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Miscellaneous - 502 WINTER STREET 4/30/2018
i 1-4 v , o� D z o m o M q O m o m o -i O I I Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _Q T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary AssesE 502 Winter Street Property Address Kyle Vogt Owner's Name North Andover Cityrrown MA 01845 State Zip Code RECEIVED JUL 22 2013 TOWN OF NORTH AN HEALTH DEPARTN 013 Date of i Date of Inspection C. 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. A. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover City/Town 978475-4786 Telephone Number B. Certification MA State S115 License Number 01810 Zip Code 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: E Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/17/2013 Insl5ectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving. authority. , -- ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 . , Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Owner Owner's Name information is North Andover MA 01845 7/17/2013 required for every page. Cityrrown State Zip Code, Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N [] ND (Explain below): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 L Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Kyle Vogt Owner's Name North Andover MA 01845 7/17/2013 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 ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Owner's Name North Andover MA 01845 7/17/2013 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 Y2 day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "t 502 Winter Street Property Address Owner Owner's Name information is required for North Andover MA 01845 7/17/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 ficial 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 502 Winter Street Property Address Owner Owner's Name information is required for North Andover MA 01845 every page. Cityrrown State Zip Code C. Checklist 7/17/2013 Date of Inspection 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): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): AAA t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Owner Owner's Name information is required for North Andover MA 01845 7/17/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 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? ❑ Yes ® No Water meter readings, if available last 2 ears usage 9 ( Y 9 (gpd))� Yes 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 • 3113 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 502 Winter Street Property Address Owner Owner's Name information is required for North Andover MA 01845 every page. Cityrrown State Zip Code D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date 7/17/2013 Date of Inspection Pumped last year, owner 1500 gallons Measured tank Inspect tank & outlet tee Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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 • 3113 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 502 Winter Street ,p Property Address Kyle Vogt Owner Owner's Name information is required for North Andover MA 01845 7/17/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 4 years old, 1/28/2009, as built plan Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: ■ - ro IIIM 2 feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall. 3" PVC in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal ❑ fiberglass If tank is metal, list age: 1 feet ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x5'x4' Sludge depth: a t5ins • 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 9 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Kyle Vogt Owner's Name North Andover MA 01845 7/17/2013 Cityrrown D. System Information (cont.) Septic Tank (cont.) State Zip Code 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? Date of Inspection 23" 1„ 8" 17" 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.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage.lnlet & outlet covers has riser 3" deep. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): 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 • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts u°' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Owner Owner's Name information is required for North Andover MA every page. Cityrrown State 01845 7/17/2013 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Kyle Vogt Owner's Name North Andover MA 01845 7/17/2013 CityrFown D. System Information (cont.) State Zip Code Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert u Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & distribution equal. No evidence of leakage. Evidence of carryover, pumped d -box to clean. D -box has riser 3" deep. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspec Subsurface Sewage Disposal System Form - wa 502 Winter Street Property Address Kyle Vogt Owner Owner's Name nformtiis North Andover required for every page. City/Town D. System Information (cont.) Type: 1:1 leaching pits El leaching chambers E] leaching galleries ❑ leaching trenches ❑ leaching fields El overflow cesspool ® innovative/alternative system Type/name of technology: Eljen In -Drain Geotextile Sand Filter Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 42 units. 3 rows 14 units per row. 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 17 tion Form Not for Voluntary Assessments MA 01845 7/17/2013 State Zip Code Date of Inspection number: number: number: number, length: number, dimensions: number: Type/name of technology: Eljen In -Drain Geotextile Sand Filter Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 42 units. 3 rows 14 units per row. 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 13 of 17 Commonwealth of Massachusetts v: Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Owner Owner's Name information is required for North Andover MA 01845 every page. City/Town State Zip Code 7/17/2013 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 • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 _ian oil Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Kyle Vogt Owner's Name North Andover Cityfrown D. System Information (cont.) MA 01845 State Zip Code 7/17/2013 Date of Inspection 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 t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 15 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 502 Winter Street Property Address Owner's Name North Andover City town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells RAA ^AnAC 7/17/2013 Date of Inspection 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: 5/22/2008 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 ficial 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 502 Winter Street Property Address Kyle Vogt Owner Owner's Name information is required for North Andover MA 01845 7/17/2013 every page. Citylrown 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summery Record Card generated on 7/16/2013 1:44:15 PM by Karen Hanlon Town of North Andover Tax Map # 210-104.A-0078-0000.0 Parcel Id 16305 502 WINTER STREET DAVE KINDRED 502 WINTER STREET NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.02 Acres FY 2014 UB Mailina index Name/Address DAVE KINDRED 502 WINTER STREET NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 24062.0 - 502 WINTER STREET 3180854 03 Cycle 03 UB Services Maint. Account No. 3180854 Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Account No. 3180854 Type Loan Number Active/Inact. From Owner Occupant Name Active/Inactive Last Billing Date 7/12/2013 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/1 01 ALL METER SIZE 264.70 1/1 Serial No Status Location Brand Type 34429296 a Active ERT HH b Badger w Water Date Reading Code Consumption Posted Date 6/14/2013 378 a Actual 54 7/24/2013 3/20/2013 324 a Actual 23 4/22/2013 12/1.3/2012 301 a Actual 29 1/9/2013 9/19/2012, 272 a Actual 18 10/15/2012 6/18/2012 254 a Actual 20 7/16/2012 3/20/2012 234 a Actual 18 4/14/2012 12/19/2011 216 a Actual 19 1/17/2012 9/16/2011 197 a Actual 39 10/13/2011 6/13/2011 158 a Actual 16 7/20/2011 3/15/2011 142 a Actual 18 4/13/2011 12/15/2010 124 a Actual 13 1/12/2011 9/16/2010 111 a Actual 21 10/15/2010 6/14/2010 90 a Actual 21 7/15/2010 3/17/2010 69 a Actual 20 4/14/2010 12/14/2009 49 a Actual 12 1/12/2010 9/16/2009 37 a Actual 16 10/15/2009 6/10/2009 21 a Actual 18 7/20/2009 3/17/2009 3 a Actual 3 4/29/2009 1/21/2009 0 n New Meter 4/29/2009 Size 0.63 0.63 Until YTD Cons 375 Variance 165% -31% 76% -13% 14% -3% -51% 131% -11% 38% -35% -5% 10% 59% -17% -23% 288% Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location:Xf / Right o t of house Left/ Right rear of house, Left/ right side of house, Left/ Right side of buildl-n'g, Left / Right on of building, Left / Right rear of building, Under deck Address city/rown 2. System Owner. Name Address (if different from location) city/rown B. Pumping Record 1. Date of Pumping 3. Type of system - Other (describe): ystem:Other(describe): State Zip Code Stat i Code - Telephone Number - r7 ` V Date Quantity Pumped Cesspool(s) eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑_o If yes, was it cleaned? ❑ Yes ❑ No. 5. Conditi n of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: Lowell Waste Water uleq ,. Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 ti ttOR TH ,,t%.ED i6t9tiO O i A � O cocwiiwewKx SAC HUS���� PUBLIC HEALTH DEPARTMENT Community Development Division CE1271�FICA7E OAF' CO_14�LIA9VC�E As of: August 6, 2009 ,This is to cert that the individuaCsu6surface dzsposa(system received a SATISTACTORTINS(ECTTOYof the: GompCete ftair1*p&cement of the Septic DisposaCSystem By: David xyndred At: 502 'MnterStreet 911ap —104.,X; Farrel —T8 North Andover, MA 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system wia 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 'TOWN OF NORTH ANDOVER cf N°11Th �y i` ED Office of COMMUNITY DEVELOPMENT AND SERVICES #.- •' °_ °gip HEALTH DEPARTMENT . %�(�P 4MOSGOOD STREET • •, s:...' FEB 1 S 2009. NORTH .kNDOVER. N/IASSACHUSETTS 01845�cHus`� UFt7ti AND 978.688.9540 — Phone �'- EP, NEWTVa ryer, REHS/RS 978.688.8476 — FAX Pub is ea Director E-MAIL: healthdept%2townofnorthandover.com WEBSITE: http:;','www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (constructed; ( ) repaired; by (Print Name) located at sD� (Installation Address) was installed in conformance with the North Andover Board of Health approved plan, originally dateand last Revised on , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the Final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: o Engineer Repres tative (Signature) 6h''Y l ,00 ku z' And - rint ame ngen neer Repre tative (Signature) 7i And - Print Name Installer: (Signature) Date: ,z/j�'/py 'And _ PrintNnme k i January 14, 2009 North Andover Board of Health Susan Sawyer, Public Health Director 1600 Osgood Street, Bldg 20, Suite 2-36 North Andover, MA 01845 RE: 502 Winter Street (Permit #BHP -2008-0216) Dear Ms. Sawyer: JAIL 15 2009 Due to weather conditions we are unable to loam over the septic system. We will do so as soon as weather permits in the spring. Sincerely, David A. Kindred FEB 18 2009 TOOK �A NORTH ANDOVER HEALTH DEPARTMENT Susan Y. Sawyer Health Director North Andover Health Department 1600 Osgood Street Building 20; Suite 2-36 North Andover, MA 01845 February 16, 2008 Dear Ms. Sawyer: As owners of the property at 502 Winter St., we are requesting a certificate of compliance. The septic system has been backfilled and final graded. However, due to weather conditions, the loaming and seeding have not been completed, and have not been inspected by the Board of Health. We take full responsibility for the completion of same in the spring of 2009. Thank you, 0 AVq Tracy and Kyle Vogt 270 Canal St. #416 Lawrence, MA 01840 " TOWN OF NORTH ANDOVER f �10RTFj Office of COMMUNITY DEVELOPMENT AND SERVICES o:o``��. HEALTH DEPARTMENT 41 1600 OSGOOD STREET; Building 2-36 #i ,* NORTH ANDOVER, MASSACHUSETTS 01845 �9SSACHUS Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: ®a��– ,-MAP: LOT: INSTALLER: - qf%– �� DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF IN GRAD INSPECTIO : SITE CONDITIONS J ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK Bottom of tank hole has 6" stone base ❑Veep hole plugged ©•-1500 gallon tank has been installed 2 H-10 loading Monolithic construction yth 7 �v� ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation — Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER NORTF Office of COMMUNITY DEVELOPMENT AND SERVICES 00 HEALTH DEPARTMENT po 1600 OSGOOD STREET; Building 2-36 4. NORTH ANDOVER, MASSACHUSETTS 01845 "Ss;;CHU Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: Comments: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Wastewater System Documentation — Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER NORTH f Office of COMMUNITY DEVELOPMENT AND SERVICES �``�a� HEALTH DEPARTMENT or 4 1600 OSGOOD STREET; Building 2-36 + ",.. NORTH ANDOVER, MASSACHUSETTS 01845"SS4CN�S S� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX F11*60 ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Is •, SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to o f layer, as provided on plan U----8`ze of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel -less disposal systems: type, number and Comments: location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Wastewater System Documentation — Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER °E NORTh Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01 845 '"SS„C,,,,5 `9 Susan Y. Sawyer, REHS/RS 978.688.9540 —Phone Public Health Director 978.688.8476 — FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: �� MAP: LOT: INSTALLER°�A -- Oc_c._ , IN S ALLER:,> 8 ��� 7% X6,57 7� PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: "�DATE "DATEOF BED BOTTOM_IN_SPECTION_:ECTION: IN I' DATE OF FINAL CONSTRUCTION S DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned [-]Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation— Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER NOR7p *D Office of COMMUNITY DEVELOPMENT AND SERVICES0-1 HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 `►"a. !, NORTH ANDOVER, MASSACHUSETTS 01845 9SSACNOSEt Susan Y. Sawyer, .REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: Comments: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Wastewater System Documentation — Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER NpRTM pt Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ❑ Hydraulic cement around inlet & outlets ❑ 1600 OSGOOD STREET; Building 2-36 ❑ NORTH ANDOVER, MASSACHUSETTS 01845 ��ss„CHU t� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM W Bottom of SAS excavated down to s oil layer, as Comments: provided on plan Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel -less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Wastewater System Documentation — Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 ",. •!'�+" NORTH ANDOVER, MASSACHUSETTS 01845 9SS/1CHU`��t Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps Comments: CONTROLPANEL Comments: size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Wastewater System Documentation — Feb 2006 Page 4 of 6 ' TOWN OF NORTH ANDOVER NORTH Of ? s..:a ' e Office of COMMUNITY DEVELOPMENT AND SERVICES 3 ```�`� �'°O. HEALTH DEPARTMENT F y 9 1600 OSGOOD STREET; Building 2-36 10 NORTH ANDOVER, MASSACHUSETTS 01845 ��S.9 CHUS�� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' 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 Wastewater System Documentation — Feb 2006 Page 5 of 6 Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 10' ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other) Foundation 10 (5) 20 (10) ❑ Drywells 20 25 ' Suction line 222(2) 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 Wastewater System Documentation — Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVERf NORTH ' Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT HEALTH o?°`;t�ao7 10 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX SYSTEM ELEVATIONS Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW INVERT ON DESIGN PLAN FIELD INVERT ELEV. Wastewater System Documentation — Feb 2006 Page 6 of 6 FINAL GRADE NSP oCTION Date: e Address: �Y OAMED? SEEDED? ❑ COVER PER PLAN? Other: Appendix A - System Installation Form In accordance with the technology approval, for each new installation, installers of E1jen systems must complete and fax or mail a copy of this form to the local approving authority and to: E1j en Corporation 125 McKee Street East Hartford, CT 06108 Installer's Name: Company Name: Street Address: �0. COL /✓�/ City: State: Zip: Property Owner: Site St et Address: I / City: State: Zip: System Type: (Residential, Commercial, School, etc.) Design Flow: Installation D e: System Startu Date: � Permit Number: Comments: COPIES: White System Owner Yellow Local Approving Authority Pink Inspector Gold Massachusetts Department of Environmental Protection 0730A -4/07 -IM -CP Gv��pC�G�DOW]1 & Associates, L.P. z. Engineering and Planning Consultants February 12, 2009 North Andover Board of Health 1600 Osgood Street Suite 2-36 North Andover, MA 01845 RE: 502 Winter Street, Sanitary Septic Disposal System Dear Members: RECEI FEB 2 3 2009 TOWN OF NOR T M ANDOVER HEALTH DEPARTMENT As required in Section 2.10 of the Town of North Andover's Minimum Requirements for Subsurface Sewage Disposal, I am hereby certifying that the septic system at 502 Winter Street has been constructed in compliance with town's requirements, the State Environmental Code 310 CMR 15.000, and the approved design. The materials used to construct the system conform with the plans specifications and the final grading has been completed in substantial conformance with the proposed design. The submitted as -built depicts the actual elevations and location of the system's components as well as the pertinent features of the site existing to date. Please do not hesitate to call should you have any questions. Sincerely, Mardian a& Associates, L.P. John A. Barrows, P1 Project Manager Cc: David Kindred 62 Montvale Avenue Tel: (781) 438-6121 Stoneham, MA 02180 Fax: (781) 438-9654 website: http://www.marchionda.com Email: mail@ march ionda.com AS -BUILT CHECKLISTRECEIVED FEB 2 2009 F TOWN OFNORTH ANDD' i% LOT NUMBER, STREET NAME HEALTH pEpARTMEN _ ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS ✓� LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS L /a. FROM SEPTIC TANK b. FROM LEACH AREA _ LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION _ LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM V LOCATION OF WATER, GAS ELECTRIC LINES, DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS ,. - DRIVEWAYS, ETC. t/ NORTH A.RRO W , LOCATION & ELEVATIONS OF BENCHMARK USED haRr Commonwealth of Massachusetts Map -Block -Lot 104.A- 0078 - Board of Health --------------------- p, Permit No North Andover BHP -2008-0216 P.I. FEE 3 CMU t F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted David -Kindred to (Construct) an Individual Sewage Disposal System. at No -502-WINTER-STREET as shown on the application for Disposal Works Construction Permit No. BHP -200.8_021.6, xDatedOctober 29, 2008 --=------------------------------ - ----------------------------------------------------------------- Issued On: Oct -29-2008 Board of Health e .o/ Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. s--� rencn Applioation for Septic Disposal Svstem Construction Permit -TOWN OF TODAY'S DATE �4ORTH ANDOVER, MA 01845 $125.00 - Component ApplicatioR is hereby made fora permit to: Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information Address o�LorLot #_11A City/Town 2.- *TYPE OF -SEPTIC SYSTEM*: ❑ Pump 2Gravity (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) ❑ Pr ssure Dose (D -Box Present) S.A.S. 2. Owner Information oe 12�r Narbf bZ Address (if different from above) City/Town State Zip Code Telephone Number 3. nstaller Informatio Name Name of Company door Add s � Ci y own State Zip Code Telephone Number (Cell Phone # if possible please) 4. Designer Information Z%fir% Name Name of Company '!� A Addres City/Town State Zip Code Telephone phone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 I pORTI{ A�plioation for Septic Disposal System TODAY'S DATE - -�� pConstruction Permit — TOV�UN OF TH ANDOVER, MA 01845 $ 250.00 - Full Repair $125.00 - Component 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 is$$ed by this Board of H)Olth. Nafner - `= ` ,/ �� Date/ - - / Applicatio pproved B: oard of Health Representative) Jb z -1/Z8 m`e Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. 2. Project Manager Obligation Form Attached. 3. Pump System? Ifso, Attach cop�ofElectrical Permit 4. Foundation As -Built. (new construction ronly): (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes111 � No Yes No Yes 1 / No 7 Yes No Yes No Application for Disposal System Construction Permit • Page 2 of 2 _• SEMC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) Relative to the application off (Installer's name) Dated Q r eY o ay s ate For plans by /v/�/.tr'�, /�sr� oe: o fSSOG. (Engineer) And dated Ale g (Ufigtnal date7 With revisions dated 4/W (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 company. a. Bottom of Bed — Generally, this is the first (V5 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: healthdept@townofnorthandover.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 approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date f ame —Print)e — e o TOWN OF NORTH ANDOVER , NUIITh Office of COMMUNITY DEVELOPMENT AND SERVICES RE ALTTR DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; ELITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 ��Bs�cKug i� Susan Y. Sawyer, REBS, RS 978..688.9540 — Phone PublicFlcaltb Director 978.688.8476—FAX healthd t g townof grthandovet.com www,town.ofnoiibandover.com APP LIC.ATIOP+T FOR SOIL TESTS DATE: 7i/Co/U step ,� PARCEL:Af LOCATION OF SOIL TEST . U rV 1 fy 1 f. -R—' roc r OWNER., Gni 67L '� ��� Contact #: ?75 — 6 98 — 6,34 APPLICANT: ��y l ��! ` Contact #: 17b y — 66 5 -6 ADDRESS- 70 ENGINEER' Contact CERTIFIED SOIL EVALUA T OR: Intended Use of Land: Residential, Subdivision Single Family Home Commercial s i : Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:_ In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM Proof of land ownt;rship (Tax bill, or letter from owner permitting test) S.S"x l t"Blot plan & Loeatinn of Tewing-(glease Indicate test pit fton. the elan) Fee of S4L5,00 per lot for . e v 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 D Only Certified Soil Evaluators may perform deep bole inspections. D Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 8 At least two deep holes and two percolation tests are required for each septic system disposal area. Repairs require at !cast two deep holes and at least one percolation test, at the discretion of the BOH representative. D Full payment will be .required for all additional tests within two weeks of testing. Within 4S days of testing, a scaled plan (no smaller than ]"-100') shall be submitted to the Board of Health ..l .. it a.,,.a.. /:�..,...1:�....L......A v ...\ JI/V '.'JAIg .IAV LV biiY1VLL vL .iL} ivJYJ `Aaare Y.rLALb IVVVA...V ay.dW/• Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line �.,A� Cn�ore.«in47ne1 I'n N,ep:wn:n.s .l nnermfnl i�nen•�1Q �' _.. ,,.. _., .....,,_..,... _.. glyCJ M� %AcSizul P..1'OSiD✓+ CPA,cL C,II`Da.t+j "'r'e.S4— a—d h`'i mwlch exp�e ed Signature of Consenation Agent cc re4 are. Date back to Health Department: (stamp in)_ LOT 3A N/F 44,300 SF +/- ZENGILOWSKI 502 WINTER STREET ASSESSOR'S MAP 104A LOT 78 LOT 3 l N/F m o r' --- .,9A, GUERRERA 60. LOT 4 i 1-7 r WETLAND LINE (typ•) 25' BUFFER ZONE LINE r .,r - 50' BUFFER ZONE LINE 75' BUFFER ZONE LINE 100' BUFFER ZONE LINE PROPOSED SEPTIC FIE TPS s n, ?o TP -08-1 PROPOSED RESERVE AREA i /r afi PROPOSED' TEST PITS r p_I EXISTING. TEST PITS\typ.) „E a a -12 Tp S2 -7- `, p 1-13 00"E S2T4 31 2.50' -S'40'00`":_ S� 3' 12'i�0' E-- S33' 1 x_40 50.30' =16.80' '---- 54.20' 58. ----------____--- WINTER STREET PLAN -_------- SOIL TESTING PLAN - MAP 104A LOT 78 502 WINTER STREET MARCHIONDA & ASSOC.,L.P. NORTH ANDOVER, MASSACHUSETTS ENGINEERING AND PLANNING CONSULTANTS DRAWN FOR 62 MONTVALE AVE. SUITE I DAVID KINDRED STONEHAM, MA. 02180 70 BRIDLE PATH (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS 01845 DATE: 2/6/08 SCALE: 1"=40' © 2003 MARCHIONDA AND ASSOCIATES, LP. H:\PROJECTS\351-37\PANTER S SEPTIC\SEPTIC PLAN -I D.DWG David. q. X wdred P.Q. Box 531 North Andover, MA 01845 (978)688-6558 FAX(978)683-4430 Date: From Total pages including cover__ t �� r 4177 Feb 0,6 08 04:57p Michael gaglione 878-657-8431 p.l FtB-06-2008 WED 03.42 PM PRUDENTIAL HOWE&DOBERTY FAX NO. 19784755101 P. 02 Susan Y. Sawyer Health Director North Andover Board of Health 1600 Osgood Street Building 20; Suite 2.36 North Andover, MA 01845 February 7, 2008 Dear Ms. Sawyer: Y hereby grant permission to David Kindred or his agents to enter onto my property at Lot 3A-502 Winter St. for the purpose of digging test holes or to perform any other necessary work during; the permitting process. Sincerely, r' Michael Gaglione 02/06/2008 5:OOPM (GMT -05:00) j I J, _ T tome :Test j' TP 3e) e q to�� $0 C -- 6 -141 A SL ; 116031L14-3115 I SL II /0 -12v C7 F5 12,5y o -Z4 S L lOY93/7- ZA-.JD C, 5b- 120t, C7 2.5`15`2. fb zti r 5)zz fs' �esf- s 6 - i4 1 A SL. 11693/& i 1- 30a ,- ! SL 3o - - C- L5 f i 2.5Y15 42v C Z F5 25Y 517 TP -os-Z wQ 3to ' Se Sd , o -7-4, A S L lOY9317- zA- , , SL JOIRlb . C, 11103 420t. CZS g� it Z-(." NORTH Q� tIED 16 �� � 7 Q I y n Q_ iOCM(MlMK• PUBLIC HEALTH DEPARTMENT Community Development Division July 1, 2008 David Kindred PO Box 531 North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for lot 3A (502) Winter Street, map 104A, Parcel 78, North Andover, MA Dear Mr. Kindred, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property. These plans dated June 11, 2008, received June 18, 2008, have been approved for a four (4) bedroom, maximum nine -room home. In accordance with local subsurface disposal regulations "Acceptable plans and any variances shall expire two years from the date approved unless construction on the lot has begun". During this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. The following variances were approved at the June 25, 2008 Board of Health meeting. - Sec 5.02 The proposed distance between a wetland and the leaching facility is 71 feet - Secton 9.01 The proposed area of the Eljen "GSF" leaching bed is 513 instead of the required 900 sq. feet. This approval is subject to the following conditions: 1. Prior to receiving a building permit or installation permit, the applicant must provide complete floor plans of the new home. Including basements and attics. 2. Prior to receiving an installation permit, the applicant must provide a foundation plan in 1" = 20' scale to overlay on the septic plan. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 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. Sincerely, Susan Y. Z�S/ /RS Public Health Director Encl: list of licensed septic system installers Cc: Christiansen and Sergi Prof. Engineers and Land Surveyors 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com MM m a rnc: h 1 o n d a & Associates, L.P. Engineering and Planning Consultants June 16, 2008 North. Andover Board of Health 1600 Osgood Street Suite 2-36 North Andover, MA 01845 JUN 1 8 2008 TOWYN OF NORTH AND HEH �F_�r ARTIVIENTER RE: 502 Winter Street (Map 104A, Parcel 78) Sanitary Septic Disposal System Dear Board Members: We are submitting for your review a revised Sanitary Septic Disposal System Design for the property at 502 Winter Street. The original design was submitted to you last December and was followed by a review response letter from. the Public Health Director dated; 1/24/2008. The revised plan has addressed the concerns stated in the review and we offer the following comments to each of the items; 1. Please provide a complete profile of the system to scale (NA 8.02c). A "to scale" system profile has been added to the plan. 2. Please provide a note on the plan listing all variance requests being sought (220(4)). North Andover routinely does.not provide variances to new construction unless the engineer proposes a system that will guarantee equal protection to the environment. Please address issue. 62 Montvale Avenue Suite I Stoneham, MA 02180 A list of the variances required frons the North Andover Septic Regulations have been added to the plan. They are listed in Note #16 of the General Notes. Two variances are being requested with this plan. The closest distance between the edge of a wetland and the leaching area is proposed to be 71 feet. Section 5.02 requires the distance to be 100 feet. The leaching area footprint proposed is 513 S.F. Section 9.01 requires a minimum of 900 S.F. It should be noted that we are not seeking any variances, from the Massachusetts "Title V" Environmental Code, .310 CMR 15.000. The revised plann proposes the use of a Eljen "7n -Drain" system which utilizes Geotextile Sand Filters. This technology has been approved for general use by Mass. D.E.P. The technology provides improved treatment to septic tank effluent.from traditional soil absorption systems. Testing on the effectiveness of the system was completed at the Massachusetts Alternative Septic System Test Center and furs been enclosed for your review. The system as shown has been sized as recommended by the approved system design guidelines. Based Tel: (781) 438-6121 Fax: (781) 438-9654 Email: mail@marchionda.com website: hnp://www.marchionda.com 4 Elm archiond $ Associates, L.P. Engineering and Planning Consultants on this information we are confident that the system as design will provide improved treatment over a smaller, footprint than the traditional design standards for leach fields or beds. Note #10 in the General Notes section indicates there are no wetlands within 100 feet of the proposed SAS however, the SAS is located 66 feet from the wetlands on the site plan. Please revise as necessary. Note #10 of the general notes has been revised as recommended. 4. Please provide a statement indicating the design will not accommodate the use of a garbage grinder. Note #9 of the general notes has been revised as recommended. Please provide all distances on the site plan from components and leaching facilities (NA 8.03a -c). Additional distances have been added to the site plan. 6. Please specify all connections are to be made watertight (222(3) & (4), NA 11.02). Construction Note #7 has been revised as recommended. 7. Please specify all pipe to be laid on a compact firm base on continuous grade in a straight of a line as possible (222(5) & (7)). Construction Note #19 has been added as recommended. 8. Please specify all tanks and distribution boxes to be watertight. Construction Note #20 has been added as recommended. 9. As depicted an insufficient number of test pits were conducted in the primary disposal area (102(2)). Additional soil observation test holes were viewed and logged on 5/22/08. The holes were witnessed by the town's consultant. The logs for these pits have been added to the plans. Two observation test holes have now been located in both the primary disposal area and the reserve disposal areas. arc iond & Associates, L.P. Engineering and Planning Consultants 10. As depicted an insufficient number of percolation tests were performed in the primary disposal area( 104(4)). The primary and reserve areas have been re -orientated in the area of the percolation. tests. 11. Please include a statement describing why trenches were not used in the design. A Eljen "In -Drain" system with Geotextile Sand Filters has been proposed to improve the effluent treatment. 12. Please include the inspection port in the appropriate details. A detail of the proposed inspection port has been added to the typical section. We hope the revised pian has satisfied the board and your staff's concerns. Please do not hesitate to contact us if you have any questions on this matter. Sincerely, Marchionda & Associates, L.P. John A. Barrows, PE Project Manager Cc: David Kindred DelleChiaie, Pamela From: John Barrows [john@marchionda.com] Sent: Thursday, January 24, 2008 12:47 PM To: -DelleChiaie, Pamela Cc: kindred.david@gmail.com; Sawyer, Susan Subject: RE: Plan Review - 502 Winter St. - Disapproval Letter Susan & Pam, We will plan on coming in tonight to get some feedback and direction from the board. Thanks, John John A. Barrows, P.E. Marchionda & Associates, L.P. This electronic mail message and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom addressed. You acknowledge that by opening the electronic documents attached hereto that you agree with the terms of the disclaimer/waiver, the statement of ownership, and other matter as documented on Marchionda & Associates' website at http://www.marchionda.com/disclaimer.htm CONFIDENTIALITY NOTICE: This email may contain confidential and privileged material for the sole use of the intended recipient(s). Any review, use, distribution or disclosure by others is strictly prohibited. If you have received this communication in error, please notify the sender immediately by email and delete the message and any file attachments from your computer. Thank you. -----Original Message ----- From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Thursday, January 24, 2008 11:46 AM To: John Barrows Cc: kindred.david@gmaii.com; Sawyer, Susan Subject: Plan Review - 502 Winter St. - Disapproval Letter Importance: High Note: I am sending this on behalf of Susan Sawyer, North Andover Health Director Dear John, Please find the attached review of the plan for 502 Winter Street. As we discussed over the phone, the plan proposed does not have any provision as to why the Board of Health should grant the variance. Not to mention the actual variance request is one of 12 missing items. So, the reality is the plan that we have is deficient in many ways and you know that a variance will likely not be approved without remediation of some kind. I would suggest that this plan is not ready to be discussed, however if you want to come to the meeting tonight just to see if a certain variance would be considered, as in the previous situation, and then come back in Feb. for the actual variance that would be ok. Either way, I will ask for you to come in February. Thank you Susan Sawyer, REHS/RS -----Original Message ----- From: John Barrows [mailto:john@marchionda.com] Sent: Wednesday, December 19, 2007 10:16 AM To: DelleChiaie, Pamela Subject: 502 Winter St. Hi Pam, Dave Kindred asked that I send you a formal request for a hearing for a septic system variance. Will this letter do the trick? Thanks, John John A. Barrows, P.E. Marchionda & Associates, L.P. This electronic mail message and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom addressed. You acknowledge that by opening the electronic documents attached hereto that you agree with the terms of the disclaimer/waiver, the statement of ownership, and other matter as documented on Marchionda & Associates' website at http://www.marchionda.com/disclaimer.htm CONFIDENTIALITY NOTICE: This email may contain confidential and privileged material for the sole use of the intended recipient(s). Any review, use, distribution or disclosure by others is strictly prohibited. If you have received this communication in error, please notify the sender immediately by email and delete the message and any file attachments from your computer. Thank you. (\ �rchion�•i� t& Associates, Enciineerinci and rte® Planning Consultants December 13, 2007 North Andover Board of Health 1600 Osgood Street Suite 2-36 North Andover, MA 01845 RE: 502 Winter Street, Sanitary Septic Disposal System Dear Members: On behalf of the applicant David Kindred, we are submitting an application for a Disposal System Construction Permit. Enclosed for your use are three copies of the plan for the Proposed Disposal System along with the appropriate filing fee. The system as designed meets the State Environmental Code, 310 CMR 15.000. Due to the proximity of the proposed leaching area to a Bordering Vegetated Wetland a variance is required to the Town of North Andover's regulations for subsurface disposal of sanitary sewage. Section 5.02 requires that a Leaching Facility be located 100 feet from a wetland. At its closest point the leaching area is proposed to be located 66 feet to the wetland. We would also like permission to use Deep Hole Observations that were performed over two years ago. These holes were performed by a Certified Soil Evaluator and witnessed by Board of Health inspectors. The results of these observations are included on the submitted plans. It should be noted that the North Andover Conservation Commission has approved the location of the proposed leaching facility and the wetland line delineated on the plan and an Order of Conditions has been issued. Please do not hesitate to call should you have any questions. Sincerely, Marchionda & Associates, L.P. rows, 1John A. Ba Project Manager Cc: David Kindred 62 Montvale Avenue Tel: (781) 438-6121 Suite I Fax: (781) 438-9654 website: http://www.marchionda.com Stoneham, MA 02180 Email: mail@marchionda.com !Marchionci� t. Planning Consultants December 19, 2007 North Andover Board of Health 1600 Osgood Street Suite 2-36 North Andover, MA 01845 RECEIVED DEC 3 12007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: 502 Winter Street, Sanitary Septic Disposal System Dear Board Members: We recently submitted to you a plan and application to construct a Sanitary Septic Disposal System at 502 Winter Street. Due to the proximity of the proposed leaching area to a Bordering Vegetated Wetland a variance is required to the Town of North Andover's regulations. On behalf of the applicant David Kindred, we would like to request a hearing with the Board of Health. Please do not hesitate to call should you have any questions on this matter. Sincerely, Marchionda & Associates, L.P. rs, John A. Barro Project Manager Cc: David Kindred 62 Montvale Avenue Tel: (781) 438-6121 Suite I Fax: (781) 438-9654 website: http://www.marchionda.com Stoneham, MA 02180 Email: mail@marchionda.com 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 Ms. Susan Sawyer Public Health Director Town of North Andover 400 Sutton Street North Andover, MA 01845 RE: Lot 3A Winter Street Dear Ms. Sawyer: February 8, 2005 RECEIVED FEB 2 2 2005 TOWN OF NORTH ANDOVER :HEALTH DEPARTMENT Enclosed herewith are three (3) copies of the revised septic plan for the above referenced site. The plan has been revised to address all of your Department's concerns as expressed in the review letter dated August 19, 2002. On July 17, 2003 we also conducted an additional test pit shown as T-3 on the enclosed plans. This test pit was performed in response to your Department's letter dated December 30, 2002. We feel your concerns have been adequately addressed and respectfully request that this matter be placed on your earliest meeting agenda for consideration of the variance request as noted on the plan. Variances are requested from Section 9.02 and 15.211 of the North Andover Board of Health Regulations. We appreciate your prompt attention to this matter. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd Enclosure cc: Mr. Mike Gaglione Attorney Mike Newhouse TOWN OF NORTH ANDOVER of NoerH Office of COMMUNITY DEVELOPMENT AND SERVICES F? • op HEALTH DEPARTMENT . w 400 OSGOOD STREET "" .r • NORTH ANDOVER, MASSACHUSETTS 01845 �,SSAMUS Susan Y. Sawyer, REHS/RS Public Health Director Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Lot 3A Winter Street March 4, 2005 Dear Mr. Dufresne, 978.688.9540 — Phone 978.688.9542 — FAX healthdept(gtownofnorthandover. com www.townofiiorthandover.com This letter is in regards to your recent revisions to the proposed new home at Lot 3A Winter Street. Per your request you have been placed on the Board of Health meeting agenda for March 24, 2005. The meeting will be held at TOOPM at the recently renovated town hall, second floor, meeting room. At that meeting your requests for variances will be heard. In addition, this office has identified the following concerns that neat to be addressed. 1) The leach field detail shows 3:1 slope away from the wall. As this wall is approximately three feet from the lot line, please indicate how this grading would be achieved or remove notation if it is not applicable. If the wall is higher than four feet the standard versa lock walls require anchoring. This plan shows a 40 ml barrier, however this cannot be placed when a geomembrane is needed for the versa-lok wall would. penetrate the membrane. Please adjust the wall details for this specific site and submit the documentation indicating specifications. 2) There must be at lease one original stamped plan 15.220(2) 3) Pleases submit the soil evaluation forms for the soil test mentioned in your submission; T-3 dated July 17, 2005. Please submit revised plans or bring them to the Board of Health meeting. All outstanding items that you may wish to discuss in detail may be addressed at that time. Since , /� Sawyer, REHS/RS Public Health Director Cc file TOWN OF NORTH ANDOVER HEALTH DITARTMENT 27 CHARI..ES STREET NORTH ANDOVER, _MASSACHUSETTS 01845 Sandra Starr Public Health Director December 30, 2002 Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Lot 3A Winter Street Dear Mr. Dufresne: Telephone (978) 658-9541 FAX (978) 688-9542 This letter comes upon review of the proposed septic plan for a new dwelling at Lot 3A Winter Street and particularly your request to use soil tests that are more than three years old. Because this is new construction, and because the percolation rate of 20 minutes per inch does not agree with the stated soil class of 1, your request for a waiver to use outdated soil testing is denied. New testing must be performed in the spring of 2003 with staff from the Health Department. The price for new construction soil testing is $425 as of January 1, 2003. Soil testing will begin in March, depending on weather conditions. Should you have any questions concerning the content of this letter, please contact me. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Gaghone — owner BOH File