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Miscellaneous - 49 EQUESTRIAN DRIVE 4/30/2018
s • 1 Lot & Street M - Map/Parcel Iq CONSTRUCTION APPROVAL Has plan review fee been paid:r ' YE§_) NO Permit# Plan Approval: Date: 26a� Z Approved by: Designer: m&e m,,k,r- Plan Date:_ a 7 Conditions: Water-Supply: f�Ta , Well Well Permit Driller: Well Tests: Chemical -Date Approved. Bacteria I Date` roved Bacteria H Date Approve`_ Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U„ Approval: Approval to Issue: 6EB, NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO, Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: a SEPTIC SYSTEM INSTALLATION CONDITIONS: . Is the installer licensed? NO Type of Construction: REPAIR New Construction: Certified Plot Plan Review Y NO Floor Plan Review YES NO Conditions.of Approval from Form U YES NO 1, Issuance of DWC permit: NO DWC Permit Paid? _ NO DWC Permit# Installer: �Q Begin Inspection: YES NO Excavation Inspection: O ec - r�L ✓ JL{--� Needed: ., Passed: g'�o B 1 Construction Inspection: Needed: As Built Plan Satisfactory: - YES: Approval of Backfill: Date: By: zee- z Final Grading Approval: Date: 1/14 ba By: -1 / 1 Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: ueu i j uo i u.i,+a P•2 Small 1 Vater Systems Services, L.L.C. Contract O rotors of Water and Wastewater Systems Post Office Box 2014 Littleton,Massachusetts 01460 Phone: (978)386-1008 • Fax: (978)486-0971 www,swss.biz December 13,2005 Wilfried Welsch 15 07 Salem Street N4 irth Andover,MA 01845 R :Wastewater Operations Contract—49 Equestrian Drive,North Andover D Wilhried: Sn all Rater Systems Services, L.L.C. (SWSS) is pleased to present this offer of annual contractual services f6i the Bioclere wastewater system located at 49 Equestrian Drive in North Andover. As you may be aw ire,we operate a number of these systems in Eastern Massachusetts and are well equipped and qualified to >perate your new facility. It is our experience that these systems should be visited regularly to ensure cle in sprayer heads and overall optimal system performance.This contract offer is based on quarterly site vi is with regular reporting to the client, to Aquapoint,DBP and the local Board of Health;this reporting is re I ired of all systems this size. Alual Contract Fee: The annual wastewater operator contract fee offered for this property is $1200.00 pej year plus operational chemicals if required by Aquapoint and tank pump-out fees. The annual fee is brc ken down to quarterly payments,payable after each quarterly visit. Th s fee ingludes licensed operator coverage of the system,quarterly inspections and routine maintenance, sar.ple collection and lab costs according to the routine quarterly sample schedule established for a system of s size by Aquapoint and the DEP;also included are data review,meter readings(if available),record ke ing,filing of all required paperwork. _ Tri able Call Rates:Trouble calls are those events or emergencies requiring operator attention outside of the ormaI schedule.Repair/replacement parts are billed separately;labor rates for trouble calls are billed at $b .00/hour with time and one-half for evenings(5:00pm—midnight)and Saturdays;with double time for nig its(midnight to 7:00am),Sundays and holidays. Tht homeowner agrees to these conditions by signing below. We appreciate this opportunity and look for and to servicing your system in the future.Please call us at(978)486-1008,with any questions. Sin erel , Det oath A.Bray EnN' onmental Analyst/Operator Accepted by Wilfried Welsch,homeowner: am /s' ature/Date I I i >d ' 4 J� CATERPILLAR 4� kA T u - ,1, Zi -?} ^� >s'1`••- �" '� ��• ��az+r�Lr•. � yrs'.- t . . 1 k r r x t '., �� y, v ✓ ,. PF `,�,". ��,'•S ..}��`♦ -^ "i,v Y i 3 Y s 1`d � o � .. .�.'. - ,, / � Vic'.` ` ;_,. .,..• . � � ��' 4*� .,,, �'"` � is .. , _ , 1 a � .S't - w J yr ..� 'f-`�`�✓ � y � ' ••` .. ♦ 1 ar�y�`������... � ,..,�T�i Lam_ +._' rs .- .0 .�t - iI T _ ' �'- �' '�„_•g:a,. SSS ,�'i:• ; 1, .k ,- �V� 1. __ S �z_- i '3'�'T ��c"re.�-r� sn .a..5'1 �� .R•� ;w .,x. .. •, .y� '�-4 � i6Z �>` `., "� � s��-,,.x moi, �rp� - ���. f `L=. r, di�f, � - • a.. a''�"jk�'i:Ys •2•f�.� , '. < T� �' .r * ♦. � i a Y: �y�4 :2 i t .. S .. \.`*„'p `,y` �.�,i'`� !'�,r,,, �M �� -�.ti lar.1•.'.'- `" _ �r ,.%+- • t'�'3�' s��""�.-' r'�1 a�.`� i f `',�,� m•-..�, k �.� ti��'"^ ►.. 1'� �,. s -sit - t„, 'Y:•e '��'i„.ate'4 'l.' - ti,�� > y�y� x f .. 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Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax CEWFICA.gE OF COV tV r TAj1VCE As of. December 20, 2005 ,This is to cert that the individualsubsurface disposafsystem was a Fully Constructed %y Geo Virnelli/Dave Maynard At: 49 Equestrian Drive 5 orthAndover, MA 01845 9Yas been instafred in accordance with the provisions of 7itfe v of the State Sanitary Code and with the North Andover Board of Aealth regufations. The Issuance of this certificate shaff not 6e construed as a guarantee that the system wiff function sate,factorify. 4SVa n 7 Sawyer, 12�fs111R5' fu6fic Yfeafth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 RECEIVED PARTIAL AS-BUILT DEC 0 6 2005 PLAN OF LAND IN c+ TOWN OF NORTH ANDOVER NORTH ANDOVER, MASS. HEALTH DEPARTMENT OWNED BY WILFRIED WELSCH ���p`JN OF �q SCALE: 1"=40' DATE!12/5/2005 8CQ Scott L. Giles R.P.L.S. No 2 AS-BUILT ELEVATIONS[] Prank. S. Giles R.P.L.S. CiSTO�� � INV.OUT OF HSE.=98.35 50 Deer Meadow Road QaA( Lp�p 5�Q INV. INTO TANK=97.35 North Andover, Mass. / INV. OUT OF TANK=97.10 LOCATION'#49 EQUESTRIAN DRIVE INV INTO BIOCLERE=97.0 INV OUT OF BIOCLERE=96.8 INV. INTO PUMP CHAMBER=92.7 INV OUT OF PUMP CHAMBER=89.9 C�O�� G I?e k ;SIN X01. Q 0, GV Go' k 0° /j o sr, 6y, EXIST.BIOCLERE `-- MODEL 18/121350 G�ti � k ° ° EXIST. 1500 GAL. #49 SEPTIC TANK G`3 X �G• k C A EXIST. k 5BEDROOM X DWELLING P.E.SLAB + G,a (VARIES) 51, EL=100.0/101.7 0 a a + PROP. TEMPORARY so Aaa311V�1S j/N STOCKPILE AREA b11V7 J/N V11 V7 522.66' e 8 fid$ T.B.M. PK A PAVEMENT NMoaBN —— _ s� ,. g d/N NMoagn3 P0.0P. VENT X� og y lk7 tx -St? �6. ROP. EROSION CONTROL 'L / n R . / mm �mg t TYP. o PROP. RESERVE AREA ( ns // � -� � aby W 30' SETBACK H (T P.) P_�:°# LEACHING .� :a' _ _ - . PROP. - g� TRENCH / PROP. 5' CLEAR AND STRI (SHEET I.� E = g' AS PER NOTE 04 `°B / epi - u`$ J -AJ.•ry - i 8g�a� T 4—A - L� 2 m _e z, 702 S.F. R �\ ARtA=2 C A �d - $ An =5.46 =g °�'a WETLAND EDGE oPGED BY INC. egg -'83 T M�ORAIFtQg' � AS WETLAN PRESE0.V A710N ABT e / L ° I 5 oCK LE I \ maa9 T.B.M. STA^ I AREA #1134 70P E �° !H oNe� EL=93.63 (U.S.G.Smlag PROP_ 2" XC S pUMP LI 9R g 21 P.V.0 N .d/ LY 400 dtio� WIC PROP. cTEDIORURBANC'g ds p l PLLCILADBT AT se FIBg g- _ Rfe IN ACCORDANCE P.I —PLAN BY W. . 1 fim � �j �rf•�� 8e� glot vz� use -8B _ dao,) - x 130 a1sNo0 3l7aIJ llnj y/N s •g ^sg Sege _ ------------------------------- - ,�• Ag ge•- t,` W 1 0 s \ PROP. EROSION CONTROL SEE A10 FOR SITEWORK SPECIFICATIONS /cm t •1° m rt � oa R w'.gLP $ 80.3 t t0 •'D M D� Ili D £: 'TJ,BJ °oz s.>o o m v ' � \ om'R EBt• QetB t B g n � a ,aM1 4 3 F o A tN/1 K" (P ao�° �'Bs.�B BE' �4• A'� Bs. °21 �-�m \ a N Q`• 9 � e• �V7 I d p w 3 m m i m I' \ BBT S' t0 o.�e'%ee O •SBe M1 A M. !Bei' m ml Z mug 1e y 9 �,o$ m9 B ``' m Q 6� \ rpTT CD 0. o m +•s m s - BPo D A Ci'pe 0 ' I 140 00 � I I mN� m�3 I !P N p Gl In ^-Z E31 InIn -( p T ! 271 a I 3o M O C N I r I o m � N £ C3 p z r po n z Frz' m n m z m It' r < O I� m � I I I I n 4 ne.�. 150.00' 255.00' STR ' Q ,1 PROI: REV.NO. DATE REVISION RK STUDIO ARCHITECTURE 1 10/22 UPDATE FOUNDATION PLAN THE WELSCH RESIDENCE PRINCIPAL, RAY KIAIA 72 PINE GROVE, AMHERSTMHERSi MA 01002 T 413.256.1253 F 413.256.6619 E rksludia@mediaone.nel 47-51 EOUESTRIAN DRIVE YEARMIIC 011YNEOING CIVIL[NfiINEERING/SEPTI(DESIGN NORTH ANDOVER,MASSACHUSETTS 01845 IE0MAR0LV= MMfl,PE.STRUGURAI ENGI ING SCALE: 1/4"=1'-0" UNLESS NOTED DATE: 09/13/01 °+•MC"'" 9y Commonwealth of Massachusetts Map-Block-Lot 105.D-0146- r o Board of Health Permit No ' North Andover BHP-2005-0723 °� .. �... • P.I. T, '�•......•^,{, FEE CHO F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Dave_Maynard to(Construct)an Individual Sewage Disposal System. at No 49 EQUESTRIAN DRIVE as shown on the application for Disposal Works Construction Permit No. BHP-2005-072 Dated December 08 2005 Issued On:Dec-08-2005 ----------------nm-LIE ---------------- - ----------------------------------- ------------------------------------- Board of Health x°�Th Application for Septic Disposal System _ � ©� TODAY'S DATE Construction Permit - TOVN OF -- "•x, ::NORTH ANDOVER MA 01845 -$=z Full Repair ' $126.. Component sACHU`� 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 cursor-do not use the return key. A. Facility Information �,!;a�'S %✓�-•'L. �!/ �l raf Address or Lot# A�&. - ef� City/Town 2.- *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 d Name Address(if different from above) City/Town State Zip Code 227F --61F Telephone Number 3. Installer Information �- Name Name of C,i6mpany - Address / City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 H °N,M Application for Septic Disposal System J'7 - --�� Construction Permit - TOWN OF TODAY'S DATE — =.y r* MA 01845 $ 250.00-Full Repair ' $125.00 -Component ORTH ANDOVER �4CHW PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: oResidential 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 been issued by this Board of Health. Name Date Applicati , Approved By. NBoard of Health Representative) dame Date Application Disapproved for the following reasons: For Office Use Only: L Fee Attached? Yes ✓ No 2. Project Manager Obligation Form Attached? Yesc/ No l d 3. Pump S, sy tem? If so,Attach copy of Electrical Permit Yes ,/ No 4. Foundation As-Built?(new construction ronly): Yes I'- _._., No (Same scale as approved plan) S. Floor Plans?(new construction only): Yes No Application for Disposal System Coltructiofl Permit•Page 2 of 2 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at '�1 9 /Det , relative to the application ofP4, dated — ( —,2000 for plans by and 61 dated,fo S-,g97 with revisions dated I understand the following obligations for management of this project: I. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersignednsed Septic Installe � � Date:%,2 - Town of North Andover, Massachusetts Form NO.3 %OR,.,, BOARD OF HEALTH �,'°•��.o �"� DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUs�t • A Applicant NANtE ADDRESS TELEPHONE Site Location , Permission is hereby granted to Construct ( Iror Repair ( ' ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CWA.WMAN,BOARD OF HEALTH Fees D.W.C. No. If 1 �-- APPLICATION FOR DISPOSAL WORKS CONSTRI CTI ON PERitiIIT �f1� DATE: CUTRRENT D, 'STA.LLER'S LICEi+SEm��� LOCATION: LICENSED D STALLER: SIGNATURE: TELEPHONES6er'S-"J�i � CHECK ONE: REP_ : NEW CONSTRUCTION: 6 IF NEW CONSTUCTION, PLEASE ATTACH FOUiNDA I N AS-B=T. Administrative Use Only S7S.00 Fee Attached? Yes ✓J No Foundation As-Buiit? Yes No Floor Plans? Yes No Approval Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at o f f„ 4Q„ 4� ;r relative to the application of �eo ,r,7�,��" , dated for plans by —�44. and dated with revisions dated I understand and eeto the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. 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 my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation-or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Li ense Se is Installer Date: t 3 49 EQUESTRIANDRIVE JS-2006-0366 Proiect Detail Report Printed On:Thu Dee 08,2005 Project Name: GIS#: 6596 Project No: G JS-2006-0366 Owner of Record WELSCH,WILFRIED 4 NO"TM Map: 105.13 Date Submitted: Dec-08-2005 1507 SALEM STREET �? *' es Block: 0146 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 49 EQUESTRIAN DRIVE a 'r' Zoning: Proposed Use: District: _ s�eNugci<� land Use: 130 Proposed Use Detail Subdivision Description Septic System Final Inspection Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2005-0075 12/7/05 @ 10:15 a.m. This was a system that was put into the ground in 1999 by Leo Vimelli. It never had a Final Const.Inspection. A new DWC was applied for today by Dave Maynard. Once application is reviewed,and all paperwork is received,the Health Dept.Will call to let him know when his permit is ready.--pfd. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Constructio BHP-2005-0723 Dec-08-2005 SIGNED OFF JS-2006-0366 Construct-Complete � _5 - l z— — 5 -Ci$ 5 r V� a�-..�,_ �. z s --p r_r �?'� C�:`fi" :z ✓ Z,r� try` e b�. Y / p 101` r GeoTMS®2005 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 Wilfried Welsch 1507 Salem Street North Andover, MA 01845 RECEIVED Phone (978)685 2968 Cell (978)618 9959 DEC 0 6 2005 Fax (978)258 0625 Email w.welsch@comcast.net TOWN OF NORTH ANDOVER Town Of North Andover HEALTH DEPARTMENT Health Department Attn: Susan Sawyer North Andover, December 2, 2005 49 Equestrian Drive, North Andover, Septic System As-Builds Dear Mrs. Sawyer, This letter is to inform you that I have retained the services of Mr. Scott Giles to prepare the as-build drawings of the septic system located at 49 Equestrian Drive, North Andover. Sincerely W ried Welsch DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, November 22, 2005 10:43 AM To: Sawyer, Susan Subject: Lot 49 Equestrian Drive Hello Susan, Received a call from Scott Giles re: above. He wants to get a final COC from the Health Department. This project has been ongoing since 1999. In essence, the original engineer was Bill Dufresne, Merrimack Eng. He and h/o, Wilfried Welsch, had a falling out. Therefore, the plans did not get revised as they should have been. Scott Giles wants to fix what needs to be done: Bioclear Champer and Pump Chamber elevations need to be changed. Will you accept revised elevations from Scott Giles? Please call him at 978.683.2645. 1 advised Mr. Giles that the Health Department historically does not allow other engineers to pickup the original engineer's plan and revise it unless it is an extreme circumstance (engineer skips town; death, etc.) Giles thinks that is unreasonable, and would like to be able to do this. He also wants to work with Peter Murphy of 9 Laconia (Lot 14) to do his As Built, I believe he mentioned. However, Neve Morin was the design engineer. Unless I am somehow mistaken, told him this would be an issue as well. Will you please review the file and let me know how I should tell him to proceed? I will bring it in shortly. If he absolutely cannot do the revisions, I will call him for you if you want. Thanks. $¢slRagavds, AWAY1004 A10001a40141afe Health Department Assistant Town of North Andover 400 Osgood Street North Andover,MA o1845 978.688.9540-Phone 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com i .w� ' Town of North Andover r40RT)l OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street `' North Andover, Massachusetts 01845 s WILLIAM J. SCOTT 9 S^CMUS< Director (978)688-9531 Fax (978)688-9542 November 5, 1999 Les Godin Merrimack Engineering 66 Park Street Andover, MA 01810 Re: Lot 23A-24A Equestrian Drive Dear Mr. Godin: This is to inform you that the proposed septic system plan for the site referenced above dated September 27, 1999 has been approved as of October 22, 1999 for a house with a maximum of eleven(11) rooms. Please note that this letter is an update of a previously issued letter. If you have any questions,. please do not hesitate to call the Board of Health office at 978- 688-9540. Sincerely, Sandra Stan-, R.S., C.H.O. Health Administrator Cc: W. Welsch File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ��`� G���s f���� 6"9) d INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. Comments: Ile O1�) B. Retaining Wall 1. Wall height and width as specified _ 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90°change 10. 10'minimum offset to water line Comments: D.. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20"manholes 7. Inlet tee minimum 12"under invert 8. Outlet tee minimum 14"under invert 9. Outlet line cemented 10. Air space 3"above tees 11. 2"-3"drop from inlet to outlet 12. Pipe set 13. Compact base with 6"of'/4"crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber 1. If separate from tank,compact base with 6"of/4"stone underneath 2. Minimum 2"pipe to d-box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d-box Comments: F. Distribution Box 1. D-box level 2. Minimum 0.IT'(2")drop from inlet to outlet 3. Minimum 6"sump 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box J 7 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double-washed-3/4"- 1 ''/z" -pea stone Bucket test done? 2. Minimum 2".of pea stone above distribution lines 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope 6. Minimum of 9"of fill graded over system 7. Toe of slope stops minimum 5' from edge of property; if not,then swale. Comments: H. Leach Trenches I. Minimum 2 trenches 2. Length of trenches agree with plan. (Max length 100') 3. Width of trenches agree with plan-Minimum 2%maximum-4'. 4. Vent present if<50 feet or specified 5. Distance between trenches minimum 4'and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6"per 100' 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipe 6'maximum 4. Pipes connected at end 5. Separation between adjacent fields 10'minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48"wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond d 1 , Town of North Andover 0CR1M OFMOF +e�,,..o COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover,Massachusetts 01845 WILLIAM J.SCOTT De++eeror (978)688-9531 Fax(978)688-9542 October 22, 1999 Les(loam Merrimack Engineering 66 Park Street Andover,MA 01810 S tiOULON' 4 Twt BE- Re: Lot 23A-24A Fquestrian Drive 1 74o t-'1- 7 Dear Les: This is to inform you that the proposed septic system p the sites referenced above have been approved for a house with a r aximum of nin ms. If you have any questions,please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Stair,R.S. Health Administrator SSlsmc cc: W. Welsh File BOARD OF APPEALS 698-9541 8I7LWINO 622-9543 CONSERVATION 688.9330 HEALTH 689-9140 PLANNING 692-9533 Oct-20-99 10: 50A Paul D_ Turbide, PE/PLS 508-465-0313 P.02 October 20, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V second review for Lot 23a-24a Equestrian Drive(revised report) Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the above- ` mentioned site. The changes to the plan are related to a revised house footprint and attendant changes to driveway and grading, the addition of a cross-section detail of the driveway crossing, and a sch 40 pvc sleeve encloses the 2" force main as it crosses wetlands. I find that the revised plan still adequately addresses the regulations. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS Equestrian24a3.doc PORT E�GINEEGING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 r MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com October 12,1999 Ms. Sandra Starr Town of North Andover Board of Health 27 Charles Street North Andover, MA 01845 RE: Plan of Subsurface Disposal System #47 - #51 Equestrian Drive -Wilfried Welsch Dear Sandy: Enclosed are three (3) copies of the subject site plan revised September 27, 1999 as follows: 1. Revised house footprint and related changes to driveway and finish grading. 2. Cross-section detail at driveway crossing added. 3. Sewer pump line at wetland crossing to be enclosed in 4" diameter schedule 40 PVC sleeve. 4. Revised note#7 (incorrect DEP File# removed). Please review the enclosed changes and contact me should you have any questions or comments. Very truly yours, MERRIMACK ENGINEERING SERVICES y &vC Les Godin Project Manager cd Enclosure � 4 MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATEq-10 _qe ToeNo. j5M 475-3555 ATTENTIO Fax E5ft 475.1448 TO RE: � A2� D ALT!-I ' 11?- SI - UES IA -ow j,. oF woeni ><4wwvCiz '17-M . 10E--D a a 11-t WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order 'A COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: X-For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS SAIL10 ., �f�4�cIG 1 COPY TO _ SIGNED: if enclosures are not as noted,kindly notify us at once. MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE JOB NO. (508) 475-3555 ATTENTION Fax (508) 475-1448 &AAjQ STARK r0 RE: WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS SRuDy. TH i S Mr- 19 R42- TXRVVYA YC�( "6CLk471ou-r is �{vy �sT t✓E,��. TH�11�tC.� ARD Cir; -A. COPY TO SIGNED: If enclosures are not as noted,kindly notify us at once. Town of North Andover t AORT§l OFFICE OF �?O`, t o 41 L COMMUNITY DEVELOPMENT AND SERVICES ° . A 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 97 CHU5Et< Director (978)688-9531 Fax (978)688-9542 July 30, 1999 Les Godin Merrimack Engineering, Inc. 66 Park Street Andover,.MA 01810 RE: 23A-24A Equestrian Drive Dear Mr. Godin: This is to confirm that at their regularly scheduled meeting on July 22, 1999 the North Andover Board of Health voted to grant a waiver to Section 5.02 of the North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage to permit the installation of a Bioclere System, Model 16/12/350 57 feet from the wetlands instead of the required 100 feet. Please respond to the consultant's request for buoyancy calculations as soon as possible in order to finalize the review/approval process. Please call the Health Office at 978-688-9540 if you have any questions. Sincerely, Sandra Starr,R.S. Health Administrator Cc: Wilfried Welsch File BOARD OF APPS.." 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com BOARa°0i I AN—Q0—VE--/--7 HF-ALTH July 19, 1999 _7 LJUS 2® 19CO �.... Town of North Andover - Board of Health 27 Charles Street North Andover, MA 01845 RE: #47-51 Equestrian Drive T.M. 105-D Parcels 145, 146 Lots 23A, 24A Combined Owner: Beachwood Builders Inc. Applicant: Wilfried Welsch Dear Board Members: Regarding the subject project and in behalf of the owner and applicant, we hereby request a Variance to the Town of North Andover Board of Health Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. Specifically we request a Variance to Regulation 5.02 "Distances" so that a leaching facility may be constructed 57 feet distant from a wetland edge as opposed to 100 feet as required. The proposed construction is to be in accordance with the plan of subsurface disposal system prepared for the subject site by Merrimack Engineering Services dated July 5, 1999 and as revised pending Board of Health review. Please schedule this item for action at the next available meeting of the Board of Health and feel free to contact me should you have any questions or comments. Very truly yours, MERRIMACK ENGINEERING SERVICES G /• C- 7 Les Godin Project Manager cd Jul -19-99 08:31A Paul O. Turbide, PE/PLS 508-465-0313 P.04 July 19, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for Lot 23—&24a-Equestrian.Drive Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. ❑ 310 CMR 247(2)states that a minimum of 2" of 1/8 to 1/2 inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer of filter fabric to be laid on top this stone. There is no regulation that I could find that allows filter fabric to be laid over the peastone, and therefore I would recommend that the filter fabric be removed from the design. ❑ Buoyancy calculations are necessary for the pump chamber, as it appears that the bottom of the chamber will be in groundwater. 310 CMR 22l(8) As per note 9, this design requires a waiver of local regulation NA 5.02 that states that a leaching bed must be 100' from wetlands. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS Equestrian24a.doc PORTIt I ENGINEERING, Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 FORM 11 - SOIL EVALUATOR PORNI Page 1 Date.0:721(10.- q..... No. ...................................... Commonwealth of Massachusetts QoE7rk A/jb0\/aV— , Massachusetts Soil SuitabilityAssessment ................................... Performed By: ....4E;-5...... .1-M....................... Witnessed By: oWI ........... ................................................................................................................................................................................................................................................................... Lowim Aftas Of oww's Num. g eHAJ� EUil-DaOS A"---w SQoS 5APbAWEPZH A -ozo6-7 New construction Repair ❑ Office Review Published Soil Survey Available: No El Yes Year Published ..... Publication Scale (0 Soil Map it ............ ...... Drainage Class Soil Limitations I aEurs.......................... Surficial Geologic Report Available: No ❑ Yes Year Published ........ Publication Scale .........—.. GeologicMaterial (Map Unit) ............................................................................................................................................... Landform ............................................................................( ............qi)............................................................................... Flood Insurance Rate Map: Z50- 000qg . Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No El Yes El Wetland Area: National Wetland Inventory Map (map unit) .............0 �!..TF�......P ........................ Wetlands Conservancy Program Map (map unit)..................... ........................................................................... Current Water Resource Conditions (USGS): Month .36 Range Above Normal El Normal [a Below Normal ❑ (A!��UFIF-ET Other References Reviewed: HAPS .tom FORM 11 - SOIL EVALUATOR FORM Page 2 On-site Review S Deep Hole Number Date:11AP-16 Time:.A.—M., Weather Location (identify on site plan) ...................................................................................................................................................................................... Land Use .-VA.-CA-0 ........................ Slope M .....Z....... Surface Stones ........''!.N..N. ....................................................... Vegetation ...l:J W5,,D.......... .I.( .k1.....FI. ....DR...4.....►'.1df.P4-'.......................................................................................................... Landform .......MOZA.i-W—tt.................................................................................................................................................................................................... Position on landscape (sketch.on the back) ........: ......................................................................................................................... Distances from: Open Water Body feet Drainage way....: . feet Possible Wet Area Sb. feet Property Line ................... feet Drinking Water Well .u.1 ..... feet Other .............-.— j , DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (inches) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency, %Gravel) �S f3W 10\12 3/<, — HA35:1 v5, V. M, 5 Y=� SAk,o SY613 10-12s/4� 1-1A9s,W5, 'FiZ . poeic: =T of S �/2 62AtJt�- fZoOTs Tb 2 I ,, 39'=log" Cz CA V. 5-Y6,13 `7�Syes/g Looe S uD SYIPI Z (O 010 ec�W row "OTT-1,63 �v(3BCI;S 39" 106" �u(it1�GEd� � Parent Material (geologic) ...... -................................................... Depth to Bedrock: .....WIA.......... Depth to Groundwater: Standing Water in the Hole: '- Weeping from Pit Face: ... i��/.1 Estimated Seasonal High Ground Water: ...(. . FORM It - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number Date:.J.1.7.10.- 76 Time:..A.r.m Weather P.T Location (identify on site plan) ................................................................................................................................................................................ Land Use .\IA-CA-47 ....................... Slope Surface Stones .... ........................................................ Vegetation ....Q00-0-FP-S...... 4 .. ............................................................................................................ Landform .......F*1012Af4e.................................................................................................................................................................................................... Positionon landscape (sketch-on the back) .......................................................................................................................................................... Distances from: Open Water Body feet Drainage way....� A7 feet Possible Wet Area ...E- -:t. feet Property Line ............. feet Drinking Water Well .QJA....... feet Other . ..................-........... EP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (inches) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency, %Gravel) -Z— 90 0\�1Z 312- F-111,3191\/61 V,FIZI'.: &J a SjLq H 6.99 1 V. FR.i �Iq mb I 0\(as-/ FIAESivi5, V, F(z (2O'0/0� PO e-KCTS 0 F, EY& Z 6t VA V, 9A LED Roo-Fg To -2&" ------------- 69A\I, gAiab -7,9',f 1Z SNI&t Z- 10 f--i OTTU5,S V, 6 iZAV, 32" Ito„ A xj� 8,4 V(ki Parent Materiel (geologic) ........... ..........TI.. .................................... Depth to Bedrock: ...IA........... Depth to Groundwater: Standing Water in the Hole: .................. Weeping from Pit Face: ... Estimated Seasonal High Ground Water: 6 FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles 2.112 inches ❑ Ground water adjustment.. feet Index Wel1'Number . Reading Date Index well level ................... Adjustment factor Adjusted ground water level ........................................................ Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _ �E If not, what is the depth of naturally occurring pervious material? Certification I certify that on -30-98 (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature — Date � '�� FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS NOZT14 AWlOVEE72 , Massachusetts Percolation Test Date: ... .. Time: ... ... .............. Observiation Hole p I .p_ 2 Depth of Perc Start Pre-soak End Pre-soak 10 _' _Z-7-' 30 0_1 SZ Time at 12" � W Z7' 30 10� SZ Time at 9" -10.1 Time at 6" 10 Time (9"-6") Rate Min./Inch Site Passed Site Failed ❑ ........................................................................ Performed By: tE S 60b1 Q Witnessed By: CWLJ� 0w 8p_0 CJQ Comments: ........................................................................................................... ....................................................................................................... FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been an appli ablehoris drequir oes not menitsVe the aapplicant and/or landowner from compliance with y pp APPLICANT FILLS OUT THIS SECTION**** PHONE VP APPLICANT_ //�� Number 7S`f (� PARCEL LOCATION: Assessor/®--p / LOT (S) ��� SUBDIVISION ST. NUMBER STREET OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: `'' DATE APPROVED CONSERVATION ADMINISTRATOR r DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH GATE APPROVEDDATE REJECTED Tl N TOR-HEAL DATE APPROVED DATE REJECTED 0 COMMENTS I PUBLIC WORKS -SEWERlWATER CONNECTIONS 1 i DRIVEWAY PERMIT j ee11 71` FIR DEPARTIPNT Jr S �� �o��$e Ab h6-1'rc 4 ��o✓l.����S �PPm nd STs ' ✓11vr+ Wn S DATE RECEIVED BY BUILDING ii,ISPE(fTOR Revised 919'jm i JDB#�7�SI �Qv�'�'T�G�Arl.i DMZ IJ Q MERRIMACK ENGINEERING SERVICES Professional Engineers • Land Surveyors • Planners SHEET NO. OF 66 Park Street CALCULATED BY- Z-^ s DATE I L�-10-!,el ANDOVER, MASSACHUSETTS 01810 475.3555 CHECKED BY DATE SCALE i .........1.................................,........... ..........�...........F...........j. .�. , .... .... .... .......... : ..... .... .... .....� .... ..... ,....... Ii ................ .......... ...........i..........`.......... ....: .. Y/ ..... ... 4! 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X . ....G �` ... .. : ...........,. ..... .... _... . ..., . ... . . ._........._................ . ...... .. ....... ... .... ....... ............ .... : 1 .................................... 1� ...............................................................:................................. ................ .... .. ....... ....... I S ............_.._.................. ......... ............... ......... .................. i ' _ ...................................... ................................................ .........................:.................... ......... .. ..: ........... . : .. .. ! i : ! I I4 BOARD OF HEALTH _ _TEL. 688-9540 _ NORTH ANDOVER, MASS. 01845 �'� .,�'�T_ , _-ALT vrR. e------- 1 i t APPLICATION FOR SOIL TESTS ) OCT 2 3 1998 DATE: 10-ZZ- RP LOCATION OF SOIL TESTS: LOTS 73A C� Zi4ft Assessor's map & parcel number. 105b FAQs 1 q,5', jy& OWNER: IcRC4woaD $vur� TEL. NO.: 7 91 "?g`-1 --70( O ADDRESS: �� HA SS A--PaA 6 A\,tE _ g f4Pr-jz &j , BA . 02o&-j ENGINEER: M. "Act TEL. 'r CERTIFIED SOIL EVALUATOR: COS CoQ, %_c Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Co ion C missiUZI., val: y�� i S151_< 5 - Peri U THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: ✓1. Proof of and ownershi (Tax bill, deed, or letter from owner permitting tests) r.S er+cc"� -'-'2. Plot plan /3. Fee of 1275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. r (�� ���. ,r _ �� .di � _ �- �����li�/J� � : � �,� �; ., ,� - i � �+� '� r,, � i � r I f ` � ! 1 i� i i w IMM. roip,F, ��llll • O'�:iiiiii[Il���R FIT .i.� III1111IIIIA ' - ' . IIi�AAAi �lAl k; � � IIIA1111111 , MINI/1111 , FPO�IN �1 T � r ' • 11 11 Z a 0 OD JL t -- f-�- - 12 07 j j i j a GK Ln CD y , I 1+ Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH p APPLICATION FOR SITE TESTING/INSPECTION is CHIJs���y Applicant ' 'Zrvklk-,— NAME j ADDRESS TELEPHONE Site Location (Z--r r l A a ,�°�a—� T)/` Engineer �8 NAME ADDRESS TELEPHONE s Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. n S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ,,ll ��ST LED 16 40 19 V nD 0b APPLICATION FOR SITE TESTING/INSPECTION 7.�ADRATED SSACHUS Applicant n.j{t21 ; NAME it ADDRESS TELEPHONE Site Location Engineer �'trY� alt. NAME. ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee 1.5 b Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH • BOARD OF HEALTH 320"'S. l64'rO0 19 0 APPLICATION FOR SITE TESTING/INSPECTION 7.9 gDRATED PPa�•�5 SSACHUS� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME `ADDRESS TELEPHONE Test/I nspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 'f NUMBER E Q�a J THE COMMONWEALTH OF MASSACHUSETTS FEE - -- Ql l�..!._. of .- -C312T�J�.. /1��jDV� This is to Certify that /lam i(/� S" • -------•------•-----------•---------------------•-•--•------------------------•-- NAME -----------•---•--•-••--•----•-------•-----------..............................:............. ADDRESS IS HEREBY GRANTED A LICENSE r. For f' / .._...8. .. � ...0 .. rn ---- -----------------------------•--- ----------------------- This license is granted in conformity with the Statutes and ordinances relating thereto, and expires...za'11 6O�..........................nless sooner suspended or revoked. --------------------------•---•-------------------------------.....------•----•------•--•_-- -- / �.. 00 •-------------------•---------..........-----------------------•--- ------.......---------- --•----•---•---•-------•-------------------------------------------------•---•-•------..... ----------....-•-----------------•--......-------•--••---------••--• FORM 488 H&W HOBBSa WARREN TM ...--.....•.......-----............................. �J O'_ "ORi i� / JG�• F- Of HORTh - APR 2 3 '?nm Y Y ¢ ��' .,.,••''th BOARD OF HEALTH .., ... ,. . f sS�cHuse NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # �� �� Date A permit is requested to: drill a well install a pump_ LOCATION• L GfIJ .0 u �`'• �L Lot # Owner 01114'(W l�✓C(J�� Address aw d4le, d/ Tel Well Contrctr JO4J Add. Pump Contrctr �4Z�f,f f s h.• S Add. 76 �v� All RWTe1 J_.•S.�v�.r.xx :xsc is is xsxyc* is irx*.it. 4-k WELLS (To be completed at time of pump test. ) Type of well , Use Diameter of well- - __ maize of casing_ Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock ? Depth to water Delivers GPM for (now 1culy: I Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor PUMPS (To be filled/i'n before installation. ) J� Name & size of pump (�1 D k(K S s����� (l SS Type_�� i T Size of tank Pump delivers ? GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yves (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health W O #_ t 5(iq / Massachusetts Department of Environmental Management Office of Water.Resources 114594 TYPE OR PRINT ONLY._ fi' Well Completion Report 1.WELL LOCATION GPS(OPTIONAL) LATITUDE LONGIT DE r Address at Well Location:U&I W<:�QAP-1 A@roperty Owner: W1 Itrif We4 5 Subdivision Name: I Mailing Address: CitylTown: P '", Cityrfown: Assessors Map Assessors Lot# NOTE: Assessors Map and Lot# mandatory if no street address available Board of Health permit obtained: Yes 4 Not Required E:1Permit Numbe Date Issued 2.WORK PERFORMED 3.PR OSED USE 4. DRILLINO METHOD ew Well ❑ Abandon Domestic . ❑ Irrigation ❑.C, n ❑ Auger ❑ Deepen El Recondition d Monitoring El Municipal Air Hammer ❑ Direct Push ❑ Re lace ❑ Other ❑ Industrial ❑ Other ❑ Mud Rotary ❑ Other S. WELL LOG OC Unconsolidated Consolidated 6. SITE SKETCH (use Permanent landmarks with distances) W Permeability co C > -0 -0 1*11N as From (ft) To (ft) High Low `� m Other Rock Type ztmp Mink t. . 120 3 0Cr 3' 50 rr i 7. WELL CONSTRUCTION 8. CASING Total Depth Drilled From (ft) To (ft) Casing Typ and Material Size O.D. (in) Well Seal Type — Date �nllin CM S 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11.ADDITIONAL W LL INFORMATION From (ft) To (ft) Material Description Purpose Developed? Yes E:1 NoFracture Enhancement? ❑ Yes )<No Method Disinfected? >6yes ❑ No 12. WELL TEST DATA(PRODUCTION WELLS) 13,STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) -a 2— ao 14. PERMANENT PUMP (IF AVAILABLE) 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description Horsepower Pump Intake Depth (ft) Nominal Pump Capacity (gpm) 16. COMMENTS 17.WELL DRILLER'S STATEMENT IThis well was drilled and/or abandoned under my supervision, according to applicable rules yY��,,. ,, (( {� and regulations, and this rep o lete and correct to the best of my knowledge. (� Driller:�J� Iv '` and Driller Signature m Registration #: Firm: i 1U ate: cJllG t/ Ri Permit#: L 110191 NOTE: W Z Completion Reports must be filed by the registered well driller within 30 days of well completion. "�; BOARD OF HEALTH.COPY. SKILL TUON OF NORTH ANM :R1 Li WELLS,PUMPS "FILTERS BOARD OF HEALTH 2 April 10, 2002 Wilsred Welech 1507 Salem Street North Andover, MA 01845 Dear Wilsred: The following is an estimate for a drilled well and pump system to be installed at 49 Equestrian Drive in North Andover, VIA. WELL Drilling: 12"pilot hole................................................................................................. $ 14.00/ft 6"well ........................................................................................................... $ 8.00/ft 8"pipe(casing).............................................................................................. $ 19.00/ft One8" drive shoe (seal)................................................................................ $ 125.00 Permit(per town requirement) ...................................................................... $ 60.00 PUMP SYSTEM This is an estimate only. Your system can only be accurately priced one the well is completed. Sizes of pump,pipe and wire may vary. 1 %2 HP Goulds submersible stainless steel pump system............................. $8,2150 Pump installed to 300'on 1 %i" steel pipe 600' 4" Schedule 40 PVC shroud Up to 100' 2"waterline Up to 100' 1 %Z"return line Up to 100' electric line Up to 100' 2" styro-insulation V350 119 gallon water storage tank ADDITIONAL COST ■ Grouting (if needed) .......................... ...... $ 300.00 .......................................... ■ Plumbing: $75.00 per hour plus materials ■ Pump Test and Lab Analysis (see note, per town requirement)........ $ 250.00 ■ Hydrofracking(if needed) ................................................................. $1,600.00 (Hydrofrackin Z is a process that uses water under high pressure and volume in attempt to increase the gallons per minute of the well.) • Over 100' offset piping (line from well to house)............................. $ 2.75/ft ■ Backhoe charges: $185.00 move charge, $85.00 per hour labor ■ Electrical to be wired by an electrician from well to house. ■ Massachusetts State Sales tax, if applicable, to be added at time of billing. 269 Proctor Hill Road • Hollis,NH 03049 • (603)465-3500 phone • (603)465351.2 fax ESTIMATE The following is an estimate only and is not the cost of your well. The actual cost cannot be calculated until the well is drilled. 12" Pilot hole drilled to 40' ($560), 6" well drilled to 500' ($4,000),40' of 8" casing ($760), drive shoe ($125), permit ($60), 1 % hp pump system ($8,210.00), pump test & lab analysis ($250) and state sales tax ($118.44)................................... $14,083.44 NOTE: ■ Customer must hire electrician to wire pump system. ■ Owner acknowledges that Contractor does NOT guarantee the quality or quantity or water, if any, obtained by drilling. ■ Skillings and Sons, Inc. will try to minimize damage to the driveway and lawn, but due to the size equipment needed to drill a well, some damage may occur. Skillings and Sons, Inc. is not liable for repairs. ■ In the event there are drillings left over after the job is complete, Skillings and Sons, Inc. will put the drillings in a pile. Or, for a fee of$100.00, Skillings and Sons, Inc. can remove the drillings and dirt from the site. PAYMENT TERMS: ■ Two contracts are enclosed. Please sign and return one copy of the contract to Skillings and Sons, Inc. with a deposit of$1,500.00 prior to scheduling the well. Please retain the other copy for you records. ■ The balance, in full, is required within 30 days from the date of invoice (If the tank and offset are not hooked up within the 30 days, you may holdback $400.00, until the job is complete). ■ Interest is 1.5%monthly on all past due balances. ■ The cost for lab analysis is based on town requirements. There may be additional testing required by the town after initial testing is complete. You will be responsible for the payment of any follow-up testing that is required by the town. ■ Lab results will NOT be released until account is paid in full (If you are holding back for the tank and offset, the results will only be released if you paid up to that point) *We accept M terCar ,Visa, Discover, American Express and cash or check. If you hav y ue ions, please do not hesitate to contact us. �1eeh 4)ir�eW Jefumn We les Telephone: (978) 618-9959 (cellular) (978) 697-1294 (cellular) (978) 258-0625 (fax) INVERT ELEVATIONS 4" PIPE © FDTN. _ SEPTIC TANK IN = SEPTIC TANK OUT = 'A or PUMP TANK IN o�� r PUMP TANK OUT :-----2 37FORCEMAIN s DIST. -BOX IN = 100.47 y DIST. BOX OUT = 100.30 397'2 END LEACH LINE #1 = 99.97 rn�° END LEACH LINE 2 = 99.98 L LAWD Cq T F TA / I N/F SLA TTER Y O x11 522.66' X7 T.B.M. PK #3 TOP F x12 co IN PAVEMENT NAIL I's, (U.S.G.S.) EL=96.03 x13 Q? x6 EROSION CON7ROL/ VEN �° �, x5 L 0 T 24- A X 14 �, h AREA=237,702 S.F. s , 4 =5.46 AC. / xis / 4 Ali 1,-9a �a / x16 a 0� X17 A�2 2` e0x co 9" CC12 s @1 T oI rC CC14 CC13 •��� CC7 DRI X;r CC15 M6 AY CC4 19 Cs C4 EXI 3 Cci6 24'RCP / EDGE OF WETLAND / C6 C3 AS FLAGGED BY / WETLAND PRESERVATION INC. x20 Cct C2 �0 6 85 w C7 � F � 2 1 CC18DUSTING C8 24' RCP INV.-91.97 I / C9 022 CC19 X21 C10 T D21 J D20 D16 D15 3 � 01 X22 D17 CC2 C1 } 4 D18 24 X23 Cl 3 + r CC23 Dii v<< C/RCL )V/F Ccz4 c16 e CONSTRUCT/ON 2g c x D,o CORP• � AS— BUILT C18 OF " SUBSURFACE DISPOSAL YS EM LOCATED IN D7 NORTH ANDOVER, MA. 08 CD AS PREPARED FOR o WILFRIED WELSCH D `4 D4 DS 1507 SALEM STREET Ln NORTH ANDOVER, MA. 01845 co SCALE: 1 "=50' DATE: SEPTEMBER 11 , 2000 i MERRIMACK ENGINEERING SERVICES PROFESSIONAL ENGINEERS • LAND SURVEYORS PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (978) 475-3555• FAX (978) 475-1448 I d Commonwealth of Massachusetts Ni 4: Tithe 5 Official Inspection Form NIAe Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .1pWpE RjMti�� N 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is North Andover MA 01845 1/12/2017 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms n INE D on the computer, use only the tab 1. Inspector: key to move your cursor-do not Neil Bateson use the return Name of Inspector key. Bateson Enterprises Inc. � Company Name 111 Argilla Road Company Address rmun Andover MA 01810 Cityrrown State Zip Code 978-475-4786 SI-15 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. 1 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 urther Evaluation by the Local Approving Authority i ' 1/12/2017 Ins6ectors(SignaturV Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 �G J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owners Name information is required for every North Andover MA 01845 1/12/2017 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 6 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 49 Equestrian Drive Property Address Wilfred Welsch Owner Owners Name information is North Andover MA 01845 1/12/2017 required for every 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 page. Cityrrown 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 %day flow t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 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 El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 • i Commonwealth of Massachusetts AMTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins.doc•rev.6/16 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments j 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 page. Cityrrown State Zip Code Date of Inspection j D. System Information Description: Number of current residents: 4 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 Seasonaluse? El Yes 0 No Water meter readings, if available(last 2 years usage (gpd)): Yes Detail: Sump P um ❑ Yes No ?P Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: i Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): I 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 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped three years ago, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees 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): Septic tank to Bioclere unit to pump tank to d-box to s.a.s. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is North Andover MA 01845 1/12/2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 17 years old, 9/11/2000, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ® cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast iron through wall PVC to septic tank, 4" PVC in house, no leaks visible. Septic Tank(locate on site plan): Depth below grade: 3.feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 4" 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 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 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 27" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 91, How were dimensions determined? Tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Pumped septic tank. Inlet tee&outlet tee have risers 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is North Andover MA 01845 1/12/2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 page. Cityfrown 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.): D-box level &distribution equal. No evidence of leakage. No evidence of carryover. Small tree growing next to d-box. Roots in box. Removed tree&roots. 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.): Pumps ok. Floats ok. Pump tank ok. Pump tank has a riser 4"deep. Alarm has both audible&visual. * 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 47' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok.Vegetation ok. No sign of ponding to surface. 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 r< 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is North Andover MA 01845 1/12/2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is North Andover MA 01845 1/12/2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Vf-4 a 112" © � A o�1e� t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts _. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is required for every North Andover MA 01845 1/12/2017 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: >4 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: No complete design plan on record ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: This is a pump system that pumps up to a mound that is over 6'tall. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Equestrian Drive Property Address Wilfred Welsch Owner Owner's Name information is North Andover MA 01845 1/12/2017 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts City/Town of . System Pumping.Record Form 4 DEP has provided this form for use-by local Boards of Health. Other form's 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 forrh they use.The System Pumping Record must be submitted.to the local Board of Health or other approving authority. A. Facility. information 1. System Location: Left/Right front of douse, Left/Right rear of house, Left/right side of house, Left/ �► Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address city/Town state Zip Code 2. System Owner. Name" Address(if different from location) cityrrown State Zip Code Telephone Number w; .B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type-of system: ❑ Cesspool(s) Q-666tic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ly'Ro If yes, was it cleaned? ❑ Yes ❑ Na ' 5. Condition of.System: Qvc AAcJ A-+Ett� 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents-were disposed: S: Lowell Waste Water AC&A f Sign c cf Hbul Date f t5formcdoc•06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 1/12/2017 1:51:03 PM by Karen Hanlon ° • Town of North Andover Tax Map # 210-105.01-0146-0000.0 Parcel Id 17105 49 EQUESTRIAN DRIVE WELSCH, WILFRIED 49 EQUESTRIAN DRIVE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 8.61 Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until WELSCH,WILFRIED Owner 49 EQUESTRIAN DRIVE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 18588.0-49 EQUESTRIAN DRIVE Last Billing Date 10/1312016 3170655 03 Cycle 03 Active UB Services Maint. Account No.3170655 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/1 WTR WATER 01 ALL METER SIZE 80.78 1/1 UB Meter Maintenance Account No.3170655 Serial No Status Location Brand Type Size YTD Cons 32154217 a Active ERT HH b Badger w Water 1 1 1037 Date Reading Code Consumption Posted Date Variance 12/9/2016 1285 a Actual 20 3% 9/9/2016 1265 a Actual 21 10/24/2016 4% 6/8/2016 1244 a Actual 20 8/2/2016 3% 3/8/2016 1224 a Actual 19 4/22/2016 12/9/2015 1205 aActual 19 1/20/2016 -2% 20 10/16/2015 3% 1186 a Actual 9/10!2015 6/9/2015 1166 a Actual 19 7/24/2015 -18% 3/10/2015 1147 a Actual 23 4/28/2015 14% 12/10/2014 1124 aActual 20 1/15/2015 -33% 9/12/2014 1104 a Actual 31 10/15/2014 -5% 6/11/2014 1073 a Actual 32 7/16/2014 41% 3/12/2014 1041 a Actual 23 4/11/2014 -32% 12/10/2013 1018 aActual 33 1/17/2014 -31% 9/11/2013 985 aActual 49 10/15/2013 152% 6/11/2013 936 aActual 18 7/24/2013 -19% 3/13/2013 917 a Actual 24 4/22/2013 -12% 12/11/2012 893 aActual 26 1/9/2013 8% 9/14/2012 867 a Actual 26 10/15/2012 -20% 6/11/2012 841 aActual 31 7/16/2012 -11% 3/12/2012 810 a Actual 34 4/14/2012 -20% 12/14/2011 776 aActual 44 1/17/2012 -1% 9/13/2011 732 a Actual 47 10/13/2011 39% 6/8/2011 685 a Actual 32 7/20/2011 41% 3/8/2011 653 a Actual 22 4/13/2011 27% 12/9/2010 631 aActual 17 1/12/2011 -23% 9/13/2010 614 a Actual z 25 10/15/2010 14% 6/7/2010 589 a Actual 20 7/15/2010 -72% 3/10/2010 569 a Actual 73 4/14/2010 164% 12/10/2009 496 a Actual 28 1/12/2010 -31% i 7765 Town of North Andover HEALTH DEPARTMENT ,SSACN�St� CHECK#: / z.. DATE: LOCATION: —9C:�q' X570/-/cvn H/O NAME: S CONTRACTOR NAME: tesdn Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ 0 Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ Title 5 Inspector (6—PrI - Title 5 Report $ ❑ Other:(Indicate) $ He gent Initials White-Applicant Yellow-Health Pink-Treasurer