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Miscellaneous - 53 OLD CART WAY 4/30/2018
LO', 6'gQ OLD CART WAY 210/107.B-0088-0000.0 G 2A ola .. . ... boll tom. + 1. R Lot & Street 0 1 i_'� C-Ps eX \AJ Map/Parcel kx5N— CONSTRU ON APPROVAL Has plan review fee been paid: YES ',NO Permit# _ Plan Approval: Date: / Approved by: , Designer: �%r/Gf Plan Date: Conditions: ��ti�/I�� U5T' ���,�'!� !S� Zo/` C,"X)aC. Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-Off: U Comments: Form"U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO A 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: JO/ 17P 01 APPROVED BY:- � SEPTIC SYSTEM INSTALLATION Is the installer licensed? jYE \ NO Type of Construction: REPAIR New Construction: Certified Plot Plan Review NO Floor Plan Review NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit # j j Installer: G :: ULL J lf�_W Begin Inspection: YES NO Excavation Inspection: fe,�lb�Of Needed: Q *SaT%J r &4"n vedr a�q, 6t)Qlz lam' remoVcj d e e! ggZ oe) s��ide, Cjeaey,L a a-,r r-Q)i � v Passed: 71171.61 By: /�.� Construction Inspection: Needed: 'lt Plan Satisfactory: �e�b4' o�7�j3 S: Approval of Backfill: Date: 7/�6 ZQ/ By: � Final Grading Approval: Date:.t b ( y' b By:_ Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: 1 �� P� s A Commonwealth of Massachusetts v Title 5 Official Inspection Subsurface Sewage Disposal System Form - Not for Voluntary ssess`ments 53 Old Cart Way Property Address _Kristen & Brendon Guthrie TOWN OF NORTH ANQMER Owner Owner's Name —�4,26�1-1 ICr 1 iVIVNT— information is North Andover Ma 01845 3/5/2012 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information i forms on the computer,use 1. Inspector: only the tab key to move your John DiVincenzo cursor-do not Name of Inspector use the return key. Stewart Septic Service Company Name r� 58 South Kimball Company Address Bradford Ma 01835 " City/Town State Zip Code 978-372-7471 S113386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evalu on by the Local Approving Authority / f� �^ 3/5/2012 Inpector's 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. 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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): !Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 --- — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form u Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r _ g .y' 53 Old Cart Way Property Address Kristen & Brendon Guthrie _ Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for —_ -- ---- every page. City/Town 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts -_--_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Old Cart Way_ Property Address Kristen & Brendon_ Guthrie Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface,a Sewage Disposal System Form Not for Voluntary Assessments 0 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for — -- every page. CityfTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd _ t5ins-11/10 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 53 Old Cart Way Property Address Kristen & Brendon Guthrie _ Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 — --- every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 ---- Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (9pd))� 102_gpd Detail: Recommend removal of garbage disposal-Water meter readings Sum pump?Sump p p ® Yes ❑ No _ Last date of occupancy: Occupied 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•11/10 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 53 Old Cart ay Property Address Kristen & Brendon Guthrie Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 _ . _ every page. City/Town 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: Andover Septic _ Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? site guage on truck Reason for pumping: Inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11110 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 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 7-27-01 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: T-6" feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): — Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: .5feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: -- 15ins•11/10 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 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name _ information is required for North Andover Ma _01845 3/5/2012 — — every page. City/Town 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 26" Scum thickness 2" -- Distance from top of scum to top of outlet tee or baffle 5" -- ----- Distance from bottom of scum to bottom of outlet tee or baffle 14.5 How were dimensions determined? Tape measure, sluge judge 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 and Outlet tees in good condition, no leakage liquid levels good. 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•11/10 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 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 15ins-11/10 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 53 Old Cart Way Property Address Kristen & Brendon Guthrie Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for _ —_— — — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 -- -- Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No leakage, No solids carry over, Box level 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.): All floats in working order, Alarm good. Pump chamber should be built to grade 1'-0" under ground Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Old Cart Way_ Property Address Kristen & Brendon Guthrie Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: -- ❑ leaching chambers number: -- ❑ leaching galleries number: — ® leaching trenches number, length: 3-41' ❑ 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.): No hydraulic failure no ponding, no damp soils 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 !Sins•11/10 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 53 Old Cart Wa Y Property Address Kristen & Brendon Guthrie _ Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for _ _ —_ -- ------- — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions -- -- Depth of solids –— -- Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 s i Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Old Cart Waw Property Address Kristen & Brendon Guthrie Owner Owner's Name information is required for North Andover Ma 01845 3/5/2012 _ -- — 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 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 } Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Old Cart Way_ Property Address Kristen & Brendon Guthrie Owner Owner's Name --- -- -- --------- —_---- information is required for North Andover _Ma 01845 3/5/2012 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 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. 7-24-01 As built Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Taken from design plans, drawn by Robert Smith Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•11110 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 53 Old Cart Way _. Property Address Kristen & Brendon Guthrie Owner Owner's Name information is North Andover Ma 01845 3/5/2012 required for -- every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1. �,a�vvm F,11e1 RT9-!ANDoeER/ :t r t;;<!-;D OF(tiEA�.i H 9 OCT 12 2N TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the.Sewage Disposal System X constructed; ( ) repaired; by ACK SULK VAT l located at S 3 0 L0 CRf� WAY (L°-" 7A) was installed in conformance with the North A�}dover Board of Health approved plan, System Design Permit#963 , plan dated _88197 ►: 6 ����, with a design flow of f_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: J UL y 0 200 Engineer Representative Final inspection date: oC7 g" ZOO ( Engineer Representative 13J JACK SLJt L1YA4 � - fo q zoos Installer: Lic.#: Date: Engineer: Date: kw� no ERT SMITH NO 13956 s� ©lstE�t14 I INSPECTION CHECKLIST FOR SEPTIC SYSTEMS. Yes NOInit_ial� / /' A. Bottom of Bed :D-46/f� Q 1. Excavation to proper depth N4";G ' �V a - 2. With trenches,sides of excavation are beneath B horizon �� t 3. Edge of excavation specified distance from foundation,etc. Commer is: Q��� e:�1 f� hav e, afe 6r e-dqe r SKS �0 ��I'Yl Q J S l / eq Com`<� addr��ect �lv4�"' SCctrl�tE?c� B. Retaining Wall 1. Wall height and width as sp 'fled 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: i 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 v 9. Manholes at any 90°change . 10. 10'minimum offset to water line Comments: D. Septic Tank z� 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. Inlpt 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 �_ G 12. Pipe set _��/ 13. Compact base with 6"of 1/4"crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber 1. If separate from tank,compact base with 6"of 1/4"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 c)n 1. D-box level i/ a 2. Minimum 0.17"(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 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-'/4"- 1 '/2" /u -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 1. 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 sem' 5. Distance between trenches minimum 4'and maximum of 6' T- 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". �/ t 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: I 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 AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS b�- LOCATIONS &DIMENSIONS OF SYSTEM, CLUDINGRESERVE TIES TO LOT LINES &DWELLING, WELLS 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 LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK& D-BOX ORIGINAL STAMP & SIGNATURE i/ IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW �� LOCATION&ELEVATIONS OF BENCHMARK USED Town of North Andover, Massachusetts Form No.3 &ORTil BOARD OF HEALTH F 19 DISPOSAL WORKS CONSTRUCTION PERMIT ,SS^CHUS Applicant el_ _ l N E ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 47(1, 13 CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the o� C G,l property at -' � �27- A relative to the application S✓� of �Q dated for plans by �uc and dated v �� with revisions dated 6 d I understand the following obligations for mana'gAient 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 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. 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 planh. No instructions by the homeowner, general contractor, or any other persons shdabsobligation. Undersigned Ler Date: Disposal Work Construction Permit# �0"41N GF INOR7"HAND0_REeR% BOARS?OF HEALTH MAY 1 2N BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: J I CURRENT INSTALLER'S LICENSE# /s1 LOCATION: OLO CART WAX LICENSED INSTAL R• � SUULI U*J SIGNATURE: IT � TELEPHONE# '7 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. I Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No 1 Floor Plans? Yes No Approval � � ���i�_� Date: BOAPD OF HEALTH MAY 12001 /-q ' THOMAS E NEVE ASSOCIATES, INC. January 11, 2000 Ms. Sandra Starr Board of Health 27 Charles Street North Andover, MA 01845 Re: Lot 7B - Old Cart Way(formerly Lot 7A) Owners: Paul &Maryanne Maus Dear Sandy: On February 2, 1998 your Board issued an approval for the sanitary disposal system for new construction for Lot 7A Old Cart Way. Since that time our client has been trying to resolve several issues with regards to the development of this lot and the existing restrictive covenants that exist on the subdivision. In order to resolve the covenant issues our client has decided to revise the lot line location between their lot (Lot 6A) and Lot 7A thus creating Lots 6B and 7B (see enclosed Form A plan which has been submitted to the Planning Board for their review and approval). Please find enclosed plans which show the new proposed lot lines and associated lot development for your review. The revised lot development requires the relocation of the septic tank and pump chamber, therefore requiring new buoyancy and pump calculations (find attached). Everything else with respect to the leaching facility design remains the same as originally approved. We will be sending this plan to the Conservation Commission for their review since an Order of Conditions currently exists for the project. The proposed revisions conform to the existing Board of Health and Conservation Commission regulations. Based on the minor revisions we ask that you accept this plan as the record plan for this site. Also, since the current approval will expire in approximately one year(February 2, 2001), we ask that you grant a one year extension to the existing approval. If you have any questions please do not hesitate to give me a call. -- JAN 8 �. • ENGINEERS • LAND SURVEYORS LAND USE PLANNERS 447 Old Boston Road U.S. Route#1 Topsfield, MA 01983 (978)887-8586 FAX(978)887-3480 Ms. Sandra Starr,NABH Page 2 January 11, 2000 Thank you, in advance, for your anticipated cooperation regarding this matter. Sincerely, THOMAS E. NEVE ASSOCIATES, INC. ` -V- t. John M. Morin, PE Executive Vice President i JMM/kmm Enclosures cc: Maryanne Maus IIS I #1463NABH.WPS Ii Town of North Andover NORTN OFFICE OF 3�o�•,`.° °oma COMMUNITY DEVELOPMENT AND SERVICES ° A # qpuwX 27 Charles Street =��, •" North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSACMUS� Director (978)688-9531 Fax(978)688-9542 February 28, 2000 Neve Associates 447 Old Boston Road Topsfield, MA 01983 RE: Lot 7B Old Cart Way Dear Mr. Morin: I This letter is to inform you that the proposed septic plan for Lot 7B Old Cart Way, North Andover, dated January 11, 2000 has been approved for a house with a maximum of nine rooms Please do not hesitate to call the Health Department at the number below if you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Maryanne Maus File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 THOMAS E. NEVE ASSOCIATES INC. Engineers • Land Surveyors • Land Use Planners [LIN44AQ @IF 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 DATE JOB NO. (508) 887-8586 5/4/00 14� FAX )508) 887-3480 ATTENTION SANo STA2R RE: TO SANDY STAiZfZ Lc)-T -713- Ol ac vJQ BOA 7-p of NCtZTb-a A�JppVE.Q _ t-1 A 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 3 REV'51-4 1o0 14&3--1 St2 AN t-'A y D1S �4• PoSL_ St'en ` r n�AV THESE ARE TRANSMITTED as checked below: XFor approval ❑ Approved as submitted ❑ Resubmit copies for approval XFor 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 1C-_)EA2 SAt-tS>Y Ps-LASE FlNo RE'w1SE.D PL-A,1S Fol L-oT -7B oIA Gcrj L,-*4ry . AS Yoy ARE AWARE wp: WE 2f✓ RCQ1J 13Y YOUR O FIc- -rte L01-IAJG7- AN Appl"r'IpNAL. S014- TEST IN T►aE PRcPoSE,p SYS-CE-r-1 AREA , ON APRs- ZS.2000 ToM ►JBVE ArJ0 <,s-)SAN FOP-P ( i3o1-1) PE.R�Rfr»:.D AoJ A'Dpl'T1a�AL TgST P1-17 Pit oo-l�) 1 K T HE RR0?05E1i> SYSTF_r N A7-P_A (see YOJ C-AiJ SES FQoM TtiESots... BOLT 1E.5.H.w.'t'. WAS E:STAgL1SNED A'T Zo'7 ?'\) Ss,JC S THE �x,ZOJ�DW ATE12 JSEp 1F6 pES1Ct N wA% EL-EJ 207.8 ao Re.v%sloos ARE- RG.4r' > PLE P%S>r ACc-GPT 'rNAm IJES l6rK3 AS -r t lE. 2EGo en PL.An3 ,w-j)' 155vE ArJ Af1FiZ /AL. AS Sot">#J AS FbSSIBLI . . -T-HA►JKS Fol Yo,31%-_ "r'-IME 1: EFFOQ--r (zESot.vle�lCr COPY TO pjztjT'Ni5 e,,ATr'62 , A.JY Q?1VE:ST IO,JS GALL RECYCLED PAPER: DC7 Contents:40%Pre-Consumer•10%Post-Consumer SIGNED: if enclosures are not as noted,kindly notify us at once. Town of North Andover 40RTti 3?a`st .o e1�ooL OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 sncHus���y WILLIAM J. SCOTT Director (978)688-9531 Fax (978) 688-9542 May 10, 2000 Neve Associates 447 Old Boston Road Topsfield, MA 01983 RE: Lot 7B Old Cart Way I Dear Mr. Morin: i This is to inform you that the proposed septic plan for Lot 7B Old Cart Way, North Andover, dated May 4,2000 has been approved for a house with a maximum of nine rooms. Please do not hesitate to call the Health Department at the number below if you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Maryanne Maus File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 f Z' `l THOMAS r�TEVE ASSOICIATE , INC. May 31, 2000 Ms. Sandra Starr Board of Health 27 Charles Street North Andover, MA 01845 Re: Lot 7A—Old Cart Way Owners: Paul and Maryanne Maus Dear Sandy: On January 11,:2000 I had submitted,.correspondence and revised plans to your office regarding the above-referenced project. At that time, as.stated in.the:correspondence; our client was preparing to go to courtwith the abutters regarding covenant,issues and-chose to revise the plans to.help resolve several of the issues. As you may recall the proposed dwelling was moved on the revised plan therefore requiring the relocation of the septic tank and pump chamber. The leach field and associated grading for the leach field remained the same. The revised plan was reviewed by the Towns Consultant and was approved with the stipulation that an additional test pit be dug in the system area. As you know a test pit was dug with Susan Ford (BOH) on April 25, 2000, which confirmed the water table used for the design. Therefore, on May 10, 2000 your office issued an approval on the revised design. Since the time of your last approval it appears that the abutters wish to withdraw their complaints and will agree to sign off on the original approved design, revised dated October 6, 1997,which was approved by your office on February 2, 1998. Since the original approved design is more appealing my client wishes to revert back to the original design, revised to October 6, 1997, as the record plan for this site. Please find attached a copy.of the soil 4og for Pit 00-1 that was performed on April 25, 2000 in the presence of Susan Ford (BOH) as well as a sketch plan showing the location of Pit 00-1. As you can see the E.S.H.W.T. in Pit 00-1 confirms the design groundwater elevation used. Therefore, at this time I ask that the design revised to.October 6, 1997 and approved by your office on February 2, 1998 stand as the record„plan for, this.project. Could you please re-issue your original approval.referencing the original approved plan revise dated October 6, 1997. • ENGINEERS . LAND SURVEYORS LAND USE PLANNERS 447 Old Boston Road U.S. Route#1 Topsfield, MA 01983 (978)887-8586 FAX(978)887-3480 Ms. Sandra Starr Page#2 May 31, 2000 I understand that this has been a confusing process and your time, effort and cooperation is greatly appreciated by my client and myself. If you have any questions please do not hesitate to call. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. John M. Morin, PE Executive Vice President JMM/jmp Attachment cc: Maryanne Maus I 1463nabh.doc I Dbfe Pwfame& Ap67 25, 20100 Pit 00-1 Bev. = 212.4' A: FM 4 N 25YJIJ �j L At,E 1 = Z O BW. FSS 2.5Y4/4 N Redo�'V C, Fa (ter) 56 P�'�'� : gENGNtMARK , 2.5Y4/4 or,�� �A-A ,rA5 5 - Qesirwd . Of • 961, 96" •'��• biz Engineer. Tom Ne ve I 36 ,3 Board of Heo/ttx Susan Ford i- ti 42.52` / a 4v j P3 1 N I N 93- � •�• P. l ?Pj 1 20 LO ' ?8 f 5 o,-7 oCP 5.F 1 _ Topography Taken From A 3y Pica EngMr►W*79 Co., Inc. \ ` 1 / ®� NORTH Town Of North Andover �? "`� " O`er Community Development & Services William J. Scott . - 27 Charles Street Director .•'�° North Andover Massachusetts 01845 (978)688-9531 �9SSACHUSEt Fax 978-688-9542 Board of Appeals July 19, 2000 (978)688-9541 Building Thomas Neve Department Neve and Associates (978)688-9545 447 Old Boston Road Topsfield, MA 01983 Conservation Department (978)688-9530 Re: Lot 7A Old Cart Way Health Department Dear Thomas: (978)688-9540 This is to inform you that the septic system plans dated 6/l/00 for the site Public Health referenced above has been approved for a maximum of nine (9) rooms. Nurse (978) 688-9543 If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Planning Department (978)688-9535 Sincerely, Sandra Starr, R.S., C.H.O. Health Director SS/smc cc: Maus File FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that allnecessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. �a■■aa■■■■■■a■■rr■■rrr■aa■■aaa■•■■aaa0E0a■■09aa0 a a 0raa000aaa000aaaa0a00aaaa0 APPLICANT JA(-K 4 k9011V SALW PHONE '761- BY- ?I Y3 u ASSESSORS MAP NUMBER /0-7 B LOT NUMBER SUBDIVISION LOTNUMBER `lA }� STREET.... O LO .c�l. WV �.`�............. .STREETNUMBER..s�......... l OFFICIAL USE NLY RECOMMENDATIONS OF TOWN AGENTS �aarrraarraraaaa■aa■■aa■■raaara■■aaaaaarrararrraaaaarraaaar■■aaraaaraaaaraa• DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED CONM ENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED / DATE APPROVED fey SEPTIC INSPECTOR-HEALTH DATE REJECTED COIvIIvI1;TlTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED 6 O DEP"ARTMLq4T IL/ AR DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North Andover, Massachusetts Form No. 1 _ C NORTH ddI� BOARD OF HEALTH Q�C.IED 6'l"Q iJ41�.1f' 6 OL ! - •p9. '�J°R °° ew°• " APPLICATION FOR SITE TESTING/INSPECTION 7 QORATED PPRy.�S 9SSACHUS�� Applicant—!OPRYAIVNe' `- NAME �g ADDRESS TELEPHONE Site Location_/,o-- Z. 3 GJ 6 C, Engineer 1 V �C- NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH �J Fee Test No. 7 / S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 2/i6loo LOCATION OF SOIL TESTS: Lot 7B Old Cart Way Assessor's map & parcel number. Man 107B, Parcel 88 OWNER: Maryanne & Paul Maus TEL. NO.: (978) 687-4498 ADDRESS: 65 Old Cart Way, North Andover, MA 01845 ENGINEER: Thomas E. Neve TEL. NO.: (978) 887-8586 CERTIFIED SOIL EVALUATOR: Thomas E. Neve Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing X Confirmatory es ing required by THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Board of Health. 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$275.00 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 u des. p Dora 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,nS, a scaled plan (no smaller1"-100')than 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. AUG-26-1998 10=27 508 688 9542 P.02 Y 1 �� �I �111��I�IIIIiIu!��1�'�1111(il 1!1111 Mill Y. �J11111 P REFERENCE DATE111111111111111111111l�11111111111 � IIG'l1111/1111!!�11l�1��1��: X11111111 � 111111111111 X11111111 � 1111111111 �, � 1lII1E7111�IE1��'�1111��3111111111 � � 1111111111i�111111fif1111H111111111 1!l�lS30-I!!IIIE�III,IQI�111111�' � ! 111� � � IIIIIIIIIIl1111111I�il��ll����G!���1 � 117�1111li�71111111111111��l�!�I�M� � 11111111111111111111111111�"�11l11! !"!!I111l�I1�"l1111!�!1�111111111 IIID IIIIIIIIIIMill IIIIIll111i�i111111 11111111111111111111111 19. .-1 � 1111111111111111111111111111111111 � 11111111111111111111 � 11111111111111 � IIIIIIIIIIIIIIHIIIIIIIIIIilillln � � ill NIIIIIIIIIIIIIIIIIIillllllll . � � IIIIHIIIIIIIIIIIIIIIIIIIIII � � n1111Hi111111111111111111111111 � IH1111111111 11111 111111111111 � IIIIIIH111111 111111 111111111111 � � o11NN1111111111111111111111 X111 IIN IIIIIHIIIIIIHIIIIIil1111111 IIIIIIHIHIIIIIIIIIIIIIImilli111 Town of North Andover, Massachusetts Form No.2 c� tORTN BOARD OF HEALTH Z©'�96 . a o L # w DESIGN APPROVAL FOR ;SSS"C14U � SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant )2n nL-A L-T?--Sl No. Site Location C)A-(' - U Reference Plans and Specs. < ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. HAIRMAN,BOARD OF HEALTH e �y Fee Site System Permit No. I i 5 Town of North Andover t 40RTPI , OFFICE OF 3r O t, a o tiooL COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street * t North Andover, Massachusetts 01845 WILLIAM J.SCOTT SS�c►+us� Director wER� �N ��55vinpv__` OOO November 4, 1996 Mr. Thomas Neve Neve Associates, Inc. 447 Old Boston Road =U. Route 1 Topsfield, MA 01983 RE: Request For Determination of Applicability - Lot 7 Old Cart Way. Dear Mr. Neve: In response to the above referenced permit application, this Department conducted an inspection of Lot 7 Old Cart Way on October 8, 1996 and November 4, 1996 in order to verify the proposed delineation of on-site wetland resource areas; Steve D'Urso accompanied me on the 4th. I offer the following comments: 1. Wetland flags 101 to 109 are approved at this time; 2. Wetland flag 208 was eliminated. Please connect 207 directly to 209; 3. Wetland flag 204(1) was added in the field approximately 15' up slope of 204 directly towards the existing stone wall; 4. While there is a predominance of sweet pepperbush on-site (Clethra alnifolia) soil borings performed up slope of 206 and 209 strongly confirm the proposed delineation by Mr. D'Urso: EXAMPLE - • A HORIZON: 0- 8" '1 OYR 3/3 • B HORIZON: 8"- L 2.5Y 5/4 W/<5% redox features. To reiterate: 1. Please reference the on-site Verbal Pool, which has been certified with the Natural Heritage & Endangered Species Program (#988), on the plan of record. It is understood that in order to be protected under the Act, the Vernal Pool must be within land Subject to Flooding; Vernal Pools within Bordering Vegetated.Wetlands (BVW) are not specifically protected as Vernal Pool habitat under the Act, but if future work is proposed that would affect a pool in a BVW, the Conservation Commission would incorporate this information in the decision making process. Regardless the pool receives protection under the North Andover Wetland ByLaw and Regulations. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 5808-9530 HEALTH 688-9540 PLANNING 688-9535 w k 2. Are you proposing wetland series #202 through #211 as a BVW, Isolated Land Subject to Flooding, or Freshwater Wetland as defined under the ByLaw? The site appears to be outside the limits of any FEMA -FIRM Zone A (i.e. BLSF). Please clarify. If I can be of further assistance or if clarification is warranted, please do not hesitate to contact this Department. Thanking you in advance... Sincerely, 0 Michael JD. How rd Conservation Administrator cc: DEP-NERD NACC BOH file I I I I i 1 Tf3V"�OF TOWN OF NORTH ANDOVER BOAR'D QEF HEALTH OFFICE OF TOWN MANAGER 120 MAIN STREET NORTH ANDOVER, MASSACHUSETTS 01845 MOR7p f � Robert J. Halpin 3?•�''� �_ °0 Telephone(508)688-9510 Town Manager - s FAX(508)688-9556 s i a SSACMUSEt June 21, 1996 Attorney Peter Caruso One Elm Square Andover, Massachusetts 0 18 10 Dear Attorney Caruso: At the Selectmen's meeting of June 17, 1996,the Board reviewed my report on the status of the layout of Old Cart Way and the discontinued portions of the cul-de-sac. Based on my report that I could determine no present or future public use for the discontinued portions of the cul-de-sac, the Board concluded that the Town should not pursue whatever claim it may have to the portions of cul-de-sac in question. I mentioned to the Board your willingness to convey the fee in the most recently approved layout, and I suggest that you prepare that deed for acceptance of the fee in consideration of the Town's waiver of its rights. Sincerely, Robert J. Halpin Town Manager cc: Attorney Joel Bard, Kopelman& Paige William J. Scott, Director, Community Development& Services George Perna, Director, Division of Public Works Sandrda Starr, Board of Health RJH:map 06;`7;`96 13:05 FAX 508 6889556 NORTH ANDOVER Z002 Board of Selectitten 1%elintttes .lune 17, 1996 Pa,-,c development of the Town Hall, Fire Station and the Bradstreet School on Main Street, as well as proceeding with a public safety facility combining both fire and police departments. Chief Dolan, Fire Department, discussed the need for the location to consider response tirnes,. and Chief Stanley,Ycglice Department, indicated the location must be highly visible. William Duffy made a MOTION, seconded by Kevin Foley, to support the option to issue a Request for Proposal for the reasibiliiy study for the uses of the Town Hall,Fire Station One and the Bradstreet School, as well as proceeding with the plan for the Public Safety Facility; vote approved 5-0. TOWN MANAGER REPORTS; Old Curt Way- The Town Manager reviewed with the Board the status of the layout of Old Cart Way and the discontinued portions of the cul-de-sac, Mr. Halpin determine no present or fiinire public use for the discontinued portions of the cul-de-sac. William Duffy made a MOTION, seconded by Kevin Foley, to support that Town should not.pursue whatever claim it ma.y have to the portions of cul-de-sac in question and to convey the ,fee in the most recently approved layout; vo�tc approved 5-0. Airport Development Project- The Town Manager has participated in planning sessions concerning thee development of rhe industrial property adjacent to the Lawrence Municipal Airport. The indications are that t p p he project oject is viable financially. 'there is a small eight-acre. - re'parcel,owned by the Town of North Artdover, which abuts the Lawrence property which is an abandoned well site which has been slated as pa1•t of the development. Mr_ Nalpin is in the process of determining whether there is any definitive future use of this well site for public I'Vater supply. While nothing definitive exists, docutrtentation obtained from the State D.E_P. indicates that the site would not likely be re-commissioned, as a water supply. The question is if the Town wishes to walk away from the well site'and add the eight acres to the development.proposal, Without:committing the idea, the Town M;anger suggested that Merrimack l;ilrineerin- proceed, as if the parcel is to he added_ it is anticipated that the City of Lawrence would extend its Economic Target Arca into North Andover as part of this effort under a job sharing g a nd revenue sharing arrarlgemetlt. John Leeman expressed his concern that.if the Town is to participate.in this development, it must address issues pertaining to traffic control, noise polluiioand public safety JN'hich may be impacted by increased traffic. School Department-New England School Development Council!Re ort- The Nev..-England School DeveioplTicill Council has issued a report about the Town's school facilities. The: Superintendent of Schools will make a presentation relative to this report encompassing the long-range plan as a future 117cetin°. Police Academv Recruit Training Fee Agreement- Under a new law adopted by tlhc legislature ui FY 1996, the Town is charged b1.900 per recruit and has the option of charging, this amount back to the recruit in order to recover it or waiving all or part of the charge. A Recruit Training Waiver Fee Agreement was presented to the Board of Selectmen for their approval., which requires a five-year eomrrtitntent from i:he ofFcer. Whatever the time the employee leaves prior to the completion of the time frame, the will recover as a pro-rated share of the training invested. Division of Public Warks Report- The Town M;JnaLer updated the Board of Selectmen regarding the report of issues pertaining to thL, Division of Public Wnrks_ Mr. lialpin's report indicated that all issues discw,sed between Mr. Halpin and George Pcrna, Director. Division of Public Works. have been dealt with and no action is required. A report.frons the Massachu5ctls Highway Department on unaccepted roads is pending and a verbal report from George Perna.Director, Division of Public Works, will be nro). i")(4 at a 1-1i-r r!�r, Town of North Andover, Massachusetts Form No. 1 Nq ORTH • BOARD OF HEALTH 01�S QED I6 •Y0 oL 19 o APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUs���h Applicant i �__1 c , t^ .k J, NAME ADDRESS TELEPHONE Site Location + # t. }. f- �, r Engineer ( !' t �.'� _z ti� , , .4 it-r� to NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I I , 1 1 1 � j � � � i ' I i G r��G'���-�" �fir(,,✓,' � q �- i ' i i ; I � � �/ ! � � -J✓.fie. �I/ I I i JI i i ! ,LI ! ' ! i I t'.�:}w��-' .1 ;Ir! i I i I :fl.' j•' F 1.i(+WO NAO y/� I//•J��."J / f'I/ � '�'{^'.F'3.- .I l �..�t��n'u1l:q I. I I I � � � it ! i I fi { ,{:�„r .t trnt{ ���,1{„•; . �:,..:� /•+ ! ,+�� I t � i �'„'1 � ��`— ' 1 •�{ s.{ �3�'r t r �'iirrrn•a...,• �a 1 c f t i I I � I -� r r , : Town of North Andover, Massachusetts Form No.2 NORTH BOARD OF HEALTH p 19�• � w ' DESIGN APPROVAL FOR SS�CNUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM ApplicantTest No. Site Location_ Reference Plans and Specs. e& n ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed I in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH • $/ Jam+ Fee tv Site System Permit No. GR I 7/'1,,A C 4r 7/ Fk 7 �- i, - 0 - 31 8' /7 � - A4 w. III COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OENVIRONMENTAL AFFAIRS n r d DEPARTMENT OF LRONMENTAL PROTECTION 8�. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 'S3 OL r c-447 lti�F� ,n/097 P ry(;O Owner's Name: To4V 9 ir6j5TE+V f✓LUL-I�W Owner's Address: S3 Oct Gam* ivaF_-t 6i AvlTd IhA G E 971 Date of Inspection: _Noyer)'MA Name of Inspector: (please print) I'W k f~'. AL LIC,y 7'14i Company Name: A LLI Jnl tn/Gjn/ 1rV Mailing Address: ?S +i Gds r LAw�' Uk 6W►Da Telephone Number:�8—Z7t�01 ) � CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: // Zd hf The system inspector shall submit a copy of this inspection report to the Approving Authority(Board DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 01-0 C-AU WA7' Owner: TO Nnj L/LL1 U Date of Inspection: M 2-0* - Inspection Summary: Check A,B,C,D or E/ALI J A. System Passes: /'b L /` � -77 „ I have not found any information which indic &1"C? �L— ( � /Vf/ "V � MR 15.303 or in 310 CMR 15.304 exist. Any failure crit ��(fl`/ Comments: `" ' , 'f t" "/ B. System Conditionally Passes: �va� One or more system components as describ( A or repaired.The system,upon completion of the repla( will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r____ tii ci�nnn 2 t Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 014 WT 407 n10Rfi h(�vy Owner ,TO ti�h/ � "„ i?'1_ D��! ,�LLjV�A Date of Inspection: NOVFM Z00 l 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 I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �� GA VJAy n/b)Qfi ,A 018gy Owner: VL AV Date of Inspection: 64& 2-0Dy i D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged gged SAS or cesspool Discharge or ponding of effluent to the surface of the ground— gr dor surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped O _ }( Any portion of the SAS,cesspool or privy is below high ground water elevation. r4A — — Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. /,//A — _ 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. //A _ — Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes@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: A/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply — _ the system is located in a nitrogen sensitive areaInterim Wellhead Protection tection 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3 014 GAATWA10,014 AND041 01 9 J MA Owner: JOW fJLCI 'T Date of Inspection: /VaE�: ie Zit 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 X Were any of the system components pumped out in the previous two weeks'? X _ Has the system received normal flows in the previous two week period? 32 Have large volumes of water been introduced to the system recently or as part of this inspection? i _ 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? X _ Was the site inspected for signs of break out'? _ Were all system components,excluding the SAS,located on site? X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? I i The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. _ x Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] 5 Page 6 of 11 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3 Qa 6ALTlAJA7 N A-1 J+/0 ✓� 0180,1O0, Owner: J-044 3J4L1�i4►t/ Date of Inspection: NOU Y71 Zob F OW CONDITIONS RESIDENTIAL y Number of bedrooms(design): r Number of bedrooms(actual): CJD DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): / Number of current residents: Z Does residence have a garbage grinder(yes or no): ND Is laundry on a separate sewage system(yes or no):AID [if yes separate inspection required] Laundry system inspected(yes or no): yf Seasonal use: (yes or no): IVO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):N 0 Last date of occupancy: 6j1eWA)TLj Z4A40/t_r^ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CI R 15.203 . gpd Basis of design flow(seats/1 rs .'s Atankt etc.): Grease trap presen Industrial waste hot(yes or no): Non-sanitary wastTitle 5 system(yes or no):Water meter readi :Last date of occup OTHER(describe): GENERAL INFORMATION Pumping Records OWK P�Pr M6�/ pP> �bd3 Source of information: d �i`l�C Was system pumped as part of the inspection(yes or no): /'/b If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of informati n: Were sewage odors detected when arriving at the site(yes or no): &/6 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �3 OLD C�"�`-�' wAy qq Owner: ��� fiLlOW d �v� 0I U�� Date of Inspection: ^10v.3'r1, U, 2,a)lv BUILDING SEWER(locate on site plan) Depth below grade: 3 0 Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: AIIA Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:X(locate on site plan) Depth below grade: Material of construction:X concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) ' Dimensions: YO 6-A(,A()N "7 X Sludge depth. Z Distance from top of sludge to bottom of outlet tee or baffle: Z Scum thickness: !/Z 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: m ✓) -Tv f/eA Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7�4ryk w,irct- rl�1' �ar��tflar�, t1�G,�TL � 7d 7r� kC. cEaiv_�1'C►J�� GREASE TRAP:_(locate on site plan) „ /f/� Depth below grade:_ /t/l Yv 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 'r:.a- c r___.__-`:---c_-- iii cn,nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 Oto r-14- ' vv/AY Owner: 'T0 N „+LLA✓ Date of Inspection: /V A' ZDDy PTIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) iI Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence ofsolids carryover,any evidence of leakage into or out of box,etc.): ,Q 1��� 7/ &c) PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): / Alarms in working order(yes or no): Comments((note condition ofp unap chamber co on of pumps and appurtenance1s eta.): i I 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: f)G� 00/tT v1,1A7 �b�� Y fi A. Owner: t/ Date of Inspection: /Vo 1�i 12 1 SOIL ABSORPTION SYSTEM(SAS):,L(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leachinggalleries,number: g ,.� p �( y/ y number,len 7 7�'��> leaching trenches, u the g leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) IV)V/J 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) J Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): -:.i_ c T-------`=-•- T-- /'11 cinnnn 9 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 640 WA- W f�Na alr9�f� Owner: Date of Inspection: 1VOMAKeJ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. .Ale SEPTIC SYSTEM TIES e PVC VEW PIKY� BUILDING CORNER W/CARM FILTER S A B $. SEWER A UNDATION25.6 Al ` ti� k SEWER INTO SEPTIC TANK 13.7 27 SEWER OUT OF SEPTIC TAN K1 SEWER INTO DOSING CHAMBER 0 j SEWER OUT OF DOSING CHAMBER 21. 45.2' 1 . 1 41'1 1 1 1' 1 1 1 1 rQ1moK0 . 100' COMMONWEALTH OF MASSACHUSETTS f .265, A6 AL 90X WITH mu 7M ON AL s#M1 IRao AL AL sono AL S ? a4r . i 1� * Aa AIL W S8W35'39'W 1000 GALLON CONCRETE DOSING CHAMBER 30.1r �I y /� W/ 1/2 HP BARNES PUMP C 1500 GALLON CONCRETE e ` SEPTIC TANK EQUIPPED WITH INLET/OUTLET TEE AND GAS E)USTING BAFFLEFOU COVER DMOED TO WITHIN 8' T.O.F.-DATION 21253' OF FINISHED GRADE AT THE INLET AND OUTLET LOCATIONS. 30. #53 IMEPNM M T- ,,,�,^��� 10 OLD CART WAY • Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Z SYSTEM INFORMATION(continued) Property Address: 5> �'� AiT Owner: 37 A/0 Date of Inspection: AW R -Z'0U y SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 4yC 8i I q 97 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must de5 cribe how you established the high ground water elevation: NIGH G lf,2 -fum�� ��„�a�G �4P{��oy'& Ankof/C PR�PA 7/I Uu iQU vZo - :A_ a r__.--- r_.__ Ill einnnn 11 Y Town of North Andover Office of the Health Department Community Development and Services Division # _ 27 Charles Street North Andover,Massachusetts 01845 "ss Nus ` Sandra Starr Telephone(978)688-9540 Public Health Director Fax(978)688-9542 f TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/17/01 This is to certify that the individual subsurface disposal system 9 constructed (X) or repaired ( ) by Jack Sullivan at 53 Old Cart Way(Lot 7A) 5 i i has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the 1 North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 'an .LaGrasse Board of Health Inspector i BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ii a Buoyancy & Pump Calculations Lot 7A — Old Cart Way North Andover, Massachusetts Prepared For Paul & Maryann Maus B V DSA N Gy CAti.--GuLA.�'1 C X1.5 � S EPTI G. TANK) �W4l.Gf) 51 C-R'N17s ZoV.Z /1 \\\Itl!!� _ 111 \�►I II _!!! 1 44 lblft El = Z07.Z� EL- _ 1/NNN- M M C P ' � 9 UO N N 0 0 0 N ...er E1= Z01-5 A A- er n n 3 �g o TOTAL_ VOLUME OV- 5EPTic- TANK = 10/-Co,X Col-419 51- 411 = 354 FL 1N51�� Vo1.+.rM>✓- Q� SEp"�L TANtL = 10-O X 5 -10 X ¢-$ - 2'7Z Ft 3 Vo�ur-tom o>= Gon+c_ = 3S4- Z-7Z = 8Z Ft F= -8Z N/pFALL OV EK TANK = lo- co'1 x Cv-4 x I f= 42G Ft ro D F?x-C-M15 lb/;rle L GZ-70 Ib ��►� VoLut�E 01= �/A"�ER' �15.PLRGED fay TANK. = io-��x G1-4�x l.lo OCP r o F = ►0� 3 ; ((oz4 CoG 4 1 b- TctGl F(J.) = 11,808+ (OZ-7o = 18)0-78 ib C FS. . Z-7) i - r I Ns1" GrFroos (Zoe l ZOT_O El- - Zo1,_3 QQQ s'-z X s- a = Z34 F t nrK (riSir C VG1ve�c nr U-'a�L�[f - -7-<o'x 4-$'x 5-O� c 1-75 Ft. t ��f �/a.lur•-•� or. Gcncrc�c = 234 - 1-Irj = 59 a ,r 3 Va1un-� a�: F;11. aver �1--a�t:�r - 8-o' x S�-Z x t' = 41 F t �/a1uMe. C� �JG}G� I��S�iat�d► by C}�a�+noet' x 8'-OLX 5'-Z X Z.7- 91 17-,16D 16(,0 > 54,7 S ( F. S. = z.z� PUMP CALCULATIONS DOSE FZEQyVRED (D) _Soi 1 ._Class Al YI N VI W W W lY F 4404- 1 - 440 PD N of vl 000 �C aaa nnn SAC.KF't_OW CAL -T IO►JS A A A �� ponce. Main Z, I a _ Z o 4 LF 33.-1 G-oi-n5 TCT'AL_ DOSE (OT) : DT,. - D + EyF = 440+ 33.E - 4-13.1 GAL = Co3.3 Ft STORAGI= NEf C-% -r RF-9QIRE.D FOR TOTAL DOSE CHT Nom- [(4 - 8 ) x(� '- �"] x HT - CO3.3Ft NT = 1.81 F1:. H 5 3/ A C.TUAL DOSE TO Sof s-rF—m ( C)A) x.48 GAL/Ft C7A t_ r:>A 414.5 33:1 c:,AL = 44O.8 GfiL_ GAL __ F-L O A T E L.E�/AT 10 t�15 , Pur�tP OFF = P�r,P In - 4 - 3 I- Co - zo5.91 - 4.Z5 + o.S = zo2.lco PuMP ON PurnP pFF -�- LUw k" 1 W W W W W W cALARM ON = PuMP Orl � O.SO = 1 -n -as saa = Zoo, 47 rrr _... aaa 0 STORA GE GAPAG t-r ABo�E VJoRKtNGS t_EvEL f y 1 N PuMP GHAMBE.R (ST� i ST = -rap InSi&r- Ele.\ - Al ore--% On� x .4'- 8 x -7 - G � I (Zorn-coCo - 204.4'7) x 4`- g A -7'- C�, = 7G.X05 Ftp = 513 CiAL ST = S'13 CsAL > 440 UAL 0.K. V STAT l G H EAD K s� HS = D- Box 1 N - Po"P OFF D- box V-3 - Pur IP ON = Z1 3.3,4 - Zo3,97 aj,-Y7 DYNAMIC- HEAD (Ho) : C ZForce Mc►:r,) 50 EQ�.]IVAt-EIJT I..ENGTH METHoD cNEcic E 1-7 _ 17' vAL�E 31 4 - GATEZ,4D _.. VALVE TOTAL l-SP-IG-rH = Z04 H p = C5.2 Ft��oo Ft� X Tot_-I l._eng}ti = C5_Z��/goo) x Z35_4 HEao Loss I r+ Pips �o 1Z.Z, N N N U,FF __= TOTAL D'YKIAMIG HEAD VI$A Nf O O O vfOO TpH = }AS + H=l = I J.Z. IZ.Z = Z3.4 aid _ nnn Pt,MP PARAMETERS 50 GPM SECTION 4A SUBMERSIBLE WASTWATER PUMPS PAGE 9 211 Non-Clogs ISSUED 7/92 SUPERSEDES ,7/91 2" Spherical Solids Handling 0 Series SE .5 HP 175 RPM SE51 SE51A & SE52) I U I ® L PUMP SPECIFICATIONS DISCHARGE:2"NPT,Vertical SPEED: 1750 RPM (Nom.) LIQUID TEMPERATURE: 160°F Intermittent. UPPER BEARING: VOLUTE:Cast Iron,ASTM A-48 Class 30. Design:Sleeve MOTOR HOUSING:Cast Iron ASTM A-48,Class 30. Lubrication:Oil SEAL PLATE:Cast Iron ASTM A-48 Class 30. Load: Radial IMPELLER: LOWER BEARING: Design:2 Vane, Open,With Pump Out Design: Single Row, Ball Vanes On Back Side. Dynamically Lubrication:Oil j Balanced. Load:Radial&Thrust Material:Cast Iron ASTM A-48 Class 30. MOTOR: SHAFT:416 Stainless Steel Design: NEMA B;Completely Oil-Filled, SQUARE RINGS:Buna-N Squirrel Cage Induction HARDWARE:300 Series Stainless Steel Insulation:Class A PAINT:Air Dry Enamel SINGLE PHASE: Permanent Split Capacitor SEAL: Design:Single Mechanical (PSC). Includes Overload Protection In Motor. Material: Rotating Faces-Carbon OPTIONAL EQUIPMENT: Seal Material, Impeller Stationary Faces-Ceramic Trims,Additional Cable. Elastomer -Buna-N Hardware-300 Series Stainless CABLE ENTRY: 15 ft.Cord (Plug on 115 Volt), Pressure Grommet for Sealing and Strain Relief. BARNES PUMPS, INC. A Burks Pumps, Inc.Cast m s .irw,a..er Distributor Sales&Service Dept. Special Bids A Project Sales Pow-++u" 420 Third Street/PO Box 603 1485 Lexington Ave. MADE IN THE U.S.A. SUM Piqua,Ohio 45356.0603 Mansfield,Ohio 44907.2674 Ph: (513)773-2442 Ph:(419)774-1517 :1H Fax: (513)773-2238 Fax:(419)774-1530 SECTION 14A PAGE 10 ISSUED 7/92 UPERSEDES 7/91 12.62 0 6.25 1.50 auakfisauw%we 4.88 I - - . —+ 9.75 2"NPT 19.00 O DISCH. O __J 1 -7 6.70 MODEL PART HP VOLT PH RPM NEMA FULL LOCKED CORD CORD CORD NO. NO. (Nom) CODE LOAD ROTOR SIZE TYPE OD AMPS AMPS SE51 086040 0.5 115 1 1750 D 11.6 18.4 14/3 SJTO 0.390 SE51A * 086041 0.5 115 1 1750 D 11.6 18.4 14/3 SJTO 0.390 SE52 086042 0.5 230 1 1750 E 5.8 10.5 14/3 SJTO 0.390 U� Underwriters Laboratories Inc. IMPQRTANTI 1.) 00 NOT USE THIS PUMP TO PUMP FLAMMABLE LIQUIDS. 2.)THIS PUMP IS Wn RECOMMENDED FOR USE IN LOCATIONS SPECIFIED AS HAZARDOUS. 3.)THIS PUMP IS Wn APPROVED FOR USE IN SWIMMING POOLS, RECREATIONAL WATER INSTALLATIONS,DECORATIVE FOUNTAINS OR ANY INSTALLATION WHERE HUMAN CONTACT WITH THE PUMPED FLUID IS COMMON WHILE THE PUMP IS RUNNING. 4.) PUMP CAN BE OPERATED DRY FOR EXTENDED PERIODS WITHOUT DAMAGE TO MOTOR AND/OR SEALS. *Supplied with 73618 Level Control. BARNES PUMPS, INC. A Burks Pumps, Inc. Company Distributor Sales&Service Dept. I Special Bids$Project Salesy+,,,,�, 420 Third Street/PO Box 603 1485 Lexington Ave. _ ft== Piqua,Ohio 45356-0603 Mansfield,Ohio 44907-2674 MADE IN THE U.S.A. �Q+��� Ph: (513)n3-2442 Ph: (419)n4-1511 Fax:(513)773.2238 Fax:(419)774-1530 . . FEM lu W■■■W■■W■Wn■■u■■■W■■■■■■■■■■ STANDARD IMPELLER SIZE ■■W■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■ Pump HP Imp. Dia. ■■■■■■W■■■WWOW■■■■■nW■■■■W ■■■■■■■■■■■■■■■W■■■W■■■■■■■■W■■W ■■W■■WVW■W■■■Wn■■■WV■■■■■/■WW■■W■■® iiliiii ui:iiiio■i■■iiuiiiiiiii■i■u■■u■i■iiouu■■ii�■i ■ rk1iBq�r�_�: I•��-old - t � � I G�—oft ., e IH106; lzllkC� PLAC3E_.- iq EAr JJ.. t 4- -Tw .. .4l :r.........._.. 'TY`Y G0{)O ( � TW z,r/+O i F i^{.W4fv 1V^ Ve4fa 0 t_4 �I � © o I i Tr— jg A-] f v - _ �., 02ZEE `° l9 L2 L2& - � _ OPMW -� -- -TO F)i :DT. 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