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North Andover Board of Assessors Public Access
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Location: 53 WHITE BIRCH LANE
Owner Name: BANACOS, FRANCIS J
LISA D BANACOS
Owner Address: 53 WHITE BIRCH LANE
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 6 - 6 Land Area: 0.53 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 2267 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 480,700 1501,300
Building Value: 282,600 303,200
Land Value: 198,100 198,100
Market Land Value: 198,100
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkId=1704161 &town=NandoverPubAcc 7/11/2011
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MAP # LOT
PARCEL # STREET
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID? <!Esid NO
PLAN APPROVAL: DATE Al'i APP. BY—
DESIGNER: %PLAN DRTE,-
CONDITIONS
WATER.SUPPLY:
WELL PERMIT_,
WELLTESTS:
COMMENTS:
--TOWN WELL
DRILLER
,,CHEMICAL
BAG-ftRIA I
BACTERIA II
UAJE APPRUVEU
DAIE (IF"PRUVED
DATE APPROVED
FORM U APPROVAL: APPROVAL TU ISSUE E5 NO
DATE ISSUED BY
CONDITIONS:
FINAL APPROVAL:.
ALL PERMITS PAID YES�) NO
WELL CONSTRUCTION APPROVAL YES, NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL 4::YS NO
OTHER YES NU
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE:BY:
•t
r
Qtb' TaaIS PI,,,.1 # e tvmr►aA-mor.; iS ujgT
A IJAt"^ oJT`( Of 1'4 E S,$ 4ue4eGg
06MEH , sT I S A z l e or a OF %& taorno
ANC? E LE vAllod of 'ri4 L. e.)% yT I WA sYSjt-r
coHPoNa,� Ty,
0
AS BUILT PLAN
No v 3 0 2006
roWN EA o H OR7_H ANDOVER
OF
SUBSURFACE DISPOSAL SYSTEM--
LOCATEDIN
e� 12-i' � A 1-1 ?may �R•, M Qom; r2$ U u ITC LAP &
AS PREPARED FOR
CZANIG t LGGS
DATE:
SCALE: 1'= 4o
'f'L, X10
0S
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS
bb (PARK STREET • ANDOVER, MASSACHUSETTS 01110 or TEL (617) 475-3555, 373-5711
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0
0
AS BUILT PLAN
No v 3 0 2006
roWN EA o H OR7_H ANDOVER
OF
SUBSURFACE DISPOSAL SYSTEM--
LOCATEDIN
e� 12-i' � A 1-1 ?may �R•, M Qom; r2$ U u ITC LAP &
AS PREPARED FOR
CZANIG t LGGS
DATE:
SCALE: 1'= 4o
'f'L, X10
0S
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS
bb (PARK STREET • ANDOVER, MASSACHUSETTS 01110 or TEL (617) 475-3555, 373-5711
m n
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
C`E1��IIF7GA�E OrF C091�l�LIAJVCYE
As of:
Novem6er30, 2006
This is to cert that the individual su6surface disposal system received a
SA71S(FACYI'ORTINS(EMONof the:
�FuffSeptic System 12epCacement
Joseph R. (Ouddy) Watson
At:
53 White Oirch .Gane
North Andover, 911,4 01845
The Issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
Sus `Y. Sawyer
(Pu6Czc Yfealth Director
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFI
The undersigned hereby certify that the Sewage Disposal System ( ) constructed;
By:
(Print Name)
Located at: y'�' t'l I -,j- 11 F f L) -
(Installation Address)
'10 0 R
gyred; Ob P����
�1
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
7-�o'-aO and last revised on '-! — 10 "OtO" with a design flow of
15,50 gallons per day. The materials used were in conformance with those specified on the
approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local
regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on
the As -built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: '7—f 7 �P
r3y L �t2L1 ;,P,�;-Pbr
And — Print Name
Mnal Construction Inspection Date:
And — Pnnt Name
Installer• nature)
a�(N OF Mks X,
E2 • ��..t� Qom, ,c_
Engineer Representative (Signature)
Engineer Representative (Signature)
Date:
��= MW_
`,..�
And — Print Name
Date: // ? 1006
Kdol4tl AlfkckfNtp�,
And — Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 53 White Birch Ln. MAP:61
INSTALLER: Buddy Watson
DESIGNER: Merrimack Engineering
PLAN DATE: 1/28/06 rev. 4/10/06
BOH APPROVAL DATE ON PLAN:
INSPECTIONS II q U�(ho�—TANK INSPECTION:Uw�
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION: 8/9/06
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
Comments:
SEPTIC TANK
LOT: 90
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
Bottom of tank hole has 6" stone base
Weep hole plugged
® 1500 gallon tank has been installed
H-10 loading Monolithic construction
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
® Inlet tee installed, centered under access port
® Outlet tee (gas baffle or effluent filter) installed,
centered under access port
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
❑ 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
® Hydraulic cement around inlet & outlet
Comments: Not sure about water tightness at time of inspection. Installer to fill tank and
check. Also, advised installer to install riser over outlet port. 8/9/06
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) li
® 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:
No liquid in pump chamber to check water tightness or drain hole.
DISTRIBUTION -BOX
® 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)
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.town0northandover.com
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
SOIL ABSORPTION SYSTEM (General)
® Bottom of SAS excavated down to 6 in into C soil
layer, as provided on plan
® Size of SAS excavated as per plan
® Title 5 sand installed, if specified on plan
® 40 Mil HDPE barrier installed
® Retaining wall (boulder / concrete / timber/ block)
❑ Final cover as per plan
. iZ TM tMi
SOIL ABSORPTION SYSTEM (Gravel -less Chambers)
® Brand and Model of Chamber Infiltrator Quick 4
® Number of chambers per row 10
® Number of rows (trenches) 4
❑ Laterals installed and ends connected to header (and
vented if impervious material above) j
® Elevations of laterals and chambers installed as on
approved plan
Comments: Vent not installed at time of final inspection.
CONTROLPANEL
Comments:
® Alarm & Pump are on separate circuits
® Alarm sounds when float is tripped
® Location of control panel:
® Rated for exterior if placed outside
® Alarm signal located inside
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
6.
SYSTEM ELEVATIONS
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COCN1CMCwK� ._
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
INVERT ON DESIGN PLAN FIELD INVERT ELEV.
Building Sewer OUT
139.85
No access
Septic Tank IN
139.30
139.22
Septic Tank OUT
139.09
139.02
Pump Chamber IN
139.00
138.97
Pump Chamber OUT
N/A pressure
N/A pressure
Distribution Box IN
141.07
141.12
Distribution Box OUT
140.87
140.95
Lateral 1 INV
140.87
140.87
Lateral 1 TOP
141.20
141.20
Lateral INV
140.87
140.87
Lateral 2 TOP
141.20
141.20
Lateral INV
140.87
140.87
Lateral 3 TOP
141.20
141.20
Lateral INV
140.87
140.87
Lateral 4 TOP
141.20
141.20
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
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
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Tank
SAS Sewer
❑
Property line
10
10 --
❑
Cellar wall
10
20 --
❑
Inground pool
10
20 --
❑
Slab foundation
10
10 --
❑
Deck, on footings, etc
5
10 --
®
Waterline
10
10 101
❑
Private drinking well
75
1002 50
❑
Irrigation well
75
100
❑
Surface Water
25
50
❑
Bordering Vegetated Wetland ,
Salt Marsh, Inland / Coastal Banka
75
100
❑
Wetlands bordering surface
water supply or trib. (in Watershed)
150
150
❑
Trib. to surface water supply
325
325
❑
Public well
400
400
❑
Interim Wellhead Prot. Area
❑
Reservoirs
400
400
❑
Drains (wat. supply/trib.)
50
100
❑
Drains (intercept g.w.)
25
50
❑
Drains (Other) Foundation
10 (5)
20 (10)
❑
Drywells
20
25
Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland
bylaws
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Map -Block -Lot
NORT�t . Commonwealth of Massachusetts 061.0- 00-90-------
Board
0-
Board of Health Permit No
° 2 BHP -2006-0213
. North Andover ----------------------
.� :•
`�,:.�,•' .I. i FEE
P
� $250.00
-------------------
F
�ssAcMust< .I.
Disposal Works Construction Permit
Permission is hereby granted JOSEPH R. ----_ ____-___--_---__--_---
_---__-
WATSONA ---
I
to (Repair) an Individual Sewage Disposal System.
I
at No 53 WHITE BIRCH LANE --
-------------------------- --------------------------------
-----------------------------------------------
as shown on the application for Disposal Works Construction Permit No. 131 -IP -20067021 Dated July 07, 2006 -----
------------------
--------- '—Bba�of tE
C
LIssued On• Jul -07-2006
----------------------------------------------------------------------------------
.........................
.................................................................................
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
_Q
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g_;;_x
Application forSeptic Disposal System
'Construction Permit —TOWN OF
Application is hereby made for a permit to:
❑ Construct a new on-site sewage disposal system*
[P epair or replace an existing on-site sewage disposal system*
❑ Repair or replace an existing system component
A. Facility
or Lot #
2.- *' PE OF SEPTIC SYSTEW:
Pump Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
I i
TOD 'S D E
$ 250.00 — Full Repair
$125.00 - Component
❑ Conventional System (pipe and stone system)
❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D -Box Present) S.A.S.
FA
Address (if different from above)
Cityown
3. Installer Information
J lel- �/A �rti
State Zip Code
Telephone Number
, L /z/.A&
Name of Company
Address "
o
eftyf StateZip Code
._de_- 93�_ 3,34 y
Telephone Number (Cell Phone # # possible please)
4. Desi ner Information
Na Name of Company
7�",
Address
Citywri State Zip Code
V?r-- 3Y
S -r
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
NORT1Application for'Septic Disposal System
3 g
=Construction Permit -TOWN OF TODAY'S DATE
''°•'- •' NORTH ANDOVER, MA 01845 250.00 -Full Repair
$125.00 - Component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: esidential Dwelling or ❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore -described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certificate of Compliance has
bee 'ssued by this Board of Health. A,
Names Date
tion A proved By: Hees epresentative)
a Date
Application Disapproved for the following reasons:
For Office Use Only: j
1. Fee Attached.
I Project Manager Obligation Form Attached.
A Pump System? Ifso, Attach copy ofElecnical Permit
4. Foundadon As Built.$ (new construction ronly):
(Same scale as approved plan)
.5 Floor Plans? (hew construction only):
Yesjn No
/ �w
Yes v it No
Yes No
Ye — No
Ye — No
Application for Disposal System Construction Permit • Page 2 of 2
JUL 10,2006 13:13 J W WATSON, JR. INC. 978-475-0413 Page 1
I IJ1 JJ/ `i i'.ib'000,10
HFAI I H
INSTALLER PROJECT MANAGIEMlJ.N'T OBL. GAT1 YNS
Ag the North Andover lircnced installer for the construction of the septic system for the
ti
propolis it `5 ... � �.��.--rcl;rtive to the application
of dated - for plans by_��?�fs'�1� and
dated _ with revisions dated
T rinderst.and thrr following obligations for manugcuecnt of this project:
i. A the installer I am obligated to obtain all permits and Board of I lualth approved pians prior
toperforming any work on a site. T must have the approved plot^ and the Pettit Oil site
where tiny vvorlC ly beiup done,
2. Av the installer T rnugt call for any and all inspections. If homeowner, eontraietor, project
trimiger, or any ol,hc'r person not associated with my company schedules an inspection and the
system is not ready theft item three shall be applicable.
3. As th(: installer I am required to have the necessary work compacted prior to the applicable:
ihspcctinns as indicated below. I undemi:and that requesting an Inspection, wi.tho»t
completion of thee items in a.ccordarice with 'File 5 and the Board of.l-lealth Regulations may
TvsiiIt in a $50,00 zine being levied against my company,
a.) Bottom of Red � generally first inspection unles, chore is a retaining wall which should be done
FITSt. Installer must request the. inspect -ion but doe% not have to ire present,
h) Final in.crcetion -- Engineer must first du their ingpcetion for elevations. tic,, etc. As -built or
verbal rix from engiTicer must bo submitted to Board of Ilualth, after which installer calls fu+
i.iup"tion time, lnstallcr moat he present for this inspection. With pump sysicm all 0eetrical
work', must be ready arm. able to eau." pump to work and alann to function.
0 Final (nude - Installer must rcgngst inspection whets all grading in complete, Uoca not have to bu
on site.
A. ,1s the installer T understand that only J. may perforin the work (other than simple excatvation)
rcgnired to complete the iwlAlation of the system identif cid in the attachnri ;application for
installation. I further understand that work by others unlicensed to install septir. system; in
North Andovcr cAn wnstitute reacnns for denial of the systern, hndl0l'. rev0vatlnn or
suspr-ncion of my lieetise to opt+rnt(' in the 'Town of'North Andover; Significant' elites to all
persons involved aro also possible.
5. As the lnstaller T understated that T must be on site during the performance of the f01lowiti
constnrotion steps'
a) rMtermination that the proper elevation of the excavation has been reached.
b) TnSpectiort of the sand and stone to be used.
i:l Final inspection by 80ar i of Health staff or consultant.
(i) Tnstallntion of tank, T) -box, pipe:., stone, veil, pump chamber., retaining wall and othar
conal,>Uurnts
6. As the installer Y under.qta.nd that i atn solely responsible for the installation of dic syvtcm as
per the approved plans. No instructions by the hootettwner, genei3l cuntmcior, or any ot)rcr
persons shall a.hsolvn rrie of this obligation.
U
Septic lnstafl'r
Coni•rnonivealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Us�eOnly
7
Permit No. < ft?
Occupancy and Fee Checked
[Rev. 9/05] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFOR�W HON Date: 12 // 6 6
City or Town of:To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) Wk j e, 4� t rte L'
Owner or Tenant VA !v Ac 6 S Telephone No.
Owner's Address .5 AM e -
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑l Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Nleters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 1- 1 -Le S-0— P •7-i I U01?
?
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
o. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑n- El�
rnd. rnd.
o• o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection an
Initiating Devices
No. of Ranges
No. of Air Cond. Total Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
Number er
ons
I KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal Connection ElOther
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
o. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors. Total BY
TelecommunicationsWiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of hires.
Estimated Value of Electrical Work: (i (7 = (When required by municipal policy.)
Work to Start: 7 -+0' Inspections to be requested in accordance with MEC Rule 10, and upon completion.
]INSURA.NCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cover ge is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and p realties of perjury, that the information on this application is true and complete.
FIRM N E: 5' + AT t. �, i ret i t�..L&--Z-t (L i s4 %_ N � LIC. NO.: I ? q 7 q A
Licensee: 41'E?AiL, Signature LIC. NO.:3N`vo & _
(If applicable, enter "exempt" in the license numbfr line.) Bus. Tel. No.:q.?" S j
Address: epi Alt. Tel. No.: " )s-
*Security System Contractor License required for this work; if applicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's anent.
Owner/Agent ,
Signature Telephone ,No FPERtYIIT FEE: r
10/19/2005 14:53 9786888476 HEALTH PAGE 02/02
INSTALLEP. PROTECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic systen for the
property at 3 �(/� ��i `�rclatiee to the application
4
of _ dated for plans by and
dated with revisions dated
T understand the following obligations for management of this project:
1. As the installer I am obligated to obtain all permits and Board of Hcalth approved plans prior
to performing any work on a site. T must have the approved plans and the permit on site
when any work is being done.
2. As the installer T must call for any and all inspections. If homeowner, contractor, project
manger, or any other person not associated with my company schedules an inspection and the
system is not ready then i.tem three shall be applicable.
3. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without
completion of the items in. accordance with Tile 5 and the Board of Health Regulations may
result in a $50.40 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 elevati.on.s, ties etc. As -built or
verbal. OK from engineer must be submitted to Board of Health, atter which installer calls for
inspection. time. Tnstaller must be present for this inspection. With pump system all electrical
work must be ready andable to cause pump to work and alarm to function.
c) Final Grade — Tnstaller must request inspection when all grading is complete. Does not have to be
on site.
4. As the installer T understand that only I may perform the work (other than simple excavation)
required to complete the installation of the system identifiedin, 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 Amy 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) tnspecti.on of the sand and stone to be used.
c) Final inspection by Board of Health staff or consultant.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber,. retaining wall and othcr
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.
U de signed Licens Septic install
Date: �' �,
TOWN OF NORTH ANDOVERof NOR*N ,
Office of COMMUNITY DEVELOPMENT AND SERVICES `z�•.
HEALTH DEPARTMENT
400 OSGOOD STREET ",. •r
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.8476 — FAX
Public Health Director E-MAIL: healthdent(cr�.townofnorthandover.com
WEBSITE: http://www.townofnorthandover.com
March 6, 2006
Anthony Donato, P.E.
Merrimack Engineering Services
66 Park Street
Andover, MA 01810
RE: Lot 61, Map 90, 53 White Birch Lane, North Andover, MA
Dear Mr. Donato,
The proposed wastewater system design plan for the above site dated January 28, 2006 has
been assessed but not fully reviewed because of a major design issue. The following item is
in need of attention prior to a full review:
The design plan proposes to increase the flow of the dwelling while the application for soil
testing indicated "Repair Testing." Therefore, insufficient deep holes and percolation testing
was performed to increase the flow from the dwelling as shown on the design plan.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater system design which will be in compliance .with all
regulations and assure protection of public health and the environment of North Andover.
Sincerely.
Susan Y. Sawyer, REHS/RS
Public Health Director
cc: Owner
Applicant
File
MERRIMACK ENGINEERING SERVICES, INC.L-1448,-
1 1 2006
_ j'�r ER
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNEREer I iv ENT
66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555,373-5721 • FAX (978IL: merreng@aol.com
April 10, 2006
Ms. Susan Sawyer:
Director of Public Health
400 Osgood Street
North Andover, MA 01845
Re: 53 White Birch Lane
Dear Ms. Sawyer:
APR; I 1 �.U06
TGvv,, _ r+uOVER
HEALTH DLPARTMENT
In response to your letter dated March 6, 2006 regarding the above referenced site, we
have completed two additional deep tests, results of which have been added to our design
plan. Unfortunately we were unable to complete a percolation test as the ground water
conditions were too wet on the day of testing since the area had received substantial
rainfall the previous day.
The deep test conducted did confirm consistent soil types to those previously performed.
Additionally, two satisfactory percolation tests have been previously performed on site in
close proximity to the deep holes we conducted, records of which are on file in your
office.
On behalf of our client, and considering the amount of testing that has been completed on
site (7 deep tests — 3 perc tests), we respectfully request that you re -consider the major
design issue specified in your letter and complete a review of the design so that
construction can commerce. The current system is in hydraulic failure and breaking out
to the ground surface and we feel it is in the best interest of our client and Public Health
in general to expedite this review as soon as possible.
Thank you for your consideration of this matter.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
Project Manager
ti
! Owner's Name:e.�
Address: 01; Og `Ilp f i wu �
Tel. -d - " 3 —tz- New �SIP
Date: L Wedands,__Zone> =SoE1 SymbolkL11 Mame i _Soil Q.
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TOWN OF NORTH ANDOVER of NORTH 1
Office of COMMUNITY DEVELOPMENT AND SERVICES o?
H A
HEALTH DEPARTMENT
t i 4
400 OSGOOD STREET'°LCi�-•
NORTH ANDOVER, MASSACHUSETTS 01845 °•�*'`�
cHuget
Susan Y. Sawyer 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
April 12, 2006
William Dufresne, Project Manager
Merrimack Engineering Services, Inc.
66 Park Street
Andover, MA 01810
RE: Subsurface Sewaee Disposal System Plan for 53 White Birch Lane
Dear Mr. Dufresne,
The North Andover Board of Health has received your septic plan submission for the above-mentioned property
dated April 10, 2006. Along with that submission there was a request in regard to the required percolation tests.
After a review of the file and all relevant information and in light of the current public health issue, for the family
living with the existing failing system, the following determination has been made.
The Health Department will accept the submission as complete and review it accordingly. The site does have
numerous pert and deep hole tests, but there is no perc in the reserve system. The regulations do require this,
however time is an important factor. Rather than outright waiving of this requirement, it has been determined that at
the time of installation a perc may be conducted at the site of the reserve as you attempted to do initially. Any result
of this perc would not affect the system going in, as the reserve is a substantial distance away from the primary.
Our office will make every attempt to review this plan as soon as possible so that construction may commence.
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 might have.
Sincerely,
Susan Y. Sawyer, REHS/RS
Public Health Director
cc: homeowner
Page 1 of 1
DelleChiaie, Pamela
From: Sawyer, Susan
Sent: Tuesday, April 25, 2006 10:07 AM
To: DelleChiaie, Pamela; Grant, Michele
Subject: FW: 53 White Birch Lane
-----Original Message -----
From: Sawyer, Susan
Sent: Tuesday, April 25, 2006 10:06 AM
To: 'info@millriverconsulting.com'
Subject: RE: 53 White Birch Lane
I have spoken to the homeowner about this. I think it is not always breaking out, however I will drive by. A wee bit
of exageration possibly, but it is definitely failing.
Susan
-----Original Message -----
From: Dan Ottenheimer [mailto:info@millriverconsulting.com]
Sent: Tuesday, April 25, 2006 7:45 AM
To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan
Subject: 53 White Birch Lane
Folks,
We have received and will initiate a review of the design plan for 53 White Birch Lane.
However, the cover letter from the designer indicates that sewage is currently ponding on the surface of
the ground at this dwelling. I would think that it is going to be several weeks if not months before a design
plan is approved and actually placed into the ground. We may wish to send an order letter to the property
owner to have them get a signed agreement with a licensed hauler to pump the septic tank as a holding
tank until a new system is installed. I believe the tank should be pumped immediately and then on a
weekly basis until further notice. If you need assistance in writing such a letter please let me know.
Dan
Daniel Ottenheimer, President
Mill River Consulting, Inc.
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting.com
danoa,millriverconsulting.com
4/25/2006
TOWN OF NORTH ANDOVER f NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT h A
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 c,+„5t�
Susan Y. Sawyer, REHS/RS
Public Health Director
April 27, 2006
Anthony Donato, P.E.
Merrimack Engineering Services
66 Park Street
Andover, MA 01810
;978.688.9540 —Phone
978.688.8476 —FAX
E-MAIL: healthdept@townofnortliaildover.com
WEBSITE: http://www.townofilorthandover.com
RE: Lot 61, May 90, 53 White Birch Lane, North Andover, MA
Dear Mr. Donato,
The proposed on-site wastewater system design plans for the above site dated April 10, 2006 and received on
April 11, 2006 has been reviewed. Unfortunately, they cannot be approved until the following items are
corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by
this design follows each item.
1. Please provide buoyancy calculations for the pump tank — 221
2. Due to inconsistencies on the issue of how to determine whether an old tank is suitable to remain, the Health
Department is now requesting the following addition to subsurface disposal plans. Please provide a detailed
description of the methodology to be used to ascertain the suitability of the existing primary (septic) tank to
determine if it sufficient to be re -used. Please provide images of the components which should be present
and a method for assuring the proper construction and operation of the tank.
3. Please provide detailed information and specifications for the control panel and alarm - 220 and 231
4. Please provide a curve for the pump specified indicating its acceptability for the conditions proposed.
5. Trenches are to be used as the soil absorption system mechanism whenever possible. Please use trenches in
this instance or explain why they cannot be utilized - 240
6. Use of gravel -less chambers for new construction requires a demonstration that the site can accommodate a
conventional soil absorption system, and only then can gravel -less chambers be utilized. Please
demonstrate compliance with this standard. You may choose to use a separate drawing or detail if that
would assist with depicting items more clearly - (see approval letter for gravel -less chambers)
Please feel free to contact the office with any questions you may have. We look forward to working with you to
obtain a wastewater system design which will be in compliance with all regulations and assure protection of public
health and the environment of North Andover.
Sincerely,
Zf
u
S an Y. Sawyer, REHS/RS
Public Health Director
cc: Owner
Applicant
File
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS o LAND SURVEYORS PLANNERS
66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555,373-5721 • FAX (978) 475-1448 • E-MAIL info@merrimackengineering.com
Ms. Susan Sawyer
Public Health Director
1600 Osgood St.
Building 20 — Suite 2-64
North Andover, MA 01845
Re: Whitebirch Lane
Dear Ms. Sawyer:
May 19, 2006
RECEIVED
MAY 2 2 2006
TOWN OF NORTH ANDOVErt
HEALTH DEPARTMENT
We are in receipt of your review letter dated April 27, 2006 for the above referenced site.
We have revised the plan in response to items 1, 2, 3, & 4 of your letter.
With regards to item 1, precast concrete tanks are manufactured with a weight and
thickness specifically designed so as not to float even if almost totally submersed in the
water table provided 9" minimum cover is provided as require by Title 5. Continually
requiring this calculation on a plan is a meaningless exercise.
With regard to item 2, the effort and cost associated with the procedure required by your
department to evaluate the condition of the existing tank would far exceed the cost of
installing a new 1500 gallon tank, we therefore propose to replace the existing 1500
gallon tank with a new 1500 gallon tank. If this design were a straight upgrade design,
our position would be different as upgrades of a system pertain to only the system
components which are failed and the tank appears to be functioning properly.
With regards to item 3, we have provided additional pump notes (9 & 10), however do
not see where in 15.220 or 15.231 more specific information is required relative to the
control panel and alarm. Please note 15.231 (7) as we are not electrical or pump
engineers and the manufacturer should be relied on for this information.
With regards to item 5 & 6, an 11 x 17 redline sketch has been enclosed. This sketch
shows that a conventional system can be accommodated on the property. From this
sketch it can be also be determined that the horizontal and vertical extent of a trench
system is much greater, thus imposing unnecessary disruption and cost to the
homeowner. As we have made this argument continuously in the past, a trench system in
fill does not function as intended by the code because the trenches are not being
constructed in naturally occurring soil but in fill and therefore function as a bed, thus the
Ms. Susan Sawyer
May 19, 2006
Page 2
intent of the code is not necessarily met. Trenches also require filling in between with
specified fill causing unnecessary financial hardship to the owner.
We feel we have adequately addressed your concerns and have provided a design which
meets the requirements of North Andover Board of Health and of Title 5 and provides a
degrade of environmental protection intended by the code.
On behalf of our client, we respectfully request the plan be approved as re -submitted.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
Project Manager
ti
cc: Banacas
MERRIMACK ENGINEERING SERVICES, INC. • 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810
�6 •1r\
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of)V'�tVIO
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eye
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
May 31, 2006
Frank and Lisa Banacos
53 White Birch Lane
North Andover, MA 01845
RE: Septic System Design, 53 White Birch Lane, North Andover, Man 61, Lot 90
Dear Homeowner,
The North Andover Board of Health has completed the review of the septic system design plan
for the above referenced property, submitted on your behalf by Merrimack Engineering Services,
dated, January 28, 2006, last revision date April 10, 2006 and received May 23, 2006.
The design has been approved for use in the construction of an onsite septic system. The 5 -
bedroom (11 -room maximum) design has been approved for use in the construction of a fully
compliant, Title V, subsurface disposal system. This approval is valid for two years from the date
of the approval in accordance with current local regulations and during this time a licensed septic
system installer must obtain a permit and complete this work, and a Certificate of Compliance be
endorsed by the installer, designer and the Town of North Andover.
This approval is subject to the following conditions:
1. If site conditions are found in the field to be different from those indicated on the design plan
and/or soil evaluation, the originally issued Disposal System Construction Permit is void,
installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit.
2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic
system installer or other representative to ensure that all other state and municipal
requirements are met. These may include review by the Conservation Commission, Zoning
Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector.
The issuance of a Disposal System Construction Permit shall not construe or imply
compliance with any of the aforementioned requirement '
3. The plan does not show a diagram of a 3 -float pump system within the pump tank. N.
Andover requires a 3 -float system for the pump on, pump off and alarm.
4. The plan does call for the installation of a septic tank effluent filter. Please be advised that
only certain brands of filters are permitted for use in Massachusetts and each is required to
follow certain approval criteria. Your designer or installer should work with you to assure a
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
licensed brand is selected for use and that the installer follows proper procedure for easy
access and identification of the filter.
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. Sawyer, REHS/RS
Public Health Director
Encl: list of licensed septic system installers
Cc: Merrimack Engineering Services
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Page 1 of 1
DelleChiaie, Pamela
From: Marianne Peters[mpeters@millriverconsulting.com]
Sent: Wednesday, August 09, 2006 3:14 PM
To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer,
Susan
Subject: Important update on 53 White Birch Lane
Regarding 53 White Birch Lane; 3 things that will need to be taken care of — either on your end or let us know and
we'll be happy to do for you.
# 1: The tank needs a manhole to grade over the let
# 2: A vent will need to be installed C,
# 3: Septic tank needs to be checked for -water -tightness; it was low today, so they're filling it up now with a
garden hose and someone should go by there, say tomorrow a.m. to see what happens. It should not have been
as low as it was today according to Randy. 11�v K
Let me know if you need us for any of this.
Marianne Peters
Mill River Consulting
2 Blackburn Center
Gloucester, MA 01930
978-282-0014 ph
978-282-0012 N
8/9/2006
1� &
TOWN OF NORTH ANDOVER of Own,
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER,, MASSACIII-JSETTS 01845 4A
978.688.9540 — Phone
Susan Y. Sawyer, REAS/RS c X8.8 87
Public Health Director E-MAIL: heilthdeDt(k)towii&f'ii6i•ihai7cf-J�&ZMi
SEPTIC PLAN SUBMITTAL FORM I FEB 10 2006
17WN OF NORTH ANDOVER
HEALTH DEPARTMENT
Date of Submission:
Site Location: LAI'je
Engineer:
New Plans? Yes ✓$225/Plan Check # (includes I" submission and one re-
review only)
Revised Plans?Yes $75/Plan Check 4
Site Evaluation Forms Included? Yes I'll/ No
Local Upgrade Form Included? NA,. Yes No
Telephone #:, Fax #: 421i—t44e
E-mail: r1Cj?,CerJ6-. ('? A, 01; COH
Homeowner r
Name: 46
OFFICE USE ONLY
When the submission is complete (including check):
>/Date stamp plans and letter
Complete and attach Receipt
> Copy File; Forward to Consultant
> Enter on Log Sheet and Database
C*
Location: OumeesNume:
rAnpWarcel:
P71
Tel #.
NeWMUL.RCPIr
011(3us
Date: di ... ........... zAmTr _Soil Symbol Ww- Son R=e YIW S
Deep Ohsmvafion Hole Logs*
Elevation
Depth
son HO.
SOU TeMme
Soil dolor
Son mot&g.
% Gravel, Stones, etc:
t., L
z.,;Nt
yz f r, 41
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Time
Time
Time
.Rnte
Percolation Tests
Performed
L' Witnessed Br.
1�!z
1�,:,5,9 1
I JAN 10 2005 �
TOWN OF NORTH ANDOVER 3 roTN
1 ! o ,0. ,�o tr-•r
Office of COMMUNITY DEVELOPMENT AND SERV -;E, o? •�� .. 1%
HEALTH
�
HEALTH DEPARTMENT
w
400 USGUOD STREET
NORTH ANDOVER. MASSACHUSETTS 01845 '�s�cNosEs
Susan Y. Sawyer, REI1S, RS
Public Health Director
APPLICATION FOR SOIL TESTS
DATE: • `"� G'�
978.688.9540 -- Phone
978.688.8476 — FAX
healtlhdeptLI)townofnorthandover.com
www.townof iortilandover.coni
MAP & PARCEL: f . S . X10
LOCATION OF SOIL TESTS: % -7 d .-1 i i 1 i l }, l g- r� t
OWNER: f,�,A !, r ti./ar,.2V F A'.—A Y -v Contact
APPLICANT: /r ,A" r—� Contact #:
ADDRESS:
ENGINEER: i/! L t €1(i�' f ' ,;�"-. 4 t 'r- fn i t Contact #: 1 ";' ) 4 `j '5 ` — ? •�;
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision f�Single Famify I� Commercial
Is This: 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 ownership (Tax bill, or letter from owner permitting test)
> 8.5"x 11 "Plot Plan & Location of Testing (please indicate test pit sites on tile plan)
> Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
> Only Certified Soil Evaluators may perform deep hole inspections.
> Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
> At least two deep holes and two percolation tests are required for each septic system disposal area.
> Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
> Full payment will be required for all additional tests within two weeks of testing.
> Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests).
> Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval
Signature of Conservation
Date back to Health Department: (stamp in):
N� �GMW5 LA IV, lob' ok ����
G
f5
LOT 4
AREA = 23, 263 S. E.
TOP OF
FOUNDA TION
ELEV. = 142.45'
N
EXIS T. 2 1 w
FND.
36
\;. \ 25' \, L 0 T 3
G TFi, 37'
® -1500 GALLON
SEPTIC TANK
PT
Q8 TP
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30.64' 42'
145
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WHITE B1RCH LAME
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: _53 White Birch_
_ _
North Andover
Owner's Name: _Frank Banacos
Owner's Address: _53 White Bir_ch
_ North Andover, MA 01845_
Date of Inspection: _6/7/2006_
Name of Inspector: Neil J. Bateson
Company Name; Bateson Enterprises Inc._
Mailing Address: _111 Argilla Road_
_Andover, Ma. 01810_
Telephone Number: ( 978 ) 475-4786_
RECEIVE®
JUN 1 l 2006
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving:Authority
X F'
1
Inspector's Signature: ` - Date: _6/7/2006_
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments:
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _53 White Birch_
_ North Andover -
Owner: _ Banacos_
Date of Inspection: _6f7/2006 _
Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure
criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated
below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass"
section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements.
If "not determined" please explain.
The septic tank is metal and over 20 years old* or the septic tank
(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is
imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by
the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain
Observation of sewage backup or break out or high static
water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven
distribution box. System will pass inspection if (with approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to
broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _53 White Birch_
_ North Andover
—
Owner: Banacos
Date of Inspection: 6n12006
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
_ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance _
"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
i
i
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 53 White Birch _
North Andover
Owner• _Banacos _
Date of Inspection: 6f7/2006 _
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
_Yes _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_Yes — Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded
or clogged SAS or cesspool j
_Yes_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
No Liquid depth in cesspool is less than 6" below invert or available volume is V2 day low.
No7 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
No Any portion of the SAS, cesspool or privy is below high ground water elevation.
_ _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ No Any portion of a cesspool or privy is within a Zone 1 of a public well.
No Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ _No Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the will 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 presenceof 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 most be attached to this form.]
_Yes_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described
in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to
determine what will be necessary to correct the failure
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
You must indicate either "yes" or "no" to each of the following: j
(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
i
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.
Page 5 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: _53 White Birch _
_ North Andover _
Owner: _Banacos
Date of Inspection: 6/7/2006_
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Yes_ — Pumping information was provided by the owner, occupant, or Board of Health
No Were any of the system components pumped out in the previous two weeks ?
Yes_ ` Has the system received normal flows in the previous two week period ?
No Have large volumes of water been introduced to the system recently or as part of this inspection ?
Yes _ Were as built plans of the system obtained and examined?
Yes Was the facility or dwelling inspected for signs of sewage back up ?
Yes Was the site inspected for signs of break out ?
Yes _ Were all system components, excluding the SAS, located on site ?
_Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the
condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum ?
_Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the
proper maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes No
_Yes_ _ Existing information.
_Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable) [3 10 CMR 15.302(3)(b)J
Page 6 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: _53 White Birch_
_ North Andover–
Owner: _Banacos _
Date of Inspection: 6/7/2006_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): _4_ Number of bedrooms (actual): _5_
DESIGN flow based on 310 CMR 15.203 _440 _
Number of current residents: _4
Does residence have a garbage grinder (yes or no): No_
Is laundry on a separate sewage system (yes or no): –No–
Laundry system inspected (yes or no): _
Seasonal use: (yes or no): _No_
Water meter reading: Yes, _
Sump pump (yes or no): _No_
Last date of occupancy: _Current
COMM ERCLUJINDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): `gpd
Basis of design flow (seats/persons/sgft,etc.):
Grease trap present (yes or no): _
Industrial waste holding tank present (yes or no):
Non -sanitary waste discharged to the Title 5 system (yes or no): —
Water meter readings, if available: —
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: _Pumped 2005, owner _
Was system pumped as part of the inspection (yes or no): _No
If yes, volume pumped: gallons -- How was quantity pumped determined? _
Reason for pumping: _
TYPE OF SYSTEM
X Septic tank, distribution box, soil absorption system
_ Single cesspool _ Overflow cesspool
Privy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
Tight tank _ Attach a copy of the DEP approval
— Other (describe): _
Approximate age of all components, date installed (if known) and source of information:_ 12 Years old,
10/23/1994, as built plan _
Were sewage odors detected when arriving at the site (yes or no): Yes_
Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 53 White Birch_
_ North Andover _
Owner: _Banacos_
Date of Inspection: 6n1206
BUILDING SEWER _ X _ (locate on site plan)
Depth below grade: _24"
Materials of construction: _ cast iron —X-40 PVC —other
Distance from private water supply well or suction line:
Comments (on condition of joints, venting, evidence of leakage, etc.) 4" PVC thru wall to tank, 3" PVC in
house, no leaks visible _
SEPTIC TANKS: X
Depth below grade: _12" _
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: 10' x 5' x 4'
Sludge depth —2" _
Distance from top of sludge to bottom of outlet tee or baffle: 24" _
Scum thickness: _2"
Distance from top of scum to top of outlet tee or baffle: -
8" -Distance from bottom of scum to bottom of outlet tee or baffle: _18"_
How were dimensions determined: _Tape Measure _
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc _ Inlet tee ok. Outlet tee ok. Depth of liquid above outlet
invert. No evidence of septic tank leaking in or out.
GREASE TRAP: _(locate on site plan)
Depth below grade: —
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.):
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 White Birch_
_ North Andover -
Owner: _Banacos
Date of Inspection: 6n12006
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass _polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: —X
—
Depth below grade _12"_
Depth of liquid level above outlet invert: 8"
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 -Boz level & distribution equal. Evidence of carryover. No evidence of
leakage. Liquid above all inverts_
PUMP CHAMBER: (locate on site plan)
Pump in working order (yes or no):
Alarm in working order (yes or no): _
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 53 White Birch_
_ North Andover_
Owner• Banacos_ j
Date of Inspection: _ 7/2006_
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number. _
leaching galleries, number:
_X leaching trenches, number, length: 2 trenches 42' long_
_ leaching field, number, dimensions:
overflow cesspool, number:
innovative/alternative system Typetname of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): _ Soil mushy. Vegetation green. Signs of ponding to surface. _
CESSPOOLS:
Number and configuration: —
Depth — top of liquid to inlet invert: —
Depth of sludge layer: _
Depth of scum layer: _
Dimensions of cesspool: _
Materials of construction: _
Indication of groundwater inflow (yes or no): _
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
t i
Page 10 of 11
OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 53 White Birch
_ North Andover_
Owner: Banacos
Date of Inspection: 6n12006_
i
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.
Ato1=42'1"
Ato2=49'4"
A to D -Boz = 62'2"
Bto1=28'
Bto2=28'5"
B to D -Boz = 45'9"
` Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _53 White Birch _
_ North Andover_
Owner: _Banacos
Date of Inspection: _617/2006_
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water _ 4' _
Please indicate (check) all methods used to determine the high ground water elevation:
X Obtained from system design plans on record - If checked, date of design plan reviewed: _3/24/1992_
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: As per design plan _
N
LOT 4
N
o
AREA =2326J S.F.
N
h
36.4' T,
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214, o LOT 3
LOT 5 36,41'
i
TOP OF
FOUNDATION
ELEV. = 142.5'
WHITE
BIRCH LANE
CON
FOUNDATION LOCATION PLAN THE HORIZONTAL cl 'O REw`�EX OF TTHHE LOOCAALLRMS TO
APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED.
(THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER
SCOTT CONSTRUCTION
RESTRICTIONS SUCH"S COVENANI�WETLANOSTS.
rEASEMEN
CLIENT ORDERS OF CONDIWAM )
THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY
THIS CERT/FICATlON 1S MADE AND LIMITED PURPOSE OTHER INAN THAT OUTLINED ABOVE.EXCEPT WITH THE
WRJTTEN PERMISSION OF CHR1371ANSEN & SOM INM
TO THE ABOVE CLIENT. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY
u unIDRIZEO uSE
LOCATION: NORTH ANDOVER,MA.
SCALE: 1 "=40' DATE.6/7/94
CHRISTIANSEN & SERGIPROFESSIONAL �,�
f60 SUMMER ST. HAVERHII.4MA. 01830 TEL 508-373-WIO
Q 1.994 BY CHR/51LINSEN & SERGI IN0.
OF CNRISTdNSEN B SERGI INCA AND ANY NA
IS PROHIBITED.ChR/SWSEN & SERGI TAKES NO RESPONSIBILITY
FOR THE UNAUTNORMED USE OF THIS DRAWING OR ANY /NFOR-
MATIDN CONTAINED HEREOX
BASED ON SCALED DATA ONLY THE PRIMARY STRUCTURE SHOWN
IS NOT LOCATED IN A FLOOD HAZARD ZONE AS SHOWN ON FEMA
FLOOD INSURANCE RATE MAP.
COMMUNITY N0.: 250098 00050 DAM612/93
uvvu.NO.:93067016
PROFILE
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