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Miscellaneous - 535 SALEM STREET 4/30/2018
Health Department r 535 Salem Street -7, S�ZTLED�j6Q6 ♦ �4 1 � h V PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF gaco?f COMPLIANCE As of: November 6, 2017 i This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Full Repair of On-Site Sewage Disposal System By: James Kellett At: 535 Salem Street Map 38 Lot 66 North Andover, MA 01845 Nichele f this cernats not be co strued as a guarantee that the system will function satisfactorily. Grant Public Health Inspector 120 Main St.,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov PUBLIC HEALTH DEPARTMENT Community&Economic Development TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION (� The undersigned he eby certify thaSewage Disposal System GA constructed; ( )repaired; ov��1��• By: J riot Name) Located at: (Installation Address) Was installed in conformance with the North Andover Board o Health approved plan, originally dated n lb/1�7 and last revised on / ,with a design flow of V 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: b �13) ,,J,) �� /,n Enginee a re nt ' (Signature) And—Print Name Final Construction Inspection Date: /VL� 'To1'_ I Engineer ep ntative(Signature) And—Print Name Installer: (Signature) Date: /� /7 And—Print Name Engineer: (Signature) Date: 1 _ And—Print Name 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov • S�.�TL'ED'7�g6 ,.=yet- • • North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 535 Salem Street MAP: 38 LOT: 66 INSTALLER: James Kellett DESIGNER: John D. Sullivan, III Sullivan Engineering Group PLAN DATE: September 1, 2017 with a final revision September 25, 2017 BOH APPROVAL DATE ON PLAN: October 13, 2017 INSPECTIONS TANK INSPECTION: 10/25/2017 DATE OF BED BOTTOM INSPECTION: 10/23/2017 DATE OF FINAL CONSTRUCTION INSPECTION: 10/30/2017 DATE OF FINAL GRADE INSPECTION:11/3/2017 SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Interior plumbing relocated to exit the front of the house. SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan j ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-20 loading ® Monolithic tank construction ® Watertightness of tank has been achieved by j visual testing ® Inlet tee installed, centered under access port i ® Outlet tee installed, centered under access port (effluent filter) ® 20" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots cement around inlet & outlet Comments: Tank Inspection —Tank was severely cracked on 2 sides as well as the bottom —Tank was cracked completely through the outside and inside - M. Grant PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: 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 N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 28 x 37 SAS over dig cuts into tank by about 1ft and also cuts into driveway 12 — 18" It shows it on the plan. Installer May consider installing a flower/mulch bed between the leach field and driveway to deter vehicles parking j on the leach field. SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ® Loamed ® Seeded ® Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ® As-Built Plan BM = 100.00 HR = 3.79 HI = 103.79 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 3.90 99.54 99.47 Septic Tank IN 4.19 99.25 99.27 Septic Tank OUT 4.46 98.98 99.02 Pump Chamber IN Pump Chamber OUT Distribution Box IN 4.49 98.95 98.97 Distribution Box OUT 4.65 98.79 98.80 Lateral 1 TOP 4.83 /4.95 Lateral 1 INVERT 98.61 / 98.49 98.63 / 98.50 Lateral 2 TOP 4.81 /4.95 Lateral 2 INVERT 98.63 / 98.49 98.63 / 98.50 Lateral 3 TOP 4.83 /4.95 Lateral 3 INVERT 98.61 / 98.49 98.63 / 98.50 Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber 5.81 98.0 98.0 SKETCH PLAN CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws T_EEDy6oc • •�'4A78A,� '1 . North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 535 Salem Street MAP: 38 LOT: 66 INSTALLER: James Kellett DESIGNER: John D. Sullivan, III Sullivan Engineering Group PLAN DATE: September 1, 2017 with a final revision September 25, 2017 BOH APPROVAL DATE ON PLAN: October 13, 2017 INSPECTIONS TANK INSPECTIO � DATE OF BED BOTTOM INSPECTION: 10/23/2017 DATE OF FINAL CONSTRUCTION INSPECTION: 10/30/17 DATE OF FINAL GRADE INSPECTION: W� SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Interior plumbing relocated to exit the front of the house. SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-20 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port e� �. e'�L toaj 'r ® Outlet tee installed, centered under access port (effluent filter) ,® 20" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots cement around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: 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 r N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 28 x 37 SAS over dig cuts into tank by about 1ft and also cuts into driveway 12 — 18" It shows it on the plan. Installer may consider installing a flower/mulch bed between the leach field and driveway to deter vehicles parking on the leach field. FINAL GRADE A' Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan BM = 100.00 H R = 3.79 HI = 103.79 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 3.90 99.54 99.47 Septic Tank IN 4.19 99.25 99.27 Septic Tank OUT 4.46 ✓ 98.98 9 9.0 2 Distribution Box IN 4.49 98.95 98.97 Distribution Box OUT 4.65 98.79 98.80 Lateral 1 TOP 4.83 /4.95 Lateral 1 INVERT 98.61 / 98.49L.." 98.63 / 98.50 Lateral 2 TOP 4.81 /4.95 Lateral 2 INVERT 98.63 / 98.49 98.63 / 98.5 Lateral 3 TOP 4.83 /4.95 r 11_� Lateral 3 INVERT 98.61 /98.49 98.6 / 98.50 Bottom of Bed 5.81 98.0 ✓ 98.00 �r CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Bank3 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 5�3 �5-S�a,� cc\ S-F Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) ✓ All changes to the design plan have been reflected and noted on the as-built plan 2) ✓ As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 7 3) Street Address,Assessor's Map and Lot Number 4) v Lot Lines and Location of Dwellings served by the system 5) 1�� cations,Elevations and Dimensions of As-built system compo ents,includin serve (if a licable) 6) Ties to all tank openings,d-box,and leach area from dwelling or Perm nt Structure t Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins ✓ Property lines v1 Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9) Location of water,gas,electric lines,cable,control panel (if applicable) 10) '� Location of Structures within 6 Inches of Finished Grade ' 11 ✓Original Stamp&Signature 12) A Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) North Arrow 15) &Elevation of Benchmark used I6 71/ Location STATEMENT ON PLAN NA 5.3 a. "I certify the locations, elevations, ties, cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the break out elevations,if applicable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was, or was not,constructed in accordance with the intended design and any manufacturer's specification." Signature of Designer Date As of:Tuesday,March 17,2015 I ' i- I CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS, ETC., SHOWN ON THIS AS—BUILT SUBSTANTIALLY AGREE WITH THE APPROVED TAX MAP 38 LOT 6 PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS HAVE BEEN MET. #547 SALEM STREET N/F DANIEL WINNING EX-1 1/2 STORY { WOOD FRAME LOT AREA STRUCTURE Ex. 1 Car OF 32,487 S.F.± HS Top of Fnd=103.32' Garage N #535 4" SCH. 40 PVC CIVIL e; �,- 44j SEWER LINE No.0586 SOIL ABSORPTION AREA SIONAl�� I LEACHING BED 56 i 20' 00 O 18'W x 27'L 9' Bit. Conc. JOHN D. SULLIVAN III, PE W/ 3 DISTRIBUTION LINES Sit. 1,500 GALLON CONC. SEPTIC �i 10 �-'.Y y T �o� TANK (MONOLI THIC) ca N RECEIVED DrivewayI H-20 CONC. END OF DISTRIBUTION m I m 7 YTH'- �Y `J D—BOX — 6 OUTLET OV - 2017 PIPES ARE INTERCONNECTED F Inspection E �A Pressurized Water 12' Port V TOWN OF NORTH ANDOVER Service (field located) HEALTH DEPARTMENT i 128.0'± �V i COO, OWNER: Ex. Bit. Conc. Sidewalk W BB W WINNING FAMILY IRREVOCABLE TRUST BB BENCHMARK: 535 SALEM STREET W SALEM STREET PK NAIL IN SIDEWALK ELEv- 100.00' NORTH ANDOVER, MA 01845 GRA PHI C SCALE (ASSUMED DATUM) SCALE. 1"-20' ASSESSOR INFORMATION : FEET 20 0 10 20 40 TAX MAP 38 LOT 66 535 SALEM STREET SCHEDULE OF ELEVATIONS DESIGN AS—BUILT SSMC AS'--BUIL EPZ" OF LAND IIN SEWER INVERT OUT OF HOUSE N/A 99.54' NORTH ANDOVER, MASSACHUSETTS SEWER INVERT INTO SEPTIC TANK 99.27' 99.23' SEPTIC SYSTEM TIES BUILDING CORNER (ESSEX COUNTY) SEWER INVERT OUT OF SEPTIC TANK 99.02' 99.02' A B SEWER INVERT INTO D—BOX 98.97' 98.96' SEWER AT FOUNDATION 27.2' N/A PREPARED FOR WINNING FAMILY IRREVOCABLE TRUST SEWER INVERT OUT OF D—BOX 98.80' 98.77' SEWER COVER OVER SEPTIC INLET 30.8' 36.9' SEWER INVERT BEGIN LEACHING TRENCH 98.63' 98.61' SEWER COVER OVER SEPTIC OUTLET 37.9' 29.6' SCALE. I "= 20' DATE: OCT. 27, 2017 SEWER INVERT END LEACHING TRENCH 98.50' 98.50' CENTER OF D—BOX 44.7' 29.2' PREPARED BY BOTTOM OF LEACHING FIELD 98.00' 98.00' EDGE OF FIELD (C) 23.3' 54.1' SULLIVAN ENGINEERING GROUP, LLC MAXIMUM SEASONAL GROUNDWATER 95.00' EDGE OF FIELD (D) 43.8' 31.0' P.O. Box 2004 LOCAL UPGRADE APPROVAL GRANTED: EDGE OF FIELD (E) 54.4' 45.2' WOBURN, MA 01888 (781) 854-8644 1) THE APPLICANT WAS GRANTED A LOCAL UPGRADE APPROVAL FROM THE EDGE OF FIELD (F) 39.8' 63.3' NORTH ANDOVER BOARD OF HEALTH TO ALLOW A THREE FOOT SEPARATION BETWEEN INSPECTION PORT 35.2' 54.0' SHEET No. 1 OF 1 THE BOTTOM OF THE LEACHING BED AND THE SEASONAL HIGH GROUNDWATER TABLE. I CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS, ETC., SHOWN ON THIS AS—BUILT SUBSTANTIALLY AGREE WITH THE APPROVED TAX MAP 38 LOT 6 PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS HAVE BEEN MET. #547 SALEM STREET N/F DANIEL WINNING EX-1 1/2 STORY WOOD FRAME LOT AREA STRUCTURE Ex. 1 Car OF 32,487 S.F.± S' Top of Fnd=103.32' Garage N #535 4" SCH. 40 PVC o CML B SEWER LINE o.41566 I Ao C GISTEFL ��� AL SOIL SOIL ABSORPTION AREA j V LEACHING BED 20' O 00 18'W x 2 7'L 56.9' 1 W1 3 DISTRIBUTION LINES Bit. Conc. V 1,500 GALLON CONC. SEPTIC JOHN D. SULLIVAN III, PE 0 10 TANK (MONOLITHIC) Cl) m TH r ; �, -CO, :; -- - - N RECEIVED m < .A Driveway H-20 CONC. -F<.' Cl) rTH-1 �,=tT NIkO'� - 1 2017 END OF DISTRIBUTION m 1 E D—BOX — 6 OUTLET PIPES ARE INTERCONNECTED i F Inspection �v 1OWN OF NORTH ANDOVER Pressurized Water I 12' Port V --i Service (field located) } r ;,;,;Wr,r' TViENT i 128.0'± i OWNER : Ex. Bit. Conc. Sidewalk BB W W WINNING FAMILY IRREVOCABLE TRUST BB BENCHMARK. 535 SALEM STREET W SALEM STREET NAIL . SIDEWALK EL ELEv- 10 000' NORTH ANDOVER, MA 01845 GRA PHI C SCALE (ASSUMED DATUM) SCALE: 1`20' ASSESSOR INFORMATION : FEET 20 0 10 20 40 TAX MAP 38 LOT 66 535 SALEM STREET SCHEDULE OF ELEVATIONS SEPTIC AS-BUILT PLAN OF LAND DESIGN AS—BUILT LOCATED IN SEWER INVERT OUT OF HOUSE N/A 99.54' NORTH ANDOVER, MASSACHUSETTS SEWER INVERT INTO SEPTIC TANK 99.27' 99.23' SEPTIC SYSTEM TIES BUILDING CORNER (ESSEX COUNTY) SEWER INVERT OUT OF SEPTIC TANK 99.02' 99.02' A B SEWER INVERT INTO D—BOX 98.97' 98.96' SEWER AT FOUNDATION 27.2' N/A PREPARED FOR SEWER INVERT OUT OF D—BOX 98.80' 98.77' SEWER COVER OVER SEPTIC INLET 30.8' 36.9' WINNING FAMILY IRREVOCABLE TRUST SEWER INVERT BEGIN LEACHING TRENCH 98.63' 98.61' SEWER COVER OVER SEPTIC OUTLET 37.9' 29,6' SCALE: I "= 20' DATE: OCT. 27, 2017 SEWER INVERT END LEACHING TRENCH 98.50' 98.50' CENTER OF D—BOX 44.7' 29.2' PREPARED BY BOTTOM OF LEACHING FIELD 98.00' 98.00' EDGE OF FIELD (C) 23.3' 54.1' SULLIVAN ENGINEERING GROUP, LLC MAXIMUM SEASONAL GROUNDWATER 95.00' EDGE OF FIELD (D) 43.8' 31.0' P.O. Box 2004 LOCAL UPGRADE APPROVAL GRANTED: EDGE OF FIELD (E) 54.4' 45.2' WOBURN, MA 01888 (781) 854-8644 1) THE APPLICANT WAS GRANTED A LOCAL UPGRADE APPROVAL FROM THE EDGE OF FIELD (F) 39.8' 63.3' NORTH ANDOVER BOARD OF HEALTH TO ALLOW A THREE FOOT SEPARATION BETWEEN INSPECTION PORT 35.2' 54.0' SHEET No. 1 OF 1 THE BOTTOM OF THE LEACHING BED AND THE SEASONAL HIGH GROUNDWATER TABLE. I CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT TAX MAP 38 LOT 6 COVERS, ETC., SHOWN ON THIS AS—BUILT SUBSTANTIALLY AGREE WITH THE APPROVED #547 SALEM STREET PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS HAVE BEEN MET. N/F DANIEL WINNING EX-1 1/2 STORY WOOD FRAME LOT AREA STRUCTURE Ex. 1 32,487 S.F.± Car NOF ^� Top of Fnd=103.32' Garage N #535 4" SCH. 40 PVC 0 CML ��- B SEWER LINE No.41586 Ci 0 SOIL ABSORPTION AREA [}V �sfONAL��G LEACHING BED I 20' O O 18'W x 2 7'L 56.9' W1 3 DISTRIBUTION LINES Bit. Conc. V 1,500 GALLON CONC. SEPTIC JOHN D. SULLIVAN III, PE 0 i 1�� — o� TANK (MONOLITHIC) i NI CD �• m N CD 0 — — Driveway /^ H-20 CONC. END OF DISTRIBUTION F. I `DH'- v p-BOX - 6 OUTLET PIPES ARE INTERCONNECTED F Inspection Pressurized Water I 12' Port V Service (field located) i 128.0'.± i Cchl OWNER: Ex. Bit. Conc. Sidewalk BB W BB W BENCHMARK: WINNING FAMILY IRREVOCABLE TRUST W PK NAIL IN SIDEWALK 535 SALEM STREET SALEM STREET ELEV= 100.00' NORTH ANDOVER, MA 01845 GRA PHIC SCALE (ASSUMED DATUM) SCALE. 1"--20' ASSESSOR INFORMATION : FEET 20 0 10 20 40 TAX MAP 38 LOT 66 535 SALEM STREET SCHEDULE OF ELEVATIONS DESIGN AS-BUILT SEPTIC AS—BUILT PLAN OF LAND LOCATED IN SEWER INVERT OUT OF HOUSE N/A 99.54' NORTH ANDOVER, MASSACHUSETTS SEWER INVERT INTO SEPTIC TANK 99.27' 99.23' SEWER INVERT OUT OF SEPTIC TANK 99.02' 99.02' SEPTIC SYSTEM TIES BUILDING CORNER (ESSEX COUNTY) A B PREPARED FOR SEWER INVERT INTO D-BOX 98.97' 98.96' SEWER AT FOUNDATION 27.2' N/A WINNING FAMILY IRREVOCABLE TRUST SEWER INVERT OUT OF D-BOX 98.80' 98.77' SEWER COVER OVER SEPTIC INLET 30.8' 36.9' SEWER INVERT BEGIN LEACHING TRENCH 98.63' 98.61' SEWER COVER OVER SEPTIC OUTLET 37.9' 29,6' SCALE: I ".= 20' DATE: OCT. 27, 2017 SEWER INVERT END LEACHING TRENCH 98.50' 98.50' CENTER OF D-BOX 44.7' 29.2' PREPARED BY BOTTOM OF LEACHING FIELD 98.00' 98.00' EDGE OF FIELD (C) 23.3' 54.1' ,SULLIVAN ENGINEERING GROUP, LLC MAXIMUM SEASONAL GROUNDWATER 95.00' EDGE OF FIELD (D) 43.8' 31.0' P.O. BOX 2004 LOCAL UPGRADE APPROVAL GRANTED: EDGE OF FIELD (E) 54.4' 45.2' WOBURN, MA 01888 1) THE APPLICANT WAS GRANTED A LOCAL UPGRADE APPROVAL FROM THE BETWEEN EDGE OF FIELD (F) 39.8' 63.3' (781) 854-8644 NOR774 ANDOVER THE BOTTOM OF THE LEACHING BED AND ATHE SEASONAL HIGH GROUNDWATER AT BLEINSPECTION PORT 1 35.2' 1 54.0' SHEET No. 1 OF 1 I CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT TAX MAP 38 LOT 6 COVERS, ETC., SHOWN ON THIS AS—BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS HAVE BEEN MET. #547 SALEM STREET N/F DANIEL WINNING EX-1 1/2 STORY WOOD FRAME LOT AREA STRUCTURE Ex. 1 C 32,487 S.F.± or !k OF = 3.32' Garage S To of F nd 10 9 P N _ #535 4" SCH. 40 PVC QB 4q C1ViL SEWER LINE No.41586 A o �a �FGI TE���� v SOIL ABSORPTION AREA j V LEACHING BED i 20' 00 O 18'W x 2 7'L 56.9' i W1 3 DISTRIBUTION LINES x Bit. Conc. V 1,500 GALLON CONC. SEPTIC JOHN D. SULLIVAN III, PE i o 10 Y — •r-� o� TANK (MONOLITHIC) o i CD . _ RECEIVED in < � Driveway f,.� H-20 CONC. �!OV — 1 ZO17 END OF DISTRIBUTION m 1 CD YTH-h \'J D—BOX — 6 OUTLET PIPES ARE INTERCONNECTED i F Inspection E ��A�A TOWN OF NORTH ANDOVER Pressurized Water 1 12' Port V HEALTH DEPARTMENT Service (field located) /Z- 128.0'± OWNER : Ex. Bit. Conc. Sidewalk BB W WINNING FAMILY IRREVOCABLE TRUST BB W BENCHMARK: 535 SALEM STREET W SALEM STREET PK NAIL /N SIDEWALK ELEv- 100.00' NORTH ANDOVER, MA 01845 GRA PHI C SCALE (ASSUMED DATUM) SCALE.• 1`20' ASSESSOR INFORMATION : FEET 20 0 10 20 40 TAX MAP 38 LOT 66 535 SALEM STREET SCHEDULE OF ELEVATIONS SEPTIC AS BUILT PLAN OF LAND DESIGN AS—BUILT LOCATED IN SEWER INVERT OUT OF HOUSE N/A 99.54' NORTH ANDOVER, MASSACHUSETTS SEWER INVERT INTO SEPTIC TANK 99.27' 99.23' SEWER INVERT OUT OF SEPTIC TANK 99.02' gg.02' SEPTIC SYSTEM TIES BUILDING CORNER (ESSEX COUNTY) A B PREPARED FOR SEWER INVERT INTO D-BOX 98.97' 98.96' SEWER AT FOUNDATION 27.2' N/A SEWER INVERT OUT OF D-BOX 98.80' 98.77' SEWER COVER OVER SEPTIC INLET 30.8' 36.9' WINNING FAMILY IRREVOCABLE TRUST SEWER INVERT BEGIN LEACHING TRENCH 98.63' 98.61' SEWER COVER OVER SEPTIC OUTLET 37.9' 29.6' SCALE: I "= 20' DATE: OCT. 27, 2017 SEWER INVERT END LEACHING TRENCH 98.50' 98.50' CENTER OF D-BOX 44.7' 29.2' PREPARED BY BOTTOM OF LEACHING FIELD 98.00' 98.00' EDGE OF FIELD (C) 23.3' 54.1' SULLIVAN ENGINEERING GROUP, LLC MAXIMUM SEASONAL GROUNDWATER 95.00' EDGE OF FIELD (D) 43.8' 31.0' P.O. BOX 2004 LOCAL UPGRADE APPROVAL GRANTED: EDGE OF FIELD (E) 54.4' 45.2 WOBURN, MA 01888 (781) 854-8644 1) HE APPLICANT WAS GRANTED A LOCAL UPGRADE APPROVAL FROM HE EDGE OF FIELD (F) 39.8' 63.3' BOARDNORTH ANDOVER SEPARATION BETWEEN THE BOTTOM OF THE LEACHING BED AND HE SEASONAL HIGH T GROUNDWATER TABLE. INSPECTION PORT 35.2' 54.0' SHEET No. 1 OF 1 ' v TOWN OF NORTH ANDOVER 5F�111�,r Community & Economic Development - RECEIVE® HEALTH DEPARTMENT 120 Mainn Street b� k41MO NORTH ANDOVER,MASSACHUSETTS 01845 TOWI`IR7H ANDOVs O NFA�TH p�pAR7MF.N� 978.688.9540—Phone 978.688.9542—FAX healthdept@northandoverma.gov northandoverma.gov www.nortliandoverma.gov APPLICATIO1 FOR SOIL TESTS DATE: ,�p �j 3 D �� MAP&PARCEL: At'`� ✓ (� J/10LOCATION OF SOIL TESTS: " 6AO,/ O.�ER WfPJP�IN Contact#: ©I )3 - APPLICANT: 5� /3 Contact#: ADDRESS: �r ✓,l�Cls". dLJ� ENGINEER: �J � J"'W Contact it: CERTIFIED SOIL EVALUATOR: ' `(� •fs Fr16)4r2 //Wb J'4 ff Intended Use of Land: Residential Subdivision Sin=Family Commercial Is This: Repair Testing:—D\ Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot Plait&Location of Testin lease indicate test piaiies ort rile planj ➢ Fee of$585.00 per lot for new construction. This covers t inimu two deep holes and two percolation tests required for each disposal area. Fee440.0 er lot for repairs or upgrades. GENERALINFO M N ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Cottuuissiot proval Date: Signature of Conservation Agettt artment: t to Date back to Health Dep p in : � • l 1 • Sullivan Engineering Group, LLC, Civil Engineers&Land Development Consultants June 30, 2017 Town of North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: 535 Salem Street, North Andover Letter granting permission for soil testing To Whom It May Concern: I,, Winning, owner of 535 Salem Street,North Andover grant permission to conduct soil testing on the property for a future septic system. �02� Signature Date: Ya' :10 �I P (l Rnv 70(14 Wnhiirn MA 01 RRR (781) R5d_RAAA P_mail iaeken1151nenmeact nPt i Town of North Andover, MA July 5, 2017 I e 038.0,01'07 �p 038r ©c a� 038.0008 c� 038.0-0004 0;,025-7 038.0-0103 3 031 >� EhA\�s 038.0-0258 ¢j 38.0-0066 sr r� 038.0 0006 038.0-0162CIA 038.0.0065 038.0-0057 t i M1"t A,n_r,7O5.. Google 1" = 96 ft Property Information Property 038.0-0066-0000.0 ID Location 535 SALEM STREET ` p Owner WINNING FAMILY IRREVOCABLE TRUST MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied,concerning v idi or accuracy of the GIS data resented the al ty cy P on this map. rf ■ t f� !! r I • �f ;y ND Commonwealth of Massachusetts ��� � X11 City/Town of North Andover '� Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal S�Q p'09,0 A. Facility Information Barbara Winning Owner Name 535 Salem Street Tax Map 38 Lot 66 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2. Soil Survey Available? ® Yes ❑ No If yes: USDA NRCS 421 B Source Soil Map Unit Canton Fine Sandy Loam none listed Soil Name Soil Limitations Coarse loamy over sandy melt out Moraine Geologic/Parent Material Landform 3. Surficial Geological Report Available? ❑ Yes ® No If yes: Year Published/Source Publication Scale Map Unit 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No If Yes,continue to#5. 5. Within a velocity zone? ❑ Yes ® No 6. Within a Mapped Wetland Area? ❑ Yes ® No MassGIS Wetland Data Layer: Wetland Type 7. Current Water Resource Conditions (USGS): 7/2017 Range: ❑ Above Normal ® Normal ❑ Below Normal Month/Year 8. Other references reviewed: 535 Salem Street, NA.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: 1 7-26-17 10 am 70 degrees/overcast Date Time Weather 1. Location Ground Elevation at Surface of Hole: 99.76 Latitude/Longitude: / feet Description of Location: In front yard...see sketch plan for location 2. Land Use grassed - residential None 2-4 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) grassed moraine Vegetation Landform Position on Landscape(SU,SH,BS, FS,TS) 3. Distances from: Open Water Body > 200 Drainage Way >200 Wetlands >150 feet feet feet Property Line 15 Drinking Water Well n/a Other feet feet feet 4. Parent Material: coarse-loamy over sandy melt out 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 94.76 inches elevation 535 Salem Street,NA.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 I\_ Commonwealth of Massachusetts City/Town of North Andover - - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: 1 Redoximorphic Features Coarse Fragments Soil Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other Depth Color Percent Gravel Cobbles (Moist) &Stones 0-15 A/Fill 10 YR 3/3 none SL 15-33 Bw 10 YR 6/8 none LS 33-96 C 2.5 Y 6/4 60" LS No Water Observed Additional Notes: 535 Salem Street,NA.doc-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 � Commonwealth of Massachusetts City/Town of North Andover p• Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: 2 7/26/17 10 am 70 degrees/overcast Date Time Weather 1. Location Ground Elevation at Surface of Hole: 100.0' Latitude/Longitude: / feet 2. Land Use Grassed -Residential none 2-4 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Grassed moraine Vegetation Landform Position on Landscape(SU,SH, BS,FS, 3. Distances from: Open Water Body > 200 Drainage Way > 200 Wetlands > 150 feet feet feet Property Line 22 Drinking Water Well n/a Other feet feet feet 4. Parent Material: coarse-loamy over sandy melt out 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 95.0' inches elevation 535 Salem Street,NA.doc-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ,r C. On-Site Review (continued) Deep Observation Hole Number: 2 Redoximorphic Features Coarse Fragments Soil Soil Horizon/Soil Matrix:Color- Soil Texture /a by Volume Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other Depth Color Percent Gravel Cobbles (Moist) &Stones 0-6 9 10 YR 3/3 none SL 9-36 Bw 10 YR 6/8 none LS 36-94 C 2.5 Y 6/4 60 LS No Water Additional Notes: 535 Salem Street, NA.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#1 Obs. Hole#2 ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ® Depth to soil redoximorphic features (mottles) 60 60 inches inches ❑ Depth to adjusted seasonal high groundwater (Sh) (USGS methodology) inches inches Index Well Number Reading Date Sh = Sc—[Sr x(OWE—OWm.)/OW l Obs. Hole# Sc Sr OWc OWmex OWr Sh Obs. Hole# Sc Sr owl OWmax OWr Sh 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 absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 33 Lower boundary: 96 inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches 535 Salem Street,NA.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Board of Health Witness Issac Rowe North Andover BOH -consultant Name of Board of Health Witness Board of Health G. Soil Evaluator 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 i a cordAce with 310 CMR 15.100 through 15.107. A� 7/28/17 Signature of Soil valu or Date John D. Sull' an S #: 2378 6-30-2019 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License 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. 535 Salem Street,NA.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 7 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 7-77 EX- 1 112 STORY WOOD FRAME STRUCTURE Ex. 1 Car Top of Fnd=103.32' Garage '02x,15 '0-X14 log 0'.x44 CI 1(54 I i01>10 24" Bit. Conc. 10 1 x 2 61 01,11 !0 01 13 0 CD Cn TH�—2 0 Driveway_0 no (04 C4 9Y5,5 C 01 Pressurized Water Se ice (field loco 99 :8_v99X58 9 9x 721 128.0'± 535 Salem Street,NA.doc-rev.8/15 of 8 i Commonwealth of Massachusetts 11Z;1'\ City/Town of North Andover Percolation Test Form 12 c 41M SVey`W 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: A. Site Information When filling out forms on the computer, use Barbara Winning only the tab key Owner Name to move your 535 Salem Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 Citylrown State Zip Code tab Contact Person(if different from Owner) Telephone Number B. Test Results 7-26-17 9:38 am Date Time Date Time Observation Hole# 1 Depth of Perc 38"-58" Start Pre-Soak 9:38 End Pre-Soak 9:56 Time at 12" 9:56 Time at 9" 10:06 Time at 6" 10:23 Time (9"-6") 17 min Rate (Min./Inch) 6 MPI Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ John D. Sullivan III, PE, CSE Test Performed By: Issac Rowe, Mill River Consulting (Consultant to NA BOH) Board of Health Witness Comments: t5form12.doc•08/15 Perc Test•Page 1 of 1 r �, f NORTH 1 796 Y ' • p Town of North Andover HEALTH DEPARTMENT 34CHUSt CHECK#: 679Z3 DATE: Q ,2 Q/ LOCATION: .53 7 5_o, ,M H/O NAME: CONTRACTOR NAME: .5., Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: Septic-Soil Testing $ yyd ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other(Indicate) $ Hea IgA entInitials White-Applicant Yellow-Health Pink-Treasurer CAR- U�' Commonwealth of Massachusetts D Cityfrown of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. RECEIVED A. Facility Information Sip 2 6 2011 Important: When filling out 1. Facility Name and Address: TOWN OF NORTH ANDOVER forms on the computer,use Winning Family Irrevocable Trust HEALTH DEPARTMENT only the tab key Name to move your 535 Salem Street cursor-do not use the return Street Address key North Andover MA 01845 Citylrown State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City1 Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Comm r " e clal ❑ School 00 4. Describe Facility: Existing Failed Cesspool to be replaced with conventional septic system 5. Type of Existing System: ❑ Privy ® Cesspool(s) ❑ Conventional ❑ Other(describe below): II 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Existing cesspool to rear of existing house Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover y: o Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 330 gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Install a 1,500 gallon concrete septic tank, H-20 rated concrete d-box, and pipe/stone leaching field 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 Percolation rate 6 min./inch Depth to groundwater 4(required) 3 (requested) ft. Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover o Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well(explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving auth 'ty. High groundwater evaluation determined John D. Sullivan III, PE, CSE 7/26/17 Evaluator's Name(type or print) Sign re Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: An upgraded leaching field with a 4 foot groundwater separation would require a retaining wall and possibly a pump system which is economically unfeasible 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: Any alternative system is not required. The only reduction would be in groundwater separation and the seasonal high groundwater table was clearly identified during soil testing. Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 �y Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: All surrounding homes have septic systems only sized for their existing flows, therefore not offering an opportunity for a shared system 4. Connection to a public sewer is not feasible: Public sewer is not available in this area. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." 9/25/17 Facility Owner's Signature Date Margaret Winning Print Name John D. Sullivan III, PE 9/25/17 Name of Preparer Date PO Box 2004 Woburn Preparers address City/Town MA 01888 781-854-8644 State/ZIP Code Telephone i Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval- Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assess '7 O 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. CityTrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms mWQed in any way. Please see completeness checklist at the end of the form. „ n� 2011 Important:When A. General Information filling out forms on the computer, cif E� use only the tab 1. Inspector: oE�� key to move your cursor-do not John DiVincenzo use the return Name of Inspector key. a J a'hd S Development Corp/Stewarts Septic Service —1� Company Name 58 South Kimball St Company Address Bradford MA 01835 City/Town State Zip Code 978-372-7471 s113386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ NeedsJFurther Evaluation by the Local Approving Authority Insp s Signature Date Th system inspector shall submit a copy of this inspection report to the Approving Authority(Board of health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts NTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >c GqM s 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town 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): i C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 1� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street M Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'. Method used to determine distance: *`This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 it Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'GSM 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. CityfTown State Zip Code Date of Inspection C. Checklist Check if the followinghave been done. Y " You must Indicate yes or no as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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: Jan 2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 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: Last pumped 1972 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 600 gallons gallons How was quantity pumped determined? site guage on truck Reason for pumping: To see where the tank was leaking Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1959 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 36"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) The septic tank is leaking below outlet invert. Only pumped once in 1972 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 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 No baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 30" Distance from bottom of scum to bottom of outlet tee or baffle No baffle How were dimensions determined? By pumpin the tank Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is leaking. Remaining sludge in the tank is very thick by the inlet. There is dry solids. 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 I t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 The 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts j W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Full to cover with dirt 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.): Lifted cover to the distribution box. It was full to cover with either dirt or dry sludge lines, to leach trenches full 3' into leach trench. 2 lines there was a lot of roots. All lines red clay with open joints. Camered lines, sludge stains 3/4 way up the pipe. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3-38' ❑ 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.): Design shows 4 38' trenches. Actually could only find 3 lines, 38' red clay pipe 36" sections, root infiltration. Sludge staining 3/4 way up leach lines. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Ttle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I ' Commonwealth of Massachusetts W Title 5 Official Inspection Form o . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. Cityrrown 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 ublic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately 3 o `Q s 64 ; 39 ` t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. Cityfrown 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: 6-9-1958 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Pulled file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Taken from contents of information from the Board of Health. See attached Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 535 Salem Street Property Address Barbara Winning Owner Owner's Name information is required for every North Andover Ma 01845 6-7-17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 e, ii BOARD OF HEALTH a � TCWN OF* NORTH ANDOVER MASS. SJ n 3:1) • DATE e ftp l 2• ADDRESS LUT NO. 3. Na. OF MDRootS . �-�. . . DEIN NO-- •�. 4, GARBAGE GRUMER " . N0.. . g. SHOff DUENSIONS OF HOUSE J Y b. Silag DISTANCES OF HOUSE TO ALL PROPERTY LINES 7• SHOW DIPrENSIONS OF LCT 8. SHOW LOCATION ANIS SI7.2 OF SEPTIC TANK CR CESSPOOL I 9. NOTE LOCATION 'AND. DISTAI1ICE OF WELL FROVI SES MUGE SYSTEM 10. SHOW LOCATION OF MOM* STMIF61, DITCHES, LEDGE ouTCROP, ETC• 11. SHOW DISTANCE OF SMIG TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL ITGULATIONS SHOULD 1E READ CAREFULT,Y, J I K ' � R. Winning Salem St. APPLICATION FOR SEWAGE DISPOSAL IESTALLATION HEALTH DEPARTMENT—NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at -0P S:slem Wit. . 1 will install this system in a accordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further,, I will construct the house sewer of bell and spigot pipe,, the minimum diameter being 4 inches,, and will, maintain a mi_-nimum grade of V until 10 feet preceding the septic tanks, where the grade shall not exceed 2%. 1 will install a concrete septic tank of .-.U0,gal.� in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. T will provide subsurface disposal field with open Jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches,, the bottom of which will provide a minimum of Z 0 lineal (QVM2 ) feet gf 'effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1.1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench# 2 inches of gravel or stone 1/8ty to IA" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case# two lines of the win be installed. A minimum of 6 .feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No pant of the in– stallation will be less than 100 feet from any private water supply,, 25 feet from any stream# 20 feet from any dwelling or 10 feet from any property line. I further free not to clover arty portion of thia inEkIlation unti3 anpro� the in$nep•bioon officer, as provided below,, and toincorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE T' Signature of Applicant - I hereby issue the above permit for the Board of Health of the Towyn of North Andover,, Massachusetts. 7•,gg � nature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE cj o Signature ns ectin Officer g p g Percolation Test 3 min. Garbe.ge Grinder _�, June 7, Mils N1ar. y Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed. Salem Street building site of Richard D. Winning. The subsoil in the area was of a sandy clay content and a 3 minute percolation test was conducted. The land in general is high. It is recommended that a 750 gallon concrete septic tank be installed together with 150 lineal. ' feet of drain pipe. Very truly yours, Z;'Ile William J. r' scoll i 017 3.48PM No. 1b99P. } 53�1 R. Winning Salem St. ,# APPLICATION FOR SEWAGE DISPOSAL IMALLATION HF=H DEPARTn11 --NORTH X-MOVER, MSS. I hereby make application ror a permit for a sewage disposal installation at Salem St. I win install this system in .� � . aecordance with all the �.aws of the Ca alth of Massachusetts and regulations of the Board of Health of the Town of..North Andover. Further, I will aonMtruat the house 'sewer of hell and spigot pipe# the minim= diameter being 4 inchesp and will maintain a minimum Grade of 1% til 10 feet preaed3 ng the septic tanks where,the grade shalt. not exceed 2%. 1 will install a concrete septi3O tank of o in size. A manhole (a) permitting easy cleaning will, be provided with removable cover (a) of iron or concrete within 12 i nchss .of the ground surface. I will provide subaurface disposal field with open joiutod bell, and spigot .A,ckron pipe at least 4 inohes in diameter and laid in a series of trenches# the bottom of which will provide a minimum of 150 lineal {MP000 fee%o£ effective ab$orption area. The pipes will ire laid on a 6 inch J AND S DEVELOPMENT CORPORATION 16300 Town of North Andover 6/28/17 50.00 Haverhill Bank 9613 title 5-535 salem st 50.00 I rNORT7932 ' q Town of North Andover HEALTH DEPARTMENT SACHUS! CHECK#: Op DATE: 7 LOCATION: 53 5 ;7"/n H/O NAME: LLJnQ CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ 'F ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ �❑[ Title 5 Inspector $ �] Title 5 Report ❑ Other:(Indicate) $ Heat Agent Initials White-Applicant Yellow-Health Pink-Treasurer � S��TT:EDj� • p°a�r�n North Andover Health Department (ommunity and Economic Development Division ��0 October 13, 2017 Winning Family Irrevocable Trust 535 Salem Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 535 Salem Street(Map 38, Lot 66) Dear Winning Family Irrevocable Trust: The proposed wastewater,system design plan for the above site dated September 1, 2017 with a final revision date of September 25, 2017 and received on September 26, 2017 has been approved. The Health Department has granted a variance to reduce the separation to groundwater from 4 feet to 3 feet. The design plan has been approved for use in the construction of a new on-site septic system for a 3-bedroom (max 7-room) home utilizing a gravity leaching system. This design plan approval is valid until October 13, 2020. 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)) i I Page 1 of 2 North Andover Health Department 120 Main Street North Andover, MA 01845 ! Phone: 978.688.9540 Fax: 978.688.9542 535 Salem Street October 13, 2017 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. Please feel free to contact the office with any questions you may have. We look forward to working with yotilto 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, /Brian J. LaGrasse, CEHT Director of Public Health Encl. Installers list cc: Sullivan Engineering Group, LLC., PO Box 2004 Woburn, MA 01888 File Page 2 of 2 g I North Andover Health Department 120 Main Street North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 • e •' Map-Block-Lot Commonwealth of Massachusetts � 038.00 06 6 y`uc ' BOARD OF HEALTH ----------------------- Permit No BHP-2017-0586 North Andover , ---------------------- P.I. FEE F.I. $350.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James-Kellett to(Construct)an Individual Sewage Disposal System. at No 535 SALEM STREET as shown on the application for Disposal Works Construction Permit No. BHP-2017-0 ated ---obe 8, _7 - --- -- ------------------ --------------------- - Issued On: Oct-18-2017 _ BOARD OF HEALTH -- �G=11 � n � Application for Septic Disposal System ��`' // 2116) �7 - Construction Permit - TO" OF TODAY'S DATE $350.00-Full Repair NORTH ANDOVER, MA 01845 $175.00-Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ElRepair or replace an existing system component—What? cursor-do not use the return A. Facility Information key. .50 Address or Lot# rah City/Town 'e`er 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump JSCGravity(choose one) ***If pump ystem, 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) ➢-_❑Pressure-Dosed(D-Box-Present)-S:A:S---- -- - -- - -- ---- -- ----- - ➢ ❑ Does the system require an effluent filter? Yes No - If yes, does plan specify make and model of filter? YES =(no further info. needed) NO=(installer must specify brand of filter before DWC issuance) W%atis the Make? �,1`QP te(/ What is the Model. 2. Owner Information Name :g 5' 3 a Ad ress(if differegt from above) ity/Town State Zip Code Email address Telephone Number 3. Installer Information Name _ Name of Company Address Ci own State Zip Code Telephone (Cell Phone#if possible please) 4. Designer Information Name Name of Company Address 1 Zd Ute_/'!/ Crown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 I 1 ' i •; r Application for Septic Disposal System Construction Permit — TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $ -Full Repair $17755..00 00-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: esidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of h Andover. I underst t until a final Certificate of Compliance has been issued by this oard of Health, th ns s tem is not approved. Name Date 6me ro d By: (Board of Health Representative) lb Date Application Disapproved for the following reasons: For Office Use Only: � Z Fee Attached. Yes No 2. Project Manager Obligation Form Attached? Yes_ No 3. Pump System? If so,Attach copy ofElectrical Permit Yes No Applicantreceived copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewedapprovallettet allpapenvorkreceivedP Yes No Missing. 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) G. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (-address of septic system) For plans by / (Engineer) Relative to the application of (Installer's name) And dated I(Originalate Dated �P 17h®% �. With revisions datedo ay s ate 2�; (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (V5 inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept@northandoverma.gov) 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 requited to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover,significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staff or consultant. d Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) 49_ 1" % � Z&4 (Name—Print me—Signed) Of NORTH,� . 8051 Town of North Andover ` '•�,;;p:: �' HEALTH DEPARTMENT ,SSAC MUStt CHECK#: 3/C 8 DATE: U LOCATION: 53 S c..t./►') S- H/O NAME: iJ) 0 11 CONTRACTOR NAME: i eeL Type Permit or License: (Check bcv) • Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ _ e� ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: -❑ Septic-Soil Testing l $ ❑ Septic-Design Approval /� r $ Septic Disposal Works Construction(DWC) $35 0 ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ "Agent Initials White-Applicant Yellow-Health Pink-Treasurer Z . l7 LC� S TTt ED - North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 535 Salem Street MAP: 38 LOT: 66 INSTALLER: James Kellett DESIGNER: John D. Sullivan, III Sullivan Engineering Group PLAN DATE: September 1, 2017 with a final revision September 25, 2017 BOH APPROVAL DATE ON PLAN: October 13, 2017 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION:/a " 02 •�� DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ 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 lot ❑ Weep hole plugged ❑ 15009 allon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Watertightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ' ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: I 6,35 If IL ABSORPTION SY TE neral SO O S (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 ( I X . Comments: J� _ 5 d cU T S IM6 5 L �6 JAA SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As-Built Plan i 1 BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN I CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. 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Sullivan Engineering Group, LLC Civil Engineers&Land Development Consultants September 25, 2017 Town of North Andover ����® Health Department 120 Main Street SEP 2 6 2017 North Andover, MA 01845 TOWN OF NORTH ANDOVER Re: 535 Salem Street, North Andover HEALTH DEPARTMENT Septic Design Plan Health Department: Enclosed are the revised Septic Design Plans(3 sets)for the above referenced property for your review and approval. In response to the review letter September 13, 2017 the following changes and/or revisions have been made (the numbering system used below is the same numbers in the review memorandum); 1) The septic tank detail on Sheet 2 has been amended to include the required drop from the inlet to the outlet tees,the minimum 3 inch air space above both tees,the 9 inch air space above the flow line, and the extension of the tees to 6 inches above the flow line 2) The d-box has a note added in two locations on Sheet 2 specifying compaction of fill material below the d-box. 3) MassDEP approval letter attached for Zabel effluent filters 4) The proposed grading on the easterly side of the proposed leaching field has been reviewed and is sufficient per Title 5 requirements. A shallow swale has been been shown along the front lot line with sufficient proposed spot grades for construction. Fill material can be achieved within the property bounds. 5) A Local Upgrade Appoval(Form 9A)has been prepared and included. It is my understanding the BOH agent can approve request(no board action needed/required). If you should have any questions or comments please feel free to contact me. Very Truly Yours, Jac / Su van, PE P.O. Box 2004 Woburn, MA 01888 (781) 854-8644 e-mail:jacksu1153@comcast.net CO? North Andover Health Department Community and Economic Development Division September 13, 2017 John D. Sullivan, III P.E. Sullivan Engineering Group, LLC P.O. Box 2004 Woburn, MA 01888 Re: Subsurface Sewage Disposal System Plan for 535 Salem Street(Map 38,Lot 66) Dear Mr. Sullivan: The proposed wastewater system design plan for the above site dated September 1, 2017 and received on September 5, 2017 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 where applicable. 1. Depict the required drop from the inlet to the outlet tees in the septic tank, the minimum 3"air space above the tees, the 9" air space above the flow line, and the extension of the tees to 6" above the flow line. (3 10 CMR 15.227(1), (4) and(5)). 2. The distribution box is specified in an area of fill material which then requires soil compaction beneath it. Please indicate this requirement. (3 10 CMR 15.221(2)) 3. Please,provide the MassDEP approval for the brand and model effluent tee filter which is proposed. 4. The proposed grading is within 5 feet of the property line therefore a Swale should be ' proposed(310 CMR 15.255(2)). Additionally,please review the grading on the eastern side of the soil absorption system to confirm that the needed fill material can be achieved within the property bounds 5. A Local Upgrade Approval request was noted on the design plan but the required accompanying Form 9A was not provided Page 1 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 I Please feel free to contact the office or Mill River Consulting at 978-282-0014 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. Since ly, ian J. LaGrasse, CEHT Director of Public Health cc: Wining Family Irrevocable Trust File Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 w • ME , TOWN OF NORTH ANDOVER =. Community &Economic Development ` HEALTH DEPARTMENT k4„'�;,; 120 Main Street NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone 978.688.9542—FAX E-MAIL:healthdept@northandoverma.gov WEBSITE:hqp://www.northandoverma.gov SEPTIC PLAN SUBMITTAL FORM �® Date of Submission: 1 Val S�Q Q�J�a�� O SAlf*' nn J-W Noy 1 Site Location: J-0 61Z PUINJ ,�f ,�0,�1�,�p�P Engineer: i G New Plans? Yes X $275/Plan Check# Sq Y (includes 1St submission and one re- review only) Revised Plans?Yes $125/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No 4 .- �)I% a Vy V Telephone�#: Fax#: E-mail: WOVU-1s) i Homeowner Name: WIWI OFFICE USE ONLY When the ission is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt - ➢ Copy File;Forward to Consultant ➢ Enter on Log Sheet and Database Ot NORTH, 7997 O.. 9 � n Town of North Andover � '•�,,,,;:: HEALTH DEPARTMENT ' 1SSACHU�+Et CHECK#: s9�y DATE: - LOCATION: 53.5 57a-Am 34 H/O NAME: / /1 CONTRACTOR NAME:J� SV k,1 44 Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ tSeptic-Design Approval $�'— ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ HA�gent Initials White-Applicant Yellow-Health Pink-Treasurer EX. SEPTIC TANK TO BE PUMPED TAX MAP 38 LOT 6 OF CONTENTS AND DECOMMISSIONED #547 SALEM STREET IN ACCORDANCE WITH TITLE 5. N/F DANIEL WINNING N Ex. 750 Gallon Conc. Septic There is no foundation Tank or perimeter drain EX. 1 1/2 STORY N WOOD FRAME STRUCTURE Ex. 1 LIMIT OF 5 FOOT OVERDIG (TYP) Top of Fnd=103.32' Car Garage FILL MATERIAL TO MEET Tree to Note: Internal Plumbing to be SPECIFICATION IN SECTION be Removed reconfigured to exit out the qY 15.255(3) OF TITLE 5 CODE front of the house as sho n. 10205 / PROP. 4" SCH. 40 PVC 10 x44 10204 / SEWER LINE PROP. INFILTRATION FIELD 102_.. �10 la._— Conventional Trench ot�34 20'Manhole - 20'Manhole Layout (Not for CONSISTING OF 5 ROWS OF56 (' 20iot:oo of to onstruction) 5 QUICK4 PLUS STANDARD LP s' INFILTRATOR UNITS24" it. Conc. PROP. 1,500 GALLON CONC. SEPTIC 701x92 00 at t •�.. 1 _ __ _._A, INSPECTION PORT TO WITHIN r ` �` y tj 4 TANK (MONOLITHIC) 3" OF FINISHED GRADE ,: ....=.-- -- -- ���- Driveway O PROP. H-20 CONC. 0'` <,� �xea 00 04 toa 04 D—BOX — 9 OUTLET INTERCONNECT ENDS OF z75TM_1 ^� _ __.100 DISTRIBUTION PIPES W/ �� Pressurized Water 15. 6 45, MIN. FINISHED GRADE 4" PVC PIPE I� Service (field located) 11.41 OVER D—BOX = 101.44' (too) 99 at �s a 128.0'± x Ex. Bit. Conc. Sidewolk z BB W 88 A W -BENCHMARK: W PK NAIL IN SIDEWALK ELEV= 100.00' SALEM STREET CASSUMED DATUM) GENERAL NOTES 1. ELEVATIONS BASED ON ASSUMED DATUM. 2. EXISTING TOPOGRAPHIC INFORMATION FROM FIELD SURVEY. 3. THE CONTRACTOR SHALL TAKE THE NECESSARY STEPS TO PROTECT EXISTING PROPERTY AND 2 A ADJACENT PROPERTIES. 0�.x 4. ALL CONSTRUCTION METHODS AND MATERIALS a SHALL CONFORM WITH THE MASSACHUSETTS DEPARTMENT v OF ENVIRONMENTAL PROTECTION STATE ENVIRONMENTAL CODE TITLE 5 (310 CMR 15.00) AND THE NORTH ANDOVER BOARD q OF HEALTH REQUIREMENTS. 5. THE DESIGN ENGINEER AND THE LOCAL APPROVING AUTHORITY ARE TO BE NOTIFIED AT LEAST 72 HOURS PRIOR TO INSPECTIONS REQUIRED BY 310 CMR 15.00. 6. THE CONTRACTOR IS TO VERIFY EXISTING SITE CONDITIONS p AND NOTIFY THE ENGINEER OF ANY DIFFERENCES. 7. THE CONTRACTOR IS RESPONSIBLE FOR ALL OF THE HORIZONTAL AND VERTICAL CONTROL OF ALL SYSTEM COMPONENTS. 8. THE FIRST TWO FEET OF EACH LINE EXITING THE DISTRIBUTION BOX SHALL BE LEVEL. 9. SEPTIC SYSTEM OWNER SHALL HAVE SEPTIC TANK INSPECTED & PUMPED OUT IN ACCORDANCE WITH \/ 310 CMR 15.351, AND AT LEAST ONCE EVERY TWO YEARS. 10. THIS PLAN HAS BEEN PREPARED FOR THE CONSTRUCTION OF THE PROPOSED SEPTIC SYSTEM. ANY ALTERATIONS MUST BE APPROVED IN WRITING BY THE nn ENGINEER. \ 11. THERE ARE NO PUBLIC OR PRIVATE WELLS WITHIN 100' JJ OF THE LEACHING FACILITY. 12. THIS SYSTEM IS NOT DESIGNED TO ACCOMODATE A GARBAGE GRINDER. O �w D 13 .THE SOIL PLACED AS BACKFILL OVER THE �/� �J 00 SYSTEM SHALL BE A MINIMUM OF NINE INCHES, "J r�nn EXCLUDING TOPSOIL, PLACED IN LIFTS AND V O O SUFFICIENTLY COMPACTED TO PREVENT (((��� , Z N 00 DEPRESSIONS DUE TO SETTLING WHICH MAY �[ O Q X INTERCEPT OR COLLECT SURFACE WATER !vw ::iRUNOFF ABOVE THE SYSTEM. BACKFILL MUST BE In / CLEAN AND FREE OF STONES AND BOULDERS W m „ 00 I\r��� GREATER THAN SIX INCHES IN SIZE. TAILINGS, �V z !lISSS CLAY OR SIMILAR MATERIALS ARE PROHIBITED. O Z FINAL COVER ABOVE THE SYSTEM SHALL BE i GRADED TO REDUCE INFILTRATION OF SURFACE ,. rTI-{1 WATER AND MINIMIZE EROSION. FINISH GRADE (/) ' o SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER 1 lU Y FOOT. SURFACE DRAINAGE SHALL BE DIRECTED. U AWAY FROM THE HOUSE & SOIL ABSORPTION SYSTEM. y f 14. THERE ARE NO TRIBUTARIES LESS THAN 325 FEET, NO \ T Z �49-^ '� RESERVOIRS/PUBLIC WELLS LESS THAN 400 FEET, AND NO DRAINS LESS THAN 50 FEET FROM THE PROPOSED SUBSURFACE DISPOSAL Q SYSTEM. THE DWELLING DOES NOT HAVE A FOUNDATION DRAIN. ln 15. PIPE PENETRATIONS IN FOUNDATION, SEPTIC TANK, AND DISTRIBUTION BOX SHALL BE SEALED WITH HYDRAULIC CEMENT. 16. THE BUILDING SEWER IS TO HAVE WATERTIGHT JOINTS, TO BE LAID ON A COMPACT & FIRM BASE, AND IS TO BE LAID ON ON CONTINUOUS GRADE IN A STRAIGHT LINE. / Q, // I /�� � ��" ,. ���_��• �� 17. MAGNETIC MARKING TAPE SHALL BE PLACED AROUND ti T'!.u► `�A� r ,-(i ttt ALL SEPTIC COMPONENTS PRIOR TO BACKFILLING. ~ 18. THIS PROPERTY IS NOT LOCATED WITHIN THE DESIGNATED SCALE', WATERSHED OF LAKE COCHICHEWICK. 1"=20 FEET .�'`.y�.LAn I�L,9 •�� � v` '�-� 19. ANNUAL MAINTENANCE OF THE EFFLUENT FILTER ON THE OUTLET SEPTIC DATE, 1 TEE IS REQUIRED. AUG. 22, 2017 SHEET, of 2 4Q V EX. SEPTIC TANK TO BE PUMPED OF CONTENTS AND DECOMMISSIONED TAX MAP 38 LOT 6 IN ACCORDANCE WITH TITLE 5. , 7 SALEM STREET .I.I N/F DANIEL WINNING v ra N Ex. 750 Gallon Can C, Septic •There is no foundation Tank oI perimeter drain rAv EX. 1 1/2 STORY i N WOOD FRAME STRUCTURE Ex.1 i Cor LIMIT OF 5 FOOT OVERDID TYP ( ) Top of Fnd=103.32• Garage FILL MATERIAL TO MEET Tree to Note: Internal Plumbing to'be SPECIFICATION IN SECTION be Removed reconfigured to exit out the 1Kr' o PROP. 4"SCH. 40 PVC front of the house as,shown., / SEWER LINE 15.255(3) OF TITLE 5 CODEr PROP. INFILTRATION FIELD Conventional Trench ^%-,ya•Mwnw• zo•Mmnwe- Layout(Not for CONSISTING OF 5 ROWS OF 20;y,ee Construction) 5 __ 6 5UICK4 PLUS STANDARD O LP INFILTRATOR UNITS 24" it.Conc. PROP. 1,500 GALLON CONC. SEPTiC INSPECTION PORT TO WITHIN ; 4 ' TANK (MONOLITHIC) 3"OF FINISHED GRADE y —' -�0 _- I Driveway PROP. H-20 CON1,0 C. INTERCONNECT 5. mfx. ENDS OF TH-1 _ _ / :;< D—BOX — 9 OUTLEr O/STRIBURON PIPES W1ass• V 4"PVC PIPE Pressurized Water 15.7 E OVER D—BOX=MIN. FINISHED GRADE Service(field located) s 100 _ sJ x 128.0'± s...,. rp, + Ex.Bit.Conc.Sidewalk 88 W W Be BENCHMARK+ 'A' PK NAIL IN SIDEWALK ELEV=100.00' SALEM STREET (ASSUMED DATUM) u FILTER FABRIC (1) 4" INLET TC9) PLASTIC PIPE SEA 4" DIA OUTLET ° ° 0 L a ti TYPICAL INFILTRATOR CHAMBER 11 c INSPECTION PORT 6' INTERNAL COUPLING TYPICAL H10 INSPECTION PORT DETAIL 2 1'2• Q PLAN VIEW ° N.T.S. 9 OUTLET H-20 SECTION VIEW W WEIGHT NOTES: ITEM NO. B-9D8H W/COVER 687 1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS. (n () NOTES. 2. DESIGN CONFORMS WITH RI CMR ISAEE, . I)PROVIDE 6"CRUSHED STONE BASE TITLE 5 REGS, FOR ➢ISTRIBUTIDN BOXES. J 2)ALL D-BOX OUTLETS TO BE AT THE SAME ELEVATION 1 US T BE CERTIFIED B Y 3)D-BOX TO BE WATERTIGHT J Q 9R SYSTEMS D-BOX (9 OUTLET)BYSHEACONCRETE PRODUCTS o N.T.S. TO PREVENT BREAKOUT: 00 OF 9" OF COVER THE FINISHED SIDE SLOPES OF THE PROPOSED SOIL ABSORPTION SYSTEM � CO d OVER SEPTIC TANK SHALL NOT BE STEEPER THAN 3:1. A MINIMUM 15 FOOT HORIZONTAL SEPARATION Q ' O 'OX' DISTANCE SHALL BE PEOVIDED BETWEEN THE SOIL ABSORPTION AREA AND Z N Q I THE ADJACENT SIDE SLOPE, r O � v ill O ---i � LEVEL 2% SLOPE (MIN.) CO FEET FINISHED GRADE INLET PIPE (TYP.) J O `� Z _Box FINISHED GRADE 4' HDPE Q Z ? � f J � 0D � Q3 INFILTRATOR UNIT �L /�C�•`. O v 9" MIN. EXCLUDING TOP SOIL oSTANDARD �J `V 'IES 36" MAX. INCLUDING TOP SOIL TOP OF CHAMBER Q3 •• Q3 QUICK4 PLUS LP pZ 12" MIN. 34'"Wx4.0'Lx6'h! Z VO SO EOP OF 7' .� ¢ °O.p!•k 4p FILTER FABRIC ••� �FlLTER�FABRIC TOP EL=99.67' l+C n Q QUICK4 PLUS STANDARD LP UNITS S o j !1. * SEE CONSTRUCTION DETAILS O O INV.=99.25' �' �V �l j EL.=99.25' N A J9.35' £L=99.DO, USE CLEAN TITLE 5 SAND 0° _ h BETWEEN INFILTRATOR UNITS —_..___ _______..____ ____________ BOT. EL-99.00' .�. 4y 7 4� 4' MIN GROUNDWATER PROVIDE MINIMUM 4 FOOT SEPARATION REMOVE ALL FILL, TOPSOIL, SUBSOIL, AND ~ BETWEEN THE BOTTOM OF THE INFILTRATOR UNIT SCALE, (BASED ON ELEV. 9DTHTH1/2) AND THE SEASONAL HIGH GROUNDWATER TABLEC-LAYER oArE. . UNSUITABLE MATERIAL VERTICALLY TO THE NOT TO SCALE 5 ROWS OF 5 INFILTRATOR UNITS SUBSURFACE SOIL ABSORPTION FIELD-CROSS SECTION Aug. 22, 2017 (NOT TO SCALE) SHEET 2 Of 2 ELEV. (FT) DTH—I DEPTH (IN) ELEV. (FT) DTH-2 DEPTH (IN) TOP OF PIT = 99.76' 00" TOP OF PIT = 100.0' 0011 _...___.._....__...._._._..._.._._........... __.—.._ HOR.A FILL HOR.A/FILL i._....__..........---r- ---- I FSL FSL 10 YR 3/3 10 YR 3/3 98.5' 15" 99.2' / g' I HORIZONBwHORIZON Bw 106..................................................................................-...._...._........................_.. _..... LS LS /0'4"SCH.40 PIC 10 YR 6/8 10 YR 6/8 s=i.02 97.0' 33" 97.0' 104 ................................_;. PROP. CI ICOVERS TO GRADE C-LAYER C-LAYER LS 5' 4-SCH.40 PVC LS , INSPEC1 ON_PORT I PROP.IhNISHED GRAOEj 2.5 Y 6/4 2.5 Y 6/4 102 ....__.__..... .........�..._...._..._....... _.._-._...._...TO................ RAOE_....._.__....____._._.....__.._.C.!__......_............_ (CLASS I FM kkeed Grade`Over ) (CLASS I) I ID-eox KI{�A'Min. BOT. OF PIT =91.7 REFUSAL 0 NONE 96" BOT. OF PIT =92.1' REFUSAL®NONE 94" j s nIi-99.05' WATER WEEPING 0 NONE WATER WEEPING 0 NONE ___.__. _I...__.. .____.. MOTTLES 0 60"(ELEV=94.76') MOTTLES 0 60""(ELEV=95.00') 100 I U piter Fabn ............................- 1nv.=100.0 d ,m 00/CK4 MUS Apo W.� O 1n 5/A/iMRO tP LNRS NOTE: SOIL EXAMINATIONS (DTH-1, DTH-2) AND PERCOLATION TESTS (PT-1) /n,.,=99g2• �'� op EL,V 99.0 P WERE PERFORMED BY JOHN D. SULLIVAN III OF SULLIVAN ENGINEERING GROUP, LLC d 2 a E p I 98 ...._..._..._...o...........__..D.Z_....u:'t'--7 ._.._._-?4..MMt:._............ ......................__......(......_......__-......_...1 ON JULY 26, 2017 AND WITNESSED BY ISSAC ROWE OF MILL RIVER CONSULTING (CONSULTANT FOR THE TOWN OF NORTH ANDOVER BOH) U _ Approxi�'n�L f -Lor So11 X o 6"CRUSH-D ALL SOIL DOWN TO IHE C-LAYER STONE COMP C D ANDIINTHIN 5 FEET�'JF THE SYSTEM I CER77FY THAT IN OCTOBER 1995 1 PASSED THE SOIL EVALUATOR EXAMINATION APPROVED w I BASE is TO Bf REMOVED AND REPLACED BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE ABOVE ANALYSIS WAS 96 a I IS CLEAN TITLE 5j ND R PERFORMED BY ME CONSISTENT 411TH THE REQUIRED TRAINING, EXPER7ISE, AND EXPERIENCE D. DESCRIBED IN 310 CMR 15.017. a 6"CRUSHED GROUNDWATER=95.0 DATE: STONE COMPACTED I BASE 9a SOIL DATA SYSTEM PROFILE NOT TO SCALE SCALE: 1"=20'(HOR) DATE TEST N0. DEPTH BOT. ELEV. RATE 1"=2'(VERTICAL) 7/26/17 1 38"-58" 95.1' 6 MPI PERCOLATION TEST RESULTS DESIGN ANALYSIS 6' SCH. 40 PVC OR 6' PVC END CAP, END PLUG SDR-35 PVC PIPE DR CLEANOUT W/IN 3' OF FINISHED GRADE ESTIMATED DAILY FLOW: RISER / V TANK VOLUME: DESIGN FLOW = 330 GPD .330 GPD X 200% = 660 GPD 660 GAL < 1,500 GAL (TITLE 5 MINIMUM) LEACHING AREA REQUIRED: PERCOLATION RATE = 6 MPI (CLASS 1) FILTER FABRIC L.T.A.R. = 0.70 GPD/SF LEACHING AREA REQUIRED: 330 GPD / 0.70 GPD/SF = 471.42 SF LEACHING AREA PROVIDED: LEACHING FIELD CONTAINING INFILTRATOR QUICK4 PLUS STANDARD LP UNITS TYPICAL INFILTRATOR• 14.15' WIDE X 20.0' LONG = TOTAL OF 25 INFILTRATOR UNITS CHAMBER EFFECTIVE LEACHING AREA= 4.73 SF/PER L.F. OF INFILTRATOR(BOTTOM ONLY) INSPECTION PDRT 6' INTERNAL COUPLING 471.42 S.F REQUIRED/ 4.73 S.F/L.F. = 99.66 L.F. REQUIRED 25 INFILTRATOR UNITS X 4 L.F./UNIT = 100 L.F. TOTAL (PROVIDED) TYPICAL H10 INSPECTION PORT DETAIL SEPTIC TANK BUOYANCE CALCULATION N.T.S. BOTTOM OF SEPTIC TANK= 95.24' MAX. SEASONAL GROUNDWATER TABLE= 96.0'1 (AT TANK LOCATION) UPLIFT FORCE: 10.5' X 5.67' X 0.76' X 62.4 LBS = 2,823 LBS WEIGHT OF TANK (EMPTY): 12,930 LBS THE INSTALLER MUST BE CERTIFIED BY WEIGHT OF SOIL OVER TANK (9"MIN): 5,051 LBS TOTAL WEIGHT(TANK + SOIL): 17,981 S.F. >UPLIFT FORCE(2,823 LBS)..OK INFIL TRA TOR SYSTEMS TOP OF FND 103.32' SYSTEM PROFILETO PREVENT BREAk NOTE: A MINIMUM OF 9"OF COVER TO THE FINISHED SIDE & DISTRIBUTION BOX. NOT TO SCALE PROVIDED OVER SEPTIC TANK SHALL NOT BE STEI S DISTANCE SHALL BE THE ADJACENT SIDE COVER TO GRADE MIN.FIINISHEO GRADE OVER D-BOX=101.44' FIRST TWO FEET 20'DIA.CAST IRON COVER TO BE SET LEVEL FINISHED GRADE 2%SLOPE (MIN.) OUT OF D-BOX \ (10) 4"SOLID p DISTRIBUTION BOX \\\ VC SCH. 40 WATERTIGHT H-20 LOADING (5=0.02 MIN) _ __Flow Una_ (5')4"soup avc scH. 4D .. 4"gp'VARIES 9" MIN. EXCLUDING TOP SOIL ID 36" MAX. INCLUDING TOP SOIL TOP OF CHAMBER £L.=100.02' 10 14'I 5=0.01 S Op1CH 40 FILTER FABRIC EL-99.67' PROPOSED EL=99.82' 1 ZABEL FILTER 6" CRUSHED QUICK4 PLUS STANDARD LP UNITS Ama-axfavc STONE BASE * EL-99.25' SEE CONSTRUCTION DETAILS (WATERTIGHT-MONOLITHIC)(H-20 RATED) WATERTIGHT EL.=99.is' EL_99.00' USE CLEAN TITLE BETWEEN INFILTRA - EL-99.57' EL-99.52' NOTE FLOW EQUALIZERS 4' MIN 6" CRUSHED STONE BASE TO BE PROVIDED AT ALL GROUNDWATER PROVIDE MINIMUM 4 f 10' MIN. TO BLDG. 1500 GALLON CONCRETE OUTLETS FROM D—BOX ELEV. = 95.0' _ BETWEEN THE BOTTOA SEPTIC TANK (MONOLITHIC) (BASED ON DTHfJ2) AND 7HE SEASONAL I 20' MIN. TO BLDG. 5 ROWS OF 5 INFILTRATOR UNITS SL S •_, R. Winning,,,-- , r Salem St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMEM--NORTH AII)OVER, MASS. T hereby make application for a permit for a sewage disposal installation at Salem St. . I will install this system in accordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Tawrn of.North Andover. Further, I will construct the house sewer of ben and spigot pipe, the minimum diameter being 4 inches,, and will maintain a minimum grade of li until 10 feet preceding the septic tanks where the grade shall not exceed 2%. I will install, a concrete septic tank of 750 gal. in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches, the bottom of which will provide a minimum of 150 lineal ( WW feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/811 to IN' (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single the line will exceed 1.00 feet in length and in any case, two lines of the will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the in— stallation will be Less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further ;igre2not to coyer any portion of this instalation until approved by the,insAec�ion officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. r DATE r —e r signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, %ssachusetts. P. DM J;M..�.�...� ..— gnature of Health Agent I have inspected the uncovered system indicated above and find everything done as described, DATE _ / 1-2, .* \' 7, ),-� Signature o nspecting Officer Pbreolation Test 3 min. Garbage Grinder June 7, 19 58 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Salem Street building site of Richard D. Winning. The subsoil in the area was of a sandy clay content and a 3 minute percolation test was conducted. The Land in general is high. It is recommended that a 750 gallon concrete septic tank be installed together with 150 lineal feet of drain pipe. Very truly yours, William J. r' scoll 3 BOARD OF HEALTH TONIN OF. NORT;i ANDOVERO WS. Ss� I .�+ 7GM eN, ]s'0 It/. uC,rA JOK 1�', f A/hJ 1 D f N1/ti7 r � 1. NAsm . DATE 2. ADDRESS . L .�,a. G e� .5.7. LOT No. . . TEL. 3. N0, OF BEDROOT-S . . . . DEN 4149-. . . . . NO.. . 0 , LL 4. GARBAGE GRINDER -199" . N0.. �'..�. 5. SHOW DILENSIONS OF HOUSE b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LIVI ES 3 �--ate •-� r 7. SHOW DIPWISIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. WE LOCATION 'AND. DISTANCE OF WELL FROT4 SMWERAGE SYSTEPVI. 10. SHOW LOCATION OF BROOKS v STPEJU6, DITCHES, LEDGE OTJTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD EE READ CAREFULLY. August 11, 1997 Zabel Environmental Technology 10409 Watterson Trail Jeffersontown, KY 40299 Attn: Lawrence Gravely Re: Application for approval of Filter: Zabel A1800 wastewater filter Dear Mr. Gravely: The Department of Environmental Protection has completed a Technical Review of the above referenced application and hereby approves the use of Zabel A1800 wastewater filter in accordance with 310 CMR 15 .289 (4) "List of Alternative System, Effluent Tee Filters" subject to the following conditions : 1 . Prior to sale of the A1800 Filter, the distributor of the system shall provide the purchaser with a copy of this approval. 2 . Prior to installation in an existing system, the owner shall obtain approval from the Board of Health for the proposed modification of the system. If the system is a failed or nonconforming system, the system shall be upgraded in accordance with 310 CMR 15. 404 in conjunction with installation of the filter. 3. All septic tanks in which a Zabel A1800 Filter is to be installed must have a 20" manhole over the outlet tee. In addition, both inlet and outlet manhole covers must clearly note (either painted with non-degradable paint or other permanent identifiable markings) the system is equipped with the Zabel A1800 Filter. 4 . When installed the Zabel A1800 Filter outlet tee must extend below the flow line in accordance with the following table: Liquid Depth in Septic Tank Depth of Zabel A1800 Filter Baffle below Flow Line 4 feet 14 inches 5 feet 19 inches 6 feet 24 inches 7 feet 29 inches y , I , • Ra i RE: Flowlink's Filter Baffles Page:2 8 feet 34 inches 5. The system owner shall have a septage Handler, licensed by the local board of health in accordance with G.L.c. 111 s. 31A and 310 CMR 15. 502, service the filter regularly, at least once every year and pump the septic tank in accordance with 310 CMR 15. 000 . The system owner shall report in writing to the local Board of Health within 30 days of the date of servicing every time the septic tank is serviced. 6. The distributor for the Zabel A1800 Filter shall provide to the local Board of Health when requested by the Board of Health, the name (s) and license number (s) of the licensed septage haulers in the town which have been trained in the proper installation and maintenance of Zabel A1800 Filter, as specified by the manufacturer and the Department. 7 . When the Zabel A1800 Filter is proposed for new construction, all other aspects of the design and construction of the system must comply with the provisions of 310 CMR 15.000 . 8. This approval shall not constitute approval of the filter in lieu of a properly sized septic tank, including but not limited to, the requirements for a properly sized septic tank for grey water when used in conjunction with a composting toilet, as described in 15.289 (3) (a) (2) . 9. In approving this filter, the Department has made no determination to the extent, if any, that it will improve the performance of an onsite sewage disposal system. If you have any question, please contact Christos Dimisioris at (617) 292-5912 . Sincerely, Michael Rapacz, Deputy Director Wastewater Management Program cc: DEP, DWPC, SERO, WERO, CERO, NERO John Higgins/Millbury Office The Public Health and Safety Organization NSF Product and Service Listings These NSF Official Listings are current as of Wednesday,April o6,2016 at 12:15 a.m.Eastern Time.Please contact NSF International to confirm the status of any Listing,report errors,or make suggestions. Alert:NSF is concerned about fraudulent downloading and manipulation of website text.Always confirm this information by clicking on the below link for the most accurate information:http://info.nsf.org/CertifiediWastewaterIListings.asp? Standard=o46&Company=7958o& NSF/ANSI 46 Evaluation of Components and Devices Used in Wastewater Treatment Systems Polylok Inc. 3 Fairfield Boulevard Wallingford,Cr o6492 United States 877-765-9565 203-265-6340 Facility:Cheshire,CT Septic Tank Effluent Filters[i] PL-122 PL-250 PL-525 PL-625 PL-68 [11 Performance tested using bead size 0.338 cm ± 0.005 cm (1/8" ± 0.00211) . Meets the full requirements of NSF/ANSI 46-2010. Facility:Evansville,IN Septic Tank Effluent Filter Components[i] A101-12x20 A101-12x28 A.101-12x36 A.1oi-8x18 A1o1-8x26 A1o1-8x32 A18oi-4xi8[4l A.1801-4x22[4][5] A3o1-12x20 A3oi-12x28 A3o1-12x36 A3o1-8x18 A3o1-8x26 A3oi-8x32 [11 Septic Tank Effluent Filter Components are exempt from bearing the NSF Component Mark and shall bear the NSF Unit Mark. I' II [4] Filter cartridges Certified in ABS and PVC materials. [5] Failure sensing and signaling equipment of this product not evaluated by NSF. j Septic Tank Effluent Filters[a]131 Aioo-12x20 M00-12x20-VC Aioo-12x20/BALL A100-12x28-VC A1oo-12x36-VC A1oo-8x18-VC A1oo-8x26-VC A1oo-8x32-VC A18Oo-4x18-30142-68A1800-4x18-VT-B35 A1800-4xi8-VT-B40 A1800-4x18-VTF-B35 Ai800-4x18-VTF-B40 A18OO-4x22-30142-68A18Oo-4x22-VT-B35 A18OO-4x22-VT-B40 A1800-4x22-VTF-B35 Ai800-4x22-VTF-B4o Apo-1=0 A300-12x20-VC A3OO-12x2o/BALL A300-12x28-VC A300-12x36-VC Apo-&18-VC A300-8x26-VC A3O0-8x32-VC A600-12x20 A6o0-12x20/BALL Moo-12x28-VC A600-12x36-VC Moo-&18-VC Moo-&26-VC A600-8x32-VC [2 Suffix VC denotes ] a filter cartridge with Versa-Case assembly. Y [3] Performance tested using bead size 0.338 cm ± 0.005 cm (1/8" ± 0.002") . Meets the full requirements of NSF/ANSI 46-2010. NOTE: All filters come Smartfilter ready. Number of matching Manufacturers is 1 Number of matching Products is 52 Processing time was o seconds I I