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Home My WebLink AboutMiscellaneous - 415 SALEM STREET 4/30/2018 415 SALEM STREET / 210/037.8-0036-0000.0 - 4 1 J North Andover Board of Assessors Public Access Page 1 of 1 1 , Parcel ID: 210/037.B-0036-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e 1 415 SALEM STREET Xr Location: 415 SALEM STREET R Owner Name: KOTCE,N MICHAEL C/O MARINK LLC. Owner Address: 415 SALEM STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 1.43 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1092 sqft ASSESSMENTS _CURRENT YEAR PREVIOUS YEAR Total Value: 299,900 279,400 Building Value: 115,800 108,800 Land Value: . 184,100 170,600 Market Land Value: 184,100 Chapter Land Value: LATEST SALE Sale Price: 305,000 Sale Date: 11/17/2005 Arms Length Sale Code: Y-YES-VALID Grantor: KOTCE,LESLIE Cert Doc: Book: 9893 Page: 125 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=803160 2/1/2006 Residential Property Record Card PARCEL ID:210/037.B-0036-0000.0 MAP:037.13 BLOCK:0036 LOT:0000.0 PARCEL ADDRESS:415 SALEM STREET PARCEL INFORMATION Use-Code: 101 Sale Price: 305,000 Book: 9893 Road Type: T Inspect Date: 09/07/2000 Tax Class: T Sale Date: 11/17/2005 Page: 125 Rd Condition: P Meas Date: 09/07/2000 Owner: Tot Fin Area: 1092 Sale Type: P Cert/Doc: Traffic: M_ Entrance: X KOTCE, N MICHAEL Tot Land Area: 1.43 Sale Valid: Y Water: Collect Id: RO C/O MARINK LLC. Grantor: KOTCE,LESLIE Sewe-r: Inspect Reas: R Address: 415 SALEM STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOW Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RN Tot Rooms: 6 Main Fn Area: . 1092 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R3 Story Height: 1 Bedrooms: 3 Up Fn Area - m" T- e`Y Code Method Sq-Ft - Ades' Influ-Y_%N_ Value Class Bsmt Area: 1092 Se 9 . yP Roof: . G Full Baths: 1 Add'Fn A�ea:��' Fn Bsmt`Area: 1 P 101 S 43560 1 182,080 Ext Wall: FB HalfBaths: Unfin Area: Bsmt Grade: 2 R 101 A 0.43 2,021 Masonry Trim: Ext_Bath Fix: Tot Fin Area:: 1092 - Foundation: CB Bath Qual: T RCNLD: 96288 DETACHED STRUCTURE INFORMATION Kitch Qual: T Eff Yr Built: 1965 Mkt Adj: 1.2 Ste Unit Mir-1 Msr-2 E-YR-1311t Grade Cond%Good P/F/E/R Cost Class Heat Type: FA Ext Kitch: _ Year Built: 1956 Sound Value: SE C 100 1988 A A ///91 300 Fuel Type: G Grade: A Cost Bldg: 115,500 VALUATION INFORMATION Fireplace: Bsmt Gar Cap: Condition: A Att Str Val 1: Current Total: 299,900 Bldg: 115,800 Land: 184,100 MktLnd: 184,100 Central AC: Y Bsmt Gar SF: Pct Complete: Att Str Va12`. Prior Total: 279,400 Bldg: 108,800 Land: 170,600 MktLnd: 170,600 Att Gar SF: %Good P/F/E/R: /100/100/77 Porch Type Porch Area Porch Grade Factor W 120 SKETCH PHOTO 42 12 FM w "` 1092 Sq.Ft.in 26 W 120 Sq. _— in 42 4115 SALEM STREET Parcel ID:210/037.6-0036-0000.0 as of 2/1/06 Page 1 of 1 RECEIVE Commonwealth of Massachuseth, MAY 2 2015 Title 5 Official Inspection Form Subsurface Sewage DisposaLSystem Farm-Not for Voluntary Assessments TOWN OF NO I NDOVER HEALTH P TME P Address Z-L tJ C -0o' Owner er's am information is g required for Yl 0'l 01I`Q`w— _ �_ 01A7 p T ?J every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist;at the end of the form. P°r'enr When filling out A.A General Information forms on the computer,use 1. Inspector only the tab key to move your Nny- [e5 cursor-do use the retumt Name of Inspector r. key. a�n l'e 5 - 2 o u x , L L l Company Name Company Address�- Cityfrogm State Zip Code Teleph ne Number License Number B. Certification 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; Ef Passes ❑ Conditionally Passes ❑ Fails ❑ Needs urther Evaluation bythe Local Approving Authority Ins s Signature Date 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. *"`*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. Title 5 Official Inspection FOM Subsurface Sewage Dispel System•Page 1 or 17 tsins•03/13 Commonwealth of Massachusetts Title 5 Official Inspection Fora I R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41-ss��1� Property Address Owner Information is Owner's Name required for every page. City[Town State Zip Code Date of.Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: [✓jI 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: 414 jai 00m-2i>jfi rP (oyr1M Vja q P1 114C� 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)fo a following statyements. If"not determined, "please,explain. The septic tank is metal and over 20 years old*or the s ' tic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration o exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced ith 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. j ❑ Y ❑ N ❑ ND (Explain below): J Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 17 t5ins•03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J S ' VVl I Property Address Owner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.); ❑ 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 ❑ Y ❑ N ❑ ND Explain below): ❑ obstruction is removed ❑ Y ❑ N ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ ❑ ND (Explain below): ❑ The System required pumping more an 4 times a year due to broken or obstructed pipe(s). The system will pass inspec/if(witpproval of the Boardof Health): ❑ broken pipe(s) d ❑ Y ❑ N ❑ ND (Explain below): obstruction is r ❑ Y ❑ N ❑ ND (Explain below): 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, saf or the environment. 1. System will pass unless Board of He determines in accordance with 310 CMR 15.3030)(b)that the system is not fu Toning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is hin 50 feet of a surface water El Cesspool or pri is within 50 feet of a bordering vegetated wetland or a salt march !Sins-03113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis osal System Form - Not for Voluntary Assessments �� roperty Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) deterimes 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 (S and the SAS is within 100 feet of a surface water supply or tributary to a surface ater supply. ❑ The system has a septic tank and SAS and the SAS i ithin a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS.and the AS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS a 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 at analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that n other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable Ito All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 9 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet.invert due to an overloaded or clogged SAS or cesspool ❑1010❑ Liquid depth in cesspool is less than 6"below invertor available volume is less than % day flow t5ins•03113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts) Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form- Not for Voluntary Assessments s5eyyl !a Property Address Owner Information is Owner's Name required for _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 2" Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s�. Number of times pumped: ❑ Q� Any portion of the SAS, Cesspool or privy is below high ground water elevation. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q� Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q" Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ [2"� 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ 2 This system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ET" 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. For large systems,you must indicate either"yes"or"no"to ch of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within X400et a surface drinkiing water supply ❑ ❑ the system is within a tributary to a surface drinking water supply ❑ ❑ the/bany efcated in a nitrogen sensitive area (Interim Wellhead Protection AreIW is r a mapped Zone II of a public water supply well If you have answered "yuestion in Section E the system iscondidered a significant threat, or answered "yes"in Seve the large system has failed. The owner or operator of any large system considered a gnificant threat under Section E or failed under Section D shall upgrade the system in accordan a with 310 CMR 1:5.304. The system owner should contact the appropriate regional office of the Department. t5ins-03/13 Title 5 Oficial Inspection Forth Subsurface Sewage Disposal System•Page 5 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 55gi /fM5 ' Property Address Owner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection C Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No d ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 12r Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Rr Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? Q� ❑ Were all system components, excluding the SAS, located on site? ❑ 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? ❑ Was the facility owner(and occupants if different from owner)provided with information on the;proper maintenance of subsurface sewage disposal systems? This size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. Q� ❑ Determined in the;field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: L Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 5 ' Title 5 official Inspection Form Subsurface Sewage Disposal System•Page 6 of 17 t5ins-03/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: L4- Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes d No Laundry system inspected? J1 jC1 ❑ Yes ❑ No Seasonaluse? / ` ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): Detail: Aq 67 c i Sump pump? ❑ Yes d No Last date of occupancy: w,ve qj Date Commercial/Industrial Flow Conditions:. Type of Establishment: Design flow(based on 310 CMR 15.20 Gallons per day(gpd) Basis of design flow(seats//rged ersons/- q.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holdingt? ❑ Yes ❑ No Non-sanitary waste die Title 5 system? ❑ Yes ❑ No Water meter readings, t5ins•03113 Tille 5 official Inspection Forth Subsurface Sewage Dlsposel System-Page 7 of 17 Commonwealth of Massachusetts L<L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments roperty Address Owner Owner's Name Information is required for every page. City/Town state Zip Code Date of Inspection D. System Information (conlL) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A:system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 t5ins•03/13 Commonwealth of Massachusetts; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a S Property Address Owner Owner's Name Information is required for every page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: O -5�' TE;,O 14 Were sewage odors detected when arriving at the site? ❑ Yes Q No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: )) ❑ cast iron ❑ 40 PVC ❑ other(explain) A�I� Distance from private water supply well or suction line: e A 10 fe—� Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): ,� t cc) A Depth below grade: ' feet Material of construction: d concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: -- A)IA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 0 X,s,X Ll �. f Ste%o Sludge depth 1' Title 5 Official Inspection Form Subsurface Sewage Disposal System•Pape 9 of 17 t5ins•03/13 Commonwealth of Massachusetts Title 5 Official Inspection Form 1.31 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments pal Property Address Owner Owner's Name Information is required for every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle "T 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 How were dimensions determined? L) P i LA� Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): !� C (,t rr e vA�I r -e Y- OT t f-0,+) 2 0 e C Lo '3U P,C,A Q 4��0 1 vlUq ,j ne tom Yn-eVi e d� Grease Trap(locate on site plan): Depth below grade: /E3 Material of construction: ❑ concrete ❑ metal ❑ fibergne ❑ other(explain) Dimensions: Scum thickness Distance from top of scum to topoutlet tee or baffle Distance from bottom of scu o bottom of outlet tee or baffle Date of last pumping: Date t5ins-03/13 Title 5 Oftal Inspection Form Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts; Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Sy4 - Property Address —(5q IfOwner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 ❑ pethylene Elother(explain) Dimensions: Capacity: (Ions Design Flow: T per day Alarm present: 11 Yes El No ZAlarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition o/aland utswitches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Title 5 Official Inspectlon Form Subsurface Sewage Disposal System•Page 1/of 17 t5ins-03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -P01 _ Property Address Owner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 5�-1- 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.): l 5 v e5 eve� P1 o Y1 I YV1 X11 C4 t! .zoylef ' 5 l ✓t 5 �P�t 2 Pump Chamber(locate on site plan): Pumps in working order: /pumps es ❑ No Alarms in working order: es ❑ No Comments (note condition of pump chamber, condittenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation no equired): If SAS not located, explain why: 7 Title 5 Of0clal Inspection Form Subsurface Sewage Disposal System•Page 12 of 17 t5ins-03113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Property Address Owner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: L_1 leaching fields number, dimensions: J C� ❑ overflow cesspool number: ❑ innovative/alternative system Type%ame of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 'SJ6,, CSS Co U2 — v::::�o-Vl1 f6 � pear Cesspools (cesspool must be pumped as part of inspection) (lo�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' flow ❑ Yes ❑ No Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 t5ins•03113 Commonwealth of Massachusett=s Title 5 Official Inspection Form Subsurface S wage Disposal System Form -Not for Voluntary Assessments y Property Address Owner Owner's Name Information is required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (coni:.) 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 by aulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form Subsurface Sewage Disposal%6tern•Page 14 of 17 t5ins•03/13 Commonwealth of Massachusetts Title 5 Official Inspection Form - I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Le 4 is Property Addres—s r Owner Owner's Name Information is required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: El hand-sketch in the area below 0 drawing attached separately ve Tine 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 17 t5ins•03173 Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L Property Address Owner Information is Owner's Name required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.,) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: " feet Please indicate all methods used to determine the high ground water elevation: E5 Obtained from system design plans on record If checked, date of design plan reviewed: o S, ae ❑ 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 USG$database-explain: You must describe how you established the high ground water elevation: Before filling this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form Subsurface Sewage Disposal System-Pape 16 of 17 t5ins-03113 Commonwealth of Massachusetts Title 5 Official Inspection Foran t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments roperty Address Owner Owner's Name Information is required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist U Inspection Summary: A, B,C, D, or E checked (✓� Inspection Summary,D (System Failure Criteria Applicable to All Systems)completed System Information - Estimated depth to high groundwater El Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i i i Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 17 of 17 t5ins-03/13 SNE 50.8' 00 Q S0 Fp0T nl NOco S1 RUCTURE 2 �� C/i E 25.1' Q A 16.0' 2 WD. S7 96.2' 1 CONC Q ROOFED APPROXIMATE GAS GAS SCREENED SERVICE LOCATION METE PORCH _ 0 28.5' c 1,500 GALLON Q `o 4 BEL CONCRETE SEPTIC TANK CONC. PAD TOP OF f W/ 2 AC X00F p 13 9' UNITS BUFF`.OT B � R ZpNE = O 10.7' TH 1 ._ COVER TO GRADE____ r 4 4.0 O PTl o ROOFED PORCH CONCRETE D-BOX TH21 0 o (ON SLAB) o"', 2 ... 20� R 44.0' 4" PVC INSPECTION � B ' PORT TO FINISHED 10.0' GRADE. z2 6, \ PT2 _ SOIL ABSORPTION AREA L;2=-- LEACHING BED j I i 18'W X 501 (900 S.F.) W/ 3 DISTRIBUTION LINES G APPROXIMATE LOCATION OF 6" PVC FUTURE RESERVE AREA PIPE TO BE USED FOR FUTURE _ -- SEWER SERVICE CONNECTION WHEN 18' W/DE-X-gO-'_L.Q I,� MUNICIPAL SEWER SERVICE BECOMES 34.9' TH4 �PT3__ AVAILABLE - - 7N6� c c -- _ GRASSED AREA'- _ ~ � 129 G- 9 IIX2 9IIX< 9 2y -- - g 9.i 7 9 7- - EOP - 12"W WA TER SHUTOFF 1IC SCALE /� L 40 80 RAIL FENC E -- - o, (3 ` POST o Q �r - l ' _ ..__ .. __ __ .._'moi► c� GRASSED AREA s �Q GRASSED AREA tj 2 WD. STEPS 1 CONC STEP � C '4; WIDE PAWD WALKWAY ` Q ROOFEDv m SCREENED DECK30.0' Cj In PORCH 7.0' o r Q BH t CONC. APRON AROUND BH BIT. CONC. r �� 28.5' �' 8.0 3 CAR DRIVEWAY ' ' 4 BEDROOM DWELLING Q) TOP OF FOUNDATION = 105.57' ?f•5 GARAGE 22.5' J 1.0' 30.0' 9 PORCH SLAB) ws 0, _ - __ 48.4' c 98.X5 S _ A VERS I / p A _ — PA VERS96 i LAJ 3' WIDE C W14" PE IN FILTER 10' .. ; i IS CONNE co rl, r �E ARfA Z U Z Q ; i PT3-+ m - - 4,<4 --- — �! c,`�• WS -16g•2-0 1 STONE MASONRY S53*39'12"E ! HEADWALL Bl T. J .J.J G c8 ---- EOP . . . 12"W BEN�RK I L E M S T R E E T PK NAIL IN SIDEWALK ELEVATION = 94. 99' (ASSUMED DA TUM) NORTH O�tt�ac �6�'�'p N Oq4 C".ac.�nww.cw ��SSACHUS PUBLIC HEALTH DEPARTMENT Community Development Division CERTIFICAT(F O F CO9VI,,DGIA5VCE As of: October 19, 2007 This is to cert that the individuaCsu6surface d4posaCsystem received a SA`17S FACT0RT 1XYPECg70Y of the: Fully RepairedwSeptic System By. jacksullivan At: 415 Salem Street Map 3 T.B; Parcel3 6 North Andover, JKA 01845 The Issuance of this certificate shaCf not be construed as a guarantee that the system wifif function satisfactorily. ,,. -Susan 9t Sawyer"µ ` Public Wealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com f _ IT �SSACHtIg� PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER ARE E N E SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the�� / Se '�wage Disposal System constructed;( )repaired; a C T - 9 2007 jIe St//L0)1Ai " I'01NN OF NORTH C,i 0QVER By: HEALTH DEPAR 1'MC.NT (Pint Name)� f -----•--�----�-,_•-, Located at: V 1"1rf 4&iy I A�T (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated j V� 1 24D and last revised on jvLy l 1 �" ,with a design flow of / 7 gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. S Z7 2o-06f Bottom of Bed Inspection Date: :/ , .. J, �* j ,�j J�1/ l /, �i_ Engineer Representative(Signature) UIYI " J And-Print Name T 16Dr Final Construction Inspection Date: V" b ,� En ineer Repre entahve(Signature) And-Print Name Installer: (Signature) Date: 41 J�v ICU VAI\) 1/wAnd-Print Name Enginer: (Signature) Date: And-Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Sullivan Engineering Group, LLC Civil Engineers&Land Development Consultants' October 4, 2007 Town of North Andover Board of Health c/o Susan Sawyer—Director of Public Health 1600 Osgood Street North Andover,MA 01845 Re: 415 Salem Street,North Andover Final Septic Grading As-Built Ms. Sawyer; Enclosed are two (2) original stamped Final Grading As-Built Plans for your review and approval for the above referenced property. If you have any questions please feel free to contact me. Very Tru s, ack Sullivan,P.E. 22 Mount Vernon Road Boxford,Massachusetts 01921 (978)352-7871-Phone 978352-7871 -Fax t10RTH _ Of t�ec 69 O 6 ~ �A O cx.uia:.rc. q• 7a AORATEO �'�y SSAC HUSS PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 415 Salem Street MAP: 37B LOT: 36 INSTALLER: Jack Sullivan DESIGNER: Jack Sullivan PLAN DATE: 7-11-06 BOH APPROVAL DATE ON PLAN: 7-20-06 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10-3-06 DATE OF FINAL GRADE INSPECTION: "0_3_0-7 SITE CONDITIONS ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Could not see relocated water line route. 10/3/06. SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading 2-PC construction li ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTH q O �t�ec s ti ;« �6 O * n ey •� 0 cu.iawwmw04 TED 0 • f 9 �SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet Comments: Watertightness of tank needs to be demonstrated. Manhole to grade over effluent filter needed. 10/3/06. DISTRIBUTION-BOX ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments` 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fox 918.688.8416 Web www.townofnorthandover.com tAORT14 Q��t�eo 06'9ti� 3? Q� o m � o� cxnii'.uwew a 0 TED SSAC HU`�� PUBLIC HEALTH DEPARTMENT Community Development Division SYSTEM ELEVATIONS INVERT INFIELD PLAN INVERT ELEV. Benchmark Building Sewer OUT 101.30 99.95 Septic Tank IN 100.52 99.75 Septic Tank OUT 100.30 99.50 Pump Chamber IN Pump Chamber OUT Distribution Box IN 99.97 99.27 Distribution Box OUT 99.81 99.10 Lateral 1 INV 99.74 99.80 Lateral 1 END 99.22 99.05 Lateral 2 INV 99.67 99.80 Lateral 2 END 99.23 99.05 Lateral 3 INV 99.65 99.80 Lateral 3 END 99.24 99.05 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com �10RTF� `� 32 bt:�i_ ••w 6 OL O M � eyy � opA c«.uin�iwrcw`��' ��SSACHUS PUBLIC HEALTH DEPARTMENT Community Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib.to surface water supply 325 325 ❑ Public well 400 400 Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofiorthandover.com i FINAL GRADE INSPECTION Address: ❑%I EDAMED? { SS� ED? COVER PER PLAN? Other: 6 Commonwealth of Massachusetts Map-Block-Lot 037.B-0036- Bo o ----------------------- Board of Health Permit No North Andover BHP-2006-0260 a P.I. ----------------------- 'SAC SO F.I. FEE $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted to(Construct)an Individual Sewage Disposal System. at No 415 SALEM STREET -- ----- ------------------------------------------------ --- ------------ -- -- - - - - - - - - - - as shown on the application for Disposal Works Construction Permit No. BHP-2006-026 Dated September 26,2006 MOO Issued On: Sep-26-2006 ------------ { o d h ------------------- o ealth i TOWN OF NORTH ANDOVER NORrk Office of COMMUNITY DEVELOPMENT AND SERVICES 3r°,..`0``° HEALTH DEPARTMENT s p 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ; NORTH ANDOVER,MASSACHUSETTS 01845 S4cHua 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director healthdeptt@townofnorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ZD ' LOCATION: HOMEOWNER NAME: LICENSED INSTALLER NAME: G SL)w�Y4/\"/ PLEASE PRINT - SIGNATURE: TELEPHONE# 797 ) CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): ($125) *NEW CONSTRUCTION: *If NEW CONSTRUCTION,please attach the Foundation As-Built Plan. C7)I $250. Wor$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes_ No Floor Plans? Yes A/,. No I I Approval of Health Agent Date: }� P_ NLN11VdL1U" ryr peptic ulsposal System Construction Permit - TOWN OF TOD Y'S DATE — '�,�'� � NORT 01845 HANDOVER MA $ 250.00—Full Repair $125.00- Component Important: Application is hereby made fora Permit to: When filling out Construct a new on-site sewage disposal s forms on the stem* g p y computer, use ❑ Repair or replace an existing on-site sewage disposal system*the tab key to move your ❑ g y component Repair or replace an existing system cursor-do not key the return A. Facility Infor atio y Y/5' �7 Address or Lot# _ /'v -- -- - —--- artun City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump Gravity (choose one) ***If pul p system, attach copy of electrical permit to application*** Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Informatio Name / Address(if different from above) — City/Town -- -- State - ------ Zip Code Telephone Number 3. Installer Information Name Name of Company --— Address _ City/Town - �- -_ State Zip Code Telephone Number(Cell Phone#if possible p/ease) 4. Desiqner Information ,�� j ,(� Name �A.VS ��` .4`d ... `'S�` (v►V _ -- 'i fi,_� /� Name of Company - --— Address ---- State Zip,Code Telephone um e r(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 Application for Septic Disposal System S X44 ot �. )Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $ 260.00-Full Repair $125.00-Component PAGE 2 OF 2 A. Facility Information Continued—, 5. Type of BuildinqXResidential Dwelling or RCommercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued this Boa Health. Name Date Appli (Board of Health Representative) _IL_ �7z Na Date /A/pplication Disap16:d for the following reasons: ............................. ................................. .......... For Office Use Only: 1. Fee Attached? Yes ✓ No 2. Project Manager Obligation Form Attached? Yes No 3. Pump System? If so,Attach copy of Electrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes t.,o No Application for Disposal System Construction Permit-Page 2 of 2 Application for Septic Disposal System 70 �� n � Construction Permit - TOVN OF TODAY'S` 'S DATE " NORTH ANDOVE R, MA 01845 $ 250.00—Full Repair x C $125.00-Component sS^C Important: Application is hereby made fora permit to: When filling out Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Infor actionf key. yr � rad Address or Lot# rnan City/Town________ — 2.- *TYPE OF SEPTIC SYSTEM*: ❑ PumpGravity (choose one) ***If pu p system, attach copy of electrical permit to application*** XConventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Informatio WIP- Name f, , ,1 /��JI V_( M41 -- Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information _ l Name Name of Company -- -- Address City/Town State Zip Code Telephone Number(Cell Phone#if possible please) a. Designer Information Name a Name of Company Address City/Town State Zip Code Telephone dumber(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 3 fA (Address of septic system) /1/V For plans by (Engineer) Relative to the application of �J /?! � (Installer's name) And dated "" ) Z� �� ngina ate Dated o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the apyroved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system isnot ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspectionwithout completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against.me and/or my company a. Bottom of Bed—Generally, this is the first (1'� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdel2t&townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. y Undersigned Licensed Septic Installer: 'JAM (Today' Date) (Name—Print) am — gne I k. Sullivan Engineering Group, LLC z w Civil Engineers&Land Development Consultants July 12,2006 JUL 1 2 2006 North Andover Health Department—Susan Sawyer 1600 Osgood Street TOWN OF EALTHvER DEPARTMENT Building 20; Suite 2-36 North Andover,MA 01845 Re: Revised Septic Plans —415 Salem Street Ms. Sawyer; Enclosed are four(4)revised septic plans based on comments in your letter dated June 21, 2006 for 415 Salem Street,North Andover. Specifically,the following revisions have been made(numbering corresponds to the numbering in your letter) 1) Setbacks distances have been added from the septic tank and soil absorption system to the dwelling and property lines. 2) The inlet and outlet tees in the septic tank have been graphically adjusted to show the tees over the inlet and outlet covers. 3) Note#17 on Sheet 1 of 2 has been added to read, "The building sewer is to have watertight joints, to be laid on a compact& firm base, and is to be laid on a continuous grade in a straight line". 4) On Sheet 2 of 2 notes have been added for the septic tank and distribution box to be watertight with 9" of cover. 5) On Sheet 1 of 2 a note has been added in the plan view indicating that Horizon A&B shall be removed at least 6"into the suitable C Horizon. 6) Orifice sizing has been added on Sheet 2 of 2 in the system profile 7) A leaching bed has been proposed in place of a trench system,therefore trench spacing is no longer relevant. 8) On Sheet 2 of 2 notes have been added to the Septic Tank detail and Distribution Box detail stating each component shall handle H-10 loading rates. 9) A note has been added on Sheet 1 of 2 stating that the North Andover Conservation Commission approved the wetland delineation of the B series wetland flags on June 14, 2006 (DEP File#: 242- 1359) 10)Additional soil testing(2 deep holes and one percolation test)was conducted on 7/11/06 to provide sufficient soil testing within each soil absorption area(primary and reserve) I have also added a Zabil effluent filter at the outlet of the septic tank per your recommendation. I have also enclosed additional soil evaluator forms to reflect the soil testing conducted on 7/11/06. If you have any questions please feel free to contact me. 7ac urs, i1111,P.E. 22 Mount Vernon Road — Boxford,Massachusetts 01921 — (978)352-7871-Phone — 978352-7871 -Fax r TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT A 400 OSGOOD STREET --• NORTH ANDOVER, MASSACHUSETTS 01845 �4 swCHU 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdeptc,townofnorthandover.com WEBSITE:hqp://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM 1 . RECEIVED Date of Submission: nw z Zo oz I V1y ' ASite Location: fb� f/�c� JINN - 206 � „ LL �, TOWN OF NORTH ANDOVER �1�`.' ��NN�/ HEALTH DEPARTMENT Engineer: New Plans? Yes—x_$225/Plan Check# (includes I"submission and one re- review only) Revised Plans? Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No � q �' l Telephone#: I7 6,35Z-7-Y)7 1 Fax#: ( 7 - `7 E-mail: Homeowner jk Name: OFFICE USE ONLY When the submis ion is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database r TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o+°.�`,4RD,,�41a� HEALTH DEPARTMENT F p i i Y 400 OSGOOD STREET ��. •° NORTH ANDOVER, MASSACHUSETTS 01$45 'ss„cHusss Susan Y.Sawyer, REBS,RS 978.648.9540 -Phone Public Health Director 978.688.8476-FAX lhealthdept(ct�townofnorthandover.coirn www.towno fnorthandover.com APPLICATION FOR SOIL TESTS ' n7 DATE: Z/ MAP&PARCEL: t �(v�� ` �� LOCATION O`F SOIL TESTS: / r `t t/ /17. 1IeAG LL(' J�T�,V(OWNER: Contact " t 9 ?-35-2- 75 7IAPPLICANT: Contact#: ADDRESS: ENGINEER: T,q Gk ��" -' "' Contact#: v— / / CERTIFIED SOIL EVALUATOR: � � ✓ V �� Intended Use of Land: Residential Subdivision Single Family Home Commercial X Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: ` In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Dat / Signature of Conservation Agent: Date back to Health Department:(stamp in): my �,�c� ioo MARINK LLC Steven Turner 22 Temple Street Boston, Massachusetts 02114 Board of Health February 1, 2006 North Andover,Massachusetts As owner of 415 Salem Street, North Andover, I give Jack Sullivan permission to conduct soil testing on the property. Please call me if you have any questions, cell 617- 797-3880. Owner: MARINK LLC Manager,Steven Turner 415 Salem Street North Andoveer T0 'd LSZT 89Z LT9 T WA J T e MT N /l 71 9.8?B W / FW HOLE / , 7 I i �,owl ��• '� LOT AREA — 1.43 AC. % ----102--- I moi' i i WPS MFMa i'—'-� i NFMf WJAI-1 AL �_— AL AL AL Ak AL of AL AL WFM3 AL AL AL I 1 _ � — files "rW►�� /�' EDGE OF WILAMS Ilf/B2 `� ` / ■F/Bi-B -- I AL WP7 (oo \ J g 1 \ / lit EWTM 1 ; / 1 1 I L\ \ 1 \ / \ / SiRticim \ DECK pis \\ / RET.WALL — -----ss / 22'MAPLE 3 DRILL J, 14-- yo iss. S53' 12 E i;;.CONG SWEWAIK SALEM STREET i 9 • Sullivan Engineering Group, LLC Civil Engineers&Land Development Consultan tan ts March 21, 2006 RECEIVE® Susan Sawyer—Board of Health Agent MAR 2 1 2006 Town of North Andover 400 Osgood Street TOWN OF NORTH ANDOVER HEALTH DEPARTMENT North Andover, MA 01845 Re: Soil Testing Locations 415 Salem Street,North Andover Susan; Attached is a site plan at 1 —40 depicting the soil testing locations conducted on February 8, 2006 at 415 Salem Street for your records. I will be submitting soil evaluator forms to your office shortly. ve YTrulY Yours, JTI� u iv E. 22 Mount Vernon Road Boxford,Massachusetts 01921 (978)352-7871-Phone 978 352-7871 -Fax SOIL TESTING LOCATIONS 415 SALEM STREET,NORTH ANDOVER _ SCALE: 1"=40' Jt IVJ 9 "z6�y DRU HOLE SOIL TESTING DATE: 2/8/06 i� f FMD '— —LOT AREA f f 2, A.t,��'•�, ------ 62,12124 S F.t AL AL r � $ fps ispt i 6 Woo dpi •_/ \ ALf / AL COMM OF�EIIAN0.4 i� MF/Bt-B wow WP7 WOW \ v } 69.4', MY 3 WEMS77NG 0 1�1 f STY WOOD ZZ O SIRUCTURE CON ��H f5 \ say / ' Qr JL �\ N 1 . \see' if s �.• f'��'��1��4��fctcQ ULL f6a� r W —•--...-5533 ert.coNr soEN+uc _ SALEM STREET i Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Wednesday, July 12, 2006 1:40 PM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@miliriverconsulting.com Subject: Soil results 415 Salem Street Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 7/19/2006 I I a , • I ' S eca'�� 'f,. �*ti�•yam : J1 I I x - , �- 1 T r 1: I d —r I a It f k : i + r . i i r ��n 1�+ Y t I iJ 5 r gA G L � ; S 49 o/ n ML, pvi �iR Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Thursday, February 02, 2006 11:56 AM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriVerconsulting.com Subject: Soil Test; 415 Salem Street The soil test for 415 Salem Street has been scheduled with Jack Sullivan for Thursday, Feb. 8th at 8:30 a.m. Please call if you have any questions. Marianne Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 2/2/2006 1 . Commonwealth of MassachusettsM STAEET City/Town of ` Form 11 - Soil Suitability.Assessment for On-Site Sewage Disposal s`y< DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information m]>0 be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they�e � oA. Facility Information N1. Facility InformationLJ.I r-+Sullivan Engineering Group,LLC Owner Name 415 Salem Street Map/Lot: Map 37B Parcel 36 Street Address North Andover MA 01845 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ® Upgrade ❑ Repair ❑ 2. Published Soil Survey available? Yes ❑ No ® If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 1 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 1 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 102.0 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way>200 Possible Wet Area 100 feet feet feet Property Line 34 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_108" Depth Standing Water in Hole Estimated Depth to High Groundwater: 66" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 2 of 7 n Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 2 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 100.3 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way >200 Possible Wet Area 106 feet feet feet Property Line 15 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material[] Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No X If Yes: Depth Weeping from Pit_None Depth Standing Water in Hole Estimated Depth to High Groundwater: 71" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 Commonwealth of Massachusetts CityfTown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y� 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 3 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 99.9 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way>200 Possible Wet Area 126 feet feet feet Property Line 30 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil[] Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_ Depth Standing Water in Hole 99" Estimated Depth to High Groundwater: 67" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 2 of 7 Commonwealth of Massachusetts 4 City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal EJ 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 4 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way>200 Possible Wet Area 158 feet feet feet Property Line 15 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_ Depth Standing Water in Hole_67" Estimated Depth to High Groundwater: 44" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M Deep Observation Hole Number: 1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (in.) Depth Color Percent Gravel Cobbles &Stones 0-7 A 10 YR 3/3 n/a LS 7-25 B 10 YR 6/8 n/a SL 25-108 C 2.5 Y 6/6 66" 5 YR 5/6 50 SL 20 Additional Notes / 08 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 7 Commonwealth of Massachusetts C ityfrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y< Deep Observation Hole Number: 2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-7 A 10 YR 3/3 n/a LS 7-35 B 10 YR 6/8 n/a SL 25-108 C 2.5 Y 6/6 71" 5 YR 5/6 50 SL 20 Additional Notes /V0 X DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal v .. Deep Observation Hole Number: 3 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones 0-9 A 10 YR 3/3 n/a LS 9-27 B 10 YR 6/8 n/a SL 27-108 C 2.5 Y 6/6 67" 5 YR 5/6 50 SL 20 Additional Notes WO WA` :X &(�ff 'in/6 Or-l— Nr011V(, DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 4 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other (In) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones 0-9 A 10 YR 3/3 n/a LS 9-28 B 10 YR 6/8 n/a SL 28-82 C 2.5 Y 6/6 44" 5 YR 5/6 50 SL 20 Additional Notes A -VI/y� (�t/ }(�, 6? 47 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal rr D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. Inche B inches, ® Depth to soil redoximorphic features (mottles) A. B. -71 _ C, Q, inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes® No❑ b. If yes, at what depth was it observed? Upper boundary: 24 Lower boundary: 108 inches inches F. Certification I certify that I have ssedPul oil evaluator examination"approved by the Department of Environmental Protection and that the abov, analysis was pe r consistent with the required training, expertise an experience described in 310 CMR 15.017. Y/) a Signature of So alua Date John D. van III, P.E. October 1995 Typed or Printed Name of Soil Evaluator "Date of Soil Evaluator Exam Randy Burley Consultant for the Town of North Andover Name of Board of Health Witness Board of Health DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal Page 6 of 7 Commonwealth of Massachusetts Cit yfrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Note: This form must be submitted to the approving authority with Percolation Test Form 12 Use this sheet for field diagrams: TO BE R ZE 69.4 9e EXISTING 2 2 1 STY WOOD p STRUCTURE ONCRE � DECK X415 t0C .$ P(Y RE . W 3 58.1' 18,PINE C se __ __96 55.8 22'MAPLE (0 tp 1�. 94��f' AININO WALL �O 168. BIT. CONC $MEW" _ I S A L E M STREET REE T W�IN SIDEWALK 0 3 0 ELEYanoN- sCso' (ASSUMED DAWN) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 7 of 7 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer,use Sullivan Engineering Group, LLC only the tab key Owner Name to move your 415 Salem Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code 978-352-7871 Contact Person(if different from Owner) Telephone Number B. Test Results 2/8/06 10:00 A.M. 2/8/06 10:00 a.m. Date Time Date Time Observation Hole# 1 2 Depth of Perc 36"-54" 42"-60" Start Pre-Soak 9:42 10:03 End Pre-Soak 9:57 10:18 Time at 12" 9:58 10:19 Time at 9" 10:28 10:48 Time at 6" 11:19 11:37 Time (9"-6") 51 min 49 min Rate (Min./Inch) 17 MPI 16 MPI Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: Randy Burley- Mill River Consulting (Consultant for the Town of North Andover BOH) Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 RECEIVED ALEM STAEEr Commonwealth of Massachusetts JUL 1 2 2006 C ity/Town of ' Form 11 - Soil Suitability AssesW,,q ' e Sew e DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Sullivan Engineering Group,LLC Owner Name Street Address 415 Salem Street Map/Lot: Map 37B Parcel 36 North Andover MA 01845 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ® Upgrade ❑ Repair ❑ 2. Published Soil Survey available? Yes ❑ No ® If yes: Year Published Publication Scale Soil Map Unit Soil Name Sod limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 7 Commonwealth of Massachusetts CityrTown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y. EJ 6. Current Water Resource Conditions(USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 1 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 102.0 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way>200 Possible Wet Area 100 feet feet feet Property Line 34 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_108" Depth Standing Water in Hole Estimated Depth to High Groundwater: 66" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6 ` 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ * Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 2 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 100.3 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way >200 Possible Wet Area 106 feet feet feet Property Line 15 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes r-1 No If Yes: Depth Weeping from Pit_None Depth Standing Water in Hole Estimated Depth to High Groundwater: 71" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 3 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 99.9 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body>200_ Drainage Way>200 Possible Wet Area 126 feet feet feet Property Line 30 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock[:] 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_ Depth Standing Water in Hole 99" Estimated Depth to High Groundwater: 67" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 4 2/8/06 10:00 a.m. 45 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole . Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way>200 Possible Wet Area 158 feet feet feet Property Line 15 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Materia[E] Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_ Depth Standing Water in Hole_67" Estimated Depth to High Groundwater: 44" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 Commonwealth of Massachusetts Cityrrown of ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 5 7/11/06 10:00 a.m. 75 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 100.0 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 10-15 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grassed Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body>200_ Drainage Way>200 Possible Wet Area 130 feet feet feet Property Line 45 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No ED If Yes: Disturbed Soil❑ Fill Material[] Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit_ Depth Standing Water in Hole_ Estimated Depth to High Groundwater: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 2 of 7 Commonwealth of Massachusetts C ity/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y� 6. Current Water Resource Conditions (USGS) 2/2006 Range: Above Normal ❑ Normal ® Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 6 7/11/06 10:00 a.m. 75 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 96.0 Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential None 10-15 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grassed Outwash Plain Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way>200 Possible Wet Area 160 feet feet feet Property Line 15 Drinking Water Well >200 Other feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock[] Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit_ 104" Depth Standing Water in Hole_104"_ Estimated Depth to High Groundwater: 56" (Depth to mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 2 of 7 Commonwealth of Massachusetts Cityrrown of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other (In.) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones 0-7 A 10 YR 3/3 n/a LS 7-25 B 10 YR 6/8 n/a SL 25-108 C 2.5 Y 6/6 66" 5 YR 5/6 50 SL 20 Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (in.) Depth Color Percent Gravel Cobbles &Stones 0-7 A 10 YR 3/3 n/a LS 7-35 B 10 YR 6/8 n/a SL 25-108 C 2.5 Y 6/6 71" 5 YR 5/6 50 SL 20 Additional Notes /V0 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 3 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones 0-9 A 10 YR 3/3 n/a LS 9-27 B 10 YR 6/8 n/a SL 27-108 C 2.5 Y 6/6 67" 5 YR 5/6 50 SL 20 Additional Notes tic% - ✓�� r"�-' DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts City/Town of ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y e Deep Observation Hole Number: 4 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other (In.) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones 0-9 A 10 YR 3/3 n/a LS 9-28 B 10 YR 6/8 n/a SL 28-82 C 2.5 Y 6/6 44" 5 YR 5/6 50 SL 20 Additional Notes PA V /114 WA)V 6 67 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 0` Deep Observation Hole Number: 5 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-3 A 10 YR 3/3 n/a LS 3-15 B 10 YR 6/8 n/a SL 15-30 FILL 30-35 A 10 YR 3/3 n/a LS 35-45 B 10 YR 6/8 n/a SL 45-102 C 2.5 Y 6/6 SL 20% Trace Boulders Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 6 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other (In.) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones 0-3 A 10 YR 3/3 n/a LS 3-19 B 10 YR 6/8 n/a SL 19-32 FILL 32-37 A 10 YR 3/3 n/a LS 37-48 B 10 YR 6/8 n/a SL 48-106 C 2.5 Y 6/6 @56" LS 20% Trace Boulders Additional Notes Groundwater weeping &Standing @ 104" DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) TH1. 66" TH2. 71" TH3. 67" TH4. 44" TH6. 56" ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes ® No ❑ b. If yes, at what depth was it observed? Upper boundary: 27 Lower boundary: 108 inches inches F. Certification I certify that I have pa ed s ' luator examination*approved by the Department of Environmental Protection and that the abov, analysis was perfor d b e n ent with the required training, expertise and)experience described in 310 CMR 15.017. 71V10k Signature of Soil vator Date John D. Sullivan III, P.E._ October 1995 Typed or Printed Name of Soil Evaluator "Date of Soil Evaluator Exam Randy Burley Consultant for the Town of North Andover Name of Board of Health Witness Board of Health DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 6 of 7 Commonwealth of Massachusetts 0 13 UVERE E 0 City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Note: This form must be submitted to the approving authority with Percolation Test Form 12 Use this sheet for field diagrams: TO BE R IE 69.4' 98 3 EXISTING LA 2 1 STY WOOD p STRUCTURE ONCRE DECK #415 LOC �$ PIG�2 y RE . W 3 58.1' 18,PINE 9s- -_.� PT3 55.8 , 22,MAPLE , E �o O ,,IINdyC 94 WALL to 168. BIT. C(Wr- SIDEWALK J SALEM STREET RfWILINVWWALK f :: 3 SZVAMN- ft V' r (A4=Mm DAMM) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 7 of 7 Commonwealth of Massachusetts City/Town of - Percolation Test Form 12 M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on the computer,use Sullivan Engineering Group, LLC only the tab key Owner Name to move your 415 Salem Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 CityfTown State Zip Code 978-352-7871 Contact Person(if different from Owner) Telephone Number B. Test Res u its 2/8/06 10:00 A.M. 2/8/06 10:00 a.m. Date Time Date Time Observation Hole# 1 2 Depth of Perc 36"-54" 42"-60" Start Pre-Soak 9:42 10:03 End Pre-Soak 9:57 10:18 Time at 12" 9:58 10:19 Time at 9" 10:28 10:48 Time at 6" 11:19 11:37 Time (9"-6") 51 min 49 min Rate(Min./Inch) 17 MPI 16 MPI Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: Randy Burley- Mill River Consulting (Consultant for the Town of North Andover BOH) Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on ti comp ter,h use Sullivan Engineering Group, LLC only the tab key Owner Name to move your 415 Salem Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 Citylrown State Zip Code 978-352-7871 Contact Person(if different from Owner) Telephone Number B. Test Results 7/11/06 9:30 a.m Date Time Date Time Observation Hole# 3 Depth of Perc 5011-68" Start Pre-Soak 9:29 End Pre-Soak 9:46 Time at 12" 9:46 Time at 9" 10:00 Time at 6" 10:15 Time (9"-6") 15 minutes Rate(Min./Inch) 5 MPI Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: Randy Burley- Mill River Consulting (on behalf of the Town of North Andover BOH) Witnessed By: Comments: i t5form12.doc•06/03 Perc Test-Page 1 of 1