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Miscellaneous - 399 SUMMER STREET 4/30/2018 (2)
Lot & Street Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paifl'd"' NO Permit# Plan Approval: Date: � Approved by: Designer: Plan Date: Conditions: a y Water Supply: Town Well Well Permit: \ Driller: Well Tests: Chemical Bacteria I Bacteria II Plumbing Sign -Off: Comments: Form "U" Approval: Date Issued Conditions: Final Approval: Date Approved Date Approved bele Approved ring Sign -off: Approval to Issue: YES By: NO All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: CONDITIONS: Is the installer licensed? Type of Construction: New Construction: Issuance of DWC permit: DWC Permit Paid? DWC Permit # Begin Inspection: Excavation Inspection: Needed: SEPTIC SYSTEM INSTALLATION YES NO NEW REPAIR Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO YES NO YES NO Installer: YES NO Passed: � 2P010Z By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: Certificate of Compliance: Approval: By: Date: DaW TOWN OF NORTH AND R U ING PERMIT FORP,,,L 06ING IL This certifies that ........................... has permission to perform .... ............. plumbing in the buildings of ................... at.. ........... ..... North Andover, Mass. Fee......... Lie. No .......... ..... ... ...... 'PLUMBING INSPECTOR Check # V ;� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING <\ (Print or Type) g/ Jhy�cyy �;�(- , Mass. Date 0 Permit # �` ' Building Location, g S /yM m e +�� Owner's Name a r -d _ (� �`�'— ry �' Type of Occupancy Resi ential kvlrb - — New 0 Renovation ❑ Replacement 99 Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &P-19 . Co- Inc- Check one: Certificate Address 35 Pleasant Street CX Corporation 714 Stoneham; Ma 02180 [] Partnership Business Telephone 781 '-438-7276 n Firm/Co. Name of Ucensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142_ Yes ® No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 121 Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass, General Laws, and that my signature on this permit application waives this requirement_ Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapt r 142 pf the General laws. By gnature of LicensedPlumber Title Type of License: Master (X Journeyman ❑ CitVyTown $ 3 2 2 APPROVE O O Ucense Number %Z" Watts 9D bfp on water line to water boiler j z O r1 W W N X J J t/f Y a U Q ~ �) Z O G Z W a 14 Jam. 'n z ut a cc: En — LL r +� i-� _2X: v� "_' Q of m y X r ; ¢ W t .- N 0 z c 0- cti 't 0 s 0 41 N Q] N v Z O W ¢ 4 W _ o a rn z ¢ W W ►- F d N o= 3 Y to a c 0: ►- J a — X p W " Ic 5;�,�(1 1-- U ? f- O a � 0 F- Z O. o 'n z x W 1 a O O . a a< X W v' — a a O a J J a cr rc ¢ 3 C a +� .. 3 Y J lD N D 3 J 3 y i- N LL V 7 0 4 C. N 3 3 V. r? "• SUB—BSMT'. BASEMENT 1ST FLOOR 2ND FLOOR `ORD.FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg . &P-19 . Co- Inc- Check one: Certificate Address 35 Pleasant Street CX Corporation 714 Stoneham; Ma 02180 [] Partnership Business Telephone 781 '-438-7276 n Firm/Co. Name of Ucensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142_ Yes ® No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy 121 Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass, General Laws, and that my signature on this permit application waives this requirement_ Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapt r 142 pf the General laws. By gnature of LicensedPlumber Title Type of License: Master (X Journeyman ❑ CitVyTown $ 3 2 2 APPROVE O O Ucense Number %Z" Watts 9D bfp on water line to water boiler j 2 Q W' J d I O� r O W Z O � ~ Z i p W O. 0. U W _ N Z_ N N W c 0 O Q .a O z m r � J J Z 0. O O W p. N O W U 1 U. O O. W. z a cc o cc LL. O LL 3 O _ J O W G1 F < U J w a W 0. LL uiN U W Y N 2 Q W' J d I O� r O W Z O � ~ Q i p W 0. W11 V I - , 6288 Date.. 1110-11 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This I certifies that .......... 1;VAIC—.5 ze cwwwD .......................................... ........................................ has permission to perform ... AP47� ... ..................................................... wiring in the building of ........ at ..... . . ...................................................... . North Andover, Mass. OXP-. ... A .... a ...... ........ 'Fee.....!� ...... Lic. No 3�7.Y.7F ............ ELEcrRICAL INSPECrOR V Check# go 1-7 //•� R� Bpygy�/ A. _-- official i%Use Only {,,,,,Ai1U/i1AllAI/BPd61.76 l�J ,�lld�'JBC'tNrlGi�f.� / 2—SPS ��-^/�� A F �J Pernut X10. t/(J� 210p )'14140 d (1� i18 aaluica� Occupancy and Fee Checked ^____•____ BOARD OF FIRE PREVENTION REGULATIONS IReev. 11199] (leave blank,) APPLICATION FOR PERMITI,^�TO�'� fl�tFOts 17-1�F�ll�`r ELECTRICAL WORK /ill work to be parformeel in accOtd-Ullce (IMEC), 527 CNIR 12-00 )t)ttkc: (PLE11SE PRINT IN iNK Olt' TY11E : ILL I,1�F'ORM. iT1 N) _Xa - City of "fit aldtl of: + 0 - -� To 11t� 1,►sl�ef to of 1'Y'il es: lay this app licatiotx tltt° undersigned !Ives t of n9 9s or h r intcnttoti to perform the electrical work described below. Location (Street & Number) � Owner or Tenant t— X_ Owner's Address `-----�"'� Is this pertnit III coltjunc II with a building pe+'ntit? �'cs ❑ ' f 11 ']din r vie,,", �- 1 It! dose 0 U! I, _ Existing Service - AIllps ----1*t'k$ New Service Amps _ ._.. r _...Voll$ Nuiltber of Feeders and Antpacile• Telephone No. No (ClICIA Appropriate Box) L)tllita Attihoriratiun No. Overhead LJOverheard ❑ Uudgrd ❑ No. of Melers Uudgrd ❑ No. of Meters No. of Recessed Fixtures No. of Ccil.-Susp. (Paddle) Fall. Fransformers Otte KV 1k Generators KNIA No. of lighting Outlets No, of Hol Tunas 11 Ill'- ❑ o. of Emergency Lighting No. of Lighting Fixtures S►t.', k rad. rnd, Batte Units No. of Receptacle Outlets N . of Oil Burners FIRE Al AI?AIS No. of Zones No. of election an No. of Switches No. of Gas Burners 11111lating Devices otal No, of Air Coll& Tons No. of Alerting Devices No. of Ranges eat PtlAup t utte r ous IMF— Of o ell- ortWiled No. of Waste Disposers Totals: Delection/Alerting Devices Spic e/A!'ea Healing iV ttnict a Local p• Other Connection No. of Dishwashers Healing Appliances IC�d R ecurlty ysicnns: No. of Devices or E 'uivaleut No. of Dryers NO, of 4Vater KW + o. o t o. of Sults Ballasts lista Wiring: No. of Devices or E uivaiettt Ilcatars __ Teleeoninnuldentions firing. No. Hydromassage Batlltubs No. of tllolars Total IIP No. of Devices or E uivalent �OTI•IE11: Attach additional detail if desired, or as required by the Inspector of wires. INSU11A.NCE COV 1.1,AGE: Unless waived by the owtrer, no Permit fur the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such covera is in force, and has exhibited proof of same tU the permit issuing office. CRECK.ONE: INSURANCE BOND ❑ OTHER Q (Specify:) uK%C&_iratn tante t p ) Estimated Value of Electrical Work-.t�J�•d c? (When required by municipal policy.) Work to Start: 21-•D5 ]nspections to be requested in accordance with NIEC Rule 10, and upon completion. ! c•ortify, fill drrr he lir-a�i`trj"s"�a,, d i enallies Of 111" r1,�,r the I„fr„•n,at'on on rlris altpiicnlivrr is hrre Attd COHrpit'!c_ rill+)) NAIIII;: � t ��i�5� /�/ ��� g .9 � � 1 __ LIC, NO.: /� (if applicable, anrer Address, OWNER'S INSU required by law. OwncrlAdent Signature Signature in the license fuunher .•INCE WA.iV%I2: 1 am aware thal the Ucemee dot's B%• illy signature below, I hereby waive this requircrttcnt. Telephone No. LIC, NO.: © / Bus. Tel. All. Tel. Na.: afar (save the liability insurance coverage: normally I am the (check onc) ❑ owner 0owucr's at rat. N & M Job number 1770% ,'' P Site: 3 y %' TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS 2 7 9nni Installer: TO V P U,4 T-X—� OIL,- Date Ir Date A. Bottom of Bed 0/ l . Excavation to proper depth % ` 2. With trenches, sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments: (Use back of sheet for diagrams.) Final Date: - Tel: 1_715 --6 /'5- -r Z'p3 Yes B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed , 3 Wall minimu 0= -to ac11, ty 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Inlet to tank cemented �-- 4. Slope minimum 0.01 or 1/8" per foot minimum a'-"-~- 5. Pipe properly set on compact firm base - 6. Pipe laid on continuous grade in straight line ! 7. Cleanouts precede all change in alignment and grade ✓� 8. Manholes at any 90° change 9. 10' minimum offset to water line ----- Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to w/in 6" of grade 5. Manholes over center and each tee 6. 3-20" manholes 7. Outlet line cemented 8. 2" - 3" drop from inlet to outlet K i-/ Y. Pipe set 10. Compact base with 6" of 3/4" crushed stone under tank 11. Tank is watertight 12. Tees 12" off side of tank No Initials N & M Job number 1770/ J� Date Comments: E. Pump Chamber 1. If separate from tank, compact base with 6" of stone 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole pres 9. Alarm in building on separate c' uit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -bo Comments: F. Distribution Box Yes No Initials 1. D -box level, 2. Minimum 0.1 T' (2") drop from inlet to outlet i 3. Minimum 6" sump 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe 1 9. First 2' from box laid level Comments: G. Soil Absorption system 1. All stone double -washed — 3/a" — 1 '/" �® -pea stone Bucket test done? 2. Minimum 2" of pea stone above distribution lines 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together 5. Toe of slope stops minimum 5' from edge of property; 5a. if not, then swale. Comments: N & M Job number 1770/ +� Date Yes No Initials H. Leach Trenches _ 1. Minimum 2 trenches 2. Length of trenches agre - ith plan. (Max. length�0�'""`� 3. Width of trenched ees with plan - Min' am`2'; in - 4'. 4. Vent preset t">50 feet or specifi 5. Minim Mance between ches 10' 6. Pi slope minimum .0 5 or 6" per 100' 7. Depth of trench elow outlet invert minimum of 6". 8. 1�jipes set on,stable base. Comments: I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipes 6' maximum 4. Pipes connected at end & vent end raised 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall betty en 12" and 48" wide 4. Apw s nholes on each pit -w 5�pes cemented with hydraulic ceme eo'6. Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 6. Grading meets 3:1 slope 7. Minimum of 9" of fill graded over system Project Request Record Town of North Andover Date: Client Id: ToNA Card Id: ToNA Client/Company Name: Boa of Health ` t{t,tr I}/, ,f, 114 { t tri r j/tr�[ r f Contact Name TMs +Sandra Starr Phone r 978 68&9540 t,,X}a trrrrdf } ! 1 f X r , rr trr'TT? r ,f ,,.. tf r rr; `r ,/F, Fax.'r 978 688-9542 �;, t rr, ft(rr +rt tT r =t, r a/ i. t1 Title Directory{ t{i ,f for Y}K , t +r{ ra, { rr'f tr r,fitrt r/!TK r 1 ,�fAddress { rrGf% /fit 127 Charles Street: sstarr@townofnorthandover r [ra{r .tX• ,, , d {l�.flr1(I ,fff frr ;itt }tNotes r f r ,,., .. r f , ! , F - r, - ,r rfTown rrr 1 .f r {, North Andover T:. 1 r ur FX ,.; +t t a/4� / ¢ft rrlr r r1 r rtHliu� dd){ill! Ni X I rr ! e }_ , r. t i r t F sI t - r t} 'r' t ! = it . rr t},, MA ' f,t Zip C6de 01845, Xr. r t ° t , r= r Xr ft r1r ,tr,a# X„rat/rlX rf ` rXState II((((,�f'sr�)t/f/.{{i° F 1 1 ! ,+1 : t,+X rr } ! • -. - tr -. + ltt +,tt' r° a / !K rOther contacts �f a lica�ble `ie Engine(Installer pp I{, "71;1 Ij,ifl;f ti+/(K) f j X =F +X 1 r i tF rX [}I lr� 'I ii ;FF j rf fry ( >f. , 11 1 j f i f} r j r r ,'_).!1 r� ryX- Xd J/d a ,,, t tfT� �aY� t,lf i9� t s Iry Phone ldK '^� r �X It �P f/Name ,XX q = r r f >d t{I td s/X a "IA 1 Tr Xrj- +: t X Title { X =+ X,r tr r dl+r 1, r Fax: i-.} t . G ,( 1 jL { fl •Elly' q#j X ,,,.[, rr JI(° { d t mail:e r , { r'yLa Ir,ftl}+t,3y1'',Ir/!1{ItdIJff'i /fA , 'Not �Wtp r1 r ,''r f1 f Ell f `TF'`,r'r{ill li/r/1%f�{ Xidr''tf ;t:fr { Lfr tlr 11fTpI:Whiff li %f} /Tf/T!'%ffi.r�f�lff�'rJP� t 1.... t F ! X , r -rr c d } -t ' - .; _ {State u, a;X, r. ,r , { Zip Code d. , t s=t:. t , a a, ,r 'Xt/ r { 7' t Proiect: Project Id: 1770 Project Title: Town of North Andover. Board of Health (JOB NO) (PROJECT NAME & STREET ADDRESS) Manager: NOW Billing Group: Billing Cod :Fixed Fee 34Q ,r r t Contract Info Project Description for each bilking group.1 ttBGl' f Applicant `'r :T/?'.� ,' `f S i'� / �' �� /� �', K {r ,rtil Assessors lylan'/©%'?- 'Lot' `,'� r, Street 3'S' ' Sy�.�i,.�;,. '577 „ 1=rr;:jtrfrr G'' T e of service 1=f C f yp f In {fi '�� r . S /� � "j'� Q `y'• r r / , ., . yT f K1Jff* r pd -, {r r (r K! f !{ r , { {( 1 1r , hT: - X , tX r., 1 , , . } y _ f+ rt Xr /rr /Il I{, "71;1 Ij,ifl;f ti+/(K) f j X =F +X 1 r i tF rX [}I lr� 'I ii ;FF j rf fry ( >f. , 11 1 j f i f} r j r r ,'_).!1 r r r : �, � r. , . `�' .„r>; ,t . , , rf 1 r 101. i Xr�v n •f r r Office(forms/jbrqutona a) cn fa Fj U- 4-- 0 v C Q 0 'H C �0 G O Q O O m O a L O a L i 42 i o E c 3 O ao - oca C O :Lj - F- C O_ s Q J E O O O C r � O 7 Cl) w c;z z o E o LU -i LL `� ui CL Ln Z 0 LA tA u < LLJ > 0 LL z -0 a 0 0 <p u 0 d m 4- 0 0 0 ce < LA C - or Q. 0 Ull CL < LA C 0 Q. 0 Ull LU LL. Z Nw. ad < ra z2F 0 m n. ce O bA 0 U 0 0 4. tA C: rz tA cz E 0 0 0. c 0 Ln L A E 0 G. cu (A (U U- 5-53' BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 6- LI G CURRENT INSTALLER'S LICENSE# LOCATION:9 LICENSED INSTA R: ��a�✓ SIGNATURE: �!'J TELEPHONE#17 ! �� ��✓� 0���� CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only ad-d--�a�` $75.00 Fee Attached? Yes No Foundation As -Built? Yes No F1oor_.Paans? /Yews No Approval Date: MAY - 4 2001 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at �� v�-..Q S relative to the application of–led-4 dated y for plans by i I, drL'i/",r_A\, and dated with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Septic Installer Date: '�-- —a Disposal Works Construction Permit # 1 Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr' Health Director November 9, 2000 Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: 399 Summer Street Dear Bill: Telephone (978) 688-9540 Fax (978) 688-9542 This letter is to notify you that the following variances have been granted for the site at 399 Summer Street. • Distance to wetlands from 100 feet to no less than 50 feet of a leach system to the wetlands • Separation of bottom of a leach area to groundwater from 4 feet to 3 feet Please note that with this second variance (separation to groundwater) that no additional rooms will be added to the dwelling unless it is tied into sewer. The Board of Health requires that a deed restriction be placed on the deed with a copy to the Board of Health before a COC can be issued. With these variances the plans for the septic repair dated 11/1/00 are approved. If you have any questions, please feel free to contact this office. Sincerely, Sandra Starr, R.S.,C.H.O. Health Director cc: Steigerwald BOARD OF APPEALS 688-9541 BUILDIINTG 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANT N -G 688-9535 TOWN OF NORTH ANDOVER BOA" OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 O6tt�eo M1°t'NO Sandra Starr, R.S., C.H.O. c? '_y+ 0. Telephone (978) 688-9540 Health Director * FAX (978) 688-9542 October 25, 2000 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 Re: 399 Summer Street Dear Bill: This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as followed: , �( 1. Legal boundaries not defined as required by 310 CMR 15.220(4)(a). Westerly boundary is omitted altogether. 2. Setback to wetland from the leaching facility appears to be less than the minimum requirement of 100 feet as per 310 CMR 15.211. Local Upgrade Approval has not been requested on the plan. 3. Minimum cover of 9 inches over septic tank is not specified as required by 310 CMR C, 228(1). rr19 4. Perc test not located on plan as required by 310 CMR 15.220(4)(i). 5. Elevation of perc test not provided as required by NA 8.02 n. 6. Groundwater separation not adjusted to the highest existing grade as required by 310 CMR 15.240 (1). If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Steigerwald file SEPTIC PLAN SUBMIT'T'AL FORM LOCATION: 77 Srotwda-e-t^ S/ NEW PLANS: YES REVISED PLANS: (fT �S SITE EVALUATION FORMS INCLUDED; DATE: $125.00/Plaia $ 60.00/Plan 1U YES DESIGN ENGINEER:�1-�- DATE TO CONSbLTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to snail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. Oct - 1 23-00 08:07A Paul D. Turbide, PE/PLS I October 20, 2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 978-465-0313 P.02 RE: Title V review for SDS upgrade at 399 Summer Street Dear Sandra, Enclosed find our review of the "Checklist for North Andover Septic System Plans" for the septic system upgrade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. o Legal boundaries not defined as required by 310 CMR 15.220(4)(a). Westerly boundary is omitted altogether. o Setback to wetland from the leaching facility appears to be less than the minimum requirement of 100 feet as per 310 CMR 15.211. Local Upgrade Approval has not been requested on the plan. u Minimum cover of 9 inches over septic tank is not specified as required by 310 CMR 228 (1). i Deep observation holes are not located within the proposed disposal area as required by 310 CMR 15.102 (2). o Perc test not located on plan as required by 310 CMR 15.220 (4) (i). o Elevation of perc test not provided as required by NA 8.02 n. o Groundwater seperation not adjusted to the highest existing grade as required by 310 CMR 15.240 (1). If you have any questions or comments please feel free to contact me. ,Sincerely PORTPaul D. Turbide, PEIPLS ENGINEERING, Civil Engineers & Land Surveyors Otte Harris Street Newburyporl, MA 01959 (9^8)465-8594 VServer MAHH\P28841Summer St 399DOC Oct -23-00 08:07A Paul D. Turbide, PE/PLS 978-465-0313 P.01 Facsimile Cover Sheet To: SANDRA STARR Company: NORTH ANDOVER BOH Phone: 978-688-9540 Fax: 978-688-9542 From: Paul D. Turbide, RUP.L.S., President Company: Port Engineering Associates, Inc. Phone: (978) 465-8594 Fax: (978) 465-0313 Date October 20, 2000 Pages Including This Cover Page: 2 Comments: Sandy, I have attached our review of the SDS upgrade at 399 Summer Street. Thanks, Paul D. Turbide, P.E./P.L.S. Page 1 of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving AuthoriVBoard of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310• CNI R 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: JAK-c 1 (moi ,TLrK-e1ZWALn Address: Ito 0"tj71wW0 C'S" tz Phone #: Lrfr,� - -?q7-;5 Address of facility: 319 17ut- 91f- 471FkOaT 2) Applicant (if different from above) Name: ���,� Address: Phone #: 3) Type of Facility: ✓ Residential Commercial School h i C- 17 j ti Institutional 4) Type of Existing System: _privy cesspool(s) other(describe) Page 2 of 5 ..."/Conventional system Type of soil absorption system (trenches, chambers, pits, etc.) ' r " 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system u uVL*w j#J gpd Approved: _yes Approval date: no Why: b) Design flow of proposed upgraded system ±&& gpd Why c) Design flow of facility _440_gpd 6) Proposed upgrade of existing system is: a) b Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: c) Which of the following are applicable to the proposed upgrade? &n__ Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) AA Percolation rate of 30-60 minutes per inch (state actual perc rate) Af4 Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) ✓ Relocation of water supply well (identify well, describe relocation) l �hTI826 Nk" MeigZ Ls4TEC ft Me--LCCA-wN ern &1p-- a- "10,C I M 11n.4 "i= Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) U-' J o �,' �y p1 P-1 Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater '27 feet As determined by: Evaluator's name: �5A0K i `7T—AW-Z- Evaluator's Signature: Date of evaluation: 7-41-ct> 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. Page 4 of 5 List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: ( Uc L e'er" aieu'�SCC l.JO JLP lzef1 LT jam. b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. DA c) A shared system is not feasible. d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes L//no Page 5 of 5 11) 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 knowing violations." g v Facility Owners Signature m --t- �( i6 CLst�d�I�li Print Name Vl l� K-4mat2 —,f" Ic,--- I-7-d;V Name of Preparer Date (2A Vz e Telephone No. & Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. Location: �/ /, ? Owner's Name: Map/Parcel: �%rb,_ ^t 0 — Address: /Z0 A7 Installer. Tel New MSG) Repair V Date: -J-6 'ctiWetlands 1 %4.� Zone II '� Soil Symbols _Soil 1Qame Soil Class Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Te=ture Soil Color Soil Mottling % Gravel, Stones, etc: I Z Ars� 119-10 q(,j T� 1W- �1vw��u� Parent Material Depth to Bedrock- ""' Standing Nater in the Hole..C—weeping from Pit Face `Z0L $$HG',V; �! <, X66 t, � � �- sr 7-% �e! 77,-1 G, �.� . Y4/3 µ (OL �, s AI,. I ] I -- ParentMaterial L Depth to Bedrock Standing water in the Hole- = Nveepingfrom Pit Face --? 3 4 ESHGtiv: O " ALU - Observation Hole r 19—( Dept] Start Time Time Time Time Rate Percolation Tests Performed B} • ��, jQ4fAy-qkf,Witnessed By: ,AORTil Ar CHUS Applican Site Loca Referenc Town of North Andover, Massachusetts BOARD OF HEALTH DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Form No. 2 19 - Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee �14::zr CHAIRMAN, BOARD OF HEALTH Site System Permit No. -IIS-6 SEPTIC PLAN SUBMITTAL FORM LOCATION: ` �u v►tiw�.Cy� S�''-� NEW PLANS: $125.00/plan 1-75-2 REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORINTS INCLUDED: DATE: 10 / 7--ez7 DESIGN ENGINEER: DATE TO CONSULTANT: PS NO *If you want your plana expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL: merreng@aol.com TO: North Andover Board of Health FROM: Bill Dufresne/Merrimack Engineering DATE: 1,9 17 RE: —�q I �4v-4 TM: 0-7 A TL: %-b OWNER (NAME & ADDRESS) Members of the Board: -- - 120 ?/KK 14 Tiw vo0 G -I w-ZL wa;FA- -A r-iVoVey-7 An upgrade sewage disposal system plan dated:.AuC. • 2v ! 2� has been submitted for the above referenced site. Pursuant to Title 5, and the North Andover Board of Health Regulations, Local upgrade approval and/or variances are being sought from the following sections. I) 1 • Za{ (fes bui.L 0&5&1- -'t`O c, r q -10�� 2) � �' Fn6L1 jyST' H 1-0 WgrLtnlr I &&I � 70' 3) Please consider these requests for approval on your earliest available meeting agenda. We respectfully request your consideration of these matters. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne cd iii r OC10 NNi ==,-Ci ^, i ICN ---- 7--07-1 701 ONl Gam: i, C i iM� ,— _ • c� r. I i lb I i NI : - T _ n-7 0 Commonwealth of Massachusetts City/Town of RECEIVEp System Pumping Record Form 4 E" ��a 3 0 Z O 11 �M DEP has provided this form for use by local Boards of Health. Other f MftgFbMpsp information must be substantially the same as that provided here. Bef ►N=m—usn—e=nitted �ith your local Board of Health to determine the form they use. The System Pumping Record to the local Board of Health or other approving authority. A. Facility Information 1. Systerp Location' eft n of hous right front of house, left side of house, right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. 1�13 City/Town 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date ,Cesspool(s) S� State Zip Code States 3E ^ , � e Telephone Number �( �l 2. Quantity Pumped Septic Tank M Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi on ��ste�� 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Lo _ re contents were disposed: G.L.S.D. ovtell Waste Wafter t5form4.doc• 06/03 F5821 Vehicle License Number Date System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 M yV• `' t1ov 20 200 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT f DEP has provided this form *for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck ��t9 Svvvi�✓ Sfir+e.�'�' AdPress dUUr4 6nLUe,f Cityrrown 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record I. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): (t- I0_,2 Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes 1 No 5. Condition of System: N'3fvt-Cl .Lev"t � . t 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: G .LAS, } k ,Lowell Waste Water State Zip Code State t35 x135 Telephone Number Zip Code 2. Quantity Pumped: 1570 C) Gallons [Septic Tank ❑ Tight Tank If yes, was it cleaned? ❑ Yes D/No F5821 Vehicle License Number 1t -1o'\2 Date t5form4.doc• 06103 System Pumping Record •Page 1 of 1 Commonwealth of Massachusetts RECEI D City/Town of APR 1 5 2009 a System Pumping Record RTH Form 4 T�HEA�TH DEPARTM NTER Important: When filling out forms on the computer, use only the tab key to move your. cursor - do not use the return key. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front, left rear, left side of hous . Rig t front 'ght rear, right 462;ho . Address City/Town State 2. System Owner: � r Name Address (if different from location) City/Town B. Pumping Record L4—(—Aoc� 1. Date of Pumping 3. Type of system: 8 Date Cesspool(s) Zip Code State. /` y dip ode Telephone Number (O jVc — 2. Quantity Pumped eptic Tank Gallons Tight Tank Lj Other (describe): 4. Effluent Tee Filter present? Yes Ij" No If yes, was it cleaned? Yes No 5. Conditio of System: �%�jc Z>ti k ) v, 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio re contents were disposed: �. L. Lowell Waste Water Of F 5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 1 Commonwealth. of Massachusetts City%Town of IVSystem Pumping Record Form 4 DEP has provided this form for use by local Boards of Health.. be submitted to the ocai Board of Health or other approving a A. Facility Information Important: When filling out 1. SyStem OC8t10 forms on the Cw computer, use only the tab key Address�� to move your cursor - do not use theretum City/Town State key. 2. System Owner Name Andress (if different from: location) E"'C"i-'E.IVE'®. MAY 0 1 2007 e System Pumping Rec ori ty )Rl h ANDOVER FltA:rH DEPARTMENT Zip Code must TOWN OF /�' SYSTEM PUMPING RECO DATE: C t—ars -Os-- SYSTEM OWNER & ADDRESS DATE OF PUMPING: RECEIVED DEC 0 2 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM LOCATION (example: left front of house) Vvu 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 FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED To: G.L.S.D Lowell Waste TOWN OF SYSTEM PUMPING RECORD DATE: C1 SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house)---""""~� DATE OF PUMPING: — QUANTITY PUMPED :C� C� GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE—Z EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (FMLAIl) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: J CONTENTS TRANSFERRED TO: 31� /-. r-IUL PIdII 3. Fee of $275.00 per lot for new construction., and two percolation tests required for each I repairs or upgrades. I GENERAL INFORMATION 1 . Only Certified Soil Evaluators may perfo 2. Only Mass. Registered Sanitarians and I plans. 3. At least two deep holes and two percola- disposal area. 4. Repairs require at least two deep holes discretion of the BOH representative. 5. Full payment will be required for all addii 6. Within 45 days of testing, a scaled plan the Board of Health showing the locatior 7. Within 60 days of testing soil evaluation YV) 40 '•: ( SII � 6 Y r fl < I S _ J „..i - �� •`tii«I'A" ..-.. '.:.w"wYY '?" ,. � wy; '. ..,..as-,.�-_ex+,,..,+�.i"^'. � 8z �.�°^a^'nTt`."`*�"i. "'�.:.. "'�p'Y'p."'.rN+l@�"fi%f �.� Town of North Andover, Massachusetts Form No. 1 CHAIRMAN, BOARD OF HEALTH Fee—$'73- Test No. 763 S.S. Permit No.-D.W.C. No._______C.C. Date-Plbg. Permit No. E D I— Applican Site Location 1. -�" Engineer— Town of North Andover, Massachusetts Form No.1 BOARD OF HEALTH C;2cr— �0 19 APPLICATION FOR SITE TESTING/INSPECTION VIE tj ADDRESS L"('W'Vq vv� Test/Inspection Date and Time Fee2?S 61 /ADDRESS TELEPHONE 7 CHAIRMAN, BOARD OF HEALTH C? ( -.� Test No. / "- — ) S.S. Permit No.— D.W.C. No. . C.C. Date—Plbg. Permit No At 1 BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: LOCATION OF SOIL TESTS: Assessor's map & parcel number. OWNER: I�. J —'.0 GIC t,v 'lX TEL. NO.: 6t:i—'N'T', ADDRESS: ENGINEER:1fimL-L4j&r2caygr,Aj�TEL. NO.: CERTIFIED SOIL EVALUATOR: _w Q0 M&;,r5�4J4, Ilnten d us of land: residential subdivision, single family home, commercial Re it test' g Undeveloped lot testing N. A. onservation Commission Approval: 1�1,5Gc �--NL�dS � !rv'J w" W1 c COA�iYz� THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 1275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1'-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing,soil evaluation forms shall be submitted. lay= NLW"O[AX I � v SSI !M cit Alt qu a 1M 1 •;1 7:6 ato1 "a1` w� 1e 1 a 101 3.1e 1 ale 1 Z6 68 r 86 L 8 16 >• re 1 P ONZS W b v i sit BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 6' 1 w° LOCATION OF SOIL TESTS: Assessor's map & parcel number. OWNER: 1�. ,,I kc, o c11 -6I6+' w TEL. NO.: ADDRESS:_ IV �-,Iftml&c ENGINEER: ,� tf1mjgL0&t2(#,1MjAj�TEL. NO.:__�l 5 �o CERTIFIED SOIL EVALUATOR: RIL't, go IMen d us of land: residential subdivision, single family home, commercial Re it test' g Undeveloped lot testing N. A. onservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 1275.00 per lot forear v construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testinq�soil evaluation forms shall be submitted. 221 t w 'J/ c.' 2uu 197 175 '"� 41W low 41 •�'• /j' 177 `�' 199 441•, 41S1S2 '�. 198 178 18S 1 Ml 41571 / 4012 1►S ti5i 41662 ►61 W 179 IIS' 4RSw �� 40M / 184 'fh 141' Yr„ 41111 18041671 r. 1 62 4a6_TI 17U 415 1 44.940 \ 163 181 44.+0° 183 152 � r ' `• • 182 / 1 r,tt 3&611 �q1S 173 151 164 % V ;� 138 . 220 1{211 �l \` l / 167 21 \ 166 w 000 153 21 !� \�4 M.JMbaf Y' 80 gape i ,S • 44 Tt 1 79 21 /y. 213 16S M 1n 41R2s1 , 71 214 44-260 78 41646 y �� 51117 215 44.1 1 72 21 h �! 2h I�OIOaf l 73 41.O�f 81 74 141 77 82 SQ%w Aw 75 83 %end 4`ng 142 S4 76 \95 59 M�O6 47.mOd r 45;010 1 41ac ^� 85 4a soo<r ��ys 48 0."1 86 219ac 141 43 o0od ,d{i 29 87 $1.10440009f IOU p 140 88 53 . 24 47 SOOcf ti163 ac d 44 10 ac 56 23 45 sl5ac szm :f 1 041K ` 91 8 7 98 92 Icy 89 1.01: 191 ac LO1 at Lot r 101 x i 1.01 ac „r I1W I92 146 ac 126, 219' lU1W.gUiJ SIRMf D2 COMMONWEALTH OF MASSACHUSETTS EXECUTAT OFFICE OF ENVIRONMENTAL AFFAIRS E �o ONE 1 BOSTON MA 02108 ii ARGEO PAUL CELLUCCI Governor 0-- TRUDY COXE si DAVID B. STRUHS Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEI II 19SPECTION FORIII PART A CER I RCATION Property Address: 399 Summer Street, North Andover Name of Owner: Jacob Steigerwald Address of Owner: 399 Summer Street, North Andover, MA. 01845 Date of Inspection: 5/27/2000 Name of Inspector: Neil J. Bateson I am a DEP approved system inspector pursuant to Section 95.340 of Title 5 (310 CMR 15.000) Company Name: Bateson Enterprises Inc. Mailing Address: 111 Argilla Road Andover, MA 01810 Telephone Number. ( 978 ) 475-4786 CERTIFICATION STATEMENT certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority "fta Inspector's Signature: Date: 5127/2000 The System Inspector shhis inspection report to the Approving Authority (Board of Health or DEP)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. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5127/2000 INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or move system components as described in the'Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than fou times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 912198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 399 Summer Street, North Andover Owner. Steigerwald Date of Inspection: 5127/2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water. Cesspool or privy is within 50 feet of a bordering vegetated wetland or a saR marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH AND PUBLIC WATER SUPPLIER, IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 912/98 1Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: _X I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _X Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X Any portion of a cesspool or privy is less -than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS - You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area @ IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 912198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 399 Summer Street, North Andover Owner: Steigerwald Data of Inspection: 5/2712000 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _X Pumping information was provided by the owner, occupant, or Board of Health. _X_ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water'have not been introduced into the system recently or as part of this inspection. _X As built plans have been obtained and examined. Note if they are not available with NIA. _X The facility or dwelling was inspected for signs of sewage back-up. _X_ The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. _X All system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X Existing information. For example, Plan at B.O.H. _X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [I 5.302(3)(b)] _X_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 FLOW CONDITIONS RESIDENTIAL: Design flow _ 150_ .g.p.d./bedroom. Number of bedrooms (design):_ 4_ Number of bedrooms (actual-4— Total actual4_Total DESIGN flow _600 _ Number of current residents: Garbage grinder (yes or no): _No _ Laundry (separate system) (yes or no):_ No If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):_ No_ Water meter readings. March 98 to March 00 = 29,100 ft' x 7.5 = 218,250 gals. / 730 days = 299 gals. 1 day Sump Pump (yes or no): _ yes_ Last date of occupancy: Current COMM ERCIALIINDUSTRIAL: Type of establishment: Design flow: gpdd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) _ Non -sanitary waste discharged to the Title 5 system: Water meter readings, if available: Last date of occupancy: OTHER. (Describe) Last date of occupancy. (yes or no) GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped March 2000, owner System pumped as part of inspection: (yes or no) No _ If yes, volume pumped: Jgallons Reason for pumping: TYPE OF SYSTEM _X_ Septic tankldistribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: House 30 years old, tank original. D -Box & Field was replaced July 6, 1981. Info at B.O.H. Sewage odors detected when arriving at the site: (yes or no) - No - revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/2712000 BUILDING SEWER: X (Locate on site plan) Depth below grade: 16" Material of construction: _X cast iron _X 40 PVC _ other (explain) Distance from private water supply well or suction line: Diameter :4" Comments: 4" cast iron thru wall. 3" PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade: 4" Material of construction_X concrete _metal _Fiberglass _Polyethylene _other (explain) If tank is metal, list age Is age confirmed by Certificate of Compliance _ (Yes/No) Dimensions: 7' x 5'x 4' Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness:0 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 dimensions were determined: Subtract scum & sludge depths to baffle length. Comments: Inlet & outlet baffle ok. Water at outlet invert. No evidence of leakage. GREASE TRAP: None (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: In Comments: revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 TIGHT OR HOLDING TANK: _None (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction: concrete _ metal _Fiberglass Polyethylene_other(explain) Dimensions: Capacity:allons Design flow:_gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No Date of previous pumping: Comments: DISTRIBUTION BOX.:_X_ (locate on site plan) Depth of liquid level above outlet invert: 8" Comments: D -box level & distribution equal. Water 8" above all outlet inverts. Evidence of carryover. No leakage. PUMP CHAMBER: —None, gravity system_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: !Revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued)) Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, if possible; excavation not required, location may be approximated by norAntrusive methods) If not located, explain: leaching pits, number leaching chambers, number: leaching galleries, number leaching trenches, number, length: leaching fields, number, dimensions: 1 field 20' x 40' overflow cesspool, number. Altemative system: Name of Technology: Comments: Soil mushy on outboard side of leach area by road. Signs of hydraulic failure, water above all inverts out of d -box. CESSPOOLS: None (locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: PRIVY: None (locate on site pian) Materials of construction: Dimensions: Depth of solids: Comments: revised 912198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 399 Summer Street, ''.North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) A to i = 26'6" Ato2=28' A to D -Box = 27' BtoI=28' Bto2=28'8" B to D -Box = 46'6" revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 0 to 1.5 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _X Observed Site (Abutting property, observation hole, basement sump etc.) —X—Determined from local conditions —X—Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers _X Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Essex County Soil Map., Sheet # 36. Ridgebury soil. Water 0 to 1.5' deep. revised 912198 Page 11 of 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service I 1 I Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 399 Summer Street, North Andover Owner: Steigerwald Date of Inspection: 5/27/2000 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. V\\ ' ' &Ii�� idBateson Bateson Enterprises, Inc. Connnionweldth of Massachusetts `'�MassachuscUs System Pumping Record System Owner System Location (?q 5v vA Date of Pumping: `3--6 �� Cesspool: No 1.4—' Yes L:J Quantity Pumped: la-elgallons Septic Tank: No Yes l�J System Pumped by: Fetre-10a Sra,'C t aed License # Contents transrerrred to : Greater Lawrence Sanitary District Date: Inspector: e Sto I Jlilt Q iINi= i= TIN .- J N/W .2/ IM i • J' i� a pWWW?o �o ct Li� W ' •. Cial WR y oh av j Q �QOJ���J kv In I%j VI LU -4 �, if 99 > NJ Lu q6 uVI 19 zz T o fQQ Ar Qr tj3Y� a V, s to -Ij VN \9 VI 01 V� -Ij W Ls I l� !LLEtJ APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application f a permit fo a sewage.disposal installation at % r v '/' T 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 of b— - 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 lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these, pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel -or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single 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. DATES'/ r Si tune of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE +/ 7 Sig ature ofyHealth Agent I have inspected the uncovered system indicated above and find everything done as describe . DATE Signature of InApecting Officer Percolation Test Garbage Grinder BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 7 2 Ff 70 ? .6 23 Ze 1. NAME - Y / �-E-./ / DATE 2. ADDRESS 90 LOT NO. 22— TEL. 170 3. NO. OF BEDROOMS , DEN YES NO 4. GARBAGE GRINDER _ YES NO 5. SHOW DIMENSIONS OF HOUSE ��e�l 12-,2- 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL A 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE n ��n� �oy 77�d NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE 5./17411 NAME OF APPLICANT George Farr SvYn mer S LOCATION Lot #22' Emumgm Address of lot no, BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay X Gravel Sand PERCOLATION TEST 7 minutes per inch, MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1.000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipes a William J, Dr s oll, Engineer Board of Healt TOWN OF 1y SYSTEM Pv DATE: G RECORD SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: 2. 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 FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.Dy Lowell Waste