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Miscellaneous - 456 SUMMER STREET 4/30/2018 (2)
r 6pbn-�, eva 1-7 a r m ( a 1 f •J (n 6 m Um C7 m 4 � ���� �� �� ��P�� ����� ' � ao� �� cl��m��_r�_ _� NorthAndoverBoal-WotAssessorsPublic Access Page 1 of 1 ,pont►, Town..of Worth Andover ` Board of Assessors. 0 Property sntPu¢ L4 Return to the Home page click on logo Record Card Parcel ID:210/107.A-0076-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge Sales r Y Summary Residence Detached Structure Condo Commercial Comparable Sales 466 SUMMER STREET Location: 456 SUMMER STREET Owner Name: OTIS,H CLARK ELEANOR M OTIS Owner Address: 456 SUMMER STREET City:NORTH ANDOVER State:MA ZIP:01845 Neighborhood: 6-6 Land Area: 1.03 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area: 1548 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 472,400 458,000 Building Value: 241,300 247,900 Land Value: 231,100 210,100 Market Land Value:231,100 Chapter Land Value: LATESTSALE Sale Price: 1 Sale Date:06/19/1990 Arms Length Sale Code: A-NO-FAMILY Grantor:OTIS,CHARLES Cert Doc: Book: 03123 Page: 0344 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=991494 5/18/2007 Commonwealth of Massachusetts RECEIVED N W Title 5 Official Inspection Form OCT 302017 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments TOWN OF NORTH ANDOVER 4c,M 456 Summer Street HEALTH DEPARTMENT Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out for on the computer, ,lvn use only the tab 1. Inspector: 0 key to move your cursor-do not James R. Kellett use the return Name of Inspector key. Kellett Excavating LLC Company Name 400 Salem Street Company Address Lynnfield MA 01940 City/Town State Zip Code 781-953-7146 S113463 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by th Local Approving Authority October 21, 2017 s a ctor's Signatu Date he system inspector shall submit a cop of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GM , 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: This system is in great condition. opened all inspection ports on infiltrator chambers to find beautiful coarse sand with minimum bio mat. 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.doc-rev.6/16 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 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. Cityrrown 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. CityTrown 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 '/z day flow t5ins.doc-rev.6/16 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 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 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 456 Summer Street M Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. Citylrown 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): 440 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: system has : 1500 gallon ,H-20 Rated, Monolithic Septic Tank with 1000 gallon Pump Chamber pumping up to 6 outlet D-Box with no speed leveler due to pump flow into D-Box. Leachfield contains Infiltrator Standard height Chambers. This is a raised system with retaining wall sourounding 2 sides. Number of current residents: 3 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 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 ,M 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): General Information Pumping Records: Source of information: Owner 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 9 years old . Installed September of 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: greater than 10 feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): no signs at all Septic Tank(locate on site plan): Depth below grade: 2feet 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'x6' Sludge depth: 6" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measuring Rod Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Very little scum and sludge . there is evidence of liquid level has been up and over tees due to faulty floats in pump chamber atleast 2 times that I know about and repaired for them years ago. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18, 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): This D-Box is in great shape. No signs of decay or leakage in or out of box. No carry oversxxx 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.): Everything in working order * 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18, 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ® leaching chambers number: 32 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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.): 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.doc•rev.6116 Title 5 Official Inspection Form: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 °M 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below 1,ied�se�r-�tely I' yr r_ SULT I'16.' Sf � v� c o oo p-- e �o,y j3 - C - 99 .3 44r.9 13 - - /o),z (Jr3Y.3 i0 — h'- ?8.1 ' V `{ Por p C.�aM�er _ 3 7. Z y 7 49 r t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar , ® Shallow wells ; Estimated depth to high ground water: 72— feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2008 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: from soil test on property 4 -211 - 07 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 456 Summer Street Property Address Hassan Hussein Owner Owner's Name information is required for every North Andover MA 01845 October 18, 2017 page. City/Town 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 NORTI� 8058 Town of North Andover `r°4 HEALTH DEPARTMENT ,SSACHUSt� CHECK#: 318J I8 DATE: LOCATION: 4/5,6 5U/`,),7m6r 54 H/O NAME: A�.Z�/� CONTRACTOR NAME: T/M 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 $ SEPTICSystems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report �s-! $ SQ `" xP ❑ Other:(Indicate) $ Healt Agent Initials White-Applicant Yellow-Health Pink-Treasurer • S�TTI>'En �y�' � North Andover Health Department (ommunity and Economic Development Division Letter of Compliance DATE: January 17,2017 TO OWNER OF RECORD PROPERTY LOCATION Hassan Hussein Michael Flemming 8 Copperfield Drive 456 Summer Street Nashua,New Hampshire, 03062 North Andover, MA. 01845 Dear Mr. Hussein, A Health Department ORDER LETTER dated, December 20f,2016,was issued to you as owner of record of the property listed above citing violations of the State Sanitary Code, 105 CMR 410.000,Minimum Standards of Fitness for Human Habitation. A re-inspection of the property has found that all of the violations noted on the Order Letter have been corrected. The Health Department would like to thank you for your cooperation. �!e ely, E. Grant North Andover Health Inspector Xc: File r 120 Main Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.north andoverma.gov North Andover Health Department (ommunity and Economic Development Division NORTH ANDOVER BOARD OF HEALTH ORDER TO CORRECT Issued under the provisions set forth in Massachusetts General Laws Chapter 111 Section 123. Date: December 21,2016 To Owner of Record: Property Location: Hassan Hussein 456 Summer Street North Andover, MA. 01845 Re:456 Summer Street-Housing Complaint Dear Mr. Hussein, The North Andover Health Department personnel conducted an authorized inspection of your property at the above referenced address on December 20, 2016 in response to a complaint filed with this Department. The inspection revealed violations of the State Sanitary Code,Chapter II as listed on the attached Violation Form. You are hereby ORDERED to correct the violations within the time allotted on the enclosed form. Failure to comply within the specified time period will result in a fine of up to $500 per day' in accordance with 105 CMR 410.910 of the State Sanitary Code. The fine will continue to accrue until the subject property is brought into compliance with this Order to Correct. Each day or portion thereof during which the violations continue shall constitute a separate offense. You have the right to request a hearing before the Board of Health if you feel this Order to Correct should be modified or withdrawn. A request for said hearing must be made in writing and received by the Health Department within seven (7) days from receipt of this Order. At said hearing you will be given an opportunity to be heard and to present witnesses and documentary evidence as to why this Order should be modified or withdrawn. All affected I Failure to comply with any order issued pursuant to the provisions of 105 CMR 410.000 shall upon conviction be fined not less than$10.00 nor more than$500. Each day's failure to comply with an order shall constitute a separate violation(105 CMR 410.910). Page 1 of 2 North Andover Health Department, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. You may be represented by an attorney. You have a right to inspect and obtain copies of all relevant records concerning the matter to be heard. A re-inspection will be performed by the North Andover Health Department subsequent to the deadlines stated in this letter. If the violations are corrected prior to the deadline,please call the North Andover Health Department at(978) 688-9540 for an inspection. If you have any questions,comments or concerns,please feel free to call me between the hours of 8:00-4:30 on Monday,Wednesday and Thursday,8:00-6:00 on Tuesday and 8:00-12:00 on Friday. Any questions regarding this matter can be answered through the North Andover Health Department. Michele Grant North Andover Public Health Inspector CC: Board of Health File Sent via: CERTIFIED MAIL# and; Regular First Class Mail RAJ C) Page 2 of 2 North Andover Health Department, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/inspection Report OWNER ADDRESS DATE C I 110 v Z f tl � U c C 1N \ Rev.6/04 0 INSPECTOR North Andover Health Department (ommunity Development Division Date: December 20,2016 Time: 2:00pm BOH Inspector: Michele Grant Tenants Name: Mike Flemming Phone Number: 978-893-6370 Location: 456 Summer Street Owner: Nassan Hussein Phone Number: 978-885-0448 Address: 8 Copperfield Drive Nashua NH. 03062 Regulation Findings Violations 105 CMR Deadline Corrected 410.750 Faulty and Inefficient Heating-Furnace, Baseboards, Radiant 24 HRS K,L, 0-3 Wall Boards Produce complete analysis on Heating System 24 HRS 410.750 No Carbon Monoxide Detectors,No Smoke Detectors 6 HRS Y (N) Fire Department was called 410.750 Drier Vent is not vented properly-Vent is routed into the 24 HRS (B) garage 410.750 Multiple Electrical Deficiencies throughout the home. 24 HRS 0-(3) Hire Licensed Electrician to evaluate and repair Broken Windows in Kitchen and Basement 48 HRS Fireplace has not been cleaned in 5 yrs. Yearly maintenance 48 HRS is required. Clean by a professional Inspectors Signature: Date: Page 1 of 2 North Andover Health Department— 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.9543 I j} 1! j1 1 e -7- -'4 r (tap y i n � sca� RECEIVED AS-BUILT CHECKLIST NOV 0 5 2008 I TOWN OF NORTH ANDOVER HEALTH DEPARTMENT LOT NUMBER, STREET NAME v ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, --` INCL TIES TO LOT LINES &DWELLING WELL a. FROM SEPTIC TANK b. FROM LEACH AREA c/r_ LOCATIONS OF DEEP HOLES &P C TESTS ELEVATIONS OF DISPOSAL YSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER,.GAS, ELECTRIC LINES, CABLE i/ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX ORIGINAL STAMP& SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW LOCATION& ELEVATIONS OF BENCHMARK USED E Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services 3�� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: A uq U S4 .2?, d2 d D f City or Town of: NORTH ANDOVER To the Inspe tar of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 5ttmm 6-A 6-� Owner or Tenant 141I S S A./y Telephone No. Owner's Address J (V)t Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building�- ;5A M'!I V Doe 111 ryUtility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters 11achuseasOfficial Use Only r e/'V/f`Ac Permit No, n o theIns table m be waived the Ins ector o Wires. . ,.. IN o.o ota Transformers KVA Generators KVA o.o Emergency Lighting ` Date... � �.�...... BatteryUnits FIRE ALARMS INo.of Zones N ORT►, - .. .. ;� o.of Detection an TOWN .017 NORTH ANDOVER Initiating Devices PERMIT FOR WIRING . No.of Alerting Devices 4 No.of Self-Contained " Detection/Alerting Devices �.� �,;re• h Municipal COW. Local❑ Connction ❑ Other ecurityy stems: No.of Devices or Equivalent This certifies that Wiring: Data rmg No.of Devices or E uival en_t has permission to perform 1 - ! .... .•...... Telecommunications mg N .of Devices or Equivalent wiring,in the building of ^.:...:... ^.. /......... ........:..... at4 r�3 wt r�, desired,or as required by the Inspector of Wires. . North Andover,Mass. �. r 'cipal policy.) -" Fee .�..... ......... Lic.No. �f :f`� / ; , ; - MEC Rule 10,and upon completion. LE CAL INSPE a ormance of electrical work may issue unless Check fl coverage or its substantial equivalent. The e to the permit issuing office.0321 . pplicadon is true and complete: atte Units —gunng C.NO.: f6 LIC.NO.: FIRE ALARMS No.of Zones "' a o.o etechon an Bus.Tel.No.• Address: d � 6 "Per M.G.L c.147,s.57-61, wo ent of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Signature Owner/Agent Telephone No. PERMIT FEE.$ 3-6 i Date... . ...... ,;oRry o TOWN OF NORTH ANDOVER A PERMIT FOR WIRING f :Y 1SSAC04US� �).1 r E.c� .,.�; This certifies that ....... has permission to perform C ............................... wiring in the buildint of r ................................................. .............. .North Andover,Mass. / G� ............................... . . �:... Fees. ............... I;c.PIa. . ........... ......... ELECTRICAL INSPECTOR Check Jt ____/._/..7 ------ 0z01 � tioo� 0*1 N N� DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, March 14, 20113:18 PM To: Grant, Michele; DelleChiaie, Pamela Subject: FW: 456 Summer The owner called again.Jim did not respond to his request last winter. He says he has a faulty pump. Does not want to file a complaint, but if any of us see Jim maybe we could ask if he gone by Summer street yet?As a gentle reminder that we know what's going on. Told her we hadn't seen him yet. Just an FYI if anyone takes a call from him. From: Sawyer, Susan Sent: Wednesday, December 15, 2010 2:40 PM To: 'jim.kellettexcavating@comcast.net' Subject: 456 Summer The owner of 456 Summer Street called to see if you were going to swing by and check his floats. Just told him I would ask you Susan lrtt S Sup awyu Juffx 3(ea&k 11)kzd" 16CO Vagood Stud 2Ug 2U,unit 2-36 ✓Vad Qndom,Ata 01845 office 978 688-9540 lax 978 68S-8476 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/"preidx.htm ]Massachusetts Public Records Law. 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:/Avww.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 a Page 1 of 1 b Io=North Andover/ou=First Administrative Group/cn=Recipients/cn=pdellech From: Sawyer, Susan Sent: Wednesday, September 17, 2008 10:02 AM To: DelleChiaie, Pamela Subject: RE: 456 Summer Street-Jim Kellet He will meet me at 2:15 as I head out of town. I am taking off after that. I have a meeting in Danvers for Rotary at 3. Don't let me forget... Thx S From: DelleChiaie, Pamela Sent: Tuesday, September 16, 2008 3:42 PM To: Sawyer Susan (ssawyer@townofnorthandover.com) Subject: 456 Summer Street -Jim Kellet Hi Susan, Jim Kellett called. There was a final inspection today. There was no water on at the house to test the pump. Is it okay to test at Final Grade? If not, he could meet you there tomorrow afternoon after 1:00 p.m. His number is: 781.953.7146. Please let me know what the final plan is also. Thanks. P grit AVvA(s, pa�e�a ne��Bea>a!e Health Department Assistant Town of North Andover 1600 Osgood Street Building 20,Suite 2-36 North Andover,MA o1845 2978.688.954o-Phone 978.688.8476-Fax tLqpj/3�toivn�ofhorthandover.com townofnorthandover.com healthdept@townofnorthandover.com This is the beginning of a New Day. I have this day to use as I will. I can waste it or grow in its light, and be of service to others. But what I do with this day is important because I have exchanged a day of my life for it. When tomorrow comes, today will be gone,forever. I hope I will not regret the price I paid for it. 9/17/2008 1 Page 1 of 1 Sawyer, Susan From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, September 16, 2008 4:10 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 456 Summer St. Dear Susan; I attended a final inspection at 456 Summer Street today (the report will be forthcoming), and there are some items you should be aware of. There was not any water in the pump chamber so I could not verify float operation, pump operation or even distribution of water in the d-box. Furthermore, there was neither inspection port nor any magnetic marking tape. Finally, the wall and manholes to grade over the pump and effluent filter still needs to be constructed. I discussed the above with installer Jim Kellett and he said he was going to contact you regarding same. As for elevations, tank"Tees,"etc. all are per plan. I just wanted to give you a"heads up." r a S Randy Burley, Project Manager 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.millriverconsulting.com rburley@millriverconsulting.com 61 9/17/2008 Page 1 of 1 y a ' /o=North Andover/ou=First Administrative Group/cn=Recipients/cn=pdellech From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Monday, September 15,2008 4:58 PM To: Sawyer, Susan Cc: DelleChiaie, Pamela; dano@millriverconsulting.com Subject: RE: 456 Summer Street All set; scheduled for tomorrow at 2:00. D Right-click here to download pictures.To help protect your privacy,Outlook prevented automatic download of this picture from the In Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web:www.miUriverconsulting.com From: Sawyer, Susan [maiIto:ssawyer@townofnorthandover.com] Sent: Monday, September 15, 2008 2:40 PM To: mpeters@millriverconsulting.com Cc: DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 456 Summer Street Jack McQuilken from JM Associates just called in regarding 456 Summer Street. He has completed his as-built of the elevations and it is ready for the town inspection. Please contact Jim Kellet for a final inspection. Thankyou Susan Susan Sawyer Public Health Director office-978 688-9540 1600 Osgood Street Bldg. 20, unit 2-36 North Andover, MA 01845 9/16/2008 JM Associates Civil Engineering Consultants 325 Main Street North Reading, Ma 01864 Tel. 978-664-6668 Fax 978-664-8155 Letter of Transmittal Date: 10/26/07 To: North Andover Health Dept. 1600 Osgood St. OCT 2 9 2007 North Andover, Ma. 01845 TOWN O. INC, ,'SER HEALTH j , -LAT Attn: Susan Sawyer RE: #456 Summer St.,North Andover, Ma . We are sending you: Copies Date Description 6 10/15/07 Septic System Repair Plan 2 10/17/07 Application for Local Upgrade Approval 2 Pump Performance Curve Barnes SE-4 CC: Hassan Hussein o ASLlD 6 1/ I* 32 6`: q 16 OOL o � � +40 Are �SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division October 31, 2007 Hassan Hussein 1 Carroll St., Unit 1 Methuen, MA 01844 RE: Septic System Design, 456 Summer Street,North Andover, Map 107A, Lot 76 IMPORTANT: Please be advised that all permits for subsurface disposal systems for this year must be issued by November 15*and the systems are to be completed by November 30m. The installation season begins March VA of each year depending on weather conditions. Dear Mr. Hussein, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by JM Associates, dated July 9, 2007, last revised October 15, 2007. This approval includes Local Upgrade Approvals for the request to have only one test pit within the area of the proposed system and a reduction of the 12 inch separation between the inlet and outlet tees of the tanks and high groundwater. This plan is valid for two years from May 23, 2007,the date that the septic system was deemed failed by a licensed inspector. Please note that the septic season for the North Andover closes on November 30m. The design has been approved for use in the construction of an onsite septic system for a 4- bedroom house(ma)dmum 9-room). 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. N 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com • 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. 3. Please keep the attached Form 9b for your records. 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. Sincere , S Y. Ser,REH /RS Public Health Director Encl: list of licensed septic system installers Form 9b Cc: JM Assoc. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com s�./7'r JM ASSOCIATES CIVIL ENGINEERS-LAND SURVEYORS (/ l (7✓I 325 MAIN STREET NORTH READING, MA. 01864 TEL. 978-664-6668 FAX 978-664-8155 Request for clarification to comments on Septic System design 456 Summer St,North Andover dated 8-29-07 Comment# 2. —Water Line Location- The existing water line is shown next to the driveway east of the proposed system We will show a setback distance from the 2LoRosed leachfield. Is this sufficient? .;rao Response: The water line is not shown on the plan we have here on file. However, It would be sufficient that eh water line be depicted and a dimension from the closet point to the leach field provided 4.—Revised breakout elevation- Raising the breakout elevation 1 foot will result in raising the retaining wall 1 foot and also necessitate a 1 foot retaining wall along the driveway. Would the board of health allow a one foot reduction to water table under Local Upgrade Approval in order to keep the wall height and expense down? Response: It is my understanding is that the Board historically does not grant a reduction in groundwater offset for aesthetic purposes or to keep costs down. Title 5 clearly states in 15.404(l) that Full Compliance is the goal of any design. Furthermore, it appears the grading requirement can be met if the elevation above the chamber system is at least 101 and a barrier is installed around the SAS at the extents of the overdig (top of barrier=breakout at elev 100) the 3:1 grading requirement can be achieved back to the driveway elevation without the use of a retaining wall as the grading requirement must only be met from the location of the barrier away from the leach area ��c - ti~*0 te&000' �6?CP CCA, '>y qr'' Cf. 4e, 4" pa 0=') 8-Effluent Filter- Can thd`effluent filter be eliminated or is it required? V v' 6t: ?/&74 Response: An effluent filter must be specified wither prior to or within the pump chamber (15.231(10)) 17- Pump Control Panel- The referenced section in Title 5 (15.220(4)(r) does not require specifications for the control panel. Please advise. Response: 15.231(2) stipulates the pump and alarm must be on separate circuit. This note must be added to the plan. Title 5 does not require that the designer specify the specific control however Mr. McQuilken may wish to control how his design operates by specifying a specific control panel 27-Vent Protection- We will propose to install a screen on the end of the vent pipe as well as a note that the vent pipe shall be backfilled tightly to prevent seepage of surface water into the system. Is this sufficient? Response: Specifying moisture resistance and animal proof protection is sufficient 32- Concrete Block Wall- It is my understanding that the Town of North Andover will allow a concrete block wall. However, a wall of this height will require horizontal geogrid approximately 3.5 —4 feet in length. This placement of the geogrid will then necessitate the polyethelyne barrier to be placed approximately 6 to 6.5 feet from the leachfield. Is this acceptable? Response: Title 5 suggests a 10 foot offset from the edge of the SAS to the impermeable barrier. Common practice is to install the barrier at the extents of the overdig 5 feet off the edge of the chambers therefore 6 feet is a sufficient distance < NORTH O �t►!D ,6 N O z I- % ��* (, eat O cxmiwewaw%I'j 'j• Argo 0 ��SSAGHUS PUBLIC HEALTH DEPARTMENT Community Development Division August 29, 2007 Mr. John McQuilkin Jr. P.E. JM Associates 325 Main Street North Reading, MA 01864 Re: Septic System Repair Plan for 456 Summer Street- Map 107A, Lot 76 Dear Mr. McQuilkin: The proposed wastewater system design plan for the above site dated July 9,2007 and received on July 30,2007 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(NA) regulation that has not met by this design follows each item for your convenience. Please clearly indicate the limits of excavation for the leach area on the site plan and appropriate profiles (NA 8.02(z)) �. Please depict the location of the water line which serves the dwelling and also confirm the water line meets the required setback distances (I 5.220(4)(m)) 3. Please indicate magnetic marking tape to be installed above the required system components 1 (15.221) /4. Recent changes to the Remedial use approval for the Infiltrator System Quick 4 Gravel-less chambers stipulates the breakout elevation to be measured from the top of the chamber. Please revise the design so the grading meets the 15' to 3:1 slope requirement or specify an impermeable barrier (15.255) \,- 5. Please specify all pipes to serve the system to be laid on compact, firm base (15.222(5)) . Please specify all pipes to serve system to be laid on continuous grade and in a straight line (15.222(7)) 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com RE: Septic System Design: 456 Summer Street,North Andover Map 107A,Lot 76 8/29/2007 Page 2 of 3 V/7. Please provide a more detailed primary(septic)tank detail (15.227(1)(4)(6)(7)) <v,'-8. Please provide an effluent filter maintenance schedule (15.227(7)) Please depict the necessary manhole cover to grade required over the effluent filter located in 7i the primary tank in the details and profile (15.221 & 15.228(2)) LA . Both the primary and pump chamber tanks appear to be partially located below the ESHGW. Please provide the appropriate buoyancy calculations (221(8)) Please provide the required notation as to the water tightness of the tanks in the system (221(1)) 12. Pleasep rovide notation that all outlets 1 ets of the distribution box shall be at the same elevation (232(3)(b)) ,,/13. Please specify and depict in the detail an inlet tee to be installed in the distribution box (15.232(3)(a)) '/I4. Please provide notation that the distribution box is to be water tight(15.221(1)) x,15°. Please specify and depict where appropriate, a riser to within 6"of final grade for the distribution box (15.232(3), 221(13), 228(1)) /16. Please provide more detailed pump calculations which include the drain back volume (15.231(2)) c 17. Please specify the make and model of control panel to serve the system (15.220(4)(r)) 19. Please provide a notation that the alarm is in the building and powered by a separate circuit of that serving the pump (15.231(9)) 0, 119. lease provide the appropriate pump performance curve for the specified pump to serve the system(15.220(4)(r)) 20. Please specify a manual operating switch for the pump (NA 12.01) 21. It appears the pump chamber outlet is depicted incorrectly in the detail. Please clarify / 22. Please specify and depict where appropriate, a riser to within 6"of final grade for the pump ✓✓✓ chamber (15.231(5)) /23. Currently the primary tank is specified as H-20 loading. Please specify a load rating for the pump chamber 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com • 1 RE:Septic System Design: 456 Summer Street,North Andover Map 107A,Lot 76 8/29/2007 Page 3 of 3 /,6,2/1. The current elevation of the outlet invert for the pump chamber is not more that 12"above ` the ESHGW. Please revise the design or request a Local Upgrade Approval (15.227(5)) 25. Only one (1) deep observation hole is utilized in the primary soil absorption area. Please request a Local Upgrade Approval (15.102(2)) �6M leaching trenches are the preferred system please provide and explanation as to why a design utilizing trenches was not chosen(15.240(6)) 7 Please specify protection for the system vent from precipitation and animal entry (15.241(1)(b)) Z8. Please specify that excavation is to extend at least 6" into natural soil (NA 9.02) �9. Please provide specifications for fill material to be used (15.255(3)) Please specify and depict where appropriate inspection ports for the soil absorption system (15.240(13)) x_`31. Please specify a 3:1 slope where grading required(15.255) 32. The current design utilizes a concrete block wall. North Andover regulations require a � g q ` /_Peasepoured concrete retaining wall. Please revise the design accordingly (NA 9.02) ease 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. Sincere S san Y. Sawyer, REHS/RS 7 Public Health Director Cc: File Homeowner 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts Cityfrown 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 when filling out 1. Facility Name and Address forms on the computer,use Hassan Hussein only the tab key Name to move your 456 Summer St cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code ar 2. Owner Name and Address(if different from above): 1 Carroll St Name Street Address Methuen MA City/Town State 01844 .Tap Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer John McQuilkin Jr.Name ® PE ❑ RS 325 Main St N. Reading MA 01845 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%: SAS size,sq.ft. %reduction 456 Summer Street 9b-rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City lfown of Local Upgrade Approval Form 9B V B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater. Separation reduction tt Percolation rate min./inch Depth to groundwater ❑ 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 Dept. 42 Approving Authority Susan Sawyer, Health Dir. 10/31/07 Print or Type Name and Title ignature �— Date 456 Summer Street 9b•rev.7/06 Local Upgrade Approval* Page 2 of 2 Commonwealth of Massachusetts City/Town of 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 Hassan Hussein only the tab key Name to move your 456 Summer St cursor-do not Street Address use the return key. North Andover Ma 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): Hassan Hussein 1 Carroll St. , Unit 1 ' Name Street Address Methuen Ma City/Town State 01844 978-794-4304 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom Dwelling _ 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): chambers LimitedUpgrdAppv1101207.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 1 .� Commonwealth of Massachusetts `- City/Town of 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: 330 Design flow of existing system: gpd Design flow of proposed upgraded system 440 gpd 440 Design flow of facility: gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): ❑ Voluntary ❑ Required by order, letter,etc. (attach copy) 5/23/07 ® Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Replace existing trench system with pumped chamber system 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of yap 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 LimitedUpgrdAppv1101207.doc•rev.7/06 Application for Local Upgrade Approval• Page 2 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. 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: Randy Burley 6/28107 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: a. The proposed elevation of the pump chamber will allow the existing building sewer and driveway to remain in place. b. At the time of soil testing we we did excavate 2 deep holes but were unaware of the location of the proposed s stem. _ 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: not necessary LimitedUpgrdAppvl 101 207.doc•rev.7/06 Application for Local Upgrade Approval• Page 3 of 3 FROM : 00000000000P F'IIOPdE HO. 0000000000 OCT. 25 2007 11:20RM r1 `I w ICl/26/20CI7 06:56 570,6648155 JM ASoOCIATi PCCai 51/05 r Commonwealth of Massachusetts -' City/Town of - Form 9A - Application for Local Upgrade Approval f^ 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: not necessary 4. Connection to a public sewer is not feasible: not available 5. The Applicatibri 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 Z] 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 "i,the facility owner,certify under penalty of law that this document and all attachments, to thou hp--,f 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." 7-0 01 Facility owner's Signature Date Hassan Hussein Print Name JM Associates Name of Preparer 325 Main St. North Reading vreparer'e addrooe rityrrown Ma 01864 978-664-6668 staterZIP Code Telephone LimltedUpgrdAppvll012c't.doc•rev.7106 Applipatlon for Local Upgrade Approval*Page 4 of 4 i Commonwealth of Liassachusetts Map-Block-Lot 107.A-0076- ° Board of.Health ----------------------- ~ a Permit No North Andover BHP-2008-0178 r�Y .,. • P.I. � 4cWusE� F.I. FEE $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted James Kellett ----------------=------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 456 SUMMER STREET ------------------------------------------------------------------------------------------------------------------------ as shown on the application for Disposal Works Construction Permit No. BHP-2008-017 Dated September 02 2008 Issued OSep-02-2008 --- ---------------------------- -- Board of Health t MO,pI s Application for Septic Disposal System a�An 7- .2 � �a°`•"' -�`�°�°c.' - Construction Permit — TOWN OF TODAYATE 49 ORTH ANDOVER MA 01845 $ 250.00—Full Repair � $125.00-Component 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 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. 45(o SQMMe(?, S+ . Address or Lot# 'N©A� YY1ov-ems. i Cityrrown 2J.- TYPE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If 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) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information JJ�ftn vyS v` N ma e q's c, Svc m e� - Address(if different from above) No Al. AVr40'je-• MN City/Town State Zip Code Telephone Number 3. Installer Information I M kega4+ kc�� �k��ya �Vk' Name Name of Company 406 S��m Address nn 14� mA dl�iu-� City wn State Zip Code �� ���' ql�' Telephone Number(Cell Phone#if possible please) 4. Designer Information ,TAG((_ Name _ - Name of Company Address N oAV 0)W-I City/Town State Zip Crode Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 :, aF Nc�ak q Application for Septic Disposal System ,� r o`ttao±s a�00 pConstruction Permit - TOWN OF TODAY'S DATE MA 01845 $250.00-Full Repair ORTH ANDOVER '�S�•• ��� ` $125.00-Component 9 SACHUS 4 PAGE 2OF2 A. Facility Information continued.... 5. Type of Building:XResidential 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 in operation until a Certificate of Compliance has beissued by thi Bard of Health. �- 5/'OV a e Date Applic i Approved B . (Board of Health Representative) N e Dat _ pplication Disapproved for the following reasons: For Office Use Only: / L Fee Attached. Yes No 2. Project Manager Obligation Form Attached. Yeo No 3. Pump Ssv tem? If so,Attach copv ofElectrrcal Permit Yes No 4. Foundation As-Built. (new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yeo No Application for Disposal System Construction Permit•Page 2 of 2 1 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: S�6 ,56/07 57./ (Address of septic system) For plans by /"I Ji/ ,, ,/[ (Engineer) Relative to the application of�!i /J� Ql ' ` (Installer's name) And dated 7— ngma ate Dated 2!'�' �G ��✓(V —();7(.�/�/ o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner, contractor,project 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 with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or MY c0mpany-- a. Bottom of Bed—Generally, this is the first (VS 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: healthdel2tQtownofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber,retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the Q12roved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve me of this obligation. kUndersigned Licensed Septic Installer: da 's Date) C P � � ame—Print) —Signed) -1 Y TOWN OF NORTH ANDOVER ' Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 = �7 Ydh., .�<9 NORTH ANDOVER,MASSACHUSETTS 01845 gecwU 978.688.9540—Phone Susan Y. Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept ),townofiioilliandover.com WEBSITE:http://\Nlww.townofnollhandover.com SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: Yr'SC� o JUL 3 0 2007 Site Location: 456 SUMMER STREET Towne Or HGALTI-f UIE:PAR,"t(v?hN'f Engineer: Tm ASSOCIATES New Plans? Yes x $225/Plan Check# (includes 1" submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yesx No Local Upgrade Form Included? Yes No x Telephone#: (9 7 8) 885-0448 Fax#: E-mail: Homeowner DName: 15 OFFICE USE ONLY When the submis ion is complete(including check): Date stamp plans and letter ➢ Complete and attach Receipt r C0P\1 :'li,': Foe-\v�wd to CorQ161ant _X___Enter on Lng Sheet and Database r DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, August 29, 2007 1:43 PM To: Sawyer, Susan Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 -----Original Message----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Monday, August 13, 2007 9:48 AM To: DelleChiaie, Pamela Subject: RE: Soil Eval-456 Summer St-sched for July 27th @ 9:00 PAMELA, I'VE NOT CALLED HIM AND I'M NOT SURE IF DAN HAS....I'LL HAVE TO CHECK W/HIM WHEN HE'S BACK LATER TODAY 0 LEFT EARLY ON FRIDAY). DAN STATED THE POLICY AND I'M NOT SURE WHY THE GENTLEMAN CAN'T ACCEPT THAT.....? From: DelleChiaie, Pamela [ma i Ito:pdel lech ia ie@townofnorthandover.com] Sent: Friday, August 10, 2007 2:04 PM To: Marianne Peters (E-mail) Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, How did you make out on this?? P -----Original Message----- From: DelleChiaie, Pamela Sent: Thursday, August 09, 2007 1:57 PM To: Marianne Peters (E-mail) Cc: Sawyer, Susan Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, Mr. Hussein is here now at my counter. This is a record of the request he made on the 30th of July. (He stated just 1 now that he made the request 3 weeks ago). His number is: 978.885.0448. If you could explain your policy of 24 hours notice of cx to him directly, I would appreciate it. Thank you. Pamela -----Original Message----- From: DelleChiaie, Pamela Sent: Thursday, August 02, 2007 10:20 AM To: Dan Obrzut (E-mail); Daniel Ottenheimer(E-mail); Marianne Peters (E-mail) Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, Please let me know what the answer is on this. The applicant called me this a.m. about it. Thanks. P -----Original Message----- From: DelleChiaie, Pamela Sent: Monday, July 30, 2007 1:13 PM To: 'Marianne Peters' Cc: Sawyer, Susan Subject: RE: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, Persepective owner, Hassan Hussein, dropped off the plans for this site today. He stated that the soil eval. for this past Friday was cx. Is that the case? It was a second request for soil tests to see the potential for another site; however, JM Assoc. arrived and stated that the new location would not work, and they called to cx. with Mill River. If you are going to rescind the charges, let me know, and I will schedule a refund of the soil evaluation fee. I don't know what your cx. policy is(24 hours notice, etc.) The soils referred to on the plan are from 6/28/07. 1 am mailing the plans for review in todays' mail. Please let me know when you receive them. -----Original Message----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Tuesday, July 17, 2007 9:05 AM To: Daniel Ottenheimer; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Soil Eval for 456 Summer St. with Jack McQuilkan of J&M scheduled for July 271h @ 9:00 Marianne Peters Mill River Consulting 2 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsulting.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, August 29, 2007 1:40 PM To: Sawyer, Susan Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High -----Original Message----- From: DelleChiaie, Pamela Sent: Thursday, August 02, 2007 10:20 AM To: Dan Obrzut (E-mail); Daniel Ottenheimer(E-mail); Marianne Peters (E-mail) Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, Please let me know what the answer is on this. The applicant called me this a.m. about it. Thanks. P -----Original Message----- From: DelleChiaie, Pamela Sent: Monday, July 30, 2007 1:13 PM To: 'Marianne Peters' Cc: Sawyer, Susan Subject: RE: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, Persepective owner, Hassan Hussein, dropped off the plans for this site today. He stated that the soil eval. for this past Friday was cx. Is that the case? It was a second request for soil tests to see the potential for another site; however, JM Assoc. arrived and stated that the new location would not work, and they called to cx. with Mill River. If you are going to rescind the charges, let me know, and I will schedule a refund of the soil evaluation fee. I don't know what your cx. policy is (24 hours notice, etc.) The soils referred to on the plan are from 6/28/07. 1 am mailing the plans for review in todays' mail. Please let me know when you receive them. -----Original Message----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Tuesday, July 17, 2007 9:05 AM To: Daniel Ottenheimer; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Eval-456 Summer St-sched for July 27th @ 9:00 3 Soil Eval for 456 Summer St. with Jack McQuilkan of J&M scheduled for July 27th @ 9:00 Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsulting.com DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, August 29, 2007 1:40 PM To: Sawyer, Susan Subject: FW: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High -----Original Message----- From: DelleChiaie, Pamela Sent: Monday, July 30, 2007 1:13 PM To: 'Marianne Peters' Cc: Sawyer, Susan Subject: RE: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Importance: High Hi, Persepective owner, Hassan Hussein, dropped off the plans for this site today. He stated that the soil eval. for this past Friday was cx. Is that the case? It was a second request for soil tests to see the potential for another site; however, JM Assoc. arrived and stated that the new location would not work, and they called to cx. with Mill River. If you are going to rescind the charges, let me know, and I will schedule a refund of the soil evaluation fee. I don't know what your cx. policy is(24 hours notice, etc.) The soils referred to on the plan are from 6/28/07. 1 am mailing the plans for review in todays' mail. Please let me know when you receive them. -----Original Message----- 4 Fsom: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Tuesday,July 17, 2007 9:05 AM To: Daniel Ottenheimer; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Eval-456 Summer St-sched for July 27th @ 9:00 Soil Eval for 456 Summer St. with Jack McQuilkan of J&M scheduled for July 271h @ 9:00 Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsulting.com 5 F Commonwealth of Massachusetts - City/Town of -_ Percolation Test Form 12 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 5 only the tab key Owner Name to move your s L l �^^ 'A" cursor-do not Street Address or Lot# use the return key. '4 N '3 1, !'✓� vvr� . G 8 Y ��¢---� City/Town State Zip Code ,vr J." t4. l41 (;j> . ck " N ?7S'• 4 CV- 4CCu Contact Person(if different from Owner) Telephone Number B. Test Results ua 4 V-i Date Time Date Time Observation Hole# Depth of Perc Z Start Pre-Soak End Pre-Soak Time at 12" ► c . 3S Time at 9" ! ° � 46 Time at 6" Time (9"-6") Rate (Min./Inch) -----� --- --- Test Passed: �f Test Passed; ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: r Witnessed By: Comments: t5form12.doc•06/03 Perc Test-Page 1 of 1 Commonwealth of Massachusetts 2_05�_ I Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal • inches elevation Deep Observation Hole Number: Soil I Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure �i_ii Horizorf Color-Moist (mottles) Texture %by Volume Consistence Other Dep'.I-. I I I Layer (Munsell) (USDA) (Moist! (in.) Depth Color Percent Gravel Cobbies &Stones o bR 4 LAIA ef 7 e e. ? ! V(16 z Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - P;i:-,,- 3-IF 7 i► North Andover Fire Department Incident Detail Print Date: December 22, 2016 Printed By: rbonenfa Narratives for Incident Number 2016000004001? Yes Other Narratives not authorized for print? None Narratives this user authorized to print: Narrative by: Firefighter/EMT James White Seq No: Date&Time Type Description Entered by Status Reviewed by Last Edit Date 1 12/20/2016 3:07:OOPM Narrative Statement Type C 12/20/2016 E2 called to assist C1 with code enforcement due to resident's concerns about CO detector activation the other day.Asst. Bldg Inspector Paul Hutchins and BOH Inspector Michelle Grant also on scene. E2 investigated for signs of CO and had 0 reading throughout residence. Property owner arrived and was informed of multiple issues with residence including: 1) Lack of smoke detector on basement level 2) Lack of inspection/cleaning of fireplaces with obvious signs of use (remnants of previous fires,fresh firewood, "Duraflame" logs present) 3) Obvious signs of neglect and lack of inspection of heating system-(last documented service from 2005) 4) Residents using lower level as bedroom without proper means of egress 5) Electrical issues (i.e. extension cords powering multi-outlet power strips and electrical junction box hanging from wall and not mounted) The building owner was made aware of all issues and advised to remedy immediately with follow up inspection to take place. Cheif McCarthy, Inspector Hutchins, and Inspector Grant to contact Gas Inspector and notify Building Inspector Belanger of situation. If NAFD needed for follow-up, Building Dept. or Health Department will contact. [JMW] ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Resources Ouantity Description Notes ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Page 2 of 2 FIDetail 06/25/14 North Andover Fire Department Fire Incident Narrative Report Print Date: December 22, 2016 Narratives for Incident Number 2016000004001 ? Yes Other Narratives not authorized for print? None Narratives this user authorized to print: Narrative by: Firefighter/EMT James White Seq No: Date&Time Narrative Description Entered by Status Reviewed by Last Edit Date 1 12/20/2016 15:07 Firefighter/EMT James Firefighter/EMT 12/20/2016 White James White E2 called to assist C1 with code enforcement due to resident's concerns about CO detector activation the other day.Asst.Bldg Inspector Paul Hutchins and BOH Inspector Michelle Grant also on scene. E2 investigated for signs of CO and had 0 reading throughout residence. Property owner arrived and was informed of multiple issues with residence including: 1)Lack of smoke detector on basement level 2)Lack of inspection/cleaning of fireplaces with obvious signs of use(remnants of previous fires,fresh firewood,"Duraflame"logs present) 3)Obvious signs of neglect and lack of inspection of heating system(last documented service from 2005) 4)Residents using lower level as bedroom without proper means of egress 5)Electrical issues(i.e. extension cords powering multi-outlet power strips and electrical junction box hanging from wall and not mounted) The building owner was made aware of all issues and advised to remedy immediately with follow up inspection to take place.Cheif McCarthy, Inspector Hutchins,and Inspector Grant to contact Gas Inspector and notify Building Inspector Belanger of situation. If NAFD needed for follow-up, Building Dept.or.Health Department will contact.[JMW] ------------------------------------------------------------------------- n Page 1 of 1 FINarrativesSingle 10/03/12 I North Andover Fire Department Incident Detail Print Date: December 22, 2016 Printed By: rbonenfa Incident No: 2016000004001. CAD No: 2016000026627, File Number: Date/Time LaoTime Running Total Nature: FD-CO Detector Activation Received: 12/20/16 13:11:56 00:00:00 00:00:00 Call Taker: Date: 12/20/16 13:11 Dispatched: 12/20/16 13:12:14 00:00:17 00:00:17 Dispatcher: Marc J Gagnon Address: 456 Summer Street Out of Station: 12/20/16 13:12:14 00:00:00 00:00:17 Member Making Report: James M White North Andover MA 01845 Arrived: 12/20/16 13:16:55 00:04:40 00:04:59 Shift Supervisor: C. Scott Nussbaum,Lieutenant Structure: To Medical: Officer in Charge: James M White,Firefighter/EM] Alarm: At Medical: Status: Complete Priority: High Cleared: 12/20/16 13:46:26 00:29:31 00:34:29 Comments: Incident Type(s): Primary Reported Description Actions Taken NOTES ■ ■ Carbon monoxide detector activation,no CO Investigate Enforce code Refer to proper authority Provide information to public or media Notify other agencies. Statements: Entity Seg No Person or Business Name Statement Date/Time Stmt Sea No Statement Status Comments No Involved Persons data returned. Involved Fire Fighter(s): Name/Title Division Notes Name/Title Division Notes James M White,Firefighter/EMT Fire Division Daniel J Pas,Firefighter/EMT Fire Division Steve G Risacher, Fire Division Firefighter/EMT Unit Chronology: Unit-Type Time Status E2-Engine 13:12:14 Responding 13:16:55 Arrived 13:39:25 Returning 13:46:26 In Quarters --------------------------- -------------------------- -------------------------------------------------------------------------- Unit Summary: Unit:E2-Engine .Time: 0:34:12 Page 1 of 2 FIDetail 06/25/14 4k NORT14 ddw. VED 16 +6 OO o "O�� e~ yy c".1[�-V1 T A04 r PPP` �y 9SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 456 Summer Street MAP: 107A LOT: 76 INSTALLER: Kellett Excavation DESIGNER: JM Associates PLAN DATE: July 9, 2007 (revised through October 15, 2007) BOH APPROVAL DATE ON PLAN: October 31, 2007 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 9/16/08 DATE OF FINAL GRADE INSPECTION: G 1lot 11 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: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan — N/A Bottom of tank hole has 6" stone base Weep hole plugged ® 1500 gallon tank has been installed H-20 loading Mono construction ® Water tightness of tank has been achieved by Visual testing 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 i NORTFr .fi 1_1D #6,1 O O e" # D c".K.K...V1 �AD'4 rE D �SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ❑ inch cover to within 6" of final grade installed over one access port, must be to grade and 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-20 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 ❑ inch cover at final grade installed over pump access port f� WateA tightness of tank has been achieved by V H 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 a tAORT#1 l • ���t -!C l6 q�O OL O A OLA. of coc"Ic.v KA V 4�RATE0 PPP�'�� SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil rubber 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 Comments: Retaining wall not constructed at time of inspection. SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Quick 4 ® Number of chambers per row: 8 ® Number of rows (trenches): 4 Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: in garage ❑ 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.lownofnorlhandover.com Inspection Form June 2008 F pORTty O �r�eo #6q�0 6 OL O ,L � ea O COCNI(lWKM V1 °'Qreo •P" A') 9SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS INVERT INFIELD PLAN INVERT ELEV. Benchmark 101.25 Building Sewer OUT 97.93 Septic Tank IN 95.99 96.36 Septic Tank OUT 95.77 96.11 Pump Chamber IN 95.71 96.01 Pump Chamber OUT 96.01 95.76 Distribution Box IN 100.06 99.94 Distribution Box OUT 99.86 99.77 Lateral 1 INVERT 99.67 99.67 Lateral 2 INVERT 99.68 99.67 Lateral 3 INVERT 99.68 99.67 Lateral 4 INVERT 99.67 99.67 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORT14 1 ` O�st`eD 16gti0 M, Tx +� T Oy O COC.IIf M1 K• 7' �sy"�q.•TEo NV�cy SSAC HUSH 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). 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 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Inspection Form June 2008 12/22/2016 Town of North Andover Mail-RE:CommDev-Ricoh NaR ovR Massachus4 s=:: Maura Deems <m deem s@northandoverm a.gov> RE: CommDev-Ricoh 1 message Laurie Killilea <laurie.killilea@adtechsystems.com> Thu, Dec 22, 2016 at 3:39 PM To: Maura Deems <mdeems@northandoverma.gov> Thank you so much for all your help with this. Have a great holiday. From: Maura Deems [maiIto:mdeems@northandoverma.gov] Sent:Thursday, December 22, 2016 2:59 PM To: Laurie Killilea <laurie.killilea@adtechsystems.com> Subject: Fwd: CommDev-Ricoh See attached as requested. Thank you, Maura Deems -- Forwarded message From: <spiceworks@northandoverma.gov> Date: Thu, Dec 22, 2016 at 2:56 PM Subject: CommDev-Ricoh To: roldham@northandoverma.gov, "Deems, Maura" <mdeems@northandoverma.gov> This E-mail was sent from "RNP002673C141A2" (MP C4504). Scan Date: 12.22.2016 14:56:57 (-0500) Queries to: spiceworks@northandoverma.gov Maura Deems Building Department Assistant Town of North Andover 120 Main Street North Andover, MA 01845 Phone 978.688.9545 Fax 978.688.9542 https://mai l.google.com/mai I/ca/u/0/?ui=2&ik=aeO2b3b5c4&view=pt&search=i nbox&th=15927fc876df8c98&sim l=159284275f4da8l5 1/2 12/2212016 Town of North Andover Mail-RE:CommDev-Ricoh Email mdeems@northandoverma.gov Web www.northandoverma.gov All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.northandoverma.gov. This email message is a private communication.The information transmitted,including attachments,is intended only for the person or entity to which it is addressed and may contain confidential,privileged,and/or proprietary material.Any review,duplication,retransmission,distribution,or other use of,or taking of any action in reliance upon,this information by persons or entities other than the intended recipient is unauthorized by the sender and is prohibited.If you have received this message in error,please contact the sender immediately by return email and delete the original message from all computer systems.Thank you. https:Hmai l.google.com/mail/ca/u/0/?ui=2&ik=aeO2b3b5c4&view=pt&search=i nbox&th=15927fc876df8c98&sim l=159284275f4da8l5 2/2 OSCAR'S HAVCR INVOICE Oscar Vazquez 14 Kenwood Rd. Invoice#: 15611 Methuen,MA 01844 Invoice date: Dec 26,2016 United States Due date: Dec 26,2016 Phone:978-397-8636 Fax:Lic#BU-059279 Amount due: the_bart31 @yahoo.com $0.00 rs Hassan Hussein 546 Summer St North Andover,MA 01845 United States 9788850448 Description Quantity Price Amount UTICA BOILER MODEL#PGA156 1 $0.00 $0.00 SERIAL#365A Subtotal $0.00 Total $0.00 USD I, tes. After Servicing the Heating System on the Boiler at the address noted above,here is a list of what was done during service. 1.Inspect And Clean Heat Exchanger 2.Troubleshoot Thermocouple"Replace Every two Years" 3.Set Water Temperature 4.Clean Burners And Runners 5.Inspect and clean Pilot Assembly 6.Replace Zone Valve 7.Visual Inspection of Flame 8.Replace Expansion Tank 9.Verified Draft 10.Check Amps on Curculator 11.Check Thermostat Settings 12.Check and Troubleshoot Zone Valves 13.Bleed"Prime"Air of Hating System Gas Heat Report This Boiler hasn't been service in years_After replacing a faulty Zone Valve,the Expansion Tank,Cleaning And Servicing the System this is my assessment. Heat Exchanger,Burners and Runners are in good conditions.Although the Boiler's Jacket was rusty from previous water leaks,was not as bad as it looked.A good Draft from Chimney can be felt.The system worked for hours without any fails during testing period.for the age of the boiler is still in good working conditions.My recommendation based on what I found is to give adequate service maintanance and tune-ups every year. OSCAR'S HAVCR INVOICE Oscar Vazquez Invoice M 15611 Phone:978-397-8636 Invoice date: Dec 22,2016 the—bart3l@yahoo.com Due date: Dec 22,2016 Amount due: $0.00 Bill To: Ship To: Hassan Hussein 546 Summer St North Andover,MA 01845 United States 9788850448 Description Quantity Price Amount UTICA BOILER MODEL#PGAI 56 1 $0.00 $0.00 SERIAL#365A Subtotal $0.00 Total $0.00 USD No After servicing the heating system on the boiler at the address noted above here is a list of what was done during service. 1.Inspect and Clean Heat Exchanger. 2.Troubleshoot Thermocouple. 3.Adjust Water Temperature. 4.Clean Burners and Runners. 5.Inspect and clean Pilot Assembly. 6.Replaced Zone Valve. 7.Replaced Expansion Tank. 8.Visual Inspection of Flame. 9.Verified adequate Draft. 10.Check Amp on Circulator. 11.Check Thermostats. 12.Check and Troubleshoot Zone Valves. 13.Bleed Air of System Terms and Conditions Gas Heat Report This Boiler hasn't been service in years.After replacing one of the zone valves,the expansion tank and servicing and cleaning the system this is my assessment.Heat Exchanger Burners and Runners are in good conditions,Although the boiler's Jacket was rusty from previous water leaks was not as bad as it looked.A good draft from chimney can be felt.The system worked for hours with out any fails during testing period.For the age of the boiler is in good working condition.My recommendation is to give adequate service and tune-up yearly. �I INGLESE ELECTRIC ' a Sandro Inglese 10 Juniper Road Andover, MA 01810 0009 DATE ORDER NO. 2 -1016 781-799-5482 SHIP TO To ......................................................................... ............`1..5...... ..............................M..........e..r:.......s.......''....... 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(7g" C) RECEIVED NOV 0 5 2008 PUBLIC HEALTH DEPARTMENT TOWN OF NORTH ANDOVER Community Development Division HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;.(11'repaired; By: _J-lASSAN NvSs i I l.` — (Print Name) Located at: e/ S (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 9 - 6 _and last revised on I 'd . 15 ° a ? _,with a design flow of _.— 4'f Y G gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative(Signature) And --Print Name — V1 4 Final Construction Inspection Date: t � ` ngineer Representative(Signature) ty-1i tic'Out (_F, ! F4 And--Print Name Installer: ,/ And- Print.Nay ie Enginer• /(*(X� (Signature) Date:—_ -Z v _ And-Print Name 1600 Osgood Street, North Andover, Massachttsetts 01845 ill one 478.688.4540 Fax 978.688.8476 Weil http://www.towncfnorthandover.eom c►ORT1i pF�zLao 16,9ti0 OL O 1� T O COCM C t-%V ATE Ay ��SSgcHus�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division C�RTIIFC HE 0 F CO�Vl�1' J1.1 E As of:. December 4, 2008 This is to cert that the individuaf su6sur ace dzsposafsystem received a SA` ISTACTORT lYS IT ECTIOJV o the: .f lFulCSystem Repair of the Subsurface Sewage 1DisposafSystem B James Xellett At: 456 Summer Street Wap 107.,X; Farrel76 North Andover, WA 01845 21ae Issuance of this certificate shall not de construed as a guarantee that the system Wia function satisfactorily. Susan 2'. Sawyer (P'u6CicWealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com �f Y 'Commonwealth of Massachusetts w Title 5 Official Inspection �' wForm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Cl<'J Y 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your Joseph Delahunty cursor-do not Name of Inspector use the return key. Delahunty Septic Service Company Name VQ 248 Danville Rd. Company Address Fremont NH 03044 ° City/Town State Zip Code 603 895 6305 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/23/07 Ins p or's ignature Date The system inspector sh submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 0 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 , t 'Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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 Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts MEOW W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ® ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to 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. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. CitylTown 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)] Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 1 Commonwealth of Massachusetts u w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: 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: Last date of occupancy/use: Date Other(describe): I Title 5 computer form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: BOH 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ® Yes ❑ No Title 5 computer form.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 23 inches 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.): Septic Tank(locate on site plan): Depth below grade: 16 inches feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------- -------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 • 5 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank has been pumped often on a yearly basis as indicated by records at BOH. Bateson Ent. had informed owner previously of field in need of replacemnt. 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 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): Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 8 inches above invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): roots in d-box and tank. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts "Owl Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: d-box above operating level, not necessary to find. Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Commentsnote condition ( of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts i W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VoluntaryAssessm Assessments °M •' 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) 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 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.): Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 every page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system incl ding ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 eet. Locate where public water supply enters the building. J J ss � � o ` _C s` U N /3 Title 5 computer form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 456 Summer St. North Andover Property Address Otis Owner Owner's Name information is required for N. Andover MA 01845 5/8/07 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 ground water: 3 feet feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: neighboring plans Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: checked recent design woork of neighboring property ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the 9 high round water elevation: site observation, BOH info on recent plans near by Bateson Ent. consulted. Title 5 computer form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 • Y r Summary Record Card generated on 6/2/2007 9:31:36 AM by Elaine Barclay Page 1 Town of North Andover Tax Map # 210-107.A-0076-0000.0 456 SUMMER STREET OTIS, H. CLARK 456 SUMMER STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.03 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until OTIS, H. CLARK Payor 456 SUMMER STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14232.0-456 SUMMER STREET Last Billing Date 3/16/2007 2100228 - 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 65.73 /1 UB Meter Maintenance Serial No Status Location Brand Type size YTD Cons 16336126 a Active ERT METE METE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 2/21/2007 753 a Actual 21 3/23/2007 8% 11/1/2006 732 a Actual 16 12/22/2006 19% 8/1/2006 716 a Actual 13 9/13/2006 -11% 703 a Actual 15 6/20/2006 0% 5/4/20060 2/2/2006 688 a Actual 15 3/13/2006 -16,6 11/3/2005 673 a Actual 17 12/14/2005 17% 8/8/2005 656 a Actual 15 9/12/2005 9% 5/10/2005 641 a Actual 13 6/8/2005 -379q 2/14/2005 628 a Actual 22 3/15/2005 11% 11/15/2004 606 a Actual 21 12/17/2004 -59% 8/11/2004 585 a Actual 46 9/20/2004 -12% 5/17/2004 539 a Actual 55 6/14/2004 4% 2/17/2004 484 a Actual 60 4/16/2004 0% 11/7/2003 424 n New Meter 0 11/7/2003 0% Commonwealth of Massachusetts Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Dispose. C. On-Site Review (Cont.) Deep Observation Hale Number: r. Z& `' f o G A M S�^•'"'' �� �- Date Time W'her i. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) S S- 2. 2. Land Use: C .Q ` . `` " c .v (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform Positio^on landscape(attach shee«; 3. Distances from: Open Water Body Zai + Drainage Way Possible Wet Area feet feet feet Property Line /G Drinking Water Well Other feet feet 4. Parent Material: L 6 - —`i S-iO� 7 Unsuitable Materials Present: Yes ❑ No rti/ If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)a Weathered/Fractured Rock❑ Bedrock(_l 5. Groundwater Observed: Yes ❑ No Yes: Depth Weeping from Pit Depth Standing Water in Hole .r E�timated Depth to High Groundwater: -1 Z '90 .O& inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page o`7 Commonwealth of Massachusetts City/Town of Form Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number- 7 - Soil Soil RedoXiMorphic Features Soil Coarse Fragments Soil Structure Depth Horizon/ Color-Most 0., r_mo S, (mottles) Texture %by Volume (In.) Layer (Munsell) (USDA) Consistence Other Depth Color Percent Gravel Cobbles &Stones G"z A (0 I"vz ------------- Add'llional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 Commonwealth of Massachusetts C"'! -_;-in of 3: _ �rc~n 'f 1 - Soil Suitability Assessment for On-Site Sewage Disposal. i=N! C. G" n-Site Review (Cont.) Deep Observation Hole Number: Z ic, zar G� to �oCJ 4ftl Y" '--y sa Date Time W= "ger Location Ground Elevation at Surface of Hole �& _V-S Location ('dentify on Pian ) S'= 2. _and Use: C ..a I— A' N C. " c (e.g,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) _ L A- w ^ Vegetation Landform Positio^on landscaoe(attach sheet, Distances from: Open Wafer Body Z�v � Drainage Way /GG � Possible Wet Area 1121:5 � feet feet feet Property Line /0 Drinking Water Well °/� Other feet feet / 4. Parent Material: L —`i .4"'Q ov I Unsuitable Materials Present: Yes ❑ No FL Yes: Disturbed Soil❑ Fill Material❑ Impervious Layers)❑ Weathered/Fractured Rock❑ Bedrock[l 5. G.oundwater Observed: Yes ❑ No [J' Depth Weeping Pit Depth Standing Water in Hole umated Depth to High Groundwater: T E inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Papq o`7 DATE .. • 1 1 Ott■.■■fE■Ef■■M■NOM■EElE■■MMMNMMtf■ IMPELLER' ■!■!i!!!!!■!■!.■!i!■!!!!■!■!■..!!!! -� ■!E■■!■■.!■■■Ei■i!!■■■■■■■■ilii■■t! 1 • li!!E!!■■!.■■liE.E!■.■!!ilii!■.!E!■ Pump HP Imp.Dia. 5.44 ��\■ilii■!!■■■■■.■■■.i!!i■■■■■■■f■■ iE\moi■■■■t■■tit■ill■Ef■■■SENSE Mason MENEM REMAIN EEE■■\\!i!i!!M■!!■■!■■!■■!!!!■M■NEM ■■■■■i�.��■■■■■!■■■iN■iii■!!!■■■■■■■ i■i■■■■!E\\EEEE!■■E■■!N■■F■!■■■■■■■■■i■/NOON■tit■! ■EN■■■EEM /!/■!!!!.■lam■■i!■■■■■■■iii!!■■■■.EE ■!!iii■.■!.!■■�■■■■■■.ii r/`N.OEEl./l.�i■iElEilE!lii.■ill■■■!Ci■EEN!!li.i■■i!!!!./!E!i I MMSEE■f■E■■■f■►`■lMEE■ii■■E!E■■■i■i■■■■■EEEE■■E■ESN■f■M■iS■!■ ■NEEMONES■■■■E■►�fME■MNlEE■!■f!■lSEEEE■i■■■■■■M■i■■■...■■.■■■ ■.!i!E!■■■■!■ii\.�!!.■/i!■!!!■■i!■i■■iliii■!i■.i■!■i.l.iill/■ ■■■!!■■■■■■■■■■■ . /■■■■■■■■■■■fiE■■■■■■■■E!■■NSEEMEEEMEMEME■ ■■■■■!■!.■■■i!i■■■�Si!!■■Et!!■■■■.■■■■■■lMN■■■/■Flit!■■EE■i■ !■Nftffftf■MMf■tt!■■��fSMMMM■■■f.N.MMff■E■■!■■■MN■■fESMMlNN! ■ES■■■■■EE■EES■■■M■NMSISMl�.�.MOEEf■Mid■■■■SMMMNENM.SMS■.E.M■ ■■■■■■■■■■■iii■■■■!.■■■■■iiM►tt■■MM■■i■■■■■■E■■■Mi■■i■E■■iif■ MEMOS!M■NE■■EMEMEM■Ei■!■.E■Eif►'i■■■■ti■■■■■■!■■■fE■■MEN■!M■MEM Mflf■■■■NEM■■E■■■■l■Mi■i■E■■E■►`\■■■■■■■■■■■■■■■■■■tSMM■EiMN■ i!■■!■t■■!!E■Eiili■■iE■■!E■■■■■►`�■!■■ilii■■■■ii■.!■■.■■■■■■!■ ■E■■■■■t■EE■■■■EEE■!■EE■EEE■■E■.►'E■■E■i■■i■■EME■■■MEEEM■■f■M ■.E!!■■!.!■tE■■i!■E■!!!!■E■tit■iti►`■EEl..I■!ii!!.■!Ei■■.Ei!■ iNi.Ei■t■iii!■■■EEEE■!E!■■E..■iN■■..�iEli■l!lii.E■■■!■■■■!■!■ MENEMME■E■MM■MMEMMIMMENE■■E.O■■Eft■■f.�■■■■i■■■■■■■■■■■■!lEfM ■■ESN■■■■■■MONO■■!M■■■NEE■■■!■■!■■■■■!\■■MSN■■MEN■EME■■MEM■M ■■■■SEEN■EEE!!!.E■■■i!■■■FEN!■■■■EEE!■�1.E■■■IEEE■■■■.i■■E■i ■■■■t■■!■■■■!■■■■■E■■■■M■■■■■■■■■iiME■■\\t■■■.■■■■■■E■EEE■!E iE■Ei■ii■■■fi!■■■EEEEE■i■E!■■■■E■.!i!■■E►\f■t■■EEE■■■TEEM■!i ■!■fi■■EEEMEN■■■!■■■■■■■■EElE■■■■EE■■E■E■\'SE■■!■IEEE■t■M■■■i ■MtfMMEMSMMMM■■/MME■■■Ef■lMMNM■MN■■■■■tM■■\\N■M..MMM■IMMN■EM ■■EEE■■!■■■■■.■■■El■■■E.■■i!■■■■■EiiE■■.i!!►`Oil■!tlESEi■!■Ei ■lfiE■■E!■EN■■iiEliiill.■E.!■■ii■■■lEiiMEi■E►�.ElEE■■/NEEM■ti MEif■■■■ii■!E■■■■■EE■EEE■■Ei■■■N■■E■■■■EEE■■■\■■■EEE■■■■■■■■ NOON■OS■iM■MMM■O■■■■■MEM■■■!!■i■NEt■.Nf■■■ESE\.\SSE■SM■■■MONM ■EEM.iSNlMElEiiiiliii■S■li.EElt!■■■iE!■EEE!■■■■!`MEF.!■■■!■ii ■■■■MMENEMM■■■MEMMEMNSEEMMENE■ MENEM MEMOS ENE■■■S■■■EEE!■■NIEE■i!!lEEE■■■EMli■■ES.■■i■■■■■►1■■■■■Ott■■ ■■■■!■■Ei■■Mff■MOO■ifM!■Ei■MM■■.■■MNNM■■■■St■■MSO\`t.M.MMf.E■ MEN S Ci' CCNpCCCCNE MEN IN MUMMUME000■'C'CC C■ MEMMEM MINES E ■ �C ■.ElC�Ei ..E..... .CICE C.N• ■■C■ NE CC:ECC , C C� f.C::C�CM.ECC■EiiCCCCCCECMC..1E .::`�CCECE:C • 1 II 1 i TOWN OF NORTH ANDOVER of NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 3 'Ila* • .. • o 10- 9 HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 •.,r'* NORTH ANDOVER, MASSACHUSETTS 01845 "SS�CHUs�t Susan Y.Sawyer,REHS,RS 978.688.9540—Phone Public Health Director 978.688.8476—.FAX healthdel2t@townofnorthandover.com www.townofnorthandover.coni AP ICATION FOR SOI TESTS DA E 6 MAP&PARCEL: /07, A -�� LOCATION OF SOIL TESTS: 4166 6,7 Gl !ii ikc r xS / - �, i,&f h4 OWNER: P 4, Contact#: -70� G Llo 2-3 APPLICANT: 9 � ffitSSx/16 Contact#: ��� V ,0 V ADDRESS: r/ 1 I tib ENGINEER: &U f t, JL I' Contact#: 7A L CERTIFIED SOIL EVALUATOR:")-" � coq I.PaJ Intended Use of Land: Residential Subdivision Single Family Hom Commercial Is This: Repair Testing:__L,� Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ . 8.5"x M"Plot plan&Location of Testinz(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 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department: (stamp in): ,µ ` \ • Commonwealth of Massachusetts F Title 5 Official Inspection For Subsurface Sewage Disposal System Form Not for Voluntary Assessments 456 Summer St Borth Andover ---- ----------- -----..------- Property Address Otis Owner Owner's Name information is required for N Andover MA 01845 5/8/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ---- Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system incl ding ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 eet. Locate where public water supply enters the building. C CJ 5 � 9 of � F-f—J I F\Cc.. I ,1 I itle S computer toun.doc o8/oti Title 5 at Inspection ubsurface Sewage Disposal System•Page 14 of 15 :06;01 2007 09:54 9786648155 JM h'=SO-�I",JE FRSE 02!0: TOWN OF NORTH ANDOVER �NOR3N i Office of C01i MUNITY DEVELOPMEWE AND SER-Y10ES S HEALTH T)JEPARTViENT r t 1600 OSGOOD STREET- RU 20; SUITE 2-36 NORTH ANDOVER, MASSA.f P I F..M tl1 R45 ;ta Susan Y.Sawyer,RE11S,RS 978.688.9540-Phone Public. Hulth 0irectur 97?1,68P..8476 FAX healthde.t(nitownoFnorthatx)over.com www,1wwno fnorthandovcr.com APPLICATION FOR SOIL TESTS DATE: LOCATION OF SOIL TE � �vw�nn�t S-hc'eef /J o, ,4vnxdover OWNER pe it Oil'5 APPLICANT: gh55�-N contact 4, ADDR-V-SS: I C.A//off�s�. � / M e�'h u ► M a I$'�'� ENGINSBRa J 0(C-k C�u ; ��r,�t : g�� ) i�I,y - X Z 04 CERTIFIED SOIL EVALUATOR: Intended Use of Land; Residential Subdivision Singl�Fami�fiom Commercial Is ifis; Repair TtWng: V Undevelupcd Loi Tcsting: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No V/_ THE FOLLOWING MUST DE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) 8.5"x 11"P oto&CRation of.re9 (n�indicate tat.0t sltt~s ort the > Fec of 325,60 per lat for R_=conAmetion. This oavvrm the rni"hnt m two deep holes and two percolation tests required for each disposal area. Fee of$MO,00 per lot for ppain 91 and- .. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep mote Inspw dons. D Only Mass.registered Sanitarians and Proficssional 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 Bali representative. > Full payment will he required for all additional test,within twe weeks of testing, > Within 45 days of testing,a scaled plan(no smaller than I"-100)shalll be submitted to the Board of Health showing the location of all tests(!Deluding aborted tests). r> Within 6o days of testing soil evaluation forms shall h4 mnhmltted, Please Do Not Write Below This Line N.A, Conservatlon Canunlssion APP.... roval Date. Slg►r wre of Omserm&n Aged :Eii���� IV Gate back io Health Department: (stamp In): 9f kjtt fVk � VAR., a �� � rC, I S 0m l S PKof� ACL rage i of i DelleChiaie, Pamela From: Marianne Petersm eters millriverconsultin .com [ p @ g ] Sent: Thursday, June 28, 2007 4:40 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil results for 456 Summer Street Soil results for 456 Summer Street, done today, June 28, are attached. Please call if questions. Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsultina.com 7/16/2007 k44 11.E etc L v R *� /�iij �.kGn✓u70% .,.,Ic/j'y t72vctT^^ St! �i e� /'p � -1:...� �T'arT .�naf d� s } ... /o_ y6 [ x'41 y,� �e s ` 147 ; LS 4alc fres . gr ry q(1 �S y�G✓ cr] �� �,`rte„�f- !..-cv/TCr1 �.� ® 7)., .1 X455 C: S I Commonwealth of Massachusetts :al Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran - Not for Voluntary Assessments 456 Summer St. North Andover .__.. .__..-._._ _----�_-- Property Address Otis Owner ..._ _. ._ --- Owner's Name Information is required for N. Andover (VIA 01845 5/8/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Sketch Of Sewage Disposal System- Provide a sketch of the sewage disposal system incl ding ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 eet. Locate where public water supply enters the building. 03 a _' J ° \ , _C Ci r) I ltle 5 cnmpuier tome doc-08106 Title 5 ial Inspection ubsurface Sewage Disposal System•Page 14 of 15 GOWN OFNIORlliANDOVER. OFFICF101"I'llF COl.IFC.TOR.OFTAXES III II IIII II llk,'BOX 124 THECOMMONWEALTH OMMONWi ALTH O MASSACIIUSE TS II�IIII�I��III�III�RI��III iII�I�IIIIiIIII�IpIlllllll N0R 11-1.AND0Vf,0Z,MA 01945 I'C)WN 01 NORTH ANl)OVliit 'M-F'8:30-430 417650085 TAX 698-955WASSR 699-9,566 'li'ax Unpaid Message Tax Map No:2.10-107.A-0076-0000.0 IS[Installment: $0.00 Please use the enclosed lockbox envelope to expedite your Location: 456 SUMMER STRI L•,T 2nd Insuilhmnt $0.00 payment. This will assist us in processing your payment more Decd/Legal : flo6k 3123 Page 344 3rd Installment $0.00 efficiently. Land Area: 1.03 Acres 4th Installment $1,2.21.33 The office of the Tax Collector is located at 120 Main Street, 4,r Ft PAYMENTRECEIPT VOUCHER OTIS,3 CLARK ll.&;AN�DR M 'IIS Paynlent:due by May 01,2007 456 SQ11VIMF;R STREI;'I' Amount Now Due : $ 1,221.33 NRAWHI iANI)ONI IZ,MA yvr id Rased upon asscssnienis as of.Ian.01,7.00fi your Rcal flstatc tax for the fiscal yrar 01845 j;.l-y: ' •,•..1, :�,yt)r:(';'I,:')F' commencing Inly 0I,7006 and ending nn.lune 30,2007 on the,described property klow is as fellows nnnmmnmi>oc. 0417kS008520070000000000000000000001000181.56000000122133049 h r BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. / �7/j� 1 44- 0vvGR� i �--- E t 4r, Lu A4 1. NAME DATE' a ala 1 2. ADDRESS � �� S� LOT NO. of TEL. G G 'cref S�%r+tmCvli'j v.l m 3. N0. OF BEDROOMS_ DEN YES j/_ NO 4. GARBAGE GRINDER YES NO }E . 5. SHOW DIMENSIONS OF HOUSE () 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES '7. SHOW DIMENSIONS OF LOT 8 SHOW LOCATION ANDZ C SI E OF SEPTI TANK OR CESSPOOL 9. M5-Dl-STA-VCE-OF 49LL-ERQM SEWERAGE YSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE �- NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. Farrr George ' Summer & Farnham Cor. `` �• APPLICATION FOR SEWAGE DISPOSAL INSTALLATION (Lot 8, Colonial , HEALTH DEPARTMENT - NORTH ANDOVER, MASS. Acres) I hereby make application for a permit for a sewage disposal installation at rnI nni ml Acres 1'.8t 8. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of3 i4-vVgd)in size.. A manhole (s) permitting easy cleaning will be provided with removabledcover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of **/J'6 -lineal (sure•-) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/41t (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. Information of avai label To be installed as required. DATE ,T'S Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE SignatureVV of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Inspecting Officer Percolation Test Garbage Grinder ?�U R � 4 BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE Tray 29, 1965 NAME OF APPLICANT George H. Farr LOCATION Lot #8, Cor. Summer & F annum Sts. Address of lot no. BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay X Gravel Sand PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. 0 jL -- %1,2� c4d William J. D scoll, Engineer Board of Health 7 I� -