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Miscellaneous - 542 SALEM STREET 4/30/2018 (2)
it 1 542 SALEM STREET 210/038.0-0004-0000.0 Y 542 SALEM STREET JS-2004-0852 Project Detail Repo,Yt Printed On:Mon Aug 30,2004 Project Name: _ GIS#: 1989 Project No: JS-2004-0852 Owner of Record SHAHEEN,PETER G&DIANNE P Map: 038.0 Date Submitted: Mar-10-2004 542 SALEM STREET Block: 0004 Status: Open NORTH ANDOVER, MA 01845 Lot: Work Category: Work Location: 542 SALEM STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Septic Project Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0043 7/16/04-As Built and Install.Cert.Forms received. COC issued.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2004-0482 Jul-06-2004 SIGNED OFF JS-2004-0852 Repair-Complete Plan Review BHP-2004-0611 Jun-28-2004 SIGNED OFF JS-2004-0852 New Soil Testing-Repair BHP-2004-0319 Mar-10-2004 Open JS-2004-0852 Soil Testing-Repair Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Grade DWC-System Repair BHP-2004-0482 Jul-16-2004 SIGNED OFF Andy McBrearty JS-2004-0852 Final Inspection DWC-System Repair BHP-2004-0482 Jul-09-2004 SIGNED OFF Dan Ottenheimer JS-2004-0852 Bottom of Bed Inspection DWC-System Repair BHP-2004-0482 Jul-07-2004 SIGNED OFF Susan Sawyer JS-2004-0852 GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Pagel of 1 Commonwealths of Massachusetts City/Town of RSoe System Pumping Record MAY �, Form 4 DEP has provided this form for use�by local Boards of Health. a lu ut the information must be substantially the same as that provided here.Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of house, Left i ht rear o , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address �� � ���y����� IR�C/w''�►� C4/-rown State Zip Code 2. System Owner. S Name Address(if different from location) Cityrrown " Sta Zip Code Telephone Number l, B. Pumping Record arAL( s� 1. Date of Pumping Date 2. Quantity Pumped: Gallons t 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No; " 5. ConditionK7 s e I 6. System Pumped By.- Nell y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo re contents were disposed: Lowell Waste Water SignAtu a qt Haul paw t5fomm4.doc•06/03 . System Pumping Recons•Page 1 of 1 AAx� q7 ' 7 3 7 �Q q ,7? 590 3a 77 i.rIW5, �ewklml_ • Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street 3 ;•,,o�;,,-� North Andover,Massachusetts 01845 �SSCHUS Susan Y.Sawyer, RENS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax �'E1�<IIFICA�IE OF VI<1'�IA CO� NC2 As of: ,duly 16, 2004 This is to cert that the individual subsurface disposal'system repaired("-X" — Euff System by ToddBateson at 542 Salem Street North Andover, JKA 01845 has been installed in accordance with the provisions of 7itfe V of the State Sanitary Code and with the North Andover Board of Health regulations. The issuance of this certificate shall not 6e construed as a guarantee.that the system will function satisfactorily. Susan T Sawyer, IRE3fS/1W,S Eublic Yfealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 o � RECEIVED JUL 16 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The dersigned hereby certify that the Sewage Disposal System( ) constructed; ( repaired; by '12 02 &112 located at m�AL_G was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow of�gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: 7-7-d _ Engineer Rep sentative Final inspection date: `7 E gmeer epresehtative Installer: � LicA Date: Design Engineer: Date: - -4 q : TN OF Mq�cy 9 DANIEL N o KORAVOS CIVIL N No.37752 FG/STS /ONAL i Page 1 of 1 O Dellechiaie, Pam From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, July 22, 2004 4:54 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 542 Salem Street Sue and Pam, Attached please find final inspection report which confirms final grading for 542 Salem Street. Dan Mill River consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com infogmillriv_erconsulting.com 7/23/2004 V 0 r- TOWN OF NORTH ANDOVER t NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT 27 CHARLES STREET 4 °'T�TD NORTH ANDOVER, MASSACHUSETTS 01 845 'Ss�CHU Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 542 Salem Street MAP: 38 LOT: 4 INSTALLER: Todd Bateson DESIGNER: Daniel Koravos PLAN DATE: 5/14/04 BOH APPROVAL DATE ON PLAN: 6/28/04 DATE OF BED BOTTOM INSPECTION: 7/7/04 — S. Sawyer DATE OF FINAL CONSTRUCTION INSPECTION: 7/9/04 Andy McBrearty DATE OF FINAL GRADE INSPECTION: 7/16/04 A. McBrearty SELECT SYSTEM TYPE PRESSURE DOSING COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Field DIMENSIONS AND DETAILS OF SAS: 20x30 SITE CONDITIONS ►� Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer Topography not appreciably altered Comments: i Page 1 of 1 U a • TOWN OF NORTH ANDOVER Of gORTF! Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01 845 �'SSU t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK X Bottom of tank hole has 6" stone base �I4 Weep hole plugged e 1500 gallon tank has been installed (H-10) (monolithic) �B Water tightness of tank has been achieved (Visual) �14 Inlet tee installed, under access port �B Outlet tee (gas baffle) installed, under access port �B 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present �B Hydraulic cement around inlet & outlet Comments: Weep Hole plugged according to installer—Tank holding water. PUMP CHAMBER X Bottom of tank hole has 6" stone base �B Weep hole plugged ►� 1000 gallon Pump Chamber installed (H-10 ) (monolithic) ►� Inlet tee installed, under access port ►� Pump(s) installed on stable base ►� Alarm float working ►� Pump On/Off float working ►� Drain hole in pressure line 24" inch cover to within 6" of final grade installed over one access port ►� Water tightness of tank has been achieved Visual j ►� Hydraulic cement around inlet & outlet Comments: Page 2 of 2 0 TOWN OF NORTH ANDOVER °f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES ,r ``'��� r°.. 0 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'ss",;CHU t� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX Installed on stable stone base q� Inlet tee (if pumped or >0.08'/foot) �D Hydraulic cement around inlet & outlets q� Observed even distribution ❑ ) Comments: SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to 6" into C soil layer, as provided on plan X Size of SAS excavated as per plan q� Title 5 sand installed, if specified on plan q� 3/4-1 'h" double washed stone installed 1/8-1/2" (peastone) double washed stone installed ►� laterals installed and ends connected to header (and vented if impervious material above) ►� Orifices @ 5 & 7 o'clock positions E3 —GFF velles7j+ disposal systems: type, n�imbeF onrl id IiiTT1ITTJJ Elevations of laterals installed as on approved plan ❑ 40 hAil I. DPF= baFrier�talled ❑ ) ►� Final cover as per plan Comments: CONTROLPANEL ►� Alarm & Pump are on separate circuits ►� Alarm sounds when float is tripped ►� Location of control panel: Garage wall Rated for e)deFiGF plaGed outs'' Comments: Page 3 of 3 i Q • TOWN OF NORTH ANDOVERID t NORTH 6 Office of COMMUNITY DEVELOPMENT AND SERVICES ,�?e..:,. -'•: O� o HEALTH DEPARTMENT y '° 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss"4CN„5 S� Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-FAX SYSTEM ELEVATIONS Benchmark: 100.0 Rod at Benchmark: 2.00 Height of Instrument: 102.00 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 95.0+/- 96.42 Septic Tank IN 94.65 94.67 Septic Tank OUT 94.40 94.33 Pump Chamber IN 94.35 93.92 Pump Chamber OUT --- 93.58 Distribution Box IN --- 98.84 D-Box OUT 98.58 98.66 Lateral 1 HIGH 98.55 98.61 Lateral 1 LOW 98.40 98.42 Lateral 2 HIGH 98.55 98.60 Lateral 2 LOW 98.40 98.42 Lateral 3 HIGH 98.55 98.65 Lateral 3 LOW 98.40 98.42 Lateral 4 HIGH 98.55 98.59 Lateral 4 LOW 98.40 98.43 Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 0 Deftchiaie, Pam From: Sawyer, Susan Sent: Wednesday, July 07, 200412:05 PM To: info@miliriverconsulting.com Cc: Dellechiaie, Pam Subject: 542 Salem BOB Contacts: Dan Ottenheimer MAI 542 Salem Street BOB.doc FYI, I did the final grade at 851 Johnson, looked good, but there were fresh deer tracks on the system. Very cool. Susan Sawyer, REHS/RS Public Health Director North Andover Health Department 27 Charles Street North Andover, MA 01845 978 688-9540 office 978 688-9542 fax i 0 O TOWN OF NORTH ANDOVER f NoaTM Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �9ss'4"MU <� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 542 Salem Street MAP: 38 LOT: 4 INSTALLER: Todd Bateson DESIGNER: Daniel Koravos PLAN DATE: 5/14/04 BOH APPROVAL DATE ON PLAN: 6/28/04 DATE OF BED BOTTOM INSPECTION: 7/7/04 — S. Sawyer DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION X PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Field DIMENSIONS AND DETAILS OF SAS: 20x30 SITE CONDITIONS ►� Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Page 1 of 1 I� 0 Q • TOWN OF NORTH ANDOVER °f rio 07"qti Office of COMMUNITY DEVELOPMENT AND SERVICES ,rr eta` °oma HEALTH DEPARTMENT * . 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 ��Ss„"HU Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK X Bottom of tank hole has 6" stone base ❑ Weep hole plugged No tanks on site yet 7/7 ❑ gallon tank has.been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present I ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER X Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: Page 2 of 2 0 0 TOWN OF NORTH ANDOVER Q 10RTh Office of COMMUNITY DEVELOPMENT AND SERVICES 3 C.t`ao tio` HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01.845 M"ss';�HU t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: i SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to 6" into C soil layer, as provided on plan X Size of SAS excavated as per plan �B Title 5 sand installed, if specified on plan ❑ 3/4-1 '/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and j location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with end sweeps j size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: Page 3 of 3 0 0 TOWN OF NORTH ANDOVER OF NORTH 7 Office of COMMUNITY DEVELOPMENT AND SERVICES 3 °``�•� 10- A HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, SMASSACHUSETTS 01845 �qs CHU E<� ACHUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV @ TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 � a Page 1 of 1 a Dellechiaie, Pam From: Andrew McBrearty[amcbrearty@miliriverconsulting.com] Sent: Friday, July 16, 2004 1:13 PM To: Susan Sawyer; 'Pamela Dellechiaie' Cc: info@millriverconsulting.com Subject: 542 Salem Street- Final Grade Sue & Pam, I have attached the inspection form for 542 Salem Street. The final grade inspection I did there today looked quite good-there was actually grass growing on the loam, and the site blended quite well into the existing yard. Let us know if you need anything else. -andy Mill Riker consulting Andrew McBrearty,Project Manager Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com amcbrearty@xqiLriverconsultin2.com 'i 7/16/2004 i z �?A AS-BUILT CHECKLIST . RECEIVED LOT' NUMBER, STREET NAME -/ JUL 16 7004 ASSESSORS MAP& PARCEL NUMBER TOHEALTHVOEPART MENTCF LOT LINES & LOCATION OF DWELLINGS ✓ LOCATIONS & DIMENSIONS OF SYSTEM, OA. ✓ TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES& PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS DRAINS WATERCOURSES WITHIN ISO' OF SYSTEM �. LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX = V/ ORIGINAL STAMP & SIGNATURE ✓ IMPERVIOUS[UUS AREAS - DRIVEWAYS ETC. NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED I UiLDI :I ES. . �t ; T��s Pi..-►.s �.c�t►�.►-Rost �s Jar �64w'lw P��. Q �{�.�16/41J•TY O1 'ji�C 5.1��7UIZ�sCige'.srL • 4 V,91tr1 , TT 1* .A er&ew a OF r4 g Lawrow I�'S •G o ..� -- a►+o a�E vArno�1 of -r«,►� �-�}T�Ne, yY�tttr+ o>- .22.x' �MPOf.1brJ'��1. , ? Q to 7 47- 19 56- hy OF�- SUBSU.RFACE DISPOSAL SYSTEM LOCATED IN rn AS PREPARED MR '' VA OF .m r— l 0o 0 po _re- �-lA� E S;O �� DANIEL m rn '�1� ?j 8 o KORAVOS XD a' < DATE: -7-8-o4 NO-37752 zo v SCALE: 1 40, �� 9 F m -7. MERRIMACK ENGINEERING SERVICES INC.. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS '. " PARK STREET 0 ANDOVER. MA55ACNUSETTS 01810 or TEL (617) 473-3553, 373-5721 O O -�, TOWN OF NORTH ANDOVER �ORTN 5y� Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 '''SS 1CHU5 Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM TE CONSTRUCTION N NOTES � / J ADDRESS: VZ SiJe+n MAP:3ff OT: y l -7 l D� INSTALLER:., DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: r� -- DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = /56;>O LOADING OF SEPTIC TANK = /� GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = ,r/,- DIMENSIONS AND DETAILS OF SAS: Z— 3- SITE CONDITIONS Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Page 1 of 4 0 0 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'SsAc►+U Susan Y. Sawyer, RE.HS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: Page 2 of 4 0 V TOWN OF NORTH ANDOVER of poR7p 4 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 27 CHARLES STREET ` o NORTH ANDOVER, MASSACHUSETTS 01 845 S�CHUS Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM Bottom of SAS excavated down t(:(,- soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 %" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: Page 3 of 4 i ` Commonwealth of Massachusetts Map-Block-Lot 038.0-0004- Board Of Health --------- Permit No------------ North Andover BHP-2004-0482 ------------------- P.I. _ FEE F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd Bateson ---------------------------- ------------------------------------- ---------------------------------- to(Repair)an Individual Sewage Disposal System. at No 542 SALEM STREET ----------------------------------------- ------ ------------- ---------------------------------------------------------- as shown on,the application for Disposal Works Construction Permit No. BHP-2004 Dated- Jul06,2004 ------ ---------- -- - ------------------------------- Issued On:Ju1-06-2004 B Of Health •me gme...mo..mome...............memo.......u.meme•me.... ■■..■...••momomememo.•..mememe..me.momemomomo....mome..me..u.nnn�uu...nou.unuuun.un.u...me.H.memo Commonwealth of Massachusetts Map-Block-l& 038.0-0004- Board Of Health ----------------------- North Andover Certificate of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System (Repair) by ....Todd Bateson ----------- - ----------------------------------------------------------------------------------- Installer at No 542 SALEM STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Perm it No. -BHF-2004-048 Dated___July_06, ---------- --------- -=---------------------------------------- Printed On:Jul-06-2004 Board Of Health .�... �,----W----�1•--ht.lJ"..-y...►--�.•�• . . .. ..f...�..�-�•,,..,.....}Yid.y—y.•-•�,...,`...y.,R!...y-.,s...y...!...j...�..y,,. _..._, Town of North Andover Health Department Date: 0 Location: Of (Indicate Address, if Residential,or Name of Business) Check#: /y Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ` ❑ Septic-Soil Testing $ ❑ Sep/tic�-Design Approval $ ❑peptic Disposal Works Construction(DWC)$ S0� ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) A Health Agent Initials 13 White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER of NOOT" Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ` ~ { 27 CHARLES STREET 'lf QONAi6o^P*y5 NORTH ANDOVER,MASSACHUSETTS 01.845 "ssaCHus�s Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthdept@tOWD fhorthandover.com www.townofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION: LICENSED INSTALLER NAME: ` PLEASE PRINT SIGNATURE: G TELEPHONE# 17 �I CHECK ONE: FULL SYSTEM REPAIR: i/ COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION,please attach the Foundation As-Built Plan. $250 Oil Fee Attached? Yes No Project Manager.Obligation From Attached? Yes No Foundation As-Built? Yes '� No Floor Plans? Yes No Approval of Health Agent Date: 0 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at S�� �� ! ^^ �' relative to the application of A ��f?�/-/dated �'— �� /—for plans by and dated . '14-o'i with revisions dated cle���1__0 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 manger, 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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that 1 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. Undersi-g5`e Licensed Septic Installer ✓ : �- Date: Disposal Works Construction Permit# TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Y 27 CHARLES STREET NORTH ANF)OVER,MASSACHUSETTS 01845 StiCHUs Heidi Griffin Community Development Director (978)688-9540 -Phone Acting Health Director (978)688-9542 -Fax FAX Bill Dufresne From: Pamela To: MERRIMACK ENGINEERING 66 PARK STREET Andover, MA 01810 978-475-1448 Pages: Fac 978-475-3555 Date: Phone: (p l> Septic Plan Response CC: RL- 0 Urgent x For Review ❑ Please Comment 11 Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: /. A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Homeowner . O O HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Jun 28 2004 1:48pm Last Transaction Date Time Tie Identification Duration Pages Result Jun 28 1:44pm Fax Sent 819784751448 3:32 5 OK I 0 . 0 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHU Susan Y.Sawyer,REHS/RS 978.688,9540—Phone Public Health Director 978.688.9542—FAX healthdeptAtownofnorthandover.com www.townofnorthandover.com Peter Shaheen June 28, 2004 542 Salem Street North Andover, MA 01845 Re: 542 Salem Street Dear Mr.Shaheen: The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property,submitted on your behalf by Merrimack Engineering Services dated May 14,2004(Last Rev. June 24,2004). The design has been approved for use in the construction of a replacement onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the time period for which this plan is valid may be reduced by the North Andover Board of Health. The application for a Local Upgrade was approved as requested,for a reduction in the separation between the soil absorption system and the high groundwater-from the required four feet to three feet.With the granting of this reduction,the maximum number of bedrooms of this dwelling has been limited to three bedrooms.This restriction shall remain on the property until such time that the dwelling is connected to a municipal sanitary sewer system and the soil absorption system is properly abandoned.Additional Local Upgrade requests were also approval for the distance from the house to the soil absorption system from 20 feet to 15 feet. This approval is subject to the following conditions: 1. The attached DEP Form 9b must be submitted to the appropriate Regional Office of the Department of Environmental Protection at One Winter Street,Boston MA by the property owner. 2. 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)). 3. 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. 0 0 Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, v Su n . Sawyer,REHS Public Health Director cc: Merrimack Engineering Services, 66 Park Street Andover, MA 01810 file ' commonwealth o�-Massachusetts O City/Town of Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. A. Facility Information Importmwhen ng out 1. Facility Name and Address fortes on the computer,use Dianne and Peter Shaheen only the tab key Name to move your 542 Salem Street cursor-do not Street Addressuse the return key. North Andover MA 01845 CitylTown State Zip Code 4:1 2. Owner Name and Address(if different from above): Name Street Address Cityfrown State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 330 gpd 5. System Designer: Daniel Koravos ® PE ❑ RS Name Address c4rrown State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ® Reduction in setback(s)—specify: Distance from the dwelling from 20 feet to 15 feet ❑ Reduction in SAS area of up to 25%: SAS size,sq.s. %reduction 542 Salem Street 9b form•rev.5102 Local Upgrade Approval- Page 1 of 2 Commonwealth r Massachusetts City/Town of Local Upgrade Approval y Form 9B B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 13 min.finch Depth to groundwater 3 ft. ❑ Relocation of water supply well (explain): List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: Approving Authority Susan Sawyer, Health DirectorJune 28, 2004 Print or Type Name and Tdle Sig tune Date 542 Salem Street 9b form•rev.5/02 local Upgrade Approval* Page e 2 of 2 P9 PP MERRIMACK ENGINEERING SERVICES,WC. �C44[ G G� W ° H(MUU I Engineers a Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE (978) 475-3555 ATTENTION Fax (978) 475-1448��Q!I' TO or .�l-u'Vv� RE: g%� WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION -7 -� THESE ARE TRAN or < ,rte `' ies for approval ❑ Ford � ✓ � Y �� for distribution ❑ As requ prints ❑ For revie 0', ❑ FORBIDS. REMARKS /J' / riITER LOAN TO US �iJ"�li'/� '1146 1-4/AJ 7.5 r-r 6142H COPY TO SIGNED: / if enclosures are not as noted,kindly notify us at once. ORT OTOWN OF NORTH ANDOVER OF N N q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p { 27 CHARLES STREET ° • 9�gATfO�P*y,�RJ NORTH ANDOVER, MASSACHUSETTS 01845 9SSacr+uSEt 978.688.9540-Phone Susan Sawyer,REHS/RS 978.688.9542-FAX Public Health Director healthdept@townoi'northandover.com www.townofnorthandover.coni FW To: e From: Fax: Ll I 3 c j� Pages: Phone: Date: 2 L/ Gly Re: CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑Please Reply ❑ Please Recycle Please contact the Health Department at the above numbers for further assistance. 0 r 0.AO S4.7�_� 5� 64.0 S-r�EE 1 �' 65-Y � W �f I I t-: 0 0 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS LIq 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com June 21, 2004 TOWN OF NORTH ANDO°dam Ms. Susan Sawyer BOARD OF HEALTH Public Health Director r Town of North Andover § E �a 2 30 27 Charles Street North Andover, MA 01845 RE: 542 Salem Street Dear Ms. Sawyer: We have received your review letter dated June 16, 2004 regarding the above referenced site. The plan has been revised to address items 6, 8, 9, 10, 11, 13, 14 and 15. With regards to item#1, the site is not within the Watershed Protection District as such all appropriate notations have been provided (see note 14). With regards to item#2, the system cannot simply be moved to accommodate the reviewers request as it will not fit either horizontally or vertically in the suggested location. The test pits performed demonstrate soil consistency as is the intent of soil testing, however if reasonable questions still exists, I would suggest an additional test pit be performed at the time of excavation inspection so as not to burden the homeowner with unnecessary backhoe costs. With regards to item#3, there was no adjustment to groundwater elevation as a result of topography. The topography throughout the front yard is generally consistent with exception to a small mounded area at the southwest corner of the property which drops back down to the street. It would be unreasonable to assume an ESWT in this area any higher than already determined. With regards to item#4, we discussed this specific situation prior to submittal of this plan and it was your opinion that this request is consistent with the Boards position on L.U.A.'s and we feel it is in compliance with Title 5 and warranted in this situation. With regards to item#5, a notation already exists indicating the septic tank shall be watertight. Additionally, notations exists which indicate the septic shall be installed and constructed in full compliance with Title 5 specs again implying that it will be watertight. Ms. Susan Sawyer June 21, 2004 Page 2 With regards to item#7, again calculations already exist on the plan showing buoyancy and we are confused as to the reviewers comment. With regards to item#12, again this information is already shown on the plan (profile and end station) however additional grading has been provided. We feel the plan, as resubmitted, adequately addressed your concerns and is compliant with Title 5 and the North Andover Board of Health Regulations and respectfully request it be approved as revised. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd I MERRIMACK ENGINEERING SERVICES,INC. 66 PARK STREET ANDOVER,MASSACHUSETTS 01810 h . 0 0 ' K 1220xi Log for NORTH ANDOVER 9786889542 Jun 18 2004 2:OOpm Last Transaction Date Time Type Identification Duration Pages Result Jun 18 1:58pm Fax Sent 89784751448 1:58 2 OK CD VA Th - TOWN OF NORTH ANDOVER ° ``7 '." b"o 3 _ so HEALTH DEPARTMENT n 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Mos°"A•. ACNV O Heidi Griffin Community Development Director (978)688-9540 -Phone Acting Health Director (978)688-9542 -Fax FAX Bill Dufresne From: Pamela To: MERRIMACK ENGINEERING 66 PARK STREET Andover, MA 01810 Fac 978-475-1448 Pages: 978-475-3555 Date: Phones (� Septic Plan Response CC: Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle O • Comments: I Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. I Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Homeowner I i i i OI I s 0 HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 O Jun 212004 12:30pm Last 30 Transactions DDB Time Type Identification Duration PeA Re u t Jun 17 3:39pm Fax Sent 819785447958 1:00 2 OK Jun 17 5:08pm Fax Sent 89784703670 3:45 10 OK Jun 17 5:12pm Fax Sent 89784703670 1:27 5 OK Jun 17 5:15pm Fax Sent 89784703670 0:35 1 OK Jun 17 6:42pm Received 9783529872 1:05 2 OK Jun 18 8:16am Received 1:46 3 OK Jun 18 10:37am Received 19786823363 2:25 4 Error 232 Jun 18 10:44am Received 0:38 0 No fax Jun 18 10:45am Received 0:38 0 No fax Jun 18 11:21am Fax Sent 818007734488 4:35 4 OK Jun 18 12:36pm Received 1978 649 3839 2:54 3 OK Jun 18 1:58pm Fax Sent 89784751448 1:58 2 OK Jun 18 2:21pm Received 16035958753 0:30 2 OK Jun 18 2:24pm Fax Sent 816177231710 0:20 1 OK Jun 18 2:44pm Fax Sent 819786811811 0:35 2 OK Jun 18 4:22pm Received PUREFAX I0_8360 CH3 1:01 2 OK Jun 19 4:46pm Received 978 946 8221 1:33 2 OK Jun 20 6:14pm Received 9787942567 0:56 2 OK Jun 21 4:31am Received 0:52 1 OK Jun 21 8:39am Fax Sent 819787746685 2:16 2 OK O Jun 21 8:59am Fax Sent 819784091269 1:46 3 OK Jun 21 9:36am Fax Sent 816178848723 0:00 0 No answer Jun 21 10:31am Fax Sent 522 0:00 0 No answer Jun 21 10:33am Fax Sent 556 1:18 2 OK Jun 21 11:loam Fax Sent 819788873480 0:52 2 OK Jun 21 11:25am Fax Sent 89784751448 1:59 2 OK Jun 21 11:29am Fax Sent 89784755401 1:35 3 OK Jun 21 11:32am Fax Sent 89784755401 7:10 13 OK Jun 21 11:49am Received 0:38 0 No fax Jun 21 12:06pm Fax Sent 89784751448 2:40 3 OK O co • _ TOWN OF NORTH ANDOVER °f NORTa q Office of COMMUNITY DEVELOPMENT AND SERVICES 3 ``*� • °� HEALTH DEPARTMENT O27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 '9gS.,CNUS�t 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.9542—FAX Public Health Director healthdept@townofnorthandover.com http://www.townofnorthandover.com ' June 16, 2004 Merrimack Engineering Services g g 66 Park Street Andover, MA 01810 RE: 542 Salem Street,North Andover,MA Dear Mr. Koravos, May 14 2004 and received on May 28 2004 The proposed septic stem design plan for the above site dated , P P P Y g P Y � Y has been reviewed. Unfortunately,it cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5:310 CMR 15.000,or North Andover regulations which is not met by this design. 1. If appropriate,please provide a note stating that there are no surface water supplies Owithin 400',public wells within 400', and no private wells within 100' - 220(4)(k). 2. Although the soils are similar in Test Hole 1 and 2,the soil absorption system does -� g ti encountered at bed ti v� not encompass both test holes. Please be aware that if soils e coun p s bottom inspection are different than those shown in the test holes, construction will be V�, halted until additional soil testing is completed. It is recommended that you move the - SAS so that it encompasses both test holes.— 102(2) 3. The adjusted ground water elevation in the vicinity of the SAS appears to be too low as the grade rises towards the southwestern portion of the leach field.—220(4)(a) 4. The design includes a Local Upgrade Approval request to reduce the separation from the bottom of the soil absorption system to the estimated seasonal high ground water from the required 4' to 3'. Several sections of Title 5 do not allow this request to be granted including 310 CMR 15.401 and 404(1)which indicate that whenever feasible a design should maintain full compliance with the standards in the regulations. While the concern stated in the Local Upgrade Approval application regarding pumping to the soil absorption system has legitimacy, it cannot displace the regulatory requirement to maintain full compliance with the code whenever feasible. Site conditions do not appear to justify this request in that a system in full compliance should be able to be placed on this site. __�5: Please include a note specifying that the septic tank is to be watertight—222(1). 6. Tees should be shown extending to the center of the access ports. - -- Please provide buoyancy calculations for the pumping chamber—221(8). 8. Please provide a detail for the inlet tee at the distribution-box -232(3)(a). O9. Please indicate that removal of soil horizons A&B shall extend at least 6"into the suitable soil of the C horizon. (NA 9.02) 10. Please provide a notation stating that all outlets from the distribution-box are to be constructed at the same elevation—232(3)(b). CP Co 11. Please provide an impermeable barrier as there is less than 15' from the edge of the SAS (breakout elevation)to the start of the 3:1 slope—255(2). rl2. Please specify a minimum 0.02 ft/ft final grade slope over leach field-240(10). O 13., The design does not depict the catch basin located approximately 10'-15' from the proposed soil absorption system. Please also indicate any drainage systems which enter or exit this basin. 14. Trenches are to be used as the soil absorption system mechanism whenever possible. Please use trenches in this instance or explain why they cannot be utilized. (3 10 CMR 15.240(6)) 15. Please provide the date of the wetland delineation and please provide the North Andover Conservation Commission's confirmation of this data. Additionally,while not a reason for disapproval,you may wish to consider selecting a different pump for use with this system. The pump curve provided indicates considerable excessive head and volume is available with this model and this might cause an excess flow problem in the distribution box. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. ZincerelSawyer,RE /R li O Public Health Director cc: Owner File O Page 1 of 1 0 0 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, June 17, 2004 8:54 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: plan reviews Sue and Pam, Attached please find the reviews of the plansr 542 Salem Stree d Lots 2&6 Gray Street. I do not believe any of these three are ready for approval as prop 542 Salem Street is missing the catch basin located about 10'from the SAS and also does not account for the change in grade beneath the field, among other things. The Gray Street lots need some serious attention by the designer. You will see in both letters that the last item listed regards the number and location of soil test pits. Having never seen these sites we didn't feel comfortable going on the verbal report we received from the designer that"previous folks said it was ok". However, if he has something in writing or if you feel it is not necessary, you may wish to delete those sentences. Dan 0 Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com 6/17/2004 a 0 �oRTy TOWN OF NORTH ANDOVER 41 ly b... L HEALTH DEPARTMENT A 27 CHARLES STREET # NORTH ANDOVER,MASSACHUSETTS 018454Z. s++cwus Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542-Fax FAX Daniel Ottenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑Please Comment ❑Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File-Address O \ HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Jun 15 2004 4:57pm Last Transaction Date Time Type Identification Duration Pages Result 1:18 2 OK Jun 15 4:51pm Fax Sent 819782820012 I Page 1 of 1 o� 0 0 DelleChiaie, Pamela To: Daniel Ottenheimer(E-mail) Cc: Sawyer, Susan Subject: Septic Plan Status-542 Salem Street Importance: High Hi Dan, Both the engineer(Merrimack Eng.)and homeowner called today looking for status of new plan review. I log this in as coming in to us on Friday, 5/28. With the long holiday, I am sure you did not get to it until June 2nd or 3rd. At this point, it has not even been quite two weeks. However, the homeowners are closing on the property sometime in early July I believe Bill stated, and are anxious to find out the status. We certainly are still within a reasonable time limit, but I wanted to give you a heads up. If you could just e-mail me back and let me know where it might be in the review process, I will call the h/o& engineer and let them know approximately when to expect an answer. Thank you! Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development& Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover.com Tel. 978-688-9540 Fax 978-688-9542 I 6/15/2004 F= Town of North Andov Health Department Date: Location: �/ �✓ / '� (Indicate Address,if Residential,or Name of Business) Check#: Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ .r; ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ 0/Septic-Design Approval $ 4'JG7✓' f ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) 086 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH A�ER% Town of North Andover BOARD OF HEALTH HEALTH DEPARTMENT �1 27 Charles Street �� 8 ?i n North Andover,MA 01845 978.688.9540 ... .-- .- health& a km onofnorthandover.cone - b SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: 2U '01� SITE LOCATION: fl'G►LAN Li'r!✓G E'f ENGINEER: F'�i;fL�l F JAC-ki NEW PLANS: YES ✓ $225.00/Plan Check#: (Includes]-VEw and one Re Review Only) REVISED PLANS: YES $75.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: NO LOCAL UPGRADE FORM INCLUDED: ES NO Telephone is: Fax#' E-mail: HOMEOWNER NAME: - 1 OFFICE USE ONLY H%en the submission is complete(including check): /ate=slanrp pkm and triter 2. Co a and attach Receipt 3. y File,Forward to Consultant 4. Enter on Log Sheet and Database 77 rLocatiom-c—S`� owner's Name:l:_ 'C'Fr! ', L Address.Tel : Lid?-�o T 7 New tt ge � X01.__ pnlr,`„�_ Date: c4-c4Wetlands5�tae II_Sotl Symbol�L Sol A=44 WTonJ Soif q Deep Observation Hole Logs Elevation Depth SoQ II niton Soil Texture Solt Color Soil Mottling. % Gravel,Stones,etc. ht A V, FMA 10 it tee- � Patent Ataterial. �I't c.V DepW to&d" —_S WIft=Wour is the Rola to 2'` lveepin=froth PIt Faa��ESHG�Y: �G 'h. .-- 04 hM Parent Matet ial "�"I L L lkpth to 114mc- Sta wwg ivata in the Hdc:IgLWeepta=km Pit vaee-46LMMV: Date —0'o,.4_,_ Percolation Tests Observation Hole# 1 " Depth of Pere " Start Pre-sosl: Time at Vt 0 Time at 9" { t(1 Time at 6" 11, y Time W-61 -Rate Min/luch l Performed Dr: ;,E � �> Witnessed Br A i G , r`' i O Massachusetts Department of Environmental Protection Ll Bureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval ._.:__. Required by 310 CMR 15.403(1) 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 5.404(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 15.417. 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 a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the �f computer,useQA r �IVA: )_ only the tab key Name to move your cursor-do not Street Address use the return key. City State Zip Code 2. Owner Name and Address: 44A -7 Name Street Address A City State 40 19)4 K-79�) &07 Zip V Nelephone Number 3. Type of Facility(check all that apply): BR/Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) conventional ❑ Other(describe below): 6. Type of soil absorption system(trenches, chambers, leach field, pits, etc): t5form9a•rev.5/02 Application for Local Upgrade Approval- Page t of 4 0 0 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A — Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: ��%AY✓c�.J�IJ gpd Design flow of proposed upgraded system gpd Design flow of facility gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): M119/01untary ❑ 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: I 9ard GAL- -$-6A1c ��IJI(;., Pz ae- PwLiP 9 x&2641- F� 3. Local Upgrade Approval is requested for: [Reduction in setback(s)—describe reductions: Z-1 -lam ❑ Percolation rate for 30 to 60 min./inch: min./inch Reduction in SAS area of u to 25%: o ❑ P reduction SAS size,sq.ft. /a eduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate l� min./inch 17 Depth to groundwater ft ❑ Relocation of water supply well (explain): t5form9a•rev.5/02 Application for Local Upgrade Approval,Page 2 of 4 O ( Massachusetts Department of Environmental Protection Bureau of Resource Protection—Wastewater Management Program Form 9A — Application for Local Upgrade Approval Required by 310 CMR 15.403(1) ❑ 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)(i)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature 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: 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: A.(/). 3. A shared system is not feasible: /k.,b1; 4. Connection to a public sewer is not feasible: t5form9a•rev.5/02 Application for Local Upgrade Approval,Page 3 of 4 Q Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program i Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 5. The Application for Local Upgrade Approval must be accompanied by all of the following(check the appropriate boxes): ❑ Application for Disposal System'Constructlon Permit O/omplete plans and specifications ite 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 "l,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." a�'!✓T Facility wner's Signature Date /2i ,co e Print Name Name of Preparer Date e;f� "12,y ei2- Preparer's address City/Town Kmx. ©rf (17p) y7S��555 State/ZIP Tee ee NOTE: 310 CMR 15.403(4)requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before commencement of construction. t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 4 of 4 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.coml Sent: Friday, April 16, 2004 10:48 AM To: Susan Sawyer; Pamela Dellechiaie Subject: Soils Test Results Sue and Pam, Attached please find the soil test results for the propees at 542 Salem Str t and 769 Forest Street for your records. Dan Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info ,millriverconsultina.com 4/16/2004 ti N ap i I oi 4. a 0 � r r I I Page 1 of 1 R 0 0 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Monday, March 22, 2004 4:59 PM To: Susan Sawyer; Brian LaGrasse; 'Pamela Dellechiaie' Subject: soils, 542 Salem Street Sue, Brian and Pam, Soil testing with Merrimack Engineering slated for 4/8 at 10:00 a.m. Dan F Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting com mfo@millriverconsulting.com 3/30/2004 Page 1 of 1 0 O DelleChiaie, Pamela From: Dan Ottenheimer[info@miliriverconsulting.com] Sent: Friday, March 19, 2004 8:53 AM To: pdellechiaie@townofnorthandover.com Subject: RE: Soil Test-542 Salem Street Pam, Sorry to report that we've never received an application for this address. I'll be glad to schedule with Bill soon, please send along a copy of the application. Dan X' 0 Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultina.com info@a millriverconsulting.com -----Original Message----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] . Sent: Thursday, March 18, 2004 4:19 PM To: Daniel Ottenheimer(E-mail) Subject: Soil Test- 542 Salem Street Importance: High Hi Dan, Have you had a chance to schedule a soil test for the above yet? Bill Dufresne called asking about it today. Thanks, Pam Pamela DelleChiaie Health D Assistant sststant Town of North Andover Community Development& Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover.com TeL 978-688-9540 Fax 978-688-9542 3/30/2004 1 BOARD OF HEALTH NORTH ANDOVER, MASS. 018451=ov W6 r of rl a;a i ;R/ ° 978-688-9540 10�!4D OF I.11,�1T a APPLICATION FOR SOIL TESiS 3 MAR ( 0 2014. J k DATE: ,�--1�—a� MAP&PARCEL: LOCATION OF SOIL TESTS: 95 Q'Z A LE JA OWNER: GZAIA,14 M4, TEL.NO.: r0-0-7 X07"7 ADDRESS: ?���.4 LEEW eyrNLtjrw�,r ENGINEER: 1;121i2a&4 `a( 4 K,KTEL.NO.: �� 7 S Af—Zc, CERTIFIED SOIL EVALUATOR: L.L- t/!.►�1Z�R�ti Intended use of land: Residential Subdivision Commercial Is This: / Repair testing v Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: . A O i ill/F �POL�rl/p �l LnJETTEE P/s gilll /.P (SET) LZ al \3 h o n M r ro t � X D F ; (B al) l,` a THlS PL lP THE �E' �P=1975.00'. 4� :t 45 •�=19.41 F ill 49��05�5D' Gt/ 9.16 eF 775 00 D �TASK' —SiA LEM • EG STREE-61'. ttei o o - BOARD OF HEALTH NORTH ANDOVER, MASS. 018 3T014N OFNORTH ANQ0',1,"'-i--71 978-688-9540 BOARD OF HEALTH APPLICATION FOR SOIL TESTS MAR 10 DATE: MAP&PARCEL: a LOCATION OF SOIL TESTS: �7 Cl"il LE OWNER: TEL.NO.: 7 X0-Z 7 ADDRESS: ?i �Z'-L6-7w nz'-r ENGINEER: 112 -+W -,,� `"r S ir Ill ti STEL.NO.: CERTIFIED SOIL EVALUATOR: L! - ' ! l�i Intended use of land: Itesidential Subdivision ng y o Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of 360.00 per lot for re airs or upgrades. �—P P P>iT — GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Fulla ment will be required for all additional p y eq o tests within two weeks of testing. 6. 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)., 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Btlow This Line N.A.Conservation Commission Approval: �' D Date Received: Check Amount: Check Date: gs�3 W . � lgz 61 3H1 sin J Q i HL P. /THAI' y o0 . 414 5j) SVA / s 1 . /"Y /d 331133447 ' CUYV 70a' _J/IY a o � , 0 BOARD OF HEALTH NORTH ANDOVER, MASS. 0184 0,;���®F�a�R-TH'X-���,�, 978-688-9540 BOA19I D OF HEALTH APPLICATION FOR SOIL TESTSMAR ( Q 201,014. g y DATE: —1 — MAP&PARCEL: LOCATION OF SOIL TESTS: 15 `7�E W OWNER: !1AA 14 0*, TEL.NO.: (p 0'7 ADDRESS: L ENGINEER: HeJM W&,k� ffh1/1)r J ti STEL.NO.: 47,5�--�7 ri s 1tf— Z.c� CERTIFIED S l� OIL EVALUATOR: L . Intended use of land: Residential Subdivision 'ngl, Farm / Commercial Is This: - Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: LMETTEE P/g/U// t P (9ET) /25 d0 L O`f 17 ,2h D ch y (sr �PC/CE9 A L=3-46.. TSE" Ae' OD 44 45 L-19.4T' OF /111,49S GAEC 9.B �tl 49_05=.5D'�Gt( �-7�T5D0 LEM GTR'. .l. Tr �eEc�srE,eE Page 1 of 2 0 Q DelleChiaie, Pamela Subject: RE: Soil Test-542 Salem Street Importance: High Hi Dan, When will this soil test be scheduled? Thanks, Pam -----Original Message----- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Friday, March 19, 2004 8:53 AM To: pdellechiaie@townofnorthandover.com Subject: RE: Soil Test- 542 Salem Street Pam, Sorry to report that we've never received an application for this address. I'll be glad to schedule with Bill soon, please send along a copy of the application. Dan X 0 Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsuliin.com 3/22/2004 Page 2 of 2 O0 info@millriverconsulting.co_m -----Original Message----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] Sent: Thursday, March 18, 2004 4:19 PM To: Daniel Ottenheimer(E-mail) Subject: Soil Test- 542 Salem Street Importance: High Hi Dan, Have you had a chance to schedule a soil test for the above yet? Bill Dufresne called asking about it today. Thanks, Pam Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development& Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover.com Tel. 978-688-9540 Fax 978-688-9542 3/22/2004 TOWN 0 NORTH ANDOVER BOARD OF HEALTH Location j �/ Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Uv a Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 7496 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer L v O tt0RTy I TOWN OF NORTH ANDOVER �6 a"ooL HEALTH DEPARTMENT ° . p 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01.845 SACHU`�E North Andover Health Department Telephone(978)688-9540 27 Charles Street FAX(978)688-9542 North Andover, MA 01845 FAX Daniel Ottenheimer From: Pamela To: Mill River Consulting ��' ��/� Pages: 3 im.Fax: Phone: 1.800.377.3044 or Date: 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test r/ Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: (541z2 Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File-Address � L o +r L o HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 Mar 19 2004 10:47am Last Transaction Date Time Twe Identification Duration Pages Result Mar 19 10:45am Fax Sent 819782820012 2:25 3 OK BOARD OF HEALT NORTH ANDOVER, MASS. 0184'5001AMo IVF 0RT-H ANQC,1E'Ri 978-688-9540 BOARD OF HEALTH APPLICATION FOR SOIL TESTS � MAR 1 0 2004. DATE: -l 0--a _ MAP&PAR(EL: a LOCATION OF SOIL TESTS: OWNER: -,5,aA TEL.NO.: & 7 ADDRESS: ?i �Z 4.1-Ew j2��lrr CERTIFIED SOIL EVALUATOR: ! L( -�- Intended use of land: Residential Subdivision nglO o Commercial Is This: / Repair testing v Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: y O low ill/F F6L rUb J LnJETTEE P/9,91t// 1.P (SET) o r /5 — 4 125ap� y.. 25, 15 5 a h Pis , n , �o o LD`a CS�; 00 0 bD 16 L-%"0 f 4.Z`1 i i Y7J a TN%S PL TSE REQ )9, 75: 4D " 4D.45 L=/9.41 OF A?AS�,4 AJ," 05�5D GV eF 77S W: A(, Ej Ec.s.B , �Fa GT REEA _ _ REc�STE,eEa Commonwealth of Massachusetts REC EiVr City/Town of System Pumping Record AUG - 12007 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Healt Ar-!f;H DEPART �sed, but the information must be substantially the same as that provided here. Before l using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use only the tab key Address to move your 6V c1v cursor-do not City/rown State Zip Code use the return key. 2. System Owner:&� Name Address(if different from location) CitylTown State 7� d� -<dip Code Telephone Number! B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) peptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [1-go If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: K- 6. 6. System Pu By: Name Vehicle License Number Company 7. Location re onten er posed: Signature Ha Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of „ .I ? 01� System Pumping Record �`-'� Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health ol"-other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of ho , Mgfit rear of h se Left rear of building. Right rear of building. Address /V0 f4-t-- Cityrrown u\ ` State Zip Code 2. System Owner: Name Address(if different from location) City/Town Sta Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) ET Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi'on of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location here contents were disposed: .L.S. ell aste Water Signature of Ya?ler Date t5form4.doc•06/03 System Pumping Record.Page 1 of 1 RECEIVED Commonwealth of Massachusetts City/Town of ; 212012 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT DEP has provided this form'for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left i ht rear of hous , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address 5 q - Cityrrown State Zip Code 2. System Owner. Name Address(if different from location) City/Town state � �Z�CodPi Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition o�Sys- trema rJ 6. B System Pumped : Y p Y Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: Zs5ignitufe Lowell Waste Water e Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of . Oi 6 System Pumping-Record ' Form 4 'TOWN OF NORTH ANDOVER 5. HEALTH DEPARTMENT DEP has provided this form for use,by local Boards of Health. Other forms may be'used, but the information-must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted.to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of house, Left/ I h§Wigigh�re�arobf , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left building, Under deck Address `�qQ� City/Town iJ State Zip Code 2. System Owner. Name' Address(d different from location) City/Town ' State Zip Code Telephone Number z B. Pumping Kecord Date of Pumping 1. Date 2. Quantity Pumped: Gallons r 3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes L_ IKO If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: 6.. System Pumped By: Neil.Bateson - F5821 Name Vehicle Uoense Number Bateson Enterprises Inc- Company 7. Location w Ire contents-were disposed: S: Lowell Waste Water Sign ait HhulDate t5form4.doc-06/03 System Pumping Record•Page 1 of 1 !I TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION �(- (example: left front of house) 6A. 6us-c DATE OF PUMPING: ,,,2 oZQUANTITY PUMPED 100-0 GALLONS CESSPOOL: NO / YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY. I, COMMENTS: CONTENTS TRANSFERRED TO: /a, _ L TOWN jANDOVER SEPTIC SYSTEM SERVICING REPORT Date: Homeowner:-� ;-7 Street Pumper t re Address Phone �,� : - �- ' Phone Nature of Service: Routine F?mercl�nr.,y . Observai:ion;; : Good Condition t/1` Full to Cover Baffles in Place Leachfield Runback Excessive Solids 110avy il I�rl jl:frllll ��) ------------------- -_-- Description of Work: ------------- Comments : A