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Miscellaneous - 43 MILL ROAD 4/30/2018
43 L ROAD lop 21 r _ T "„ .,.._, . ,.,_.... ,".-_._ :.._ G .5 4+.:r •,u wno� "h . �':'" y.:i.�. +F 1^ 4�iya;"�a ryy,",�'�` ry yy "+W.�M1y t,,.h �yd}.r�s d1O7.Ci-009-0000 'kr � er n 1 1 r s North Andover Board of Assessors Pa Access Page 1 of 1 NORTH North Andover Bard of Assessors Of •�ao '�.V *i�Ot . .E•3:.. *� �t0 .SSACHUSB roperty Record Card Click Seal To Return Parcel ID:210/107.C-0109-0000.0 FY:2010 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels t Search for Sales a 0. i Summary Residence Detached Structure _ l�ty Condo '""'�'`� . 43 MILL ROAD Commercial Location: 43 MILL ROAD Owner Name: KOBER,KARL G MARY D KOBER Owner Address: 43 MILL ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5-5 Land Area: 1.05 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2482 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 437,000 459,200 Building Value: 239,300 261,500 Land Value: 197,700 197,700 Market Land Value: 197,700 Chapter Land Value: LATEST SALE Sale Price: 212,500 Sale Date: 06/14/1993 Arms Length Sale Code: Y-YES-VALID Grantor: ROBSON REALTY TRUSTN Cert Doc: Book: 03756 Page: 0017 I http://csc-ma.us/PROPAPP/display.do?linkId=1519875&town=NandoverPubAcc 9/14/2010 Residential Property Record Card PARCEL_ID:210/107.C-0109-0000.0 MAP:107.0 BLOCK:0109 LOT:0000.0 PARCEL ADDRESS:43 MILL ROAD FY:2010 PARCEL INFORMATION Use-Code: 101 Sale Price: 212,500 Book: 03756 Road Type: T Inspect Date: 05/18/2008 Tax Class: T Sale Date: 06/14/93 ,_Page: 0017_ Rd Condition: P Meas Date: 05/18/2008 Owner: Tot Fin Area: 2482 Sale Type: P Cert/Doc: Traffic: M Entrance: X KOBER,KARL G Tot Land Area: 1.05 Sale Valid: YWater: Collect Id: RRC MARY D KOBER Grantor: ROBSON REALTY TRUSTN Sewer: Inspect Reas: C Address: 43 MILL ROAD Exempt-B/L% / Resid-B/L%a 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 6 Main Fn Area: 1240 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R2 Story Height: 2.35 Bedrooms: 3 Up Fn Area: 1242 Bsmt Area: 1240 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 197,326 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0 0.050 380 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 2482 VALUATION INFORMATION Foundation: CNBath Qual: T RCNLD: 239281 Current Total: 437,000 Bldg: 239,300 Land: 197,700 MktLnd: 197,700 Kitch Qual: T Eff Yr Built: 1962 Mkt Adj: Prior Total: 459,200 Bldg: 261,500 Land: 197,700 MktLnd: 197,700 Heat Type: HW Ext Kitch: Year Built: 1731 Sound Value: Fuel Type: O Grade: G Cost Bldg: 239,300 - Fireplace: 1 Bsmt Gar Cap: Condition: AG Aft Str Val 1: Central AC: N Bsmt Gar SF: Pct Complete: Aft Sir Va12: Aft Gar SF: . 576%Good P/F/E/R: /100/100/77 Porch Type Porch Area Porch Grade Factor E 32 W 348 SKETCH PHOTO FU"SIG 1 S76 SgFt 24 24 s j, r FU'35/FM/B 11 440 SgFt 11 " 40 W 12 348 Sq.Ft 12 FU/FM/B 29 20 800 SgFt 20 zz - i Ea AQ 43 MILL ROAD Parcel ID:210/107.C-0109-0000.0 as of 9/14/10 Page 1 of 1 43 MILL ROAD JS-2005-0192 Proiect Detail Report Printed On:Thu Oct 14,2004 Project Name: GIS#: 7871 Project No: JS-2005-0192 Owner of Record KOBER, KARL G&MARY D c� Na RTr.4M Map: 107.0 Date Submitted: Apr-21-2004 43 MILL ROAD o+ * ��' Block: 0109 Status: Open NORTH ANDOVER, MA 01845 Lot: Work Category: Work Location: 43 MILL ROAD o - A; Zoning: Proposed Use: District: �'.t'''•,f,�`` ' land Use: 101 Proposed Use Detail Subdivision SSACMtls6 Description Septic System Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0118 9/24/04-V.❑43 Mill Road—Request for approval of offset distance variances with regard to the movement of the wetland line. Designed for a water table reduction with the FAST system. Wo did this to keep nice landscaping in yard. See letter for distances.And put in as motion. CB makes a motion to grant 3 bedroom variance,as well as other offset distances in letter. TT 2nd. All in favor. 9/20/04-Received Rev. 1 Plan from NEES showing new wetland line at the request of the Conservation commission. The wetland line has been moved closer to the system. The plan now requires offset distance variances to the local bylaw. See submission. Ben requests that approval of these variances on the agenda for the BOH if you feel that approval at a meeting is required. --p.d. 8/27/04-received slightly revised plan from NEES addressing issues with the Conservation Commission. Changes did not affect or alter the septic system design. Plans revised and submitted for our records and to match the records with the Conservation Commission.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2004-0702 Oct-14-2004 SIGNED OFF JS-2005-0192 Repair-Complete Plan Review BHP-2004-0608 Sep-28-2004 SIGNED OFF JS-2005-0192 Plan Review Soil Testing-Repair BHP-2004-0607 Apr-21-2004 SIGNED OFF JS-2005-0192 Soil Testing GeoTMS©2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 LlMassachusetts Department of Environmental Protection Bureau of Resource P.rotettion - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems "el"C/VE D A. Installation QVC 25 2016 Important:When TOWNodd Strin Stringer OF N 0 filling out forms Owner p EF FR on the computer, ART1y use sur only the tab 43 Mill Rd key to move your Facility Street Address cursor-do not N Andover use the return key. city Zip VQ Mailing address of owner, if different: Street Address/PO Box: City State Zip - ext. Telephone Number B. Authorized Service Provider Sewer Works 0&M Firm 26 Hillside Ave Street Address Westford Ma 01886 City State Zip (9 78)692-4410 ext. Telephone Number David Chandler Certified Operator Name Certification Number C. Facility/System Information 24428 Fast.05 DEP ID Manufacturer ID Model Number 4/2005 4/2005 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ❑ Yes ® No D. Operating Information 7/8/2016 10/26/2015 Inspection Date Previous Inspection Date 10" Sludge Depth(to be checked yearly) Pumping Recommended E] Yes ® No t5aiom.doc•rev.04-11-13 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and OW Form for Title 5 IIA Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ❑ musty ® earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH 7.3 SU DO 3.0 m,g/L Turbidity 10 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ® Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection&during this inspection: cleaned filter, blower amps 1.9 Notes and Comments: t5aiom.doc•rev.04-11-13 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and 0&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a M chusetts certified operator in accordance with 257 CMR 2.00. 7/7/2016 Operator S nature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health as follows for each inspection performed: Remedial Use–by January 31st of each year for the previous calendar year Piloting Use-within—45 days of inspection date Provisional Use–by March 31 t of each year for the previous 12 months General Use–by September 301h of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Pro hgram One Winter Street, 5t Floor Boston, MA 02108 t5aiom.doc•rev.04-11-13 Page 3 of 3 CON TRACT/ESTIMATE Sewer Works 26 Hillside Ave. Westford, Ma 01886 E EI✓ED 978-692-4490 JUN 3 p www.sewerworks.net 2015 Email. david @sewerworks.net TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Date: 5/27/2015 ...... _ ress:43 M4 Name: Todd Stringer Addill Rd City,State,Zip:N Andover, Ma 01845 Job location: same Phone: Property owner: same ............. Work to be performed: 1. Contract is for one visit per year. Inspection to include testing unit for ph;DO(dissolved oxygen)and for turbidy. Includes fling of required DEP forms with copies to state,N Andover Health Dept.;and customer. Inspect filters and control unit. Cost is$220.00 per visit., includes lab fees. Total $220.00. Septic tank pumping as required: and additional$295.00. Price does not include any repairs that may be required. 2. Should the unit fail the above field tests of ph; DO and turbidy. Then the following tests will need to be performed: BOD (Biological oxygen demand); ; TSS(total suspended solids). The costs for the above tests is$275.00 which includes all lab fees. This information to be placed on fled reports. 3. Should additional site visits be required, additional charges will apply. 4. Servicing and inspecting the Fast unit is no guarantee the unit will function properly as manufacturer states. The total contract sum for the work specified above is......:$220..00 Payments are to be made as follows: Deposit amount: Due: Balance due at billing..:$cost pet visit All payments are due when customer is billed. An account balance after 30 days from billing date is subject to monthly finance charges of 1 1/2% if under$500, 1%if over$500. If Customer indebtedness is not paid in full according to the terms of this contract,then all guarantees are null and void. Signed:...Davaid B Chandler(electronically)...................................................... David B. Chandler Sewer Works Date;......5/27/2015....................... Acceptance o�proposal: The prices,specifications and conditions set forth in this contract are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date:...... .......I..... Signed:....... ..P.. .............. • Sg'S10ED'7�6 North Andover Health Department (ommunity and Economic Development Division June 16, 2015 Mr. Todd Stringer 43 Mill Road North Andover, MA 01845 Dear Mr. Stringer: The Health office received a letter on June 10, 2015 from Wastewater Treatment Services, Inc. informing us of your choice to not renew your maintenance contract with them. The Health Department no longer has a current maintenance contract on file and requests that you send in the new company's contract that you have chosen for your alternative septic system within 14 days of receipt of this letter. Failure to do may result in the issuance of a Health Department Order to Correct. Thank you for your anticipated compliance. Sincerely, Michele E. Grant Health Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com North Andover Health Department Community and Economic Development Division June 16, 2015 Mr. Todd Stringer 43 Mill Road North Andover, MA 01845 Dear Mr. Stringer: The Health office received a letter on June 10, 2015 from Wastewater Treatment Services, Inc. informing us of your choice to not renew your maintenance contract with them. The Health Department no longer has a current maintenance contract on file and requests that you send in the new company's contract that you have chosen for your alternative septic system within 14 days of receipt of this letter. Failure to do may result in the issuance of a Health Department Order to Correct. Thank you for your anticipated compliance. "' Si cerely, Michele E. Grant Health Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 June 5, 2015 RECEIVED JUN 10 2015 Mr. Todd Stringer 43 Mill Road TOWN OF NORTH ANDOVER HEALTH DEPARTMENT North Andover, MA 01845 Re: Serial Number: 24428 Location: 43 Mill Road,North Andover MA Dear Mr. Stringer: We understand you do not wish to continue your maintenance contract with our company. Please be advised the Massachusetts Department of Environmental Protection requires a maintenance contract be in place for the life of the alternative septic system. Also,we are required to inform both the state and local agency of your decision. If you have any questions or need additional information please call our office at (508) 880-0233. Sincerely, Donna L. Callan Copy to: Ma r t 'I Nor 1606 � Nord viron�1eutaf Protection 511 A ant of En for Title -- � arm' Title 5 and �&M Form Massachusetts�epprotection - Resource ect;on a Bureau of roVed lnsp Systems pEP Ape t and Disposal Treatm p. Installation Todd Strin er int;When Owner Q1845 filing out forms 43 111 Rd dress Zip R.ECEI�ED on the computer, M the Faci►ity Street Ad use only tab Vey to move your N Andover d0 not cursor- city if different: use the return address TMENT key Mailing of owner, ZAP H�,LTH DEPAR �� Street State Ow - e)d' Telephone Number B• puthor1Ze d service Provider $ewef Works Q1886 o&M Finn ZIP 2g Hillside AVe' NIa Street Address State Westford City 978 I -4410 ext Certification Number Telephone Number b Chandler paved erator Name certified OP atjon Fast 0.5 ste m Inform Model Number Ci• FacilityIsy NA`�u+acturerlD 412005 unknown start of Operation ® Remedlal DEP ID piloting 412005 ❑provisional ❑ ® No Installation Date ❑ General ❑ (es APProval Type' less than r m°.lyear: Seasonal Residence'used Information unknown action Date Operating Previous Insp ommended ❑ Yes to �• pumping Rec 101261201 ate, Inspection D slud e no measurable early) Page 1 of 3 Sludge Depth Ito be checked Y t5aiom•dor or. 11-07-05 Page 2 of 3 t5 t5aiom.doc•, �� f ty �\ Commonwealth of Massachusetts G ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assesents TOWN CO N TH ANDYRR. T"4 43 Mill Road North Andover NUALTH MIP'AN Mf Property Address Mary Kober _ Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Moreau use the return Name of Inspector key. Wastewater Treatment Services my Company Name 44 Commercial Street Company Address Raynham MA 02767 CitylTown State Zip Code 508-880-0233 S14045 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 E aluation by-the Loc Approving Authority y 10/13/2010 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts iTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ug43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityfrown 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: The sytem is in good working condition. The sytem is a Biomicrobics Modular FAST treatment unit with a pump chamber to a leach field. 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) 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 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 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 II of a public water supply well If you have answered"yes"to an question in Section E the system is considered a significant threat Y Y any Y 9 1 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. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityrrown 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? ® ❑ 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 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information required fortevery North Andover MA 01845 10/08/2010 page. City/Town state Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 Commercial/industrial 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: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ® Innovative/Alternative technology. A h ttac 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): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 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: 6 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): All piping looks to be in good condition. No signs of leakage. Septic Tank(locate on site plan): Depth below grade: 1.5' 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: Sludge depth: 6"Septic-6" FAST t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. City/Town 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 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measuring tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No pumpng recomend at this time. 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owners Name information is North Andover MA 01845 10/08/2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ 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? ❑ Yes ❑ No t5ins•09/08Inspection Form:Subsurface Sewage Ois osal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °y 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): 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 is in good condition. No sign of infilttration or leakage. Pumps and alarms are in working condition. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts ERA Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M �y 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 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: ❑ overflow cesspool number: 1-20X30 ❑ 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.): Leach field is in the front yard yard. No sign of breakout or damaged components. No odors 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. City/Town 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityrrown 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 �T VC, h 4 l I� t a. t5ins•091108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 page. Cityrrown 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+1 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: 2004 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: You must describe how you established the high ground water elevation: Design Criteria on record. Site inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Mill Road North Andover Property Address Mary Kober Owner Owner's Name information is required for every North Andover MA 01845 10/08/2010 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 44 Commercial Street Raynham,MA 02767 Tel: (508)880-0233 Fax: (508)880-7232 July 20, 2010 North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST® Wastewater Treatment System - Serial Number: 24428 Attached please find the Field Inspection & Service Report with field test results for services performed on 7/1/10 at the property of Mary Kober located at 43 Mill Road, North Andover, MA. Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Mary Kober Massachusetts DEP I4C0RP0RATE0 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite@biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FASP System 14106 INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: 43 Mill Road Name:Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name:Mary Kober Mail Address: 43 Mill Road Mail Address: 44 Commercial Street North Andover,MAO 1 845 Raynham,MA 02767 Phone: Fax: e-mail: Phone:(508)880-0233 Fax:(508)880-7232 e-mail: INSTALLATION INFORMATION Model No. Serial No. Date of Installation Date of last pump out MicroFAST,5 24428 1/4/2005 I/l/2008 EQUIPMENT YES NO MAINTENANCE PERFORMED AND COMMENTS Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating x (if present) Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone 6" Aerobic Treatment Zone 6" EFFLUENT(optional) LIMIT RESULT Estimated Daily Flow 330 gpd pH(Standard Units) 7 Color Clear Temperature 66 Odor Earthy Comments: TECHNICIAN SERVICE DATE Michael Moreau 7/1/10 Town of North Andover °f Na RT," Office of the Health Department Community Development and Services Division * - 400 OSGOOD STREET North Andover,Massachusetts 01845 � S^cHus t Susan Y. Sawyer,RENS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax CFRTTFICArr(','E0(F C09WI '.GIANC2 As of: December 12, 2004 This is to cert that the indvidualsu6surface disposalsystem repaired(X)l — FuffSystem by ,john Soucy at 43 Miff oad North Andover, 31A 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the Noah Andover ooard of Yfealth regulations. 'The issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. e. ,r usd 2'. Sawyer Qj Tu6Cic Yfealth 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( j constructed; ( )repaired; located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit* ,plan dated with a 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 vwith.the provisions of 310 CMR.15.000,Tits 5 and local regulations,-and the final grading ' 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: I 18 b SB T{f Engineer Representative Final inspection date: la12-ID �j- Gv j 2 Engineer Representative Installer. nc.#: Date: t'A OF�qs Engineer. Date: GOOD,JR. CIVIL NO.45891 GIST���o REC DEC 0 3 2004 TOWN OF RfR HEALTH DE.T'Ak_l,'`__N NEW ENGLAND ENGINEERING SERVICES INC December 3, 2004 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 DEC 0 3 2004 Re: 43 Mill Road, North Andover TOHEALTFi DEPARTS�T R Septic System As-Built Plan Submittal Dear Mrs. Sawyer: The following Septic As-Built plans for the above referenced property are being submitted for approval and issuance of Certificate of Compliance. Enclosed are the following: 1. (3) Copies of the Septic System As-Built Plan. 2. (1) Installation Certification Form. Please contact this office with any questions or concerns. Sincerely, __2 e- Thomas Hec or Project Engineer 6013EECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 TOWN OF NORTH ANDOVER OE NORTh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 CH„5 t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ADDRESS: 43 Mill Rd MAP:107c LOT: 109 INSTALLER: Soucy Septic DESIGNER: NEES PLAN DATE:8/23/2004 BOH APPROVAL DATE ON PLAN: 10/16/2004 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 11/22/2004 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Advanced Treatment COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK= H-10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Infiltrator field&FAST Treatment DIMENSIONS AND DETAILS OF SAS: 4 rows of 5 chambers SITE CONDITIONS ®Existing septic tank properly abandoned ®Internal plumbing all to one building sewer ®Topography not appreciably altered Comments: Page 1 of 4 TOWN OF NORTH ANDOVER °E NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES 3 ``t HEALTH DEPARTMENT 49 27 CHARLES STREET ► NORTH ANDOVER, MASSACHUSETTS 01845 ��ss;CHU s� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual) ® Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: FAST Startup test has not been performed as of (11/22/04). Told by Installer that tank has 6" stone base. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading 2-Piece construction) ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ® Watertightness of tank has been achieved I Visual testing ® Hydraulic cement around inlet & outlet Comments: Told by Installer that tank has 6 stone base and weep hole plugged Page 2 of 4 TOWN OF NORTH ANDOVER °t NORTa 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT4 Wp 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��Ss4"0 t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ADVANCED TREATMENT TECHNOLOGY ® Type of treatment: FAST ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Has not yet been certified by manufacturer (11/22/04) SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ® Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: PRESSURE DISTRIBUTION ® 2-1/2" inch manifold ® 4 laterals installed with end sweeps size: 1.5" material: PVC ® Squirt test 2 ft in height ® Equal distribution to all laterals ® orifice size 5/16 inch as per plan Comments: Page 3 of 4 TOWN OF NORTH ANDOVER G��►ORTol 1 Office of COMMUNITY DEVELOPMENT AND SERVICES o?e'ba'.o'"- HEALTH DEPARTMENT 27 CHARLES STREET ►'^, . 4� NORTH ANDOVER,MASSACHUSETTS 01845 �'ss„cou t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: Exterior.wall (LHS of house) ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 3.04 Height of Instrument: 103.04 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 98.07 97.97 Septic Tank IN 97.85 97.46 Septic Tank OUT 97.50 96.95 Pump Chamber IN 97.55 96.86 Pump Chamber OUT 97.30 97.51 Distribution Box IN Distribution Box OUT 97.51 Manifold Lateral 1 HIGH 9988 9986 Lateral 1 LOW 9988 99.86 Lateral 2 HIGH 9988 99.86 Lateral 2 LOW 9988 99.84 Lateral 3 HIGH 9988 9985 Lateral 3 LOW 9988 99.84 Lateral 4 HIGH 9988 99.86 Lateral 4 LOW 9988 99.86 Lateral 5 HIGH 9988 99.86 Lateral 5 LOW 9988 99.86 Page 4 of 4 r Commonwealth of Massachusetts Map-Biock-Lot ' 107.C-0109 ----- -------- Board of Health P ,itNo_ North A nd6Ver E Hp2Q04 0702 t --- ------ P.t. F.l $250.00 ----------------------- Disposal ---- ----- isposaf Works Construction 'Permit i Permission is hereby granted John Soucy to(Repair)an Individual Sewage Disposal System: at No 43 MILL ROAD ------------------------------------------ --- - -- ------------ -------------- ----- -- ------ -------------------------------------------- as -------- --=------- ------ as shown on the application for Disposal Works Construction Permit No. BHP-2004 070 Dated (7ctober 14,2004--- ------------------------------ ---- ---------------------------- Issued On Oct-14-2004 Board of Health c -.{ t ,iyk5t"s a�'1Si4?-- ,Fk CbmmgnWe th of Mas$aehosetts 'Health Ys S3 44 dO Rnd ver �0 �l All � V 'lI �Jt�1 vaf 4 i r ry`Y { t S`,1�✓ .i't 1'.il'Y, 8 �Ll$p�s`dl +- �' 11L � t r T" ' glr 2 � o,uak. � y *�* Ta wxaions cif ITk S of IhO,State nnrii odeg �stcti� tioA mit Nq BIW,-2404.070 Dated 01, a }� - -- --- 46 E fP N F 1 TOWN OF NORTH ANDOVER o�N°RTy q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 A SACNUS Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthde t vtownofnorthandover.com www.townfnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION• LICENSED INSTALLER NAME: �o�c PLEASE PINT r.� SIGNATURE: c TELEPHONE#lo& or �I CHECK ONE: FULL SYSTEM REPAIR: ✓ 250 COMPONENT REPAIR(indicate what parts): ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent / Date: e�/6129 f INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at q3 ^V 0 relative to the application of t &,, Ca4ated 1V-1t(-0!1 for plans by At, �,�_and dated `�— —� with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction.steps: a) Determination that the.proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned JLiiced Septic Installer A,^ AA Date: L 0 > Disposal W s Construction Permit# •1 BOARD OF HEALT.,- NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: MAP&PARCEL: B a n 10`7 (L' Lt 167 LOCATION OF SOIL TESTS: '7_ M t l I R0611 OWNER: TEL.NO.:_61 7 ' �6 7 —5d<193 ADDRESS: `73 114 1 1nCud ENGINEER: / Se ,n��c �� ,t r vw r „ �e f J IC.F S TEL.NO.: _17 CERTIFIED SOIL EVALUATOR: - Ule"N wl"VI ���5 � Intended use of land: Residential Subdivision .......'..w.... 'S�iigle Family Home Commercial ' Is This: Repair testing �_ Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No_ X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: OciOn pyk,,P) Date Received: % Check Amount: _ Check Date: A�/ ti 41 4 ."leeTZ JF 0 F� y OI r / R 3.T IfJf I Y c. w- >i, ;� ti i-��-•Fa-r-ia Q1 I / 1 To'�E5 Ic.til bTZD.y6. I A� I l I ]] U YJ�p VE cc CSO rl r-C L Fite 04-2��2• ,. J-4 41 ?4c) +tic) S I VEL - - - �. +. + 41� -1 1 4,1 16 a 1 i ]may/ ♦ j I Uril dal .. " i o 1 j � f � iT � • ii tl } I • . 11l 1 . f ,, • ! TT, I + I I ;ir It ,� . ' � ►. i _ i , t i I I i f ' I r I SSS 1 E Page 1 of 1 Dellechiaie, Pam From: Dan Ottenheimer(info@millriverconsulting.com] Sent: Wednesday, July 28, 2004 2:01 PM To: Susan Sawyer; amcbreartymillriverconsuI ing.com; 'Pamela Dellechiaie' Subject: perc test results Sue and Pam, Attached please find the percolation test results for three properties: 545 Winter Street, 42 Penni La e, 43 Mill Road. These were completed a few weeks ago and the results already faxed over to you. Scanned are now attached which should be clearer to read than the faxes. Dan Mill diver eonsu ting 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.millriverconsult�.com info@millriverconsulting.com 7/28/2004 ' Page 1 of 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 23, 2004 4:00 PM To: DelleChiaie, Pamela Subject: FW: perc tests -----Original Message----- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Tuesday,June 22, 2004 4:14 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: perc tests Sue and Pam, We are going to try tackle three sites which New EnglandBering Services has been designing a septic system upgrade and which are in need of percolatio sts only (so already completed). On Wednesday July 7 we will attempt 545 Winter Street,42 Penni Lane, nd 43 Mill Road. Dan xi 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@a millriverconsulting.com 6/23/2004 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 testingt 43 Mill Road a d 42 Penni Lane. ■ Will get you inspection reports for 178 Stonecleave an 60 Raleigh Tavern shortly. • We cannot find any record of having gone out to 426 Summer Street. Dan a 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.millriverconsultLng.com info@millriverconsulting.com 5/25/2004 NEW ENGLAND ENGINEERING SERVICES INC August 24, 2004 Susan Sawyer North Andover Board of Health AUG 27 Charles Street North Andover, MA 0l 845 TOH� Or H oEP�TME TE Re: 43 Mill Road,North Andover Septic System Design Dear Susan: The following plans and enclosures for the above referenced property are being submitted for approval. 1. (5) Copies of the Septic System Design Plans. 2. (1) Copy of the soil evaluator sheets. 3. (1) Check for payment of the Town approval fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, -JA17/��G Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 r Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover,MA 01845 978.688.9540 healthdepWownofnorthandover.com AUG 24 2004 T O SALT tvUNTH SEPTIC PLAN SUBMITTAL FO °SPAR MENreR DATE OF SUBMISSION: Z1 d Y" SITE LOCATION: L Xd1f ENGINEER:_ A 16u 4/V 4-C4-A)1) NEW PLANS: YES 1,Z $225.00/Plan Check#: (Includes 1 EW and one Re-Review Only) REVISED PLANS: YES $75.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone#• Fax#: E-mail: HOMEOWNER NAME: hal�. !4�t M?s. •9-(z OFFICE USE ONLY When the submission is complete(Including check): 1. / Date stamp plans and letter 2. Complete and attach Receipt 3. File; Forward to Consultant 4. Enter on Log Sheet and Database FORM 11 SOIL EVALUATOR FORNM Page I of 3 No. Date: Commonwealth of Massachusetts Al. Wl �d� , ,Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: .... ... ����/� .... ....... ..... . . .... Date: Witnessed By: ..... ...... ..... .... .97. ...... ............. L=46on Address or �� 01L Owtv's Name. L41 I N�mAddress and Telephom' 1 lvo . pewconstruction [--] Repair Office Review Published Soil Survey Available: No El Yes 21 Year Published ............. Publication Scale Soil Map Unit C Drainage Class Soil Limitations ................. .......... Surficial Geologic Report Available: No 0 Yes 0 Year Published Publication Scale GeologicMaterial (Map Unit) . ........................................................................................................... Landform ...................................I...................................................... ............................................... Flood Insurance Rate Map: Above 500 year flood boundary No E]Yes RI Within 500 year flood boundary No 0Yes 0 Within 100 year flood boundary No E]Yes D Wetland Area: National Wetland Inventory Map (map unit) ........................... ............................ Wetlands Conservancy Program Map (map unit) ................................................. ... ....... Current Water Resource Conditions (USGS): Monthow/e- Range :Above Nor-mal ©Normal FhelcwNormal El Other References Reviewed: DEP APPROVED FORA-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot 140. On-site Review � Deep Hole Number J. Date:.��� Time:.Al) WeatherC �� (f 7 Location Eiden 'fy on site plan) :.:: :::.... _... _ Land Use Slope (%) Surface Stones Vegetation ... Landform Position on landscape Distances from: Open Water Body 3� feet Drainage way G feet Possible Wet Area feet Property Line . `. feet Drinking Water Well ./2.0 feet Other . .:.. ................_:. DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) � 4f 0 Parent Material (geologic) 7/—/- L DepthtoBedrock: _ Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:_7 Estimated Seasonal High Ground Water:__ 4Q DEP APPROVED F0101- 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page Z of 3 Location Address or Lot No. On-site Review / a Deep Hole Number .::. Date:.:. 1 �/�� Time: Weather r z)y Location (identify on site plan) Tzm c7 .1 :T.. ...:::,_:.: . Land Use -4( Slope (%) 4 Surface Stones Vegetation Landform . . �G�ZoI/�'//, .. . �/�,,�/ 1 . Position on landscape - Distances from: Open Water Body �'d��feet Drainage way />�t� feet Possible Wet Area feet Property Line ... a.. feet Drinking Water Well :. .. feet Other .. .:.:.:.::...::.:........ ...::.:.. DEEP OBSERVATION HOLE LOG t Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) 7Z� � �/l y a.., .... Parent Material (geologic) ZefmvJ -7-7 L DepthtoBedrock: Depth to GroundwatIer: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water:_ DEP APPROVED FO"t• 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 4� 11z C % X10. ,elAi Z)o4/7Z Determination for Seasonal High Water Table Method Used: I ❑ Depth observed standing in observation hole......... inches ❑ Depth weeping from side of observation hole ......... inches © Depth to soil mottles .... .:� inches /- 44 El Ground _ 111-0 11 Ground water adjustment ................... feet - Index Well Number .................. Reading Date .................. Index well level Adjustment factor ................... Adjusted ground water level ............._.................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in 41t areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? _ Certification I certify that on / �� (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. � z o� Signatur ate � DEP APPROVED FORM•12107195 NEW ENGLAND ENGINEERING SERVICES INC August 27, 2004 R�D��VED Susan Sawyer AUG 2 � 2004 North Andover Board of Health r'ANDOVER 27 Charles Street HE L1,H DEPARTMENT North Andover, MA 01845 Re: 43 Mill Road Septic System Design Revised Plan Dear Susan: Enclosed are the following documents concerning the above referenced property. 1. 5 Copies of septic system design plans. Changes were made to the plans to address issues with the Conservation Commission. These changes did not affect or alter the septic system design. These plans are being revised and submitted for your records and to match the records with the Conservation Commission. Please contact this office with any questions or concerns at(978)-686-1768. Sincerely, Thomas Hector, EIT Project Engineer 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 NEW ENGLAND ENGINEERING SERVICES INC RECEIVED September 20, 2004 Susan Sawyer SEP 2 0 2004 North Andover Board of Health TOWN OF NORTH ANDOVER 27 Charles Street HEALTH DEPARTMENT North Andover, MA 01845 Re: 43 Mill Road, North Andover Dear Susan: Enclosed are 5 copies of revised plans for the above referenced property. These plans have been revised to show a new wetland line at the request of the conservation commission. The wetland line has been moved closer to the system. The plan now requires the following offset distance variances to the local bylaw. 1. Reduction in the offset distance between the leach field and the wetland from 100 feet required to 62 feet. 2. Reduction in the offset distance between the septic tank and the wetland from 75 feet required to 65 feet. 3. Reduction in the offset distance between the pump chamber and the wetland from 75 feet required to 56 feet. Please include the approval of these variances on the agenda for the Board of Health if you feel that approval at a meeting is required. If you have any questions please do not hesitate to contact this office. Sincerely, 6--) co ?— Benjamin C. Osgood, Jr., P.E. President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 TOWN OF NORTH ANDOVER f N°RTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ' 27 CHARLES STREET 4ne �� NORTH ANDOVER, MASSACHUSETTS 01845 'ssAC1ww4u Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX September 24,2004 Karl Kober 43 Mill Road North Andover,MA 01845 Re:43 Mill Road,Map 107C,Lot 109 Dear Mr. Kober, The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property,submitted on your behalf by Engineering&Surveying Services dated August 23,2004(Last Rev. September 17,2004). The design has been approved for use in the construction of a replacement onsite septic system.This approval was granted with the following variances to the North Andover Board of Health septic regulations: 1) A reduction in the offset distance between the leach bed and a wetland from 100 ft to 62 ft 2) A reduction in the offset distance between the pump chamber and a wetland from 75 feet to 56,feet 3) A reduction in the offset distance between the septic and and a wetland from 75 feet to 65 feet 4) To allow the construction of a septic system to accommodate a 3 bedroom house 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 is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. 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(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. 3. Please provide a maintenance agreement for the MicroFast treatment unit and the pressure distribution system as required and/or for a minimum of two years. 4. The N.Andover BOH approved a variance to the local regulations allowing the construction of a 3- bedroom septic system.Please provide proof of recording a document providing for a 3-bedroom deed restriction.(a sample of the restriction is attached for your convenience)—NA 1.05 & 13.01 Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have.Please be advised that a final Certificate if Compliance will not be issued until all the above conditions are met. Sincerel an Y. Sawyer,RE /RS Public Health Director cc: Engineering and Surveying Services file