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Miscellaneous - 680 FOSTER STREET 4/30/2018
680 FOSTER STREET 210/104_B-0053-40000.0 North Andover Board of Assessors Public Access Page I of 1 HpRT► rfh Andover Board of Assess®rs #^o M ,SS"CN°5�` roperty Record Card Parcel ID :210/104.B-0053-0000.0 FY:2012 Community:North Andover SKETCH Click on Sketch to Enlarge Click on Photo to Enlar e V. ., . 491 A 7LL r l J ��.. `. •iii min 680 FOSTER STREET " J ' Location: 680 FOSTER STREET Owner Name: CLARKE,CATHERINE F Owner Address: 680 FOSTER STREET City: NORTH ANDOVER State: MA Zip: 01845 UNeighborhood: 5-5 Land Area: 9.80 acres se Code: 101-SNGL-FAM-RES Total Finished Area: 1428 sqft Total Value: 353,900 431,500 Building Value: 148,900 167,300 Land Value: 205,000 264,200 Market Land Value: 205,000 Chapter Land Value: LATEST AL 7Price: 0 Sale Date: 01/01/1971 As Length Sale Code: N-NO-OTHER Grantor: Doc: Book: 01183 Page: 0580 http://csc-ma.us/PROPAPP/display.do?linkId=1894497&town=NandoverPubAcc 5/30/2012 Residential Property Record Card PARCEL ID:210/104.B-0053-0000.0 MAP:104.B BLOCK:0053 LOT:0000.0 PARCEL ADDRESS:680 FOSTER STREET FY:2012 PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: 01183 Road Type: T Inspect Date: 05/23/2008 Tax Class. T Sale Date: 01/01/71 Page: 0580 Rd Condition: P Meas Date: 05/23/2008 Owner: Tot Fin Area: 1428 Sale'Type: Cert/Doc: Traffic: M Entrance: X CLARKE,CATHERINE F Tot Land Area: 9.80 Sale Valid: N Water: Collect Id: RRC Address: _ Gr- antor: Sewer: Inspect Reas: C 680 FOSTER STREET NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 816 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 Story Height: 1.75 Bedrooms: 4 Up Fn Area: 612 Bsmt Area: 1040 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: L Full Baths: 1 Add Fn Area: Fn Bsmt Area: " 1 P 101 S 43560 1.000 138,128 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: F 2 R 101 A 0 8.800 66,880 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1428 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: __ 126907 - Str Unit Msr-1 Msr-2 E-YR-BIt Grade_Cond%Good P/F/E/R Cost Class Kitch Qual: T Eff Yr Built: 1980 Mkt Adj: B5 S 1568 0.00 1988 A F 50///50 22,000 + Heat Type: HW Ext Kitch: Year Built: 1974 Sound Value: Fuel Type: O Grade: - A Cost Bldg: 126,9001 VALUATION INFORMATION Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Val1: Current Total: 353,900 Bldg: 148,900 Land: 205,000 MktLnd: 205,000 Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Prior Total: 431,500 Bldg: 167,300 Land: 264,200 MktLnd: 264,200 Aft Gar SF: 484%Good P/F/E/R: //100/81 Porch Tyne Porch Area Porch Grade Factor P 192 W 384 SKETCH PHOTO W s \ f 384 S .Ftp' ?/^ 24 24 £ FUx0.71 B 12 192 S 1k C a',, , ■ ; t e , 24 816 8�6tgQ#fl a` t 484 Sq. 2 10 $ 34 22 61 FOSTER STREET ` Parcel ID:210/104.6-0053-0000.0 as of 5/30/12 Page 1 of 1 IWF PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Cerci 'cate o Comphance As of ,uuf 2T, 2012 This is to cert that a SATISEACTORT IMPECTION Was completed for the: Co"4te an On Site Wastewater p4qsaCSystem By: John �DiVincenzo at: 680 TosterStreet Parcel ID :210/104.B-0053-0000.0 North ndover W 01845 The Issuance of this certificate shaft not 6e construed as a guarantee that the On Site Sewage IDisposaf System wifiCfunction satisfactorily. ISusJn T Sawyer, 1RE*�V— Pu6Cic%eafth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER ;,►oRTH , Office of COMMUNITY DEVELOPMENT AND SERVICES 3 �•'`�•° 1°- ` ' • A HEALTH DEPARTMENT t , 400 OSGOOD STREET s NORTH ANDOVER, MASSACHUSETTS 01845 'sS�1C14U 978.688.9540-Phone Susan Y.Sawyer,REHS/RS 978.688.8476-FAX Public Health Director E-MAIL:healthdept(Dtownofnorthandover.com WEBSITE:hn://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(X) constructed; (h ) repaired; y - (Print Name) 2dC' 4KANWVER �located at AJC) �(� � T TOWNR (Installation Address) PARTMENT was installed in conformance with the North Andover Board of Health approved plan, originally dated ?-'11 1 and last Revised on .5 10 112.-- , with a design flow of 14 S 3 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. J (114 Bed inspection date: �� '7 Z(��Z Engineer R esentative(Signature) Cif ef) �e And-Print Name Final inspection date: Engineer epresentative(Signature) And-Prin ame r Installer: -�. (Signature) Date: �� �. -;z� 1 axV, IV ��" And-Print Name Engineer: 6%�/ (Signature) Date: C � Qi U✓� f°"' 1G � t� And-Print TtN6 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Certificate of Compliance As of.• ,NCy 2T, 2012 This is to cert that a S,3TIS FACS ORT INS ECrIION Was completed for the: Complete R 4 ement/ air of an On Site 7Nastezyater osaCSystem Oy. John DiVincenzo at: 680 Foster,Street Parcel ID :210/104.B-0053-0000.0 North Andover, WA 01845 The Issuance of this certificate shaC not be construed as a guarantee that the On Site Sewage Inisposaf System wiff function satisfactorily. �us n TSawyer, 12�F � S u6fic Y[ea�th Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER N°RTH ZD Office of COMMUNITY DEVELOPMENT AND SERVICES o? HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHv`+tt 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476-FAX Public Health Director E-MAIL:healthdeptotownofnorthandover.com WEBSITE:hn://www.townofnorthandove'r.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (4) constructed; ( )repaired; bye W 1 (Print Name) J� ��i? located at Cobo �'(� ( � TOWN OF NaRTf ANDOVER (Installation Address) PARTMENT was installed in conformance with the North Andover Board of Health approved plan, originally dated S Z7 112- and last Revised on -5 10 112— , with a design flow of Li 's 3 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: 12- Z �Z Engineer R esentative(Signature) And-Print Name Final inspection date: Engineer epresentative(Signature) And-PrintName 72 Installer: (Signature) Date: OL � 1✓IYy �=� And-Print Name Engineer: (Signature) Date: ct n' U►� G r� 1 And-Print e i �SF,TTtiEby�' • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Cenific Comphance As of.• y27 This is to cert that a S 4TIS EAC ORT INS PECIION Was completed for the: CompCete Wmlacement/pair o f an On Site Wastewater osaCSystem By: loFin DiVincenzo at: 680 TosterStreet Parcel ID :210/104.B-0053-0000.0 North.Andover, 5A 01845 The Issuance of this certificate shaft not be construed as a guarantee that the On Site Sewage 1DisposaC System wifiCfunction satisfactorily. �LJn TSawDrer, %Tu6CicWealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER ,NORTH -' Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 400 OSGOOD STREET �°� -=3-• '� NORTH ANDOVER, MASSACHUSETTS 01845 'sscoust` 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept(cbtownofnorthandover.com WEBSITE:hn://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM e INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System()0 constructed; ( ) repaired; bye C W (Print Name) Jul �� located at (.0 C J0 �_o S n S-T 1 , TOWN OF NORTM ANDOVER (Installation Address) KEAufi-DEPARTMENI was installed in conformance with the North Andover Board of Health approved plan, originally � dated 2ii 7 112- and last Revised on -5 10 1 12.- , with a design flow of Li 5 2 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 P Health�//?412- Bed ins ection date: �" (� Z� Engineer R4fesentative(Signature) Z e� 7And-Print Name Final inspection date: Engineer representative(Signature) o And-Prin ame Installer: (Signature) Date: And-Print Name Engineer: Al% (Signature) Date: C k aL L\Vo And-Print 926 Massachusetts Department of Environmental Protection ( Bureau of Resource Protection 4 L�, I WELL DRILLER _ Please specify work performed: Address at well location: ',Decommissioned Street Number: Street Name. p Please specify well type: Building Lotft Assessor's Mapik ' '10 W..�._........., _- a - Assessors Lot# ZIP Code Number Of W8115: 104-60053 101845 , Ii 1 j s City/Town: - __ Well Location NORTH ANDOVER 3. In public right-of-way: GPS r g Yes y I No North: West . - ? 42 40635. 171.02977.,........_ . - f Subdivislon/Property/Descriptlon: Mailing Address . _ b click here d some as well logia len add, Property Owner: Street Number Street Name ". �STEWART SEPTIC INC IWO iFOSTER . City/rown State: 1 Engineering Firm: [NORTH DDVER..... 1. -= _ MASSACHUSETTS ZIP Code •. � ;STEWART SEPTk;INC ? Board of health permit obtained: g . ', 1 Yes Ile 6Required j s" {f ....-.A,....�. 1 _ Permit Number Date Issued 2 1 E P,r'IassDEP Horne ( Contact ( Feedback I Tour I Privacy Policy - UL -- TOWN OF NO TH ANDOVER - L HEALTH DEPARTMENT ht;ps.fledle ,dep.t;,u .: r ra .. '+ntivlairl,PSox -i'24i 42 :2., At? --_ Page 2 Massachusetts Department of Environmental Protection L , Bureau of Resource Protection-Well Driller Program -:-- Well Completion Reports(Decommission) Well Driller- Decommission Form WELL INFORMATION Date Decommissioned - Depth of Decommissioned Well �� ADDITIONAL INFORMATION(IF AVAILABLE) Original WCR#for Well ended information type Decommissioned Well Overburden Bedrock 177.E a.., Was a new well drilled? ii yes' WCR flor New Well CASING Casing Type Steel m v Casing Diameter Was casing ripped or Was Casing left in place? Yes No perforated? Yes o From To 3 Were obstructions left in the well? �Yes f� If yes,what type? t-Choose Description v Surface Seal Type CemenUBentonite v DECOMMISSIONING MATERIAL From ft(BGS) To{t(BGS) Material 1 Weight Material 2 Weight Water(gat)Batches Method Of Placement Choose Material -Choose Material f-Choose Place lent w t-- �1�Cjrtft' C't4J1� WATER LEVEL Date Measured Static Depth RGi(R) Flawing Rate(gpm) - ____ - COMMENTS IV V JUL'r-NORTH A TOWN 00 FkTH A DOVER OVER ztS � CIo ...:_. HEALTH DEPAIRT_MENT Maximum Characters(200) WELL DRILLERS STATEMENT _ This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my _. knowledge. Driller Registration# Monitoring(M) Supervising Driller Signature: Firm Rig Permit# Date Job Complete: ftttpe:i;, trp 9 H,r,_: S y ti hi cr= ,cruet. ,IeW"'1_'_DRl LEfi,Di.aspx 724fS?"2:13 AM '&r, of 2 AS BUILT CHECKLIST .1� l/ All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number, Street Name,Assessors Map and Parcel Number ca'�I.OD Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system,including r erve(if applicable) Ties to dwelling or Permanent Structure&Wells �� a.From Septic Tank b.From Leach Area L/ Ties to Lot Lines from leach area Locations of Deep Holes&Peres Elevations of Disposal System v Top of Foundation Elevation Locations of Wells,Drains,Watercourses within 150 feet of system v Location of water,gas,electric lines,cable t� Distances from Corners of House to Center of Tank&D-Box Location of Structures within 6 Inches of Finished Grade Original Stamp&Signature Location and holder of any easements which could impact the system Impervious Areas;Driveways,etc North Arrow Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) "1 certify the locations, elevations, ties, cover material; exposed component covers etc. shown on this as-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 TOWN OF NORTH ANDOVER 01 NOR*M Office of COMMUNITY DEVELOPMENT AND SERVICES 3? •�� #_ 9 HEALTH DEPARTMENT . . 400 OSGOOD STREET ` °+ -=�-• '' +••ono�r� NORTH ANDOVER, MASSACHUSETTS 01845 'SSACHt15�t 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthde t i,townofnorthandover.com WEBSITE:hn://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM v INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (1L) constructed; ( ) repaired; J RECEIVE by WARTS (Print Name) JU Jl� located at 61 )� �(�S Cj -T- WN OF dc-RT ANCDOVER (Installation Address) HEALIMU PARTMENT was installed in conformance with the North Andover Board of Health approved plan, originally dated 3 27 12- and last Revised on -5 1 a I I Z , 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 R esentative(Signature) en S,Lezk And-Print Name Final inspection date: Engineer presentative(Signature) And-Prin arae Instaalller: -� (Signature) Date: �� Z And-Print Name Engineer: 'r'eJ('&(Signature) Date: 24, ^�� And-Print e r DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, July 03, 2012 3:24 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St Attachments: Construction Inspection Form 7-3-12.doc The inspection went fine,for the most part. e existing system had not yet been abandoned and the inlet pipe to the septic tank was only there loosely 3rot cemented)because it was not yet connected to the house plumbing.All other pipes and ports that were not used were Cemented. I got the trucking bills;two loads were washed concrete sand early on;then 8 loads were leaching sand. I calculated he would need 122 yd of sand(for the leaching area)and he bought 142 yd. of the leaching sand. The overage makes sense as he should have bedded the new waterline in sand. ,!e waterline is in but not active.Apparently the wate�department �onn cation until nex e . Feel free to contact me if you have any questions. Sincerely, Randy Burley,Project Manager Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax: 978-282-1318 www.millriverconsulting.com rburley@miliriverconsultin2.com Mill Rm 1 . consuilt ng Civil tngimeLring ! ,nvaronintrital Permittin} Muni[ipaJ EAVironrnCntai 11C.)Jr1s COM�Ulf.ing Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 6132 Y 3?'o-'a •��� K � '.t 6 9 Town of North Andover HEALTH DEPARTMENT S4 U ,r,! CHECK#: 7/ DATE: LOCATION: Q H/O NAME: d;&42e1_ CONTRACTOR NAME: Type of Permit or License: Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic,-Design Approval $ f%J L4V5eptic Disposal Works Construction(DWC) $ 7�✓ (J" ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ •11 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer . 5 � LCommonwealth of Massachusetts Map-Block-Lot 104_B0053 BOARD OF HEALTH • Permit No North Andover -BHP-2012-0635------------ ---------- P•I• FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John DiVincenzo to(Repair)an Individual Sewage Disposal System. at No 680 FOSTER STREET -6_80 shown on the application for Disposal Works Construction Permit No. BHP-2012-063 Dated _-May-30,-2012 ----------------------- - - --------- ----------------------------------------------------------------- Issued On: May-30-2012 BOARD OF HEALTH • tigT Commonwealth of Massachusetts Map-Block-Lot c . 104.130053 BOARD OF HEALTH North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFY That the Individual Sewage Disposal System (Repair) by __John DiVincenzo -------------------------------------------------------------------------------------------------------------------------------------------------- Installer at No 680 EE -----------FOST----- R-----------STRET------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. 13HP-20127063 Dated May_30,_2012___. - ---------------------------------------- Printed On:May-30-2012 BOARD OF HEALTH 4' f Cf NORTH,h f w• o w F p Town of North Andover HEALTH DEPARTMENT ,SSACMU5�4 ti. .CHECK#: LJ DAT ?' LOCATION: j H NAME: CONTRACTOR NAM x0l Type of Permit or Licens : (Check box) ❑ Animal $ ❑ Body Art Establishment $ r ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septi esign Approval $ r-- da Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ f Wealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer � �v�r o s � i �,-�, � t l� ���� ��`�� _� P ��� t � C. .AppYication for Septic Disposal System ' Construction Permit - TOWN OF ° Full Re air ORTH ANDOVER, MA 01845 $125.00-Component SACHUS� Important: Application is hereby made for a permit to: When filling out ❑ C nstruct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return A. Facility, Information key. `7 fIF�1;�r i VQ Address or Lot# , ISI City/Town TOWN If• I�I A C 2.-*TYPE OF SEPTIC SYSTEM*: � MH RA,. it-7 ump ❑ Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** VCnventional System (pipe and stone system) infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information C_ ATH FJZ/AJE C l� k Name 1 Z� 12 Address(if different from above) 4- ity/Town State Zip Code Telephone Number 3. Installer Information,/-75 s -eP /-/ Name Name of Company 5-FL 1�po�f �, � � b4i st- Ad�drressss r City/Town State Zip Code .9 -7 :5__a �� Telephone Number(Cell hone#if possible please) 4. Designer Information C 1-4-y4CtAj A , My/t45 1 <� J Name Name of Company CT, Address H AUFjt. -tlP, � 3 City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 r . � • �.°���.. °' •Application for Septic Disposal System 3r;•`;�- °'�' °c TODAY'S DATE pConstruction Permit - TOWN OF .•r` , $250.00-Full Repair ORTH ANDOVERMA 01845 _•°� $125.00 -Component ,SSACHUs�t PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance hae been issued by this Board Health. O / Name Date f r App Yn A ro oard-qf Health Representative) Ile 'Z._ Na a Date Application Disapproved for the following reasons: For Office Use Only: / 1. Fee Attached? Yes i/ No Z. Project Manager Obligation Form Attached? Yes v 3. Pump S stem? If so Attach co ofElectrical Permit Yes � tol� 4. Foundation As-Built?(new construction ronly): Yes (Same scale as approvedplan) 'II ,,,W� 5. Floor Plans (newconstruction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 t No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH —vW AJ OF /Vog-rlJ Aljb uP, APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair Upgrade ( ) Abandon ( ) - X Complete System ❑Individual Components A O Location o D sTC R Owner's_57Name Ando'/el?�� Map/Parcel# Ad/dress V _7 _ln`57�9 Lot# Telephone# amc 19 so- �i m tEx(ll�O Nov/• V/�Qt(I /%!7 -70 ZA/L6I/ C�.�esi�e l�V69 W4 Address Address X 78 S-S6- as ?� Telephone# Telephone# Type of Building: .S- /1l C l6 rkyl t l/ �ij6L mj,- Lot Size q5' q.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) qL10 gpd Calculated design flow y53 gpd Design flow provided L15-3 gpd Plan: Date AI)IRC U Number of sheets Revision Date Title ?ro Do S Fb 5 uh5g r-CQc6 5VA,)A b �s- Description of Soil(s) X717 Z Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 3 DESCRIPTION OF REPAIRS OR ALTERATIONS 14 l 00 7,111311 o At C e7 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 -- --- ------ ----- - -- -- - - --- -- --- ------------------- ------- - --- -- ----- --- - No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ------------------------------------------------------------------------- No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARRENrM PUBLISHERS- BOSTON • 2 i DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, May 08, 2012 4:10 PM To: Greg Saab Cc: Sawyer, Susan Subject: Septic Plan Approval -680 Foster Street, North Andover, MA 01845 & note regarding DWC Application Attachments: 20120508152336085.pdf Follow Up Flag: Follow up Flag Status: Flagged To: Greg Saab&r Clayton Morin E.S.S. 978-556-0284 Attached is a scanned copy of the septic plan approval for 680 Foster Street,North Andover. Please read through the letter for the specifics of the design approval. The original letter has been mailed to the homeowner. The Application for Septic Disposal System Construction Permit was submitted to the Health Department on March 29,2012,the same day as the application for a plan review. This application shows that Stewarts Septic (John DiVincenzo?)is going to be the installer of the system. If this is approved by the homeowner,John needs to come in and sign the application and submit a check for$250.00. In addition,this is a pump system,so I will need a copy of the electrical permit before the permit for construction will be issued. Thank you for your assistance. Please call with any questions. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street i Bldg.20 i Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email Ddellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com 1 R w •• R� �S��LED j��' • • '7F, North Andover Health Department Community Development Division May 8, 2012 Catherine Clark 680 Foster Street North Andover, MA 01845 Re: Plan Approval for a Subsurface Sewage Disposal System Plan for 680 Foster Street (Map 10413,Lot 53),North Andover,MA 01845 Dear Homeowners, The North Andover Board of Health has completed the review of the septic system design plans for the above referenced property, submitted on your behalf by ESS dated March 27,2012, last revised May 3, 2012. The design has been approved for use in the construction of a replacement, four bedroom(maximum 9 room home), on-site septic system. Generally,this plan is good for three (3) years, however as this is a repair system, Title V requires that the system be installed within two (2)years from the date of the inspection failure, December 28, 2012. This plan approval includes local variance approvals by the North Andover Board of Health to allow the septic tank and the pump tank to be less than the local requirement of 75 feet from the depicted wetland line. These approvals were granted at a public Board of Health meeting held on Thursday, April 26, 2012. During this time, a licensed septic system installer must obtain a permit and complete this work. A list of septic installers licensed in North Andover may be found on our website: http://www.townofiiorthandover.com/Pages/NAndoverMA Health. In addition, a Certificate of Compliance(COC)must be endorsed by the septic installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 'G80 Foster Street ' May 8, 2012 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide-a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely Susan Y. wyer, REHS Public Health Director cc: Clayton Morin, PE file Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 —MROW RECEIVED SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT QBLI6k "I? TOWN OF NORTH ANDOVER As the North Ando/vv licensed installer for the construction for the septic system f4_rt_11EVDPD81YAWMENT (Address of septic system) For plans by Relative to the application of (� l^i 1 �� 0���11, (Engineer) (Installers name) And dated rgma date) Dated S- ,/6 Ll Z, o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved flans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations ma�E result in a X50 00 fine being levied against me and/or my company. a. Bottom of Bed—Generally,this is the first (1s� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built of verbal OK (or e-mail to: healthdel2t@townofnorthandover.co from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work(other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer,I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box, p pes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer,I understand that I am solely responsible for the installation of the system as 12er the Q12roved 121ans. No instructions byght ho e er neral contractor or an other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) V `¢VNCL_e^--2-4 ame—Print) (Name—Signed) 6 J •wf - 0 - Commonwealth of Massachusetts Official Use only Department of Fire Services PemutNo, f VM, BOARD OF FIRE PREVENTION REGULATIONS [Revel 1 (leahd Fee lank)Checked , (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(1VIE ),527 CMR 12.00 (PLEASE PRINTNINK OR TYPEALL INFORMATION) Date: ,2 da City or Town of: NORTH ANDOVER To the lnsp ctor Wires: By this application the undersigned gives notice of his or her intention to pbrform the electrical work described below. Location(Street&Number) Owner or Tenant k4+0,-n, G)*r-(.i Telephone No. Owner's Address (�— Is th' 'th a building permit? Yes ❑ No ❑ (CheckAppropriateBox) ----�- ;r• - .. .. .. .- --- - N . _ _ �� ,tion o. r" 0 + 0 ❑ No.of Meters TOWN OF NORTH ANDOVER Date.....J..�. .`� .. El No.of Meters HEALTH BEPA�TMEN`( Noft 3?e `"-;',��L TOWN OF NORTH ANDOVER PERMIT FOR WIRING '' f he walvedby theInspector of Wires. i ' sformers KVA '•,•_ "h W rators KVA cbus Emergency igliting µ �ry Units This certifies that ........... .:......... ... r. ................................. J ALARMS No,of Zones has permission to perform i .(..1. - 1 „•...••.....••„•... fDetingD and •••••••••••• ••••••••••••••••�••••• itiatin Devices wiring in the building of........ �fA Alerting Devices :'Self-Contained at.6.4f........ .................................... .North Andover,Mass. tion/Alerting Devices �� ❑ Municipal ❑ Connection her Fee...��...... Lic.No. ........... .. t„�.............. . ELECTRICAL INSPECTOR fS Y stems:Y Check # 33V of Devices or Equivalent t Wiring: i of DevicesorE uivalent mmunications Wiring: _ -of Devices or E uivalent At ach dditional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability' surance including"completed operation”coverage or its substantial equivalent. The undersigned certifies that such coy ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties oft erjary,that the information on this application is true and cor piefE FIRM NAME: LIC.NO.: Licensee: �� 7Signature_ LIC.NO.: f (Ifapplicable,e�nteeer,,«�xampp�"in the license number line.) $us.Tel.No.: _ Address: rJ GvG �s�; - Alt.Tel.No.: 'Per M.G.L c.147,` V-61,security work requires Department ofPublic Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)[]owner El owner's agent. Owner/Agent Signature Telenhnn�Nn. PERWT FF.F-.T DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, July 10, 2012 9:54 AM To: DelleChiaie, Pamela Cc: Grant, Michele Subject: FW: 680 Foster St Attachments: Construction Inspection Form 7-3-12.doc FYI This property has a well to be abandoned.The installer states a well contractor will be doing it soon. Please hold the COC.This is one type of requirement that has been forgotten in the past, and I know there is at least one well in town that is not abandoned that should be per our requirements. S From: Randy Burley jmailto:rburley(amillriverconsulting.com1 Sent: Tuesday, July 03, 2012 3:24 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St The inspection went fine,for the most part. The existing system ' - ' d the inlet pipe to the septic tank was only there loosely(not cemPn*- )use plumbing. All other pipes and ports that were not used were cer. I go, ry to sand earl on;then 8 loads were leaching sand. l � Y g �l I calc ping area)and he bought 142 yd. of the leaching sand. The overage make: a in sand. The wG apartment is on vacation until next week. Feel fret Clef � 7 Sincerely Randy Bun Mill River River( � 6 Sargent Strt j'I , Gloucester,MA 01930-2719 �S� a"! 978-282-0014 fax: 978-282-1318 www.miliriverconsultinp,.com y rburley@millriverconsultiniz.com 111 10110 'I : consulting Crura tngrneering i Envooneitntai prreratin8 M-UniCIp"tt Environrn.rn,si Nc,11111 Cant.ulttng 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, July 10, 2012 9:54 AM To: DelleChiaie, Pamela Cc: Grant, Michele Subject: FW: 680 Foster St Attachments: Construction Inspection Form 7-3-12.doc FYI This property has a well to be abandoned.The installer states a well contractor will be doing it soon. Please hold the COC.This is one type of requirement that has been forgotten in the past, and I know there is at least one well in town that is not abandoned that should be per our requirements. S From: Randy Burley jmailto:rburleyCaamillriverconsulting.com1 Sent: Tuesday, July 03, 2012 3:24 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St The inspection went fine,for the most part. The existing system had not yet been abandoned and the inlet pipe to the septic tank was only there loosely(not cemented)because it was not yet connected to the house plumbing. All other pipes and ports that were not used were cemented. I got the trucking bills;two loads were washed concrete sand early on;then 8 loads were leaching sand. I calculated he would need 122 yd of sand(for the leaching area)and he bought 142 yd. of the leaching sand.The overage makes sense as he should have bedded the new waterline in sand. The waterline is in but not active. Apparently the water department is on vacation until next week. Feel free to contact me if you have any questions. 71'1 �L Sincerely, pp—�l/O�ll�//��'/B�' Randy Burley,Project Manager Se o M_r Mill River Consulting,Inc. / �ii So- 6 Sargent Street ✓ � / y ��� Gloucester MA 01930-2719 w � 978-282-0014 lal 77, fax: 978-282-1318 www.milfriverconsultinp-.com y rburley@millriverconsulting.com >. fl_ _ River cons u I t ng Civil Engin Bring • Envifonmentgl Prrinit.ting Municipal Enviranmtnlol Ht-111h Contiulung 1 • SF f IMD'1�6 • • n North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 680 Foster St. MAP: 104B LOT: 53 INSTALLER: Stewart's Septic Service DESIGNER: ESS — Clay Morin PLAN DATE: March 27, 2012 BOH APPROVAL DATE ON PLAN: May 7, 2012 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 7-3-12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: At the time of the inspection the existing system had not yet been abandoned. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ❑ Water tightness of tank has been achieved by testing ® Inlet tee installed, centered under accessp ort ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: As the tank was not full; visual water tightness could not be verified, although the tank was monolithic and should not leak. The septic tank inlet was yet to be cemented in. Installer was in the process of installing pipe. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ® Hydraulic cement around inlet & outlet Comments: The pump chamber only had minimal water in the bottom so water tightness could not be verified; but it was a monolithic tank and should not leak. 9 , CONTROL PANEL ® Alarm & Pump are on separate circuits Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: There were two alarms. On inside and one outside. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows: 5 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Building Sewer OUT 136.82 135.3 Septic Tank IN 135.09 135.0 Septic Tank OUT 134.90 134.75 Pump Chamber IN 134.83 134.70 Pump Chamber OUT 134.60 134.45 Distribution Box IN 141.38 141.44 Distribution Box OUT 141.26 141.27 Lateral 1 TOP Chamb 141.50 141.50 Lateral 2 TOP Chamb 141.52 141.50 Lateral 3 TOP Chamb 141.52 141.50 Lateral 4 TOP Chamb 141.51 141.50 Lateral 5 TOP Chamb 141.52 141.50 Bottom of Bed/Chamber 140.51 140.50 6 (ov//i / v `/ r`,C� +.cam✓ r FINAL GRADE INSPECTION Date: � Address: 43/0 o/ LOAMED? v tfl SEEDED? �COVER PER PLAN. Other: x DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, July 09, 2012 2:49 PM To: DelleChiaie, Pamela Cc: Grant, Michele Subject: FW: 680 Foster St Attachments: Construction Inspection Form 7-3-12.doc I left Greg a message. If he has not viewed the water test yet, pls call and we could meet him there to observe. If already done no problem. S. From: Randy Burley[maiIto:rburley(amilIriverconsulting.coml Sent: Tuesday, July 03, 2012 3:24 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St The inspection went fine, for the most part. The existing system had not yet been abandoned and the inlet pipe to the septic tank was only there loosely(not cemented)because it was not yet connected to the house plumbing.All other pipes and ports that were not used were cemented. I got the trucking bills; two loads were washed concrete sand early on;then 8 loads were leaching sand. I calculated he would need 122 yd of sand(for the leaching area)and he bought 142 yd. of the leaching sand. The overage makes sense as he should have bedded the new waterline in sand. The waterline is in but not active.Apparently the water department is on vacation until next week. Feel free to contact me if you have any questions. Sincerely, Randy Burley,Project Manager Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax: 978-282-1318 www.millriverconsultiniz.com rburleyJ_millriverconsultin .com Ali River cons uItiing Civil tngrnetnfi,g * 4nvironrnr;•nto4 :permil.1111V Municipiit Environmental mr—O 11 Consulting, Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/preidx.htm. 1 IZZ North Andover Health Department [ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 680 Foster St. MAP: 104B LOT: 53 INSTALLER: Stewart's Septic Service DESIGNER: ESS — Clay Morin PLAN DATE: March 27, 2012 BOH APPROVAL DATE ON PLAN: May 7, 2012 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 7-3-12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: At the time of the inspection the existing system had not yet been abandoned. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ❑ Watertightness of tank has been achieved by testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: As the tank was not full; visual water tightness could not be verified, although the tank was monolithic and should not leak. The septic tank inlet was yet to be cemented in. Installer was in the process of installing pipe. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ® Hydraulic cement around inlet & outlet Comments: The pump chamber only had minimal water in the bottom so water tightness could not be verified; but it was a monolithic tank and should not leak. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: There were two alarms. On inside and one outside. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows: 5 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Building Sewer OUT 136.82 135.3 Septic Tank IN 135.09 135.0 Septic Tank OUT 134.90 134.75 Pump Chamber IN 134.83 134.70 Pump Chamber OUT 134.60 134.45 Distribution Box IN 141.38 141.44 Distribution Box OUT 141.26 141.27 Lateral 1 TOP Chamb 141.50 •141.50 Lateral 2 TOP Chamb 141.52 141.50 Lateral 3 TOP Chamb 141.52 141.50 Lateral 4 TOP Chamb 141.51 141.50 Lateral 5 TOP Chamb 141.52 141.50 Bottom of Bed/Chamber, 140.51 140.50 DelleCihiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, July 03, 2012 3:24 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St Attachments: Construction Inspection Form 7-3-12.doc The inspection went fine, for the most part. The existing system had not yet been abandoned and the inlet pipe to the septic tank was only there loosely(not cemented)because it was not yet connected to the house plumbing. All other pipes and ports that were not used were cemented. I got the trucking bills;two loads were washed concrete sand early on;then 8 loads were leaching sand. I calculated he would need 122 yd of sand(for the leaching area)and he bought 142 yd. of the leaching sand. The overage makes sense as he should have bedded the new waterline in sand. The waterline is in but not active.Apparently the water department is on vacation until next week. Feel free to contact me if you have any questions. Sincerely, Randy Burley,Project Manager Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax:978-282-1318 www.miliriverconsultinp-.com rburlev@millriverconsulting.com Mill RIOV. er cons u It i ng< Civil tnginerrrig # EnvilanarientaJ parMittrng. Municipal FnvirGnmen9al HU411.It CanoOting Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. 1 JL North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 680 Foster St. MAP: 104B LOT: 53 INSTALLER: Stewart's Septic Service DESIGNER: ESS — Clay Morin PLAN DATE: March 27, 2012 BOH APPROVAL DATE ON PLAN: May 7, 2012 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 7-3-12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: At the time of the inspection the existing system had not yet been abandoned. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ❑ Water tightness of tank has been achieved by testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: As the tank was not full; visual water tightness could not be verified, although the tank was monolithic and should not leak. The septic tank inlet was yet to be cemented in. Installer was in the process of installing pipe. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ® Hydraulic cement around inlet & outlet Comments: The pump chamber only had minimal water in the bottom so water tightness could not be verified; but it was a monolithic tank and should not leak. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: There were two alarms. On inside and one outside. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows: 5 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Building Sewer OUT 136.82 135.3 Septic Tank IN 135.09 135.0 Septic Tank OUT 134.90 134.75 Pump Chamber IN 134.83 134.70 Pump Chamber OUT 134.60 134.45 Distribution Box IN 141.38 141.44 Distribution Box OUT 141.26 141.27 Lateral 1 TOP Chamb 141.50 141.50 Lateral 2 TOP Chamb 141.52 141.50 Lateral 3 TOP Chamb 141.52 141.50 Lateral 4 TOP Chamb 141.51 141.50 Lateral 5 TOP Chamb 141.52 141.50 Bottom of Bed/Chamber 140.51 140.50 i DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, July 27, 2012 11:40 AM To: 'dmoore0783@aol.com' Cc: Sawyer, Susan; Greg Saab Subject: COC (Certificate of Compliance) -680 Foster Street, North Andover, MA 01845 Attachments: 20120727110800834.pdf Importance: High Follow Up Flag: Follow up Flag Status: Flagged To: Debbie Moore Realtor 978-502-7683 Dear Debbie, Attached is the scanned copy of the COC (Certificate of Compliance)for the septic system at 680 Foster Street, North Andover. Although Susan had inspections this morning,and we just received the final documents yesterday afternoon, she was able to fit in a review of the final septic as built and related plan information in order to generate this COC,as you expressed the urgent request of your customers. Would you like me to mail the original document directly to the homeowners? If so,what is their name? Please call if you have any additional questions,and have a wonderful afternoon. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com i' 1 i ry • �egKLED j o 66 . ��nrets tv� PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Ce1vfi*cate,,o Com Cance As of.- July 2012 This is to certify that a SA`IISITAC`I0RT INSTECT109V Was completed for the: Co�fetefticement/ aid qLan On;Site WastewaterisosaCSystem s of n (Ditiincenzo at: 680 T'osterS treet Parcel ID :210/104.B-0053-0000.0 je ortfi.fndmer, W 01845 The Issuance of this certificate sluff not be construed as a guarantee tfiat tfre On Site Sewage <Disposaf System wiCCfinnction satisfactorify. /Sus n.T Sawy r, /96 (u6l c 5 eaCtl(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www,towoof northandover.com TOWN OF NORTH ANDOVER a 0011TH y� Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 00 11 . - 400 OSGOOD STREET ' a; �qir o1 °+�n drpgh NORTH ANDOVER, MASSACHUSETTS 01845 ,83ALN�b�� 978.688.9540--Phone Susan Y.Sawyer, REHS/RS 978.688.8476-FAX Public Health Director E-MAIL: healthdept a.townofnorthandover.com WEBSITE: http:/hvw,v.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (K) constructed; (.)repaired R9V _ (Print Name) NORT ANDOVER located at (D C) ._0 STP,�, rbwN (Installation Address) EA[TF1-0EPAR'TMENT was installed in conformance with the North Andover Board of Health approved plan, originally dated Z'7 112-- and last Revised on -1510 11 Z- - , with a design flow of Li .J 3 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: 12- (Q4112_ Engineer R esentative(Signature) Com/'ee� G 7 And- Print Natne Final inspection date: el-/ Engineer presentative(Signature) 4 And-Prin ame. - jhistaller: • (Signature) Date:ry And-Print Name Engineer: (Signature) Date: 7--24, _- C t Gt O✓� i1�c� !" i�_ And-Print Nahic DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, July 27, 2012 9:12 AM To: Sawyer, Susan Subject: FW: 680 Foster St Attachments: Construction Inspection Form 7-3-12.doc Hi Susan, Debbie Moore (realtor)represents the seller for this property. The buyers have been living in the house for a month,and they are eager to wrap up the project to obtain the COC. I explained to her that the final as built, certification and well de-commission reports just came in yesterday afternoon,and you are out on two inspections. I told her that we would do everything to get it signed off for her as soon as possible,but it could be that it is not done until Monday to allow enough time for review. So.....anyway,this one is a priority for the residents involved,so if you can fit it in between your inspections that would be great. Thank you. O --Pamela From: Sawyer, Susan Sent: Tuesday, July 10, 2012 9:54 AM To: DelleChiaie, Pamela Cc: Grant, Michele Subject: FW: 680 Foster St FYI This property has a well to be abandoned.The installer states a well contractor will be doing it soon. Please hold the COC.This is one type of requirement that has been forgotten in the past, and I know there is at least one well in town that is not abandoned that should be per our requirements. S From: Randy Burley [mailto:rburley(a millriverconsulting.com] Sent: Tuesday, July 03, 2012 3:24 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St The inspection went fine, for the most part. The existing system had not yet been abandoned and the inlet pipe to the septic tank was only there loosely(not cemented)because it was not yet connected to the house plumbing. All other pipes and ports that were not used were cemented. I got the trucking bills;two loads were washed concrete sand early on;then 8 loads were leaching sand. I calculated he would need 122 yd of sand(for the leaching area)and he bought 142 yd. of the leaching sand. The overage makes sense as he should have bedded the new waterline in sand. The waterline is in but not active. Apparently the water department is on vacation until next week. Feel free to contact me if you have any questions. Sincerely, Randy Burley,Project Manager Mill River Consulting,Inc. 1 `6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax:978-282-1318 www.miliriverconsulting.com rburley@miliriverconsultinp-.com Mill con suliti ng Crvtl [ngweermg ! Environmental Pifrntittirt£ Aluni[ipa! Ennrronmrntal Mcaltlt Consulting Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. 2 • S�TTL'ED�6�' • rr North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 680 Foster St. MAP: 104B LOT: 53 INSTALLER: Stewart's Septic Service DESIGNER: ESS — Clay Morin PLAN DATE: March 27, 2012 BOH APPROVAL DATE ON PLAN: May 7, 2012 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 7-3-12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: At the time of the inspection the existing system had not yet been abandoned. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ❑ Water tightness of tank has been achieved by testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: As the tank was not full; visual water tightness could not be verified, although the tank was monolithic and should not leak. The septic tank inlet was yet to be cemented in. Installer was in the process of installing pipe. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ® Hydraulic cement around inlet & outlet Comments: The pump chamber only had minimal water in the bottom so water tightness could not be verified; but it was a monolithic tank and should not leak. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: There were two alarms. On inside and one outside. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows: 5 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Building Sewer OUT 136.82 135.3 Septic Tank IN 135.09 135.0 Septic Tank OUT 134.90 134.75 Pump Chamber IN 134.83 134.70 Pump Chamber OUT 134.60 134.45 Distribution Box IN 141.38 141.44 Distribution Box OUT 141.26 141.27 Lateral 1 TOP Chamb 141.50 141.50 Lateral 2 TOP Chamb 141.52 141.50 Lateral 3 TOP Chamb 141.52 141.50 Lateral 4 TOP Chamb 141.51 141.50 Lateral 5 TOP Chamb 141.52 141.50 Bottom of Bed/Chamber 140.51 140.50 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.255: continued (f) where a retaining wall to stabilize the slope is required and also is proposed as an u impervious barrier,in addition to meeting the requirements in 310 CMR 15.255(2),it shall be constructed of suitable structural material and be designed by a Massachusetts Registered Professional Engineer. (3) Fill material for systems constructed in fill shall consist of select on-site or imported soil material. The fill shall be comprised of clean granular sand,be free from organic matter and deleterious substances, and shall not contain Remediation Waste as that term is defined in 310 CMR 40.0000. Mixtures and layers of different classes of soil shall not be used The fill shall not contain any material larger than two inches.A sieve analysis,using a#4 sieve,shall be performed on a representative sample of the fill.Up to 45%by weight of the fill sample may be retained on the#4 sieve. Sieve analyses also shall be performed on the fraction of the fill sample passing the#4 sieve, such analyses must demonstrate that the material meets each of the following specifications: SIEVE SIZE EFFECTIVE %THAT MUST PARTICLE SIZE PASS SIEVE # 4 4.75 mm 100% #50 0.30 mm 10%_ 100% #100 0.15 mm 0%- 20% #200 0.075 mm 0%- 5% A plot of the sieve analyses of the portion of the sample passing the#4 sieve shall fall on or between the lines on the following graph: PARTICLE SIZE DISTRIBUTION 100 #200 #100 450 #4 Sieve Size j 90 l 60 AL0 70 0 Z 60 a / • a / LU 50 a t �• W40 W 1 4 30 O � 20 o / 10 0 Micron 60 li0o 600 2 6 10 mm 4/21106 a in rut>z _Saa Particle Size Distribution Report a e 90 l I I 1 1 I 1 ! jai;•vttli':fit. 11 i?a't>t.1 1 1 I I so I f / WZ so I I 1 1 I I 1 II llllft, I I I V ' tL LU 1 1 1 I I I t IL30 h ' � 1 I I I I 1 1 I 1 1�•. h��� 1 ( 1Q i t i 1 I 1 1 I t i �� Va?';�i.tl 100 10 1 GRAJIN S -mm. %cobbles %t %um %Fines Coir" Fine I Come I m mum Fine Slit 4A 0,0 0.0 2.6 66.4 30.0 1.0 Tilt Recuft(ASTM C 138& ASTM C t17f M,t rial Dseorit>tft�in Cine Percom Spec: Poo? Sand Sias Fir (PenCWM p6fell) #4 100.0 100.0 #10 97.4 #20 18.6 Pt= LLo Pis #40 31.0 450 15-1 10.0-100.0 #80 4.3 VW6(D 2487). AASHTO(m 145)m #100 2.7 010-20,0 CosAlCim� #200 1.0 010-S.0 Dot: 1,1313 085m 0.9751 08q■ 0.6404 Dy04 0,5597 08D= 0.4175 D;;- 0.2488 D-O= 0.2510 Cu■ 2.55 C,Q 1.08 Rernerlte Material mad$Mass Title V sand gradation specification. Dabs Received:5-31-12 Rabe Tested: 5-31-12 Tested Bye Scott TeBordo Checked Sy:Derek Richards Tide!Bmwh Mmiger MtI ntle V �osatloe'.'Se la iao Dade Sampled: 5-31-12 12 jALV—JOHN C &attley' mTc uckiag TURNER Project: M;so,Testing Services Dover NH 023 TO'd bT:Ol ZTOZ 6T unr Z�V69S2816:xQ3 Nd1N3ddHMA311N39 rtrtF,fli CUSTOMER • Bentley Warren Trucking, Inc. 105 Turnpike Road • P.O. Box 626 1DllllllJlllllllll; Ipswich, MA 01938 (978) 356-5000 o 6 (0 a Ticket# tZA0313039 I s io 'IPSWICH 1 BW512 : € t : Zt :] a toA PO No. STUAR�TS SEPT f2 f101) CUS'TO+iER —i n-nn Load 0 5 Bags 0 16 Ship To 51 w:tdt3FtND Yds 0 O Z 6;30 FOSTER STREET" za :'1tT. ANDOVER t*iA i9 �o 21 LEACHING SAND- Product 343. 48zz Gros s 7S320 1b 37. 66 Truc_king $ 1,070. 1310 za 0kiN0 —r,rr2-5 T a r e 10+Z 0 l b 15. 5+7► Tax $ 21. 47 zs 26 0 t 4432 lig 22. Er COD Total 464. 95 28 29 ® 1��4 All accounts are due and payable within 30 days frofn:i2voiAq;dwt Any account rem_ aining unpaid thereafter, will be 37 charged a finance charge of 11/2% per month (18% per year) until the unpaid balance is fully paid. NOT RESPONSIBLE 32 FOR ANY DAMAGES PAST CURB LINE. s3 06/14/2012 11:50 FAX 978 685 6721 TORRONEO INDUSTRIES INC. Z001/002 SIEVE ANALYSIS 6/14/2012 OF COARSE WICIS KINGSTON MATERIALS A Division of Torromeo Industries, Inc., P.O. Box 2308, Methuen, MA 01844 978-686-5634 Kingston Plant at 18 Dorre Road, Kingston, NH Methuen Plant at 33 Old Ferry Road .......................... .......... ............. ............. ....................... N 1VIQUAL... .. ... ..... ............ ............ U V ...........- ................... L ........ . .. .... . .... ............................... .............. ................. RE 0 N-T .... ............... .......... ............................. .... ..... ............ .............. ................ .......... ................ ...... ............. S E &'T. T -A.- T.INED lNeD, PAS IN 3/8" 0 0 0 100 #4 39.1 5 5 95 #8 308.6 36 40 60 #16 190.7 22 63 37 #30 109.6 13 75 25 #50 93.4 11 86 14 #100 75 9 95 5 #200 31.6 4 99 1 PAN 11 1 TOTALS 859 100 ................ ............ ........... ........... ............. ............ ............. SIEVE ANALYSIS OF COARSE WICIS 6 TOTAL%PASSING ...... .....MIN.DEVIATION MAX.DEVIATION 120 100 80 60 40 20 0 1 2 3 4 5 6 7 8 SIEVE SIZES Enviro-Septic System Sand Doc. North Andover Health Department (ommunity Development Division April 16, 2012 Clayton Morin, P.E. Engineering & Surveying Services 70 Bailey Court Haverhill, MA 01832 Re: Subsurface Subsurface Sewage Disposal System Plan for 680 Foster Street(Map 104B,Lot 53)Disposal System Plan for 680 Foster Street(Map 104B,Lot 53) Dear Mr. Morin: The proposed wastewater system design plan for the above site dated March 27, 2012 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1) Please depict abutter's names and address's (NA 3.2) 2) Please include the following statement: "I certify the locations, elevations and ties shown on this plan result from an actual survey made on the ground"then sign and date (NA 3.2) 3) Please use the "most recent" DEP soil evaluation and percolation forms (NA 2.3) 4) Please either move the leaching field 3'f to the southwest so the leaching chambers touch both test pits, or request a local upgrade approval for only having one test pit in the leaching area(15.102(2)) 5) Please clarify the "Percolation Rate" data in the "Soil Test Data". It appears to have been carried over from a previous job. 6) Local variance required is for distance less than 75 feet to both tanks. Please add to plan and request in writing to attend the next BOH meeting. 7) The well cannot be converted to an agricultural well, as it is too close to the system and tanks. It must be permanently discontinued and decommissioned. The proper technique is listed in the Town's well regulation. 1. Section 6. PERMANENT OR TEMPORARY WELL ABANDONMENT 6.1 All permanently abandoned wells shall be tightly sealed by approved methods to prevent pollution of the ground water. Prior to plugging, the well shall be checked for debris that may interfere with the process. If the integrity of the original well seal is in doubt,the casing shall be removed or perforated. Plan Disapproval—680 Foster Street,North Andover—4/18/12 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 a a In addition all pumping equipment and associated plumbing shall be disconnected and removed. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerel , Susan Y. Sawyer, RE S Public Health Director Cc: File Homeowner Plan Disapproval—680 Foster Street,North Andover—4/18/12 Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 • DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, April 24, 2012 4:09 PM To: DelleChiaie, Pamela Subject: FW: 680 FOSTER STREET Greg will bring the revised plans. It is too late for me to look at them. S From: Sawyer, Susan Sent: Tuesday, April 24, 2012 3:58 PM To: 'ess-greg@comcast.net' Subject: 680 FOSTER STREET Hi Greg, I received your message. At this point just, bring the plans and we will go down the points and you can show the changes.We havq 5 members so at least 3 plans should be good. See you on Thursday Susan From: ess-gre~a@comcast.net [mailto:ess-greg@comcast.net) Sent: Wednesday, April 18, 2012 4:04 PM To: Sawyer, Susan Cc: greg Subject: 680 FOSTER STREET Hi Susan Just got your message. We would like to request a local wavier for the septic and pump tank to the wetlands less than 75'. Thanks Greg Saab Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. 1 I • DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, April 19, 2012 11:14 AM To: Greg Saab Cc: Sawyer, Susan Subject: Septic-680 Foster Street, North Andover- Plan Disapproval Attachments: 20120419103658164.pdf Attached is your septic plan disapproval for 680 Foster Street, North Andover. Please address the outstanding issues and resubmit a revised plan for approval. Thank you. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email Pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com i ila 1 IMPORTANTM AG For Day, c-c-z '' l!, ime ' C� P.M. M . ! g Phone � � l �� FAX Area Code Number Extension MOBILE Area Code Number Extension Telephoned Retur ed— ur call RUSH Came to see you Pleas Special attention Wants to see you Will call again Caller on hold Message r Signed �/ �O L.�/✓ Universal"48023 LITHO IN U.S.A. I •' r ' • • S�{TIED I�5 . a 1-101 North Andover Health Department Community Development Division QNSITE WASTEWATER SYSTEM CQNSTRUC OTES LOCATION INFORMATION ADDRESS: MAP: LOT: INSTALLER:r DESIGNER. PLAN DA BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 0 {,� `�- DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base �nAn ,I/ ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base / ❑ Wee plugged Weep hole p 99 4 . �� ❑ gallon tank has been installed loading �. g ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by testing 1�^ ��y� f ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet et & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or>0.08'/foot) ❑ Hydraulic cement around inlet & outlets El Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTE (General) Bottom of SAS excavated down to C soil layer, as provided on plan [� Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) j ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: ,; Yom" 4 ko� _'� r�/� - SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = i n^n BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws °RTN Application for Septic Disposal System 3:•`" ' °c TOUAYSD E pConstruction Permit — TOWN OF .o ORTH ANDOVER, MA 01845 $125.00 -Component ,SSACHUS�� Important: Application is hereby made for a permit to: IVEWhen filling out ❑ Construct a new on-site sewage disposal system* °` SD forms on the computer,use [ epair or replace an existing on-site sewage disposal s ystem* r only the tab key AM 1 ? to move your ❑ Repair or replace an existing system component—Wh ? cursor-do not use the return TOWN of.MPO MOM key. A. Facility Informatio HE _VAI Addre or of# ILEI City/Town 2.-*TYPE OF SEPTIC SYSTEM*: / J � EYPump El � gyp{Gravity (choose one) / ***If pump system, attach copy of electrical permit to application*** 11ea� ❑ Co ventional System (pipe and stone system) Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name. Address(if different from above) /1.0 /-rfk1�3E— Clty/Town �— State Zip Code Telephone Number 3. Installer Information k .5 !s S /c_ Name Name of Company s A' res ' &49r� ra' • a/7 City/Town StSt to Zip Code Telephone Number(Cell Phone#if possible please) 4. Dei mer Information , Name r Name of Company ' i Ad;;s �b r` 6'12 Cly/Town State Zip Code ,7�� –a 2 R y Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 NORTH Application for Septic Disposal System TODAY'S DATE ' Xonstruction Permit - TOWN OF , MA 01845 $ 250.00-Full Repair ORTH ANDOVER '� "°••n°°'y�' $125.00 -Component ,SSMC US PAGE 2OF2 A. Facility Informatio continued.... 5. Type of Building: esidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date Aganipo /Bi' rd of Health Representative) �Z' P jam.. N me Date Application Disapproved for the o owing reasons: For Office Use Only: 1. Fee Attached? Yes No Z. Project Manager Obligation Form Attached? Yes No 3. Pump S sy tem? If so,Attach copy ofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 � S�TTGEDl�•' • 12Y North Andover Health Department (ommunity Development Division c� ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATIO � ADDRESS: MAP: C�� LOT: INSTALLER. DESIGNER: C!'� PLAN DATE: BOH APPROVAL DAT€'O PLAN: z. 7 zz,) INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: �-7 l� DATE OF FINAL CONSTRUCTION INSPECTION. DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed loading ❑ Monolithic tank construction ❑ Watertightness of tank has been achieved by testing ❑ Inlet tee installed, centered under access port y ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm. float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or>0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to. header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete/timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = r BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral INVERT Top of Chamber Bottom of Bed/Chamber J SKETCH PLAN de CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall. 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325' 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws North Andover Health.Department Community Development Division April 16, 2012 Clayton Morin,P.E. Engineering& Surveying Services 70 Bailey Court Haverhill, MA 01832 Re: Subsurface Sewage Disposal System Plan for 680 Foster Street(Map 104B,Lot 53) Dear Mr. Morin: The proposed wastewater system design plan for the above site dated March 27, 2012 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this deli to lows each item where applicable. Please depict abutter's names and address's (NA 3.2) Please include the following statement: "I certify the locations, elevations and ties shown on this plan result from anactual survey made on the ground"then sign and date (NA 3.2) Please use the"most recent"DEP soil evaluation and percolation forms(NA 2.3) Please either move the leaching field 3'±to the southwest so the leaching chambers touch both test pits, or request a local upgrade approval for only having one test pit in the leaching area(15.102(2)) � ) Please clarify the "Percolation Rate"data in the "Soil Test Data". It appears to have been carried over from a previous job. 6) Local variance required is for distance less than 75 feet to both tanks. Please add to plan and request in writing to attend the.next BOH meeting. 7) The well cannot be converted to an agricultural well,as it is too close to the system and tanks. It must be permanently discontinued and decommissioned. The proper / technique is listed in the Town's well regulation. 1. Section 6. PERMANENT, OR TEMPORARY WELL ABANDONMENT 6.1 All permanently abandoned wells. shall be tightly sealed by approved methods to prevent pollution of the;ground water. Prior to plugging, the well shall be checked for debris that may`interfere-with the process. If,the.integrity of the original well seal is in doubt--the casing shall be removed or perforated. Plan Disapproval=680:Foster Street,North Andover=4/18/12 T Page 1 of 2 North Andover Health Department, 1600Osgood-Street, Building 20,`�Suite 2-36, North Andover, MA 01845 Phone"978.688:954 Fax: 978.688.8476 -3- � ' �� ti« ,: . . .. . . . ., _: : : - :` �.., _ , v In addition all pumping equipment and associated plumbing shall be disconnected and removed. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerel , Susan Y. Sawyer RE S �'Y Public Health Director Cc: File Homeowner Plan Disapproval—680 Foster Street,North Andover—4/18/12 Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 .3f •A S�{ LED 7�G� , North Andover Health Department Community Development Division May 8, 2012 Catherine Clark 680 Foster Street North Andover, MA 01845 Re: Plan Approval for a Subsurface Sewage Disposal System Plan for 680 Foster Street (Map 104B,Lot 53),North Andover,MA 01845 Dear Homeowners, The North Andover Board of Health has completed the review of the septic system design plans for the above referenced property, submitted on your behalf by ESS dated March 27,2012, last revised May 3, 2012. The design has been approved for use in the construction of a replacement, four bedroom(maximum 9 room home), on-site septic system. Generally, this plan is good for three (3) years, however as this is a repair system, Title V requires that the system be installed within two (2)years from the date of the inspection failure, December 28, 2012. This plan approval includes local variance approvals by the North Andover Board of Health to allow the septic tank and the pump tank to be less than the local requirement of 75 feet from the depicted wetland line. These approvals were granted at a public Board of Health meeting held on Thursday, April 26, 2012. During this time, a licensed septic system installer must obtain a permit and complete this work. A list of septic installers licensed in North Andover may be found on our website: http://www.townofnorthandover.com/Pages/NAndoverMA Health. In addition, a Certificate of Compliance(COC)must be endorsed by the septic installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 I' 680 Foster Street May 8, 2012 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(l)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely Susan Y. wyer, REHS Public Health Director cc: Clayton Morin, PE file Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 �w - OTIRV MAY - 4W? TOWN OF NORTH ANDOVgl, HEALTH 11ARTME"NT <C-\ Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information OwnQr Nam_D ® Street AddressMap/Lot��� .... /► # City L%GIl State Zip Code B. Site Information 1. (Check one) ❑ New Construction pgrade ❑ Repair 2. Published Soil Survey Available? Yes ❑ No If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil Limitations 3. Suur/rff�icial Geological Report Available?❑/ Yes If/ye's: Year Pub li ed Publication Scale Map Unit LS�lit �L( 1 �i L C3 r'C U.�`L9—�—�L��f✓T e Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? Yes ❑ No Within the 100-year flood boundary? ❑ Yes 1to Within the 500-year flood boundary? ❑ Yes No Within a velocity zone? ❑ Yes P-90--- 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy ProgramMap Map Unit me 6. Current Water Resource Conditions(USGS): M thNear Range: ❑ Above Normal Normal ❑ Below Normal 7. Other references reviewed: t5fonnl l.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8 SL\ Commonwealth of Massachusetts City/Town of Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review(minimum of two holes reqWate proposed primary and reserved disposal area) ZDeep Observation Hole Number: Time Weather 1. Location ` Ground Elevation at Surface of Hole:// Location(identify on plan): P �4 2. Land Use pGv-e! r f--) S 5'o,-- - t �O (e.g.,woodland,agricultural fivFV.t lot,etc.) / Surface Stones Slope(%) Vegetation /©6 TLandform /0 Position on Landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way Possible Wet Area f f»O �fee'\t /�feet��_t_ feet Pro erty Lin j feet Drinking Water Well feet Other reef 4. Parent Material: 0 4 Unsuitable Materials Present: ❑ Yes If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layers) ❑ Weathered/Fractured Rock ❑ Bedrock t/ 5. Groundwater Observed: Yes ❑ No If yes, ze 3G .Weeping from Pit Dept Standing Water in Hole Estimated Depth to High Groundwater: inches elevation t5forrnl1.doc-rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 5\ Commonwealth of Massachusetts City/Town of Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review(continued) Deep Observation Hole Number: Redoxlmorphic Features Coarse Fragments Depth(In.) Soil Horizord Soil Matrix:Color. (mottles) Soil Texture %by Volume Soil Soll Layer Moist Munsell Consistence Other y (Munsell) Depth Color Percent (USDA) Gravel Cobbles& Structure (Moist) Stones W4 a% Additional Notes: t5fonn1l.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 S Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review(minimum of two holes requiredat eve proposed primary and reserved disposal area) Deep Observation Hole Number: 2 1. Location to Time Weather Ground Elevation at Surface of Hole: � Location(identify on plan): � <--- 2-� 2 Land Use to 4— G l 0'1 a^tel (e.g.,woodland,agriadtural f(,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform Position on Land pe(attach sheet) 3. Distances from: Open Water Body lcl Dfeetrainage Way /An Possible Wet Area ��U'r Property Linefeel i= Drinking Water Well `re�� Other feet 4. Parent Material: d e' Unsuitable Materials Present: es ❑ No If Yes: ❑ Disturbed Soil ❑ Fill Material Impervious Layer(s) ❑ Weathered/Fractured Rockedrock 5. Groundwater Observed: 0 r If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: inches ele anon t5fonn11.doc-rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 -C-\ Commonwealth of Massachusetts City/Town of Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review(continued) Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color. (mottles) Soil Texture %by Volume Soil Depth(In.) Soil Consistence Other Layer Moist(Munsell) (USDA) Cobbles 8 Structure Depth Color Percent Gravel (Moist) Stones 8-� 2 y✓ 7,fl Z, Additional Notes: 2,-'— 7 t5formll.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: D e Time Weather 1. Location \ L u4 D Ground Elevation at Surface 71/" Location(identify on plan): �lJ 2. Land Use woodland a 'cultural I (e.g., fi d, cant lot,etc.) Surface Stones � � Slope(%) toQ© 6� /'-l0� Vegetation Landform fi Position on dscape(attach sheet) 3. Distances from: Open Water Body ` Drainage Way /__0_tPossible Wet Area 1y� fe�et�� feet feet Property Line QL feet Drinking Water Well e Other feet 4. Parent Material: 4_+406:�� r� Unsuitable Materials Present: es ❑ No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layers) ❑ Weathered/Fractured Rock edrock 5. Groundwater Observed: ❑ Yes VO If yes: Det Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: ;nches elevation I t5forrnl1.doc•rev.1/10 Forth 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Redoxlmorphic Features Coarse Fragments Depth In. Soil Horizon/Soil Matrix:Color. (mottles) Soil Texture %by Volume Soil Soil P ( ) Layer Moist(Munsell) (USDA) Structure Consistence Other Depth Color Percent ravel Cobbles 8 (Moist) Stones Lj�(�� t•— ' lopY71 ! • 5 � Additional Notes: f t5fonn1l.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 _ Commonwealth of Massachusetts Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches A. B. ZDepth ��-weeping from side of observation hole inches inches to soil redoximorphic features (mottles) A. 3 U Q B. 4F inches inches ElGroundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at leas our feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil abso system? Yes ❑ No b. If yes,at what depth was it observed? Upper boundary: inches Lower boundary: inches 3 « 76/r t5forrnl1.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 .C-\ Commonwealth of Massachusetts City/Town of Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation,as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Date Td or Printed Name of Soil Eva for/[License# ` Date of Soil v ator Exam Z 14ame of Board of Aalth Witness Boa d of Health Note:In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percolation Test Form 12. l5forml1.doc-rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of Percolation Test o Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms the /1 /��/� computeto A T—r,use C� r / only the tab key OwneF Name move your c cursor-do not use the return Street Add ss or Lot# key. 1`�t'� � j /���l�f/ 'i-- of City/Town State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results 4rD�ao 3 Tim e Date Time Observation Hole# Depth of Perc Start Pre-Soak �•e End Pre-Soak 9' Time at 12" Cr Time at 9" �� s Time at 6" Time(9"-6") - 12, Rate(Min./Inch) - Test Passed: �� Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performe Witnessed By: Comments: t5form12.doc-06/03 Perc Test•Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, March 07, 2012 10:55 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Gaffney, Heidi; Sawyer, Susan Subject: Septic Soil Testing -680 Foster Street, North Andover Attachments: 20120307102510813.pdf Hello, Please schedule soil testing for 680 Foster Street,North Andover. Conservation comments from Heidi Gaffney - "Test pits must staymore than 50'from wetlands." The application is attached. Layout plan will be separate email. The engineer is Clayton Morin and the CSE is Greg Saab. Thank you. Best Regards, PameCa DelleChiaie Departmental Assistant I Community Development Division (Health Department Town of North Andover-1600 Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover, MA 01845 I& Office-978-688-9540 12 Fax-978-688-8476 1 Website-http://www.townofnofthandover.com/Pages/index 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, March 07, 2012 10:56 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Gaffney, Heidi; Sawyer, Susan Subject: Septic Soil Testing Plan -680 Foster Street Attachments: 20120307102629531.pdf Attached is the soil testing location information for 680 Foster Street,North Andover. Thank you. Best Regards, Pamela DelleChiaie Departmental Assistant I Community Development Division I Health Department Town of North Andover-1600 Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover,MA 01845 H Office-978-688-9540 12 Fax-978-688-8476 1 Website-hftp://www.townofnorthandover.com/Pages/index 1 ', TOWN OF NORTH ANDOVER aeµam Office of COMMUNITY DEVELOPMENT AND SERVICES ��:�•.� o HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 "4�� •*�` — NORTH ANDOVER,MASSACHUSETTS 01845 �'ss lNusECE1P-- Susan Y.Sawyer,RENS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX 1'1AR�, �U1z healthde t townofiiorthaudov .com www.townofiiorthandover.com t OWN OF NOPMI Ah.DOVER 14EALTti DEPART pAEN'r APPLICATION FOR SOIL TESTS DATE: 1 � MAP&PARCEL: 1 53 LOCATION OF SOIL TESTS: Su- C A:A"AeJ_-> -A OWNER: (2A 1-W •-1/JG Ct,4kL Contact#: APPLICANT: S�? r,�112TS —T� 'C, _Contact#: T78. �e) /• ,9 5V ADDRESS: ENGINEER: 14 1140121 J Contact#: q 78- S 3 CERTIFIED SOIL EVALUATOR: 6r6 S Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing:® Undeveloped Lot Testing Upgrade for Addition:❑ In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Piot plait&Location of Testing(please indicate test pit sites oft the 01010 ➢ Fee of 5425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of35 60.00 per lot for repairs or upgrades. GENERAL INFORMATION Y Only Certified Soil Evaluators may perform deep hole inspections. Y Only Mass,Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. Full payment will be required for all additional tests within two weeks of testing. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). D Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: )blla {{ Signature of Conservation Agent: �'el D r� ' t�r� ttJctl Ltt� in Date back to Health Department:(star�tp I EXISTING CONDITIONS PROPOSED SOIL TESTING i FOR: 'CtvWt7zn1 AT: 680 FOSTER STREET MAP 104.B LOT 46 NORTH ANDOVER, MASSACHUSETTS DATE: MARCH 01 , 2 OF SCALE: 1 20' a�Clayt o M v •o C IL T7 70 Bailey Court *E s s Haverhill, MA 01832 ! l 978.556.0284 NO. DATE REVISION .rrl LEGEND I - -72- EXISTING CONTOUR 4 ' PROPOSED TESTING AREA WATER SERVICE r CO.) UTILITY POLE � t r I ® WELL TREE EDGE OF WOODS I � WETLAND FLAG 0 w N IV V't S7230'00"W 102.30' FLAG 15A _ FLAG 16A \ --- - - FLAG 14A -?32- FLAG 17A I FLAG 13A SPORTS COURT FLAG 12A FLAG 18A FLAG 11A FLAG 19A / BARN FLAG 10A • � � LOT 1 �,BY LEAH BASBANES FLAG 20A FLAG 23A 11�Ik 4 FLAG BA FLAG 24A � AG 25A / t I FLAG 7A i 0 6A DECK t FLAG 6A 1 / / co GARAGE p p0 / / I . / / 0 G� 4/. ��� / DRIVEWAY i �j/��N�16� ��; l j FLAG 5A \ FLAG 4A WELL FLAG 3A ' FLAG 2A Rf10POSED TEST PIT LOCATIONS \ FLAG 1A X NATER SERVICE \ -- ` _ \ S72 30'00"W 322.50' --S72'30'00"W 150.00' 50' BUFFER ZONE F O S T E R S T R E E T N LEGEND — —72— — EXISTING CONTOUR a PROPOSED TESTING AREA o ® WATER SERVICE n+ UTILITY POLE $� 0 ® WELL LOT 2 - x TREE AREA 8. 78 AC \ J EDGE OF WOODS WETLAND FLAG WETLANDS DELINEATE CE6R FLAG FLAG 28A n,r 3 FLAG 31A 2 i � FLALA G 3OA ML-A,4— FLAG 32A t EXISTING CONDITIONS PROPOSED SOIL TESTING --- 50' BUFFER ZONE i FOR: CArH-emnrE- CC AP, ! AT: 680 FOSTER STREET MAP 104.6 LOT 46 x NORTH ANDOVER, MASSACHUSETTS DATE: MARCH 01, 2 / x SCALE: 1"=20' ciayt M ! o C 1 70 Bailey Court j<r6>EssHaverhill, MA 08 978.556.0284 NO. DATE REVISION A J t 10RiY/ 6015 F r 9 Town of North Andover `�'• HEALTH DEPARTMENT ,SSACNUS�t CHECK DATE: / LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check boxf ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC-Systems: eo Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer of AORTh," 't 6 015 3r�,'. • 30 x * Town of North Andover `�'•�,;:o:. HEALTH DEPARTMENT ,S34 USt� CHECK#: DATE: / LOCATION: H/0 NAME: CONTRACTOR NAME: cti( Type of Permit or License: (Check bo ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $. ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: -40 9--septic-Soil Testing $� ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer va�JurvrLvrmrnI wnrUKAIivn 10530 The Town of North Andover 03/05/12 360.00 i i Haverhill Bank (872 680 Foster street 360.00 1 , TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES `_` HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20• SUITE 2-36 "1 • .r NOR'T'H ANDOVER,MASSACHUSETTS 01845 �'s� K�►g�`� EcEI) p Susan Y.Sawyer,RENS,RS 978.688.9540-Phone Public Health Director 978.688.8476-FAX MAR " l healthde t townofnorthandov .com Ag www.townofnorthandover.com TOWN OF NORTH ANDOVER HEALTH DEPARTMENT APPLICATION FOR SOIL TESTS DATE: MAP&PARCEL: LOCATION OF SOIL TESTS: S A}�G\'ie-D 'PLA>J OWNER: 0,A-r /,1J1i (LILA k Contact#: APPLICANT: -5-ra X441S Contact#: -78. 5-d 9,25-1 ADDRESS: _ . f L J ._. f LJO+� I '�` V� ll�.�✓ ENGINEER: L K iQ 114012lrJ Contact#: 9 1<3- CERTIFIED 3CERTIFIED SOIL EVALUATOR: ( oe e:r& SA 6 Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing:® Undeveloped Lot Testing Upgrade for Addition: In the Lake Cochichewick Watershed? Yes� No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than I"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date': Signature of Conservation Agent. 't Date back to Health Department: (stamp in): to 6043 MORTN WWW 0 Town of North Andover �'•>,,,,o.: HEALTH DEPARTMENT ,SSACNU`+t� ' CHECK#: 4040 DA E: LOCATION: c,�it_ H/O NAME: / CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ peptic-Soil Testing;7 Septic-Design Approval $ eptic Disposal Works Construction(DWC) $L ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ' ❑ Other. (Indicate) $ ffealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer 03/29/2012 18:33 FAX 9785560284 ESS R001 'TOWN OF NORTH ANDOVER At Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET;BUILDING 20; SUITE 2-36 . .......... NORTH ANDOVER,MASSACHUSETTS 01845 Susan V.Sawyer,RENS/RS 978,688.9540-Phone Public Health Director 978,688.8476-FAX E-MAIL:healthdeDt(a)tGmMl€—,oLt-L--aWg -noom WEBSITE:bftp://w%&.townBR-Al UAU jtbm SEPTIC PLAN SUBMITTAL FORM R 3 0 2012 TOWN OF NORTH ANDOVER Date of Submission:— a l < HEALTH DEPARTMENT Site Location: F0 5 Engineer: ki f-41 A--" 4 e5)/&/v New Plans? Yes �$225/Plan Cheek# includes 1'tsubmission and one re- review only) Revised Plans?Yes $75/Plan Cheek Site Evaluation Forms Included? Yes � No Local Upgrade Form Included? Yes No_Z Telephone#: E-mail:_ Homeowner Name: C1 le, OFFICE USE ONLY Whenthe sub ission is complete(including check): > Date stamp plans and letter > v J Complete and attach Receipt > Copy File;Forward to Consultant ➢ V Enter on Log Sheet and Database 03/29/2012 18:33 FAX 9785560284 ESS Q002 FORM 1t - SOIL EVAL'UAT'OR FORM P2ge 9f 3 No- Date: COMMalt>lwealth Of Massae'husetts "4:5 2TH ��Uq a v� 2 , Massachusetts Performed By: -7 , .. Date: w 1triC5xed $y: � .........�,����................... G! AAhwQQ42 D iV is,t?.Ty 4 �2 a TOW.. �gd �d5TE2 �7 ew Construction 13Repair � w d2rK •4.v�,� ��� (�(�ice >Revlew Published Soil Survey Available: No ❑ yes Year Published 1(79-/ ""' ......"" Publication Sae 5 Soil Map Unit C1710 Class . Sosl LlmlwionsvT Surficial Geologic Report Available; No (� Yes ❑ Year Published 11 8.5--. „ , Publication Scale Geologic mverial (Map Unit) Landform .......... . .... ... ........... .......................... .. I'll Flood�nsurance Rata Map: Above 500 year flood boundary No [,,,]ry,�Yes Within 500 year flood boundary No l" . ❑ Within 100 year flood boundary No (E Yes ❑ Wetland Arta: National Wetland lnvetttMy MV (rnnp unit) Wetlands Cowmwq program Map(map wdt) -................. Current Wats Rmurce Conditior►s(USGS): oath � ngn :Above NomW �Norrnal l�"Below Normal ❑ OdW7 References ltavietrrod; DO Al'!!lO"ID roAM•IrMM 03/29/2012 18:34 FAX 9785560284 ESS U003 rage a of j Location Address or Lot f�o. On-site Review Deep Hole Number .... • Date:.• �•�y Time:q, , Weather Location (identify on Re to Land Use "Y el ""g Slope (%)6__3— Surface Stones Vegetation � Landform Position on landscape (sketch on the back) . Distances from: ->� Open Water Body '7 j tfeet Drainage way feet Possible Wet Area 754- feet Property Line '76— feet Drinking Water Well -3,611 feet Other DEEP OBSERVATION HOLE LOGO Other Depth from Soil Horizon Soil Tex•fure Soil color Soil Surface (Inches) (USDA) (Munsell) Mottling (structure,Slones,G aviel)rs, Consistency, �aP FSS- baa 7.5 � �g ee Dept hto8edreck; Parent Material (geologic) 444/✓J 474 �r Deyth to Groundwater: Standing Water in the Hole:; jl� Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORAI•12107195 03/29/2012 18:35 FAX 9785560284 ESS U004 k agc L of 3 Location Address or Lot too. On-site Review 9 � Sao �I�jl l �r � Deep Hole Number �Date':. Time: Weather x r Location (identify oI f�, surface Stones Land Use n ` � .._..•iteI N Slope (%} Vegetation LL-" v o Landform .Position on landscape (sketch on the back) Distance0rom: t 7S feet Open Water Body ��_^ feet Drainage way . Possible Wet Area 7f feet Property Line 3 07 feet Drinking Water Well Sp feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Tell f e soil Color Soil Other SDA) Surface►Inches) (Munsell) Mottling (Structure,Stones,GI aveljrs, Consistency, rf Ap � Ir ��(�` © r , �r 1 7,2;V& ,3V& s �oynle �. - z-s�' POSAL 5��� Depthto8edrock: 7'� Parent Material (geologic) _ Weeping from Pit Face: AL''d Depth to Groundwater: Standing Water in the r Estimated Seasonal High Ground Water; UEP APPROVED FORhl•11/07/9S 03/29/2012 18:35 FAX 9785560284 ESS Q005 rage z of 3 Location Address or Lot too. _ On-site Review .: ., Deep Hole Number Date. r Z Time: Weather a`� Location (identify on site plan) ���•- - ��` Land Use L4?��-1" Slope M Surface Stones . Vegetation Landform . Position on landscape (sketch on the back) Distances from: I �- Open Water Body -�5 t feet Drainage way S— feet Possible Wet Area - 4 r feet Property Line 201 feet Drinking Water Well �p� feet Other _ ' DEEP OBSERVATION HOLE LOG other Depth from Soil Horizon Soil Texture Soil color Soil Surface(Inches) (USDA) (Munsell) Mottling (Structure,5tones,Gravlel)rs, Consistency. ( � .ag �w 7, i C Parent Material (geologic) �J "n DepthtoSedrock: Face: e in from Pit Depth to Groundwater: Standing Water in the Hole: W � eP 9 Estimated Seasonal High Ground Water: DEP APPROVED FORM-1210719S 03/29/2012 18:36 FAX 9785560284 ESS IA006 Ilk FORM 11 - SOIL' LVALUATOR FoRm Page 3 of 3 Location Address or Lor No. rP 2 57'` ry Mei_hnd UUssgd: Depth observed standing in observation hole., inches ' 6 'Joih weeping from side of observation hole inches Depth to soil mottles .73v inches 44Z ye- j Ground water adjustment . . .. ., feet Index Well Number .............._ Reading Date ... Index well level .........•. .. � Adjustment factor ,,...•......... Adjusted gr6und water level Death ofNate,rally O,gpurcingPervious. Ma-toriai .. Does at least four feet of naturally occurring pervious material exist In all areas observed throughout the area proposed for the soil absorptign system?j ___ If not, what is the depth of naturally occurring pervious matprialT � � x Certification I certify that on7 idate) i have passed the soil Ovaluatar examination approved by the ep rtment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experlence described in 310 CMR 15.017. • A Signatu Data 3 //. 1 . t OV ARRQVM POM1•Iu1Trri' i i A D`elleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Wednesday, March 14, 2012 2:37 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 680 Foster St Attachments: Soil 680 Foster St.PDF Please find attached the soil testing results from 680 Foster St. All went well. Sincerely, Randy Burley Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsulting.co rburleygmillriverconsultiniz.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:htto://www.sec.state.ma.us/ore/oreidx.htm. Please consider the environment before printing this email. I 1 P— — F ` C �Fl � µ I � — �/f c I • _ iii IT'j- r. W a l - li J—. , a 1 � I , t orle. �i6 � axe e. ' I t I 4 — , - I , { l , .., �,. � � •moi$ DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Friday, March 09, 2012 10:22 AM To: DelleChiaie, Pamela Subject: RE: Septic Soil Testing Plan -680 Foster Street Pamela, Did anyone set this up for you? I've been out. From: DelleChiaie, Pamela [maiIto:pdellech@townofnorthandover.coml Sent: Wednesday, March 07, 2012 10:56 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Gaffney, Heidi; Sawyer, Susan Subject: Septic Soil Testing Plan - 680 Foster Street Attached is the soil testing location information for 680 Foster Street,North Andover. Thank you. Best Regards, PameCa,DelleChiaie Departmental Assistant I Community Development Division I Health Department Town of North Andover-1600 Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover,MA 01845 9 Office-978-688-9540 12 Fax-978-688-8476 1 Website-hftp://www.townofnorthandover.com/Pa-ges/inde Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http:/Avww.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 Of,NOR Th 6001 10 9 + Town of North Andover HEALTH DEPARTMENT ,SS4CMU�+E� CHECK#: DATE- LOCATION:' ATE:LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (C box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ =Title spector $ _ Report $ ❑ Other. (Indicate) $ (Zea lth Agent Initials White-Applicant Yellow-Health Pink-Treasurer y, 6001 -Of,NORTH 1y Town of North AndU er ......�: HEALTH DEPARTMENT CHECK#: DATE: ( � �ps LOCATION: ll/ ale H/O NAME: CONTRACTOR NAME: G� Type of Permit or License(Cy(-ct box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrasWSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑�tt'le Inspector $ Report $ �� ❑ Other:(Indicate) $ ealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massa@husetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �f a a''v 680 Foster St -7J Property Address ] Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every 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. Important: When filling out A. General Information forms on the computer,use ;Q 1. Inspector: only the tab key `/f/J l to move your cursor-do not John DiVincenzo } Name of Inspector use the return C � key. Stewart Septic Service Company Name ! J r� 58 South Kimball ; Company Address Bradford i 'ems" City/Town de 978-372-7471 Telephone Number B. Certification I certify that I have personally inspected, I that the information reported below Is true, accurate and compleie-as uru,c-.,,,,---._..__`„ n. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ N eds Furth r Ev uation by the Local Approving Authority Ins ector's Signature Date i he 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ' Commonwealth of Massa@husetts /4 Title 5 Official Inspection Form R = _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a e —,.• 680 Foster St l t Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every 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. Important: When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your John DiVincenzo _ cursor-do not Name of Inspector use the return key. Stewart Septic Service Company Name Q 58 South Kimball Company Address Bradford Ma 01835 City/Town State Zip Code 978-372-7471 S113386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ N eds Furth r Eva1 ation by the Local Approving Authority Ins ector's Signature Date he 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•11110 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 °M„ •'' 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. City/Town 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 pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 y Commonwealth of Massachusetts -W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is No.Andover Ma 01845 12/28/2011 required for _ every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D System Failure y e Criteria Applicable to All stems: p Systems: Y You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w, 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area–IWPA) or a mapped Zone I I of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts MENEM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for NO.Andover Ma 01845 12/28/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage Well 9 ( Y 9 (gPd))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° ., 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Andover Septic Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: -- Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 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 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 50 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 75 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1'-4"feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: — t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every 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 28" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6.5 11 Distance from bottom of scum to bottom of outlet tee or baffle 16" -- How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Baffles in place, no leakage, level good Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is No.Andover Ma 01845 12/28/2011 required for _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•11/10 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 680 Foster St Property Address Catherine Clark _ Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): Dist Box leaking, solids carry over, Box is not level Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 680 Foster St Property Address Catherine Clark Owner Owner's Name information is No.Andover Ma 01845 12/28/2011 required for _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) -Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-40' ❑ 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.): Bottom of system and wet lands at same elevations. System is in water table Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form: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 „ 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 01845 12/28/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: — Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is required for No.Andover Ma 11/28/11 every page. Citylrown State Zip Code Date of Inspection D. System In (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 wh a public water supply enters the building. Check one of the boxes below: hand-sketch In the area below ❑ drawing attached separately D S T G v n t5ins•11/10 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 680 Foster St Property Address Catherine Clark Owner Owner's Name information is No.Andover Ma 01845 12/28/2011 required for _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Water on property 20; from systme. Shot grades and water is the same elevation as bottom of the system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 N ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 680 Foster St Property Address Catherine Clark Owner Owner's Name information is 01845 12/28/2011 No.Andover Ma 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 ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information —Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 14 R.IT AYl1 D 01% �. �. MASSSASHUSETTS S'h r •• l 1•��:( �,. r OC9 2008 hei proYlded jhlrf lorrn 1cr eo locos Boa�rC,iir�ol'n�o`a H, y�'ca�,� 00 luoml{{od to the local aQw: of noa In N FiFf�l9-SP_• •• o� clr_ia� ro�Ir,-O_e�lnorrry_,J A. FaclI —In f-o"'Tr lon ..r �.,r��, .• Sy'slQm location:•. ~74 nt�m.yrd ;: . CI�1I �:. , Syslam Owner.. .o /wdrO." tit QV(Vlnl •rcm buuon) T/'7pf10n1 N„mp/r -�- B1-Pumping Record - p1�9' cell 3, TYpe G! 8Y310M:.. L7 . C999p y r V •'c- L 100lO SBpC TVA � , I�nl Teri -�•Q%Other (descrlbe�; , n ee Fllle(Pr�•SanCl n Yes [D n'0 If Yes. 89 it —04 C.oiidl�lori'p(;9ym_ ,.1;, vmpod SIG -� :. . I1�,ir^�/�'11`i�l)rtr•' l'r!' I4r � '�,`�rJl!,1,1 f'4•'", I 10^�GO � +� 11''v.'^./dl ... '(,'r� •i.11,�. / ✓t. 'SIV, m��• �1j�; ; 1orf1 ; '�;,r,,1.. . i loca on.where oorllenl�'yvera d os . ', ,�` •, ,�•,l';, ,,,, :sift.. •, h . . . �, ' ' ;,;�; .r.'• � ' ,i a.ify�(!rill,:``:..;':1 olh1lVal'��'N°o' ��:-^^�w•mem,BoY/d0 ser/appjoy')s (6lorms.n�naln9�eCl 1 Address G4b. _1�©s-rAZI�Z S7:; - Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Acti'on and notes: action Document/ document/ Num. Action Department Board of Appeals — Board of Health-- Planning Board — Conservation Commission — Building Department GAB Robins North America, Inc. ull Date 6. *+ �^ Building Commissioner/Inspector of Buildings " ✓Board of Health/Board of Selectmen NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139 Section 313 is appropriate, please direct it to the attention of the writer and include a reference to the cap- tioned insured, location, policy number, date of loss, and GAB Robins file number. 1 Insured: _ ir'c_' lAlgE Property Address: _ ?0 ' 7-C R X T. 'G`•C, .• Policy No. Loss of 19 ' GAB Robins File No. 611 (Signature) Title: On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. z ignattu/r/e JJJJ/an�nd date Form 645(2/78)