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Miscellaneous - 44 BRUIN HILL ROAD 4/30/2018
i BRUIN HILL ROAD d 21 Oil 1104.A-0097-0000.0 T coi, z 70 Y � St . S 4 ��j r MAP # I"�"� - ----- LOT #_.._..................._._ .._....._...__..._...._........ .._ .... PARCEL # _-_-- - -_---- STREET-_..__. ZfJ CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID' YES NO PLAN APPROVAL: DATE /-l� L !nl> APP. BY. _.._...-,..... _..... /�y��5v!/L __----- 1-E:..._._��t �_.. ...�� DESIGNER: PLAN DA _-- COND I T I ONS -� WATER SUPPLY: OWN WELL WELL PERMIT _____ —�._.__.. DRILLER. ...._...........__... WELL TESTS: CHEMICAL DA I-E Af-`PItUVED,.-_.__._......_..__....... .... BACTERIA I DA 1 E F-1PPRUVED BACTERIA II DAZE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL 1-0 ISSUE YES' NO DATE ISSUED BY - - .__.._._........_. CONDITIONS: L('!J5 -- C5 / t�9 FINAL APPROVAL: , ALL PERMITS PAID LE''� IIID WELL CONSTRUCTION APPROVAL YE$ NO SEPTIC SYSTEM CONSTRUCTION APPROVAL AYE=S_/ NO OTHER YES flu ANY VARIANCE NEEDED YES NU FINAL BOARD OF HEALTH APPROVAL: DAI'E:.t;����I BY:...�. .. - ., i IS THE INSTALLER LICENSED? ES NO TYRE OF CONSTRUCTION: REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW 114- YES CONDITIONS OF APPROVAL YES ' (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO - DWC PERMIT NO. .� INSTALLER:-_-_-15IW4 BEGIN INSPECTION YES 0: EXCAVATION INSPECTION: NEEDED.- PASSED EEDED:PASSED BY CONSTRUCTION INSPECTION: NEEDED: ......................_ �- -- - -- .._._._..._.._....._.. ............. . AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: FINAL GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: BY f " ' C Y MAP # COQ /-� --`- LOT # �--------- ___._.._.__...(_..._-.---.--.._._.. PARCEL # 1� STREET.�"tQ tAtL` Rf�l CONS-T.R.U.- I.ON__....._ _ROVAL„ HAS PLAN REVIEW FEE BEEN PA ,D YES NO PLAN APPROVAL: DATE e> APP. BY. DESIGNER: r� //�` /L - _ _ PLAN DATE._ ........--- CONDITIONS 12cc_ [Gc WATER SUPPLY: OW WELL WELL PERMIT _---_- DRILLER._...._--.-----.-.----.__..._........___.............._....____......_......_.__....._.... WELL TESTS: CHEMICAL DATE APPROVED,_____.-_._,__..__._ BACTERIA I DATE APPROVED BACTERIA II DATE APPROVED COMM FORM U OVAL: APPROVAL T ISS NO DATE ISSUED �? 7 - BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: Y 1 SEPT I_G._$Y�T�M__I NSTALLAT�.ON. IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT <z5) NO DWC PERMIT NO. INSTALLER:,._........._.___..._._.___......__—....__....__._ BEGIN INSPECTION YES NO: ------_.__--_ .._...._._.............. ............... EXCAVATION INSPECTION: NEEDED: _---------__........................___.._.__..._.__.......__.........................._. PASSED__--- _ ---------- BY— --- -- _..__............... ....-.................. — -- CONSTRUCTION INSPECTION: NEEDED s___._...__................_........._....................................._._......__................_._........_._.__.._._ AS BUILT PLAN SATISFACTORY: YES:_____ _______..__—__._.._....__..._..____....._.....__._._.._._._.._.._.___._....__... APPROVAL TO BACKFILL: DATE BY—_....._............................. FINAL GRADING APPROVAL: DATE----__._—_—..--.--___..BY._.___.........._...................._._..._...__._....._...................._............... FINAL CONSTRUCTION APPROVAL: DATE:---------............................BY .............................................. Commonwealth of Massachusetts City/Town of . System Pumping-Record Form 4 DEP has provided this form for use-by local Boards of Health. Other forms may be*used, but the information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Locatio Le gh# onto Nous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Rig ron o uildirig, Left/Right rear of building, Under deck Address L( CRY/Town State Zip Code 2. System Owner Name Address(if different from location) CityTrown RECi State ,� Z�Code ; JUN 3 0 2015 Telephone Number �� ; _ WN OF NOR. ANDOVER ENT B. Pumping ReCouu- I. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank 9 ❑ Other(describe): 4. Effluent Tee Filter present? ®'Yep ❑ No If yes,was it cleaned? es ❑ Na " 5. Condition of System: G s? 4 6.- System Zurn4d By: c� C ,Ll Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents-were disposed: Lowell Waste Water r- C.9^6'� Sign a Haul Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of RECE City/Town of System Pumping-Record 10V System ; X014 Fort 4 TOWN r ANUOVER DEP has provided this form for usezby local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the forrim 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:Rig fron of;ho;use Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/ g roullding, Left/Right rear of building, Under deck AddressW City/Town State Tp Code 2. System Owner. Name Address(d different from location) CilylTownState _ 71p Code Telephone Number �3 B. Pumping Record 1. Date of Pumping p 9date Quantity Pumped:ed: , Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No. " 5. Condition of 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company 7. Lova' . e contents were disposed: G.L S. Lowell Waste Water Sign HauleV Date t5fomu4.doc-06/03 System Pumping Record•Page 1 of 1 I • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 11/3/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On-Site Sewage Disposal System By: Todd Bateson At: 44 Bruin Hill Road Map 104.A Lot 0097 ort Andover, MA 01845 I suarice of thri�c fic t�`shal of be construed as a guarantee that the system will function satisfactorily. /A1.46 C Michele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com tµORtl,4 � p SsACNU�E'C PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired; By' 1 (Print Name) Located at: q '1 oiK) (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated and last revised on _����' 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 with the provisions of 310.CMR 1.5.000,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. Bottom of Bed Inspection Date: p Engineer Representative(Signature f/ILL , 11lu�_, RECE'N i- And-Print Name &L�Q Final Construction Inspection Date: --;3,A9-14 NOV 0 3.2014 /� Engineer Representative(Signa. K)A N OF NORTH ANDOVER �1 L t/ Ou F ��ii 1.1/i HEALTH DEPARTMENT And-Print Name "�' Installer: (Signature) Date: �d_30 -� 1 // �// And-Print Name Enginer: V�IE�tU4 �vf*4(0t6 QA-Signature) Date: Ia,-51-- �r And-Print Name 1600 Osgood Street North Andover,ndover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com k i SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN. PRE-EXIST BLDG. CORNER A B C D � s� THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 157.76 SEPTIC TANK OUT 28.5 38.2 - _ A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION SEPTIC TANK OUT 157.51 PUMP TANK OUT 35.8 31.5 - - AND ELEVATION OF THE EXISTING SYSTEM PUMP TANK IN 157.47 DIST. BOX 52.0 30.3 - - COMPONENTS. DIST. BOX IN 158.34 DIST. BOX OUT 158.16 INV. BEG 158.11 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; INV. END 157. EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY BOTT. S.A.S. -1-157.43 AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. ,,to SIGNATURE OF DESIGNER DATE 200 80 15012 \ LOT 2A (87,120 S.F.) \ 200' WIDE NEW ENLAND POWER COMPANY EASEMENT GAL SEPT r� SEPTIC T �, 1000 GAL. PUMP TANK t \ IN ECTION z-z P RT D V0X 4 ' LEACH FIELD t2 VENT (800 S.F.) `\\ ._ - - - rt98:88' Y 7 104.20 BRUIN Rm ROAD IH OF�4ssq VLADIMIR L NEMCHEIVOK m I AS BUILT PLAN A�°�FSS �NG���� ANAL E OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./44 BRUIN HILL ROAD AS PREPARED FOR m z ROSEANN FARESE TM: 104A �° �- '► DATE: 10-30-14 7 TL: 97 E a �� SCALE: 1"=40' "66ii 43W, 0 20 40 80 MERRRUCK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 w North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 44 Bruin Hill Rd. MAP: 104A LOT: 97 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering PLAN DATE: 7/10/14, rev. 8/11/14 BOH APPROVAL DATE ON PLAN: 8/19/14 INSPECTIONS TANK INSPECTION: 10/28/14 DATE OF BED BOTTOM INSPECTION: 10/28/14 DATE OF FINAL CONSTRUCTION INSPECTION: 10/31/14 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base X Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port F71 Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: Tank to house 17.6, house to pump tank 25'4" PUMP CHAMBER X Bottom of tank hole has 6" stone base X Weep hole plugged X 1000 gallon Pump Chamber installed ® H-10 loading X Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: i SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, , aspon rovided Ian p X Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: W31'x51'L SOIL ABSORPTION SYSTEM = Stone & pipe gravity system FINAL GRADE VN/, amed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer E�/ As-Built Plan 0 BM = 159.59 H R = 5.04 HI = 164.63 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 6.27 158.01 157.79 Septic Tank IN 6.52 157.76 157.50 Septic Tank OUT 6.75 157.53 157.25 Pump Chamber IN 6.82 157.46 157.20 (2")Pump Chamber OUT 7.09 157.37 ---- (2") Distribution Box IN 6.14 158.32 158.30 Distribution Box OUT 6.14 158.14 158.13 Lateral 1 TOP 6.20 / 6.40 Lateral 1 INVERT 158.08 / 157.88 158.10 / 157.90 Lateral 2 TOP 6.18 /6.38 Lateral 2 INVERT 158.10 / 157.90 158.10 / 157.90 Lateral 3 TOP 6.19 / 6.40 Lateral 3 INVERT 158.09 / 157.88 158.10 / 157.90 Lateral 4 TOP 6.18 / 6.40 Lateral 4 INVERT 158.10 / 157.88 158.10 / 157.90 Top of Chamber Bottom of Bed/Chamber 157.38 157.40 �I it M CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 Suction line 222(2) z 100 feet is a minimum d lesser acceptable distance and no variance is allowed for a i p s stance(NA 5.02). s As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws � Sy'S��D'lcya • North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 44 Bruin Hill Rd. MAP: 104A LOT: 97 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering PLAN DATE: 7/10/14, rev. 8/11/14 BOH APPROVAL DATE ON PLAN: 8/19/14 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 10/28/14 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: f Ca SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned \ ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTI NK ❑ Building sewer in continuous grade, on compacted firm base V Cleanouts per plan Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon tank has been installed H-10 loading Monolithic tank construction `�- ` ❑ Water tightness of tank has been achieved by visual testing \ ❑ Inlet tee installed, centered under access port ' 1 • II ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER / Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon Pump Chamber installed H-10 loading Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan L Comments: VV (/ � IL_ �'� SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ` ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As-Built Plan i BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT i Top of Chamber Bottom of Bed/Chamber SKETCH PLAN f CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains .w.interce t 25 50 ( p g ) ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Commonwealth of Massachusetts Map-Block-Lot • 104.A0097 II ----------------------- BOARD OF HEALTH Permit No North Andover BHP-2014-0796 ------------ -- -- P.I. FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONISTRUCTION PERMIT Permission is hereby granted Todd-Bateson to(Construct)an Individual Sewage Disposal System. at No 44 BRUIN HILL ROAD as shown on the application for Disposal Works Construction Permit No. BHP-2014-079 Dated September 23,2014 ----------------------- ----------------------------- F"" r TI Issued On: Sep-23-2014 _ 1 ----- ORD�OF HETH r........................................................................................................................................................................... 44 BRUIN HILL ROAD Reference No: BHJ-2014-000032 ................................... Permit No: BHP-2014-0796 Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Account No: Septic Account Rev Fee Type: .................................... DWC-Full Repair PERMIT Receipt No: REC-2015-000369 ......................................................................................... .................................... Paid By: Paid in Full On: Tue Sep 23,2014 Todd Bateson .................................... ......................................................................................... Check No: 8257 Received By: .................................... Lisa Blackburn ......................................................................................... DEPARTMENT'S COPY Amount: $250.00 -------------- L......................................................................................................................................... ...................... --------------------------------------------------------------- ------------- ................. -----------*"'*..........."--------------------------------*—....... 44 BRUIN HILL ROAD Reference No: BHJ-2014-000032 ................................... Permit No: BHP-2014-0796 Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Account No: Septic Account Rev FeeType: ................................... DWC-Full Repair PERMIT Receipt No: REC-2015-000369 ......................................................................................... ................................... Paid By: Paid in Full On: Tue Sep 23,2014 ................................... Todd Bateson ......................................................................................... Check No: 8257 Received By: ................................... Lisa Blackburn ......................................................................................... CUSTOMER'S COPY Amount: $250.00 ........................................................................................................................................ .......... i _ Application for Septic Disposal Systerl? ` 'S Construction Permit - TOWN OF TODAYDATE $250.00'–Full Repair NORTH ANDOVER, MA 01845 $125.00—Component Important Application is hereby made for a permit to: When filling out ❑Coqgtruct a new on-site sewage disposal system* forms on the computer,use repair or replace an existing on-site sewage disposal'system* only the tab key to move your E]Repair or replace an existing system component–What? cursor-do not use the return A. Facility Information `,41 i key. "7 7 Address or Lot# as City/Town t ` 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ump ❑Gravity(choose one) —If pump sys em, attach copy of electrical permit to application' ➢pump System (pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes V No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of fl/ter before DWC issuance) What is the Make? What is the Moder' 2. Owner Information 6 s� ANS ,t rx5, Name Address(if different from above) Cityrrown State Zip Code 47)�r 1�1 r . 1e>j 0-L4- .-- Telephone Number 3. Installer Information Name f// A F e + Name of ComMOO ENTERPRISES,INC. Address V [ L ANDOVER k4A 01810 Cityrrown State �/ c� Zip Code Q IS- c9 Telephone Number(Cell Phone#ff possible please) 4. Designer Information Name Name of Compan Address City/Town State Zip Code 9! Telephone'Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 t .r :T •+to Application..for Septic Disposal :System } p construction Permit - TOWN OF TODAY'S DATE -ORTH ANDOVER, MA 01.845 $.250.00-Full Repair $125.00.-Component SACNU`+ PAGE 2 OF 2 A. Facility.Information continued.... 5. Type,of Building: esidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover,and not to place the system fn operation until a Certificate of Compliance has been Issued this Board of Health. Name � Date Application r ed By: (Board of Health Representative) Name Z-3 Date App tion Disapproved for the following reasons: For Office Use Only: 1 Fee Attached. Yesv No 2. ProjectMariager Obligation Form Attached. Ye' No 3.: Pvstem:? Ifsoi Attach ofElectrical Permit` Yes No 4. Foundation As Built?(hew construction ronly); Yes_ No (Same scale as approved plan) .5 Floor Plans?(hew construction only): NO Applrcition for•Dispo3al System Gonstractioo Permit-Page 2 of 2 SEM, S'A'S7C : ' =•�It1flf EaC'I'M14X&(;RMMN '_OBIJGA IOM Aa fl*N¢ath Andover.&MMed iiaettt m r the=#ftgcOt•f0s:�� n � 'ti878teM'forr.the�apc�y$t: (Ad4rM of sepdc sptt=) -1for plow by tie�the.apgttcaetaa of �� ���e�� aid 4ftd Dated adars a With 9Vddow dated (haat revised date) I understand the following obligations for management of1w proicce: i. -��-}}aha the iatuDA4 IA= Dbl*�W io obta(.im#I peupita+and'B=d O' Mea th appmvesd pim to ��•un3r.Se7a a ,• L=11417E flits ADt�rtlyCE� RlY.b.lL As. 4ex etaoei nonot? iia ,caQ for anp sad ei$3asp honeoanae CtlatCaetQr,.project maflagrr,at Any item t ger ssr oeia#ed with my rmapaaP an lnsp cldoa and the spstein is not tesdy,then "bei mppH=ble. I As ti�iu�-I�regl=d to.hava the sit �r . i� ted� F � aets�d•ptfa�xfl the mous ss • �' slrael'1d bn••deaa• �� �t�n� .(1'-`bj.'tstap - ts;thes+e is A'rctairmag�+a�l,�liie)s ihspecdojQ bat dQi S.neat have tO be,PUlbtie. . 'varbul C)K•(at fa: ealldmichu dErt �ep e:Tet�ieme�.•thes,etc. be ttibariittied trj*hc Board ofl3eettb,s}eti�v =ins�ll�r• rasa ins g- - time. mllcr iriust be press. t far tl>i ,inapeetlont, with at pile%g a um" deqftkuk ll tg -A=be readp sad able to . 'exuae,Izutrip.•tc�a►rje ti;id;sls�r.to{ .. . •' • ;. . - c. - tteteilllet toast tegtut saapc�tion arhtjilgda� a r, plata: Iffier docs have to die ttfte.• not 4. Aa the inst 'I ttaxts nd that only 1. per6mdtt; otftatGamn to eplete tligeiatesttltett of the eryn and�orIeii Qf IvIi�_�tettl t iet#tie �pp �men)and reg4tired r, �f4I utstaltAtlOa: seaaaels for dn+ial f 1+ts Patein w` ��'t'br acs +` e -- � .1— � ... the Trscs�3 5.. Ak the iaswex,•I vhdertt,eitR t#sstI mus a ori=a the pa ce-af tfi7e foIlo coastNcfioa StCV5, '° 8 CtCr1tI�A�O r' �lAlC f1119�tki+j}ff0!!0*6@ Y��ltiaJR6rQtJ�98-,6*4p machcd 66 Irtsatftexo he used c F&dAWcc fovbyBowtadFesM saffore= t, d Isn�tlrllata'av ofmak,D�-. aa�PrY�p'�rt v m tt rg llssrLl atter cormpr.�rcatx►. � � - . - �'�� No�stturtioiss,��,• is ......,rte. �i�t...,..����..a . *. .— f ia;l�Fj�CMDF1 alt$�90LtYB undenjana uCe 3Ed S rrodaoa I��teY JUL-20-2005 08:32A FROM: TO:19784755451 P. 1/1 'I I l I I � I I N I �I I . i I 1 I 1 I I Date.... •`. ~ TOWN OF NORTH ANDOVER! t PERMIT F©R WIRING f •�� Win•f'���4' I i s certifies th t •........... - . ..... ..... 0...4.�Av.......... ....... ............ Permission o perform ng in the buVdin of ` ..............•..... ,North Andover,Mass '_� .... ��$LF.C'i'R[CALINSPf:Cf'OR..•................. 747 I i I t I f t I i � I I I I I i f 'l �. I f North Andover Health Department (ommunity Development Division August 19, 2014 i Richard&Rose Farese 44 Bruin Hill Road North Andover, MA 01.845 Re: Subsurface Sewage Disposal System Plan for 44 Bruin Hill,Map 104A,Lot 97 Dear Mr. Farese: The proposed wastewater system design plan for the above site dated July 10, 2014 with a final revision date August 8, 2014 received on August 15, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom (max 9-room)home. This plan is generally good for 3-years from the date of approval however, as this is for a repair system,this is reduced to 2-years. The plan received the following local upgrade approval. 1) Use of only one deep hole in proposed disposal area During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. 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 also subject to the following conditions: ` 1. Please keep the attached DEP Form 9b for your records (attached) 2. 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)). 3. 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Q 44 Bruin Hill Road August 19, 2014 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. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely,, [Y./Susa Zer, HS/RS Public Health Director Encl. Form 9B Installers list cc: Vladimir Nemchenok, Merrimack Eng. Services File I I Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of North Andover HF Local Upgrade Approval Form 913 �M DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Richard and Rose Farese key to move your Name cursor-do not 44 Bruin Hill Road use the return key. Street Address North Andover MA 01845 �y City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemenchenok X PE ❑RS Name 66 Park Street Andover MA 01820 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: o/o SAS sizes9.ft. reduction 44 Bruin Hill Road Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 913 �M B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater tt ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Det /17 Approving Authority Susan Sawyer ,' f August 19, 2014 Print or Type Name and Title S' nature Date 44 Bruin Hill Road Local Upgrade Approval, P pg pp age 2 of 2 N°eTN 6 9 r; 9t ti° � a • Town of North Andover HEALTH DEPARTMENT SACHUSf CHECK#: DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Cob d( 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 r $ ❑ 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) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ ( P0 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer ' i 1 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:hl!p://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: .l' I S - I L,L 2014 jowt4 OF NUR(H ANDOVER e 4 Site Location: �k' !J �� (L(, 1, AL H DEPARTMENT Engineer: -t New Plans? Yes $225/Plan Check# 7�_71_Z (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? Yes " No Telephone#: [170 7 q-75 Fax#: (q- q75, H*9 E-mail: Homeowner Name: OFFICE USE ONLY When the s7bission is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant > Enter on Log Sheet and Database ill i F/ t r Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. 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 15.415. NOTE: Local upgrade approval shall not be granted 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 an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use Richard & Rose Ann Farese Residence only the tab key Name to move your 44 Bruin Hill Road cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code tab 2. Owner Name and Address(if different from above): SAME Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ Schdo'1EGEI E l 4. Describe Facility: JUL 2 Z 20' 4 BDRM. House TfMA„ * mn _. NORTH ANP I HEAVAVEPARTMENTa 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Trenches t5form9a.doc•rev.7/06 Application for Local-Upgrade Approval*Page 1 of 4 ( � t Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval wM DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Total Replacement(see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ 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 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluators Name(type or print) Signature Date of evaluation C. Explanation 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: NA 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc•rev.7/06 Application for Local Upgrade Approval, Page 3 of 4 /! Commonwealth of Massachusetts Cityrrown of North Andover Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 5. 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): D. Certification "l, 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." 7-15-14 Fac lity Owner's Signature Date Rose AnrcFarese Print Name Bill Dufresne/Merrimack Engineering 7-15-14 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval Page 4 of 4 a Commonwealth of Massachusetts City/Town of y Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information &AAA942 4 W�?A QQ?, FA"11706 Owner Name AZ 177 4A ft4AWLA.- Street Address r Map/Lot# Weo�_ANPQSIZ�i City State Zip Code B. Site Information 1. (Check one) ❑ New Construction grade ❑ Repair qee tt91 oto q 4652. Published Soil SurveyAvailable? Yes El No If es: ®� t� y Year Published Publicati n Scale Soil Map Unit ! A""Q Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes No If yes: Year Published Publication Scale Map Unit —I'll L, l IV t—�O ph l 11.1 Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? MoYes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS). Mo th�r Range: ❑ Above Normal Normal ❑ SelowyNorma Q� T. Other references reviewed: AN OVER HEALTH DEPARTMENT Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Yf C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: --Z*-14 i 2 PPAJ V Q:'WAjf a —770" Date Time Weather 1. Location Ground Elevation at Surface of Hole: I Location (identify on plan): 2. Land Use Vo-I Y -/`V �aou)� (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) I kw k) &!P. —gip 4PIF Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Bodyfeel Drainage Way ?I Io Possible Wet Area et1 Property Line feet Drinking Water Well 10— > Other feet 4. Parent Material: 11--l-L Unsuitable Materials Present: CSj4es ❑ No If Yes: ❑ Disturbed Soil Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: Yes ❑ No If yes: x'72 Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: &4 13.0 inches elevation Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Y( , C. On-Site Review (continued) Deep Observation Hole Number: � 1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Cobbles& Structure Consistence Other Depth Color Percent Gravel Stones 9f 0/c- (p ��3 > 5 10— IS 10 +1A'"Ilv>o i=11440 Additional Notes: Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Z' rZ&-`4 17Z OCA) LJ6l*ll) — 70's Date Time Weather 1. Location Ground Elevation at Surface of Hole: l '� Location (identify on plan): 17rz PL.&O °I 2. Land Use � �Ip,�I. �E.L IS ut 0-50/0 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) L2 t,o Vegetation Landform Posit�ioi on Landscbape(attach sheet) 3. Distances from: Open Water Body ?I00 Drainage Way � Possible Wet Area �! feet feet feet Property Line 42 fee Drinking Water Well fee Other feet -Th 4. Parent Material: Unsuitable Materials Present: a-/Yes ❑ No If Yes: ❑ Disturbed Soil ZFillMaterial ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 67 -inches Ise iql i Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) -� Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) � Munsell Consistence Other Layer Moist(Munsell) (USDA) Cobbles& Structure (Moist) Depth Color Percent ravel Stones F'I U,1 --- Additional Notes: .l Soil Evaluation Forms.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches pth weeping from side of observation hole A. B. ;/Depth inches inches to soil redoximorphic features (mottles) A. ("A B. inches inches El Groundwater B. Groundwater adjustment(USGS methodology) inches inches. 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Doesat ast four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil abso Ion system? Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inches -7 Lower boundary: inches� Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 1 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluato Date r-s-i±.a: 9 S �+0 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam —ThAA fi -I Qqln �0r?;N)e1& Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percolation Test Form 12. Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the n computer,use only the tab key Owner Name to move your �14 41 LA, b�[/ cursor-do not Street Address r Lot# use the return A � key. ri tV CitylTown St to Zip Code �0 1ilop- /0� Contact Person(if different from Owner) Telep no eh Number B. Test Results Date I Time Date Time Observation Hole# Depth of Perc 1 Start.Pre-Soak 124 End Pre-Soak Time at 12" Time at 9" I ► I Time at 6" I Time(9"-6") I Rate (Min./Inch) Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 MCOPY North Andover Health Department Community Development Division August 6,2014 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewaze Disposal System Plan for 44 Bruin Hill Road,Map 104A,Lot 97 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated July 10,2014 and received on July 22, 2014 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Please indicate the orifice size in the distribution piping is to be 3/8"-5/8" in size(3 10 CMR 15.251(8)) 2. Please indicate the need for the base aggregate and the cover layer of pea stone to be double- washed stone(3 10 CMR 15.247) 3. Please provide for the brand and model effluent filter which you propose to have used(3 10 CMR 15.227(7)) 4. Please provide greater clarity for the site contractor regarding the inlet tee inside the distribution box including dimensions of piping, distances from to and bottom of box and other relevant features Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. /Sincerelwy S h ire r cc: Rose Ann Farese File Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 6826 9 Town of North Andover HEALTH DEPARTMENT s�CMUSt CHECK#: UT) DATE: LOCATION: H/O NAME: i 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:)( &02P Septic-Soil Testing ❑ Septic-Design Approval ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer s s. TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT = a s 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,RENS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthdept aQownofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS !f_ DATE: r!l j�� MAP&PARCEL: ��'f A / -7 LOCATION OF SOIL TESTS: 44 o(L(,{I L) If L(i EM9 OWNER: V—V I! t(.yL() Contact#: �Gr �� (p�i� �a��Qc✓ APPLICANT: y��� Contact#: 70 1, ?ZZ-�; ADDRESS: _[ SJR 1►,.� ��1� ��. ENGINEER: 'fy�,IiJAGk� la-DC �6 Contact#: CERTIFIED SOIL EVALUATOR: f CElVED Intended Use of Land: R7U* ndeveloped Subdivision SnHComme ial JUN 17 2014 Is This: Repair Testing: LotTesting. Upgrade for Addy ofiQWN OF NORTH ANDO VI In the Lake Cochichewick Watershed? Yes No V HEALTH DEPARTMEP- THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x Il"Plot plan A Location of Testing(Please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than F'-] shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approvq4 Date. Signature of Conservation Agent: Date back to Health Department: (stamp in): CL 146 j s r 144 5, i t i.of 2 Wit. I3��.3Y i r. 4& / �;n; is srrwc rf _ L,F, tr 17 2 IG 1,0 CP r BRUIN ROA B R ---- zo 70 1i1.�,. Blackburn, Lisa From: Blackburn, Lisa Sent: Tuesday,July 22, 2014 1:49 PM To: Dan Ottenheimer;Isaac Rowe; Pam Lally Subject: 44 Bruin Hill Good Afternoon, I will be mailing out paperwork and design plans for 44 Bruin Hill Rd.today. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com .a 1 Commonwealth of Massachusetts RECEIV = City/Town of System Pumping Record JUL .1 4 2E)1 D4 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMERwT DEP has provided this form for use;by local Boards of Health. Other forms Nd;bt�tre information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility_ Information 1. System Locatio . Le /Ri vont of ho , Left/Right rear of house, Left/right side of house, Left/ Right side of but Ing, Left-/Rig *nt of building, Left/Right rear of building, Under deck Address U I V\- 4t,%Acue-r City/Town State Trp Code 2. System Owner. Name Address(if different from location) City/Town ' State Zip Code Telephone Number z B. Pumping Record 1. Date of Pumping �_l ry 2. Quantity Pumped: DateGallons 3. Type of system: ❑ Cesspool(s) Septic 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 Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: Lowell Waste Water 1:72-i L-- Sign a cf HauaryDate ' t5f6mm4.doc•06/03 System Pumping Record•Page 1 of 1 Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Thursday,June 26, 2014 4:01 PM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; 'Isaac Rowe' Subject: RE:44 Bruin Hill Attachments: 44 Bruin Hill Road - Soil testing results 6-26-14.PDF Susan/Lisa, Attached are the soil testing results for the above referenced property. Only about 5'of fill material here so we were able to conduct a perc test. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe@millriverconsulting.com www.miliriverconsulting.com -----Original Message----- From: Blackburn, Lisa [mailto:LBlackburnCa@townofnorthandover.com] Sent: Monday,June 23, 2014 4:13 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Bill Dufresne Subject:44 Bruin Hill Please set up a date for soil testing with Bill Dufresne.Thank you. -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Monday,June 23, 2014 4:19 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 06.23.2014 16:18:57 (-0400) Queries to: noreply@townofnorthandover.com f { Y 1 � j E l ; 1 i i • f , t its _� Blackburn, Lisa From: Pam Lally <plally@millriverconsulting.com> Sent: Tuesday,June 24, 201410:53 AM To: Blackburn, Lisa; 'Isaac Rowe' Cc: 'Bill Dufresne' Subject: RE:44 Bruin Hill Hi Lisa, We have this scheduled for Thur. 6/26 in the afternoon. Thanks very much, Pam -----Original Message----- From: Blackburn, Lisa [ma iIto:LBlackburn@townofnorthandover.com] Sent: Monday,June 23, 2014 4:13 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Bill Dufresne Subject:44 Bruin Hill Please set up a date for soil testing with Bill Dufresne.Thank you. -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Monday,June 23, 2014 4:19 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date:06.23.2014 16:18:57 (-0400) Queries to: noreply@townofnorthandover.com 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. 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. Noel, 6739 Of � •�,h0 ;^ Town of North Andover HEALTH DEPARTMENT ,ssACNUgtt CHECK#: DATE: 4hl LOCATION: C0 1 n' 1 14 H/O NAME: T_AT,_if �L 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 $ ❑ TrasIVSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $ ❑ Other. (Indicate) $ i Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer ' Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1 °y( 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any i+ way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use APR � ( L014 only the tab key 1. Inspector: to move yourTOWN OF Neil J. Bateson cursor-do not use the return Name of Inspector V orf key. Bateson Enterprises Inc. IAV Company Name 111 Argilla Road Company Address Andover MA 01810 Citylrown State Zip Code 978-475-4786 S115 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 ❑ Ne ds Further Evaluation by the Local Approving Authority cin 3/31/2014 In p cto s Signatu 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 autt orifi """"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. I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r ` Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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•3/13 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 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is North Andover MA 01845 3/31/2014 required for every page. Citylrown 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 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 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 Y day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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 4 E] ® 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. ® 1:1The 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 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. t5ins•3/13 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 °< 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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? ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 t5ins•3/13 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 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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: Pumped 2008, Pumping record at B.O.H. 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Original to house, no date on as built plan. 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: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall, T PVC in house. Water leaking around pipe leaving foundation Septic Tank(locate on site plan): Depth below grade: .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: 10'x 5'x 4' Sludge depth: 8" t5ins•3113 Title 5 Official Inspection Forth: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 't 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. Cityfrown 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 25" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle 2" Distance from bottom of scum to bottom of outlet tee or baffle 4" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee clogged clean same.0utlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. 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•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. CitylTown 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 2" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. Evidence of carryover. No evidence of leakage. D- box badly corroded. Liquid level 2"above all leach pipes. 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 44 Bruin Hill Road Property Address Richard Farese Owner .Owner's Name information is required for North Andover MA 01845 3/31/2014 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3 trenches 56' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok.Vegetation ok. No sign of ponding to surface. Camera leach pipes, liquid above all leach pipes. Signs of hydraulic failure 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-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owners Name information is required for North Andover MA 01845 3/31/2014 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.): I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments "< 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 . every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately O O t _ `30L(ott a— U p�=►fit 6 4-� LA�I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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: >4feet 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: 6/7/1990 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 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 44 Bruin Hill Road Property Address Richard Farese Owner Owner's Name information is required for North Andover MA 01845 3/31/2014 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of North Andover Tax Map # 210-104.A-0097-0000.0 Parcel Id 16324 44 BRUIN HILL ROAD ROSEANNE FARESE 44 BRUIN HILL ROAD NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 2 Acres FY 2014 UB Mailing Index Name/Address Type Loan Number Active/Inact, From Until ROSEANNE FARESE Owner 44 BRUIN HILL ROAD NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 18162.0-44 BRUIN HILL ROAD Last Billing Date 1/7/2014 3180190 03 Cycle 03 Active UB Services Maint. Account No.3180190 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 11 9.18 1/ WTR WATER 01 ALL METER SIZE 135.90 /1 UB Meter Maintenance Account No.3180190 Serial No Status Location Brand Type Size YTD Cons 13240189 a Active 00 METE METE w Water 11 963 Date Reading Code Consumption Posted Date Variance 3/13/2014 1533 a Actual 40 39% 12/16/2013 1493 a Actual 31 1/17/2014 -25% 9/13/2013 1462 a Actual 40 10/15/2013 18% 6/14/2013 1422 a Actual 32 7/24/2013 3% 3/20/2013 1390 a Actual 35 4/22/2013 2% 12/13/2012 1355 a Actual 30 1/9/2013 -14% 9/19/2012 1325 a Actual 38 10/15/2012 19% 6/18/2012 1287 a Actual 31 7/16/2012 -1% 3/20/2012 1256 a Actual 32 4/14/2012 5% 12/19/2011 1224 a Actual 31 1/17/2012 -15% 9/16/2011 1193 a Actual 37 10/13/2011 -5% 6/13/2011 1156 a Actual 37 7/20/2011 5% 3/15/2011 1119 a Actual 36 4/13/2011 -7% 12/13/2010 1083 a Actual 37 1/12/2011 2% 9/16/2010 1046 a Actual 40 10/15/2010 -50% 6/11/2010 1006 a Actual 71 7/15/2010 -7% 3/17/2010 935 a Actual 83 4/14/2010 28% 12/14/2009 852 a Actual 62 1/12/2010 16% 9/16/2009 790 a Actual 59 10/15/2009 12% 6/10/2009 731 a Actual 45 7/20/2009 -9% 3/18/2009 686 a Actual 55 4/29/2009 8% 12/15/2008 631 a Actual 50 1/20/2009 90% 9/15/2008 581 a Actual 28 10/10/2008 12% 6/10/2008 553 a Actual 23 7/16/2008 -58% 3%13/2008 530 a Actual 54 4/11/2008 47% 12%17/2007 476 a Actual 40 1/22/2008 195% 9/13/2007 436 a Actual 12 10/12/2007 26% 6/21/2007 424 a Actual 11 7/20/2007 -78% 3/16/2007 413 a Actual 48 4/16/2007 8% 12/13/2006 .365 a Actual 40 1/19/2007 -2% 9/20/2006 325 a Actual 44 10/20/2006 28% AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation /-3-7. 7g' House �;� 7 7� s 7,�g Tank IN Tank OUT /.� 7 61 D-box IN 76 D-box OUT Trench Inverts Line 1 Line 2l�� .,� 7 Line 3 /.5 S 7 Line 4 53. 513 Bottom of Exc. �SyU� /Sy G, 1-5-j,_5- Stone OK? D-box checked? Pipes cemented? 1 NORSE ENVIRONMENTAL SERVICES, INC. 3 PondWew Place Tyngsboro, Mass. 01879 TEL. 649-9932 AS-BUILT SURVEY Lot 2B 1" = 20 ' Owner : James Graphoni Installer : John Cormier Location - Elevation Foundation Outlet . . . 157 . 79 Tank Inlet . . . . . . . . . . 157 . 59 Tank Outlet . . . . . . . . . 157 . 44 D-Box Inlet . . . . . . . . . 156 . 67 41 9 D-Box Outlet. . . . . . . . 156 . 49 Beg. Trench #1 . . . . . . 156 . 49 it #2 . . . . . . 156 . 41 " to #3 . . . . . . 155 . 85 End Trench #1 . . . . . . 156 . 00 if it #2 . . . . . . 156 . 00 to it #3 . . . . . . 155. 53 8 Bot . Trench #1 . . . . . . 154 . 00 to to #2 . . . . . . 154 . 02 #3 . . . . . . 153 . 53 a•y9' A - 69' %�-- _ L1 73 5 - 731 OF�qs � G � m , J r BRUIN HIL g86L ROAD FRED g i . �1�59,��1�ih1'�ir���r+ ,i,;ii..1•� ''1 1 ,�•.%;.i7i i�, •, r.L•r•t,•n �.V`,`V'lllM v;i•;;.1:. •, .;.y,,i..;: RM DO" • 1 ,OVE�� S 1� ACHU 5 : `e .u.tnp.In` ecord' �--- V SETTS ' N iy yyy/// yT;;:i,,::,'I" r.+.. � D Z J,, •• 1 1.�N i�; k•� JA JI. J.'M j,'�i.l:l.!l.Ir•' . '.I 1•\IJ.,��, ��;i�111.yr::i��?a Klll�r�{'rrH v$^:4:t��. .�IS;rl�.1i11�:71i':r', .��,�,,YJ,q.i,,,. t..,l,,,rt'r,'ii•7!?'•JyF rt;v'w�fal'� DEP•,has provided Is for 0ou m r• fo us a•b• _ • local t3 1 , • oa Y rds otf'�f�a' aI :be submitted to tha.local't3oard of Health or other a t ' IT A'�ystema Pumping pproving author) P 9 Recorc ,m_, A. Faclllty,lnforn'1 tlon T "F 'T Lin t7 '(lUt(1Q:Out .1; System locatlon; 19 � W kay Address to move your:, `j�L� ✓�J7��G'�Yt�J}� • .wn►or:•do�Qt :; :: e' rotum:, t ,,CIt�Rown ; ' Slate t L� lr.i4 vv���� 1, 'i•i' ',;'i l.,.. ..!t•;IJi`:'�;.,1',•� r`�i':r a.y'�•r: .. �. pCode �r. ;jib"r>•ri2,,,SSt' System Ownsr'� ',,f''• 1;;, , IIVI U ,l !', " •.•r i'• 7t,.:, Address(If dtnerent from bcatlon) I V- Ckq/Tovm:•> ~1; Slate j Telephone Number :,l' ;r:"•"•1%lir��;�' ;:'•i•.`i'' .•v;r..�. :... , C)a `�11'.r ::)ii,!aJ«5>�y:i���'t''fits.y;.r/,7JItq:.Jli�Jl�'�I'1�•L�'"q�'.�' r• ' t�'of Pumpinq dale 2• QuantJty Pum pad: ;• '.Type Pf.aystam;`; ❑ Cesspool(s) Septic Tenk ❑ Tight Tank ',.Other(d ascribe);" .;:�?thy,;:�" :'r.;/•• •;' ------------- ri•t Tae FIIte r�sant?..[] Yes No {.p ❑ If yes, s It cleaned? ❑. : i ,I�+�f?;, 1:i !!'rl;y;r r•i:�a�?i�i�•. Wa e ❑ Yes No ' 0.1 ?,''�ih�lltt',�:.:.�.�,;611�;Co�dlpc�Q�s i'�!'. .,, ","• ,., _ . ri:. ;Arl,tfil.y:iJi!l'(l:Y7l'.....,..... J;' ' ' !r ',d,tv l(j�.J4.j:it`"��,?;'•,'. .��ll 1�};'.•:`!,'. L�JG� (94.. . . •,•,'.5}•` �.;.t•y:: P'S:In. •iC�.?'•4t%�!.411'l�'r' '•"�'{'' �/�A :`� •,,.•..i.,,t• -It�••t'1.•p�/Y;r;, � 1 ti 5�i1 � .I��'•yf��'�t.�:' •t•, Vehicle cent umbel ::L:'.N; `I•�:r:�, �.,�� Y'�':.:. �'P 1, �/fy A�// ��!/{,��'rCrjp�.�'�.,/'!\.i.�11 X1;1.. .. �C� ' 'i..{. r��, r(:,r � �',�1�•dH�),'taV•l�,t�.�'.4�:�,tllr t',�,t/,t i`I S v 1 :;T y f.!• {4• < ):`.r:�('}:. ars .. �' {a F•;;,;j''::a:7r:' Loca Gh.where concants'Were dlPposad; • .. 1 ..,..;yj„•,:..:. •,..1.;.�. ,fid !'`'•;`<<1. � I i,” '•' �ti '•tiP„`r � 2/,y:a•i'1 •'l,�: iJv /V�`/yi//�I,l/ ,;' ;•�'.'S':;i> ,,�: ,a:/,.�1•� r1,.„;lhr::.4",Y .I:i�w'i i'r', W rr } 1' '\t'r i411''an�•,�:'JJir d.� r't','�}3`.::,.'}'...::r°� 1'yl�' ..6:I t' ' •,,,,fir _ Y �. .. . 'C ; ��':,��:�':w:�'..3'•r.,:�.','�•Sbnalure.G(Haula J r• Date /wrvtiV, a m ssr o"• �A g v/dap/wataNapprovaJs/t6(orms,htm#Inspect •t5forrr}•4,doal•ONQJ � '�,; �! . System Pumping Record Paya 1 _. . '• .- ; t "�J t - L XAORTH 11VAL ummwc�, V (i 7AL Town of 0 n over 0 .� r No. 297 AT 'o -4 K �'An& er�i, ME win , Mass 9% BOARD OF HEALTH e &9 PERMIT T (rffu I LD THIS CERTIFIES THATW#J.!W.A31MW.......co.Aa.ep.r. ......c.d............... 05150 B R has permission to ereerwrM.FA...... buildingsonAor.....Nwo-o* .....&.040...oQ?.(w C U I �/' 4 r Im Aff Chimney to be occupied as r.-A"1xv... ................................ Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in AUMBIN9 INSPECTOR C this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. 7b Corp io tweV vow onum a AW• Final oft VIOLATION of the Zoning or Building Regulations Voids this Permit. *Olt AS 7POWC 45 wxmwa Vsy. &oPERMIT EXPIRES IN 6 MONTHS ELECTRICAL"PECT seg hLESS FDA FEE 11"LE g2cl /. CON, UC STARTS ce WE FRAME PERM$ F Final 'T1 71LUINGTNIPEIIR GAS INSPECTOR PERMIT FOR FRAM�/C .iI%nclv Permit Required to Occupy Building Rough DATE!LPSy FEE PA I D; Final Display in -a-'- Conspic'uous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det , Building Inspector _01 2A &4Ak) A5 MEMO TO: BUILDING INSPECTOR'S OFFICE FROM: BOARD OF HEALTH DATE: JANUARY 14 1991 RE: LOT 2A BRUIN HILL RD. PLEASE BE ADVISED THAT THE BOARD OF HEALTH APPROVAL FOR LOT 2A BRUIN HILL RD. HAS BEEN REINSTATED. PLANS SATISFACTORY TO THIS DEPARTMENT WERE APPROVED AND A PORTION OF THE SYSTEM HAS BEEN INSTALLED. THANK YOU FOR YOUR CONTINUED COOPERATION IN THIS AND OTHER MATTERS. Add ress '-fl't 80-uc►.t JL4 t L L ►� Title of File Page 9 of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Documnan o d note action Document/ document/ ent/ , filum• Action Department Board of Appeals - Board of Health Planning Board _ Conseruatiion Commission - Building ding Departrnent '_______ G FORM U TOWN OI" NORTH ANDOVER LOT RELEASE FUR!-1 SUBDIVISION / r .41 ASSESsms MAP SUBDIVISION LOT(S) C -_ PERMANEN't' AIMRESS (ASSIGNED BY 1). P.W.�— STREET APPLICANT I'IiUNE ✓ _ r DA'Z'E OF APPLICATION 'I'UWN USE !BELOW THIS L1NE ov/ f PLE NI G 4B0 R1) DATE Al�l�ltt)VI'D t( 2-- _10 '1'601, 'LANNER DATE REJI C'1'EU t ` CONSERVATION COMMISSIO11 DATE,. APPROVED CONSERVATION ADMI P1• � 1)A"1'E It1;J I;C'1'l:ll ,BOARD 0 EALT DM H' APPROVED 11L' L' I A 1 RI DATE 1tEJEC'I'I:D ','-'-,DEPARTMENT OF PUBLIC WORKS j)RIVEWAY PERMIT ;. S.EWER WATER CONNECTIONS ) _t r 1--�—'r /� -- w -- — FIRE D�Y'r. pint 2&1ZI ,'RECEIVED BY BUILDING INSPECTION DATE '!Tris forst shall be signed by the agents of the I'lannlnl; incl 11callh Boards , the Conservation Commission prior to the l.:;suance of ally butldl.nl,, permits for the •sub 'e shall. - subject lot. '!'Iris form �ha.l.l. not relelve the .rpp.li�ant from the compliance of any app.11.cable Town requlrentent or Bylaw. NORTH Of BOARD OF HEALTH � A t 120 MAIN STREET ,,r10�PP`�g TEL: 682-6483 �SSACHUS5- NORTH ANDOVER, MASS. 01845 Ext. 32 or 33 October 2 , 1990 Mr. John Cormier c/o Norse Environmental Services 3 Pond View Place Tyngsboro, MA 01879 Re: Lot lA Bruin Hill Rd. No. Andover, MA 01845 Dear Mr. Cormier: I have completed a review of the latest plans for Lot 1A Bruin Hill. The plans have been approved by this office and therefore Board of Health approval for this lot only has been reinstated. Please be advised that I will be submitting a copy of this letter to the Building Department which will serve as notice to the Building Inspector to allow you to begin construction on this lot. Sincerely, ' Michael J. Rosati Health Agent MJR/rel c.c. Building Inspector NORrh ott, 3= BOARD OF HEALTH O 7D 120 MAIN STREET TEL: 682-6483 �SSAC`HUSEt� NORTH ANDOVER, MASS. 01845 Ext. 32 or 33' September 11, 1990 1 Mr. John Cormier c/o Norse Environmental Services 3 Pond View Place Tyngsboro, MA 01879 Re: Lots lA & 2A Bruin Hill Rd. No. Andover, MA 01845 �+ Dear Mr. Cormier: I have completed a preliminary review of the revised plans for Lots 1A and 2A Bruin Hill Rd. , revised 8/29/90. It is my understanding that foundation drains have been installed around these foundations. The designs submitted have been based on the assumption that foundation drains have not been installed. Therefore, before these plans can be fully reviewed, the designs should be revised to meet the local and state regula ions (including reserve areas) , relative to subsurface ra ' Sincerely, Michael J. Rosati Health Agent MJR/re l c.c. Mr. Robert Nicetta Building Inspector NORTH Ot t t o ° 4/ BOARD OF HEALTH � A r9 ^s 120 MAIN STREET TEL: 682-6483 SACCUS PEt�y NORTH ANDOVER, MASS. 01845 Ext. 32 or 33 CH I 1 M E M O TO: BUILDING INSPECTOR'S OFFICE FROM: BOARD OF HEALTH r. DATE: AUGUST 9, 1990 RE: LOTS 1A AND 2A BRUIN HILL ROAD UPON AN INSPECTION OF LOTS 1A AND 2A BRUIN HILL ROAD, IT APPEARS THAT THE BUILDER HAS PLACED THE FOUNDATIONS IN A DIFFERENT LOCATION THAN SPECIFIED ON THE PLANS APPROVED BY THIS OFFICE. THE BOARD OF HEALTH APPROVAL HAS BEEN SUSPENDED UNTIL THE SITUATION CAN BE ASSESSED. PLEASE SUSPEND ISSUING THE FRAMING PERMITS FOR THESE LOTS UNTIL NEW PLANS HAVE BEEN APPROVED BY THIS OFFICE. THANK YOU FOR YOUR COOPERATION IN THIS MATTER. MJR/REL t tkoRTH Br) ARD OF HEALTH � A 1 " x 120 MAIN STREET TEL: 682-6483 �9sS.4cHusE��y NORTH ANDOVER, MASS. 01845 Ext. 32 or 33 August 7, 1990 Mr. Steven Eriksen Norse Environmental 3 Pond View Pl. Tyngsboro, MA 01879 Dear Steve: This office has completed the review of the septic system +, design for Lot 2A Bruin Hill Rd. submitted by your office revised 8/2/90. The plans appear to meet all the necessary requirements for design approval, however, fill material and excavation work is needed on Lot 1A. Please inform your client that before a Certificate of Occupancy can be issued for Lot 1A, an easement for the work associated with Lot 2A must be created or the work must be completed. Very truly urs, / Michael J. Rosati Acting Health Agent MJR/rel NORSE ENVIRONMENTAL SERVICES, INC. 3 Pondview Place - Tyngsboro, Mass. 01879 TEL.649-9932 CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSTALLATION I� STEVEN ERIKSEN 11 A Registered Sanitarian duly licensed by the Commonwealth of Massachusetts , License Number 886 , and working as an employee for Norse Environmental Services , Inc . certify that I have visually inspected the construction of the individual subsurface sewage disposal system at the referenced location and hereby certify that to the best of my knowledge and belief all work has been performed and completed in general .compliance with the terms of the permit and in general accordance with the plans approved by the local Board of Health. Furthermore, all construction appears to comply with the provisions of Title V of the Massachusetts Environmental Code (310 CMR 15 .00) and all applicable local regulations. LOT NUMBER: 2B STREET ADDRESS: Bruin Hill Road TOWN: North Andover DATE: 8/28/92 �.._ ��E*fit►+ OF�'� SIGNATURE "��� SEAL! STEVEN ERIKSEN >; x Fytt, SAMI �__ f rrr',�:�r��f"t" '+"8o-,�1`�` ;'•+H���'t''J'"�E..^t`�"�yik�"'t,t�"''.v� aF'��pfkbt ..:��hxtZT�4 h�.r�...�}'>�st�Ar'�F'i l<x r.y�.�•,{`.S�aF'iw�5i�''� rY•s'<r _ .. r' -, .. �. 14 ly .r.T r 'S. . 1 Ur Ll I "3 fV IE $e" r 1 jIN —F? M1 f 1 1 M1 i I'r 1 + - • I r 1 �1 rl 1 .f f I •/ -�* ���� . \�?�� ~C'I�> . , . � %�'\ ::��. \«��2 %6J'% d?�@ y�� ���\ m»ae �/� .ƒ�\ ��� . �� 2./ ,:� . ,: � /