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Miscellaneous - 60 RALEIGH TAVERN LANE 4/30/2018 (2)
6Q RAILF-QA 4-T$El�l1AHE 210/107.139.0000.0 Ur"C 14081 (D, 9 HA$TtNQS, MN 60 RALEIGH TAVERNLANE JS-2003-0607 Proiect Detail Report Printed On:Mon Aug 30,2004 Project Name: GIS#: 7447 Project No: JS-2003-0607 lOwner of Record MC ENTEE, VINCENT E&ANNE Map: 107.A Date Submitted: Apr-24-2003 ( 60 RALEIGH TAVERN LANE Block: 01.39 Status: Open 1 NORTH ANDOVER, MA 01845 Lot: Work Category: Work Location: 60 RALEIGH TAVERN LANE Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Soil Testing �omments: of Work: L } Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0014 8/23/04-Install.Cert.And As Built received. Issue COC. 21/04-Bill Dufresne called and stated septic is ready for a Final Inspection.--p.d. 5/11/04-Received Bed Bottom inspection. Installer is Mike Reilly.--p.d. 11/13/03-(hand del.@ 3:35 p.m.)Bill Dufresne of Merrimack Eng.Submitted revised plans based on a minor error he found on the last set of plans submitted. For the file. 11/10/03-DWC Issued. Signed by BL. 10/23/03-Plan approval at BOH Meeting. 9/13/03-Plan Received Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Constructio BHP-2003-0359 Nov-10-2003 SIGNED OFF JS-2003-0607 Construct-Complete r New Soil Tests BHP-2003-0047 Apr-24-2003 SIGNED OFF JS-2003-0607 June 19,2003 Soil tests Plan Review BHP-2003-0302 Nov-10-2003 SIGNED OFF JS-2003-0607 Plan Review Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Grade DWC-System Construction BHP-2003-0359 Jul-07-2004 SIGNED OFF Susan Sawyer JS-2003-0607 Final Inspection DWC-System Construction BHP-2003-0359 May-24-2004 New Dan Ottenheimer JS-2003-0607 Final Grade DWC-System Construction BHP-2003-0359 May-24-2004 New Dan Ottenheimer JS-2003-0607 Bed bottom DWC-System Construction BHP-2003-0359 May-10-2004 FULL COMPLY Dan Ottenheimer JS-2003-0607 GeoTMSO 2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 60 RALEIGH TAVERNLANE JS-2003-0607 Project Detail Report Printed On:Tue May 11,2004 Project Name: GIS#: 7447 Project No: JS-2003-0607 Owner of Record MC ENTEE,VINCENT E&ANNE Map: 107.A Date Submitted: Apr-24-2003 60 RALEIGH TAVERN LANE Block: 0139 Status: Open NORTH ANDOVER,MA 01845 Lot: jWork Category: Work Location: 60 RALEIGH TAVERN LANE Zoning: Proposed Use: District: land Use: 101 JProposed Use Detail Subdivision Description Soil Testing Comments: of Work: I Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0014 5/11/04-Received Bed Bottom inspection. Installer is Mike Reilly. 11/13/03-(hand del.@ 3:35 p.m.)Bill Dufresne of Merrimack Eng.Submitted revised plans based on a minor error he found on the last set of plans submitted. For the file. 11/10/03-DWC Issued. Signed by BL. 10/23/03-Plan approval at BOH Meeting. 9/13/03-Plan Received Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Constructio BHP-2003-0359 Nov-10-2003 SIGNED OFF JS-2003-0607 Construct-Complete New Soil Tests BHP-2003-0047 Apr-24-2003 SIGNED OFF JS-2003-0607 June 19,2003 Soil tests Plan Review BHP-2003-0302 Nov-10-2003 SIGNED OFF JS-2003-0607 Plan Review �y s` Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Bed bottom DWC-System Construction BHP-2003-0359 May-10-2004 FULL COMPLY Dan Ottenheimer JS-2003-0607 © y t two oaf 6 Sc�c�f ��— GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Pagel of 1 Commonwealth of Massachusetts W City/Town of North Andover E 5 2013 a System Pumping Record` M sye e Form 4 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out pu1. System Location: on the computer, use only the tab key to move your Address Gc) �Z&oc& tpycc n cursor-do not North Andover Ma 01845 use the return City/Town State Zip Code key. 2. System Owner: Name 2nxn Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping / 1 2. Pumped: p g Date Quantity Gallons 3. Type of system: ❑ Cesspool(s) VSeptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ] No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: od 6. Sy tem Pumped B VeN N me Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Ste art's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 S S nature of Haul r � Date i Signature of R6eeiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 ` 7 Commonwealth of Massachusetts RECEIVED City/Town o.f NORTH ANDOVER MA SAUS - System Pumping Record •�Form 4 TOWN OF NORTH ANDOVER HEALTH WARTMENT DEP has provided this form for use by local Boards of Health. The System Pumping Record mu; 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 cursor-do not use the return City/Town key. Zip Code 2. System Owner: r • Name _--._______.__��e�__�__.---..__�.—..___.__...____.____._.__._.. Address(if different from location)---._... _...__.__._._.,.—.�_._�.—.-...._---_._.._.._.____.__._..._—....... —.-.--.----------__---- Cityrrown ------------- -State ---------- --- .. Zip Code Telephone Number B. Pumping Record 1. Date.of Pumping C& -- 2. Quantity Pumped: Date y Gallons - 3. ype of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank Other(describe): 4. Effluent Tee Filter present? ❑ Yes Z--�o If yes, was it cleaned? ❑ Ye_ _ r 5. Condition of System: 6. kePumped By: -- --._ ._.... — Vehicle License Number �— - Company l 7. .. Location where contents were disposed: J Si ature of Haur/- Date http://www.mass.govi/dep/water/ provals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record-Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 10-30-00, SYSTEM OWNER &ADDRESS SYSTEM LOCATION fvA�� (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED1 ,50?) 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: COMMENTS: CONTENTS TRANSFERRED TO: L wtDi . Eh *T E: N mo PL..� # Gt&n P itowrTty" ib u oT PrZ9--W 577 A 61.,"^01r of-r4r iwosing ll�L 9S./� 14./ �¢ to 4Krf.H , rT is ,A eL40W VP t4& La 'rkW Ib .Z4,4e 36d ��3.Z ' l �oHPpN�.1a Tom. 9¢:�9 RECEIVED REecs /o/ 13 C2j /w-98 AUG 2 3 2004 AUF /DO-63 TOWN OF NORTH ANDOV OWN r HEALTH DEPARTMENT NES *44 !00.93 z3,.a �1 ply Tim D / Y \o ' 1 •� ol SAN TKRN I �► N ` •Q N \ml I ® 4—VENT \ I ars iL.4 e AS BUILT PLAN OF BSURFACE Dt SYSTEMASLS �} LOCATED INTi iVDRT/� ANDD VCK, /1/I,4 � �D 7,4LZ-/Gly T,4 VZ-TW L AS PREPARED FOR =' r DATE: 9-1104f- TL / 39 SCALE: MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER MASSACHUSETTS O1i10 or TEL (617) 475.3555, 373.5721 TRANSMISSION VERIFICATION REPORT TIME 10/1012006 13:47 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE,TIME 10110 13:47 FAX NO. /NAME 819788250096 DURATION 00:00:54 PAGE(S) 03 RESULT OK MODE STANDARD ECM North Andover Hearth I),-- 1600 Osgood street Building zo, Suite 2.36 Letter Nor of Transr�itta�� ` .....m `._,�. - th Andover, MA 0 1 845 978.688.9540 , Phone X78.688.8476 •- Fax Doge heal, de t oNmofnartl a dWr. and- E-mail LSSA www fouvnofao fhandover.ce Website TO: DATE; COMPANY: q ¢ j / FROM: Pamela UelleChiaie,Health Department assistant Phone: /' �J� Ol� �'�J RE: ,per y� Fox: ��" L.ad..�. ��✓ �j � 61/e off'@ sendingYDjj.' 06 py of Letter L7 pthOrf' �.r//�n below These are transmitted as checked below: )�- � arll�,o► � �7krgtpvn►� � � > OFA- wo%l=ynW — � � ,C7IarYaWL&0 �' C1Srdrrri+ REMARKS: ° COPY TO: North Andover Health Department NORTh q O �i�eo ,ay ti� ' 1600 Osgood Street letter of Transmittal 3? '°`''- � '° °� ti Building 20, Suite 2-36 — North Andover, MA 01845 978.688.9540 - Phone '� °, CCW(K(WKK _,� � ►PPy(5 978.688.8476 — Fax Page of A°q�reo �SSgCHus�� healthdept(Cb-townofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: DATE: v COMPANY: FROM: Pamela DelleChiaie,Health Department Assistant Phone: / �(J U l� RE: Fox: 77leS (07 We are sending you. O Copy of Letter laps L7 Other(fill in below f These are transmitted as checked below: =L7 aFNokd L7rw4PO;d Daa*nt q*fw REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: Town of North Andover f'AORTA# ° 44L10,� •{' Office of the Health Department o•:" '''°°� Community Development and Services Division 27 Charles Street " °+ • �-• �`�' North Andover,Massachusetts 01845 �ss�caus Susan Y. Sawyer, REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax CE1�2I FICA�I'E 01F C091APII.�NC2 As of: August 23, 2004 7fiis is to cettify that the individuafsu6surface disposafsystem repaired ("f� — Fuf(System by Mike Reilly at 60Raleigh tavern Gane North Andover, 911A 01845 has been instaffed in accordance with the provisions of Titfe v of the State Sanitary Code and with the North Andover Board of ifeafth regulations. The Issuance of this certificate shaff not 6e construed as a guarantee that the system wiff function satisfactorily. S n �Y Sawyer, RE3fS/WS fu6ficWealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 RE� � . 'FIE 3 "01"OF NOF. TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTIM PE INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( epaired: by Ni t Le YLe i Li- located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved design flow ofd 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: - A a Engineer Repres ntative Final inspection date: l8`�� Engineer RepiYsentative Installer: Lic.#: Date: H Engineer: ,�►"`^ _, Date: 43 11415q �f 3 CIVET. cn No.40706 f UiLDI 1 PS �t�� Itis, 64.,/Pj,,-F,y ur+flGiclrrfonl is JPf Ind'F'M�J• Pr26- R A./ Z 4f t,A U+ .JTY of-rae 5wf'uUdFrca 14F—L. Ib 9S./� 24.E 4MH• ST It ^ 6Ue~ OP'649 IaAYvg 7c PrA NO LLE VNnod PF -rAlk 9,-'1f rNh *Y**P-t 9¢.79 Z �,fa GOMP0114�J f4. 911(1�9 RECEIVED RECEP AV.13 1W-99 AUG 2 3 2004 AUC 5'W ekz Li /w'63 TOWN OF NORTHANOOV WNr HEALTH DEPARTMENT Ile' „ ¢3 ioo•6Z - ' ++ loo.93 ,I II s+L y57.a'. f.Pig E D 4 \\\y I I � m � T.1uK\. 0 • I I \\X. ; I p / C6R�GGD � r I ,r r 1 Lars ILA r rA-D J – � C 44 AS BUILT PLAN OF SIjBSURFACE DISPOSAL SYSTEM-e" : 4 LOCATED IN iVDRT! ANDDVE?, hf,455 o ZA Z716Y TAVEPN Lit AS PREPARED FOR Vl VC ENT lvc EIVTEE TiYI ID 7 DATE: 8•//.ate -TL /3 9 SCALE: MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS u,,,nnR Saar • ANDOVK MASSACKLOMS 01810 4 TEL(617)475,35"-ansril Page 1 of 1 � U Dellechiaie, Pamela From: Dan Ottenheimer(info@millriverconsulting.com] Sent: Thursday, May 27, 2004 1:49 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 60 Raleigh Tavern Lane Sue and Pam, Attached please find the final construction inspection form for 60 Raleigh Tavern Lane. Outstanding items which either you or us need to check are: 1. Impermeable barrier not yet installed, needs to be checked at time of final construction inspection. 2. Outlet from septic tank was not sealed and was leaking septage. Contractor was to return and seal with hydraulic cement. 3. Septic tank is only 1,000 gallons. This should be approved via a LUA and shown on as-built plan. 4. Final grade and cover. 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 info@millriverconsulting.com 8/30/2004 r1 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Tuesday, May 25, 2004 8:42 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: mise. Sue and Pam, A few items: ■ 0 Raleigh Tavern ane final inspection went ok except the existing tank size appears to be 1,000 gallons no e , 00 gallons indicated on Merrimack's plan. The plan proposed re-using the existing 1,500 gallon septic tank. I have told the contractor not to backfill the tank until further notice but that it was ok to backfill the SAS. I have left word with Dufrene's voice mail to either call for the tank to be replaced or to request a Local Upgrade Approval as allowed under Title 5 for using a 1,000 gallon tank (not sure it would be granted, but he could apply for it). Asked him to contact either you or me with his conclusion. ■ Will be out much of the day tomorrow(Tuesday)so call, don't e-mail, if you need anything. Call office and leave message or call cell phone. ■ Andy and I will not be available at all on Wednesday. ■ We will be in town on Thursday doing soil testing at 43 Mill Road and 42 Penni Lane. ■ Will get you inspection reports for 178 Stonecleaved 60 Raleigh Tavern shortly. ■ We cannot find any record of having gone out to 426 Summer Stree . 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.millriverconsultin2.com info millriv_erconsultinga.com 5/25/2004 MILL RIVER CONSULTING Septic System Management Services TOWN OF NORTH ANDOVER SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 60 Raleigh Tavern Lane MAP:107A LOT: 139 INSTALLER: Mike Reilly DESIGNER: Merrimack PLAN DATE: 11/13/03 BOH APPROVAL DATE ON PLAN: 11/24/03 DATE OF BED BOTTOM INSPECTION:5/10/04 DATE OF FINAL CONSTRUCTION INSPECTION- 5/24/04 DATE OF FINAL GRADE INSPECTION: y SELECT SYSTEM TYPE Pressure Dosing COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 - existing (See Notes) LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Field DIMENSIONS AND DETAILS OF SAS: 25' x 30' SITE CONDITIONS ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282. 0014 info@millriverconsulting.com Page 1 of 1 0 0 MILL RIVER CONSULTING Septic System Management Services SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed unknown loading unknown construction ❑ Watertightness of tank has been achieved ® Inlet tee installed, over access port ® Outlet tee (gas baffle or effluent filter) installed, over access port ❑ Manhole 24 inch cover to within 6" of final grade installed ® over one access port ® over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: -Existing outside tank dims: 5'W x 8'6"L x 5'D which appears to be a 1,000 gallon tank. Contractor instructed to cease work on this part of septic system until further notice. Outlet Tee was leaking septage due to lack of hydraulic cement - to be repaired by Installer. PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading 2-Piece construction) ® Inlet tee installed, over access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® Manhole w/ 24 inch cover to within 6" of final grade ® installed over one access port ® Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Hydromatic pump model SKV40 provided instead of pump specified. ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: n/a 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.3044 978.282. 0014 info@millriverconsulting.com Page 2 of 2 MILL RIVER CONSULTING Septic System Management Services 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: Installer provided reducer (2" pipe -> 4" pipe at d-box) to help slow flow into D-Box (OK). SOIL ABSORPTION SYSTEM ® 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 ® 3/4-1 Y2" 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: -Bed Bottom inspection: Standing water at bottom corner of excavation. Mottles were found at this depth too so this finding appears accurate.❑❑ -Construction Inspection: Barrier to be installed, need to check at final grade inspection. 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:n/a CONTROLPANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: Basement wall, near sewer outlet ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.3044 978.282. 0014 info@millriverconsulting.com Page 3 of 3 U MILL RIVER CONSULTING Septic System Management Services Benchmark: 100.00 Rod at Benchmark: 5.30 Height of Instrument: 105.30 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 95.60 Septic Tank IN 95.40 95.16 Septic Tank OUT 95.20 94.78 Pump Chamber IN 95.10 Pump Chamber OUT 94.44 Distribution Box IN 101.14 Distribution Box OUT 100.98 100.98 Manifold Lateral 1 HIGH 100.95 100.91 Lateral 1 LOW 100.80 100.83 Lateral 2 HIGH 100.95 100.92 Lateral 2 LOW 100.80 100.83 Lateral 3 HIGH 100.95 100.97 Lateral 3 LOW 100.80 100.83 Lateral 4 HIGH 100.95 100.92 Lateral 4 LOW 100.80 100.83 Lateral 5 HIGH 100.95 100.91 Lateral 5 LOW 100.80 100.83 Lateral 1 is furthest from house. 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.30.44 978.282. 0014 info@millriverconsulting.com Page 4 of 4 "N Page 1 of 2 DelleChiaie, Pamela From: Dan Ottenheimer(info@millriverconsulting.com] Sent: Monday, May 24, 2004 10:20 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: RE: 60 Raleigh Tavern Lane-Final Inspection Request All set for today (5/24) at 1:00 p.m. 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.millriverconsultiniz.com Wfo@millriverconsulting.com -----Original Message----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] Sent: Friday, May 21, 2004 10:33 AM To: Daniel Ottenheimer(E-mail) Cc: Sawyer, Susan Subject: 60 Raleigh Tavern Lane- Final Inspection Request Importance: High Hi Dan, Bill Dufresne called and stated that 60 R.T. Lane is ready for a final inspection. The installer is Mike Reill 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 5/24/2004 Page 1 of 1 0 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Tuesday, May 11, 2004 3:08 PM To: Susan Sawyer; 'Pamela Dellechiaie' Subject: 60 Raleigh Tavern Lane Sue and Pam, Performed a bed bottom inspection of 60 Raleigh Tavern Lane on May 10. Found no problems except I sunk into the ground over my ankles in wet a soupy mess. Such are the hazards of construction in the spring. 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@millriverconsulting.com 5/11/2004 MILL RIVER CONSULTING Septic System Management Services TOWN OF NORTH ANDOVER SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 60 Raleigh Tavern Lane MAP: 107A LOT: 139 INSTALLER: Mike Reilly DESIGNER: Merrimack Engineering Services PLAN DATE: 11/13/03 BOW APPROVAL DATE ON PLAN: 11/24/03 DATE OF BED BOTTOM INSPECTION: May 10, 2004 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 = 1,500 gallon (existing) LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = 1,000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Field DIMENSIONS AND DETAILS OF SAS: 25 x 30 with 5' overdig SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: 2 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282. 0014 info@millriverconsulting.com Page 1 of 4 MILL RIVER CONSULTING Septic System Management Services 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: 2 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282. 0014 info@millriverconsulting.com Page 2 of 4 r- KILL RIVER CONSULTING Septic System Management Services D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.087foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to C soil layer, as provided on plan O 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: Wet site at time of construction. Standing water found at depth of Redoximorphic features noted on soil evaluation. 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: 2 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.3044 978.282. 0014 info@millriverconsulting.com Page 3 of 4 r 0 MILL RIVER CONSULTING Septic System Management Services SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 95.60 Septic Tank IN 95.40 Septic Tank OUT 95.20 Pump Chamber IN 95.10 Pump Chamber OUT Distribution Box IN Distribution Box OUT 100.98 Manifold Lateral 1 HIGH 100.95 Lateral 1 LOW 100.80 2 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.3044 978.282. 0014 info@millriverconsulting. com Page 4 of 4 Commonwealth of Massachusetts Map-Block-Lot 107.A-0139- -- - ----------------- Board Of Health PennitNo North Andover -BH----P-2003-0359 ------------------ P.I. FEE F.I. $250.00 ------------------ Disposal Works Construction Permit Permission is hereby granted X ike Reilly------------- ------------------------------------------------------------------------------ to(Construct)an Individual Sewage Disposal System. at No 60 RALEIGH TAVERN LANE ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2003g_-FILE d--_November 10,_2003 --------------- -------------- ------------ ---------- Issued On:Nov-10-2003 Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map-Block-Lot 107.A- Board Of Health --- ----- ----------- North Andover Certificate of Co nce THIS IS TO CERTIFY,That the In ' Sewage Disposal System (Construct) by ---Mike Reilly------------- ---------- - ------ ---------------- ---------------------------- -------------------------------------------------- - Installer at No 60 RALEIGH T LANE has been installed' ccordance with the provisions of TITLE 5 of the State Environmental Code as described in the application isposal Works Construction Permit No._BHP-20037035 Dated---November 10,-2003 ----------------------------------------------------------------- Printed On:Nov-10-2003 Board Of Health TOWN F ORTH ANIJOVE D� BOARD OF HEALTH i - Location Permit # Food Service / $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Constructior `v $ �5 Soil Testing $ _ 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 $ 71 OA, Health Agent 4Jhite - Applicant Yellow - Dept. Pink - Treasurer APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 11.4-03 CURRENT INSTALLER'S LICENSE# LOCATION: i LICENSED INSTALLER: kme- Rc-.ltv e E, R 7C,(I r SIGNATURE;,, f,,,,_/ TELEPHONE#_(? A - - j_J�3 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $ 00 Fee Attached? Yes No Foundation As-built? Yes No Floor plans on Yes No Approval ' Date: r U NSTALLER PROJECT MANAGEMOT OBLIGATIONS w As the North.Andover licensed installer for the construction of the septic system for the propertyat � r�• a.���cA Crelative to the application M � 14 Y� �,1 ,C'4"ew of - - dated for plans by e( ��c.1=iXW and dated with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto project manger, or any other person not associated with my company schedules'an inspectio and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicabl inspections as indicated below. I understand that requesting an inspection,, withou completion of the items in accordance with Tile 5 and the Board of Health Regulations ma: 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 dons fust. Installgtmust 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 o] verbal OK from engineer must be submitted to Board of Health, after which installer calls foi inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade.—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to installseptic systems in North Andover can constitute reasons for denial of the, system, and/or revocation or suspension of my license in the Town of North .Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: 1! Disposal Works Construction Permit# J/ TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (Aconstructed; ( )repaired; by M abe P� located was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# ,plan dated , with a design flow Of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer-- Uc.#: Date: r35 Engineer: Date: Q yr L 03 Cer�,� n . J `- J MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com October 15, 2003 Mr. Brian LaGrasse Health Inspector Town of North Andover �.- - - -� 27 Charles Street T!Y` r `FRF .F HE! H'' R' North Andover, MA 01845 y� { 4 OCT 7 RE: 60 Raleigh Tavern Lane North Andover, MA ' O Dear Mr. LaGrasse: We have received your letter dated October 2, 2003 regarding the above referenced site. Items 1-9, 11-13 and 15 have been addressed. Item#10 deals with the type of S.A.S. designed and Item#14 deals with a local upgrade request both of which are not being recommended by your current reviewer, however, are request that have historically been approved by your Department and previous review consultants. On behalf of our client,we respectfully request this matter be placed on the October 23, 2003 meeting agenda so we may discuss those issues with the Board. We thank you for consideration of this matter. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd 7 , ._. ......y._...i..r.�r:....nry�.^v-........ _...:.. ,....F.�rv�z .:..,.ter,..i........ .. ... .: .... .. .,-.. .. ... .. .' r�•:�1ae'n ..r .. ._. .."_. ,. ..... 1!r L IV% 1 �F3�intG.`.A'SVBs�iv.��3»nt o� �.a-,T wrs;�C.bk- sY. Oi.t>'?.NoRTH AU Doves itR As..yt'Y ''T tis�c-.t. .� ,►. ' , svioWN otv PLa.ty 8V HAYr-9`..V-tvC.��ti'i •TL1.NG� i, Iraq.: mr� D .cc. '2 .� . .v �, !e� �r:�.�i trf;.7�.., hS�� i • 1 n•9Li t y���11�r3F!��� r>� Y '� :���,r .. i �: �:.. t 4�Kr�kil j�L to.t % �� t, ! i d�•. 1 I A 7 t 171^.'N� :• f / n t .. 3.X.7.. -y ..� v K . f L. Iti:. .� y 11 1 R � - .. All* - r• r. '1:: Yf t Y 1# r! ji i rt'er r r � ? rt f• d (i �.7r >. t y. A r./ d S ! ..t i 3 .rp�' atY d 5` V :,r .tl - �• 1 7r tr S 1 .J•,a �Ir'7��'y ,.r .. y�l '# 1 1. � t�tet�} 4 V �µ t. �t� rta.its1 � cl�lli/trt tS'. .`# t¢a 1r dr+3a_�e �''�y:•,I,ti i ;Ji [1 1 est '•rt s A 'j i f~ v r � pQRTH -• TOWN OF NORTH ANDOVER �� cQ HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �qs��C .E� s/1CHU`� Sandra Starr,R.S.,C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 FAX Bill Dufresne From: Pamela To: MERRIMACK ENGINEERING 66 PARK STREET Andover, MA 01810 978-475-1448 Pages: 2 Fax: 978-475-3555 Date: Phone: Septic Plan Response CC: Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: �-� �`�copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Homeowner � 1 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET '�°► - NORTH ANDOVER, MASSACHUSETTS 01845 SACMUSE Heidi Griffin 978.688.9540—Phone Acting Health Director 978.688.9542—FAX October 2, 2003 Daniel Koravos, P.E. Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: 60 Raleigh Tavern Lane, Map 107A, Lot 139 Dear Mr. Koravos: The proposed septic system design plans for the above site dated August 28, 2003 have been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval: 1. Please provide the names of all abutters of the property being served. (NA 8.02j) 2. Please provide the location and elevation of the foundation drain. If there is no drain, please make a statement to that effect on the plan. (NA 8.02y) 3. Please provide a profile that is to scale. (NA 8.02c) 4. Please specify on the plan that the existing septic tank must be inspected by a Title 5 Inspector and certification provided to the Board of Health that the tank meets the following criteria: a. 2-3" drop from inlet to outlet. (3 10 CMR 15227(5)) b. minimum of 4'liquid depth. (3 10 CMR 15.223(2)) c. there must be three manhole covers. (3 10 CMR 15.228(2)) d. there is 9" minimum and 36" maximum of cover material over the tank(3 10 CMR 15.221(7) and 228(1)) e. the tank has a loading of at least H-10 (3 10 CMR 15.226(3)) f. the tank must not be leaking. 5. Please specify on the plan the following requirements for the existing septic tank: a. The inlet tee to the septic tank must extend 10" minimum below the flow line and the outlet tee must extend 14" below the flow line. (3 10 CMR 15.227(6)) b. Tees must extend 6" above the flow line. (3 10 CMR 15.227(1)) c. Tees must have 3" air space above them. (3 10 CMR 15.227(4)) d. One manhole must be brought to within 6" of final grade. If the cover is located at grade, it must be secured. (3 10 CMR 15.228(2)) e. The inlet and outlet tees must be located directly under the manholes. (3 10 CMR 15.227(l)) C f � �J 6. Please specify on the plan that the inlet tee in the d-box must be 1" min. over the outlet invert. (3 10 CMR 15.232(3)(a)) 7. Please specify that the soil beneath the distribution box must be compacted since it is non-native. (3 10 CMR 15.221(2)) 8. Please specify the pump chamber loading. (3 10 CMR 15.226(1)) 9. Please provide more detail in the profile, showing and requiring that a maximum of 36" of cover material be placed over the pump chamber. (3 10 CMR 15.221(7)) 10. Since 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) 11. Please specify that the distribution lines be connected with a solid pipe. (NA 15.01) 12. Please provide a line running through the profile depicting existing grade (3 10 CMR 220(4)(o)) 13. Please propose a swale where the fill around the leach area will be within 5' of the property line. Also, the existing 98' topographic contour line should be extended (on the Acorn Trust property) to determine if the required slope grading is being met. 14. 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. 15. Please indicate the pump operating point on the pump curve. While not a reason for disapproval, it appears you may be able to: 1. Utilize a smaller pump and reduce construction and operation costs. It appears that the 0.5 horsepower pump specified could possibly be replaced with a smaller unit. 2. Not design based on 900 sq. ft. of soil absorption system but on the design loading rate as specified in state and local regulations. 3. You may wish to include the use of a barrier in compliance with the Massachusetts Department of Environmental Protection Policy BRP/DWM/WPeP/G02-1 in order to reduce or eliminate grading and drainage issues. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Brian Lagrasse Health Inspector cc: Homeowner CD&S Dir. File Page 2 of 2 f 1 HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 Oct 03 2003 8:57am Last Transaction Date Time Twe Identification Dura ion Pages Result Oct 3 8:54am Fax Sent 89784751448 2:49 3 OK Page 1 of 1 Pamela DelleChiaie From: "Dan Ottenheimer'<info@milldverconsulting.com> To: "Heidi Griffin"<hgriffin@townofnorthandover.com>; <biagrasse@townofnorthandover.com>; <pdellechiaie@townofnorthandover.com> Sent: Thursday, October 02,2003 4:26 PM Attach: Raleigh Tavern#60 Plan Review.doc Subject: 60 Raleigh Tavern Road Heidi, Brian and Pam, Attached please find the plan review for #60 Raleigh Tavern Lane. Dan Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 info@ m i I Iriverconsu Iti ng.com 10/3/2003 .'TOWN OF RTH ANDOVER BOARD OF HEALTH— Location EALTHLocationC/ Permit # w Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ 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 $ 7U5 ? Health Agent White - Applicant Yellow - Dept. Pink - Treasurer SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: ES $225.00/Plan Check #:. (Includes I"Re-Re iew O y) REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: S NO— TC -- - TC LOCAL UPGRADE FORM INCLUDED: ES N i DATE: g' DATE TO CONSULTANT: DESIGN ENGINEER:kF_1"t *-QAC r— x( (05;&I elephone#((�75_^ l� OFFICE USE ONLY When the submission is complete(including check): i. ._Date stamp plans 2. Complete the DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM form 3. Attach file and route to the Health Director for review J rinter.. �� l2 (�IG► .. ,� o per's Name: vtg"t.rl' 'A c _►,3-reg' el: t- o?q, -rL, I " Address: /-0 Vb0t�„W 1&aj Tel#:�.$�-Z229 New tSuk_Repair ✓ Date: G-lit-o 3 Wetlands T►MR�'ZORe k_--Soil Symbol�t r Soil R'ame 'je vtC Son ClissJ;2 Deep Observation Hole Logs Elevation Depth Soil Horizon Sol'Texture Soil Color Soil Mottling % Gravel,Stones,etc: b-�,'' dem Parent Material. -' I V V Depth to&dr0&*.=_shndin=Neter•in the Hole:_ _ikeepin=from Pit Fax : «EgG%V: o L_ Ic9IYw2/2, — W� �,�,a.a.'V.Fix" I,0`'�w�fG 1•_ . ;,r-- l..l kys�ori' �(Z� Parent Material -rut,V Depth to Bedraelt„�StU&S(Vater W the Bola ee • .__Weeping irnm tit Faa�_ESHGIY: _ZfI" Date 6-1-1-017 Percolation Tests Observation Hole Depth of P11 Start Prt:-soil: Z !3 L4 Time at 12" Z,LM Time at 9" 3 r Ap Time at 6" Time(9"-6")— •Rate M'n&ch Performed B�___��( p �}�, Witnessed Br. FORM 9A - Application for Lo l Upgrade Approval Y Commonwealth of Massachusetts OWT— 1- • > jjrA(�%j j ,Massachusetts (City/Town) Application for LOCAL UPGRADE APPROVAL Title 5,.310 CMR 15.000 DEP Approved Form 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 systelh 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 15.417. 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. Facility Address: 60 KALz iz L `r�ovis-J City/Town: h12. Facility/System owner: r E,NTEE Address: 60 eA Lin" -r-Vew 1Y City/Town: laOrt;Tt.1 ANt/gtZ State:_ Zip: Telephone: Type of Facility(check all that apply): [ esidential ❑Institutional ❑Commercial ❑School Describe facilityfsl y� e ,� VFzpa[AL5`yi-LI-i Type of existing system: ❑Privy ' ❑Cesspool(s) Ej('�'onventional System ❑Other(describe) Type of soil absorption system(trenches,chambers,leach field,pits,etc) Design Flow per 310 CMR 15.203:, Design flow of existing system uvlcuc 40 gpd Design flow of proposed upgraded system`140 gpd Design flow of facility }�O_gpd Proposed upgrade of system is: g4oluntary ❑Required by order,letter,etc.(attach copy) ❑Required following inspection pursuant to 310 CMR 15.301 Provide date of inspection / / FORM 9A - Application for Local Upgrade Approval Department of Environmental Protection DEP Approved Form—3/20/02 Pagel of 3 Describe the proposed grade to the system CA g�i 5cz> A. tL, -TT pJl, -TD �A.) Local Upgrade Approval is requested for: ❑ Reduction in setback(s) (Describe reductions) ❑ Percolation rate for 30 to 60 min/inch Percolation rate min/inch Y ❑ Reduction in SAS area of up to 25% (SAS size and%redudtion) SAS sq ft Reduction [� Reduction in separation between the SAS and high groundwater Separation reductionft Percolation rate min/inch Depth to groundwater ft ❑ Relocation of water supply well(Explain) ❑ Other requirements of 310 CMR 15.000 that cannot be met Describe and specify sections of the Code .If the proposed uperade 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.elevation determined by: _ A t Det (Print or type evaluator's Name) (Signature of evaluator) (Evaluation D e) 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: Depamnent of Environmental Protection DEP Approved Form-320/02 Page 2 of 3 pE &ORTH E TOWN OF NORTH ANDOVER HEALTH DEPARTMENT . 27 CHARLES STREET x NORTH ANDOVER, MASSACHUSETTS 01845 �q"°�••°�''�� SS�CHus� Sandra Starr,R.S., C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 t, FAX Bill Dufresne prom; Pamela for Sandra Starr TO: MERRIMACK ENGINEERING 66 PARK STREET Andover,MA 01810 , Fac 978-475-1448 Pages: 2 978-475-3555 Date: , Phone: Septic Plan Response CC: Sandra Starr,R.S.,C.H.O. Re: Health Director ❑Urgent x For Review ❑Please Comment ❑Please Reply ❑Please Recycle • Comments.- Attached omments:Attached is the response from Sandra Starr regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-954 or assistance with any questions. Thank you. Xc: Address File Chrono File Town of North Andover, Massachusetts Form No. , < ,tAORTH BOARD OF HEALTH 6 4 6 O * C' a o 0h TEDWPP 'yy APPLICATION FOR SITE TESTING/INSPECTION P 9SSACHUS�� Applicant NAME ADDRESS TELEPHONE'S_ Site Location /.�" Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee Test No. X71 S.S. ermit No. D.W.C. No. C.C. Date Plbg. Permit No. - n 1111111111 � _ It IIn111111111 � 1 IIN IIIIIIIIIIn1 ��� 1 1 It 1111111111111 _= IN 11111 11111 1,��� 1 1 1111 11111 .�������*�► 1 N NNII 1111111 In 1 1111 111111 11111 11 � ►. 11 1 In111 11111 IN 1 11 INI 1111111 1 111 � - ��;�• . :: . � _ � 11 NIINI 11111 1 1 1 � � 1 t1 11 1 INn11 ��� 111 t1 111 11 1111 1 , 1 111 111 111111 a1111 1 t1 !G ��i©11N1 log; � - t N 1 1 1 IIN11N11111111 � � -- + �� . 11. 11 1111111111111111 ��� F. -�- �' f � Town of Wirth Andover, Massachusetts Form No. 1 pORTH BOARD OF HEALTH 3�o�tt`ED 619tiOL 6 (1 + ' op °°° Ew,° ' APPLICATION FOR SITE TESTING/INSPECTION ��SSAC HU`����y i Applicant NAME AD RESS TELEPHONE Site Location &/"�/- 0,���4 Engineer NAME '/ ADDRESS TELEPHONE Test/Inspection Date and Time J =E-MZll RMWN,ffOA RVIM H EALTH Q'G/ Fee `©D Test No. or I.C. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 PR 3 M APPLICATION FOR SOIL TESTS DATE: MAP&PARCEL: 10 7 A VA to_ LOCATION OF SOIL TESTS: (per {�; � � � ��C►I�st OWNER: l, l E E TEL. NO.: ADDRESS: �O� n jLWaH TAy�� )L esK1 ENGINEER: ��L ,� �l�({� TEL. NO.: CERTIFIED SOIL EVALUATOR: Pa w, u Intended Use.of Land: Residential Subdivision Commercial Is This: � s" Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 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$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) 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"A 00') 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 I N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: —7 MAY-- I 2003 L- 5 ass 1\ 1°Jet, v 13P , � Z I•,�ZP Q 10, v o 11 P �LL �1QP �• W QQ�0 M z 0 P os \ � \ 9 Q<G 92 14' \Y LL P U 0 i CL N P ' 6 Iw co 3 P K n; 6S 25.00' M n �1 ��•323 0 R,q4,61 X8 56 Gy FRN 44/VF i� BOARD OF HEALTH ,- �NORTH ANDOVER, MA 018��� 978-688-9540 � APR 2 3 29 APPLICATION FOR SOIL TESTS DATE: D MAP & PARCEL: 10 7 A LOCATION OF SOIL TESTS: OWNER: r, TEL. NO.: ADDRESS: ENGINEER: Id amm TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision mgl. �Ho Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 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$200.00 per lot for repairs or Lipgrades. (If time is not critical, fee for repairs is $75.00) 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 I"-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: X15`` ' LS'S. �FE RAt�'p d aAO` SS \ , `oJet, r �3 P P Z � oWX , m --jO 1�P �Q o u. LL ���P 0 ` Po��.PP�� Z3z \Q ol ff�0 lap Q. n Z o5\0� \ 9 P `1C� X.ua L W S I G QQ..•�``1\2: 14• O LL P LU U? 11� z - N P 0- ' 6 ILLJ Iw° 5P � 3 P / S 25.00' 8- r- s� A' 032'pd R0 F� Gy FRN SNF. � o TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) C, 1194+1 S� C [/Ub(i� DATE OF PUMPING: { a QUANTITY PUMPED l GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES �- NATURE OF SERVICE: ROUTINE EMERGENCY A NOV 3 0 2001 OBSERVATIONS: GOOD CONDITION FULL TO C04- HEAVY O4HEAVY GREASE BAFFLES IN-PL-ACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: w\ ` /Com nonwealth of Massachusetts 1 " ' Massachusetts System Pumping Record System Owner System Location Date of Pumping: ��`— ! R-4 Quantity Pumped: l Jgallons Cesspool: No �`a''� Yes L.) Septic Tank: No LJ Yes System Pumped by: Si eddet License # Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector- 1 � C nano wealth of Massacinlsbtts P, Massacltttsetts stem I'utnping Record System Owtier System Location V/V ST Uste of lumping: Quantity Pumped: gallons Cesspool: No I Yes L) Septic Tank: No Yes [4—"- System Pumped by: VareQost S#.eeywo4 d License# Contents transferrred to : Greater Lawrence eanitsry district Date: Inspector: X y•I•NV.i,11,�'r'. OfP.he� Provided 1h1i lolm rol ;poor soar JUN`'- 4 2009 po t'=�r1•lllod to ulv ioctl 8c�rc; cr ., r °I "0° •" '•' ,, , .',V .. . pJ,InprClllprr �IIRJ dPN6R�"f-PAfV`bOVER TMENT :..1`;�'a1, •fid' �••) •••111: 1.1r ,..'611 CIr��NM •.'1/ 1 ',I Y.,r,I,�,, I' 1,�r..1' �; I , �' 1�, ' S�llr '�--... Owner, ' ,. ,,.' .1 :�,1, ,:r�ri� NI!111'•:;f,�;; i,: 'r!�'';'�;' ' •�;� �OrNt (114V(irrnl rp'n buVc^) __ Cq;.A,n - .Pumping'RQ�ord , 5 • Oe,o o! Pvmpinp ' rYDf v! 'Mom,'.: L f ,---------_ BPI.0 r811A , Q%Ochar (doacriCo1;� Fm�an.► Too Flllo(P(9„sent? ,.. ,I•.,• %v It1.11'�: ' .:'.!Ir, `�`'�•b,l ''••.oiidlyon'o(;9Y},�m;''•�:%, , . �-- ', , I 1'�.7•f• .,,�. Y1,.' Gt r \;B' ;tSyr1;Py'mPad`'gy;' , ,' rr;i ��^�S rl�/)/l r Y7�' ;I•I 1�'' '' I y,h)Gf Uc41)1t n'':'^v on. ark\cor�lonla:ware dl9posav: rl'•I11 'r•Ly,f v ,111; It- .l. 1 . I I , rn•rw • 7r1 r V m e s�•porlde�we�o�leDp1oYa/sllblorm�,ntmatn9Pac1 �\ y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT of ENv1RONmFNTAL PROmCnm ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY CO? Secret, ARGEO PAUL CELLUCCI DAVID B.STRUT Governor Commisaior SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: CvO T�ALzk6k5 YAJe-et ol Name of Owner Lkt . -�-N1 AlZ14 KA`(MJ%' s 1f-2TI:iG9�e_ Address of Owner: SAmg� Dat.of Inapecdon Z' Zc��"r v ., MR Nanta of hUPs tar:(Pleases Printl �a3 M �x ec I am a DEP approved yet hapector pursuant to Section 15.340 of Title 5(310 CMR 15.0001 Company Name: cots Maung Address: _ Q o z�dp Z Telaphorw Number: eono - Q;,Z_• CSG ct Q CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sitesewage disposal systems. The system: V Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ FailsLJGp► inspector's Sipnaore: Dae: Z ` The System inspector shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)withIn thirty 130)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owne shall submit the report to the appropriate regional office of the Department of�Environmentat Protection. The original should'be sent tolls system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 i��Printed on Recycled Paper • C 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Q PART A - CERTIFICATION(cofltiraisM . Property Address: 60 (�C91LE�� A,,& L.ptyl?,_ k4ot"'T4 Pl00VER.M d 84 Date of Ir"oetioL WSPECTION SUMMARY: Chock A, B, C, or A A. SY,SjTFyi PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 16.303 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. Indicate yes, no,or not determined(Y, N.or NO). Describe basis of determination in all instances. If'not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance.lattached)indicating that the tank was installed within twenty 120)yaws prior to the date of the inspection:or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiitration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipels) or due to a broken, settled or uneven distribution box. The system will pass inspection If(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box Is levelled or replaced The system required pumphtg-snore than four times a yeardue to broken or obstrocted plpe(s►. Thesysterrt wit!pa= inspection if(with approval of the Board of Health): -- • • broken pipe(s)are replaced obstruction Is removed revised 9/2/98 Page 2ortt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(con*w@M Coo ( -' 1� t 1.. q,, Odot Aw�0ov�.G�, M 4 wim: Address: qR Ju C� 2 r.rt.r: Date of Intpedi n 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES N ACCORDANCE WITH 310 CMR 16.303(1)(b1 THAT THE SYSTEM IS NOT FUNCTIONING N A MANNER WHICH WIL1..PRQTECT THE PUBLIC HEALTI!AND SAFETY AND THE ENVRONMENT* Cesspool or privy Is within 50 feet-of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH IAND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING N A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: - The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply Of tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less then 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of-ammonis nitrogen and nitrate nitrogen is*goes to or less than 5 ppm. Method used to determine distance (approximation not vWWI.- 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(conaand) PropertyAddreea: CccP. l$�C ��� �. � ,�a��-I A Doi ,M� (D �b4e5 Owner- Data of Inspoctim 2�zs •99 D. SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of•sewage into 4ocility-or eyetrtn componenrdo@Ko an overloaded orvieggedSAS&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. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipels). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for -coliform bacteria,volatile organic-compounds,ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one-or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system-iwviWn 200 feetok-t+iln►ta",&.@Au► w'/ly - -- • -- the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=1WPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 16.30412►. Please consult the local regional office of the Department for further infognation. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. Dabs of Irrap.elien: Check if the following have been done:You must indicate either"Yes" or "No" as to each of the following: Yes No ` Pumping information was provided by the owner, occupant,or Board of Health. -None of the aystemsongsosents iiawbaan puwgwd4sratJaast two Weeks andtbe system hasbeesasoeiwrgwwiad Bow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was Inspected for signs of brbakout. /ice _ All system components,excluding the Soil Absorption System,have been located on the site. C _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on•the site has been determined based on:- riiMFA$VR2,MW _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 0 5.30213)IM The facility owner land--wat,.1f diftarsat from.nwnerl.wsre.prayidedawith ialorlaatioa`an f - SubSurface Disposal Systems. revised 9/2/98 Page 5ofII �f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFORMATION Property Address: Cao 4L1 e V{ `OUft),( LAlt-� k VAI O r6G" A'- OVe4, Owner: �-�4�C�� ••F M�f.' { P`�1Ut`�S�ZCi�,I@,�J(Z k Dow at inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: Q g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual) Total DESIGN flow Number of current residents: Z Garbage grinder lyes or no):14-0 Laundry(separate system) lyes or no1:, 0, If yes, separatainspection.required _ Laundry system inspected (yes or no) Seasonal use lyes or no):JiQ Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no)J�10 Last date of occupancy:—QJPtelv COMMERCIALIINDUSTR1/1L: Type of establishment: Design flow: and 1 Based on 15.2031 Basis of design flow Grease trap present:lyes or no)_ Industrial Waste Holding Tank present:lyes or nol_ Non-sanitary waste discharged to the Title 5 system:lyes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of info�atioon- WM JUS -4 a System pumped as part of inspection: (yes or no)-hLO If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed known)-and source ef,infarna*m: -•-?� Sewage odors detected when arriving at the site:(yes or no) 'Lin revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �00 ( i"i1�o44 ` � � Napz� MA owns: Date of Inspection: BUILDING SEWER: (Locate on site plan) �' Depth below grade:, Material of construction: cast iron_40 PVC_other(explain) Distance from private water supply well or suction line )c-0 Diameter 4�_L C) Comments:(condition of joints,venting,evidence of feake'e,-ow) SEPTIC TANK:_ (locate on site plan) Depth below grade: ZZ Material of construction: ✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is Instal,list age_ 1s.age.confirmed by Certificate of Compliance_(Yes/No) Dimensions: " 10 x, '� " 0 W -'�-5, 'q K Sludge depth: cl it Distance from top of sludge to bottom of outlet tee orbaffle-,7 + Scum thickness: Distance from top of scum to top of outlet tea or baffle: Distance from bottom of scum to bottom of outlet tea or baffle: Now dimensions were determined: IYLaLF��'FJ�M�N f' Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structuraHmogrity, evidence of leakage,etc.) 1 k ' -C k- �T 1 GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Data of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page IofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(condmm4 RopertAddress: Cryo ( 1�' iCoJ.E `C�'tv(:z1�k�t I.IFFi ,1 �(02Z�( Ak-Wo\/er,-,\MA o\S45 OwnerW AQIt Date of wpeCtioic z. z.S� Cl TIGHT OR HOLDWG TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions.- Capacity: imensions:Capacity: gallons Design flow: gallonsiday Alarm present Alarm level: Alarm In working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: " Comments: (note-if lev and distribution is equal,evidenee of solids carryover,evidence of leakage into or out of box,etc.)__7_- -— 4 C6't-WSl F La S�5 P o V CJIP-- PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alums in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOi,b-.\JRM PART C SYSTEM INFORMATION(contlraud) Property Address: 490 (ZPrI k A QQ " LP t`(q, , %qo kt. A 4-t vGP—, M4 o l 84 5 Owner: R.K Ck Ae6 -t- �M q&e w4`i' M U alSt�2 Deis of Irapeetimc .Z.7-G -(�1 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:_ C leaching trenches,number,length: : �� leeching fields,number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of by raulic failure,level of ponding, damp soil,condition of vegetation, etc.) �l.. �1kt_ r Tl,o �chDo�+�ct✓ aF P�l�l.C�rbll.0 CESSPOOLS:_ (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of,vegstation, etc.) PRIVY:_ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.) revised 9/2/98 Page 9of11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTKM FORM PART C SYSTEM NFORMATION(condrwd) Prop«t„Address: o,rrn.r: (�-�c.N,�t2.►!J -� r/1�C2-'� K� Mvt�SZ�C(��� nes of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 1 au-N4 22� CNe Ooulq Z,(Q . A - C— I 1(-O �`f W A - p_ t Iroy 14 3 o. C- ZZ H oUS�'— � � / 33 � - � -24 •2 A)ff 'ta G`O _ F 38• r revised 9/2/98 Page 10 of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrilinisM Property Addr a : 4 RA L��6 t —AV" LAI-1 ,Daft of Owner: m4RAC Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater �+Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions � Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) PLO"" CAI auk �Z �t•rtl ti3� RwA:vc� Vam 92.to tom-W`r - 38" CoO � cC f: `AuQ" �> � V'6e2to kgVkovVx- , M q s'E-AA%)ny iCLO 6��L( 2�3 YIQS A �1 LS RA?� CID Aeev C)f C roC� revised 9/2/98 Pap 11ortt Z3 KVS Information Systems, Inc. 00M, SMUUB04A/CS/UOS/LO05 TOWN OF NORTH ANDO TERMINAL NO: 000 CONSUMER METER F/M TIME: 13:38: ''il Acct: 01-2439000-0 MUNSTERTEIGER RICHARD C 60 RALEIGH TAVERN Meter No: 001 Rev Mtr/#: N 000 Book: 10 Page: 24390.00000 Meter Flg: O [ Connector: ] Digits: 4] Dim Cd: A] Multiplier: ] Arb #: Manf Cd: ] Units: Pipe Size: ] Len: ) Type: J Req: 00/00/0000 Inst: 00/00/0000 Cnct: 00/00/0000 Disc: 00/00/0000 Cd: Wrk Cd: ] Mt Code: ] Met Loc: ] In/Out: Notes: 5/8 TRISEAL ] Serial #: 0020590606 Bgn: Cur: 2535 A Preu: 2517 E 2nd Preu: 2502 A [2 ` From: 11/30/1998 To: 01/29/1999 Cur2: Preu2: Next: 00/00/0 Cns Cr: Nth Bill: 03 User: ] ,..::.....: Consumption Information ---------------------------- --- First 12 Billing Months ------[3] ------ Last 12 Billing Months ------- 03/1999 18A 09/1997 23C 03/1996 18C 09/1994 12/1998 1SE 06/1997 9CI 12/1995 18C 06/1994 09/1998 14A 03/1997 16C 09/1995 21C 03/1994 06/1998 8A 12/1996 16CI 06/1995 24C 12/1993 3 ' 03/1998 20C 89/1996 16CI 03/1995 17C 09/1993 1 12/1997 16C 06/1996 11CI 12/1994 28C 06/1993 First 12 Total: 182 1 Last 12 Total: 251 <ESC> to Enter New Meter Number <M>odify, <D>elete or <N>ext nq ....... ..v:: _. .. ... .::.: .....i........... '..i iTe ::::. ..:.... _ I ," IM 14 ..fM ltltld't Sttst APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. , hereby m 4e application for a permit for a sewage disposal installation at 1e-1 L�"" . I will install this system in ac- cordance with all the Aawe 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 minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 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 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of -2- D d lineal (square) 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 sioilar 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 1/8" 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 tile 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 installation will be less than 100 feet from any private water supply; O :�aet from any dwell; a.rg nr 10 feet fry 04--y property line. 21, feet from any stream, 2 I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be ub tted with application. DATE a _ f C1,6, t.( -f Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 171 Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as describ d. DATE IG c > Signature ofI s ecting Officer Percolation Test-—Z 1.1, Garbage Grinder , s r BOARD OF HEALTH OF NORTH ANDOVERy MASSACHUSETTS . SEWAGE DISPOSAL NAME OF APPLICANT C DATE LOCATION Lot 16 Ralei h Tavern Address of lot no. _ BUILDING: Dwelling X Other SYSTEM: New }( Repair GENERAL DESCRIPTION OF LAND hi h SUBSOIL: Clay_ Gravel Sand _ PERCOLATION TEST minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK i nnn gallon capacity. LEACH FIELD 2LD lineal feet of drain pipe. 1161" gravel under bed L William �Jer scoll ,� Engine r Board of Health BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. -------------------- • t 1 0 tit, ,CJ - .1- / �`O DATE Iu f `� ---- 1. NAME .. , 1. �JLOT NO TEL. 2. ADDRESS -P' 1 - 3. N0. OF BEDROOMS 1. DEN YES . NO. 4. GARBAGE GRINDER YES NO„_,___ 5. SHOW DIMENSIONS OF HOUSE , 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES / 7. SHOW DIMENSIONS OF LOT m 0 -3��U 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSFOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY- Commonwealth of Massachusetts u W City/Town of No.Andover W° System Pumping Record Form 4 4M yvey`•y 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the yQlf r -Fnve f n computer, use l only the tab key Address to move your No Andover Ma cursor-do not City/Town State Zip Code use the return key. 2 System Owner: Name ITOWNOF 0 2012 A/ Address(if different from location) RTH ANDOVERI HEALTH P Citylrown State Telephone Number B. Pumping Record Dct ah 1. Date of Pumping ate � ) 2. Quantity Pumped: 11 ��- - Ga ons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap i ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: ld� 6. System Pumped By: 17 U1 Names Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-tre tment Plant, 20 So. Mill Bradford, Ma 01835 it Signature of Ha Date I Signature of Rele;pradlity Date i it t5form4.doc•03/06 System Pumping Record•Page 1 of 1 !