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Miscellaneous - 615 BOXFORD STREET 4/30/2018
615 Boxford Street Lot & Street Map/Parcel - CONSTRUCTION APPROVAL Has"plan review fee been paid: YES NO Permit#_ Plan Approval: Date: Approved.by: kDl4l -Plan Date: .:.-. .- h =Designer:. � - � -Conditions: Water.Supply: Town :Well Permit eDriller- -- r 1�lL��.� . j 1J A Wel! Tests: Chemical Date Approved Iaf � z Bacteria I Date Approved 1 f i Bacteria ll Date Approvedov 4Plumbmg Sign Off. Wiring Sign off - , Comments. Form "U"Approval Approval`to Issue YES - �Date-lssued !- y_ By. =Conditions: - ~.Final Approval: - - - 3 _ -AI1 Permit&Paid? Y N0 h a Well,Construction Approval? :_ Y NO Septic System Construction Approval? `X N0, :Certification? _ NO,, _Other? _ - - _ YES NO Any Variance Needed?_ YES FINAL BOARD OF.HEALTH APPROVAL: DATE: APPROVED BY: �� SEPTIG.SYSTEWINSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: - NEW . REPAIR New Construction: Certified Plot Plan.Review 'YES, NO Floor-Plan Review YES NO Is Conditions of Approval.fromY 5 NO. .Form-U- ` 1 suance of. DWC permit:' NO . DWC Permit.Paid? YES 04` NO DWC Permit:# Installer: ; } Begin Inspection: = YES NO Excavation Inspection: Needed: Passed: f - �- -By' Construction Inspection:. T - Needed: _ - -- As. it P1a Satisfactory:. : . } Y S: Approval of Backfill: Date: By: Final Grading Approval: Date: (�� By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: / / f Commonwealth of Massachusetts RECEIVED City/Town of IVB pm �m MAY 19 2014 System Pumping Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Facility Information: System Location: - &�L'=:A6, , 10 IEL Address A V)4 WWPA AA- City own State Zip Code System Owner: Name: Adress(if different from location of pump) City/Town State Zip Code Telephone Number Pumping Record Date of Pumpin Quantity Pumped f, gallons Type of System X Septic Tank Grease Trap Other (what) System Pumped by: Company: ROOTER-MAN 46 Portland Street Lawrence,MA 01843 Location where contents were disposed: � � S f) Signature of Hauler Date CIMII MODWea fth of Massachusetts C k-it-v/Town of K),5C4-,P, Prr.,,cbjo RECEIVED —A R Pumping Record APER "i O�!nZ TOWN OFNORTH 1-acifilly Information: H DEPARTMENT S ji c.tem! Location., Add State Ovvqer: AA;—H '0f different from location of pump) State Z 1 '7 i`i mpng Record Dat:� c)f Quantity Pumped ne of SvsteM_/-K\ Septic Tank—Grease Trap Other Pumped by ,-onwany: ROOTER-]NN 46 Portland Street Lawrence. MA 0 i 84� where contents were disposed:... Azvo -�.s T. Ofhauler— Datc-3/0o4rql Commonwealth of Massachusetts North Andover, Massachusetts System Pumping Record System Owner&Address: Lynn L. Murphy J� " Nit 615 Boxford Rwad 0 OVER 14 North Andover, Ma 01845 �� �P Np p T HEAL►► Location of system: Front Date of Pumping: July 28,2010 Type of system: Septic Gallons Pumped: 1500 gallons System pumped by: Service Pumping& Drain Co.,Inc. S Hallberg Park North Reading,Ma License#: BHP-2010-0359,0373,0374,0375,0376,0377,0378 Contents transferred to: Greater Lawrence Sanitary District Date: July 28, 2010 Pumping Technician: PD This is PROPRIETARY and CONFIDENTIAL information that may 1 be used only by the Board of Health for regulatory purposes RECEIVED Commonwealth of Massachuse is SEP 19 2006 City/Town of N 6 Y`t't I TOWN OF NOR-r!--1 AN',-)O')/ER System Pumping Record HEALTH DEP-'RT"-?ENJT Form 4 A. Facilit Info mation System Owner: Address: Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) Septic 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: 6. System Pumped By: Nameftilt D( I 'n 0 Vehicle License Number Company:Rooterman 12 East Dracut Rd. Methuen,MA 011844 7. Location where contents were disposed: Signature of Hauler �M Date Signature of Receiving Facility / INVERT ELEVATIONS .BUILDING TIES 4" PIPE 0 F TN. = 123.50 BUILDING CORNER A B SEPTIC TANK IN = 123.28 SEPTIC TANK 15.3' 33.7' SEPTIC TANK OUT = 123.05 PUMP TANK — — PUMP TANK IN — DIST. BOX 36.0 53.8PUMP TANK OUT — 22.69 CORN. LEACH FIELD 1 52.3 85.6 I T. X IN = 1 CORN. LEACH FIELD 2 . 61.2 91.0' DIST. BOX OUT = 122.52 CORN. LEACH FIELD 3 57.5' 44.3' ND EACH IN 1 = 1 CORN. LEACH FIELD 4 47.0' 29.2' END LEACH LINE 2 = 122.08 22.08 END LEACH LINE #3 = 122.08 END LEACH LINE3 = 122.08 OUTLET / INV.=llW5± LO T 0 jp AREA=43,560 S.F. o •'S' v ao z 0 WATER SERVICE z s X mo m 30' d 36' MIN. (UNDER CONSTRUCTFON 39 4 BDRM. N N W.F.D. T.F.=127.5 0) C.F.=120.0 N1 A MIN. B O SEPTIC TANK rl o 0)N (fl GRAVEL N 000 G7 DRIVEWAY P-1 (NOT CONSTR.) 1 ---T-�• — — -- � U T-z D-BOX O 31' — — — J 40 40 LEACHING 143.63' TRENCH (TYP.) FUTURE GAS 6.37' SERVICE EDGES OF 13-OXFORD STREET PAVEMENT AS- BUILT OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MA. AS PREPARED FOR H � SOF 9cy RFACO LLC �� DANIEL GN cn �' 621 RIVERSIDE AVE. 0 KORAV CIVIL HAVERHILL, MA. 01830 No.37752 SCALE: 1"=20' ;sT N �! DATE: MARCH 24, 2000 s SAS_ I C° LOT#2 BOXFORD STREET I MEWUMACK 9 GOIEEMG SER'VI`CES a PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 TEL (978) 475-3555• FAX (978) 475-4448 ° Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 615 BOXFORD STREET G 0 Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Immo out forms A. General Information filling out forms on the computer, APR Vx;U use only the tab 1. Inspector. I key to move your TOWN 0r N0R�MOOS cursor-do not James Wright HEALTH use the return key. Name of Inspector Aspen Environmental Services LLC t6 Company Name 270 Lawrence St Company Address Methuen MA 01844 City/Town State Zip Code 978-681-5023 2035 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Basses ❑ Conditionally Passes ❑ Fails ❑ eeds Further Evaluation by the Local Approving Authority i nspe ss" Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. *""*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-- Page 1 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •` 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) :ste sses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years *or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltratio r exfiltration or tank failure is imminent. System will pass inspection if the existing/isred witha complying septic tank asapproved by the Board of Health. A metal septic tank willn if it is structurally sound, not leaking and if a Certificate of Compliance indicating thess than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 ' � ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is every NORTH ANDOVER required for eve MA 01845 04/14/11 page. Cityr- own State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pu ping more than 4 times a year due to broken or obstructed pipe(s).The system will pass insp tion if(with approval of the Board of Health): ❑ broken pi (s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruc on is removed ❑ Y ❑ N ❑ ND(Explain below).- C) elow):C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safe or the environment. 1. System will pass unless Board ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is t functioning in a manner which will protect public health, safety and the environmen ❑ Cesspool or priv is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins 09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ 6�/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 2 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ p/ Static liquid level in the distribution box above outlet invert due to an overloaded r clogged SAS or cesspool El Liquid depth in cesspool is less than 6"below invert or available volume is less than Y day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M r 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 2--� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El [ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0/,— Any portion of cesspool or privy is within 100 feet of a surface water supply or _�' tributary to a surface water supply. El EJ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 1X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the syste ' within 400 feet of a surface drinking water supply ❑ ❑ th ystem is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone I I of a public water supply well If you have a wered"yes"to any question in Section E the system is considered a significant threat, or answere "yes"in Section D above the large system has failed.The owner or operator of any large system c sidered a significant threat under Section E or failed under Section D shall upgrade the system i accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,• 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER required for every MA 01845 04/14/11 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No �❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ P Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) I� ❑ Was the facility or dwelling inspected for signs of sewage back up? Q"' ❑ Was the site inspected for signs of break out? MJ ❑ Were all system components, excluding the SAS, located on site? LTJ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and.location of the Soil Absorption System(SAS)on the site has been determined based on: �❑ Existing information. For example, a plan at the Board of Health. ❑ gDetermined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): - - DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•09/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER MA required for every01845 04/14/11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes �o Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes [0 tvo Laundry system inspected? ❑ Yes 2""No Seasonal use? ❑ Yes @/No Water meter readings, if available.(last 2 years usage(gpd)): Detail: Sump Sump pump? ❑ Yes No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Ions per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc. Grease trap present? ❑ Yes ❑ No Industrial waste holding.tan resent? ❑ Yes ❑ No Non-sanitary waste ' charged to the Title 5 system? El Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 7 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes VO If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: `0- Were sewage odors detected when arriving at the site? ❑ Yes ffl—lo Building Sewer(locate on site plan): _ a Depth below grade: feet Material of construction: ❑cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: fe dt Material of construction: ncrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: �2 .z` <� Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER required for every MA 01845 04/14/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle S Distance from bottom of scum to bottom of outlet tee or baffle �I How were dimensions determined? o1 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Z/ Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑f rglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of s m to top of outlet tee or baffle Distance from bolt of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations ' nd outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert Bence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal El fiberglass ❑ polyethylene El other(explain): /ter Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: r ❑ Yes ❑ No 1 Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and.float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER required for every MA 01845 04/14/11 page. Ekir-rown State Zip Code Date of Inspection D. system Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert C9 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pu chamber, condition of pumps and appurtenances,etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Stdsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y M 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER required for every MA 01845 04/14/11 page. dii/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding; damp soil, condition of vegetation, etc.): Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids Z Depth of scum l Dimensions of c Materials of con Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 TNe 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 13 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER required for every MA 01845 04/14/11 i page. CiVr-ro w nn State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of by is failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note conXditiof oil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•09108 Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 n Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is every NORTH ANDOVER required for eve MA 01845 04/14/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ❑ nd-sketch in the area below drawing attached separately BUILDING TIES BUILDING CORNER A B r SEPTIC TANK 15.3 33.7 PUMP TANK - I - /o DIST. BOX 36.0 53.8' OUTLET / CORN. LEACH FIELD 1 52.3 85.6 888 666 NV.=11 . CORN. LEACH FIELD 2 61.2 91.0 CORN. LEACH FIELD 3 57 5 44.3' ° yy CORN. LEACH FIELD 4 0' 9 OT INVERT ELEVATIONS A A=89, 9 S.F. ~ y> z W TE ERVICE Z s 4" PIPE ® FDTN. = 123.50 SEPTIC TANK IN = 123.28 tia° 30' a SEPTIC TANK T = 123.05 PUMP TANK IR— – i 36' MIN. J UMP TANK 0 T - (UNDER CONSTRUCTION) 3 DIST. 0 = 1 4 BDRM. N DIST. BOX OUT = 122. 52 W.F.D. END LEACH LI 1 8 T.F.=127.9' N END LEACH LI 2 = 122.08 1A a ND LEACH E #3 = 122.08 END LEACK UNE3 = 122&B o c6 SEPTIC N � TANK o00 GRAVEL 0 DRIVEWAY (NOT C.ON57R.) D-BOX 9MER :—_ s vE- 2 40' 40' — i — — (. LEACHING 143.63' TRENCH (TYP) 6.37' XFORD STREET 1PAVE5OF BO PAVEMENT t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 04/14/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope ❑ Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please ind'cate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Date UX Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: �'�/�/moi!-1 n/�= ..f'�' //—:� S/��✓/�-�_/®�,/ Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 615 BOXFORD STREET Property Address LYNN MURPHY Owner Owner's Name information is NORTH ANDOVER MA 01845 04114!11 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked IInspection Summary D(System Failure Criteria Applicable to All Systems)completed S tem Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t s TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 6 /-T 25baCFo R D ST o2TH, A/u a ", Owner's Name: PETE R VA CLEF- /=Owner's Address: SAfME Date of Inspection: 09F914 /G, Z403 Name of Inspector:(please print) A066 7' ALU 9001-S Company Name: V SPACE IMSPELTADA) SERVICE Mailing Address: 12C. A4E r4g,I Al A C ST 'A 3 3 Gu113 14 R1412"A1,1, 0tg -a Telephone Number: g9'7p'^ 6S- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: XPasses _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority _ Fails L _ '/ Inspector's Signature: �(�,Lu/ ,o Date: 7 �� J03 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inTpection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use.. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A // CERTIFICATION (continued) Property Address: toy `-t Owner: —e '�+- , Date of Inspection: 16 O Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XI have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: ,► v A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the_for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 z. Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / "d&t Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: /U A- Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: a 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: q0 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped_. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (VagNo)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15:303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B /CHECKLIST Property Address: is IX.cf' k Owner• ov. L), U'— Date of Inspection: D Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yep No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? K _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part.0 is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �J� Ge C.1 Owner: Date of Inspection: / o FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): .330 Number of current residents: .3 Does residence have a garbage grinder(yes or no):/UO Is laundry on a separate sewage system(yes or no): d[if yes separate inspection required] Laundry system inspected(yes or no): Nd Seasonal use:(yes or no): 1&0 � Water meier readings,if available(last 2 years usage(gpd)): if,4, Sump pump(yes or no):WO Last date of occupancy: TU440w_�'' COMMERCIALANDUSTRIAL N Type of establishment: Design flow(based on 310 CMR 15.203): Qpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes�or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: hag -tuy Was system pumped as paffof the inspection(yes or no): VO V If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: Y E OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be ob_tained from system owner) _Tight tank —Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if own) d source of information: 3 Z Sl co Were sewage odors detected when arriving at the site(yes or no): NO 6 Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: G fit' N. a Owner: 0 4% Date of Inspection: 16yo BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron X40 PVC_other(explain): Distance from private water supply well or suction line: Z oo Comments(on condition ofjoints,venting,evidence of leakage,etc.): C.MT2� ad1n' SEPTIC TANK: (locate on site plan) _ Depth below grader — Material of construction: concrete_metal fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle: J?O Scum thickness: N Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: /4D a How were dimensions determined: MEX!s uRE.D L)rTA CCAzjaz'ATrp T STic!G. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as'r grated to outlet invert,evidence of leakage,etc.): Lo GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee.or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Owner: IIA41 Date of Inspection: / 0 TIGHT or HOLDING TANK:_(tank must be pumped at time of inspection)(locate on site plan) . Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): /7 "-S"Au I-INl.E"T- 4 ©LLTI r ala Lem-r�Q — gaj7vto PUMP CHAMBER:_(locate on site plan) /t f Pumps in working order(yes or no):_ / U Alarms in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMn INFORMATION(continued) Property Address: 49kX4DJ�'t Gl Owner: Date of Inspection: W. J. SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: -2-— 4-D overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) ` , - Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Aj, 14 Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6(S &:x �ST Owner Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. A 8— C 33. 7 6 r.s �x><oK 0 sT A-D 36 A FRONT 8 0 'CO 0 Ic t !1167" �D SCALA see 10 � r � Page 11 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Owner: , Date of Inspection: SITE EXAM Slope Surface water ✓ Check cellar +� Shallow wells Estimated depth to ground water- v feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must des ribe ho��blishe tho high ground water elevation: � J 11 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 6/29/00 This is to certify that the individual subsurface disposal system constructed (X) or repaired () by Peter Breen at 615 Boxford Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. hel. uance of this certificate shall not be construed as a guarantee that the system will OW satisfactorily. �D� nspector TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 6/29/00 This is to certify that the individual subsurface disposal system constructed (X) or repaired () by Peter Breen at 615 Boxford Street has been installed in accordance with therovisions of Title V of the State Sanitary Code r � and with the North Andover Board of Health regulations. Th4puance of this certificate shall not be construed as a guarantee that the system will satisfactorily. Board of Health Inspector I TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( ) constructed; ( )repaired; by located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# il/3, dated s o/&l9% , 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: bo Engineer Representative Final inspection date: ngineer Re resentative Installer: Lic.#: Date: Design Engineer: Date: 6, .ee ^l�V�'vi OF S. � HIS K011, 03 t-1 s�U CIVIL ch ' 37752 A. r�s'ONALEN`'�� Town of North Andover, Massachusetts Form No.3 • &ORTN BOARD OF HEALTH � A7` • � p DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHu`�Ej Applicant � _th� XL NAME ff ADDRESS TELEPHONE Site Location w�� Permission is hereby granted to Construct (L4 or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at S7 relative to the application of EfEY-�eC!f , , dated o-1106 for plans by M-8rflMoe,-k and dated %O/� with revisions dated I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to 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 two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against 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 BOH,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. 3. As the installer I understazid 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 install septic 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 J�ei Date: ' G U APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERTIMT DATE: CURRENT INSTALLER'S LICENSE, LOCATION: 6�,j 1'�8 x�y %( 6S`✓ LICENSED INSTALLER: SIGNATURE: ��// . l� TELEPHONE,---Z ���/ CHECK ONE: REP AIR: NEW CONSTRUCTION: V i IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. i I I Administrative Use Only X75.00 Fee Attached? Yes ,;./ter No i Foundation As-Built? Yes No Floor Plans? Yes No Approval GL� Date: 3 BUILDING TIES BUILDING CORNER A B J SEPTIC TANK 15.3' 33.7' PUMP TANK - - o DIST. BOX 36.0' 53.8' 1 OUTLET CORN. LEACH FIELD #1 52.3 85.6 INV.-1t CORN. LEACH FIELD #2 61.2' 91.0' o 0 CORN. LEACH FIELD #3 57.5' 44.3' ��� CORN. LEACH FIELD 4 47.0' 29.2' SOT 2A a� �°o ui ui INVERT ELEVATIONS AREA=89,259 S.F. Z „ WATER SERVICE z5 0 Z 4 PIPE © FDTN. = 123.50 SEPTIC TANK IN = 123.28 30' SEPTIC TANK OUT = 123.05cl Lo PUMP TANK IN - i 36' MIN. w PUMP TANK OUT — (UNDER CONSTRUCTION) 3 in DIST. BOX IN = 122.69 '(04 BDRM. N DIST. BOX OUT = 122.52 N W.F.D. END LEACH LINE #1 = 122.08 T.F.=127.9' N END LEACH LINE 2 = 122.08 i A B END LEACH LINE 3 = 122.08 71 A END LEACH LINE #3 = 122.08 0 d- SEPTIC N co TANK 000 GRAVEL DRIVEWAY P_-a__RE_S F`'V__ - _ ( f`>E_f�Vk.___ -- 1 (NOT CONSTR.) — D-BOX E R-7VF o_.-._ ' _ .R F_Sfr.--Vl. 31' 40' 40' , LEACHING 143.63' TRENCH (TYP.) FUTURE GAS 6.37' SERVICE B OXFORD STREET EDGES PAVEMENN T BENCHMARK: TOP STONE BOUND EL=123.15 (U.S.G.S./M.S.L. AS—BUILT NOTE: THIS PLAN & CERTIFICATION IS NOT OF A WARRANTY OF THE SUBSURFACE DISPOSAL OF THE SUBSURFACE DISPOSAL SYSTEM ANDTEL�EVATION OF THHEDEXXISTING SYSTEM LOCATION LOCATED IN COMPONENTS. NORTH ANDOVER, MA. AS PREPARED FOR RFACO LLC ,, m 621 RIVERSIDE AVE.cn cyG < K EL HAVERHILL, MA. 01830 AM �, VOS SCALE: 1"=20' " CIVIL 'O No.37752 N DATE: MARCH 24, 2000 o LOT #2A BOXFORD STREET ASSESSOR'S REFERENCE MAP 105-C, PARCEL #7 u^--- MERRIMACK ENGINEERING SERVICES PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (978) 475-3555• FAX (978) 475-1448 /V BUILDING TIES BUILDING CORNER JA B SEPTIC TANK 133.7'PUMP TANK -DIST. BOX 353.8' OUTLET CORN. LEACH FIELD #1 52.3 85.6 INV.--ll CORN. LEACH FIELD #2 61.2' 91.0', CORN. LEACH FIELD 3 57.5 44.3 CORN. LEACH FIELD 4 47.0' 29.2' �w W LOT 2 a o INVERT ELEVATIONS A EA=89, 9 S.F. �. z o „ WATE ERVICE z 5 0 4 PIPE @ FDTN. = 123.50 SEPTIC TANK IN = 123.28 30' Q Ln SEPTIC TANK OUT = 123.05 in PUMP TANK IN - 36' MIN. w PUMP TANK OUT — (UNDER CONSTRUCTION) 3 ;n DIST. BOX IN = 122.69 cD 4 BDRM. cv DIST. BOX OUT = 122.52 N W.F.D. END LEACH LINE 1 ----T2"7._0g r.F.=127.9' END LEACH LI 2 = 122.08 i A B END LEACHKNE W3 = 122.08 CO END LEACA LINE W3 = 122.08 0 SEPTIC N TANK 000 GRAVEL _ _t G� DRIVEWAY F�ESEr�V _. � (�rSE_RVL_._ I (NOT 'CONSTR.) D-BOX - _ _ i__2__ -- P-17S E 31' 40' - 40' �C LEACHING 143.63' C9r� TRENCH (TYP.) A av 6.37' BOXFORD STREET EDGES PAVEMENT BENCHMARK: TOP STONE BOUND EL=123.15 (U.S.G.S./M.S.L. AS— BUILT NOTE: THIS PLAN & CERTIFICATION IS NOT OF A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEOF THE SUBSURFACE DISPOSAL SYSTEM AND EILEVATION OF THHEDEXXISTING SYSTEM LOCATION LOCATED IN COMPONENTS. NORTH ANDOVER, MA. AS PREPARED FOR RFAC O LLC m 621 RIVERSIDE AVE. ` oy < HAVERHILL, MA. 01830 K om SCALE: 1"=20' U No 3i75zCA NGisTDATE: MARCH 24, 2000 Q CD LOT #2A BOXFORD STREET ASSESSOR'S REFERENCE MAP 105-C, PARCEL #7 �^--- MERRIMACK ENGINEERING SERVICES PROFESSIONAL ENGINEERS * LAND SURVEYORS • PLANNERS j 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (978) 475-3555• FAX (978) 475-1448 ' i r � �� �� � ' ���� �r,,�� �d �` r „�-��_ �i c NORTH Town ,of Andever 0 9,� Y L A O dover, Mass., COC MICMEWICK ADRATED PC:) wim jm"' E R MIT T D S BOARD OF HEALTH Food/Kitchen Septic System BOLKING INSPEC'T'OR THIS CERTIFIES THAT ...... .......... ....... .. ..........tLew.............................................................................. ...... Foundation � has permission to erect.............. ...................... buildings on ..�.01...�#. 40-tT......0-04,0.r�.,$ Rough cc.. t0 be occupied as V� N /i �A��/ 0 fi Chimney L .. .....................I............................ . ...... . p P... .. .. . P every p .�..................................�.................. .... Final provided that the person acceptingthis permit shall in eve respect conform to the terms of thea application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover.Z 8 A Dec, * 0111 00001 F0' < S C A + PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. -C. DS a Firoy•Fa, t Rough ` PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI S AR ELECTRICAL INSPECTOR Rough I ' • Service BUILDING INSPECTOR in Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner BLDG, PERM. 114 FEET�� �� • � Street No. rj SEE REVERSE SIDE LESS FDA FEE'_-' Smoke Det. _ �✓ � 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 27, 1999 Ms. Sandra Starr Health Administrator 27 Charles Street North Andover, MA 01845 RE: Lot 2 Boxford Street,North Andover Dear Ms. Starr: In response to your review and comments regarding the subject septic system design plan, please note the following: • With regard to groundwater separation and in conformance with C.M.R. 15.104 (5), the system is designed for a percolation rate of 15 min/in, therefore as per C.M.R. 15.212, the vertical separation distance above the high groundwater elevation needs to be four feet. The plan notes that the system is also (conservatively)five feet above the water table in the vicinity of test P-2 where a percolation rate of 2 min/in was obtained. • The well is proposed in the location shown so that no work needs to take place within the 100 foot buffer zone to wetlands. This location is necessary due to the existing septic system location for house#595. Considering that the locations of the well and subsurface disposal system at house#595 are existing and that the proposed well location for the subject lot is in conformance with Title V and local regulations, we feel that no hardship will result. In order to provide certainty to the well location after construction, we propose that the final as-built plan for the subsurface disposal system be stamped by a Registered Land Surveyor. Please review the above comments and feel free to contact me should you have any questions or comments. Very truly yours, MERRIMACK ENGINEERING SERVICES Les Godin Project Manager cd cc: Mr. Robert Ahern SEPTIC PLAN SUBMITTAL FORM LOCATION: CrM . 105-e— BA Z•7 Lv l Z NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: 10- 1Z-gq DESIGN ENGINEER: HE_9Z4 M A Ge_ E9411 je=)';6 Svcs, DATE TO CONSULTANT: *If.you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. Ti C',1V'm OF NOIH AND6VR/ .� When the submission is all in place, route to the Health Secretary. LC,,�t3D 0F€EEALTi-9--meq �, I : Town of North Andover, Massachusetts Form No,s M ; NOR,h BOARD OF HEALTH 41 I p • i«+..... •. N ; f,,b.��.n•�.•�,� DESIGN APPROVAL j SS�CMUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant Test No. Site Location kl—cof� Reference Plans and Specs— ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to a installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH OF HEALTH jn�`S�� Site System Permit No. Fee . ���� Town of North Andover Q NORTH OFFICE OF 3� `tt • COMMUNITY DEVELOPMENT AND SERVICES0 p 27 Charles Street North Andover,Massachusetts 01845 �y°°^ •° °��5 WILLIAM J.SCOTT SSAc►+uSE Director (978)688-9531 Fax(978)688-9542 November 9, 1999 Les Godin Merrimack Engineering 66 Park Street Andover,MA-01810 RE: Lot 2 Boxford Street Dear Les: This is to inform you that the proposed septic system plans for the site referenced above have been approved for a house with a maximum of nine(9)rooms. If you have any questions,please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr,R.S., C.H.O. Health Administrator SS/smc cc: R. Ahern File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover , NpRT4 1 p tao OFFICE OF 3a h`` '' ° COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover,Massachusetts 01845 QA'.7f 0.PP 5 WILLIAM J.SCOTT �9SSgCHus�t Director (978)688-9531 Fax(978)688-9542 October 25, 1999 Les Go& Merrimack Engineering 66 Park Street Andover,MA 01810 RE: Lot 2 Boxford Street,North Andover Dear Mr. Godin: This is to inform you that the proposed plan for the installation of a septic system located at Lot 2 Boxford Street,North Andover,has deficiencies which must be addressed before the plan can be approved. These deficiencies are as follows: • Seasonal high water is shown at elevation 116.9'. The 2 mpi percolation rate requires 5' to groundwater. The elevation of the bottom of the SAS,therefore, should be 121.9',not 121.1'. • The well is only 4-5 feet off the property line. Although not specifically regulated,it is recommended that the well be at least 20' from the property line. Please be advised that all plan resubmittals require a$60.00 fee. If you have any questions, feel free to contact the Health Department at 978-688-9540. Sincerely, Sandra Starr,R.S. Health Administrator Cc: Orange Street Dev. File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Oct-15-99 08: 19A Paul D. Turbide, PE/PLS 508-465-0313 P.05 October 15, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V review for 595a Boxford Street Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the review of the above-mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. o Seasonal high water is shown at elevation 116.9'. Separation between bottom of leaching bed and ESWH is shown as 5' in design(because one of the perc rates was less than 2 min/in). Therefore the elevation of the bottom of the leaching bed should be 121.9'. The design shows this bottom of bed elevation as 121.1. Therefore the whole system must be raised by 0.8'. I note that the proposed well is about 4 or 5 feet off the property line. Is there any local regulation that governs the minimum distance that a well should be from a property line? If you have any questions or comments please feel free to contact me. I Sincerely Carlton A. Brown,PE/PLS Boxford595al.doc » PODT E�GINEEHING Civil Engineers& Land Surveyors One..Harris Street Newburyport,MA 01951) (97a)465-8594 INSTRUCTIONS: This form is•usedto'ueri6that all-necessary approval/permits from Boards and Departments having junsdiction have been obtained. Ms.does not relieve the applicant and or landowner from compliance with any applicable requirements. imagnum rrwrrt •i,Rr�r��rrrarr urr:r r uwrorrrrr■■sunup soon r■■■r■rrrrrrnow was r0r APPLICANT ! - �/�' `� PHONE ASSESSORS MAP NUMBER -. / LOT NUMBER SUBDIVISION LOT NUMBER tU STREET NUMBER STREET .rrr-r■■■■■ ■o r■r■■ a■■rrr�rrrrr■riirrr8-rra.rrrra0■rrrsrr■0.■■.r■-■ra■r■rra0 OFFICIAL USE ONLY •t� , / ■■r: ■■■■■■.■r■' .■�r.■■ ■rr■ru■■■■"a■rrr■r■■■■■r■■�ro■*DO ii■r ro■■■■■r■ itY■�-� . RECOMMENDATIONS OF TOWN AGENTS �■rr�:r■■■w,ar■■'■ra.0#r Y.ti■■. *San WON.■r.r DATE APPROVED CONSERVATION ADIv1WISTRATOR,.; ' DATE REJECTED CO Y S 4 DATE APPROVED TOWNPLAPINER r: DATE REJECTED COMIvfEN rs DATE:APPROVED FOOD INSPECTOR_'HEALTH DATE REJECTED DATE APPROVED �_5EP IIS INSP CTOT� HEAL. DATE REJECTED COIvIIv1ENTS J !lam �� �V � ✓�r5�__/1-�'�`'t-se y /�/1 a� �w�G�s^i T� � O � _ .. PUBLIC WORDS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEFARTIviENT DATE REJECTED i COMMENTS RECEIVED BY BUILDING INSPECTOR DATE ='J 4t Town of North Andover, Massachusetts Form No.2 NORrit BOARD OF HEALTH o 19 9 K • - DESIGN APPROVAL FOR SSACHl15Et SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location Reference Plans and Specs. EN (NEER D G DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTR Fee Site System Permit No. /fd� INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initials A. Bottom of Bed 1. Excavation to proper depth _S� �`� 2. With trenches,sides of excavation are beneath B horizon 3 �/� 3. Edge of excavation specified distance from foundation,etc. Comments: B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90°change 10. 10'minimum offset to water line Comments: D. Septic Tank 1. Level 1, 2. 1,500 gal minimum 3. Gas baffle present on outlety 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20"manholes 7. Inlet tee minimum 12"under invert 8. Outlet tee minimum 14"under invert 9. Outlet line cemented ✓ 10. Air space 3"above tees 11. 2"-3"drop from inlet to outlet t ; 12. Pipe set 13. Compact base with 6"of 3/4"crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber 1. If separate from tank,compact base with 6"of 1/4"stone underneath 2. Minimum 2"pipe to d-box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d-box Comments: F. Distribution Box 1. D-box level 2. Minimum 0.IT'(2")drop from inlet to outlet V-1� 3. Minimum 6"sump L-11-- 4. -11`4. Outlet pipes show equal distribution i/ 5. Compact base with 6"of stone beneath box . 6. Box is watertight 7. All lines cemented with hydraulic cement S. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double-washed-'/."- 1 ''/z" -pea stone Bucket test done? 2. Minimum 2",of pea stone above distribution lines 3. Minimum 6"stone beneath pipe ,/ 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope 6. Minimum of 9"of fill graded over system 7. Toe of slope stops minimum 5' from edge of property;if not,then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max.length 100') 3. Width of trenches agree with plan-Minimum 2';maximum-4'. -7- 4. Vent present if<50 feet or specified 5. Distance between trenches minimum 4'and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6"per 100' 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: 1. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipe 6'maximum 4. Pipes connected at end 5. Separation between adjacent fields 10'minimum 6. Pipes set on stable base 7. Maximum 4'separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48"wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond r r t FORM U - LOT RELEASE FORM L,- that all necessary approvals/permits from INSTRUCTIONS: This form is used to verify -Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. f '*****************************APPLICANT FILLS OUT THIS SECTION APPLICANT � PHONE LOCATION: Assessor's Map Number D S 4PARCEL /0�e SUBDIVISION LOT (S) STREET B F°`r") S ST. NUMBER 2 *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS f TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECT - EALTH DATE DATE REJECTED APPROVED 01 SECT SE TH DATE APPROVED - DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm BOARD OF HEALTH --TEL, 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: LOCATION OF SOIL TESTS: _'3�x r- 510 Assessor's map & parcel number: Idf OWNER: (�R�7�z �.� y.2�,�'� iaSU.v TEL. NO.: �E�3 `K7/j' ADDRESS: 1S.5 ENGINEER: -/e22�'rji� ��� NQe�r%NbTEL. NO.:--//- 7S* 3SS"� CERTIFIED SOIL EVALUATOR: /Z2 Intended use of land: residential subdivision sing) amity ome ercial Repair testing Undevel ed to st' N. A-�sery t' �r�n1 i n Appro al: Ulm -fit 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$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than V-1 shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. I 2 !.e se SobTe JA < �. 4A z� Sg 46exr"�5•� U w tir ere 5A 2 t•gill, as 22 48 2` 1 3 � 38 i 1 � y 1.17 Ac. 28 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3�0�t QED 16 L 19 E APPLICATION FOR SITE TESTING/INSPECTION SSACHUSE :.. Applicant1J -O(11,�. NAME o ADDRESS TELEPHONE j Site Location Ann CS,� Engineer V-V� NAME ADDR S TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 - SOIL EVALUATOR FORA, Page 1 No.......................... Date.. .::.��..-.. � .......... Commonwealth of Massachusetts Woe—,H hj4novElz, Massachusetts Soil Suitability Assessmeut_for Ort-site Sewage Disposal Performed By: 6-ob1J14.......................:................................. j..t.-Z.4."q8 Witnessed By: .:... ................................................................................................................................................................................................... __.._ ...._._ ........................ 1,=don Address a owner'$Nam. d���G � t�� '�� Lal 2 Box1`a 1zi- STS I Telephone"I ISo i MA i N 977 t� I OS-G ►tz. S�sn.w� 2 Tw>!S B��2`/ �`"�/� 4187 New Construction RI Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published Publication Scale Soil Map Uni Drainage Class W..I ... Soil Limitations ... `... g......ev.t ...1=.! .a.a........... P►NT4...1�J� Surficial Geologic Report Available: No ❑ Yes ❑ Year Published .....—. Publication Scale .................. GeologicMaterial (Map Unit) ..............`................................................................................................................................... Landform .................................................................................................................................................................................................................. Flood Insurance Rate Map: 2090 -0001.c_ (6-Z-q3) Above 500 year flood boundary No ❑ Yes 9 Yf 1�.NY".U. 1�1en1� Within 500 year flood boundary No ❑ Yes ❑ _ _ Within 100 year flood boundary No ❑ Yes ❑ - M999 F j Wetland Area: _ _ --w---e--- �- "J National Wetland Inventory Map (map unit) .............................. ...................................... . .............. ..W . Wetlands Conservancy Program Map (map unit)......— .................................................. ........... Current Water Resource Conditions (USGS): Month WOV,` 13 Range : Above Normal ❑ Norm 1 ® Below Normal El�RSSvr�tED) Other References Reviewed: A PS 0 FOR1%1 It - SOIL EVALUATOR FORM Page 2 On-site Review, Deep Hole Number TJ Time, Weather a. ..Dyl............................ Location (identify on site plan) .................................................................................................................................. Land Use S'iP-4---Fh-M .............. Slope (%I ...... Surface Stones nos . .........I...............................I............................. Vegetation ................................................................................................................................................................................................... Landform ..... ........... ........................................................................................................................................................................................ .. . ........ ... .... Position on landscape (sketch,on the back) 4. . ....... ......................... Distances from: Open Water Body -.R.N2-:t feet Drainage way feet Possible Wet Area .10Q-t feet Property Una feet (��T)- Drinking Water Well !.QQr.. feet Other ........................ DM OBSERVATION HOLE LOG Depth from Surface Sail Horizon Soil Texture Sail Color Soil Mottling Other Depth(it nrlo�)mhe SOL (USDA) (Munsell) IStructure.Stones,Bouloiers, Consistency, Graven AP &j U SAV I b\jPz L, S , 51q to NS F 69AW—L ------------- parent Material (geologic) T1 L'.L...... ............................................................ Depth to Bedrock: .................. pep1hIg Grgund&1jftL. Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: FORM It - SOIL EVALUATOR FORM Page 2 On-site Review, Deep Hole Number Date-.1.1.-Za-.�6 Time:.h.:171 Weather 9�0.y.......................... Location (identify on site plan) .......P1 ..A.tQ.............................................................I........................................................I................... Lend Ube �tR.(a� Slope(%) 2....... Surface Stones .......F-0..�...................................................... Vegetation �005D.................................................................................................................................................................................................... Landform ........................................................................................................................................................................................ Position on landscape (sketch.on the back) ........................................... Distances from: Open Water Body tap.t feet Drainage way....-�..... feet Possible Wet Area W0.1- feet Property Line .... feet (9-1wIr Drinking Water Well feet Other ......................................... F DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other 1 861 (USDA) (Munsetil IStructurs,Stones,BoLdOars, Depth trom I Consistency,%Gravel) Lj FA V, SA ktD If Gov 0'q vz/6 le,� L' S . TZ) 66 5ys)q Parent Material (geologic) ............................................................ Depth to Bedrock: ............................ .WLh to Groundwater: Standing Water in the Hole: Weeping from Pit Face: J4 Estimated Seasonal High Ground Water: FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table Method Used: 7--- ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole................... inches (� Depth to soil mottles 1I,1�.)..60 inches ❑ Ground water adjustment..fir feet Index Well Number Reading Date ................... Index well level ................... Adjustment factor ....... Adjusted ground water level ................................................. Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _ LF If not, what is the depth of naturally occurring pervious material? Certification I certify that on q-30 (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature '�� a Date FO RNI 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS WOEM Aujwvi! , Massachusetts Percolation Test Date: .....1-t-W.-I:0 . Time: Observation Hole # P P-Z Depth of Pere 3q�,t = �4 Z 1 t ZLt"= 'Aa, Start Pre-soak lo: o to=a� End Pre-soak 15.4 Z S Z4 CMAC.. us Time at 12" Time at 9" 10: D: L(.1 Time at 6" Time (9"-6") I,� M 11•.[ - Rate Min./Inch 2M�N. Site Passed Site Failed ❑ ................. ..... ...... `....,......................................................................... Performed By: C S C ahl til Witnessed By: f?pzu -f Comments: _............ NOV-40-98 03:34P Paul D. Turbide PE PLS 508-465-0313 P.02 - _ _. 2 .. ---- - . oj I1 j t! --- I _ 1 n M 0 n. i I T ' 4-7 Ln Ln Im I � .yy}y'.. Ln 03 z j 46 ON 02 North Andover Water Treatment Plant 420 Great Pond Road North Andover,MA 01845 No&A � Lab June 27,2000 Client: Russell Ahearn The following are the results of the tests performed on your well samples: Test(s)Performed. Total Coliform Bacteria Date Lab'1CD# Location Total Counts/100 ml. 6/26/00 B5135 615 Boxford Street 0 North Andover,MA 01845 If you have any further questions please call us at 688-9574. Sincerely, Kelly Long JUN 27 1 Senior Water Analyst North Andover Water Treatment Plant Mass. Cert. # for Bacteria -MA21054 _ - . -'. y h.l.. i Y5 � : ' `F v ' 'J, �r f - ` - . f � p I x NUMBER * PEE v,ill 1. � /5 THE COMMONWEALTH OFT; ASSACHUSE7TS � t P4, I. (/� _ - .: m ¢ . . _ a f _r. ... _ -• -. a r u i _. _ % This is to Certify that ��G 1 _ Y 1rL/- .-- _ � �Kl ., . � �, , . . NAME r _ rc .. J - ADDEESS yg z " - IS-- EREBY+GRANT A-LICENSE_. _ i - .. ' R:r __ .. .. -__ , . „_ - 7 _.__ — i . For - - - .. .. _ 1:77, �.� ... ... ............................................................................ - _ ..................... r •-1 - ..___ _ ..._..._ ........................................_ -1 . ____ _ - ...... ...... ... . _.. .... . This license is ante in-conformity with the Statutes and orihnance,,elating thereto, and �4 -V b, ? p(� . , , expires_=_ __ l ! % unless sooners p�nded or"'revoked. a. - Fr - I - - . i F s :; . ....:......../` :�_ :... X9.99. :::::::::::::.... �.. � ._. �.y. _ 'i. '- d ,--.-I FORM 488 H&W HOBBS&WARRE jm - _ ....------- ice'—,«M - - .. A j- ',, r- . I - i - - - - _ __ _ _ - - — y .. - _ r - - .._ :-.. .. '.. - - - _._ . ._ - :. - -. .. - ., _ a.., ,��b ..i .,. ' — Y d i F i' r i tl j G ' ~Ry 1 h S J 7' m, k -- -. .._. -- _ -. _. ., .. :.,, . :. i. .: ,,.... .,.. %;, . .. - - : :, . .. .. 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"s:1 + '..11, f 's` _ , f. ..I.:tr t 1;u °,�58'^ :11,�t'FsY{ r 5 :j` t:'�1 r It ,r p .,.•� /, ,:rtn'k, :'q x{�,p{• 5 t;l,,a4+1�1_ -s � b> n, '[1i. t. >1' -.e:-.;.1 { x-,., ..r ._in „ -n� , 17 12. t" _x-4. L;.F '{ ,- uit t�R2 }¢teS ._%r f., ,.:al' , :,X! ,_y"t -.� {• - r ' a.<`3�..1 €; 'S� "'xy,3Y• •5 �t a�rr ,..,�z ,C „i: _ r. ., t,.,k. S :.. -.{, { ' e•�, BOARD OF HEALTH �S$A USES NORTH ANDOVER, MASS. - "APPLICATION FOR WELL AND PUMP PERMIT Permit # 6619 Date A permit is requested to: drill a well install a pump _t LOCATION: OAC I O� �. Lot # CL OwneAddressi.(��SCx�/k.1 + � Tel Well Contrctr �cDr1 � Kdd. I SMP M F - Pump Contrctr IIA(LE Add. Tel WELLS (To be completed at time of pump test. ) , Type of well Use Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes '(_) No '(_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) - Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor . PUMPS (To be filled in before installation. ) Name & size of pump Type ' Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic Sleeve used to protect pipe? des (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector i Board of Health w :�. Ora . o #`•:•" Main Office;Laboralory At:Tramway Marketplace 22 Manchester Rd Rt. 28 Route 16& 25 + =`( Derry, NH 03038 West pssfpee,kH 03890 (603)432.3044 1.8p0.699•Q 9t 0 *i CL"exttftcate of Anzdysis fax rin king �Vater i2 K'LiEIN :)R. �1 SALT;M, NH 03079 "P MPL F, DOXF'LRD ST /MAP SCI p r ; ..C, 1 C;, 1 M E S.I Yl PIJ=;U: .. 1 n f 1c,:c'c l� . o a F,r, RE Sr-IL. ry e RE�_C MIEN'DFP LEVEL i- r�,`Y•..,1E'1= r r .=tt _y:D�-'S;> >t ljt� i.1CTf e ,� r phi (:17_C"t iCt F' Y 1 1' d 1 r t r-_� 1_ C,n' ; QK ;MORE JJIFr '7:F r;: ?E F•ARJV,., .i r r B THE EFA :FESS '^'IA_K , i_rR L.0WEST l.'AT., rFAi Ji! POiN`:. ]F. CJ�r I 3Aq'I0N .' THRIS _ EXL,EEZ i �IMARY STDS 'CAUS � 1.' FA 1,7_7P E TES y E' C FI� ECONDAi?Y STL_. . ONES \710T FAIL TES, i 'Ii`R03I(_ 27.L AIr.t_1N r;LST -'1 0 •'.C;tThS LD t,'LAY NOT Fes; T'AL`E`. zAlIPLES ,tii THE E 1.M._ t. A'^ER "Ctrl.. .,L, KAY VAP17 F 'i`$I r? t Nott 2 3 1999 , r ' �.r�,c,G' Ram,4�'.} _ �• , :\jai.prized r� _ _ %•sem»:r ,: z #of �t 4 0 e'o pyo Post-ir x Note 7671 Date pages To '. From 0 je p C t. - ey "e Phone# Phone# —L1 �i� +..,e•''`,y BOARD Fax# , � SSACMUSEt NORTH Al Fax# ',f/ 9(,� . APPLICATION FOR- permit OR Permit # Date A permit is requested to: drill a well ;' install a pump LOCATION• u) Cl_ Si , I o s o- Lot # g OwnegM(n Address Tel Well Contrctr C�nC sign l lKAdd. �*���� �� Tel Pump Contrctr .:A n�E Add. Tel WELLS (To be completed at time of pump test. ) Type of well l-,)et Use Diameter of well �� Size of casing�� X (2501-co X ^4 Depth of bed rock ,3g Depth casing into bedrock c C/ J'G Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock IIoU Depth to water Delivers_ GPM for (how long?) Drawdown 5D feet after pumping hours at GPM Date of completion ���/'�' /� &4,) Signature of well contractor PUMPS (To be filled in before installation. ) Name & size of pump 3 Type ,l /n/, Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (L) Sleeve used to protect pipe? Yes (_) No ( ) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(constructed; ( ) repaired: by located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# dated with an approved design flow of'A49 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: Lic.#: Date: Design Engineer: Date: . y—moo APR 1 9 a E r INVERT ELEVATIONS BUILDING TIES 4" PIPE FTN. = 123.50 BUILDING CORNER A B SEPTIC TANK IN = 1.23.28 SEPTIC TANK 15.3' 33.7' SEPTIC TANK OUT = 123.05 PUMP TANK IN — PUMP TANK — — PUMP TANK OUT — DIST. BOX 36.0' 53.8DIST. BX IN = 122.69 CORN. LEACH FIELD #1 52.3 -5�-6 DIST. BOX OUT = 122.52 CORN. LEACH FIELD 2 61.2' 91.0' ND LEACH IN 1 = 1 CORN. LEACH FIELD 3 57.5' 44.3' END LEACH LINE 2 = 122.08 22,00 CORN. LEACH FIELD 4 47.0' 29.2' END LEACH LINE j3 I= 122.08 END LEACH LINE #3 1= 122.08' OUTLET / INV.=11 t T o Nv J_ AREA=43,560 S.F. uJ a .��p � fr ao zcr as X WATER SERVICE z jv0 m 30' a i 36' _ MIN. (UNDER CONSTRUCTION) 3 4 BDRM. Lo N W.F.D. N T.F.=127.5 C.F.=120.0 N !A MIN. B O SEPTIC TANKrl o N CA cD 000 GRAVEL o DRIVEWAY P_1 (NOT CONSTR.) _T_— -=J04) • Ln v T-2D-BOX o 11 31' — — — _ — — — 40' 40' (o LEACHING 143.63' TRENCH (TYP.) FUTURE GAS 6.3T SERVICE EDGES OF 6OXFORD STREET PAVEMENT AS— BUILT OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MA. AS PREPARED FOR iIAOF� � q RFACO LLC ��� p � DANIEL c!► m621 RIVERSIDE AVE. KOCIVIL� `7 HAVERHILL, MA. 01830ro Ivo.37752 SCALE: 1"=20' ,�;sT DATE: MARCH 24, 2000 LOT #2 BOXFORD STREET M a� l vS c � .�� 7 4 f ` MOMMI4CK ENGINEERING SERMCES PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS ry 66 PARK STREET ANDOVER. MASSACHUSETTS 01810 TEL. (978) 475-35550 FAX (978) 475-1448 1 BUILDING TIES INVERT ELEVATIONS 4" PIPE 0 FDTN. = 12150 BUILDING CORNER A B SEPTIC TANK IN, = 1.23.28 SEPTIC TANK 15.3' 33.7' SEPTIC TANK OUT = 123.05 PUMP TANK — — PUMP TANK OUT — DIST. BOX 36.0 53.8 DIST. X IN = 1 CORN. LEACH FIELD 1 . 52.3 85.6 DIST. BOX OUT = 122.52 22.6 CORN. LEACH FIELD 2 61.2' 91.0' END LEACH IN 1 = 122. 8 CORN. LEACH FIELD 3 57.5' 44.3' END LEACH LINE #2 = 122.08 CORN. LEACH FIELD #4 47.0' 1 29.2' END LEACH LINE #3 = 122.08 END LEACH LIN 3 = 122,08' OUTLET / INV.=11&5± �I T ° IN/ AREA=43,560 S.F. •'�'yv W aV) z WATER SERVICE ZS x 40 m 30' a 36' — MIN. (UNDER CONSTRUCTION 3 4 BDRM. `4 N W.F.D. N T.F.=127.5 C.F.=120.0 N 1 A MIN. B O SEPTIC TANK o o N tD N 000 GRAVEL G7 DRIVEWAY P_1 (NOT CONSTR.) d T-ZD-BOX r- p 31' 40' 40' lo � 1 LEACHING 143.63' TRENCH (TYP.) FUTURE GAS 6.37' SERVICE EDGES OF 6OXFORD STREET PAVEMENT AS- BUILT OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MA. AS PREPARED FOR NOF RFACO LLC p � DANIEL N ( ' 621 RIVERSIDE AVE. o KORv LOS N HAVERHILL, MA. 01830 No.s7752 j SCALE: 1"=20' o DATE: MARCH 24, 2000 LOT #2 BOXFORD STREET MERMAACK ENGNEERf11-G SER Cf S PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS ry 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 TEL (978) 475-3555• FAX (978) 475-1448