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Miscellaneous - 38 WHITE BIRCH LANE 4/30/2018 (2)
7, I M- N oO w W 0. 2 Q M o m 0 co o c7 o = o 0 O m MAP # LOT # j --- PARCEL # STREET CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? 7 A�YES - NO PLAN APPROVAL: DATE 7 APP. BY DESIGNER: Gj/�iC�ST/A�i/SE/� PLAN DATE_ Z!1; Ml 9 CONDITIONS WATER SUPPLY: WELL WELL PERMIT _..... ............... WELL TESTS.- CHEMICAL DA I E APPRUVED._.___ TERIA I DALE OPPRUVED BACTERI COMMENTS: DATE APPROVED- FORM PPROVED- FORM U APPROVAL: APPROVAL TO ISSUE Y NO DATE ISSUED / GAl BY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DALE:. _........_..._ ._BY: r w w � SE�Y�ZEM�NSS94l,�T� QLl ���.`• �..�:''' �• ....«,; �,.:� � - A ?� #i. \.1 - a ��Ct - ! i %`� •moi i ..,'. r � :•l.t: ate. •INSTALLER •': ..i. .. -. � :x IS THE LICENSED? YES NO `r.TYPE.OF CONSTRUCTION: NEW REPAIR' . NEW CONSTRUCTION. CERTIFIED PLOT PLAN ,REVIEW NO ' CONDITIONS OF.. APPROVAL '::' YES NO (FROM FORM U) .. • �` ISSUANCE DWC PERMIT r - ` ' YES NO _•OF 1• ' DWC PERMITN0. '' % �:-' *INSTALLER: -F/M• M&Z- ld BEGIN INSPECTION ES :.=:EXCAVATION . INSPECTION: _ :NEEDED: '~PASSED BY =:-;CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: /©' z.71 APPROVAL TO BACKFILL: DATE: BY .FINAL DATE Y , GRADING APPROVAL: FINAL CONSTRUCTION APPROVAL: DATE: BY COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 38 White Birch Lane _ —North Andover_ Owner's Name: _Jeflerey Shapiro _ Owner's Address: 38 White Birch Lane_ _ North Andover, MA 01845_ Date of Inspection: 2/6/2004_ Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 475-4786_ ,F �vci� ar,ui: r SOV' � GF HEAL7kl i ._. 9 FEB ` 2 2G" _ ►. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: JAM Date: 2/6/2004_ The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. ► � Page 2 of 11 ` OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 White Birch Lane_ _ North Andover_ Owner: _Shapiro Date of Inspection: _2/6/2004_ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: _ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: ! Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 White Birch Lane- - North Andover— Owner: _Shapira Date of Inspection: 2/6/2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance _ _ **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 . OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 White Birch Lane _ North Andover— Owner: _Shapiro _ Date of Inspection: 2/6/2004 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No _ _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6" below invert or available volume is 1/2 day flow. No— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _No_ Any portion of the SAS, cesspool or privy is below high ground water elevation. No— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water T supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No(Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply — , the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 38 White Birch Lane- - North Andover— Owner: _Shapiro Date of Inspection: _2/6/2004 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes _ Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks ? _Yes _ Has the system received normal flows in the previous two week period ? _No_ Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes_ _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Yes _ Was the facility or dwelling inspected for signs of sewage back up ? Yes Was the site inspected for signs of break out ? _Yes_ _ Were all system components, excluding the SAS, located on site ? _Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no _Yes_ _ Existing information. _No_ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 38 White Birch Lane- - North Andover– Owner: _Shapiro_ Date of Inspection: 2/6/2004_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): _440_ Number of current residents: _4 Does residence have a garbage grinder (yes or no): Yes Is laundry on a separate sewage system (yes or no): _ No Laundry system inspected (yes or no): — Seasonal use: (yes or no): _No_ Water meter readings: Yes_ Sump pump (yes or no): _No Last date of occupancy: _Current_ COMMERCIALANDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2002. Info at B.O.H._ Was system pumped as part of the inspection (yes or no): Yes _ If yes, volume pumped: _1500_gallons -- How was quantity pumped determined? _Measured tank_ Reason for pumping: _Inspect tank & baffles.— TYPE OF SYSTEM _X_ Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval _ Other (describe): _ Approximate age of all components, date installed (if known) and source of information: _9 years old, 10/16/1995, As built plan._ Were sewage odors detected when arriving at the site (yes or no): _No .1 1. Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 White Birch Lane- - North Andover— Owner: _Shapiro Date of Inspection: 2/62004 BUILDING SEWER (locate on site plan) X Depth below grade: _36" Materials of construction: _ cast iron X_40 PVC other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): _4" PVC thru wall to septic tank 3" PVC in house, no leaks._ SEPTIC TANK: X locate on site plan) Depth below grade: _21 _ Material of construction: —X—concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: _10' x 5' x 4' Sludge depth: _6"_ Distance from top of sludge to bottom of outlet tee or baffle: 21"_ Scum thickness: _6" Distance from top of scum to top of outlet tee or baffle: _8" Distance from bottom of scum to bottom of outlet tee or baffle: _15" How were dimensions determined: _Difference in sludge & scum depth to baffle length _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet baffle ok. Found outlet gas baffle on inlet tee. Removed same. Outlet baffle ok. Depth of liquid at outlet invert. No evidence of leakage. _ GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): , Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 White Birch Lane- - North Andover— Owner: _Shapiro Date of Inspection: 2/6/2004 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _I" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):_ D -box level & distribution equal. No evidence of leakage. Evidence of solid carryover. Pumped d -box to clean. D -box cover broken, replaced same._ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): _ Alarm in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 9 : Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 White Birch Lane _ _ North Andover — Owner: _Shapiro Date of Inspection: 2/6/2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. n Septi(9) eptiTank A B / I Garage House Water Meter Driveway D Boz A to Tank = 41'5" A to D -Boz = 83'8" B to Tank = 28'5" B to D -Boz = 5519' Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 38 White Birch Lane _ _ North Andover— Owner: _Shapiro Date of Inspection: 2/6/2004_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4'_ Please indicate (check) all methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record - If checked, date of design plan reviewed: _5/10/1994_ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: _ Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: _ You must describe how you established the high ground water elevation: Design Plan_ Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 38 White Birch Lane, North Andover Owner: Shapiro Date of Inspection: 2/6/2004 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil ateson Bateson Enterprises, Inc. n Feb 11 04 08:02a Z O Z a a E w rn w F .fl Q 1 = O J N a w b _ � LL Z O m o tA L� '� Z a a CL CA :3 Z — `n O u ~ > U (A= Q J D Q V) w a = p a Q, > N 0 C LL O a p0 Q U N v r 0 ce t Z O m .► c 3v o o c Q C 3 o`� O u t LA �. , 06 LA N b � D a`o E u a� tN fa "*+ c 10 ?p hMpl * ♦ Q N a- Ln LL WHITE BIRCH LANE 100. o" -r 154.1' LOT 1 o A=45110 S.F. `o 1. 228.3' FOUNDATION LOCATION PLAN CLIENT. IPSWICH SAVINGS BANK THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: NORTH ANDOVER,MA. SCALE. I"=60' DATE: MAY 10,1995 7 / EXIST / /FND;l b to V O I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL APPLICABLE ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS WETLANDS,EASE•MENTS ORDERS OF CONDITIONS,ETC.) THIS DRAWING SHALL NOT BE USED BY THE CUENT FOR ANY PURPOSE OTHER THAN THAT OU77JNED ABOVE,EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISNANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR— MATION CONTAINED HEREON. CHRISTIANSEN , SERGI PROUND/ONAL E O INEERS SUR160 SUMMER ST. HAVERHILL.MA. 01830 TEL. 508-575-0510 Q 1995 BY CHRISTIANSEN & SERGI INC. BASED ON SCALED DATA ONLY THE PRIMARY STRUCTURE SHOWN IS NOT LOCATED IN A FLOOD HAZARD ZONE AS SHOWN ON FEMA FLOOD INSURANCE RATE MAP. COMMUNITY NO.: 250098 0005C DATE. -612193 UVVU.IVU.: y.3U0/UU I O CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 September 21, 1994 North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lots 1-3, 5-9 White Birch II Dear Board of Health Members: (508) 373-0310 FAX: (508) 372-3960 iii► b— cciall Vl •,iy Client, Scott Construction �.,(�., t `Wvt,i;u iYi�� , app-a.ai :: re t. c: Board at your meeting on September 29, 1994 to request variances from Title V of the State Environmental Code and the Town of North Andover's Minimum Requirements for the Subsurface Disposal of Sanitary Sewage for the above referenced lots. The Variances requested are as follows: 1. 310 CMR 15.02(17), (North Andover Regulation 2.18) Construction in Fill The variance requested is to allow for the required area of excavation of impervious material around the leaching facility to be reduced from 25 feet in all directions from the leaching facility to 10 feet in all directions from the leaching facility. 2. 310 CMR 15.14(Illustration B), 310 CMR 15.15 (Illustration C), (North Andover Regulation 6.02u.) Downhill Sloes Requirement The variance requested is to allow for the downhill slope requirement to be reduced from the required horizontal distance of 150 times the slope to a horizontal distance of 15 feet to a 3:1 slope. I look forward to presenting these requests to the Board at the meeting on September 29th. Very j7ryly Y stiansen IaH0N k CALL FOR SS 0L8(TE TIME 1 �- 1/I CJI-- PHONEf DF Lk (� z'H O N E `-� A611.2NEQ OUR CALL PLEASE GALL AREI� COC�E NUMBE ENsin MESSAGE WILL CALL AGAIN ej GAME TO SEE YOU WANTS Tt7 G TOPS"" FORM 4003 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 April 24, 1995 North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 1, White Birch II Dear Board of Health Members: (508) 373-0310 FAX: (508) 372-3960 On behalf of my client, Scott Construction Co., I would like to appear before the Board at your next scheduled meeting to request variances from the Town of North Andover's Minimum Requirements for the Subsurface Disposal of Sanitary Sewage for the above referenced lot. The variances requested are as follows: 1. North Andover Regulation 2.14.4 Minimum Capacity The variance requested is to allow for the minimum capacity of the disposal system to be reduced from the required 660 gallons per day to the design flow of 440 gallons per day. 2. North Andover Regulation 2.14 Sewage Flow Estimates The variance requested is to allow for the estimated daily flow per bedroom to be reduced from the required 165 gallons per day to the Title V estimate of 110 gallons per day. A Subsurface Diposal Works Construction Permit has previously been issued for this lot under the old Title V Regulations. The required sideslope requirements under those regulations would have required the clearing of an extensive area of trees around the leaching facility. In order to reduce the area of clearing and filling, we appeared before the Board of Health last fall and obtained a variance to allow for the reduced sideslopes to what is the current Title V requirement. We were since informed by Health Agent Sandy Starr that the Department of Environmental Protection would not approve any variances that would mix the old and new Title V Regulations. For this reason, we have redesigned the disposal system according to the new Title V requirements, and are requesting these variances to allow for the construction of the system, which will be still be substantially larger in available leaching area (900 square feet vs. 504 square feet) than the previously approved system, with the reduced sideslope requirements. Please notify me when you have scheduled a meeting for this request for variances. f pORTIy Oat��ao �a,�0 O O � a 0 HUS Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location CA�-� 'W 1 Uj kAj— &-A-�� Reference Plans and Specs ENGINEER 0 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. 0 Fee CSO CHAIRMAN, BOARD OF HEALTH Site System Permit No. 3 --)-/ cn-a m D O O w. �i0 fD O O m x z Z z Cil z �� P o. C y D M �•► cp N � O CO) Cl) D n z y T r p O 'C c) =• a CO) Dto 7 O n ' c p dc CD CD O CL CD CD C'7 CSD O CCD � Z M D m C CD Q y y C m z o tG < z y p O x CD 'N 0 -n CSD O D CD CD m O vi< Q N �Q CLO m 10 CO) o'o=m n CD 0 •I . •� ca m H � o a 3• �o Z vi -i o "" CD o -n �c�� o m W o CO CA o N o rr m: CO m 2 m� m o r n \ to � o m '� G y C 9 C. �.0 m i1 �y� � y� D CL 0 : V G)�to 0CD n-0 CDHCD f CD O .w H �. 0 03 N H d d :C � o :( O. H 9CCD r. :Em y ? o C y , `, �'' mCD C CD Co N li Om COOD � .. o o 0 CD o OV H� m � c C/)' m y v cv C3 '[ 100, < 0. `D S ' m a C6 m O co s o .y c2 0 . i j • 0 co G OP'tT.'oOG `D O O O O w. �i0 fD O O O O O O IS : a a1 el)O �^ a. z Cil �� P o. C ?� Y rb M �•► = x . � t z 0 y 0 0 c O37OL90F6 'oN JN/M VNG 2 Q �j ^ a a ki M M Q CIO •°Ia�O ''v� (� 1' `t o° M 2 op c� n t\ O O O V2�~� �= Q m ry ce M � op M h h W ZOO to;� O^ tO `O www ow O v4iQw�o Qw (� > o o !s W w W Zj o �o lu lU w 3?LQ ZZI o �wwy�o oo m VLo 'Q a v! L.�CA N vJ m ori C 4 4 Z. 2 2 pOQ2o �� �p m J r~r^^ 4 a W W W �- �QQ �ti Q vJ O O O O O ti wZO�1 Q I � Q Q Q W��ZV 4i. o 2 2 2 2 2 Z Z? ?o15 iz 2 > Q� � p � m F 3 �41 S WZ I i C3 a36�M tV 1 11.2' 24.1' X091 26.2' a ^ Ff HON3�1 _ �I a 40 W v v w W M o � O Fes. O J No......................... THE COMMONWEALTH OF MASSACHUSETTS row/t/ OF HEALT�H/ iow !/. .......OF ...... N.—.0 .9 ... A.N0oV. 'k ..................... Fuit............._............... Appliratillli for D1 71 w3al 1111r1w T11111itrurfiall Funlit Application is hereby trade for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System At : ..............H! KA9..c. /..(ISNe.............................................................. .......��.�:I.T.. Rlc�ri..� res"v:.�..ief Y �............. ...�? .��.��25. �:.. I�RUl.�1.1�� �h!.................. Ohs ncr Address .........................................I.....' ....Iler..................I...................... ............. ......... T....................^dd.................I............................. Type of Building Size Lot..4$J.�%a....... Sq. feet Dwelling — No. of Bctlrnoms..............:.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of littildittb ...........I....I............ No. of persons ............................ Showers ( ) — Cafeteria ( ) Otherfixtures............................................................................................................ ............................. Design Flow ............... ,1� ............. .......gallons per person per day. Total daily flow.................?...................gallons. t � Sy Scptic Tank •�-- Liquid capacity/.5b0.galluns Length.1d.... �.... Width.6t .... .... Diameter ................ Dep th..,��.� .......... Disposal T�o..FLfr`1�... Width...... 1.57........ Total Length.......tat7 °.... Total leaching area..... 70.0.... sq. ft. Sce,page Pit No ..................... Diameter.................... Depth below inlet.................... Total leaching area .................. sq. ft. Other Distribution box (X) Dosing tank ) Percolation Test Results Performed by.. ..CHP!!- MM�JW -f...Y,, (1 INS Date ... �j19j9.¢� 7k5J-9¢ Ef..... �..... Test Pit No. 1...,.� ........minutes per inch Depth of Test Pit........ liY"11. Depth to ground water ... L.c.,...... "..l' ��" Test Pit No, 2.....4 ....... minutes per inch Depth of Test Pit.......�O ....... Depth to ground water..tx...........C%f.'. 14-14) ............................................................................................................................................................. Description of Soil..... t !>T...1 !4!!!1�?"t'..t. l.%itil....G.(A.Yf.y.....1.!. ekr.......................................................................... ................................................... .......................................................... :.......................................................................................... ........................................................................................................................................................................................................ Nature of Repairs or Alterations — Answer when applicable......................................:........................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LF, 5 of the State Sanitary Code -- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................................................... Date ApplicationApproved By................................................................................................................. I........................ Date Application Disapproved for the following reasons: ......................................................................................................... : ...... ......................................................................................................................................................................................................... Date PermitNo ......................................................... Issued................. ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... OF ..................................................................................... Tnlifirafir of Ti mpfianu THIS IS TO CERTIFY, That the Individual Sewnge Disposal System constructed ( ) or Repaired ( ) by.......................................................................................................................:............................................................................ Installer at..................................................................................................................................................................................................... has been installed in accordance with the prn%-kiogs of TITLE 5 of The State Sanitary Code. as described in the application for Disposal Works CUIWRIC6011 fhcnnit No.." ::.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOPY. DATE................. ................................................ I.............. Inspector.................................................................................... THE COMMONWEALTH' OF MASSACHUSETTS BOARD OF HEALTH ........................................ OF ..........................................................I.......................... i\t U ......................... FEE ........................ !m5p nt I , orlin Cliamraxrtin Vnmit Pcrnnissiotnis hereby granted.............................................................................................................................................. to Construct ( ) or lZeptir ( ) an Individual Sewage Disposal System atNo.......................................................................................................................................................................................... S'"et as shown un the applic:ttiun for I)ispas;Il 11'url;; Construction Permit No ..................... Datcd .......................................... ........................................................................................... Board of Health DATE.................................................. I............ I .............. I. .FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS s� -FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. 16 ****************Applicant fills out this section***************** APPLICANT: qQT lel -0tlj Phone .Y71V- O C r LOCATION: Assessor's Map Number Parcel Subdivision t iIdLu� Street Lots) St. Number 39 ************************Official Use Only************************ RECONDATIO OF TOWN AGENTS: 77 Date Approved fl� Conservation Ad inistrator Date Rejected Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Corinents Date Approved Date Rejected Date Approved Date Rejected Date Approved 9 7 Date Rejected of Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date f gORTq f t � • i h sACMus tSJ Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant JIM M a 'e/" -'-'0N1 Test No. Site Location Reference Plans and T ENGINEER utblbN U1%I G Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. X% _ No......................... Fuic_........... _.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN ........................................... O F....................N 0.119....A.K.R ARRURR ................... . Appliratinti for Biqoo if Nadia T11riil#riAr#iun Vni i# Application is hereby inadc for a Permit to Construct ( x ) or Repair ( )tui Individual Sewage Disposal System at: CHERISE CIRCLE Lo :.....:........................•t.on ..•...A...JJ.......................................................................................................................................... cai• ress or Lot No. ...... ....S.�9TT...G.Q.t�S��U��X.RN...�I`i�......................... 1.2...RO ;ERS RA, ....... AAS.91.?11111.... ".................. Owner' Address .......Insta...................................................... Address .. .... .............. i Type of Building Size Loi ....... Y.J� .0 .Sq, feet Dwelling —No, of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (• ) Other—Type of Building No. of persons ............................ Showers ( ) Cafeteria ( ) Otherfixtures...................................................................................................................................................... Design Flow.............8.2.:.5.............. .gallons per personer day. Total daily flow.............? -Q....................... gallons. Septic Tank — Liquid 'capacity1.5.Q�..galIon s Length 1.�.'.-.§..IWidth.�? t-.$.��. Diameter ................ Depth.5 -.:'.� " Disposal. Trench — No. ...2 ............... Width ..... 2.'........... Total Length ........ !*P.y�...... Total leaching area.....�� .. s ft. ... q. Seepage Pit No ..................... Diameter.................... Depth below inlet................... Total leaching area .................. sq. ft. Other Distribution box ( X ) Dosing tank ( ) Percolation Test Results Performed by..... C H, R I S T I A N S,9. j`._ SER I N CDate.... S�/Olrj, P�G J� P -2Z Test Pit No. 1... '� ......minutes per inch Depthq t Pit ... Depth to ground w ..... ...... Test Pat No. 2....!y...... ,r• water ... �7 :minutes per inch Dept of TpSt Pit..::.�Z1....I... Depth to ground water._ ..�.......... Descriptionof Soil......................................................... 6 .........................................ea ....... ;�.d" .TC.4�y.................................................... ................................................................................................................................................................... Nature of Repairs or Alterations — Answer when applicable................................................. ............................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Cumpliance has been issued by the board of health. Signed...................................................................................... ...Z/Dat ApplicationApproved By.................................................................................................. ....................Dat................ Date Application Disapproved for the following reasons: ...........................................................................................,,,,,,,,,,,,,, ....................................................................................................................................................................................... K. •.... •......... Date PermitNo ......................................................... Issued................ ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................... OF ...................................... ............................. .... ......... Tvrtif irntp of Tiampliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................................................................................................................................................................................ InataII4r at................................................................................................................................................................................ has been installed in accordance with the provisions of TITI- 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ......................................... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........::.........................................I......................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... ........,..........,...................... o F.................... ......... .......... ,............................ ..............., FEE ........................ %ivimal Nab Permission is hereby granted ...........................................•...... ............................................................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.............................................................................................._....... .............................................................................. Street as shown on the application for Disposal Works Construction Permit No ..................... Dat'd .......................................... ......................................................................................................... DATE................................................................................ Board of Health FORM IZ55 A. M. SULKIN, BOSTON No......................... run............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN......................... OF....................N TH ND V .1111.. 4.R:..........A........Q...?.R...:..............:....... . Appliratilln for Dirivogal lIlarlt'g C iamitrarfilan Pumi# Application is hereby made for u Permit to Construct ( x ) or Repair ( ) tut Individual Sewage Disposal System at: ........ I ....... . CHER.ISE CIRCL.E...........................I.......... Location • Address or Lot No. .........U.Ca......................... 1.2... R 0 G;ERS....R b.r,....JJAI:.r..................... Owner Address ................................................... ........................................................ I ............... I ........................ I....... .............. Installer AddressType of Building Size Lot ....... Y.J�...L .Sq. feet Dwelling —No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder (• ) Other—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures...................................................................................................................................................... Design Flow.............8.2.:.5..................gallons per person ger da�. Total daily flow.............?. D....................... gallons. Septic Tank Liquid' capacity1.5.Q �..galIons Length 1. ...-.�?.. Width.?. ` -.A". Di ............... h 1 :A11 —" 1111 Diameter Depth ... Disposal. Trench — No, ...2 ............... Width ..... 2.............. Total Length.............. Total leaching area ...... ....sq, it. Seepage Pit No ............... Diameter.................... Depth below inlet.................... Total leaching area .................. sq. ft. Other Distribution box (x) Dosing tank ( ) Percolation Test Results Performed by..... C..STEN � P�� .... ....... Nate ..... `�1.............. P— Test Pit No. L. 3........minutes per inch Depth '� ?,Z t Pit.... �I.. Depth to round water...... P Test Pit No. 2....!.;.;::::minutes per inch Depth 4Tfst Pit..::.��J jr.::: Depth to ground water....//.......... .................. I..... ....I... ............................................... . Description of Soil.......... ................................,............ yy.... F...... �:.:....................:.......:................. Nature of Repairs or Alterations 1111 Answer when applicable.............................................................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT LZ 5 of the State Sanitary Code -- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .............................. /Dal ApplicationApproved By.................................................................................................. ............... Application Disapproved for the ............................................................................................n,io......... . r. f allozvin� reasons: ,. „ .......................................................... ................... .... ................................................................. .......................... I............................ Date PermitNo ......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... O F...........................................11.1...1.............111.1................ (ffnlif irate of Tampliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................................................................................................................................................................................ installer at.................................................................................................................................................................................. has been installecl in accordance with the provisions of TITIN 5 of The State Sanitary Code as described in the application for Oisposal Works Construction Permit No ......................................... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............:................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS - -- BOARD OF HEALTH No..................................................,................OF......,.................... ............................... ................. Futt........................ 15iiplanlrl� �ztttfrfiun�rttf Permissionis hereby granted................................................................................................................I....................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.............................................................................................._................................................................................... Street as shown on the application for Disposal Worlcs Construction Permit No ..................... Dated........................................... ......................................................................................................... Board of Health DATE................................................................ FORM 1255 A. M. SULKIN, BOSTON