pooloeptic - Design Approval 0, Septic Disposal Works Construction (DWQ $ 13, Septic Disposal Works Installers (DW[) 0 Title:5 Inspector $ El Title 5 Report $ 0 Other. (Indicate) $ 1829 HealthAgentInitiak; White - Applicant Yellow -Health. Pink - Trea: surer C . TOWN OF NORTH ANDOVER f N°RTM Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT 400 OSGOOD STREET �: •OA4no ��'� NORTH ANDOVER, MASSACHUSETTS 01845 isa�c«us£t 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdeptaa,townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM OcToffx V Z406 OCT - 4 2006 Date of Submission: To,M,q vr- "WR i H ANDOVER FIEAL Site Location: TH DEPARTMENT Engineer: fui-LIVE/ 4'NGl(Uffl , IC 641yo <ii j _K, _ New Plans? Yes /� 225 Ian Check # review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes X No Local Upgrade Form Included? Yes x No. 62 Telephone #: J ," ., J SZ � g / f Fax #:_ E-mail:✓�rl�,s��- j C6yI�� (includes 1St submission and one re - SAF 143 M64 Name: Homeowner r✓�17 yPj) ) f)��il uV,V OFFICE USE ONLY When the sub 'ssion is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database z October 4, 2006 „w r North Andover Health Department — Susan Sawyer 1600 Osgood Street Building 20; Suite 2-36 North Andover, MA 01845 Re: Septic Upgrade Plan — 38 Farnum Street Ms. Sawyer; Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants OCT - 4 2006 TOANDOVER HEALTH DEPARTMENT Enclosed is a package for a septic upgrade at 38 Famum Street, North Andover consisting of the following: 1) Four (4) sets of Plans 2) A completed Septic Plan submittal form 3) A check for $225.00 (Check #: 115 8) 4) Two (2) sets of soil evaluator forms 5) A Form 9A — Local Upgrade Approval Form 6) Title 5 approval letter for "Presby Enviro-Septic" Leaching system. The applicant is requesting a local upgrade approval, by means of an alternative system (Presby Enviro- Septic) to allow a 2 foot reduction in the vertical separation from the seasonal high groundwater table to the bottom to sand bed of the Presby system. This is allowed per Title 5 for remedial use for this type of system per the approval of the Local Approving Authority. J 1 urs, S IN E. 22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352 -7871 -Phone — 978 352-7871 - Fax Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval :p 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. A. Facility Information (continued) 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leachinq Trenches 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): 550 gpd 550 gpd 550 gpd ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Replace existing 1000 gallon septic tank w/ a new 1500 gallon poly septic tank, concrete d -box, and soil absorption field consisting of cultec contactor C-4 units. 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 (4 feet separation required, 3 feet requested) ft. Percolation rate 11 min./inch Depth to groundwater 3 ft. Local Upgrade Approval - 38 Famum Street, North Andover • rev. 5/02 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A — Application for Local Upgrade Approval ,a. 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Other requirements of 310 CMR 15.000 that cannot be met— describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405 1) (1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation John D. Sullivan III Evaluator's Name (type or print) C. Explanation 7/14/06 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: An upgraded system in full compliance would require additional site grading, a dosing chamber, and possibly a concrete retaining wall to deal with septic breakout. It would also involve clearing of a large wooded area for sufficient off -grading of the soil absorption area. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system is not economically feasible. An alternative system would be more costly to the applicant in the construction phase and long term maintenance phase. Local Upgrade Approval - 38 Farnum Street, North Andover • rev. 5/02 Application for Local Upgrade Approval• Page 3 of 4 Commonwealth of Massachusetts ID a City/Town of North Andover Form 9A - Application for Local Upgrade Approval o 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. C. Explanation (continued) 3. A shared system is not feasible: A shared system is not feasible since the majority of the neighborhood is presently replacing failed septic systems. 4. Connection to a public sewer is not feasible: There is no municipal sewer available in this location 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit Z Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited toi penalties or fine and/or imprisonment for deliberate violations." Facil' Owner's Signature ff Ray DiGiovanni Print Name John D. Sullivan III, P.E. Name of Preparer 22 Mount Vernon Road Preparer's address MA 01921 State2lP Code Local Upgrade Approval - 38 Farnum Street, North Andover • rev. 5/02 1/22/07 Date 1/22/07 Date Boxford City/Town 978-352-7871 Telephone Application for Local Upgrade Approval, Page 4 of 4 DelleChiaie, Pamela From: Sawyer, Susan Sent: Friday, November 17, 2006 9:48 AM To: DelleChiaie, Pamela; Grant, Michele Subject: FW: Hello .... quick question FYI on a question from Jack Sullivan about septics -----Original Message ----- From: Sawyer, Susan Sent: Friday, November 17, 2006 9:47 AM To: 'jacksu1153@comcast.net' Subject: RE: Hello .... quick question Page 1 of 1 Jack Nov. 15th was the cut off for construction permits, however, this crazy warm weather has caused me to approve a few more. If it were done today, I would say go ahead if Soucy can get right on it. I figure next Wed is the new cutoff for permits. After that they will have to get approval from the Board. A system with an active failure can always ask for BOH approval at the Dec. 22nd meeting if they really want to go ahead with it. Susan -----Original Message ----- From: jacksu1153@comcast.net [mailto:jacksu1153@comcast.net] Sent: Friday, November 17, 2006 9:08 AM To: Sawyer, Susan Subject: re: Hello .... quick question Hi Susan, I got the comments back from the consultant regarding the septic upgrade for 38 Farnum Street. The owner is going to hire Soucy to install the system. I know you have a cut-off date of December 1 for system installations. Is this date flexible based on weather conditions and the fact that the owner has a failed system??? If so, I will look to fast track the revisions. If not, then I have plenty of time!! If they have to wait till spring that is o.k. since the system failure is due to high groundwater conditions in the Spring. Figured I would check. Have a good weekend. Jack Sullivan Sullivan Engineering Group, LLC 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 Phone + Fax 11/17/2006 TRANSMISSION VERIFICATION REPORT TIME 1111612006 14:32 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 11116 14:32 FAX NO./NAME 819783527871 DURATION 00:00:45 PAGE(S) 04 RESULT OK MODE STANDARD ECM North_kndover Health Departs -en# 1 600 Osgood Street Building 20, Suite 2.36 (North Andover, MA 01845 97 8.688.9540 - Phone 978.688.8476 — Fax healthdopi(&_tawnofnarthandover.com - E -Mail www.townofnorthandav®Lcom - Website setter of Transmittal, Page _ / of ro: OF ,.� DATE: A �� iIle 46, COMPANY, � FROM: Pamela DelleChiaie, Health Department Assistant 1t, LAME ro: OF ,.� DATE: A �� iIle 46, COMPANY, � FROM: Pamela DelleChiaie, Health Department Assistant Phone: Fax: / / / We are sending yoas 04 y of l efter D Plans !J Other (fill rn below) These are transmitted as checked below: 0ArvwdaAbtd > O*A*vow ➢ 0rar PV d > L7rwAt*warnolm wp# ➢ 0&&p" >, Orar rcw& > C&m" a slbrr qpvsd ➢ L7&A7 "t a �arrrsi. North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdept@townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter ®f Transmittal Page / of '` NORT#1 0etts-10 06, +� % .y may_ eoc.aiiwww _ 1' *� TO: a DATE: COMPANY: FROM: Pamela DelleChiaie, Health Department Assistant Phone: / ,y . /��� RE: O�i c%,Lj�✓�� Fax: COPY TO: ii We are sending you: lJCopy of Letter O Plans O Other (fill in below) These are transmitted as checked below: ➢ L7*Reg vs&d ➢ OkrRek wva 1 nawn ➢ aAsRegra w ➢ Errrawmw ➢ CRestino copiesf6r qpvHi ➢ L7&6,* *wfvr&t. REMARKS: COPY TO: COPY TO: SIGNED: COPY TO: Health Department November 14, 2006 Jack Sullivan, P.E. Sullivan Engineering Group, LLC 22 Mount Vernon Road Boxford, MA 01921 Re: Wastewater Treatment and Dispersal System Plan for 38 Farnum Street, Map 107A, Lot 88 Dear Mr. Sullivan: The proposed wastewater system design plans for the above site dated October 1, 2006 and received on October 4, 2006 have been reviewed. Unfortunately, they cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Please clarify the following items on the design plan as indicated in the Massachusetts DEP approval letter for use of the Enviro-Septic Leaching System: ➢ The requirement for an annual inspection should be indicated on the design plan and a draft maintenance agreement submitted between the property owner and a responsible maintenance entity which demonstrates the steps which will take place during an inspection and the duration of the maintenance agreement ➢ The requirement for a notice to be placed on the deed should be indicated on the design plan, and a draft of the notice provided for review ➢ The specifications for the sand to be placed beneath the Enviro-Septic Leaching System should be more clearly described with grain size, uniformity coefficient and other parameters indicated 2. Please indicate the Long Term Acceptance Rate used as the basis for this design on the plan 3. Please depict the "high vent" on the system profile 4. Please provided clearer notation as to the pump brand and model to be used 5. Please clarify the Vent Detail or the Site Plan as they appear to conflict regarding the location of the two vents — are they at the opposite or the same end of the Enviro- Septic Leaching System? 6. Please clarify what steps are to be taken by the installer if the existing leaching trenches which are to be abandoned are found to be in the location of the proposed Enviro-Septic Leaching System or the 5' overdig 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01846 Phone: 978.688.9640 Fax: 978.688.8476 7. Please depict the 5' sand overdig on the System Profile and Effluent Disposal Area Cross Section so there is no confusion for the installer. Please also describe steps, if any, which should be taken at the interface between the sand overdig and the specified concrete sand. Providing construction sequence or other guidance to the installer for this phase of work would be very helpful 8. Please clarify the notation in the Effluent Disposal Area Cross Section which indicates "septic sand". It is unclear if this is proposed to be the specified concrete sand or the specified sand which meets Title 5 specifications 9. Please clarify the breakout elevation described as 98.86 at the bottom of the distribution pipes. Title 5 would indicate it to be at the top of the Enviro-Septic Leaching System unless you have some other information to clarify this matter 10. Please clarify your intention to utilize a distribution box with 5" outlet pipes as these are not readily available from most suppliers 11. Please indicated the required placement of magnetic marking tape or comparable means around the on-site wastewater system - 221 12. Please clarify Note # 15 indicating the presence or absence of a foundation drain currently at the site, not in the future 13. Please provide construction details regarding the primary (septic) tank internal components such as 3" airspace above tees, gas baffle, 9" air space above flow line, tee depth, etc. — 227 14. Please specify the model of the brand effluent filter you have specified and also indicate on the design plan the requirement for annual filter maintenance — 227 15. Please indicate the requirement for a manhole to be placed at grade over the tank opening with the effluent filter — 227 16. Please provide tank buoyancy calculations for both tanks — 221 17. Please indicate the distribution box is to have all outlets at the same elevation unless the Enviro-Septic Leaching System requires a different configuration — 232 18. Please depict the inlet tee inside the distribution box on the box detail and provide appropriate specifications for construction such as height of the top of tee, etc — 232 19. Since the distribution box is proposed to be installed in the sand fill area, please indicate the need for proper compaction of the material beneath the stone base — 221 20. Please indicate the distribution box is to be watertight — 221 21. Please indicate the need for the box to have a riser to within 6" of final grade or differently as may be required by the Enviro-Septic Leaching System — 232 & 221 22. Please include the flowback volume in the pump calculations — 231 23. Please provide for the manhole to be at grade above the pump chamber — 231 24. Please provide notation regarding the requirement for the pump chamber to be watertight 25. Please provide specifications for the sand fill material to be used in the 5' overdig area —255 26. Please provide for an inspection port in the soil absorption system area — 240 27. Please provide a description of the methodology to be used by the contractor to have the pump provide flow at no greater than 40 gpm as indicated in Note 11 in the pump chamber detail Additionally, based on the current design plan it does not appear that a Local Upgrade Approval needs to be sought to allow use of the Enviro-Septic Leaching System as proposed. Please have the design plan reviewed by a representative of the Enviro-Septic Leaching System and have them provide a letter of endorsement of the design plan. 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. Sincer Susan Y. Sawyer, REHS/RS Public Health Director cc: Owner File Page 1 of 2 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Monday, November 13, 2006 12:43 PM To: DelleChiaie, Pamela Subject: RE:38 Farnum Street I have spoken with Jack Sullivan about the design. He is doing a bit of research to make sure he has specified a particular product correctly and will then get back to me. He knows the plan will be disapproved as proposed. The plan reviews for 45 & 445 Forest Street are almost done. No major issues apparent with either. Dan 0 Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano@millriv_erconsulting.com From: DelleChiaie, Pamela [mai Ito: pdellechiaie@townofnorthandover.com] Sent: Monday, November 13, 2006 12:21 PM To: info@millriverconsulting.com Subject: RE: 35 Turtle Lane Importance: High Thanks Dan. I am also looking for the plan review for 38 Farnum Street. Thanks, Pamela -----Original Message ----- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Monday, November 13, 2006 12:09 PM To: DelleChiaie, Pamela Subject: RE: 35 Turtle Lane sorry Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 11/14/2006 i 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriv_erconsulting.com dano _ millriverconsulting.com From: DelleChiaie, Pamela [mai Ito: pdellech ia ie@townofnorthandover.com] Sent: Monday, November 13, 2006 11:06 AM To: info@milIriverconsuIting.com Subject: RE: 35 Turtle Lane Importance: High No attachment received. Please send. Thank you. 11/14/2006 Page 2 of 2 -----Original Message ----- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent:. Friday, October 27, 2006 7:21 AM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 35 Turtle Lane Construction Inspection attached for 35 Turtle Lane. No problems noted during the inspection. Dan Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 ww__w.mi l lriverconsulting. corm dano@millriverconsulting.com DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Wednesday, November 15, 2006 11:56 AM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 38 Farnum Street plan review Plan review is attached. You got your money's worth out of us for this one —whew. You will see that I closed by suggesting the manufacturer review the revised design plans and demonstrate that, they are in compliance. I am not sure how detailed they would be in their review but I think it would be beneficial. Dan X Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriv_erconsulting.com dano@millriverconsulting.com 11/15/2006 August 7, 2006 North Andover Health Department — Susan Sawyer 1600 Osgood Street Building 20; Suite 2-36 North Andover, MA 01845 Re: Soil Testing Locations 38 Farnum Street Ms. Sawyer; Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants AUG 0 9 2006 TO`ddN OF HEATH DE: ,fkt7ty> FN T Enclosed is a plot plan showing the two (2) soil testing locations conducted on July 14, 2006 at 38 Farnum Street, North Andover for your records. I will be submitting the soil evaluator forms in the near future. 22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352 -7871 -Phone — 978 352-7871 - Fax AUG 0 9 2006 TOWN OF ;yC F:' H AUDOVER HEALTH DEPAR 1 MENT SOIL TESTING LOCATIONS CONDUCTED ON JULY 14, 2006 BY JOHN SULLIVAN AND WITNESSED BY MILL RIVER CONSULTANTS. LEGEND: DTH -2 Q5 = SOIL TESTING LOCATION SOIL MS ANG LOCA 77ONS #J8 FA RNUM S TREE T NORTH ANDOVER, MA PREPARED BY: JOHN D. SULLIVAN III, P.E. 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 SCALE: 1"=50' DATE: 8/8/06 Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Monday, July 17, 2006 11:41 AM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: Soils 38 Farnum Street By the way, the same people who witnessed this soil test witnessed 415 Salem Street. Thanks, Lisa Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverco.1sulting.com 7/19/2006 d l Lh........ w �. 4 Page 1 of 1 DeileChiaie, Pamela r From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Thursday, July 06, 2006 10:39 AM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Evals; 38 Farnum/140 Marian/415 Salem The following soil evals have been scheduled: 1r- Salem.-with-.hack-Sullivan—=July 11tH 8 Famum with Jack Sullivan -July 14tH 140 Marian n-ve�7iv ith-Merrimae-k-Engineering -July 25 All are at 9:00 a.m. Please call if questions. Marianne 0 Daniel Ottenheimer, President Mill River Consulting, Inc. On -Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millrivercon5ulting.com dano@millriverconsulting.com 7/6/2006 Town of North Andover Health Department Date: - :r Location Cr (Indicate Address, if Residential, or Name of Business) -.rCheck #• , , Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type. $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ` ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC --PERMITS: eptic - Soil Testing $� ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ s. Sun tanning. $ Swimming Pool $ Tobacco - $ TrashIsolid Waste Hauler $ Well Construction $ ➢ OTHER: (Indicate) Health Agent Initials 1610 White -Applicant Yellow - Health Pink - Treasurer ri North Andover Health Department .1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdeptO)-townofnorthandover.com - E-mail www.townofnorthandover.com - Website Letter ®f Transmittal Page % of 1 T0: DANIEL OTTENHEIMER DATE: ` 1"olln COMPANY: MILL RIVER CONSULTING FROM: Pamela DelleChiaie, Health Department Assistant Phone: 1.800.377.3044 or 978.282.0014 Re: - Fax: 978.282.0012 We ore sendingyou.- oPP il Test A /icvtion O Plans for Review O Other Y These are transmitted as checked below: 0 A Required 0 A Requested REMARKS: COPY TO: Homeowner Fax # Or Mailed COPY TO: Fax # Or Mailed Fax # COPY TO: Or Mailed TRANSMISSION VERIFICATION REPORT TIME 0612612006 15:21 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 06126 15:20 FAX NO./NAME 819782820012 DURATION 00:00:56 PAGE(S) 05 RESULT OK MODE STANDARD ECM Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants June 14, 2006 North Andover Health Department Attn: Susan Sawyer 1600 Osgood Street North Andover, MA 01845 Susan; I=am looking to set-up a -soil testing date for -an existing failed septic system at 38 Farnum-.Stre-et, North Andover. Enclosed are the following: 1). A completed Application for Soil Tests 2) A check for $360.00 3) A letter from the homeowner allowing the testing 4) A plot plan showing the proposed soil testing locations. Thank you for your help in setting up the testing date. If you have any questions please feel free to contact me. Very Trul Y , a (SU11P an z 22 Mount Vernon Road — Boxford, Massachusetts 01921 — (978) 352 -7871 -Phone — 978 352-7971 - Fax TOWN OF NORTH ANDOVER f NORT1} Office of COMMUNITY DEVELOPMENT AND SERVICES �� •' - HEALTH DEPARTMENT _ p 400 OSGOOD STREET NED NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS, RS 978.688.9540 - Phone JUN 19 2006 Public Health Director 978.688:8476 - FAX healthde t(a)townofnortha dbr W1t,6ffi NORTH ANDOVER www.townofnorthandover. o H DEPAR.TiviENT APPLICATION FOR SOIL TESTS ,InAJ Z3 gab fiw to /A (Ag& a DATE: 2 Q MAP 8c PARCEL: LOCATION OF SOIL TESTS: ✓ t/ f4" /%�" Vy) OWNER: gv'r &UC dlcidvh*f APPLICANT. -(41* I\ ,' Contact #. 1/0 t7& Y771 / Contact #: ADDRESS:( �,,�) -'7 ENGINEER ✓ A� J UJ `+-' Contact #: �� / CERTIFIED SOIL EVALUATOR- Intended VALUATOR Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing. k' Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No x ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ &5"x 11 "Plot Plan & Location of Testine (please indicate test nit 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 c , 5360.00 per lot for repairs or upgrades. GENERAL INFORMATION i ➢ 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 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department: (stamp in): Ray and Kellie DiGiovanni 38Farnum Street North Andover, MA 01845 June 2, 2006 Town of North Andover MA Board of Health North Andover, MA As owners of 38 Farnum Street, North Andover, we give Jack Sullivan permission to conduct soil testing on the property. Please call us if you have any questions. Our phone number is (978) 681-4775. Sincerely, waaxola Ray and Kellie DiGiovanni /a � APPROX. WET AREA ---30— _ 82 — N � � z —92— 180't \ \ o \ i \ i�96''\\ \ a \ \ M \ - \ cn 7 \ { I \700 R4, 1 J I DECK \ o i ' O O 2 STORY !p�OnC \ / WELLING /100_' 1N.59�6' o"w N67 '6'30"W 53.99' X102.43 FARNUM STREET 'U _t.f\r I Ci 01 ssIOyAL�� \3 G PROP. TESTHOLE #2 PROP. TESTHOLE #1 BENCHMARK. PK NAIL IN 10" PINE ELEVATION = 100.00' (ASSUMED DA TUM) PLOT PLAN OF LAND #J8 FARNUM STREET NORTH ANDOVER, MA PREPARED BY: JOHN D. SULLIVAN III, P.E. 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 SCALE: 1"=50' DATE: 6/13/06 oar" �•.,....�...;, o �` �o�N DP�O DF HFA SO ro -SUBSURFACE SEWAGE DISPOSAL SYSTBjM MPECTLaMOTZORM Address of property j V;U ei-I r�7s Owner's name (:::Y()v`V -Sa_6�as Date of Inspection Q PART A CHECKLIST Check if following have been done: Pumping information was requested of the owner, occupant, and Board of Heal . 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 a lable with N/A. �< �Thefility or dwelling was inspected for signs of sewage back-up. The s' as inspected for signs of breakout. i All system components, excluding the SAS, 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 stud epth of scum. The size and location of the SAS on the site has been determined based on a ing information or approximated by non -intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential -�4number of bedrooms -�— number of current residents `'445garbage grinder, yes or no '(C laundry connected to system, yes or no �o seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: IJ/ ]� Last date of occupancy GENERAL INFORMATION Pumping records and source of information: 14 �,A "A,�s 8 Type 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: .Ox � 5- ' � C` r 1 s I _ I 0 Sewage odors detected when arriving at the site, yes or no 07 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK:y (locate on site plan) depth below grade: �d`1 material of construction: `- concrete metal FRP other(explain) dimensions • ' X S I x L4 I �� �© 8v� +( sludge depth aLf" distance from top of sludge to bottom of outlet tee or baffle 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 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,. depth of liquid level in relation to outlet invert, structural integrity, den e f leakage, recpmmend t'o s f r r`�air , etc. c 'rrc� p ' ) u1 f b (Q U V 0 a� DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evi ence f le kage It, or u� of ox, recommend t' � ep 'rs, etc. Q �� 1 c 11\c S—kA" I_ _C ' Zl alp Q l) J a" p G7 PUMP CHAMBER: �� �`\�-�-�J�t (locate on site plan) U v pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued 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 and number leaching chambers and number leaching galleries and number leaching trenches, number, length �e 2 10 "k 0. leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, cond'tion of ve etation, reco en as for main n nce or re air e c kAS CESSPOOLS (locate on site plan) :1(1o�Ae 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, recommendations for maintenance or repairs,etc.) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) - _9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at lea locate all wells withi k two permanent references landmarks or benchmarks 0 ' Ell 4 o a5ey�+� 4S D A DEPTH TO GROUNDWATER n 1' �,V\ sk��5 `I depth to groundwater 1�f� �C��CLQ k 0 Uj 0�: :�C", 0 11 method of determination or approximation: om� ok- J e CVti. 0 N 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indichte yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) Yom' Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? NLiquid depth in cesspool <611 below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal's cracked? structurally unsound? substantial infiltration?.substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributar to a surface PP Y tributary *to supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS)? Iy within 50 feet of a private water supply well. +�J less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. .., SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name Company Address d i E31 v Certification Statement I certify that I have personally inspected the sewage disposal system this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Chec ne: at and 13 I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date���-- Original to system owner Copies to: Buyer (if applicable) Approving authority t � r;, WILLIAM F. WELD Governor ARGEO PAUL CELLUCCI Lt. Govemor COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ";;V?.! i DEPARTMENT OF ENVIRONMENT LAPROTECTION ONE WINTER STREET. BOSTON. NIA.021"08 ,61 1-393-5500 Ix I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: ?j-C1i� Vim. ��� v ���`'``'es of Owner: Date of Inspection:{?, .._ t -Cl 1 (If different) Name of Inspector:SA, I am a DW approved system inspec or pursuant to Section 15.340 of Title 5 (310 CMR, 15.000) Company Name: {:'�' U `" ti `_, '"T \C. Mailing Address: t l �!a , C) I%- IC j Telephone Number. — t- _.1_ TRUDY COX"E Secrctan DAVID B. STRUHS Commissioner CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete'as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sitesewage posal systems. The system: L Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _F s Inspector's Signature: �J'"""'t� Date: The System Inspector s4hal 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) ISYSSTTE`M fA'SS�: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: 15.303. One or more system components as described in tht "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. (revised 04/2s/99) Page 1 of 10 DEP on the world Wide Web: http://www.mapnet.state.ma.us/dep Printed on Recyded Paper SUBSURFACE SEWAGE DISP05AL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: M - Date of Inspection: BI 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 Cj 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 15 NOT FUNCTIONING IN A MANNER 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 (xovisod 04/25/97) Pogo 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION (continued) Property Address:NC��a'� Owner: w Date of inspection: CCM, 11 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 box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or avajlable volume is less than 1/2 day flow. 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 with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for cohiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ 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 11 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) page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:'. Owner: Date of Inspection: .e,- 1 -cue Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes�____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 pan of this inspection. #/ J Ar- 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 bade -up. rJ 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 land 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)j (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM PART C SYSTEM/ INFORMATION Property Address:�ti,`� Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: o rt.pp,�d./bedroom for S.A.S. Number of bedrooms: Ll Number of current residents: Garbage gander (yes or no): PS Laundry connected to sys (yes or no): Vv< Seasonal use (yes or no): FVO Water meter readings, if available (last two (2) year usage (gpd) Sump Pump (yes or no):V? Last date of occupancy: hag -r V\cd C, 3 COMMERC I ALA N DUSTRIAL: 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 late of occupann OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: kk System pumped as part of inspection: (yes or no) j If yes, volume pumpe. MDO allpns Reason for pumping: �V� '�eC TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) UA Technology etc. Copy of up to date contracts Other APPROXIMATE AGE of all components; date installed (if known) and source of information: '-� � `. - (i k=� �� �(-(j 'A.t_{ ,i Sewage odors detected when arriving at the site: (yes or no) No (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: •-� v-.' � Owner: t Date of Inspection BUILDING SEWER: (Locate on site plan) i( Depth below grade: Material of Construction: cas" t iron _ 40 PVC other (ex Iain) Distance frorpsppyate water supply well or suction lire Diameter ``�11 Comments: (conditiop of joints, venting, evidence of leakage, etc.) SEPTIC TANK:._ (locate on site plan) Depth below grade: LCA Material of construction: ,co"' ncrete _metal _Fiberglass _,Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: '9 X X Sludge depth: %.A; ii Diseance from top of sludge to bottom of outlet tee or baffle: Scum thickness:7-�. %� " Distance from top of scum to top of outlet tee or baffle: C311 Distance from bottom of scum to bottom of outlet tee or baffle: 1 How dimensions were determined: 3��'`�'d��=�_Sr..��` A Q. - Comments: (recommendation for pumping, condi of irk aid outlet eeT or bas, death of liquid lejrel�relaEt�o� Ar outlet invert, GREASE TRAP: UXOV',k- (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 04/15/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: `, .) �1�1f\V �,v� �1c�'Nk"' t�'�l 1LIS .I�_ Owner: Date of Inspection: k- q� TIGHT OR HOLDING TANK:"4,e (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: 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: 0 Comments: (note if letti evidence of solids prrygver, evidence of leakage into or oui of bo(x-etc.) ; D_ ���'F ca PUMP CHAMBER: -��Iv �a�-c:�w''. (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) Pape 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 4 \ Date of Inspection:.._', SOIL ABSORPTION SYSTEM (SAS):_, (locate on site plan, if possible; excavation hot 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: C 1 lcw� leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note _condition of oil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ti c C CESSPOOLS: nCW, (locate on site plan) Number and cor figuration: 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 pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: �OVkl (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (rovimed 04/25/97) Page a of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner:`,�� `t Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks ;oca e3lnwells within 100' (Locate where public water supply comes into house) . 0(%VP- w� tl�Ll �tuc c);\ a� 4-",,� ( l` `3 " I11. it Ci 1r-, I 1 �5 0 ( uA=LA (revised 04/25/97) I >,kA 4 ?, v). {3„r Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: I/ Depth to Groundwater �feet Please indicate all the methods used to determine High Groundwater Elevation: Ob from Design Plans on record _ Ob Watton of Site (Abutting property, observation h e, basement sumpeju►J Deter ine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how ,you established the High Groundwater Elevation. Must be completed) (revised 04/25/97) Page 20 of 10 Uk (9711) 475- 1 -17.1 FAX. (9111) 475-5-151 �IIE SON ENTERPRISES, INC, fifFAV011piv WOW A &Pvvr I.JAVJ 7 5FVIIC: 5YOV1114 A r4401V1118 SWACC: 11 J A0114 Opiul 0 Andovo-, hia�s. 0 11110 T 11; 14 5 114awo1-t I kill Ii u p C.) i.- L HV,FppqfFRnl�alrt, d har J11 40ea poph roppvl+ looup-d hearowitli 1w 11104:uly OaLied 111,o1l lily oppovyW000f 404 1 horolq 4Iwc:ji4Illl c4ity of vp-4f P11fro"t apptjq ovitwlll, ....... ... Ulu ljo 1..-ULioll L11 C L - pc 6u6 l,c: Pawl It Farr, George Lot 144 Famlham St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I herebymake application pP for a permit for a sewage disposal installation at Lot 11,, Farnham St. I will install this system in ac- cordance with all the laws of the 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 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of1000_ �a1. 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 180 lineal (sque:Tv-) 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 tile 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 %Z% gnature of Applicant /ter I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE , �- S S nature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATEi Signature of specting Offi Ter I Percolation Test 11 min_ ,Sr); I., r, -�12� Garbage Grinder Nc� BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 9 Y ® .V K- 1. NAME �f"G /� • /Cf�'J' DATE'. O 2. ADDRESS /cXcIAJGA LOT NO. /*y/f'"" 5/TEL. 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO 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• ATION AND DISTANC, 10. TION OF BR , , DITCHES, LEDGE, Tc..IV 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE:LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE December 27, .19065 NAME OF APPLICANT George Farr LOCATION Lot 14, Farnham St. Address of lot no. BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay Gravely_Clay K Sand PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. illiam J. D iscoll, Jngineer Board of He th ij . FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. I ........................................... ■ ............................... ■ APPLICANT �� W,4(91 4 L)A N N i PHONE �` �� ASSESSORS MAP NUMBER IL,9 17 J LOT NUMBER RAO SUBDIVISION LOT NUMBER STREET r A STREET NUMBER "39 OFFICIAL USE ONLY ,REC MN ENDATIONS OF TOWN AGENTSj� �jc . �� V� �o .lam AVL od V_\ C� r 1 hDATE APPROVED O d CONSERVATION ADMINISTRATOR 1 DATE REJECTED COMMENTS 'V d� DATE APPROVED TOWN PLANNER DATE REJECTED CONIIvIENTS DATE APPROVED FOOD INSP R - HEALTH DATE REJECTED DATE APPROVED TIC CTOR - HEALTH DATE REJECTED % COMMENTS AV PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING '°.- s.,T�15:�ec4�`:fti1'titfiCtR1,USC'''C�gI _ BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building COMMiSSioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: RE Map Number Parcel Number /Jo . An d!O)Pj,:� iIY7,,!q aa c/�, 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Property Dimensions: �// JVV Lot Area (so Frontage e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard " Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 5 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Nam (Print) Address for Service 9i Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M M X Z O z M O r S® M r r 0 z ^ Q MORTGAGE INSPECT/ON, PLAN AT 38 FARNUM STREET NORTH ANDOVER, MA. N0. ESSEX REGISTRY OF DEEDS.' BIC 212/8 PG. 92 CERTIFIED TO.'ANDOVER SAVINGS BANK 5'3/8 SCAL E.' I "- 60DA TE.' SEPTEMBER 25, /995 63.09' 142.90' /90.5/ ' C c. 2 STY. Par o 3 W- KOOD LOT /4 0 o►ycc. 47500 S.F. -i o_ r- ENCI - - PORCH rn 445.87' 8 x8 ' 's .NOTES.' "'/) DO NOT USE OFFSETS TO ESTABLISH PROPERTY LINES OR TO ERECT ANY STRUCTURE. 2)PROPERTY LINES ARE DETERMINED FROM COMPILED INFORMATION TO BE USED FOR MORTGAGE PURPOSES ONLY. CER T/F/CATIONS. ' BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF, I HEREBY CERTIFY THAT THE PERMANENT STRUCTURES INDICATED ARE LOCATED ON THE. GROUND APPROXIMATELY AS SHOWN AND ARE CONFORMING TO THE ZONING SETBACK RECUIREMENTS OF THE MUNICIPAL IT Y NO. ANDOVER WHEN CONSTRUCTED AND THAT THE STRUCTURESHOWN IS NOT LOCATED /N A FLOOD HAZARD ZONE AS PER FE. M. A. MAP, COMMUNITY NO. 250099 EFFECTIVE DATE.' 06- 02-93 ZONE.'X JOHN ABAGIS Q ASSOCIATES , PROFESSIONAL LAND SUR11EYORS /37 CHANDLER ROAD, ANDOVER, MA, (508) 688- 4899 AA°L ICA N7" CA HIL L NO. P2,458 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38t As sAJ�%)r`J�tit.C1-� Sl Owner: Date of Inspection: ) SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate -alt Iwells within 100' (Locate where public water supply comes into house) o r, vp LA (revised 01/25/97) page 9 of 10 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) ll,1'I'E OF PUMPING: % Q QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES�� NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: CONIMENTS: CONTENTS TRANSFERRED TO: FULL TO COVI-'IZ BAFFLES IN PL,4CE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) ri 44.- 0 O N +-+ F— I III c f '�3 G t 10 C Q C � � t s �i a � o � � � f f Q L � G. a u c � L � O E41 Z 42 Z M tflC 'C A � 'f c s= to w � a E C L 7a R O `j 41 GGQ 2 O -O O CY] � i.+ I ~ N C O t>= a Q O E ra m U a O D C , OU 0 Z �jo Cnm�onwealth of Massachusetts ° "U�-f Massachusetts System Pumping Record System Uwner C 6z�w cI Date of Pumping: e?— ( — 9C, Cesspool: No I Yes L.1 System Location s TUTMs' :n• - C. =� . AUG 1 Quantity Pumped: 1C gallons Septic Tank: No Ll Yes r� System Pumped by: aredda si>'avqldeQ License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: FOMI 4 - SYSTEM E 1995 Commonwealth of Massachusetts Massachusetts System Pumping Record ystem Owner N'stem Location ugly Date of Pumping: 1 Quantinv Pumped: [ � gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by- _ License #: Contents transferred to: Date Inspector LTT Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The S ftt rl 1[l�tg R ord must be submitted to the local Board of Health or other approving a+ thority. onnn A. Facility Information I TCQ,--t,l\j OF `FORTH ANDOVER Important: ` '` DEPARTMENT When filling out 1. System Location: �—� r forms on the computer, use only the tab key Address to moveour j\/,, ' cursor - do not use the return City/Town State Zip Code key. 2. Syst m Owner: A QW ly l Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping p 9 Date 2. Quantity Pumped: Gallons 3.. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes E� No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. tem Pumped B %ame p Vehicle License Number I 11Y Company 7. Location where contents were disposed: Signa;ure otllauler `-- http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 Dater System Pumping Record • Page 1 of 1