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HomeMy WebLinkAboutMiscellaneous - 531 FOREST STREET 4/30/2018 531 FOREST STREET 21011.068 D044-D000.0 o \� t a ` a � p/ i North Andover Board of Assessors Public Access Page 1 of 1 I NORTH Rooth Andover Board of Assessors .kZ:.. sr 9SSACN°gam roperty Record Card Click Sea]To Return Parcel ID :210/106.B-0044-0000.0 FY:2011 Community : North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels 14 .Search for Sales Inti Summary T Residence {- Detached Structure Condo �� �.-�'`""� w �•a���>�,.$ 531 FOREST STREET Commercial Location: 531 FOREST STREET Owner Name: BARON,STACEY C/O GMAC MORTGAGE LLC Owner Address: 1100 VIRGINIA DRIVESUITE 300 4 City: FORT WASHINGTON State: PA . Zip: 19034 Neighborhood:6-6 Land Area: 1.03 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1188 soft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 338,200 335,900 Building Value: 131,100 128,800 Land Value: 207,100 207,100 Market and Value: 207,100 Chapter Land Value: LATEST SALE Sale Price: 337,500 Sale Date: 06/11/2007 Arms Length Sale Code: Y-YES-VALID Grantor: JOBLON,TANYA. Cert Doc: Book: 10789 Page: 235 I http://csc-ma.us/PROPAPP/display.do?linkld=1707978&town=NandoverPubAcc 3/24/2011 Residential Property Record Card PARCEL ID:210/106.B-0044-0000.0 MAP:106.B BLOCK:0044 LOT:0000.0 PARCEL ADDRESS:531 FOREST STREET FY:2011 PARCEL INFORMATION Use-Code: 101' Safe Price: 337,500 Book: _ 10789 Road Type; T' T Inspect Date T 09/21/2®03 Owner: Tax Class: �T Sale Date: 06/11_/07_ -Page: -235_ _ Rd Condition: P Meas Date: - 09/21/2003 BARON,STACEY Tot Fin Area: 1.188 _Safe Type__P_V Cert/Doc: - _ _W Traffic: M _Entrance:_ _v X-' C/O GMAC MORTGAGE LLC Tot Land Area: '1.03 _ Sale Valid: Y _� Water: Collect Id _RRC- Grantor:— JOBLON,TANYA- —Sewer: InspecfReas: S Address: �- -- - - -- —--__—_ _ _ —. -� _ - _ _ . 1100 VIRGINIA DRIVE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / FORT WASHINGTON PA 19034 RESIDENCE INFORMATION LAND INFORMATION Style: RR Tot Rooms: 6 Main Fn Area: 1188 Attic: NBHD CODE: 6 NBHD CLASS: 6 ZONE: R2 - - -- - __ --- - - - Se �T'e"Code Method S�Ft_Acres - Influ-Yf Value Class Story Height: -4.00Bedrooms: 3 Up Fn Area:_ Bsmt Asea: 336 g_-- _ Yp__ _ __ _.____ p" -�__ _ ___ J' -_ 1 P 101 S 43560 1.000- 206,910 Roof: G --Full Baths: 1 Add Fn Area T_-Fn'Bsmt Area: 336 — - - -- - _ 2 R 101 A 0 0.030 228 -Ext Wall: �FB Half-Baths: 1 Unfin Area: Bsmt Grade: Masonry Trim:_ Ext Bath Fix: 0 Tot Fin Area: 1188 VALUATION INFORMATION Foundation: CN Bath Quak T _ RCNLD: 131088 Current Total: 338,200 Bldg: 131,100 Land: 207,100 MktLnd: 207,100 Kitch Qual: T Eff Yr Built_ 1980 Mkt Adj_ Prior Total: 335,900 Bldg: 128,800 Land: 207,100 MktLnd: 207,100 Heat Type: HW Ext Kitch:F Year Bwl_t: - 1976_ Sound Value Fuel Type __: O ----_ - �GFade: 'AG. Cost Bldg: — 131,1_00__1 Fireplace:- _'_1 Bsmt_Gar Capp _Condition: A AttStr Val 1:• v Central AC: N• Bsmt Gar S_F: 480 Pct Complete:��r _ _ Att Str Val2: Aft Gar SF %Good P/F/E/R: /100/100/82 Porch Type Porch Area Porch Grade Factor E 168 W 120 SKETCH PHOTO A14 . E W �; 12 168 Sq.Fb 120 Sq. 0 +uw; 1D FM i k4 1188 Sq.Ft 480 Sq.Ft 25 24 26 c _ a tt . 531 FOREST STREET Parcel ID:210/106.13-0044-0000.0 as of 3/24/11 Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael J. Wood use the return Name of Inspector key. Service Pumping & Drain Co., Inc. Company Name 5 Hallberg Park Company Address North Reading MA 01864 Cityrrown State Zip Code 978-276-0217 5021 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ` ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority RECEIVED APR 2 7 2015 4-12-2015 TOWN OF NORTH ANDOVER Inspe is Signatur Date11EAEFH DEPARTMENT The system inspector shall submit a copy of this inspection report to the Approving AuthorityBoard pp 9 ( of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts 64 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19; 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is North Andover MA 01845 4-2-2015 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) I Inspection Summary: Check A,B,C,D or E/always complete all of Section D � i A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are j indicated below. i Comments: I I I B) System Conditionally Passes: I ❑ 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. I Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. I 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 i Compliance indicating that the tank is less than 20 years old is available. i ❑ Y ❑ N ❑ ND (Explain below): I I I i I t5ins•3H3 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i" 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N. ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR M303(1)(b)that the system is not functioning in a manner which will protect public health; safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of:17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is North Andover MA 01845 4-2-2015 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 asses if the well water analysis, performed at a DEP certified labor Y P Y , p story, 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 99 P ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sawage Disposal System•Page 4.of 17. Commonwealth of Massachusetts Tine 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. 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 drinkingwater supply I pp Y ❑ ❑ 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•3H3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of. Commonwealth of Massachusetts h v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page. City/Town 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 an of the system components um in ® y y p pumped out 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Titles 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 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 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?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currently occupied Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Ganonser da d P y(gP ) 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: t51ns•3/13 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 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 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: owner Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation.and maintenance contract(to be obtained from system owner)and a copy of latest i inspection of the UA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Septic tank, pump chamber, distribution box, SAS t5ins•3/13 Title 5 Official Inspectlon Form:Subsurface'Sewage Disposal System•Page 8 of V Commonwealth of Massachusetts ` Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: This system is approximately 4 years old according to plans dated 3-2-2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 38"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): There are no visible signs of failure. Septic Tank(locate on site plan): Depth below grade: 28 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 5' I Sludge depth: 4„ ! t5ins•3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 90,17 I - I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner owner's Name information is required for every North Andover MA 01845 4-2-2015 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 >2 3" Scum thickness Distance from top of scum to top of outlet tee or baffle 9.1 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape measure/sludge 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.): There are no visible signs of failure. This system has an outlet filter which should be cleaned annually. 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 t5ina•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of.17. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is North Andover MA 01845 4-2-2015 required for 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 t5ins•3/13 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 531 Forest Street Property Address. Jeffrey Lloy and.Gina Funari Owner Owner's Name information is North Andover MA 01845 4-2-2015 required for every page. Cityrrown 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 at invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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 components appear to be in good working order. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 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 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is North Andover MA 01845 4-2-2015 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 40 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There are 40 infiltrator chambers. There are no visible signs of failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityfrown 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 ygr4 lf 3$1 g � O -&� f(sn up zmr._ 1 a„ 321 C AAM f t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 II ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page, Citylrown 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: 60"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: 3-2-2011 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: Plans Before filing this inspection Report, please see Report Completeness Checklist on next xt page. t5ins•3113 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 531 Forest Street Property Address Jeffrey Lloy and Gina Funari Owner Owner's Name information is required for every North Andover MA 01845 4-2-2015 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file J t51ns•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 .. • • • s PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division p(FWq- j%C E jrrT oT CoW�.�A,1 J- As of: riC28 2011 ghis is to certify that the infiividuaf su6surface dui posed system received a SMISTACTORMSMMOMof the: Complete flair and'Construction of an On-Site S Sewage 0sposafsystem By games KPffett .fit• . • 53 1 Forest Street 210/106.B-0044-0000.0 Wa 1 06.B^4 'arceG-0044 5 ortfiAndover, wA 01845 MiceIssua this certifica t 6e construedas aguarantee that the system udff function satisfactorily. , �7fS/sR,S SPu &V as rDt'rector u MeaCth(Director 1600 Osgood Street,North Andover,Massachusetts 41845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnerthandaver.com I, DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, April 28, 20114:46 PM To: 'christian@silvestricorp.com' Cc: Bill Dufresne (wrdufresne@comcast.net); 'jim.kellettexcavating@comcast.net; Sawyer, Susan Subject: COC-Septic-531 Forest Street, North Andover, MA 01845 Attachments: 20110428162753473 Importance: High Follow Up Flag: Follow up Flag Status: Flagged Re:531 Forest Street,North Andover,MA 01845 Owner: Christian Silvestri c/o: Silvestri Corporation 13-15 Delaware Drive Salem,NH 03079 Contact: 603.235.7447-Cell 603.898.0344-Office Dear Mr. Silvestri, Attached is the Certificate of Compliance for the septic system at 531 Forest Street,North Andover,MA Please call the office on Friday if you have any further questions. fiat�eganda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 W Office-978-688-9540 Fax-978-688-8476 (] Email-pdellechiaieCa)townofnorthandover.com Website http_//www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 pORTfh P OQ 4t�aora�h0 r RREIVED PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(.),constructed;( )repaired; By: �c T rr (Print Name) Located at: )?j _ I 0!fXt-r 7r e�j (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated ��— and last revised on ?7-Z__ ] f ,with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 4-7- 11 Engineer Represen live(Signature) And—Print Name Final Construction Inspection Date: Engineer Representative(Signature) And—Print Name Installer: (Signature) Date: e And—Print Name Enginer: Vlki4d AA0kA1#d_ (Signature) Date: Oee2' e'o And—Print Name .1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com ,ay^ North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 531 Forest St. MAP: 106 B LOT: 44 INSTALLER: Jim Kellett DESIGNER: Merrimack, Vladimir Nemchenck PLAN DATE: 1-18-11 BOH APPROVAL DATE ON PLAN: 3-22-11 � I INSPECTIONS I TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTI N: 4/14/11 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan Yes, cleanout and bend added to waste pipe ® Existing septic tank properly abandoned Z Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base Cleanouts per plan Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ❑ Watertightness of tank has been achieved by testing Z Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Only minimal water in tank, need to recheck water-tightness PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction Z 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 ❑ . cover at final grade installed over pump access port ® Water tightness of tank has been achieved by visual testing ® Hydraulic cement around inlet & outlet Comments: Pump chamber had approx. close to half full of water CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: crawl space under stairs inside ® Alarm signal located inside: crawl space under stairs inside Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ❑ Inlet tee (if pumped or >0.087foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: D-Box had inlet baffle wall; this wall's purpose is to diffuse the velocity as the wastewater enters, but it would not allow the inlet-pipe to J completely drain. I advised the installer to drill two -1" or 2" holes in the baffle so the liquid would drain into the leaching pipes and not remain trapped behind the baffle wall. SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to 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 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: As there was no barrier proposed, special attention needs to be paid to final grading to insre breakout has been met. R&5 61 VV M, I Y#m-'k_ SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: LP Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows (trenches): 5 Comments: Total Chambers = 40 A SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Septic Tank IN . 94.54 94.25 Septic Tank OUT 94.28 94.00 Pump Chamber IN 94.26 93.95 Pump Chamber OUT n/a pressure n/a pressure Distribution Box IN 97.73 97.70 Distribution Box OUT 97.57 97.53 Lateral 1 INVERT 97.48 97.48 Lateral 2 INVERT 97.48 97.48 Lateral 3 INVERT 97.49 97.48 Lateral 4 INVERT 97.49 97.48 Lateral 5 INVERT 97.48. 97.48 I actually found a couple of errors on the as-built check list and will send you a new one soon. As for the last one submitted, 531 Forest. I know you did not have this prior so I will not hold you to it. Except for one thing I am concerned of.The break out. Would you please send me an email with the statement including the confirmation that the breakout has been met for 531 Forest?The current one, on your as-built only regards the components. We thought about requiring an actual final grade for the as-built, but rather than the extra expense to the homeowner decided that a statement would suffice. You can probably guess that an old problem between a homeowner, engineer and installer, regarding break out, 'influenced this decision. Thank you. I will go ahead and prepare the COC anticipating your email. Susan From: DelleChiaie, Pamela Sent: Wednesday, April 27, 20119:58 AM To: Bill Dufresne (brdufresne@comcast.net); Osgood, Benjamin C. Cc: Sawyer, Susan; Grant, Michele Subject: Septic - AS BUILT CHECKLIST Hello, Susan asked me to send you the new,updated As Built Checklist to use with all future submissions of As-Built plans to the Health Department. Please call if any question. Thank you. feat� Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 I Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 R Fax-978-688-8476 D Email-pdellechiaie@townofnorthandover.com `6 Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:hfta://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. 2 Map-Block-Lot wo�xM , Commonwealth of Massachusetts r Parmg No 4---------- Board of Health North Andover BHP-2o11--- -- �� P.I. FEE F.I. $250:00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James-Kellett ---------------------------------------------------=------------------------------------------------- to(Repair-FULL SYSTEM)an Individual Sewage Disposal System. at No 531 FOREST STREET " -------------------------------------------------------------------------------------------------------5----------- as shown on the application for Disposal Works Construction Permit No. BHP-2011.056 '" Ddted--A;March.30,2011 Lf I LL ----------------------------------------------------------------- Issued On:Mar-30-2011 Board of Health r' ,fir°e';'tio Application for Septic Disposal Svstem s Bpd TODAY'S DATE aConstruction Permit — TOWN OF , MA 01845 $250.00—Full Repair ORTH ANDOVER s�CK„y $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the g p y computer,use XRepair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not key the return y. A. Facility Information - O 53 02es-i- strcEms► 7REEIVEID —V Address or Lot# 'IN'it 113 A ISI City/Town 2.-*TYPE OF SEPTIC SYSTEM*: TOwN or EPA RTMENMEN ANDOVER HEALTH D@PAT Pump ❑ Gravity(choose one) ***If pump system,attach copy of electrical permit to application*** ❑Conventional System(pipe and stone system) 'Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information C T�C me l'lyi �. 1,1,;AplenT.s LL C. Name Address(if different from above) City/Town " State Zip Code Telephone Number 3. Installer Information Name c Name of Company Address /_�hn/�/_/ a/9y� City/Town State Zip Code/ Telephone Number(Cell Phone#if possible please) a. Desianer Informatiog"'p, Name Name of Company 6, G Oz S � Address All-povfn / /1--17/1 Ur` City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 • y Application for Septic Disposal Svstem *Construction Permit - TOWN OF TODAY'S DATE ORTH ANDOVER, MA 01845 $250.00—Full Repair �+s��K,►s $125.00-Component PAGE 2 OF 2 A. Facility Information continued.... S. Type of Buildina: Residential 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 No h Andover, and not to place the system in operation until a Certificate of Compliance has b e issued by this B aid&f Health. 4 ame L. Date r Applicati ApprovedBy: and of Health Representative) L Al ame Date Application Disapproved for the following reasons: For Office Use Only: P 1. �4ttach � Yes L No 2. Project Manaex Obligation Form Attached? Yes o 3. Pump vs7em?-"Ifso,Attach copy of Electrical it es✓ No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Pians?(new construction only): Yes No I Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licens d installe forthe onstruction for the septic system for the property at: ,�2 / Y plans b l (Address of septic system) For P Y //P (Engineer) Relative to the application of RJ nstaller's name) And dated i rigma ate Dated — l (today's ate With revisions dated — ` (Last revisee d date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans 2dor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally,this is the first(VS inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal OK(or e-mail to: healthdept antownofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer,I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used.. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other . components. 6. As the installer,I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor,or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: L f— j� (Today's Date) Af ame—Print) a —Signed) Commonwealth of Massachusetts /official use Only Permit No. 1 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 leave blank APPLICATION FOR PERMIT TO PERFORM ELECT , - All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 C (PLEASE PRINT IN NK OR TYPE ALL INpORMATIOA9 Date: March 30,201 f� C City or Town o£ North Andover To the Inspector of described below. w By this application the undersigned gives notice of his or her int! ion to perform the electrical wor d TOWN OF NORTH ANDOVER Location(Street&Number) 'fit 3 r Owner or Tenant CBC Realty Investment,LLC Telep Owner's Address 76 State Street Newburyport,MA.01950 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Residential Dwelling Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity flat switches and control panel. in table may be waived by the Inspector of Wires. 10002 � No.of Tota Date.... .:. l- Transformers KV A t Generators KVA Of NORTH, O.O mergency t mg �? � TOWN OF NORTH ANDOVER 0 le Units PERMIT FOR WIRING FIRE FARMS No.of Zones �o -:•'; 7 No. v c Initiating Dees �sscMusE� No.of Alerting Devices No.of Self-Contained This certifies that ......... P �C�Nj¢1-aJ Detection/Alertin Devices ......... ................................................... Municipal Local❑ Connection Other has permission to perform ... "C""" Security Systems: wiring in the building of �A C nt ..............J................................. Data Wiring: ass. at ..� /GL �� No.of Devices or Equivalent I ................. orth Andover, nlcatlons wm : Irl Te No.of Devices or Equivalent Fee.... No. �.Z. � ............... . ..... / . ECTRICAL INSPE R Check # til if desired,or as required by the Inspector of Wires. �unicipal policy.) fth MEC Rule 10,and upon completion. INSURANCE COVERAUt: umess waircu vy erformance 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 rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE coF BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: David W Meehan LIC.NO.: 81296A Licensee: David W Meehan Signatuk YAJ T lPe LIC.NO.: 8126A (If applicable, enter "exempt"in the license number line.) V Bus.Tel.No.: 978-587-7518 Address: 4 Mulberry Drive Peabody,MA.01960 Alt.Tel.No.: 978-5354022 *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 re- quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent PERMIT FEE:$ Signature Telephone No. _t . ,OPY • R7�HDa ,. ��Lv fir.. North Andover Health Department (ommunity Development Division March 22, 2011 CBC Realty Investments, LLC 76 State Street Newburyport, MA 01950-2821 RE: Subsurface Sewage Disposal System Plan for 531 Forest Street Map 106B lot 44 North Andover, Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review ofthe septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated January 18, 2011,last revised February 14, 2011. The design has been approved for use in the construction of a replacement onsite septic system for a three bedroom design at 330 gallons per day. Generally this plan would be good for 3-years from the date of approval,however since this repair is the result of a Title V report failure,this system must be completed within two years of the date of the failure, July 17,'2010. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also 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 (3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 531 Forest Street March 22, 2011 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 and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Z u an Y.�$a er, RE �R$� ublic ealth Dire or cc: Vladimir Nemchenok, Merrimack Engineering file c Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, February 14, 20119:56 AM To: Bill Dufresne (brdufresne@comcast.net) Cc: Sawyer, Susan Subject: Septic- Plan Disapproval-531 Forest Street Attachments: 20110214094517126 Dear Bill, Please see the attached letter from Susan re: plan review for 531 Forest Street. Thank you. haat Rg4SW4, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 9 Office-978-688-9540 Fax-978-688=8476 Email-pdellechiaieotownofnorthandover.com '11] Website hM://www.townofnorthandover.com/Pages/index "We can never seethe path of our life 4'we are too busy focusing on the pebbles under our feet."--Anonymous 1 • S��TI>ED n� . oil r--=- • it ATZD North Andover Health Department (ommunity Development Division February 14,2011 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 531 Forest St.,Map 106B,Lot 44 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated January 18,2011 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Please provide 12"between the ESHGW and tank piping or request a Local Upgrade Approval (15.221(5)) 2. While the use of mercury floats is not disallowed in Mass,the sale of mercury floats has been banned in Mass since May 1, 2009.Please consider replacing the mercury floats with mechanical floats or some other switching method 3. Please provide the proper breakout protection(move the proposed 98 contour 15' off the edge of the leaching area)or provide an impermeable barrier(15.255 (2)) 4. Note 13 indicate no wells within 200 ft. of the system. If the well across the street is less than 200 ft, please provide approximate distance. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. YSincere r,REHS th Director cc: CBC Realty Investments,LLC File North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Friday, February 11, 20112:14 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: FW: The synopsis Claire gave me was that while there is no law saying you can not use mercury floats, but there is a law that says you can't sell them in Mass. .. She said there use should be"discouraged"though. Randy Burley Project Manager 978-282-0014 From: Golden, Claire (DEP) [mailto:Ciaire.Golden(-astate.ma.us1 Sent: Friday, February 11, 2011 11:11 AM To: Randy Burley Subject: Mercury floats would be classified as a mercury switch or relay device and would be covered by the MA Mercury Management Act provisions regarding the sale of such products.Their use should be discouraged. Switches and relays that contain mercury cannot be sold in Massachusetts after May 1, 2009. .The sales ban does not apply if the use of a product is a federal requirement or if a specific exemption is obtained from MassDEP. To obtain an exemption, a manufacturer must demonstrate: = The product benefits the environment or protects public health or safety, => There is no technically feasible alternative to the use of mercury in the product, =:;> A"non-mercury" alternative is not available at a reasonable cost, and => There is a system in place to collect the"end of life" mercury product and recycle the mercury content. (see attachment as well). NEWMO and NEIWPCC did a project for us last year looking at mercury device use at water treatment plants. Additional information including alternatives may be found at http://www.newmoa.org/prevention/mercury/imerc/factsheets/pum ps.cfm Claire A. Golden Environmental Engineer IV Watershed Permitting Program MaSSl)EP/NERD/BRP ' 2058 Lowell Street Wilmington, MA 01887 1 � S�TSI"ED7� North Andover Health Department (ommunity Development Division February 11,2011 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disaosal System Plan for 531'Forest St.,Mau 106B,Lot 44 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated January 18,2011 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5` 310 CMR 15.000,or North Andover regulation that is not met by this design follows each item. 1 F1ease—ro� Leh-e-rmnes-of-abutter-s-from-the most-recent-tax-map-(NA 3�2) k a-\2 Ea,a annotate-the-proposed 98-foot contour(NA 3.2) 3. Please provide 12"between the ESHGW and tank piping or request a Local Upgrade Approval(15.221(5)) 4. While the use of mercury floats is not disallowed in Mass,the sale of mercury floats has been banned in Mass since May 1,2009.Please consider replacing the mercury floats with mechanical floats or some other switching method -�r , r5-^Rl ase indica'�Ph�-final grade over the leaching area is to be pitched at 2%min.(15.240(10)) 6. Please provide the proper breakout protection(move the proposed 98 contour 15' off the edge of the leaching area)or provide an impermeable barrier(15.255(2)) f 7. Please provide approximate distance to the well across the street Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y.Sawyer,REHS/RS Public Health Director cc: File Page 1-of 1 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 A TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 �"'a •>`#* NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM - Date of Submission: I-ZI—I I �101S ' TOWN OF NORTH ANDOVER Site Location: �J ,� HE LTM DEPARTMENT Engineer: - Diu- New Plans? Yes V $ 25/Plan C eck# b 11 g (i cludes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? Yes No Telephone#:� 5-K71�7_ Fax#: (1 7)_�7Cj-) j E-mail: Or%�COA CA; Homeowner Name: ` OFFICE USE ONLY When the submiss'on is complete(including check): ➢ Date stamp plans and letter ➢ c// Complete and attach Receipt ➢ l/ Copy File; Forward to Consultant ➢ ✓ Enter on Log Sheet and Database �� 0//_6 Commonwealth of Massachusetts - City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M� Z A. Facility Information , :. G67e— e"LTY Owner Name "�, 14— v Street dress Map/Lot# '–i 43 NEli�t)uj?�J!Z2al- City State Zip ode B. Site Information 1. (Check one) ❑ New Construction [Upgrade ❑ Repair 2. Published Soil Survey Available? Yes ❑ No If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes WIN o If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? Yes ❑ No Within the 100-year flood boundary? E] Yes No Y rY Within the 500-year flood boundary? ❑ Yes E No Within a velocity zone? ❑ Yes L`7 No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS): 17-1-20I G Range: ❑ Above Normal VNormal ❑ Below Normal Month/Year 7. Other references reviewed: i t5foeml 1.doc•rev. 1/10 Form 11–Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal o C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) T-I 1 - 17-11 ( 0'•�� -,.j �) 1 S a&04N�C Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole: qo,z Location (identify on plan): �PI; �tiS 2. Land Use !!�l.i-�G L� 1= r-I t i .� ��LZ (e.g.,woodland,agric Rural field,vacant lot,etc) Surface tones Slope(%) k 1 tJ 6012 fi t -2 L.�P' Vegetation LandformPosition` on Landscape(attach sheet) ?Icm � � 1 1� � 3. Distances from: Open Water Body fee Drainage Way feet Possible Wet Area feet D I-1• I Property' Line feet Drinking Water Well fee- t Other feet 4. Parent Material: I I Unsuitable Materials Present: ❑ Yes �'No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 60 1�• 2 P 9 inches elevation i t5form11.doc•rev.1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: I Redoximorphic Features Coarse Fragments Soil Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Depth(In.) USDA Structure Consistence Other Layer Moist(Munsell) (USDA) Cobbles 8 (Moist) Depth Color Percent Gravel Stones S O YgL�1 f'i�,L• ' ?S�•1C� Zs t✓-1'�' ip� 5YNa Z' g I",AA.AW-,?.l i Additional Notes: t5form11.doc•rev.1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 <in,\ Commonwealth of Massachusetts ` City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ,J C. On-Site Review (continued) Deep Observation Hole Number: Date Time Dy� Weather r '� 1. Location / Ground Elevation at Surface of Hole. Location (identify on plan): �Zio(>L-o Gk�-1 4 "e j-auol _ � ��� 42- FE 2. Land Use (e.g.,woodland,agricultural field,vacant of,etc.) Surface Stones S o (%) �..At,0l►.) e IVs - -lC .��, pe ' �L- M Vegetation Landform Position on Landscape(attach sheet) I 0 � 3. Distances from: Open Water Body feet Drainage Way fee Possible Wet Area fee Property Line feet- Drinking Water Well feet� Other feet 4. Parent Material: Unsuitable Materials Present: es ❑ No If Yes: ❑ Disturbed Soil 21�illMaterial ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes No If yes: Depth Weeping from Pit Depth Standing Water in Hole Depth to High Groundwater: 762Estimated De P g inches elevation l t5form11.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Page 4 of 8 Commonwealth of Massachusetts City/Town of d Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Z Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) USDA Structure Consistence Other Layer Moist(Munsell) (USDA) Cobbles& (Moist) Depth Color Percent ravel Stones Additional Notes: t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 <tsl Commonwealth of Massachusetts ' City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal , Y' D. Determination of High Groundwater Elevation 1. Method Used: A. B. ❑ Depth observed standing water in observation hole inches inches A. B. ❑ Depth weeping from side of observation hole inches inches A. t, B. VDepth to soil redoximorphic features (mottles) inches inches A. B. ❑ Groundwater adjustment(USGS methodology) inches inches 2 Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorp on system? es ❑ No It It tl b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: inches t5forml 1.doc•rev. 1110 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts ' City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. ignature o oil Evaluator Date I Typed or Printed Name of Soil Evaluator License# Date of Soil Evaluator Exam Name of Board ot Heal Witness Bard of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out A. Site Information I forms on the computer,use 4 only the tab key Owner Name to move your 9�! cursor-do not Street Address or Lot# use the return G�^7 key. 06. 1!�l(9 ice. ' City/Town ,. State Zip Code Z r.ontict Person(if different from Owner) elephone'Number x B. Test Results Date p Time Date Time Observation Hole# �- - Depth of Perc Start Pre-Soak ` End Pre-Soak Time at 12" I 1 Time at 9" ► I � L8 Time at 6" Time(9"-6") Rate(Min./inch) Test Passed: [� Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnessed By: Comments: i t5form12.doc•06/03 Perc Test•Page 1 of 1 I - 531 FOREST STREET JS-2011-000355 Pr®iect Detail llep®�t Printed On:Wed Mar 30,2011 Project Name: Septic System GIS#: _ . 6936. Project No: JS-20.1.1-000355. Owner of Record CBC INVESTMENTS- - - Map: 106.13 Date Submitted: Mar-21-2011 76 STATE STREET Block: 0044 Status: Open NEWBURYPORT,MA 01950-2821 Lot: Work Cate ory; Work Location: 531 FOREST STREET 40 g Zoning: Proposed Use: District: � ''"•X14•`' ' land Use: 101 Proposed Use Detail Subdivision 5 BCH Description Septic System Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health YELLOW FLAG BHJ-2011-000008 3/30/2011-Received DWC application from Jim Kellett. Missing Obligation Form and copy of electrical permit. 3/22/2011-Septic Plan Approval letter sent out. 3/18/2011(Fri)-received revised setpic plan hand delivered by Bill Dufresne at 4 p.m. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Design Approval-Plan Re-BHP-2011-0562 Mar-22-2011 APPROVED JS-2011-000355 Septic System upgrade DWC-System Repair BHP-2011-0569 Mar-30-2011 SIGNED OFF JS-2011-000355 GeoTMS®2011 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 TOWN OF NORTH ANDOVER f N RTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER MASSACHUSETTS 01845 'ssaT,,,,5�t iiE 'v Susan Y.Sawyer,RENS,RS lhlthde 688.9540—Phone Public Health Director 688.8476—FAX JAN "C Z U 1 1 t townofnorthandover.com �� .townofnorthandover.com TOOF NORTH ADOVER APPLICATION FOR SOIL DEPARTMENT DATE: I— P::2 ® Z O L MAP&PARCEL: G LOCATION OF SOIL TESTS: OWNER: V-,ao Contact#: APPLICANT: C gr, g urt�ADu 9��Dntact#(M ADDRESS:76 .��TC � " IJP. O?Lf lzY f�Wf-,M4 6;1 *:�r ENGINEER: Contact#: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential SubdivisionIngle Family Home Commercial Is This: Repair Testing: Undeveloped Lot Tes ' 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 nit sites on the elan) ➢ 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 II N.A. Conservation Commission Approval ate. Signature of Conservation Agent: /V 0 W Date back to Health Department: (stamp in): I1 s, / 71 1 say i i O 7S0 J y� / / O a2yt 9s3 1 1 I 8 so Soo t � ism 0 X* - 7 0 \�'� �° 45,soo fs i s i 1 \ 6 1 � 45 SOo ± i \ 4 3 \' 1 50,000 1! 46,000 ± 45 000 x 45000 ± Q . � ti � 1 W i .. 1 C \` �jTf Q 2000 iso.o PLAN OF LAND IN . PUU-iJ SOA D UPEWAL } OAMLAW SRPi?T REX.comm, NOMr/4 ANDOVER, MAss. PLditASAL DD�9D tIr OWNED BY 1 A"A/A NAUJOKS Hipipr,' z; -- SCALE /=5o JAN. 1963 a r•J' .Pm_1�m.cL((ae�l�oe v�l�S. ¢� -� f•ko...�Slp j.f� _ ARASSE-a ASSOCIATE r041DAllgy ST. HAVE/2"I—,M,. ra; PRINTED BY:Pamela DelleChiaie- PLEASE LEAVE IN PRINT-OUT TRAY.,.,...THANK YOU. DelleChiaie, Pamela From: brdufresne@comcast.net Sent: Thursday, January 06, 2011 12:50 PM To: DelleChiaie, Pamela Subject: Re: 531 Forest Street / TM 1068 TL 44 Pam, I have a copy of a Title 5 inspection which was performed on 7-17-10 for 531 Forest Street by Paul Cardone of Septic Compliance, Inc. His report indicates that he obtained an as-built plan for this site from the BOH. Could you please e-mail me the as-built and approved design plan for this site if you in fact have them. am doing an upgrade design and will be submitting an application for soil testing to you soon. Thank you, Bill Dufresne Merrimack Engineering ----- Original Message ----- From: "Pamela DelleChiaie" <Pdellech(D-townofnorthandover.com> To: "Bill Dufresne (b rdufresne(cD-comcast.net)" <brdufresne(a)-comcast.net> Sent: Tuesday, January 4, 2011 3:59:43 PM Subject: FW: 62 Farnum Street - Septic File Information -Atach 2 Information you requested on 62 Farnum Street -Atach 2 Best Regards, Pamela DelleChiaie Departmental Assistant lCommunity Development Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 N Office - 978-688-9540 9 Fax - 978-688-8476 9 Email - Pdellechiaie(cDtownofnorthandover com ; Website hftp://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous -----Original Message----- I OF 2 DelleChiaie,Pamela ti PRINTED BY: Pamela DelleChiaie-PLEASE LEAVE IN PRINT-OUT TRAY.......THANK YOU. DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Monday, January 17, 20112:48 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: Emailing: Soil test results 531 Forest St.pdf Attachments: Soil test results 531 Forest St.pdf Happy Martin Luther King day. Please find attached the results of the soil testing at 531 Forest Street. Sincerely, Randy Burley The message is ready to be sent with the following file or link attachments: Soil test results 531 Forest St.pdf Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/vreidx.htm. Please consider the environment before printing this email. ,i IDFI DelleChiaie,Pamela r• - r III , T i I j -4._4 , I I f � t ink 3 IT rev 75,E .IY I i II , I � r _ I � t Commonwealth of Massachusetts . W Title 5 Official Inspection Form . �. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 531 Forest t_ Property Address " Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-20opection page. City/Town State Zip Code Date of In Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not F. Paul Cardone use the return Name of Inspector key. ;! r Septic Compliance, Inc. QsJI�� U1 Q Company Name 4om Boston Street TOWN OF NORTH ANDOVER ITMENT file Company Address Topsfield _ Ma. 01983 City/Town State Zip Code 978-407-1808 978-681-0726 3294 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 E alu by cal Approving Authority I ctor'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. t 531 Forest St No.andover me 7-17-10 coco early•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 531 Forest Property Address Coco,Early &Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 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. 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 531 Forest St No.andover me 7-17-10 coca early-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 i t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 531 Forest M Property Address Coco,Early &Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a p p y borderingvegetated wetland or a salt 9 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. 531 Forest St No.andover me 7-17-10 coco early-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 531 Forest Property Address Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: i 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 1h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 531 Forest St No.andover me 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 531 Forest Property Address Coco,Early &Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 531 Forest St No.andover me 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 531 Forest Property Address Coco,Early &Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town 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)] 531 Forest St No.andover ma 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 531 Forest Property Address Coco,Early&Associates Owner Owners Name information is required for every North Andover Ma. 01845 7-17-2010 page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 Number of current residents: 5 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 (gpd)): Well Sump pump? ❑ 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? I ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 531 Forest Sl No.andover ma 7-17-10 Coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 531 Forest M Property Address Coco,Early &Associates Owner Owner's Name information is North Andover Ma. 01845 7-17-2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Last pump on file 7-19-06 Emergency pump 9-7-05 18009allons 1000 tank 800 pump chamber Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Pump truck tube To properly p integrity inspect structural inte rit of the tank and Reason for pumping:p p g baffles Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: According to report on file,built in 1977 I Were sewage odors detected when arriving at the site? ❑ Yes ® No 531 Forest St No.andover ma 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 531 Forest Property Address Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 24"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.): looked in OK condition ( old system ) Septic Tank (locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1" 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? Septic Dip-Stick 531 Forest St No.andover ma 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G'M 531 Forest Property Address Coco,Early &Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 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.): We recommend tank be pumped on a yearly basis, Baffles are deteriorating, we recommend sanitary tee's pvc be put on,level was ok,no apparent leakage. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): I Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 531 Forest St No.andover ma 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 531 Forest Property Address Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: N/A Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): i Depth of liquid level above outlet invert Even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in need of replacement deteriorating around pipes,some carryover,distribution appeared to be equal. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No 531 Forest Sl No.andover ma 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 i Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 531 Forest Property Address Coco,Early&Associates Owner Owners Name information is required for North Andover Ma. 01 4 q eery 8 5 7-17-2010 page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Some solids in pump chamber,chamber itself ok, pump works, wires in chamber need to be tied up according to the pumper. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 shallow pits ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): yard area stoney none none no grassy front 531 Forest St No.andover me 7-17-10 coco early°08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 531 Forest Property Address Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i Privy (locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 531 Forest St No.andover me 7-17-10 coco early-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 531 Forest Street North Andover,MA 01845 Owner's Name: Michael Ciofolo Date of Inspection: November 8,2006 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. ® w E4L p isTAtJCCS IGO `} Z�' T 3.S•ot .. 2r, �- bg 38.3 94-0 - P - . p� a 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 531 Forest Street North Andover,MA 01845 Owner's Name: Michael Ciofolo Date of Inspection: November 8,2006 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. e, w EcL p 5,T A>jtES 1 v zM � 3S�a 1.14•a 32 0 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 531 Forest Property Address Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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. I 531 Forest St No.andover me 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 531 Forest Property Address Coco,Early&Associates Owner Owner's Name information is required for every North Andover Ma. 01845 7-17-2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 6'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: i i You must describe how you established the high ground water elevation: Took info. of of report on file dating 11-8-06,basement was dry, no sump The house had a garbage grinder,system not designed for one ,also had a water softener,we recommend softener be leached to a separate area not in main system. At the time of the inspection the bottom of the pipe to the top of the liquid in the pit was 2" not enough separation need atleast 6" 531 Forest St No.andover ma 7-17-10 coco early•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 ME PROFESSIONAL EXPERTS IN THE SEPTIC & ®RAIN INDUSTRY A — PLEASE PAY FROM THIS SILL— Aomer Name: ? r 7 CHISHOLM ROAD vice Location: KINGSTON, NH 03848 (603)329-6005•(978)3748803 me: --• _ ;� 978 921-5353. 978 465-2121 • 603 772-2759 itact www.boraczekseptic.com ng Address: • RESIDENTIAL / COMMERCIAL • SERVICING THE ENTIRE NORTH SHORE • CERTIFIED TITLE V INSPECTORS �p SAME DAY EMERGENCY SERVICE e of Service: _ Nature of Service Special Instructions ❑Completed / 71- ,I 7 akeg. Maint. ❑Incomplete/Reason: 9 ❑EmergencyP r• e ❑Schedule: C []-f5ay ❑Night AM /PM :rvices Rendered :uum Pumping ❑Car Wash eptic ❑Dump Charges rywe Tank minimum 54ons of sand Observations Drain Cleaning I I- rywell o ood Condition ❑Main Line each Pit/Overflow $ hon+9/o fuel _surcharge.Any amount over ❑Leach field Runback ❑Toilet Bowl '-Box 5 tons will be billed. ❑Riding High ❑Kitchen Sink •ump Chamber (liquid level) 0 Bathtub/Shower ;rease Trap ❑Yearly Profile Fee$ ❑Full to Cover ❑Vanity atch Basin ❑Excessive Solids ❑Floor Drain ortable Toilet Top/Bottom ❑Yard Drain ❑Boraczek Charges ❑Use No Powdered Soap ether $ 4 hour minimum P ❑Vent lty. $ 1 hour travel ❑Heavy Grease ❑Water Jetting iize: ❑Roots ❑Other ❑Suggest Electric Rootering ❑Footage: Inder 1000 galltins 01000 gallons ❑1500 gallons ❑Van Called 000 gallons ❑3006 gallons ❑4000 gallons ❑Other 000 gallons ❑6000 gallons ❑other scellaneous igging Charge ❑Backhoe ❑Inspection kation tc i in. ❑Kubota hrs. ❑Title V Inspection ervice Call ❑Consultation Reason: abor ❑Estimate ❑Pump Repair laiting_Time ❑System Installation ❑Repair ❑Portable Toilet Rental ❑System Treatment Iging Charge Is Per Driver's Discretion ❑Baffle ❑Rejuvenation ascription of Work :commendations Terms of Payment: C.O.D. PARTS uum Pumping Drain Cleaning Payment Reguired.Dpon Service 'CI Cashes '% TA _Yr. -Month Yr. Month eck ❑Credit rms & Conditions DISCOUNT lot responsible for damage beyond the curb)fne. 3.1.5%per month will be charged to accounts past due. _ II complaints shall be reported within 48 Furs. 4.The purchaser agrees to pay all cost of collection. TOTAL i ! undersigned agree to all term and conditionsr- _ns .tomer Signature !%�•""..F,�- � Serviceman t^••�'�_'1 r SUMMARY OF INVERTS BUILDING TIES f SEWER 0 FDTN. PRE-EXIST. BLDG. CORNER A B C Nom. THIS PLAN & CERTIFICATION IS NOT r SEPTIC TANK IN 94.50 SEPTIC TANK OUT 39.2 24.5 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 94.27 PUMP TANK OUT 45.2 33.4 SYSTEM. IT 1S A RECORD OF THE LOCATION PUMP TANK IN 94.25 T. B 0 X 48.4 38.0 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 97.72 COMPONENTS. DIST. BOX OUT 97.54 INV. IN CRAM, 97.44 BOTT. CHAM. 97.15 DWI, w r~ Swu TANK 11000 OAL POMP TAW K a� 7 D-Box ry ( / 4D RIFIL1RAT& i CHA1BE718 V¢NT i arse. . 150' MET I I IH OF MAss9 oy O VLADIMIR L. G g NEMCHENOK m V � y AS , BUILT FLAN At ��G� OF SUBSURFACE DISPOSAL SYSTEM' 0 LOCATED INrn o NORTH ANDOVER, MASS./531 FOREST STREET n AS PREPARED FOR m = a zO j CBC REALTY INVESTMENTS TM: 106B m ;v DATE: 1 4-20-11 TL: 44 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 .. . . • ����L � • •. • � CLQ�t1 �SND�.t/��ty� • Ivo G'4'e'3'46E' /S� y / PROPOSED SZIS' FAGS SEK/Ao* blSf L, cSysncm 7 Pk'U GAS D�(JEGG./�'✓li, LOT #Z P,eopodeb -Zor aT e.4,blAl'G 7 0247'E OL(/A/E2 NCtiif�lA�'� �O.t.'cSi C1�• R-VISID 41/ 717 , 10 LDCA T/o ti: LOT' Z / / O.E'E5 T '-S IV 00 cTosEPN cT BAR OAGAL[. o WE-5 rWAR b e-(RCGP Tei. l)6-S/C,(J DATA : .; � �, \ \ TYPE• DF B!!/C�/A/G= -3. BC"Z���C��t�l ,(J GfIEZ�../�tf-G� . , ARACE � CELL4� PLUMB N FAG/G/T/E j i I SE6f/AhE FLOW EST/MATE_ 4.50G G 0, . l . ' SEPT/C 74".A< /000 �Ac - .f pwELC ! -10" ,4R'EA 9D0 �5 L1�5o 'P?lo BcZ f� Z. f J �PERCOCAT/O�c1 TESTS• i DATE -/S-7G -. ! TDP ELE//AT/ON BZ,O A2rnDp J EGEvAT/aN D / 1 &4 7-41,C4 rioA/ 3 o iLl/A/. M/N. F " OROP /tiI/M. M/N. it4in/ A41A.' �" DROP 9 �{,J/N_ Al/N. M7N: Al , 3. B' Nl. d ff� fir.. .. !� �V / � /v.T P/Ts4--VAT/ON BZ.o a?�. o 9� ;I y.. SO/c- TYPES T/a.L ' B.M. - - - - -------- -• / 1p O ,3 AND 2AUEZ- kw") 6,q 4 OC T :a WA rE On/ ,f3ouc DEC / W fan.•/.: '. \ 50. „ o•_ E C62. ISrdJ 45 T07 0M EGEIIA7 74-,o _ ;2 f3 TESTS CG�rc/Dl1GTED B�/ <TD�E,oN .T..'BQCBAGA000 ; �.S. 3So 74 .TAC' 1 5 . .�'7 •, It rev TESTS W1rNESSE� BY : Ale AA/!)oVEr HEALTf� DEPT. i PZAA! e DES/ctil ee l7 Fie/A cS'HE•E7 , / OF 2 C,