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Home My WebLink AboutMiscellaneous - 426 SUMMER STREET 4/30/2018 426 SUMMER STREET 01107.P.00'8C)000.0 - I Y r ' I 4 426 SUMMER STREET JS-2004-0262 Proiect Detail Report Printed On:Tue May 18,2004 Project Name: GIS#: 7386 Project No: JS-2004-0262 Owner of Record ORDER OF ST AUGUSTINE,INC Map: 107.A Date Submitted: Feb-19-2003 426 SUMMER STREET Block: 0078 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 426 SUMMER STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Plan Review Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0125 5/18/04-Carla Bums asked for status of property. No record of final inspection. Called Todd Bateson. Confirmed Brian LaGrasse did Final and Final Grade. Will look up info.When back to the office and will call me. Left Carla a message to let her know waiting for info. " 3/10/04-Bottom of Bed Inspection. 2/26/04-DWC Permit taken by Todd Bateson. Signed off by Brian. 12/30/03-Helen Comeau calling to check on status of plan. On Brian's desk-not sent to consultant. Ms.Comeau stated that Brian would send to consultant. As a result of the conversation today,it was decided to keep plan here,have Brian review,and call her on Monday with a decision. Call Ms.Comeau at: 978.475.2644. 12/12/03-Revised Plan submitted 12/8/03-Plan Denied 12/3/03-Helen Comeau calling to check on status of plans. Call her back at 978.475.2644. 11/21/03-Rev. 1 Plan received and sent to Consultant. 9/8/03-Plan review back from Consultant. Faxed to Daniel Koravos at Merrimack Engineering. Building,Electrical&Mechanical Permits GREEN FLAG BEM-2004-0210 Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2004-0298 Feb-26-2004 SIGNED OFF JS-2004-0262 Plan Review BHP-2003-0274 Sep-08-2003 DENIED JS-2004-0262 Plan Review Revised Plan Review BHP-2003-0411 Jan-07-2004 SIGNED OFF JS-2004-0262 3rd Plan Review Revised Plan Review BHP-2003-0385 Dec-08-2003 DENIED JS-2004-0262 2nd Plan Review Inspection History GeoTMS®2004 Des Landers Municipal Solutions,Inc. Page 1 of 2 426 SUMMER STREET JS-2004-0262 Proiect Detail Report Printed On:Tue May 18,2004 Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Bottom of Bed Inspection DWC-System Repair BHP-2004-0298 Mar-10-2004 SIGNED OFF Brian LaGrasse JS-2004-0262 • GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 A O�4NORTN 5406 10 p Town.of North Andover HEALTH DEPARTMENT SACMUSt '1 CHECK#: _Zf� . DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $. ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑�itle nspector $ eport $ 7 ❑ Other:(Indicate) $ I Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer w Commonwealth of Massachusetts -191V90 0 Title 5 Official Inspection Form AM 28 Za11 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments TOWN OF NORTH ANDOVER 426 Summer Street HEALTH DEPAR)SENT Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 v 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 anj r way.Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr. cursor-do not Name of Inspector use the return key. none Company Name 16 Hillside Avenue, Unit 3 Company Address Amesbury MA 01913 Cityrrown State Zip Code 978-834-6585 870 Telephone 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority C— /V '- 4-22-11 Inspector's 5 nature 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. r 4,Mot c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is North Andover MA 01845 4-21-11 required for every page. Cityrrown 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: ® 1 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)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. ❑ Y ❑ N ❑ ND(Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown 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 ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑-,ND (Explain below): ❑ obstruction is removed ❑ 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, 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M �r 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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 each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is North Andover MA 01845 4-21-11 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? I ❑ E Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of El ® I 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? ® ❑ 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? The 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. ❑ ® 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: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ® Yes ❑ No Last date of occupancy: CURRENT Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,..°' 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is North Andover MA 01845 4-21-11 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: June 2009 per BOH records 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): Pump Chamber Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Constructed March 2004 per as built Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5"feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipe under slab and not visible in basement. Septic Tank(locate on site plan): 0.75 Depth below grade: feet feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gallons <2.. Sludge depth: Comfnonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .°� 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown 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 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Measure Stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. PVC tee in good condition. Recommend the installation of an effluent filter on the outlet. Grease Trap(locate on site plan): Depth below grade: feet 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: Date k a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 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, ( p P 9 � 9 tY, 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 ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? 0 Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 426 Summer Street Property Address Cameron and Sharon Syme Owner owner's Name information is required for North Andover MA 01845 4-21-11 C' /Town State Zi Code Date of Inspection every page. �Y P Pe D. System Information (cont.) Distribution Box(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.): Box in good condition. Distribution equal. No evidence of soilids carryover or leakage in or out. I Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber in good condition. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 20' x 37' ❑ 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, etc.): Area of leach field looks normal. No evidence of ponding, damp soil, or unusual vegetation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 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.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is North Andover MA 01845 4-21-11 required for every page. City/Town 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: ® hand-sketch in the area below ❑ drawing attached separately Pl s-r,4AjcES C 7Z TAAJ 9, Z 2 t I p T Z,) T A,N IC — Z 0 G TO ?U AA I? — 3? �,a P,,^^� — Z9.3 b" g-tn DB')x TH� I� C D DRwe Po(Lcvi I,..ZflcaSE . A- 1�C S 1 )2l gU7\0/V M M (Z i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �f 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 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: 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date 02 Date ® 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: usgs maps You must describe how you established the high ground water elevation: System built in an area which was raised . Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 426 Summer Street Property Address Cameron and Sharon Syme Owner Owner's Name information is required for North Andover MA 01845 4-21-11 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® 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 ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file A ' DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 20, 20112:13 PM To: 'Osgood, Benjamin C.' Subject: I.R. -Septic File-426 Summer Street-Scanned documents Attachments: 20110420133829200 Ben, As you requested this morning,I have attached scanned copies of the information in the 426 Summer Street file. sw Rrgaada, Pamela DelleChiaie Departmental Assistant I Community Development I_Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 0 Fax-978-688-8476 0 Email-ndellechiaiegtownofnorthandover.com -2S Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 " k � o 4" DIA. SCH. S 0.02 F7 .a INV.= INV.- ' C.F.= �x tom; ,. j .i e e, A-._ 12 ! L i Ij 'FORMANCE WITH 310 CMR 15.255 (3). NASHED AS NECESSARY AND FREE OF IRON, FINES, AND DUST. :SIGNED FOR USE WITH A GARBAGE GRINDER. SOOTS AND SUBSOIL AND REPLACE WITH SPECIFIED FILL WITHIN k ;iJi: ,!i`•LI. v-+ !`r�.!•:1—i rG7 21 G' 117�-. fps, %:_.�`� . THE SYSTEM SHALL BE FREE OF CLAY, STONES, MASONRY, JSTRUCTION MATERIAL. THE TOP 4" SHALL BE LOAMED AND fINERY WHICH MAY CRUSH OR DISTURB THE ALIGNMENT OF OSAL AREA SHALL NOT BE ALLOWED. E NOT TO BE INSTALLED WITHIN L?A_ FT. OF THE SEPTIC TANK THE SOIL ABSORPTION SYSTEM. DIA, SCHEDULE 40 PVC. LL J- "%V F _o►r r c^rm w, IN G 6Jd+.i %w_.� PF'P�Wr -r6l Phar f 9.7`-gyp I s'' LCULA TIONS BEDROOMS x i IYJ GAL./DAY = 4I�IUCY t'c� aj �. E: 1 a M.P.I. TCZ H FIELD (SEE DETAIL) EQUIRED = �I_;r GAL. x GPD/S. F. ROVIDED: WIDE x _ _t LONG F. L-,-f-0 _ � r cl N MAY 9, 1996, ! PASSED THE EXAMINATION APPROVED "NT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE RFORMED BY ME CONSISTENT WITH THE REQUIRED TRAINING, <PERIENCE DESCRIBED IN 310 CMR 15.017. DATE PLA N Of- WAGE - ITAI*:-. 1�5 .r AS PREPARED FOR U4 L -ter~I )AIT 4 '!"N c .._... . .. DATE:, Z- A LOT _7 SUBDIVISION LOT � _..f._51P_ CK ENGINEERINGCSS S fi k Ir J 4 ! J �G •N (51,q&1? �F 8\ jQbCuL, s . NK AS ALT PLAN OF SUBSL*tFME � AL SYSTEM ;` ✓ LOCATED INT .w ww�ti esti DAO All*K flfl Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record Form 4 JUN a 8 2009 DEP has provided this form for use by local Boards of Health. Othet tLr�T�� i information must be substantially the same as that provided here. B with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left side of house. Right fro , rig re , right si of ho se. forms on the computer,use only the tab key Address p r to move your (� cursor-do not use the return City/Town State Zip Code key. 2. System Owner. 1� ^ ON Name Address(if different from location) CirylTown Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) eptic Tank ® Tight Tank ® Other(describe): 4. Effluent Tee Filter present? ® Yes No If yes,was it cleaned? [3 Yes 0 No 5. Condition of SsteU�m V\,- 8. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio h ntents were disposed: S.D Lowell Waste Water igna ure of H or Date t5form4.doca 06103 System Pumping Recons Page 1 of 1 Commonwealth of Massachusetts RECEEVla� \\\\j City/Town of System Pumping Record MAY 2 9 2007 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health.Other y u e Information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the � computer,use only the tab key Address to move your cursor-do not use the return City/Town State Zip Code key. 2. System Owner: Name Address(if different from location) City/Town Stat �i� Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) 29eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes E;�<o If yes,was it cleaned? ❑ Yes ❑ No 5. Condi n of System: 6. Syste P meed By: Name Vehicle License Number Company 7. Location are conte wer posed: Slgnawe of atQR Date t5forrnCdoc•06103 System Pumping Record•Page I of 1 Town of North Andover f ttORTH a ' do Office of the Health Department Community Development and Services Division M 27 Charles Street North Andover,Massachusetts 01845 �9"s@ ACHU6 t Susan Y.Sawyer,R$HS/RS 978.688.9540-Phone Public.Health Director 978.688.9542-Fax OT C09YPLr. ONCE As of: May 26, 2004 pis is to certify that the individuafsuku ace d o rf asp safsystem repaired -Av 6y Todd Bateson at 426 Summer,Street WorthAndover, XX 01845 has been installed in accordance with the provisions of Title V of the State sanitary Code and with the NorthAndover(Board of iTealth regufttions ?l:e Issuance of this certificate shall'not 6e construed as a guarantee that the system wiff function satisfactorily. S an T.sawyer, QX2E7fS1gU TubCuWealth Director BOARD OF APPEAI S 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The dersigned hereby certify that the Sewage Disposal System( ) constructed; ( repaired; located at was installed in conformance with the North Andover Board of Health approved oved la pp plan, System Design Permit# dated Y g , with an approved design , g flow of 44o 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 al re ulations g , 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. Bed inspection date: -^.lr> �� Engineer Represe tative Final inspection date: ';' [ 2-04 Engineer Representative Installer• -j Date• Design Engineer: t` oti,,., A,� Date: o��,•cKo�� y . DANIEL KORAVOS ___ _ _ CIVIL �43V11i�OF NORTH AC�lU4J`.�f=R% No.37762 BOARD OF H[nLEH` Page 1 of 1 DelleChiaie, Pamela From: Pamela DelleChiaie[pdellechiaie@townofnorthandover.com)on behalf of DelleChiaie, Pamela Sent: Tuesday, May 18, 2004 2:48 PM To: 'Dufresne Bill(E-mail)`; 'Dufresne Bill(E-mail 2)' Cc: Sawyer, Susan; 'Carla.Bums@NEMoves.com' Subject: 426 Summer Street-Need As Built and Certification Forms Hi Bili, We need to close out this file. We need the Final As Built and the certification form signed by youand Todd Bateson. Please forward it asap,as there is a closing on the property at the end of the month. Carla Burns is the realtor. Thank you. Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development&Services 27 Charles Street North Andover, MA 09845 pdellechiaie @townofnortl Lando ver.corn Tel. 978-688-9540 Fax 978-688-9542 Meet People in Just One Click Clic�iliere_.; 5/18/2004 Lvi11 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@ool.com November 17,2003 Mr. Brian LaGrasse,Health Inspector {-,!• Town of North Andover Board of Health 27 Charles Street �(�� 2 2003 North Andover,MA 01845 RE: 426 Stmuner Street �. �,,.....: ... �....- �} Dear Mr. LaGrasse: We have received your letter dated September 8,2003 regarding the above reference site. We have revised the plan(3 copies enclosed) to address all your concerns with exception to items 18 and 21 which pertain to those issues discussed with the Board at last months meeting regarding leach fields and granting of L.U.A.'s. On behalf of our client,we respectfully request the plan be approved as resubmitted. We appreciate your prompt response to this matter. Very holy yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd Enclosure Location: 4'7-,(,, owner's Name: Map/Parcel: A"r'�"r '1� C Wuh— tL Address: �t> L u 4 Thee�-r Installer. Tel Op*12rzN New(SISo) Repair Date. • ��?� etlands ne . II - � ,_„_,,,Solt Symbol,�Soll11hme So . it Class,-,� Deep Observation Hole Logs : - Elevation Depth Solt Horizon, Soil Texture Soil Color Soli hiottlia o 9. /o Gravel,Stones,etc.. r f V V�klkWa Z '5 fZG►�arGaLAS ,, • �•►•iac9 IV� G� �i•L. 4 SYt.4/e. i40 j;A►. e0r• Parent Ataterfal__A�, Dep4i to Bedract r—Standln Nater In the Hot -- u = S9ieepIng fraMPlt Faee�_FSgG%Y;•�� UkANut.� V, FgMAIOJA; . i �'Gy, Zf 5�t%, �wWCm N1a91Iv�� IWE19� - Patent Mo-CrtaI 1 Lli��bep8i to Bedtaelt` Stenndlns Nater in flee Hole: Weeptnt from Pit Facee��G1Yt`J. Date Percolation Tests Observation Hole! j Depth of Pere t ' Start Pre-soak . Time at 12" j Time at 91, t , Time at 6" Time(9"-6") -Rate Minllnch Performed By _Witnessed B�•• p . - r Y FORM 9A _ Application for Local Upgrade Approval Commonwealth of Massach usetts Massachusetts .. Applic-anon for-LOCAL UPGRADE APPROVAL Title 5,-310 CMR 15.000 DEP Approved Form Required by 310 CMR 15.403(1) Form 9A Is to be submitted.to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where4ull compliance,as defined in 310 CMR 15.404(1),Is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405,or in full .-compliance with the requirements of 310 CMR 15.000,require a variance pursuant to 310 CAIA 15.410 through 15.417, UTE:Local upgrade pMOval a � ' shall not be granted for an upgrade proposal that includes the addition of a new design now to a cesspool or-privy,or the addition of anew design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. FacilityAddress: +V/ Nl City/Town: . Facility/System owner: -TT-1 C e l�f('1 A 11 L � ��/ !��,��f�� Address: a'''"q` �� Y` ""41vtll City/Town: Telephone: State: Zip: Type of Facility(check all that na-•ply): residenal []Institutional ❑CDescribe facility ommercial ❑School Type of existing system: ❑Privy ❑Cesspool(s) ❑Conventional System ,Other(describe) t!o Type of soil absorption system(trenches,chambers,leach field,pits,etc) jj tq/ ,y Design Flow per 310 CMR 15.203:. Design flow of existing system d Design flow of proposed upgraded system gPd Design flow of facility g gpd. Proposed upgrade of system is: ETV0IuntWY 0 Required by order,letter,etc.(attach copy) ❑Required following inspection pursuant to 310 CMR 15,301 Provide date of inspection FORM 9A - Application for Local Upgrade Approval Department of Environmental protection DEP Approved Farm—3/20/02 Page 1 of 3 r r Describe'the proposed upgrade t��o``the system Mfl"7`�A SSry -�� Jl��_ r.o��i 9f0��lr�t-,� a2I rl_ Local Upgrade Approval is requested for: _ �. [}� Reduction is setbacks) (Describe reductions) 15,41, ❑ Percolation rate for 30 to 60 min/inch Percolation rate min/inch ❑ Reduction in SAS area-of up to 25% (SAS size and%reduction) SAS sq ft Reduction % Reduction in separation between the SAS and high groundwater Separation reduction ft Percolation rate�� min/inch- Depth to groundwater .#} a ❑ Relocation of water supply well(Explain) ❑ Other requirements of 310 CMR 15.000 that cannot be met Describe and specify sections of the Code .Tf the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation,an Approved Soil Evaluator must determine the. high groundwater elevation pursuant to 310 CMIZ 15.4.05(1)(i)(1),The soil evaluator must be a'member or agent olhe local annroviny authority, High groundwater elevation determined by: / OZ (Print or type evaluator's Name) (Signature of evaluator) (Evaluation Date) Explain why full compliance,as defined in 310 CMR 15.404(1),is not feasible. (Each section must be completed) 1. An-upgraded system in full compliance with 310 CMR 15.000 is not feasible: —IV HQ12r an. Y� 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 Is not feasible: Department of Environmental Protection DEP Approved Fonn—3/20/02 Page 2 of 3 f ' FORM 9A - Application for Local Upgrade Approval 3. A shared system is not feasible:_ ,(�A 4. Cannection to a public sewer is not feasible: A/& �?j g7L,r�ygL The Application for Local Upgrade Approval must be accompanied by all of the following: (Check the appropriate boxes) ❑ Application for Disposal System Construction Permit Complete plans and specifications [ Site evaluation forms ❑ A list of abutters affected by reditced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.4 P 05(2). ❑ Other(List) CERTIFICATION. "I,the facility owner,certify under penalty of law that this document and all attachments,to the best of my knowledge and belief,are true,accurate,and complete.I am aware that there may be significant consequences for submitting false information,including,but not limited to,penalties or fine and/or imprisonment for deliberate violations. Facility owner's s n tur `/��. Da e�l�•�/0� Printname Name of preparern-r1-,j.MjWwjd2Date / 0 3 Preparer's Address: Clty/Town: CkadjIL, State: . Zip: tpi Preparer's telephone:-[ax ) tj�—�,�e�s"— OTE: 310 CMR 15.403(4)requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection,Bureau of Resource Protection,Division of Watershed Management,upon Issuance by the local approving authority and before commencement of construction. Department of Environmental Protection DEP Approved Form—3120/02 Page 3 of 3 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 I . , - 6 ?002. APPLICATION FOR SOIL TEST'S DATE: - •-D i MAP &PARCEL: TH I& A TL 70 LOCATION OF SOIL TESTS: 4 L(, (2upiti al, 4,rrwer ' ZLrL = OWNER: , _ ITEL.NO.: G'm jjaL �t GONI Vst 14 ADDRESS: ENGINEER: TEL. NO.: �� CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision (!mgle, amily H e Commercial Is This: Repair Testing: Undeveloped Iot testing: In the Lake Cochichewick Watershed? Yes No L/ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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$200.00 per lot for repairs or mpgmdes. (If time.is not critical, fee for repairs is$75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing, 6. Within 45 days of testing, a scaled plan(no smaller than F"- shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation foims shall be submitted. Please Leo Not..Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: :C 4 StigO/Y/S/ON OF LANG � /vo,e7w Aivoovs e. 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Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of house, Left/QtTo ous eft/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address `- I jl a C" Citylrown � State Zip Code 2. System Owner. Name Address(if different from location) RECEIVED citylrown Ste APR 2. 12015 Telephone Number TOWN OF NORTH ANDOVER z HEALTH DEPARTMENT B. Pumping Record l q�-I � / : 1. Date of Pumping Date 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes a<o If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of s, to 6.- System Pumped By. Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati contents were disposed: Cx�S. Lowell Waste Water Sign Haule Date t5form4.doe-06/03 System Pumping Record•Page 1 of 1 DelleChiaie, Pamela From: benjamin osgood [bosgoodpe@gmail.com] Sent: Wednesday, April 20, 2011 10:01 AM To: DelleChiaie, Pamela Subject: As Built Good morning Pamela, I am doing a Title 5 inspection at 426 Summer Street. Could you send me a copy of the as built plan? thank you for your help Ben Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. o � 1 . Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH Q�tt�Evb q/�p 3••y s p a A APPLICATION FOR SITE TESTING/INSPECTION ArED ��SSACHUSE��y Applicant —G /J/ C6 !i NAMEADDRESS ��- TELEPHONE Site Location-7 ol &I ocation7o&// Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time HAIRMAN,BOARD OF HEALTH f Fee-0 Test No. A% S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. }' Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH Q�SS 46 0- i R o.,.._,, ,>° • APPLICATION FOR SITE TESTING/INSPECTION ACHUs��y t f _ Applicant NAME ADDRESSc�- TELEPHONE Site Location �f,0l//2 ' Engineer NAME s ADDRESS TELEPHONE Test/Inspection Date and TimeAD CNAIRMAN,BOARD OF HEALTH Fee Test No. f0� s , i s S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. - r Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record _SAV Form 4 JUN _ 8 2009 DEP has provided this form for use b local Boards of Health. Othe iO �([y�(y Q(�SFT �{�Atfyy��$Qyyf9 P Y HE�L'1�'i7�'A�4�IEI�P information must be substantially the same as that provided here. B with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left sideof house. Right fro , righ rea , right s of h6use. forms on the computer,use only the tab key Address to move your cursor-do not use the return Cityfrown State Zip Code key. 2. System Owner: Name Address(if different from location) City/Town Telephone Number B. Pumping Record J 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: Cesspool(s) eptic Tank 0 Tight Tank Other(describe): 4. Effluent Tee Filter present? Yes No If yes,was it cleaned? Yes No 5. Condition of S,yste/ V\,- 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ntents were disposed: zl�.L.S.D Lowell Waste Water igna ure of H u r Date t5form4.doc•06/03 ' System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record MAY 2 9 2007 r` Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Othermay u t e information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location- forms on the tr ` -- computer,use only the tab key Address L4r--:) : � S V��•0 � — to move your �j ��Y cursor-do not City/Town State Zip Code use the return key. 2. System Owner: qQ \ Name ISI Address(if different from location) City/Town State ]Code Telephone Number B. Pumping Record � �, � 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ,®-�o If yes,was it cleaned? ❑ Yes ❑ No 5. Condi ' n of System: 6. Syste P mid By: Name Vehicle License Number Company 7. Location ere conte wer ' posed: Signat of a I Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Town of North AndoverNORT#1 O tt�c°Y6g4•G Office of the Health Department 1°- t A Community Development and Services Division19 27 Charles Street North Andover,Massachusetts 02845 CHU Susan Y. Sawyer, REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax fYFR Ig7IC42E Off' COW<1'. JANCE As of: May 26, 2004 ghis is to cert that the individual su6surface d4osal system repaired(f' by Todd (Bateson at 426 SummerStreet North Andover, WA 01845 has been instalred in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover 0oard of feafth regulations. The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. S an `Y. Sawyer, WREJfS1QU fu6fw Ifealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( ) constructed; ( vfrepaired; by 'Ta pry ffi&T-a located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# , dated , with an approved design flow of�gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Represe tative Final inspection date: r Engineer Representative Installer: Lic.#: Date: 4(/ Design Engineer( �q-,, 'j! Vt�� Date: `5'of 'lad OFMgs, 0 ti 7 DANT EL G � N o KORAVOS CIVIL No.37752 Cn TOWN OF NORTH ANDOVER/ BOARD OF HEALTH �0/STEQ`� xvAic MAY 2 4 2004 j Page 1 of 1 DelleChiaie, Pamela From: Pamela DelleChiaie [pdellechiaie@townofnorthandover.com] on behalf of DelleChiaie, Pamela Sent: Tuesday, May 18, 2004 2:48 PM To: 'Dufresne Bill (E-mail)'; 'Dufresne Bill (E-mail 2)' Cc: Sawyer, Susan; 'Carla.Bums@NEMoves.com' Subject: 426 Summer Street-Need As Built and Certification Forms Hi Bill, We need to close out this file. We need the Final As Built and the certification form signed by you and Todd Bateson. Please forward it asap, as there is a closing on the property at the end of the month. Carla Burns is the realtor. Thank you. Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development& Services 27 Charles Street North Andover, MA 09845 pdellechiaie@townofnorthandover.com Tel. 978-688-9540 Fax 978-688-9542 Meet People in Just One ClickL_Cli-k-Here 5/18/2004 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com November 17, 2003 Mr. Brian LaGrasse, Health Inspector Town of North Andover Board of Health 'NOV 2000 27 Charles Street �� North Andover, MA 01845 RE: 426 Summer Street Dear Mr. LaGrasse: We have received your letter dated September 8, 2003 regarding the above reference site. We have revised the plan(3 copies enclosed) to address all your concerns with exception to .items 18 and 21 which pertain to those issues discussed with the Board at last months 1 (meeting regarding leach fields and granting �- On behalf of our client, we respectfully request the plan be approved as resubmitted. We appreciate your prompt response to this matter. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd Enclosure Location: 1- owner's Name:- ! Map/Parcel: Address: Installer. Telt 32 4- -414 New iSiSol Repair ✓ Date:IQ•Z�t7Z Wetlands lone II Soil Symbol G _Soil lQame r Soil class–.F— Deep lassDeep Observation Hole Lo s Elevation Depth Soil Horizon Soil Tem- re Soil Color Soil hlottlino 0 . /o Gravel,Stones,etc lo 10/3 • f!121!tr�►1.� hey* iV C 7'f i Parent hfaterial ekl LL'_Depth to Bedrock==:Standin \Vater in the Hole: —Weeping from i Pit Face= ESHGtV:�_ Z 09• olt �S4 . Ifl� y1 .i r V. F;MA019, t F Ly, 5yKA! IlAfflj("- Parent Material 14,1 ,l Depth to Bedroll. Standing Water ht the Holr. e,VK � _ p ,,from Pit Face ESHG%V.57 r Date_ Percolation Tests Observation Hole Depth of PAak Start Pre-s Time at 12Time at 9" Time at 6"Time(9"-Rate Mim4 Performed B��_ Witnessed RN. An FORM 9A - Application for Local Upgrade Approval Commonwealth ofMassachusetts ,Massachusetts (City/Town) Applie—a-ow--for FOCAL UPGRADE APPROVAL Title 5,310 CMR 15.000 .DEP Approved Form Required by 310 CMR 15.403(1) Form 9A is to be submitted.to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance,as defined in 310 CMR 15.404(1),is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405,or in full ..compliance with the requirements of 310 CMR 15.000,require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be ranted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy,or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. Facility Address: 47,te City/Town:� Facility/System owner:TN E 11.l Cl Address: ` ` �(7'f� �1 ccr-1 f51L' City/Town: Telephone: State: Zip; Type of Facility(check all that apply): 9 esidential ElInstitutional ❑Commercial ❑ School Describe facility U 17L' occ,fJ Type of existing system: ,_❑.,/Privy ❑ Cesspool(s) []Conventional System tl Other(describe) Ido 1:r-",a) Type of soil absorption system(trenches,chambers,leach field,pits,etc) Lt t) Design Flow per 310 CMR 15.203: Design flow of existing systemLW d Design flow of proposed upgraded system � Design flow of facility A4 Agpa _ gpd Proposed upgrade of system is: oluntary ❑Required by order, letter,etc.(attach copy) ❑Required following inspection pursuant to 310 CMR 15.301 Provide date of inspection 1'10—:1111111111 FORM 9A - Application for Local Upgrade Approval Department of Environmental Protection DEP Approved Form-3/20/02 Page 1 of 3 t Describe the proposed upgrade to the system mg;L 115or, "L ye, I AA 1,69po E AL, 19u j4 g1T- s u.1c&y�,y/_J_' O-S7f0 igjut.=�r9r-t!:> / Local Upgrade Approval is requested for: Reduction in setbacks " Lam' O (Describe �,.®,.5.. --ip-... ._�-p_r-&a. . ❑ Percolation rate for 30 to 60 min/inch Percolation rate min/inch ❑ Reduction in SAS area of up to 25% (SAS size and%reduction) SAS sq ft Reduction Reduction in separation between the SAS and high groundwater Separation reduction eq.0 ft Percolation rate_mintinch' Depth to groundwater ft ❑ Relocation of water supply well(Explain) ❑ Other requirements of 310 CMR 15.000 that cannot be met Describe and specify sections of the Code If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation,an Approved Soil Evaluator must determine the. high groundwater elevation pursuant to 310 CMR•15.4.05(1)(i)(1).The soil evaluator must be a'member or agent of the local aoorovina authority. High groundwater elevation determined by: ' —�ZA1l 2}�J� 12i°L (Print or type evaluator's Name) (Signature of evaluator) (Evaluation Date) Explain why full compliance,as defined in 310 CMR 15.404(1),is not feasible. (Each section must be completed) ' t 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: 2 An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: I Department of Environmental Protection DEP Approved Form—320/02 Page 2 of 3 r FORM 9A - Application for Local Upgrade Approval 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: Nmwa Av4yLAtp5,4 eas 'The Application for Local Upgrade Approval must be accompanied by all of the following: . (Check the appropriate boxes) ❑ Application for Disposal System Construction Permit [� Complete.plans and specifications Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List) CERTIFICATION: . "I,the facility owner,certify under penalty of law that this document and all attachments,to the best of my knowledge and belief,are true,accurate,and complete.I am aware that there may be significant consequences for submitting false information,including,but not limited to,penalties or / fine and/or imprisonment for deliberate violations. Facility owner's s' natur Da Print name 't 41 - �� I Name of preparer ' Date Preparer's Address: City/Town: �r- f)g!�_ State: kt4:5S Zip: OW�.p Preparer's telephone:_(!Im ) �— NOTE: 310 CMR 15.403(4)requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection,Bureau of Resource Protection,Division of Watershed Management,upon issuance by the local approving authority and before commencement of construction. Department of Environmental Protection DEP Approved Form-3/20/02 Page 3 of 3 BOARD OF HEALTH NORTH ANDOVER, MA 01845 .x' _711 978-688-9540 6 2002 APPLICATION FOR SOIL TESTSr DATE: - --OZ, MAP &PARCEL: T11 la?a TL 170 LOCATION OF SOIL TESTS: p OWNER: I ,6 F 6T, AL16d MM&TEL. NO.: of 75 C v I L" COH ea 4 ADDRESS: ENGINEER: _0'C��1�-I NI�G�i �iJC _TEL. NO.: CERTIFIED SOIL EVALUATOR: A LL' Intended Use of Land: Residential Subdivision mgl amily He Commercial Is This: Repair Testing: (.� Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No Ll THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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$200.00 per lot for repairs or gpigrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"A 00') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please I0o NoX Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: i ill :r 541BO/V/5/ON OF LANO i is-- /3 -+•b,,_, "COL.O/V/AL AC eE5 NOeTf-1 A/VOOVE',e, MASS. AS SU2VE✓EO Fbe .SCALE:/'4006LEMBE.Q /966 � eaerx fr, Pa6eeu rn. �J/j� `\// ✓.8✓ ryafrs!Ef.I[i6J1YAe0f / 0/nni�Be..d�PPro vc/Und� �r/'///`' .... — ... •:�•` ��6�L'�y N/ sls.e Aeeea. ,f•o,P 5/,'117 / 1A 4a;60o,.' h 45,Z6 o4, 44 4a.230 f: ♦� So,/28 1/+ S 5/7 j , ...... /� O r 49.a6Br' a 2bS f-FA.ne lw. , V v _,�-.O L=.i LO N 0 I 10IM DE I Cir C' I I NI L..•i ��„C A . i itvIE i Twl` I ItVi� .n. I Y� !? Ck i' c i 4 1 � � r - - rt� UILDI :I Eh ,f ocrn t -rfl is JoT W_o ppilti• .7 27" s46 a IJ�'"'Lh�.ITY o T►�c 'S�•+$Summa ar.� 4%(4'feH , ST is A Zieww VP 149 L6x+trb►J IG-_rA AW E L,L Vorno61 of 'A.4, yrs q-1111 it �� Z 7• �3 617 oil „ h it ##1 i Ito ploy �o vrz UT I r � AS WILT PLAN °FSLjBSU-RFACE� SYSTEM guru T w14 of NORTH ANDD Fv WCATEID IN A t� BOARD OF HUXTH Oz i—t�f D� Dt I I `�7. /�T�.CO %�-�N"°J �T�YZ' AS PREPARED FOR ��,cK oFMgss9 °Q �l 'MAY��20fl �� DANIEL oy r� tl. ,G C� L4 ,ivnN i4oij r- o KORAVOS m o TE'1 1 -2 CIVIL DATE: '7�- I Ol.{ NO:37752 SCALE: 4,+d '701 9F�J do T \� MER RIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER. MASSACHUSETTS 01810 or TEL (617) 475.3533. 373-5721 i Town of North Andover F 40RTh Office of the Planning Departments04 o Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 �SSAcr+us�t http://www.townoffiorthandover.com Town Planner P (978) 688-9535 Julie Parrino F (978) 688-9542 INFORMATION REQUEST TOWN PLANNER Please use this form if the Town Planner is unavailable to provide immediate assistance. The Planner can provide information on new development in Town, Planning Board actions and meetings, and Planning Board application procedures. Please fill out the attached form in its entirety to ensure an accurate and prompt response. All requests for information will be handled as soon as possible. CONTACT INFORMATION Date: Name: Phone number: Fax number: Address: INQUIRY Property in question: (Please include as much information as possible, e.g.: address; tax map and parcel number, subdivision or site plan name.) Inquiry: Thank you for your interest and inquiry. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 �) ID e�b✓I i�� AS-BUILT CHEECKLIST LOT NUMBER, STREET NAME p ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES &DWELLING, WELLS '�"'a. FROM SEPTIC TANK E/b. FROM LEACH AREA lam' LOCATIONS OF DEEP HOLES &PERE TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION ' LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE ✓ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW �/� LOCATION&ELEVATIONS OF BENCHMARK USED /�� j/a` y G� � �� ^; N;11�yS� � � C� �,f �eC�v rl36 3� SYY� Commonwealth of Massachusetts Map-Block Lot 107.A-0078- ----------------------- Board Of Health Permit No -20 North Andover BHP04"0? ----P-20------------- P.I. FEE F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No -426--SUMMER-STREET as shown on the application for Disposal Works Construction Permit No.-BHP-2004----02 - - ---Dated February 26,2004 -------------- ------------------------ -----I�- '---------------------------------- Issued On:Feb-26-2004 Bo Of Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map-Block-Lot 107.A-0078- Board Of Health ----------------------- North Andover Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by Todd Bateson -------------------------------------------------------------------- ---------- ------------------------------------------------ - Installer at No 426 SUNMER STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2004-029 r Dated _ February_26,2004_ ----------------------------------------------------------------- Printed On:Feb-26-2004 Board Of Health S TOWN OF NORTH ANDOVE BOARD OF HEALTH W� 0Z Location Permit # / Food Service Retail Food ��/f $ Limited Retail $ Seasonal $ Disposal Works Installers /g Disposal Works Construction Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 7480 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer a w v' APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTA LER �� S-13 SIGNATURE: TELEPHONE# k7 FrIS- °3 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. -0 d �� Administrative Use Only �J $ .00 Fee Attached? Yes No Foundation As-built? Yes No Floor plans onj es No Approval f Date: �[ 61 1 INSTALLER PROJECT MANAGEMENT OBLIGATIONS J./ As the North.Andover licensed installer for the construction of the septic system for the property at �-loY s ,� 5 relative to the application , of lodto �i_dated i�-�'o dL for plans by K P1,4( "`j and dated v7 with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto project manger, or any other person not associated with my company schedules an inspectio and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicabl inspections as indicated below. I understand that requesting an inspection,. withou completion of the items in accordance with Tile 5 and the Board of Health Regulations fila: result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally.fsrst inspection unless there is a retaining wall which should be dons first. InstalWinust request the inspection but does not have to be present. b) Final inspection — Engineer must.fust do their inspection for elevations, ties, etc. As-built of verbal OK from engineer must be submitted to Board of Health, after which installer calls foi inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready.and able to cause pump to work and alarm to function. quest inspection when all gradifig is complete.. Does not have to be c) Final Grade—Instalier must re on site. 3. As the installer I understand that persons or companies not associated with.my company may not perform the work required by my company to complete the installation of the system identified in.the attached application for installation. I further understand that work by others unlicensed to installseptic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. n of 5. As the installer I understand that I osolelythe homeole for the wner, generalaclontractort or any they he system as per the approved plans. No instructs y persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Disposal Works Construction Permit# INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO itials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon V 3. Edge of excavation specified distance from oundation,etc. Comments: ,t B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer I. Pipe diameter minimum 4" Z ' ✓� 2. Schedule 40 pipe l 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base - 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90°change 10. 10' minimum offset to water line -- Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20"manholes 7. Inlet tee minimum 12"under invert 8. Outlet tee minimum 14"under invert 9. Outlet line cemented 10. Air space 3"above tees 11. 2"-3"drop from inlet to outlet 12. Pipe set 13. Compact base with 6"of 1/4"crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber / 1. If separate from tank,compact base with 6"of 3/4"stone underneath 2. Minimum 2"pipe to d-box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size.agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d-box Comments: F. Distribution Box I. D-box level 2. Minimum 0.IT'(2")drop from inlet to outlet 3. Minimum 6"sump 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe - Comments: G. Soil Absorption system I. All stone double-washed-'/s"- 1 '/z" -pea stone Bucket test done? 2. Minimum 2"of pea stone above distribution lines 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope 6. Minimum of 9"of fill graded over system 7. Toe.of slope stops minimum 5' from edge of property; if not,then Swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan-Minimum maxi um-4'. 4. Vent present if<50 feet or specified 5. Distance between trenches minimum 4'and maximu of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6"per 100' S. Depth of trenches below outlet invert minimum of ". VI Yes NO 9. Pipes set on stable base. Comments: I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipe 6'maximum 4. Pipes connected at end 5. Separation between adjacent fields 10'minimum 6. Pipes set on stable base 7. Maximum 4'separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: I Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48"wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond ��A I'' 7i � a s 44 3 � . P-- - 0 µORTPI TOWN. OF NORTH ANDOVER HEALTH DEPARTMENT ° . p Y Y 27 CHARLES STREET • � � " NORTH ANDOVER, MASSACHUSETTS 01845 SACHUS Heidi 6rifjin Community Development Director (978)688-9540 -Phone Acting Health Director (978)688-9542 -Fax FAX Bill Dufresne From: Pamela To: MERRIMACK ENGINEERING 66 PARK STREET Andover, MA 01810 Fax: 978-475-1448 Pages: 1 �..J Phone: 978-475-3555 Date: T3 G Septic Plan Response CC: Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Homeowner Town of North Andover o� NORTH � Office of the Health Department �� E°_ O 9 Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 9SSgCHU Sandra Starr Telephone (978) 688-9540 Public Health Director Fax(978)688-9542 January 7, 2004 Daniel Koravos Merrimack Engineering Services 66 Park Street North Andover,MA 01845 Re: 426 Summer Street,Map 107A,Lot 78 Dear Mr. Koravos, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by Merrimack Engineering Services dated December 3, 2002. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance,must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid may be reduced by the North Andover Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(310 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Though not a reason for disapproval, you are encouraged to consider the following items: 1. Your design includes a requirement for a butyl wrap around the pump chamber. You may wish to review this requirement and if maintained,provide improved specifications for the contractor to follow. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 w 2. You may be able to reduce drainage and fill issues with use of an impervious barrier in compliance with in compliance with the Massachusetts Department of Environmental Protection Policy BRP/DWM/WPeP/G02-1. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sin /el,,,,B isasse Health Inspector cc: Homeowner File Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@milldverconsulbng.com] Sent: Thursday, December 04, 2003 9:09 AM To: 'Heidi Griffin'; Brian LaGrasse; Pamela Dellechiaie Subject: 426 Summer Street Heidi, Brian and Pam, We have reviewed the revised septic design plan for 426 Summer Street and wish to discuss this matter with someone from your office. We are not certain how to interpret Title 5 versus what we believe was indicated by the Board of Health at a recent meeting. Please call at your earliest convenience. Thanks, Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultin�,g com info@millriverconsultina.com 12/4/2003 Town of North Andover 0..d-o n NORTH Office of the Health Department o � Eo 6},�°IL ? O Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 4SSaCHUS�� Sandra Starr Telephone (978) 688-9540 Public Health Director Fax (978) 688-9542 January 7, 2004 Daniel Koravos Merrimack Engineering Services 66 Park Street North Andover,MA 01845 Re: 426 Summer Street,Map 107A,Lot 78 Dear Mr. Koravos, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by Merrimack Engineering Services dated December 3, 2002. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed b the installer, designer and the Town of North Andover. The time period for which this plan ' Y � pe p Is valid may be reduced by the North Andover.Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. I This approval is subject to the following conditions: 1. If site conditions are foundin the field to be different from those indicated on the design plan. and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Though not a reason for disapproval, you are encouraged to consider the following items: 1. Your design includes a requirement for a butyl wrap around the pump chamber. You may wish to review this requirement and if maintained,provide improved specifications for the contractor to follow. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 685-9540 PLANNING 688-9535 4 s/ 2. You may be able to reduce drainage and fill issues with use of an impervious barrier in compliance with in compliance with the Massachusetts Department of Environmental Protection Policy BRP/DWM/WPeP/G02-1. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sin el a J. LaGrasse Health Inspector cc: Homeowner File MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS_ • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com December 11, 2003 Mr. Brian LaGrasse Health Inspector -� 1 2 Office of Community Development and Services ; . — - -- _J 27 Charles Street North Andover, MA 01845 ' 1" RE: 426 Summer Street Dear Mr. LaGrasse: I appreciate your speaking with me regarding your letter dated December 8, 2003 for the above referenced project. As discussed, I have revised the plan to address items 2 and 3 of your letter. Also as discussed,no further action is required regarding items 1, 5 and 6. With regards to item #4, all necessary pump calculations have been provided. No control panel details are required and it is noted on the plan that the pump shall be installed according to Title 5 specs and the manufacturers specs and shall be installed by a Licensed Electrician. Flow back volume has not been ignored, but is 15 gallons or .057 vertical feet and is negligible with respect to this design. Finally, with regard to item#7, reduction of the separation to groundwater by 0.5 feet has a significant impact horizontally in that it allows for compliance with the breakout requirements without requesting a waiver from grading requirements and eliminates the need for a retaining wall. We feel this plan, as revised, meets all of your concerns as we discussed and respectfully request this design be approved as resubmitted. Very truly yours, MERRIMACK ENGINEERING SERVICES Lo�'�_ William Dufresne Project Manager cd w t%ORTH q TOWN OF NORTH ANDOVER 0 '6 ,. HEALTH DEPARTMENT 27 CHARLES STREET # � oq ,fir NORTH ANDOVER,MASSACHUSETTS 01845 �qs§��•� $ACNUS Sandra Starr,R.S.,C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 i FAX Bill Dufresne From: Pamela To: MERRIMACK ENGINEERING 66 PARK STREET Andover,MA 01810 978-475-1448 Pages: Fax: 978-475-3555 Date: Phone: Septic Plan Response CC: Re: ❑ Urgent x For Review ❑Please Comment ❑ Please Reply ❑ Please Recycle • Comments: At is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Homeowner w HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 Dec 09 2003 3:49pm Last Transaction Date Time Type Identification Duration Pages Result Dec 9 3:44pm Fax Sent 819784751448 4:14 6 OK I TOWN OF NORTH ANDOVER Gf 10R7H 1 Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT a 27 CHARLES STREET ' " NORTH ANDOVER,MASSACHUSETTS 01845 RSSACHUSES Heidi Griffin 978.688.9540—Phone Acting Health Director 978.688.9542—FAX December 8, 2003 Daniel Koravos Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: 426 Summer Street, Map 107A,Lot 78 Dear Mr. Koravos: The proposed septic system design plans for the above site dated November 15, 2003 have been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval: 0 A.. Soil compaction beneath the distribution box should be specified since it is indicated to place the structure in fill material rather than in native soil. (3 10 CMR 15.221) 2. Please provide distances from the septic tank and soil absorption system to the property line. (NA 8.03) 3. Please indicate that removal of soil horizons A&B shall extend at least 6" into the suitable soil of the C horizon. (NA 9.02) 04. Pump calculations and control panel details are not provided, nor does it appear that the drainback volume of the pipe volume has been included in the design calculations. (3 10 CMR 15.220 and 23 1) 5. Trenches are the required type of soil absorption system when using pressure dosing of effluent. (3 10 CMR 15.254) 6. The drainage swale provided to collect surface runoff due to the grading provided within 5' of the southern property line should encourage the retention of water on the subject parcel rather than shedding water onto the adjacent property as proposed, (3 10 CMR 15.255) 61L '-07. A Local Upgrade Approval for reduced separation from the bottom of the soil absorption system to the estimated seasonal high ground water is requested with this design. This is requested because of limited horizontal space as indicated on Form 9A. Reducing the separation distance in this instance has little impact on the horizontal space needed. Inadequate justification has been provided as to why full compliance with the code is not feasible. (3 10 CMR 15.405) Though not a reason for disapproval, you are encouraged to consider the following items: 1. Providing several distance ties to fixed objects and the proposed soil absorption system will assist with placement during the construction phase. 2. Your design includes a requirement for a butyl wrap around the pump chamber. You may wish to review this requirement and if maintained, provide improved specifications for the contractor to follow. 3. The design appears to specify a pump size larger than required for adequate wastewater transport to the soil absorption system. You may wish to consider utilizing a smaller pump or utilizing a mechanism to reduce the flow rate at the distribution box such as the use of a settling box or a larger volume pipe at the inlet. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerelyb7t� /� � B in LaGrasse Health Inspector cc: Homeowner CD&S Dir. File Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@milldverconsultng.com] Sent: Monday, December 08, 2003 11:22 AM To: Heidi Griffin; Brian LaGrasse; Pamela Dellechiaie Subject:426 Summer.Street version 2 Heidi, Brian and Pam, Attached please find a revised plan review letter for 426 Summer Street. One paragraph was changed to more accurately reflect the regulatory requirement. Sorry for any confusion. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com 12/8/2003 k- TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 9SSRCHU Sandra Starr,R.S.,C.H.O. (978)688-9540-Telephone Public Health Director (978)688-9542-Fax TO: From: Fax: Pages: Phone: Date: Re: CC: ❑Urgent ❑ For Review ❑Please Comment ❑Please Reply ❑Please Recycle e Please call 978-688-9540 for assistance with any questions. Thank you. xc: Address File Chrono File TOWN OF NORTH ANDOVER o�NOR=N Office of COMMUNITY DEVELOPMENT AND SERVICES o °`'� 0. HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845CHU cwusss Heidi Griffin 978.688.9540—Phone Acting Health Director 978.688.9542—FAX September 8, 2003 Daniel Koravos Merrimack Engineering Services 66 Park Street North Andover, MA 01845. Re: 426 Summer Street, Map 107A, Lot 78 Dear Mr. Koravos: The proposed septic system design plans for the above site dated December 3, 2002 have been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval: 1. Please provide the full legal boundaries and abutters of the property being served. This may be accomplished on a separate sheet if necessary due to the parcel size. (3 10 CMR 15.220 and NA 8.02j) 2. Please provide the record name and mailing address of the current owners on the design plan. (NA 8.02k) 3. The system profile indicates it is to both horizontal and vertical scale however certain features, notably the pump chamber, do not appear to be at scale. (3 10 CMR 15.220 (4)and NA 8.02) 4. Please provide the engineering discipline within your stamp. (MGL c. 112 s. 81M) 5. A note is required specifying watertight joints in the building sewer. (3 10 CMR 15.222(3)&(4)) 6. A note is required stating the building sewer shall be laid on a compact, firm base. (3 10 CMR 15.222(5)) 7. Tees on septic tank must extend 6" above flow line, and it is unclear from the plan whether this is proposed. (3 10 CMR 15.227(1)) 8. There must be a 9" air space above the flow line, and it is unclear from the plan whether this is proposed. (3 10 CMR 15.227(4)) 9. Inlet and outlet tees must be located on the centerline of the tank and it is not clear from the plan that this shall be required. (3 10 CMR 15.227(1)) 10. The septic tank and pump chamber must have 9" min cover. It does not appear that this is provided. (3 10 CMR 15.228(1)and 221(7)). 11. The septic tank and pump chamber loading must be stated on the plan. (3 10 CMR 15.226(3)) 12. The construction of access manholes in the septic tank does not coincide between the detail Section View and Top View. 13. Buoyancy calculations should be provided as the concrete tanks will intersect the estimated seasonal high ground water. (3 10 CMR 15.221) 14. Distribution box invert elevations are not provided. (3 10 CMR 15.220) 15. Soil compaction beneath the distribution box should be specified. (3 10 CMR 15.221) 16. Please provide the specifications, or reference to the appropriate code section standards, for the fill material indicated in note 4 and depicted on the site plan. (3 10 CMR 15.220) 17. Pump calculations, control panel details and pump curve are not provided. (3 10 CMR 15.220 and 23 1) 18. Trenches to be used as the soil absorption system mechanism whenever possible. Please use trenches in this instance or explain why they were not utilized. (3 10 CMR 15.240) 19. Please detail the mechanism for removing storm water runoff onto the soil absorption system from the driveway. (3 10 CMR 15.240& 245) 20. Please provide a drainage swale to collect surface runoff duo to the grading provided within 5' of the southern property line. (3 10 CMR 15.255) 21. A Local Upgrade Approval for reduced separation from the bottom of the soil absorption system to the estimated seasonal high ground water is requested with this design. This is requested because of limited horizontal space as indicated on Form 9A. Reducing the separation distance in this instance has little impact on the horizontal space needed. Inadequate justification has been provided as to why full compliance with the code is not feasible. (3 10 CMR 15.405) Though not a reason for disapproval, you are encouraged to consider the following items: 1. Providing several distance ties to fixed objects and the proposed soil absorption system will assist with placement during the construction phase. 2. Dosing greater than once per day increases the efficacy of wastewater treatment and reduces possible ponding problems with the soil absorption system. You are encouraged to review the currently proposed once daily dosing. 3. Your design includes a requirement for a butyl wrap around the pump chamber. You may wish to review this requirement and if maintained, provide improved specifications for the contractor to follow. 4. You may be able to reduce drainage and fill issues with use of an impervious barrier in compliance with in compliance with the Massachusetts Department of Environmental .Protection Policy BRP/DWM/WPeP/G02-1. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Brian LaGrasse Health Inspector cc: Homeowner CD&S Dir. File Page 1 of 1 Pamela DelleChiaie From: "Dan Ottenheimer"<info@millriverconsul6ng.com> To: <biagrasse@townofnorthandover.com>; <pdellechiaie@townofnorthandover.com> Sent: Monday, September.08,2003 4:35 PM Attach: Summer St.#426 Plan Review.doc Subject: 426 Summer Street Plan Review Brain and Pam, Attached please find the plan review letter for 426 Summer Street. Dan Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 info@milldverconsuIting.com 9/9/2003 Town of North Andover pOR71 , 1 ,9016 Office of the Health Department Community Development and Services Division p 27 Charles Street North Andover,Massachusetts 01845 'ssACKusg� Sandra Starr Telephone(978)688-9540 Public Health Director Fax(978)688-9542 September 8,2003 Daniel Koravos Merrimack Engineering Services 66 Park Street North Andover,MA 01845 Re: 426 Summer Street,Map 107A,Lot 78 Dear Mr. Koravos: The proposed septic system design plans for the above site dated December 3,2002 have been reviewed. Unfortunately,the plans cannot be approved as submitted. The following items are in need of attention prior to approval: I. Please provide the full legal boundaries and abutters of the property being served. This may be accomplished on a separate sheet if necessary due to the parcel size. (3 10 CMR 15.220 and NA 8.02j) 2. Please provide the record name and mailing address of the current owners on the design plan. (NA 8.02k) 3. The system profile indicates it is to both horizontal and vertical scale however certain features,notably the pump chamber,do not appear to be at scale. (3 10 CMR 15.220(4)and NA 8.02) 4. Please provide the engineering discipline within your stamp. (MGL c. 112 s. 81 M) 5. A note is required specifying watertight joints in the building sewer. (3 10 CMR 15.222(3)&(4)) 6. A note is required stating the building sewer shall be laid on a compact, firm base. (3 10 CMR 15.222(5)) 7. Tees on septic tank must extend 6"above flow line, and it is unclear from the plan whether this is proposed. (3 10 CMR 15.227(1)) 8. There must be a 9"air space above the flow line, and it is unclear from the plan whether this is proposed. (3 10 CMR 15.227(4)) 9. Inlet and outlet tees must be located on the centerline of the tank and it is not clear from the plan that this shall be required. (3 10 CMR 15.227(1)) 10. The septic tank and pump chamber must have 9"min cover. It does not appear that this is provided. (3 10 CMR 15.228(1)and 221(7)). 11. The septic tank and pump chamber loading must be stated on the plan. (3 10 CMR 15.226(3)) 12. The construction of access manholes in the septic tank does not coincide between the detail Section View and Top View. 13. Buoyancy calculations should be provided as the concrete tanks will intersect the estimated seasonal high ground water. (3 10 CMR 15.221) BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 14. Distribution box invert elevations are not provided. (3 10 CMR 15.220) 15. Soil compaction beneath the distribution box should be specified. (3 10 CMR 15.221) 16. Please provide the specifications, or reference to the appropriate code section standards, for the fill material indicated in note 4 and depicted on the site plan. (3 10 CMR 15.220) 17. Pump calculations, control panel details and pump curve are not provided. (3 10 CMR 15.220 and 23 1) 18. Trenches to be used as the soil absorption system mechanism whenever possible. Please use trenches in this instance or explain why they were not utilized. (3 10 CMR 15.240) 19. Please detail the mechanism for removing storm water runoff onto the soil absorption system from the driveway. (310 CMR 15.240&245) 20. Please provide a drainage swale to collect surface runoff due to the grading provided within 5' of the southern property line. (3 10 CMR 15.255) 21. A Local Upgrade Approval for reduced separation from the bottom of the soil absorption system to the estimated seasonal high ground water is requested with this design. This is requested because of limited horizontal space as indicated on Form 9A. Reducing the separation distance in this instance has little impact on the horizontal space needed. Inadequate justification has been provided as to why full compliance with the code is not feasible. (310 CMR 15.405) Though not a reason for disapproval,you are encouraged to consider the following items: 1. Providing several distance ries to fixed objects and the proposed soil absorption system will assist with placement during the construction phase. 2. Dosing greater than once per day increases the efficacy of wastewater treatment and reduces possible ponding problems with the soil absorption system. You are encouraged to review the currently proposed once daily dosing. 3. Your design includes a requirement for a butyl wrap around the pump chamber. You may wish to review this requirement and if maintained,provide improved specifications for the contractor to follow. 4. You may be able to reduce drainage and fill issues with use of an impervious barrier in compliance with in compliance with the Massachusetts Department of Environmental Protection Policy BRP/DWMNVPeP/G02-1. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. V A Grasse Health Inspector cc: Homeowner CD&S Dir. File 9 TOWN OF NORTH ANDOVER BOARD OF HEALTH Location Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Z-14-1L?1 Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 7045 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer 514 l G� 1 � �� ,, � �� , �� -77 SEPTIC PLAIN SUBMITTAL FORM LOCATION: NEW PLANS: S $160.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: NO DATE: DESIGN ENGINEER: 1r �G ��f l�IIJ EEKI fl DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. t o FJ TOWN OF NORTH AIV®®VER ;Q1 BOARD OF HEALTH Q Uj, Location4el y/. O `�^' = Z` AT6 :Z +- Permit # OF Food Service $ 0 �- O `^ Z °� E. Retail Food $ r N, -0 �. Limited Retail $ _rSeasonal $ 0, Disposal Works Installers $ W ' W Q,, _, ' O p Disposal Works Construction $ v � aQ ,ro m cO Soil Testing $ QO. Q W / s ty. Design Approval Permit (/ $ `oQ p , w v 0 D Dumpster Permit $ -- n.. z 3" ;:o. _ C O Burial Permit $ c .;,., o . cn is Swimming Pool Permit $ tAro o Animal Permit $ a a d 4- ,pip Recreational Camp Permit $ A^ L `3 Well Construction Permit $ Funeral Directors Permit $ a 0 w 60:; o, Massage Establishment License $ h \ e !.Q \j - ►O • s�wc•fir ~•MOy,»r ,;Q °�' �:..,. .;fro v': Massage Practice License $" Suntanning Establishment $ ` Offal/Trash Hauler $ Other $ 7045 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer C r-.TION: so' VV/ITN ,COL i ION T_-z-: inI ilv1= TIME E ISI`�� i L.'.-.u ^, _ Page 1 of 1 DelleChiaie Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Tuesday, May 25, 2004 8:42 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: misc. Sue and Pam, A few items: • 60 Raleigh Tavern Lane final inspection went ok except the existing tank size appears to be 1,000 gallons not the 1,500 gallons indicated on Merrimack's plan. The plan proposed re-using the existing 1,500 gallon septic tank. I have told the contractor not to backfill the tank until further notice but that it was ok to backfill the SAS. I have left word with Dufrene's voice mail to either call for the tank to be replaced or to request a Local Upgrade Approval as allowed under Title 5 for using a 1,000 gallon tank (not sure it would be granted, but he could apply for it). Asked him to contact either you or me with his conclusion. ■ Will be out much of the day tomorrow(Tuesday)so call, don't e-mail, if you need anything. Call office and leave message or call cell phone. ■ Andy and I will not be available at all on Wednesday. ■ We will be in town on Thursday doing soil testing at 43 Mill Road and 42 Penni Lane. / r ■ Will get you inspection reports for 178 Stonecleave and 60 Raleigh Tavern shortly. • We cannot find any record of having gon out to 426 Summer Street. "G Dan x Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 (� www.millriverconsulting.com info@millriverconsulting.com millriverconsulting.com 01 5/25/2004 Commonwealth of Massachusetts City/Town of , m System Pumping Record Form.4 JUN e? t U 11 i4^M 'i DEP has provided this form for use by local Boards of He t � � k� ed, but the information must be.substantially the same as that provid rm, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left fro house, right front of house, left side of house, right side of house, Left rear of hous , right e r of hous left side of building, right rear of building, under deck. SvVXI,,-v�� Citylrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Stat Zi Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition,of System: \ 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: .L.S. /jLoweIINMsteWpter Signa u of auler Date t5form4.doc•06103 System Pumping Record•Page 1 of 1