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Home My WebLink AboutMiscellaneous - 445 FOREST STREET 4/30/2018 445 FOREST STREET 21D/WA D].3a-0000:0 s I I North Andover Board of Assessors Public Access Page 1 of 1 h Town of'Worth Andover-, d of Assessors Property Return to the Home page click on logo Record Card Parcel ID: 210/106.A-0131-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge Sales 4 x - Summary Residence Detached Structure Condo _ s Commercial 9 r ` Comparable Sales 4 , 445 FOREST STREET 9 Location: 445 FOREST STREET Owner Name: WEDGE,NANCY G Owner Address: 445 FOREST STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6-6 Land Area: 2.02 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1665 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 470,800 450,100 Building Value: 231,800 235,300 Land Value: 239,000 214,800 Market Land Value: 239,000 Chapter Land Value: LATEST SALE Sale Price:20,000 Sale Date: 06/20/1982 Arms Length Sale Code:H-NO-COURT-ORD Grantor: WEDGE RONALD J Cert Doc: Book: 01584 Page: 0286 Y,! a http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=990885 4/18/2007 Residential Property Record Card PARCEL ID:210/106.A-0131-0000.0 MAP:106.A BLOCK:0131 LOT:0000.0 PARCEL ADDRESSA45 FOREST STREET PARCEL INFORMATION Use-Cede: 101' Sale Price: 209006 Book: ' 01584 Road Type: _T Inspect Date: 09/18/2003 Owner: Tax Class: T Sale Date: 06/20/1982 Page: 0286 Rd Condition: P Meas Date: To _ ° WEDGE,NANCY G tFfn Area: 1665 Sale Type: P_ Cerf/Doc: Traffic: M Entrance: Address: Tot Land Area: 2.02 Sale Valid_: H Water: Collect Id: RRC O6 445 FOREST STREET Grantor`' WEDGE RONALD J ` ` Sewer: Inspect Reas: NORTH ANDOVER MA 01845 Exempt-B/L% 0/0 Resid-B/L% 100/100 Comm-B/LNO Indust-B/L% 0/0 Open Sp-B/L% 0/0 RESIDENCE INFORMATION - LAND INFORMATION Style: RN Tot Rooms: 6 Main Fn Area: 1665 Attic:" NBHD CODE: 6 NBHD CLASS: 6 ZONE: R1 r _ - -__ _-_____ _ _ Se Type ' Code Method—Sq-Ft_ Acres Influ=Y/N' Value Class Story Height: 1 Bedrooms: 3 Up Fn Area: Bsmt Area: 1665 _g - - - 1 P 101 S 43560 1 230,868 Roof: _ " G"�-Full Baths: 2 Add Fn Area: - _ Fn Bs`mt Area:_ __ _- _� _ ra 2 R 101 A 1.02 8,160 Ext Wall:. OT Half Baths: Unfin Area: _ Bsmt Grade: Masoniy Trim_ Ext Bath Fix: To_t Fin Area. 1665 Foundation: CN Bath Qual T RCNLD 231621 DETACHED STRUCTURE INFORMATION - - - - - - _Qu - - Str "Unit Msr=1 Msr-2 E=YR-YRGfade Cond%Good P/F/E/R Cost Class Kitch al: T `EffYr Built: - 1980 Mkt Adj: ' SE S' P 80 1988 A A ///89 T 200 Heat Type: ER Ext Kitch: Year Built: - 1973 Sound Value: Fuel Type: a E ` Grade: - AG " -Cost Bldg:' 231,600 VALUATION INFORMATION _Fireplace: ,1 Bsmt Gar Cap: Condition: A _Att Str Val1_: Current Total: 470,800 Bldg: 231,800 Land: 239,000 MktLnd: 239,000 Central AC: N Bsmt Gar SF: Pct Complete- Att S't�V6l2: Prior Totaf: 450,100 Bldg: 235,300 Land: 214,800 MktLnd: 214,800 Aft Gar SF: 484%Good P/F/E/R: /100/100/85 Porch Type Porch Area Porch Grade Factor P 326 SKETCH PHOTO 1p4 Sq�2 25 37 12 i 22 ?h G 484 Sq:Ft. 2m 22 FM •— , 1665 Sq.R. 12 1 6 Sq.Ft.- _. 57 �..z 37 445 FOREST STREET Parcel ID:210/106.A-0131-0000.0 as of 4/18/07 Page 1 of 1 Bk 10790 P9157 17993 06--13--2007 a 12 2 07P NOTICE The property referred to in a deed recorded at Book 1584 Page 286, located at 445 Forest Street,North Andover,Essex County,Massachusetts has been improved with a subsurface sewage disposal system designed to accommodate a home with three bedrooms.The dwelling is hereby restricted to having no more than three bedrooms until such time as a subsurface sewage disposal system having a larger capacity is designed, approved by the North Andover Board of Health,and installed at the property. This notice is being given by the property owner ro 113 Nancy We0ge Dite Commonwealth of Massachusetts County of Essex On This\3 Day of June,2007 i Before me,the undersigned Notary Public,personally appeared Name of Document Signer Proved to me through satisfactory evidence of identification,which was/were Description of evidence of identification To be the person whose name is signed on the proceeding or attached document,and acknowledged to me that he/she signed it voluntarily for its stated purpose. Signature of Notary Public Printed name of Notary Public 'zz' My Commission expires(Date) RECEIPT Printed:06-13-2007 ® 12:07:57 Essex North Registry Robert F. Kelley Register Trans#: 83979 Oper:KEVINA NANCY WEDGE Book 10790 Page 157 Inst#: 17993 Ctl#: 107 Rec:6-13-2007 ® 12:07:51p NAND 445 FOREST ST DOC DESCRIPTION TRANS AMT NOTICE Surcharge CPA $20.00 20.00 50.00 recording fee 50.00 5.00 TECH FEE 5.00 Total fees: 75.00 *** Total charges: 75.00 CHECK PM 5760 75.00 I NORTi4 q OL O In y� T yy LA C CCKNIC.N WKM V 0,4 PUBLIC HEALTH DEPARTMENT Community Development Division CFR2I FIC. O2E O F Cogy(Pl- TgNM As of: ,dune 1.5, 2007 Tfiis is to cert that the individual subsurface disposal system received a SA7ISFAC`IORTIM(PLOIo3Vof the: Complete Septic System Repair ,john Soucy At: 448 Forest Street J.Kap 1060; Parcel 131 North Andover, JKA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. S n `Y. Sawyer, E�fS/U Public 91ealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER t NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o= •'i+� �� HEALTH DEPARTMENT ' 400 OSGOOD STREET *•�, NORTH ANDOVER, MASSACHUSETTS 01845 'ss^emus�� 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept i,townofnorthandover.com . WEBSITE:hqp://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) construc U, __ by (Print Name) JU/N�-,P 2007 ti� 6resf j/. Al �d ver TOW: PAR1 M NT located at ILPY'5- d. t�E��rr�DPr1RTrviENT (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 Q gallons per day. The materials used were in conformance with those specified on the approved pian;the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: 0S/Cj Engineer Representative(Signature) David And-Print Name Final inspection date: J? eq Enginoer Represent `ve(Signature) •.,. C_ �.s a_Q J And- rint Name Installer: (Signature) Date: (0 o� SOLILC And-Print Name Engineer: (Signature) Date: i s v �h� /'Y�i✓� C— t�5 O��2 And-Print Name pORTH 0610-110 06'gtiO � 0,�.`+_ •,.,�, 6 0 070 n eyy c �qq «.niiwrc. w^• ��SSACH0,44 US PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 445 Forest Street MAP: 106A LOT: 131 INSTALLER: John Soucy DESIGNER: New England Engineering Services PLAN DATE:October 18, 2006 BOH APPROVAL DATE ON PLAN: February 26, 2007 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 5/29/07 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.lownofnorthandover.com NORTFf q p ,t�ec 06t E+ � 0 O�A tot NlLnWwKN♦y7' 04 r10 _ ��SSgCHUs PUBLIC HEALTH DEPARTMENT Community Development Division ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: Combination tank 1500/500 gal. septic tank/pump chamber was not full so water tightness could not be verified on 5/29/07. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® Combo Tank installed. Size: 2000 gal. (1500/500) ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic 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" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Pump chamber had enough liquid (water from a hose) to verify pump operation but not water tightness. DISTRIBUTION-BOX Z Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution El levelers provided (not required) Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 14ORTH q 0 p O LOLMIL IWKMTop$I 7' ��SSACHUS♦�� PUBLIC HEALTH DEPARTMENT Community Development Division SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber Infiltrator Quick 4 ® Number of chambers per row 8 ® Number of rows (trenches) 3 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan Comments: CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: In basement ❑ Rated for exterior if placed outside ® Alarm signal located inside Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978,688.9540 Fax 978.688.8476 Web www.townofnorthandover.corn 14ORTH q ti T °A COCO.C.,4r v ��SSACHUS PUBLIC HEALTH DEPARTMENT (ommunity eveP Dlo ment Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT ELEV. Building Sewer OUT 98.24 Existing i Septic Tank IN 97.77 97.40 Septic Tank OUT -------- ------------ Pump Chamber IN -------- ------------ Pump Chamber OUT 97.51 97.15 Distribution Box IN 99.43 99.37 Distribution Box OUT 99.25 99.20 Lateral 1 INV 99.16 99.10 Lateral 1 TOP 99.49 99.43 Lateral 2 INV 99.15 99.10 Lateral to al 2 TOP 99.48 99.43 Lateral INV 99.16 99.10 Lateral 3 TOP 99.49 99.43 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTi4 q 0 G O'pA COCMI[MIWKM`y1' ACHUS PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall - 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 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(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 acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ►, t1ORTFI O� t�eo 6 4 OO 0 A o [oc.�rKiw¢r 1' 9 �.9 p�gATIDu[ `,�(y SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION J=CL 4 Lc, - (3 1 ADDRESS: AP: L : S"J01 `j`� INSTALLER: DESIGNER: �3 y � < PLAN DATE: Q BOH APPROVAL DATE N PLAN: INSPECTIONS �/ / ✓ TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: ��"�' DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: j SEPTIC TANK Bottom of tank hole has 6" stone base tv�o ❑ Weep hole plugged ��6 ❑ 1500 gallon tank has been installed G H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ElInlet tee installed, centered under access port " ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port i t 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORT1i q ,6 �r O Y 3`� °`'''_ �' ° OL F' ~ 4F eye O ♦ww COCMCgMKw ��SSACHUS PUBLIC HEALTH DEPARTMENT (ommunity Development Division ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic 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" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution Comments: ElSpeed levelers provided (not required) 2 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.fownofnorthandover.com 0ORT1i p� t e o , 'qq. t 6. O 41 _, e% ° LAKS It e WI[ CO[ ■V �1 4°gwNICM rao Olt •RC2 �sSacHus�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division SOIL ABSORPTION SYSTEM (General) // Bottom of SAS excavated down to 6 in into C soil � �✓ ,` �I��joGd layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) El cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber Infiltrator Quick 4 ❑ Number of chambers per row --k ❑ Number of rows (trenches) A ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside ❑ Alarm signal located inside Comments: 3 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTil q O �.fuao Lbw �O Ot A o �q GOGMIGMIWK■v �9SSACHUS��y PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT 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 INV Lateral 1 TOP Lateral 2 INV Lateral 2 TOP Lateral 3 INV Lateral 3 TOP Lateral 4 INV Lateral 4 TOP 4 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ttORTH O�tt�eo °q�'G 6 OL O L N � ?, vy °9 coni iwwe« q°j�Argo��`,�'�g SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib.to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot.Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 5 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.com AS-BUILT CHECKLIST JUN - 7 2007 I TOWN dr ;.. A )'i'%-NT FfEAI_1`F'i Li�erNi�t`i`ib;ENT LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE _ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA / r LOCATIONS OF DEEP HOLES&PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX ORIGINAL STAMP & SIGNATURE --f IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW �� LOCATION & ELEVATIONS OF BENCHMARK USED Ma70131 - Commonwealth fox , of Massachusetts106° Board of Health Per BHP-2007-0062 • � �� North Andover ----------------------- FEE--------- ----------- FEE • 4.°� s4•'" P.I. $250.00 �Ss��Ny5E� F.I. Disposal Works Construction Permit Permission is hereby granted John Soucy-------------------- ------------------------ ------------------------------------------------- - to(Repair)an Individual Sewage Disposal System. atNo- -445 FOREST_STREET---------- ------------ ------------------------------------------ ----------------------------------------------- ------------ as shown on the application for Disposal Works Construction Permit No. BHP-2007-006 Dated April 02,2007 • Issued On:Apr-02-2007 air �LE i I I ,�Na RT Application for Seotic Disposal System `p Construction Permit - TOWN OF TODAY'S DATE ORTH ANDOVER MA 01845 $250.00-Full Repair �'b•,ry°��'`� $125.00-Component 9SS�C uSe� Important: _Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use en'Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component-What? cursor-do not use the return A. Facility Information key. 1-1&15- 6(y Address or Lot# reb - A-1 COO �ICity/Town 2.-*TYPEOF SEPTIC SYSTEM*: > Pump ❑ Gravity(choose one) ***1 pump system, attach copy of electrical permit to application*** > �Conventional System (pipe and stone system) > ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.) > ❑ Pressure Distribution S.A.S. (No D-Box) > ❑ Pressure Dosed(D-Box Present)S.A.S. es h system require an effluent filter? Yes No fa c -�>� If YES- rther information needed. IfNO-installetr�s ear rand o 61te before DWC is issued. Wbat is the Make? ghat is the Model. 2. Owner Information Name �I �� o �cS� Address(if different from above) City/Town State Zip Code Telephone Numb -7 3. Installer Information ZD L,,� pt�lC. Ca-et,L 1�/1v Name Name of Compa y Address Cityrrown State Zip Code Telephone Nu ber(Cell Phone#if possible please) 4. Designer Information Name Name of Company Addrels A/ % 6% City/Town VV14 State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 6' ,NORTApplication for Seplic Disposal System Of4< e�l'O Construction Permit - TOWN OF TODAY'S DATE / '✓ �►'b „o�%""H ORTH ANDOVER, MA 01845 $250.00-Full Repan �SswcNusR< $125.00-Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: Resi�den_tia,11 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 Environmen I Code, as well as the Local Subsurface Disposal Regulations for the Town of North An er. I understand that until a final Certificate of Compliance has been issued by this Bo rd f Health, the " stalled system is not approved. 3 ��l—y7 Name Date App' ion Approved B : (Ioard of Health Representative) 3 �7 N e Date Application Disapproved for the following reasons: .y,.,Y,,.,......,.....,....�... ....._...,._,.Y..�..,...,.,rv ,ww,,�nM.,.....b.�.. �,w...-......�..a..,-.w.M_..,w.w....,....,.w....._„�...,,�.Y,,...W,�,.�.�,.....,..,..�w„�.,..�. -- .4..,..�,....�... For Office Use Only: L Fee Attached.' Yes No 2. Project Manager Obligation Form Attached a Yes No 3. Pump-S-stem? If so,Attach copy ofElectrical Permit Yeses No - P 4. Reviewed approvalletter, all paperwork received. Yes No M1SSIng:' 5. Foundation As-Built?(new uction only): Yes 0 (Same scale as approved plan 6. Floor Plans?(new construction only): No Application for Disposal system Construction Permit•Page 2 of 2 Ar � .SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by a `' (Engineer) Relative to the application of _� v � vxj\C (Installer's name) And dated t o ( I ngma ate Dated (Iooday s date With revisions dated _ L-- (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans pAor to performingan work on a site. I must have thea roved Tans and the permit on site when an work is Y pp p p y being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection without completion of the items in accordance . M with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company a. Bottom of Bed–Generally, this is the first (1'� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection–Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK or e-mail to: healthde t townofnorthandover.com from the engineer must ( p � ) be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade–Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank,D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely resl2onsible for the installation of the system as 12er the apl2roved plans. No instructions by omeowner, general contractor, or a12y other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: Nt/l� o� (Today's Date) 3—d -07 (Name--Print) (Name–Signed) The Commonwealth of Massachusetts � �.y Oft U"°* Department of Public Safety `j OoCuprloy i FN dMdyd_ BOARD OF FIRE PAEVENnON REGULATIONS 527 CMR 12M 3/90 ownW014 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK M wok to be verbrmrd in aoco►dance wNh ft Mnm twsaus Ss ftW Code,It2 CMR t oo (PLEASE PRINT IN INK DAAU. INFORMATION) Cir or Town of Z1�j 4�• — Oahe vv�.: The underaipned Applies for a permit to perform the electrical work described below. RECEW Location(Street&Number) AFR~-- ZUUt Owrw or Tenant - S OwrWe Address Is oft perm*in c onjun with a bonding permit: YeS C3No 0-- (Cheek/F let 6eX ARTMENT Purpm Of BuNdM'IQ C. �Y lihwge MY ANlh za*m Na Exieting Service :22P-6 Amps 7 Z& ///y Vohs Overhead a'uwwd ❑ No.of Meters ,. --„ Ampe j Vbft Owhesd Q Und9rd ❑ No.of Mohn Number of Feeder9s and Ampac*y Location and Nature of Proposed Electrical vVorlc '?/%c.- . ),` ��• ,r /�•n�!fid v€� ssznsr ,„� .yrs - -^� ae��; Of r�Or111Af6 sw'x'% Fi'9flxF.82�FS 'j,EF�9�/^e®asrte KVA Ger�Oreios Total K A Date.... `1._� : mergency LioM'np`'°h+'n° rZALARMS N a. bones f HORTM No.Of On and F:;•'�`'°:•. "�Op TOWN OF NORTH ANDOVER "d'�'�D01NO°a PERMIT FO � e#Sounds R ,WIRING � + IVO.of SSM CHUS�� LOW Ccs` bn❑Othy a � �t:oM► This certifies that .......... has permission to perform ,=. ....;.. ......... wiring in the building of..................r'.c � ....... ......................... .... .,l•...........,North Mdover,Mass. WrAW equivabnt VES NO ❑ Fee.! �j'2 Liz Check # 7317 signed under the of psrlttry_ — — - FIM NAME Uc.NOA�� 8wTNa A .TAddetr. _ d '�& 0. Na OWNER'S IN&MtVX E WAIVER: I am away that the lioonsm does not haw the Ina mrm ww"Ge or iter Su bftntim equivalent nmquMad by Maaead mft General Laws.end VW my signature on this pal, appaoation wawss this mquirptnWt owner ❑ Agent ❑ (erases-- c,onr} ( wiftle at Owns►err AgsrU1 Telephone No: MRW FEES I I I ' TOWN OF NORTH ANDOVER E�►ORTN 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1,6od 4@q OSGOOD STREET 4nn� NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y.Sawyer,REHS/RS 978.688.9540—Phone978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:hqp://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM EWHEAA ED Date of Submission: ($ d cry d oole 996 j Site Location: y Fore l- 6. 4 1/o f�TN1NT R Engineer: 65 O JY C � New Plans? Yes r/$225/Plan Check# (includes 1St submission and one re- review only) i . Revised Plans? Yes $75/Plan Check# Site Evaluation Forms Included? Yes L,---' No OLocal Upgrade Form Included? Yes No Telephone#: Fax#: E-mail: Homeowner Name: OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ ✓/ Complete and attach Receipt ➢ c/ Copy File; Forward to Consultant ➢ Enter on LoSheet and Database g O I I Commonwealth of Massachusetts City/Town of ,AJo9Tq AN4a vc K W Percolation Test Form 12 ac GSM Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer,use Nancy Wedge only the tab key Owner Name to move your 445 Forest Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code � 978-794-9793 Contact Person(if different from Owner) Telephone Number B. Test Results 10-10-06 10:00 Date Time Date Time Observation Hole# PT1 Depth of Perc 36'719" Start Pre-Soak 10:07 End Pre-Soak 10:22 Time at 12" 10:22 Time at 9" 10:27 Time at 6" 10:33 Time (9"-6") 6 Minutes I Rate (Min./Inch) 2 Min/Inch Test Passed: ® Test Passed: ❑ Test Failed: ElTest Failed: ❑ � Thomas Hector Test Performed By: Randy Burley, Mill River Consulting Witnessed By: Comments: I I i t5form12.doc•06/03 Perc Test•Page 1 of 1 I Commonwealth of Massachusetts City/Town of nJ®RT" A&;DOVE a Form 11 - Soil Suitability Assessment for On Sewage Disposal DEP has provided this form for use by on-site professionals this formCchal eok with youralocalOther forms Board of Heath toed determine the formut the nthelon y useust be substantially the same as provided here. Before g A. Facility Information 1. Facility Informaton®� ,vG. i Owner Name Map/Lot t o641'`-3® (-f,f 5 Iia S S f Street Address A Ole 4(5" 'evO glj A&DO tl6& State Zip Code City/Town B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair Cbg 2 Published Soil Survey available? Yes ® No ❑ If yes: ('18'1 Year Published Publication Scale Soil Map Unit CA VTPA)— t/ERY 57-0Vy �4a�� SAQD)� �A"1 R4 t ' AiT7 Soil Name Soil limitations ;. Sur-ficial Geological Report available? Yes ❑ No ❑ If yes: Year Published Publication Scale Map Unit i Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes [ No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No 09 Within a Velocity Zone? Yes ❑ No X 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Name Map Unit DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 7 � \ Commonwealth of Massachusetts City/Town of No RTH AAA)"E iZ - - — Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) n&e� ,Pc)& Range: Above Normal [*� E]Normal Below Normal M ❑ 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) C' Deep Observation Hole Number: TP I 16 -(o -oG �:o o Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) 96A Z Y'A I1 9Slope 2. Land Use: Surface Stones (e.g. woodland, agricultural field,vacant lot,etc.) � K 5 g7�, Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body feet C7 Drainage Wayf7,5 Possible Wet Area �e� eet Property Line 20 Drinking Water Well feet_160 Other feet 4. Parent Material: Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock[] Bedrock❑ 5. Groundwater Observed: Yes �] No ❑ 6c9If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: ��•` 020® q3'qS DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 7 \ Commonwealth of Massachusetts C ity/Town of N o (,T N A v[>® VCR, -- j Form 71 - Soil Suitability Assessment for ®n-Site Sewage Disposal inches elevation Deep Observation Hole Number: -rP J Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (I n.) Depth Color Percent Gravel Cobbles &Stones 7.5'YR 76 3o-Y3 C—, 10 yeZ 7/Y LS Additional Notes ,GTQ',jG c,1 AT9 tZ 6� /%)C) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7 Commonwealth of Massachusetts City/Town of N o fZ Vvq A vDO V E 1Z_ For ral 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) � fd-to-off !1 :06 Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) K44 K YA 4 A En's 2. Land Use: Surface StonesSlope (%) (e.g.woodland, agricultural field,vacant lot,etc.) b Rej5S T44E Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body 0000+ Drainage Way teet —� Possible Wet Area Ze�p t fe feet Property Line L10 Drinking Water Well Z® Other feet feet Unsuitable Materials Present: Yes ❑ No [K 4. Parent Material: If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit �- Depth Standing Water in Hole Estimated Depth to High Groundwater: 1140 Do q 3' ®9 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of /,uo 1�� ANS®v£f� -- — Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number- T� Soil Coarse Fragments Soil Soil Soil Soil Matrix: Redoximorphic Features volume Structure Consistence Horizon/ Color-Moist ( Other mottles Texture % by (Moist) ) (USDA) Depth Layer (Munsell) (In.) Depth Color Percent Gravel Cobbles &Stones -�� Ft LL 5-Y2 5r6 100 Additional Notes RoOTI �® •' &0'* J AiIJ � o td✓✓/fT�,IZ DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of 70 0 13 ei A.vDov C Form 11 - Soil Suitability Assessment for ®n-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. inches B inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. inches B inches-- ❑ Groundwater adjustment (USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes ® No ❑ 1 3 ® a cop Lower boundary:Z• c o D b. If yes, at what depth was it observed? Upper boundary:znc hes 3 inches F. Certification I certify that I have passed the soil evaluator examination" approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Date Signature of Soil Evaluator �OL! � Z ®0� 1:0 0 MAS 6C 'Date of Soil Evaluator Exam Typed or Printed Name of Soil Evaluator 9 A,v D V &L Board of Health Name of Board of Health Witne s Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for on-Site Sewage Disposal • Page 6 of 7 Commonwealth of Massachusetts C ity/Town of n1 o t� Acv D®t�E iZ Form 11 - Soil Suitability Assessment for On-Site Sewage [disposal Y Use this sheet for field diagrams: See Pt-AN S DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal Page 7 of 7 TOWN OF NORTH ANDOVER Officeof COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 C U SU In Y SaWy er, R E H S, PS 978.688.9640 . Phone S E P Public 1.1 ealth Director 978,688.8476 FAX health ' ovvnofnorLhar.dd -[c(.)ra 4 r \nivv,v�,.to,Nnofrorthandover.coru",a- APPL I CATI ON FOR SOI L TESTS DATE. "-)R '1QZay1'b�CxC(0 MAP& PARCEL: LOCATION OF SOIL TESTS. 4q5- FoVes� Sir Ci k,6. Aocver OWNER: MAI We-d-V, Contact APPLICANT:'mp_ Contact ADDRESS. ENGINEER: B94�,AJILL4/L ontact ? 65) 1-7L-Ap CERTIFIED SOIL EVALUATOR: .4 C- Intended Useof Land: Residential Subdivision ily Home} Commercial IsThis:. Repair Testing: 1'1�Undeveloped Lot Testing:_ Upgrade for Addition: In the Lake Cochichewick WaiteVied? Yes No THE FOLLOWING MUST BE INCLUDED WITH THISFORM > Proof of land ownership(Tax bill,or letter from owner permitting test) > 8.5-x 11-Plot plan& Location of Testing(please indicate test pit sites on the plan) > Fee of$425.00 per lot for new construction. This ooversthe minimum two deep holes and two percolation tests required for each disposal area. Feeof$360.0 per lot for repairs or up-grades, GENERAL INFORMATION > Only Certified Soil Evaluatorsmay perform deep hole inspection& > 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 discreti on of the BON representative. > Full payment will be required for all additional tests within two weeks of testing. > Within 45 days of testing,aseal ed plan(no smaller than 1--r100shall be submitted to the Board of Health showing the location of all tests(ind udi ng aborted tests). Within 60daysof testingsoil evaluationformsshall besubmitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Qatff. Signature of Conservation Agent:_---- ' Date back to Health Department: (stampin):-:�vw U \y Cl Q co Page 1 of 1 DelleChiaie, Pamela From: Soucysewer@comcast.net Sent: Thursday, June 14, 2007 3:41 PM To: DelleChiaie, Pamela Subject: Soucy's Sewer Service, Inc. TO: Pamela FROM: North Andover BOH DATE: 06-14-2007 RE: Melanie LeMere, John Soucy's secretary is going down to the Health Office of North Andover tomorrow Friday June 15th 2007 with John Soucy's signature stamp from Soucy's Sewer Service, Inc. and that he is verifying that the system is completed and that Melanie LeMere will be using his signature stamp to sign off on the certificate of compliance designers installers certificate for Nancy Wedge on 445 Forest Street in North Andover. Any questions or concerns please contact the office at 978-470- 1400. Thank You, John Soucy Soucy's Sewer Service, Inc. 6/14/2007 DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, May 22, 2007 11:32 AM To: DelleChiaie, Pamela Subject: FW: 1627 Osgood Street fyi -----Original Message----- From: Sawyer,Susan Sent: Tuesday, May 22,2007 11:31 AM To: Dan Ottenheimer(E-mail) Subject: 1627 Osgood Street FYI I just completed the Bottom of Bed inspection at 1627 Osgood Street. Briscoe is the installer. This is their first in town. It turns out there were 2 building sewers (one from an addition) that come to a Y. He had not conferred with Ben as to what to do and just did his own thing. I warned him that he must always call his engineer before changing things and this may not be acceptable. I stopped by Ben's office and told him abut it. He was going to check it out to be sure that tying them together was not an option. Briscoe is used to working in Groveland with Ed and is not familiar with your/our requirements. Just a heads up. Also just want you to know that Chestnut Street and 445 Forest Street are ettiOBOU� oday as well. I guess the good weather is here. Time to get busy. Thanks Susan 1 The Commonwealth of Massachusetts .L Oft`"° 7 N. r 4b.__.....�. � Department of Public Safety ooc,mrnoy s w.dwawe_ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 pm.Menw APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Nock to be wbmwd in s000rdenoe*ft the Msnschusetfe GeddCpl Code.82 CMR 12:00 (PLEASE PRWr IN INK OR ALL INFORMATION) Date f M—i. 2C2_..;..- My or Town of � }��/ � To the inspeeW of Wkw The undersigned applbs for a permit to pwform the electrical work described below. LocOm(SMset&Number) Owner of Tenant OwrWe Address 4. Is dit permit M cw%junctM, with a building permit: Yes ❑ No L (Check Appropriate Box) Purpose Of&Af �t/l:L� Yl/L�/ �'fi/)'JlF� Llblily AuMor4x*m No. ExWM Service Amps ML2 Volts Overhead ❑-'Uwwd ❑ No.of Meters ,f Ampe 1 Vials Overhead ❑ Undprd No.of Mems Number of Feeders and Ampacity - Locsttorf and Nature of Proposed Electricol Work ej j--;q Z96,/d, Na of Lighdrq Outldb Na d HotTube I Na of Tranelormers KVVAA No.of L10"Fixtures Swimming Pod grnttAbove ❑ I ❑ GerwraMr+e Na of!!wgwm LiamInO Na of Aweptede Na of 04 Bu.-0 No,of Swftoh Oulleq Na of On burners A } FIFE ALARMS Na Zonae Told ; No.of, and _ Na of Rartpss Na of Aa Coed. toms I �' .snit' Devioee Na of DtepoMk � �T �/ � � sof 9oundi . ons c Na d DMlwrraehers ' Speoe/Arwi '� /K / Na of SMI ndkV Deviose JNo:d Dryers / , r' I /K \ L.«+ cor>n.alon❑Other Na d Nota M t(1M}^ NO. i No.di I *Low I No.Mydro MaTube `� _Pb.d Motors ToW HP nage OTHER iYrY.r�� F` INSURANCE COW AfiE: Pursuant b the requirements of Meesochusefte Gwwral Laws ._.,/ I have a current Lhbi�ty lnauranoe Poky indinlinp Can peraUons Cownsge or ftauewl�l equivalent. YES L7 NO O 1 have WxnNted vaNdl prod of tune to oft of lia Yn No ❑. N you Nave chwkAd 8.please indCate the type of coverage by Checking the appropriate box. INSUmwE e¢>,C7 oTmR C7 (PMsee swim !lv (Explrv*m Data) Esfi n&W Vaiw of Elo*W Wok S r V*wu to Start /��l/f /` y�' � /li/ �'`7✓ �z/ fpned undw the d perfury FIRM NAME / '' UC.N0.=ZC�.... U00ne a GS. s Signature 4Nc NO. Address / X' /l2. ? fit//I�B�f.Te too c OWNER$ IN&OW CE WAVER: 1 am aware stat ft k*rm a do,e�nofheve the inwmioe ooverage or na wbstarttlaf oQuwagit as lquW by Meaaohkaetls 13a+erd Laws.and ttat my signature an this patnit appacdion waives tfde requ mnVt. ownw C] Agent C] (weeaecfr.cham) �IgrWurs of OwnerorAwo TeMphorm Na PEAWT FEES_. ✓ -- t%ORTH A �r 0 A p COCMGMfMK% �• PUBLIC HEALTH DEPARTMENT Community Development Division February 26, 2007 Nancy Wedge 445 Forest Street North Andover, MA 01845 RE: Septic System Design, 445 Forest Street, North Andover,Map 106A, Lot 131 Dear Homeowner, The North Andover Board of Health has received information from your engineer and is now releasing the approval that had been pending since last November. This office completed the review of the septic system design plan for the above referenced property, submitted on your behalf by New England Engineering Services Inc., dated October 18, 2006. The design has been approved for use in the construction of an onsite septic system. At a regularly schedule Board of Health meeting the board voted unanimously to allow a variance to the local North Andover subsurface disposal regulations. The variance was to allow the construction of a system for a 3-bedroom house. The variance requires that a deed restriction be placed on the property stating that fact and proof of recording must be submitted prior to the issuance of a disposal works construction permit. . Attached is a sample copy of a deed restriction. This plan is valid is valid for two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. 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 subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com system installer or other representative to ensure that all other state and municipal 10, 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 or imply compliance with any of the aforementioned requirement. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated, The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerel , Y. Sa S S " wy Pu lic Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 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 w filling out 1. Facility Name and Address forms on the E computer,use Nancy Wedge only the tab key Name to move your 445 Forest Street cursor-do not Sheet Address use the return key. North Andover MA 01845 City/Town state zip cod® 2. Owner Name and Address(if different from above): Name Street Address Citylrown state Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 330 9Pd 5. System Designer: Ben Osgood Jr. Name 0 P ElRS 1600 Osgood Street Bldg 20 North Andover MA Address Cityrrown State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setbacks)—specify: ❑ Reduction in SAS area of up to 2596: SAS size s4•ft. %raluation 445 Forest form 9b 2.26.07•rev.7/oe Local Upgrade Approval- Page 1 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate min.Armh Depth to groundwater ft ® Relocation of water supply well (explain): 310 Cmr 15 Allow one test pit in the primary and reserve disposal areas in lieu of two as required by Title V 15.102(2 ❑ 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 pert test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): To allow a subsurface disposal system for a 3-bedroom home with a deed restriction List variances granted requiring DEP approval: N.Andover Board of Health Approving Authority Susan Sawyer, Health Director February 26,2007 Print or Type Name and T rde Si nature Date 445 ForW form 9b 2.26.07•rev.7/06 Local Upgrade Approval•Page 2 of 2 P NEw IENGLAND IENGINEEMNG SERVICFS9 INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01843 TIM: (978) 686-1768 • Fax: (978) 327-6138 Benjamin C. Osgood, Jr., P.E. President February 21, 2007 Susan Sawyer North Andover Board of Health EHEALTHCDEPA]RTMENT 1600 Osgood Street North Andover, MA 01845 Re: 445 Forest Street,North Andover Dear Susan: This letter is being written in response to your letter dated November 27, 2006 regarding the septic system design at the above referenced property. I recently found the letter in a to-be-filed bin and apologize for taking such a long time to respond. You had two comments regarding the proposed septic system design which are addressed as follows: 1. A local upgrade approval form has been completed and is enclosed. 2. The system was designed as a leach field in lieu of trenches in order to minimize the tree cutting which would be required. If trenches were designed the area of disturbance would be greater and filling would extend in to areas which are currently wooded. If you have any questions, or need additional information,please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood,Jr., P.E. President ' Commonwealth of Massachusetts City/Town of �o• �ndowv- a Form 9A — Application for Local Upgrade Approval 4M 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 5.404(1), is not feasible. 310 CMR 15.403(4) requires the system owner to provide a co of the local upgrade approval to the O q Y P PY P9 PP appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be 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 Nancy Wedge only the tab key Name to move your 445 Forest Street cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code tab 2. Owner Name and Address if different from above): Same as above 'ehA1 Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Installation of a subsurface sewage disposal system 5. Type of Existing System: ® Privy ❑ Cesspool(s) ❑ Conventional ❑ Other(describe below): i Form 9A Application for Local Upgrade Approval.doc•rev.5/02 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of m o Form 9A - Application for Local Upgrade Approval a Y �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. A. Facility Information (continued) 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field 7. Design Flow per 310 CMR 15.203: Design flow of existing system: unknown gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330gpd 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: Unknown date of inspection 2. Describe the proposed upgrade to the system: Replacement of Leaching facility and System Components. 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 ft Form 9A Application for Local Upgrade Approval.doc•rev.5/02 Application for Local Upgrade Approval, Page 2 of 4 Commonwealth of Massachusetts City/Town of o Form 9A - Application for Local Upgrade Approval ^M Sye e 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): ® Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: Allow one test pit in the primary and reserve disposal areas in lieu of two as required by Title 5 Section 15.102(2). 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)(i)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's 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: No other available location on lot. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system would be cost prohibitive. Form 9A Application for Local Upgrade Approval.doc•rev.5/02 Application for Local Upgrade Approval, Page 3 of 4 �` Commonwealth of Massachusetts City/Town of a o 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: No other adjacent is available. 4. Connection to a public sewer is not feasible: Public sewer is not available in the area. 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 i I ❑ Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. j Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." G 2/21/07 Facilit wner's Signatu Date Be gamin C. Osgo Jr., P.E. Print Name I New England Engineering Services, Inc. 2/21/07 Name of Preparer Date 1600 Osgood St Bldg 20 Suite 2-64 No. Andover Preparer's address City/Town MA 01845 (978)686-1768 State/ZIP Code Telephone Form 9A Application for Local Upgrade Approval.doc•rev.5/02 Application for Local Upgrade Approval* Page 4 of 4 t4oRT14 q O O '" M 4 • a �� . coeaeanewrcw� rap'If ��SSAC Ht-2S�� PUBLIC WEALTH DEPARTMENT Community Development Division October 30, 2006 Nancy Wedge 445 Forest Street North Andover, MA 01845 RE: Septic System Design, 445 Forest Street,North Andover, Map 106A, Lot 131 Dear Homeowner, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property, submitted on your behalf by New England Engineering Services Inc., dated, October 18, 2006. The design has been approved for use in the construction of an onsite septic system. At a regularly schedule Board of Health meeting the board voted unanimously to allow a variance to the local North Andover subsurface disposal regulations. The variance was to allow the construction of a system for a 3-bedroom house. The variance requires that a deed restriction be placed on the property stating that fact and proof of recording must be submitted prior to the issuance of a disposal works construction permit. . Attached is a sample copy of a deed restriction. This plan is valid is valid for two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. 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 subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. Permit The issuance of a Disposal System Construction e shall not construe or imply p y compliance with any of the aforementioned requirement. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. 7Sincer Sawyer, REHS/RS Public Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services 1600 Osgood Street North Andover,,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Monday, November 27, 2006 6:30 AM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 445 Forest Street We only see three issues with this design plan: 1. There is only one test pit in the leach area, but since the soils seem very consistent we do not see a problem with this. However, this would require a Local Upgrade Approval for only having one test pit in the soil absorption system area. 2. The building sewer coming out of the house is not identified, probably because it was not determined. This should not be a big impediment as we have a system which is pumping to a d-box anyhow and the pump can easily handle the flow even if the tank has to drop a few feet from what is shown on the plan. It would be nice to know now, but is not critical. 3. The design uses a field instead of trenches, and.no explanation is provided as to why trenches cannot be used. am out at a seminar today but will be around tomorrow (Tuesday). Dan e Daniel Ottenheimer,President Mill River Consulting, Inc. On-Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultin2.com dano@millriv_erconsultin .corn 12/5/2006 .r N Ew IENGLAND IENGMEER NG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Teel: (978) 686-1768 • Fax: (978) 327-6138 October 18, 2006 Project# 1285 Ms. Sue Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 OCT 2 3- 2006 TOWN OF NORTH ANDOVER Re: 445 Forest Street, North Andover,MA HEALTH DEPARTMENT Local Health Bylaw Variance Request Dear Ms. Sawyer, The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following variance: Local Health Bylaw Variance Request Allow a septic system be designed to serve three bedrooms in lieu of four bedroom minimum required by local North Andover Health By-Law. If you have any comments or questions please do not hesitate to contact this office. Sincerely, 4, (�. Benjamin C. Osgood, . P.E. President March 31, 1996 To Whom It May Concern: I have recently learned that the draining plan and soil analysis, concerning the Long Pasture development on Forest Street, was done and recorded incorrectly. I plan to have my soil analyzed so that I will know if damage takes place on my property. As you can in the plans, my well is very close to the Long Pasture boundary. Since the Long Pasture development will have septic systems, I am very concerned about my drinking water. I plan to hold the Town of North Andover responsible for any contamination due to the incorrectly recorded draining and soil analysis. The entire plan should be redone before any building on the Long Pasture site begins Nancy G. Wedge 445 Forest Street N. Andover, MA 01845 r COMMONWEALTH OF MASSACHUSETTS Q EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a ti C,7 gV0 TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_445 Forest Street [DECEIVE® _North Andover_ Owner's Name:_Nancy Wedge SEP Owner's Address:_445 Forest Street 4 2006 _North Andover,MA 01845_ TOWN OF NORTH ANDOVER Date of Inspection:8/31/2006_ HEALTH DEPARTMENT Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ —Andover,MA 01810 Telephone Number:_(978)4754786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority _ Is � ., Inspector's Signature: ` RJ� .___ ate: _8/31/2006_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 ' M y OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_445 Forest Street_ _North Andover_ Owner•_Wedge_ Date of Inspection:_8/31/2006_ 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_445 Forest Strut _North Andover_ Own er•_Wedge_ Date of Inspection: 8/31/2006 p — C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance— i "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_445 Forest Street_ _North Andover_ Owner: Wedge_ Date of Inspection:_8/31/2006_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no?'to each of the following for all inspections: _ onent due to overloaded or clogged SAS or _ No Backup of sewage into facility or system comp �� cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No_ Liquid depth in cesspool is less than 6"below invert or available volume is''h day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _Yes_ _ Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ No Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone lI of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_445 Forest Street_ _North Andover_ Owner:_Wedge_ Date of Inspection:_8/31/2006_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health _No Were any of the system components pumped out in the previous two weeks? Yes_ ` Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? N/A _ Were as built plans of the system obtained and examined? Yes — Was the facility or dwelling inspected for signs of sewage back up? Yes_ _ Was the site inspected for signs of break out? _Yes_ _ Were all system components,excluding the SAS,located on site 7 _Yes_ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _N/A_ — Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_445 Forest Street_ North Andover Owner: Wedge_ Date of Inspection:_8!31/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_N/A_ Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203_N/A_ Number of current residents:_3 Does residence have a garbage grinder(yes or no): Yes_ Is laundry on a separate sewage system(yes or no):_No_ Laundry system inspected(yes or no): _ Seasonal use: (yes or no):_No_ Water meter reading:_On well water,>100' to septic system_ Sump pump(yes or no): Yes_ Last date of occupancy:_Current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available:— Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped last month,owner_ Was system pumped as part of the inspection(yes or no):_No_ If yes,volume pumped:_gallons--How was quantity pumped determined?_ Reason for pumping: _ TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool_Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_Unknown_ Were sewage odors detected when arriving at the site(yes or no):_No_ Page 8 of 11 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 Forest Street_ _North Andover– Owner: Wedge_ Date of Inspection:_8/31/2006_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_---Polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOXS: X Depth below grade _)811 _ Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-box level&distribution equal.No evidence of leakage,evidence of carryover._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):— Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_445 Forest Street_ _North Andover_ Owner: Wedge_ Date of Inspection:_8/31/2006_ SOIL ABSORPTION SYSTEM(SAS):_X�(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: _X leaching trenches,number,length:—4 trenches 50'long_ leaching field,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 oL Vegetation oL No sign of ponding to surface.— CESSPOOLS: Number and configuration: Depth—top of liquid to inlet invert:_ Depth of sludge layer:_ Depth of scum layer:, Dimensions of cesspool:— Materials of construction: _ Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition o(-vegetation,etc.): ' Page 10 of 11 ! OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_445 Forest Street_ _North Andover— Owner: Wedge_ Date of Inspection:_8/31/2006_ SKETCH OF SEWAGE DISPOSAL SYSTEM j Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building Driveway To Well Garage House i Porch A B A to 1 =2'9' Ato2=9' 1 A to D-ox=48' Septic Tank B to 1=10'8" Bto2=13'8" 2 B to D-Boz=5011" D- Boz Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_445 Forest Street_ _North Andover Owner: Wedge_ Date of Inspection: 8/31/206_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_1.5 to 3'_ Please indicate(check)all methods used to determine the high ground water elevation: _ Obtained from system design plans on record-If checked,date of design plan reviewed:_ Observed site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explain:_Design Plan on Lot#7 Long Pasture_ Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: Essex County Soil Map_ You must describe how you established the high ground water elevation:_Septic system design on Lot 7 of Long Pasture shows ground water 18"below original ground&Essex County Soil Map,Sheet#36,Scituate Soil, Water 1.5 to 3.Deep_ Tel: (978)475-4786 s Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems &Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 445 Forest Street, North Andover j Owner: Wedge Date of Inspection: 8/31/2006 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system Neil J. Bateson Bateson Enterprises, Inc.