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HomeMy WebLinkAboutMiscellaneous - 41 CHERISE CIRCLE 4/30/2018 41 CHERISE CIRCLE i 210/061.0-0101-0000.0 \1 1 4 � 1 Town of North Andover, Massachusetts Form No. 1 NORTil q BOARD OF HEALTH O SLED 16 ti °0 19� o APPLICATION FOR SITE TESTING/INSPECTION SS CRUS �y Applicant `�Q�► NAME ADDRESS —�— TELEPHONE Site Location 1 ........ !�— Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time T ��,6 CHAIRMAN,BOARD OF HEALTH Fee ksp � Test No. L'1�6 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 4- MAP # LOT #__ ______.__. PARCEL # STREET_ I& ?__. �����..... CON,STRUCTI_QN__.APPROVAL HAS PLAN REVIEW FEE BEEN PAID? �y YES NO PLAN APPROVAL: DATE fill APP. BY_„�/"' __ ..__._._.. DESIGNER: 1i157���/l/5c�/�/ PLAN DATE,- 7- CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT --. _ DRILLER,_....__.._.__.__....._.._...._......_._. _.. .. WELL TESTS: CHEMICAL DA I E OPPROVED..._. BA IA I DA I E OPPRUVED BACTERIA I DATE AFPFtUVEll COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED 9/'^ - 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: DATE: BY: � '�3 }, `1_ ., �E.�G�SY�.�.��.NSIfl4�.A.�:.CIQ.�I � _ . , • � ;:r• - y"� •'.�.'.' ��'. r ..'_', tiA..•a}-: J .':.J ,.. i -"r -. �..?';...�c,A .,Kr ��-•.� =+•t'rAw. i���• J �,_'u �: _ - ,,. IS THE INSTALLER LICENSED? =t TYPE. OF CONSTRUCTION: �� t NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NO CONDITIONS OF..APPROVAL.,. YES NO (FROM FORM U) r -ISSUANCE OF DWC PERMIT . ` s NO :DWC PERMIT- NO. INSTALLER: T%m _ BEGIN INSPECTION ,EXCAVATION .INSPECTION: ; NEEDED: r. 'a' , T •, •. ' tr•. IV ., PASSED . .. .: ._. . . BY :.:CONSTRUCTION INSPECTION= NEEDED: AS BUILT PLAN SATISFACTORY: YES: 11 APPROVAL. TO BACKFILL: DATE: Zg�--' '` BY -� 1' r' ,.FINAL . GRADING APPROVAL: DATE -BY FINAL FINAL CONSTRUCTION APPROVAL: DATE: n/j ` BY r -."•�. __ VAS- MAP # AppRO _ NU ELCONSTRUCTION_._.._ YES ARC . BEEN PAID /a 9' App- B 7/1Z_��h� N AS PLAN REV IE DATE PLAN D LAN AppRSVAL� 1 r P (J DESIGNER: CONDITIONS • WN LER._..._._----`-"`-.------ DR AtiE A`�pRUVLD._- -� SUPPLY • D - WATER MICAL cart c��,NRuv�v WELL PERMIT CNE I u ,p�tU L TESTS`— BAC.jERip I DACE A�= WEL- - RIA I BACTE . COMMENTS• • •. E5/ NU AF,PROV A�- T D •. App ROV AL: � BY "_�.."__"._-_—_ FORM U SUED �0 DATE IS CONDITIONS' yE5 NU Y Eg tdU YE5 NU ApQROVA�- S PAID AppROVAl- AppvjUVAl- YES F IZyAL ALL P CRONg-[RUCT GO S T RUCT I ON NU WEpTIC `',,STEM YES S -'- NEEDED ANY .VARIANCE HEALTH APPROVAL F IMAs" BOARD �F /Tri4 9E �/� raHE' INSTALLER LIC a F�ENSED? '= t':w;�' ±' YES NO . OF CONSTRUCTION: ; J NEW REPAIR' -.NEW CONSTRUCTION: ..,. CERTIFIED PLOT PLAN REVIEW_ YES NO s > CONDITIONS OF..APPROVAL YES NO ✓'�� �.f..- (FROM FORM U) t. ., —ISSUANCE DWCYPERMIT -` YES NO - 1YDWC PERMITN0. INSTALLER: BEGIN INSPECTION YES N0: � \ EXCAVATION ,INSPECTION: ; NEEDED: 4•,• Y LTJ. •1.'•,- _ F.i. • T` _r .. ... .`_..� :. C' ;PASSED .BY ;CONSTRUCTION INSPECTIONS NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: HY " .FINAL. GRADING APPROVAL: DATE HY _ .FINAL CONSTRUCTION APPROVAL: DATE: BY COMMONWEALTH OF MASSACHUSETTS ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 7 U DEPARTMENT OF ENVIRONMENTAL PROTECTIONaRTH !0-' A BOARD OF HEAL " F Y� jUL 3 1 2002 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 41 Cherise Circle_ _North Andover_ Owner's Name:_Kathleen O'Brien_ Owner's Address:_41 Cherise Circle- -North ircle__North Andover,MA 01845_ Date of Inspection:_7/26/2002_ Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc.— Mailing Address:—111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)475-4786_ 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: _7/26/2002_ 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: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection:_7/26/2002_ 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: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection:_7/26/2002_ 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 1 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: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection:_7/26/2002 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No T _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 less than'h 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. —No7 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 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: 41 Cherise Circle_ _North Andover— Owner: O'Brien_ Date of Inspection: 7/26/2002_ 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.For example,a plan at the Board of Health. 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: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection:_7/26/2002_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_660 Number of current residents: Does residence have a garbage grinder(yes or no): No_ Is laundry on a separate sewage 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:_Aug.00 to Jul.02=16,700 Ft3 x 7.5=125,250 Gals./730 Days=172 Gal./Day_ Sump pump(yes or no):_No_ Last date of occupancy:_Current COMMERCIAL/1NDUSTRIAL 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 last year,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500Jgallons--How was quantity pumped determined?_Measured tank Reason for pumping:_Inspect tank&tees. 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:_7 years old. 12/07/1995. As built plan. Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:�41 Cherise Circle_ _North Andover — Owner: O'Brien Date of Inspection:_7/26/2002_ BUILDING SEWER(locate on site plan)X Depth below grade: 22" Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"PVC thru garage floor.4"PVC to septic tank.3"PVC in house.No leaks._ SEPTIC TANK: X locate on site plan) Depth below grade:_10" 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: 3" 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:_19" How were dimensions determined:_Subtract scum&sludge depth to tee 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 tee ok.Outlet tee 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:_41 Cherise Circle_ North Andover— Owner: O'Brien Date of Inspection:_7/26/2002 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:_0_ 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.Evidence of carryover,pumped d-bog to clean.No evidence of leakage.D-bog cover broken,replaced same._ PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection: 7/26/2002_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: _X_leaching trenches,number,length:_4 trenches 62'long_ leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, _Soil oL Vegetation oL No sign of ponding to surface. CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate 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(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection:_7/26/2002 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. D-Boz Porch SeptiTank B Driveway House 62' Water M ter C Driveway A to Tank=54' B to Tank=13' B to D-Boz=57'8" C to D-Boz=75'6" Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 Cherise Circle_ _North Andover— Owner: O'Brien Date of Inspection: 7/26/2002_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 feet 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:_7/27/1995_ 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: As per revised 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: 41 Cherise Circle, North Andover Owner: O'Brien Date of Inspection: 7/26/2002 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 J. Bateson Bateson Enterprises, Inc. Town of North Andover of NORTH 1 OFFICE OF 3a ,�`"e °• °a� COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street North Andover Massachusetts 01845 So" '.o 5 x WILLIAM J.SCOTT SAC US Director August 2, 1996 To whom it may concern: To date there has been no certificate of compliance issued for the septic system located at 41 heris circl , No r. Sandra Starr Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FORM U - LOT 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. ****************Applicant fills out this section****************** APPLICANT: C� COIJ 1 C1 Phone Y,-7y 6 02 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street L/ 'C� C( � St. Number ************************Official Use Only************************ RECO NDATIONS OF TOWN AGENTS:-:—:E / Date Approved D Conservation Adm'nistrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected 74AAb Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date NORTH Andover 'Town of �� 6 o , .;.: `G�'•Fr 4 No. 9 7 o - ._ �A Tor dover, Mass.,(3 It 19Rg COC HIC HE WICK ADRATE BOARD OF HEALTH PER MIT T D 41111 w Food/Kitchen Septic Systemdj 7L 1 BUILDING INSPECTOR Cry THIS CERTIFIES THAT...h/d -> ...crr5�.. . �+........................................................................................... Foundatio �C1Z� has permission to erect...................F ?!�!! ,.... buildings o. .-4.(..... ............................ n . . ..... ...........................toug t0 be OCCUPIed aS ! -..��4A�1►ner .... / Ylv��.C�,........ �.................................. Ein mne provided that the person accepting thisit shall in every re'spect cdnform to the terms of the application on file in P y 9 P P A FDU A IA96 l this office, and to the provisions of the Codes and By-Laws relating to the Ins eC o of � Buildings in the Town of North Andover. REGULATED BY PARA. 114.8-S. B.C. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 4 y PERMIT EXPIRES 6 MO FEE PAID��=___ `�4�t�_ &-b _ ELECT CAL INSP T UNLESS CONS Uz O 9-4.Gbjz,S !� ,� PERMIT FOR FRAME/BUILDING � ..... ..... .. . BUILDING INSPECTOR Cr, DATE. a l FEE PAID' i'W • Occupancy Permit Required to Occupy Building GAS INSP OR Rough ��� O ( O Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. _ J ✓ Burner b` � � ��e ' PLANNING FINAL CONSERVATION F �� Street No.`�LJ°��[/4�i-410 , ,��LL Smoke Det. .S'p SEWER/WATER FINAL p fi� �RIVEWAY ENTRY PERMIT �7n 14 , PA1,5k _AA 4.4 Town of North Andover, Massachusetts Form No.2 NORTh BOARD OF HEALTH 19 y i w 9 i 4 DESIGN APPROVAL FOR SSACHUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant bojv� Test No. : Site Location l-Ort' q jjk-� & A� Reference Plans and Specs. �� 1J1�k ��--�`-�* °� �Q_A,QA ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRM ,BOARD OF HEAL FeeSite System Permit No. /3 P— PLAN REVIEW CHECKLIST ) ADDRESS-/,,2-9 y 9 �l/��.e�st� C�/,e«CG-ENGINEER (211z1 j r14w6&/y GENERAL / 3 COPIES STAMP C/ LOCUS t/ NORTH ARROW SCALE � ,/e CONTOURS �� PROFILED/ SECTION BENCHMARK IL SOIL & PERC INFO �/� ELEVATIONS WETS. DISCLAIMER L-/ WELLS & WETLANDS Q,—WATERSHED? DRIVEWAY B ev) WATER LINE FDN DRAIN_( SCH40_jZ TESTS CURRENT? Lll SEPTIC TANK MIN 1500G t/ . 17 INVERT DROP -'�/ GARB. GRINDER(+200% EDF) 25 ' TO CELLAR ✓ MANHOLE TO GRADE ELEV ---� GW --- D-BOX W ----D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET ,' y.LS- OUTLET lam = r 17 (2" OR . 17 FT) TEE REQ'D?-Ab- LEACHING MIN 660 GPD? RESERVE AREA L/4 ' FROM PRIMARY? 6,---/2% SLOPE 100 ' TO WETLANDS L/ 100 ' TO WELLS /--� 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS ,, 325 ' TO SURFACE H2O SUPP Y 4 ' PERM. SOIL BELOW FACILITY �- MIN 12" COVER �� FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET? %-� � TRENCHES MIN 660 gpd SLOPE (min . 005 or 611/1001 ) >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright @ 1993 by S.L.Starr ,koRTN BOARD OF HEALTH • t ^ i 120 MAIN STREET TEL. 682-6483 �9SsICMUSEtth NORTH ANDOVER, MASS. 01845 Ext23 May 11, 1994 Christiansen & Sergi 160 Summer Street Haverhill, MA Re: Lots #3-9 White Birch II Dear Phil: I have briefly looked at these plans and find that most of them do not have sufficient test holes in the system. In addition, there will be changes in light of the testing done today. Would you please review these plans keeping in mind the criteria I recently sent you, add the new tests and re-submit the designs. Sincerely, Sandra Starr, R.S . Health Administrator cc: Karen Nelson, Director, Planning & Comm. Dev. Jim Grifoni File f PLAN REVIEW CHECKLIST L-- ADDRESS C M } 3 a ENGINEER GENERAL ! / 3 COPIES STAMP LOCUS NORTH ARROW C,1 SCALE CONTOURS /� PROFILE SECTION BENCHMARK SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED?__b/() DRIVEWAYy (Eley) WATER LINE !/ FDN DRAIN SCH40TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G . 17 INVERT DROP GARB. GRINDER ,Jd(+200% EDF) 25 ' TO CELLAR MANHOLE ELEV GW # COMPS. D-BOX SIZE # LINES 4- FIRST 2 ' LEVEL STATEMENT INLET �2 - OUTLET 2'� _ (2" OR . 17 FT) TEE REQ'D? LEACHING MIN 660 GPD? C/ RESERVE AREA 4 ' FROM PRIMARY? 2% SLOPE —Z 100 ' TO WETLANDS 100 ' TO WELLS 4 ' TO S.H.GW !/ (5 '>2M/IN) 35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP c� 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET? p � h� � TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 61 ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT + SIDE X LDNG = TOT I l T Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH f NoRTI{ L �,'�•,.,o.�t� DISPOSAL WORKS CONSTRUCTION PERMIT SS�CMUSE Applicant NAME ADDRESS TELEPHONE Site Location 1-07— 9 Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. `7 8 j7i� CTTAI BOARD OF HEALTH Fee �O D.W.C. No. 79 tr�4� I t I t i _ I Dill VZ4 % 4=k4, 5-S 4 C 4 47514Z I • I RESULTS OF SOILS TESTING ON CHRISTIAN WAY EXTENSION AUGUST 11, 1993 Lot 1: Perc #1-1 at 62" Perc #1-2 at 72" SOAK @ 12:39 SOAK @ 12:43 12" - 1:04 12" - 1:07 9" - 1:57 9" - 1:40 6" - ABORT 6" - ABORT Deep Hole #1-1 Deep Hole #1-2 0" - 24" - Top & subsoil 0" - 24" - Top & subsoil 24"-102" - Tan, sandy till 24"-108" - Sandy till. No observed water. Boulders to 48" . No observed water. Lot 2 : Perc #2-1 at 77" Perc #2-2 at 70" SOAK @ 12 :50 SOAK @ 12 :47 12" - 1: 10 12" - 1: 12 9" - 1: 56 9" - 1:48 6" - ABORT 6" - ABORT Deep Hole #2-1 Deep Hole #2-2 0" - 32" - Top & subsoil 0" - 30" - Top & subsoil 3211- 90" - Tan, mottled 3011- 74" - Light tan sandy sandy loam loam (till) Lot 3 : Deep Hole #3-1 Deep hole #3-2 0" - 30" - Top & subsoil 0" - 40" - Top & subsoil 3011- 66" - Silty, sandy 4011- 64" - Gray silty sand gravel (Brwn sandy loam) 64"-120" - Brown, sandy loam, 6611- 96" - Olive brown sandy gravelly loam. Water @ 9 ' Water @ 96" RESULTS OF SOILS TESTING ON CHRISTIAN WAY EXTENSION AUGUST 13, 1993 Lot 1: Perc #1-1 Perc #1-2 SOAK @1:35 SOAK @ 1:39 12" - 1:53 12" - 1:55 9" - 2:40 9" - 2 : 31 6" - 3:45 6" - 3:23 Lot 2: Perc #2-1 Perc #2-2 SOAK @ 1: 32 SOAK @ 1:26 12" - 1:47 12" - 1:41 9" - 2: 34 9" - 2 : 16 6" - 3:34 6" - 2 :52 Lot 3 : Perc #3-1 Perc #3-2 SOAK @ 4 : 02 SOAK @ 2 : 01 12" - 4:23 12" - 2 :21 9" - 4:28 9" - 3 :54 6" - 4: 34 6" - ABORT Lot 4: Perc #4-1 Perc #4-2 SOAK @ 4: 05 SOAK @ 4:07 12" - 4:21 12" - 4:22 9" - 4:36 9" - 4 : 38 6" - 4:56 6" - 4 :57 Lot 4: Deep Hole #4-1 0" - 30" - Top & subsoil 3011- 80" - Gray/tan mottled silty sand 80"-102" - Light brown sandy loam Observed water at 102" Lot 8: Perc #8-1 at 52" Perc #8-2 at 84" SOAK @ 2:05 SOAK @ 2 :06 12" - 2 :26 12" - 2:29 9" - 2 :55 9" - ABORT - 9 3/4" @ 2 : 59 6" - 3 :40 Perc #8-3 at 80" Perc #8-4 SOAK @ 2: 11 SOAK @ 4 :05 12" - 2: 35 12" - 4:25 9" - 8" - 4:28 6" - 2:56 6" - 4: 36 5" - 4:40 4" - 4:44 Deep Hole 8-1 Deep Hole 8-3 0" - 24" - Top & subsoil 0" - 20" - Top & subsoil 2411- 57" - Tan silty sand 2011- 42" - Tan silty sand 57"-112" -Light brown silty 4211- 80" - Light brown sand, sand. Platey on east some silt. sid eof hole. Deep Hole 8-4 0" - 24" - Top & subsoil 2411- 48" - Tan silty sand 4811- 72" - Light brown sand. REFUSAL PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC . 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED GW MIN 4 ' BELOW BOTTOM- OF FIELD PIPE ENDS JOINED? 4" PEA STONE? V DIST LINE SLOPE . 005?- 1/', >31COVER-VENT V SCH 40 1 MIN 12" COVER RATE LDG X 660 = 5?"*.r,o X TOTAL_ G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY Spm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME Spm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1 ' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH Copyright© 1995 by S.L.Starr CER TIFIED PL 0 T PLAN CUOCO CORNIER ENGINEERING ASSOCIATES.INC. L 0 T 9 CIVIL ENGINEERS - LAND SURVEYORS 39 SIMON STREET�UNIT 10-NAS-ISN Ni 03060-16031 BB2-IBIZ 170 MAN ST. UNIT 212 TEWKSBLRY.MA 01876.50®851.9807 CHERI SE CIR CLE T°"B°�OARD OFFAN HEALTH N. ANDOVER, MA S SA CH USE T T S SCALE: 1" = 50 ' OCTOBER 30, 1995 NOV 14 CHER/SE f CIRCLE LOT 10 "OPEN SPACE" LOT 8 R=60'00 ' `" L_100 00 a oma, a E 241 33'01x, 27 y6 $0 IJ 21�' £X/SANG FOUNDA AON 10/27/1995 503 2 TOP FNOTN = 138.06 v Tv LOT 9 .30,581 S0. FT, o 9 . WDE Zg6 3.01 ORA/NAGE EASEMENT °1 0 LOT 10 "OPEN SPACE" \ I HEREBY CERT/FY TO THE N.ANDOVER BU/LD/NG DEPARTMENT THA T THE FOUNDA TION IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES CONFORM W/TH THE TOWN OF N. ANDOVER ZONING REGULAT/ONS REGARD/NG SETBACKS FROM THE STREET L/NES PSN�, OF 4f AND LOT LINES. a�`` gssI I FURTHER CERT/FY THA T THE FOUNDA TION /S NOT L OCA TED IN A FEDERAL �° RICHARD FL 000 HAZARD AREA AS SHOWN ON FL ODD INSURANCE RA TE MAP DA TED c E. T4 CUOCO JUNE 2, 1993 0 No.2987�0 co4 F �S FILE.- 6286 BOUNDARY INFORMATION TAKEN FROM' ENRD PLAN# 12376 r