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Miscellaneous - 7 DUNCAN DRIVE 4/30/2018 (3)
Duncan Drive r a t 0. 1 Lot & Street 0 Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permits Plan Approval: Date: a 9 Approved by: Designer: Plan Date: Conditions: Water Supply: Town Well Permit: _.Driller: y/e/ra- --` Well Tests: Chemical Date Approved�/ G� 0- -Bacteria I Date-Approved ''' �/.66 Bacteria H Date Approved _r Plumbing•Sign-Off: Wiring Si--n-Off- Comments: Form"L"' Approval: Approval to-Issue: ANO w �- Date Issued z By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? -�� NO Certification? �a NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? NO Type of Construction: - REPAIR New Construction: _ -_Certified Plot Plan Review NO NO —Floor Plan Review C-yES NO _ Conditions of Approval from Form U YES NO _Issuance of DWC permit: - ,_XES__� NO .DWC Permit Paid? YES NO . DWC Permit Installer- Begin-Inspection:_ L 110'Wec,ted YES� NO - `f_/W?70 Excavation Inspection: —Needed.- Passed: Needed:Passed: / By: ✓ w - .-Construction Inspection: Needed: lt_Plan Satisfacto YES` Approval of Backfill: Date: (o //pb By: -Final Grading Approval: Dater—/ 60 By: Final Construction Approval: Date: x/ By: Certificate of Compliance: Approval: /� Date: • S�TTLED���' • • • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 3/27/14 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-Box By: John Soucy At: 7 Duncan Dr. Map 105.0 Lot 0040 North Andover, MA 01845 e Issuance of th' e if a e sha not be construed as a guarantee that the system will function satisfactorily. 1 Xichele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com of MO p,M,y 6761 Town of North Andover ` HEALTH DEPARTMENT �SSCHU CHECK# E. 4 4 LOCATION: -bunu 6 H/O NAME: CONTRACTOR NAM&%,- ) 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 $ ❑ 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 Commonwealth of Massachusetts W Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON _ Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John J. Soucy use the return Name of Inspector key. Soucy's Sewer Service Inc. _ r� Company Name 78 North Broadway Company Address Salem NH 03079 City/Town State Zip Code 603-898-9339 13397 _ 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 RECEIVED ❑ Nee Further Evaluation by the Local Approving Authority I APR 2 2 2014 _ 03/27/14 _ TOWN OF NORTH ANDOVER S cto s Slgna re Date The system inspector shall submi copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days f 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <, M 7 DUNCAN DRIVE _ Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) _ Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 b Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,^M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON _ Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 — — page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM0 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 -- — 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 II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 page. CityrFown 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): 440 t5ins•3/13 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON _ Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for every -- - — page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: See Attached Sump pump? ❑ Yes ® No Last date of occupancy: Current 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: CURRENTDate Other(describe below): General Information Pumping Records: Source of information: Soucy's Sewer Service Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 i gallons How was quantity pumped determined? Reason for pumping: Maintenance and Inspection _ 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): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 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: 15+ (1998) Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 6" Depth below grade: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,^M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 - -- 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 38" — — 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14" -- How were dimensions determined? Tape and sludge tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 7 DUNCAN DRIVE _ Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 - - -- 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M _ 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for 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 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.): "D" BOX REPLACED PRIOR TO INSPECTION, SEE PERMIT Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 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 °M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 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: ❑ leaching fields . number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: ELJEN IN DRAINS (24) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): NO SIGNS OF HYDRAULIC FAILURE _. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts _. Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 DUNCAN DRIVE _ Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 required for every ____.__— page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties t at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately EX/STINO PROPOSED- --ice--- —Q— SURFACE CONTOUR Sri Z ?271X7 SPOT ELEVATION c DEEP SOIL 08SERVA7IL to 9 Q PERCOLATION TEST Y°�� ;p" PROMINENT TREE, DIA. B.M. '0a,& ELEVA LION BENCH'MA, V✓S-- WA TER SER NCE 0CUS MAF` Dc \�0 16.7,77 i 4$`— p fY�fJ-31 b 'I 1 RESE vE, T-1.. SA 'T F '�8 I 134.5; l PJ5ly'17. - f27-.5'' I 1 o_ Imo. 3 r ;NV.- /76.0'x t � � \tito i r 93,`0 t� L.;m;-r pF SES K 2� \4E?LA-t40 GrYP.� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is required for every N. ANDOVER MA 01845 03/27/14 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: 3.75' (45") 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: 09/15/1998 _ 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: DIG HOLE WITH AUGER IN LOW DROP OFF AREA, TO 4', NO WATER. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 h Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 7 DUNCAN DRIVE Property Address KATHLEEN &JOSEPH GARON Owner Owner's Name information is N. ANDOVER MA 01845 03/27/14 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .............................. ............. rir Commonwealth of Massachusetts Map-Block-Lot --- ------ ------- BOARD OF HEALTH Permit No BHP'-2014-0457 North Andover P.I. FEB F.1. $125.00 -------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted JOh-a SO4CY ........... ------- ----------- -------- ---------- to(Repair)an Individual Sewage Disposal System.. at No 7 DUNCAN DRIVE -boy,------ ----------- ....................... ------------ as shown on the application for Disposal Works Construction Permit No. B�=T -945�� e -------------------------- ---------------------- issued On:Mar-25-2044 BOARD OF HEALTH ................. ..................... ......... ..............................- ............. ............ .......... ............................. ................. ..................... .............. 7 DUNCAN DRIVE ............ ............................. ........ Reference No: BHJ-2014-00000 9 ................................... Permit NO: BHP-2014-0457 ...........w........4............. Department: North Andover BOARD OF HEALTH Account No: 1001001.1.5.0510-00 .......................................................................... .....w............................. Fee Type. Receipt No: REC-2014-001227 DWC-Component Repair PERMIT .................................. ..............I........................................................ Paid By: Paid in Full On, Tue Mar 25,2014 ............................. John Soucy ................. .............. Check No: 26609 .............................................. ............ Received BY: Lisa Blackburn ................... .......................... .............. Amount: $125.00 Is COPY CUSTOMER ............................. ................... ......... ........................................................................ O North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 7 Duncan Dr. MAP: 105.0 LOT: 0040 INSTALLER: John Soucy DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: D-Box 3/27/14 DATE OF BED BOTTOM INSPECTION: 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 ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port 1 ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ❑ 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 �Z-.'/H-20 D-Box Inlet tee (if pumped or >0.08'/foot) ®� Hydraulic cement around inlet & outlets O//'Observed even distribution Speed levelers provided (not required) � Schedule 40 PVC Pipe Comments: Commonwealth of Massachusetts Map-Block-Lot ----------------------- BOARD OF HEALTH Permit No North Andover BHP-2014-0457 ------------ -- -- P.I. FEE F.I. $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John Soucy to(Repair)an Individual Sewage Disposal System. at No 7 DUNCAN DRIVE as shown on the application for Disposal Works Construction Permit No. BHP- 147045 e -------- _ 1 ----------------------------------------------------------------- Issued On: Mar-25-2014 BOARD OF HEALTH ...-•-•--•--•--••---------•-------•--• ---------- ---------------------------- ...............*........................................................... 7 DUNCAN DRIVE Reference No: BHJ-2014-000009 ................................... Permit No: BHP-2014-0457 Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Account No: 1001001.1.5.0510.00 Fee Type: ................................... REC-2014-001227 DWC-Component Repair PERMIT Receipt No: ................................... ......................................................................................... Paid By: Paid in Full On: Tue Mar 25,2014 .......................... John Soucy ......................................................................................... Check No: 26609 Received By: ................................... Lisa Blackburn ......................................................................................... CUSTOMER'S COPY Amount: $125.00 ....................................................................................................................................... .......... • .r" 'k°� , Commonwealth of Massachusetts Map-Block-Lot BOARD OF HEALTH Permit No North Andover BHP-2014-0457 FEE $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted JOhn-SOUCY--------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 7 DL NCAN DRIVE -b— as shown on the application for Disposal Works Construction Permit No. BHP-20f4_045'__bated . March 25,2014 --------------- -----------------------------------------------------------------� Issued On: Mar-25-2014 BOARD OF HEALTH ................................... ........................ ........................................................................................................ : BHJ-2014-000009 7 DUNCAN DRIVE Reference No ................................... Permit No: BHP-2014-0457 ................................... Department: North Andover BOARD OF HEALTH ......................................................................................... Account No: 1001001.1.5.0510.00 .................... Fee Type: .............. Receipt No: REC-2014-001227. DWC-Component Repair PERMIT .................................... ................................................................................... id By: Paid in Full On: Tue Mar 25,2014 .................................... John Soucy ................ Check No: 26609 ........................................................................ .................................... Received By: Lisa Blackburn ................................ ........................................................ Amount: DEPARTMENT'S COPY $125.00 ........... ............................................ .................................................................................. µORTk of Application for Septic Disposal System 03/20/2014 t .e �ti TODAY'S DATE Construction Permit - TOWN OF ORTH ANDOVER, MA 01845 $250.00—Full Repair $125.00 -Component �sxACHt15f'' Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑■ Repair or replace an existing system component—What? DISTRIBUTION BOX cursor-do not key the return A. Facility Information Y 7 DUNCAN DRIVE Address or Lot# N.ANDOVER City/Town 2.-*TYPE OF SEPTIC SYSTEM'`: h►AR 2 5 20,14 ❑ Pump ❑■ Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** . ❑■ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information JOSEPHGARON Name 7 DUNCAN DRIVE Address(if different from above) N.ANDOVER MA 01845 CityfTown State Zip Code 978-681-8582 Telephone Number 3. Installer Information JOHN SOUCY SOUCY SEWER SERVICE INC Name Name of Company 78 N.BROADWAY Address SALEM NH 03079 City/Town State Zip Code 603-898-9339 Telephone Number(Cell Phone#if possible please) 4. Desi ner Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Application for Septic Disposal System 3�a`': ''�• o� Construction Permit - TOWN OF TODAY' DAT $250.00-Full Repair ORTH ANDOVER, MA 01845 $125.00-Component 9 sRCHU PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: XResidential 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 Environm I Code,as well as the Local Subsurface Disposal Regulations for the Town of North do r,and not t place the system in operation until a Certificate of Compliance has be issue by this B r of Health. 'G ame Date 7 71 /We pproved oard of Health Representative) -�� I� li Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump S sy tem? If so,Attach cop,v 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 North Andover Water Treatment Plant 420 Great Pond Road North Andover,MA 01845 North Andover Lab June 8, 2000 Mr.Robert Moore William Barrett Fine Homes 1049 Turnpike Street North Andover,Ma 01845 Dear Mr. Moore: The following are the results of the private well sample collected at 7 Duncan Drive on June 6, 2000: Total Coliform Bacteria 0 per 100ml 8.05 pH 0.10 mg/l phosphate 1 color units 0.01 mg/l nitrate 0.23 turbidity units 0.022 mg/1 iron 44 mg/1 as CaCO3 Total Hardness 0.023 mg/1 manganese 16 mg/1 as Calcium 0.97 mg/1 as Magnesium Comments: The well is free from bacteria, and all the parameters are excellent for a well. The results of these analyses meet the required federal and state standards for drinking water. The range for a well pH is 6.5—8.5. The nitrate level is well below the standard of 10 mg/1. The maximum level for well water turbidity is 1.0 turbidity units and for color 15 color units but naturally the lower the number the better. Your results are well below the maximum level. The well water is also very soft with the range being below 100mg/1 as CaCO3 as an indicator of soft water. If you have any further questions please call us at 688-9574. Sincerely, Kellyng Senior Water Analyst North Andover Water Treatment Plant .� A2-03-200 12:33PM FROM P. 2 2-03-200 10:SOAM FROM c_ 1 C. 66 t-ITTLETON ROAD,WESTFORD,MA 01686 (976)02.8396 FAX(978)692.0023 t•Soo-649.TEST !report Nun*a: C-wps-44726 Report Dift. February 1,2000 Client: Sample taken at: Wilmtingtan Pump Supply Inc. Lot A.Duncatti Road F.O.BOx 517 N.Andover,MA Wilmington MA 01887 Sample taken by: Client On: 1/26100 Kgffm Of TU ST PARANMTER EPA MAX RESULTS UNITS Total Coliform(P) 0 0 per 100m] Calcium NO Limit 13.4 rog/L Copper(S) 1.3 <0.02 mng/L Iron(S) 0.3 # 1.2 rng/L Magnesi um No Limit 2.3 Mel- Manganese(S) 0,05 0.04 mg/L Potassium(S) Not Spec. 029 UW/L Sodium "28 26.1 mg/L Alkalinity(S) NOT Spec. 76 mg/L Amnwnia Not Spec. <0.03 rag/L Chloride(S) 250 6.7 MA Chlorine Not Spec. 0.36 MOIL Color(S) - 15 4 3U CMCJ Conductivity Not Sync. 204 umbovcm Hardness No Limit 43 mg/L Nitrates(as N)(P) 10 <0.01 mg/L Nitrites(as NXP) 1 <0.01 mg/L PH(S) 6.5-8.5 8.5 SU Odor(S) 3 2 TOIL Sulphates(S) 250 20.0 mc/L Turbiditi_ -- _... Not Spec. Sediment pos/neg nag NT=Not tested.#--Value Exceeds EPA STD,TNTC=Too Numerous To Count "=$adVound Bacteria Noted,"-EPA Advisory Litten,'=Exceeds Advisory Limit (P)=Primary EPA Standard.(S)-Secondary EPA Standard(may aBvcx aesthetics of Drinking Water,i.e coli present This water sample.as subrnittvd,is oonsidemd Safe to drink acoording to EPA. guidelines.However,one or more parameters exceeds EPA secondary wandard as denoted by the#sign. Massaehustdtr State Certified Mie F. advert,far Testing Laboratory#MA048 Thorslensam LabvaunY Inc. b2-03-200 12:32PM FROM P. 1 Date Da LF" 4w Number of a s includi cover 4.sheet TO: FROM: William Barrett Homes Div. of C.V.D.C. 9049 Tumpike Street North Andover. MA 01845 Phone Fax Phone Phone97 -682-2320 Fax Phone 978-682.2397 CC: REMARKS: ❑ Urgent For yourreview ❑ Reply ASAP ❑ Please Comment • ,�; ,� 6 ,, � DOVER: m rd 15 T-7 • ,'I, o�P. { '.,,,...•.:y'. � %`,,:.hJUL 0 8 2009 ai plovldod )hli lorrn for neo �`;' .o^vr 6oarcl o qua':^ >: �, 00 (Iod to 1,0 IOCII BCdrC rr ., .... .,, oa In or curer •aa 3WNV pFl��ppiA�1DOVER A, Facillry lrlforri"1�H H ALIHCYEPARTMENT •'.) '.'.1 ll l t' 777 f 11 . ,. ,,.' ., ;,,I, ;,',�• Nun, .,� ,� . .,�. 'ry V,, , �; ,Y.I'll• ,'• .. A4dr►44 (II4Vflll inl In buVcn) — ,r61:Pumpin 8.Re'g,ord 46 Ty�e41 +yJ(em;,. l 0979 opl.c TO ' 9JC�1b9�: Ehluon( TaoFlllo(�r9�onr? r' Yo9No ..'I •�•.b`',•;1���'r'�ai,�'•�:'t,ii:'���I�i,ij��fl��rr;,.,. II y67 ^9C'98n90? .. . '•! �.' ,��:�Coridl�lori'Q(:9Y. ��m;;'.�,��" ' S .iii/ .l•'.!� •�Y;,a` "1•i,,�! ''I. ���Tr SY1 rP�'m pod i�'r•;>;;�''•I•ilrtt%' i I� (1�'l � ',�rJ drl.fi ,'; . �',�;Cti ,'/Il,i�• IYr �,l'' �I :I' r VI�Ic11 154 m •�,�(.'.i%`,`` .. .�,w�w1���1� (r'1�,,L;i�'a�''4j�' ,ji,11�,f,,,IIVI(f.�l/��' ' ,on.Yrhars,cor�lonla;weie dl;po sae: o/N)V4 J D ,' .' (ff.,Y%';L..•,..,,., ,. Ill .ma,J- r/da3F,yrsler/approYeJa/iblorm�.n ma)n9oeC1 NIP SEP - 7 2005 _r, / xx • UA71. OF A N-nTY L yt� Oe Kok,;rtp,�' L)Uzi hA Y'.) OOOD CON,v I ri or, �MAYY OUAU L BAC KFI e-�L D K LN F3 SOLID$ �OL rD C.A RA YO YBA 6bo�� TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) f��477 I-Rio/A+- �o . 1d1-,6/6qg DATE OF PUMPING: G A-V!2, QUANTITY PUMPED ISoo GALLO'N'S CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED T0: NORTH Town of And No. 0A1 ~ = 7 _ �O 't- LA o dover, Mass., COCHICHEWICK ADRATE D p? C S BOARD OF HEALTH PER. M IT T D Food/Kitchen Septic System 4N _, ,,L � / 6 BUILDING INSPECTOR THIS CERTIFIES THAT...4e�! .......1O( ~.. .. ........V. � N If 4 . Foundation��� has permission to erect............. ........................ buildin s on .� .. .. A NlCi4� � Rough C, has &#. to be occupied as... ........... . ............................................. Chimneoy6 provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 6-8- this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 0-0 Buildings in the Town of North Andover. '©� C 1:40 PL BING INSR EC_TO� VIOLATION of the Zoning or Building Regulations Voids this Permit. ou PERMIT EXPIRES IN 6 MO cf/t l MONTHS UNLESS CONSTRUCTIO S T ELEC Ic c Rou ��� ........ . k. ... . .. .. .. . ... �6A BUILDING INSPECTOR in Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove l Rough , r t ' A No Lathing or Dry Wall To Be Done DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner BLDG. Pfrf °�� 1� Street No. O+�O� ' ��' - d 2Q LESS t�, I O / pIIlE FS : / 1007 0.. SEE REVERSE SIDE Smoke Det. tOf TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 6/8/00 This is to certify that the individual subsurface disposal system constructed (X) or repaired () by Tom Sawyer at 7 Duncan Drive has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( constructed; ( )repaired; by located at - () n C 0. V was installed in conformance with the North Andover Board of Health approved plan, System Design Permit#_' dated , with an approved design flow of Z/�gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: 4WD C, LicA Date: --6 -ZaelO Design Engineer: Date: `'7- _oaa PV S J_OSEPt1 icy Jcs SERWA 1 CIViI rA u No.36981 o � FSSIONAI PLAN OF LAND exist. well IN NORTH ANDOVER, MASS. OWNED BY JOSEPH GARON SCALE.' 1"=20' DATE.5/25/2000 Scott L. Giles R.P.L.S. Frank. S. Giles 50 Deer Meadow Road g� North Andover, Mass. �Opx / A / S.B. / FND. TABLE OF ELEVATIONS OUT OF HSE.=132.67 IN TANK=132.47 OUT TANK=132.28 1 IN D. BOX=132.15 OUT D. BOX=131.99 \ END#1=131.97 EXIST. BIT. CONC. \ END#2=131.98 DRIVE \ TOP RET. WALL=132.60 y J 101 \ / 43'+1- P_2 \ I hereby certify that I have inspected the construction of the disposal system and that the construction and final grading has been in accordance with the designers intent and that the materials used conform to the plan sppecifications 1 #2 JIT-2 ` and 310 CMR 15:00. 1 \ X \ � S.B. FND. \ \ A \ , w —7 D V t1 cavo D o 1 U e 10, ,��N Of \� \ Lot A ' ` .`y \\ \ m \ Area=58,200 s.f. Z 72 y \ X \ Z N MAP 105'C' /StEBEd �°4 \ \ 01 N p PARCEL #40 t tAIm% PLAN#7580 N.E.R.D. \ Z D.S Q \ P-1 2 ���It' or 44SS a JOSEPH m y. J. �. 23. o SERWATKA CIVIL -' CA \ 2 O �� No.36981 � FSI C3,` SSIONAL E��G\� \ N m \ 71 � o \ Z O S61uj / B.M.IS INV.OF PIPE ELEV.=118.4 \ \0, \ S'Llee� 150 i APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 1 -IS - �2'y©y CT RRENT INST'ALLER'S LICENSER LOCATION: 40 �- /� i r I-i irl'izt! 6,4 LICENSED LNSTALLER: , T SIGNATURE: c J=, TELEPHONE# 22g-liAi -.S%/ 3 CHECK. ONE: REFAM: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only ♦ V S7 5.00 Fee Attached?�n Yes N/ o Foundation As-Built? Yes v bio Floor Plans? Yes V No ^ rc / e7 :-app.,;va1_ �/� Date, APR 18 Town of North Andover, Massachusetts Form No.3 AORTH BOARD OF HEALTH O � S^„.�.�s� DISPOSAL WORKS CONSTRUCTION PERMIT SACMUS Applicant NA DDRE55 + TELEPHONE Site Location 1 b Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. /d 7 S CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at�„� ,(�,�,✓�y� J'- relative to the application of ,�/, /�cr, ,,,+�� f , dated -/ Xe d for plans byes ; A 42 dated r-s= with revisions dated ;? 9 I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. .t 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned License- Septic Installer 14"d r Date: i �;t 18 BRADFORD BRADFORD ENGINEERING COMPANY,3 WASHINGTON SQUARE,P.O.BOX 1244,HAVERHILL,MASSACHUSETTS 01831, TEL.(978)373-2396 FAX:(978)373-8021 REGISTERED CIVIL ENGINEERS AND LAND SURVEYORS May 26,,2000 William Barrett Homes 1049 Turnpike Street North Andover,MA 01845 Re: Inspection of Retaining Wall 7 Duncan Dive North Andover,MA Mr.Barrett:. As requested by you, Peter D.Mauritz,a strucuml engineer with Bradford Engineering Company,visited and inspected the above referenced property. The purpose of the inspection was to assess the construction of the retaining wall along the front of the property that was designed by Mr.Mauritz. The inspection revealed the wall to be constructed in accordance with the plans.The construction methods employed are sound and the wall appears to have been adequately constructed and is structurally sound I hope the above information adequately addresses your needs. Should you have any questions or require any additional information,please do not hesitate to call. Very truly yours, &�- 'D. "O,,CnI Peter D.Mauritz P.E. Strucutral Engineer Bradford Engineering Company 31 y� I L• i - r'a j I� 1 -T � 1 j I 22'-(Y' j 10-0 I _ 45'-21/2" 14'-31/2" _ _ ! --------------------c----------- - ------Ev ----- r----------- ----------------------- � ; o ---------- ---------------------- --------------- � ! ao I • _ 1 !- - 1 ------ ------ I GN:CY'X Z4"CONf fO 16 I I 4"CONC m9.A8iW. I I I 1 6.4. 6'-4" 6'-4" 6'-4" 6'-4" = I I 1 I/8"FU FOOT 4 I 1 = r ; 1 f_r-1 F 1 -- -------- -3-2 X 12 NV-W CEWR XAM ON u` - I 31/2"LJVLY ca. I I ON 30"X 501 X CGt MTE Foofm I I L-------------------J 14 I I �. _-� I �, Q fl N I IAll 1 I ----------------------- - - ----------------------------- - 1 ' o n,-0" FGUNnMON PLAN � �l SCALE 1/8"-11-0" .j; 111 Av ____. .. .. ..... - rr• - t. -..� ... :. .-... -_. .. �. ._ .: ... .. _.. .. . �-'- •'. __.. .. .. _ .. 1 Ij I , I j 22'-O" I 101-0" 45'-21/2" I 14'-31/2" 4'`/" y.-3.. y,_6.. �0.,0�� � 91-0" I 8'-O 12'-81/x' t f T41/2" I i ' 10'-0' EN L fV�k7if� - 2 4 I � 80)([3AY`MNGO'N PINING p00M ( `�T I I 4 MA51�12 PW I 6191/2:: i3 6.11 4'-0"C. 11'-3"C.O. -r05f • � � � 5°FD.� -- I N?lF-WPI-L -- cv I �� --- FAMH.Y OOM 4 4 4 OPEN 0 4 o I C I SV FOYM 2'tb" - r —1 ImNvtmw i� Ul 6.-0.. 10•-0.. 6•-0,. 6 3'-6.. '-6. q.-0„ 9'- " 8,-0 8.-0.. 4.-0.. q-6.. 8.-0.. 4'-0" ` �U I I I 22'-0 X-6" I - �K5T�LOR PIAN �- 5cqz I/8" -V-o" 052 5f. i I I ZJ-6" I6'-b" rn I C9 b N I O � LA — O ' — -- o .; Z - r� a i L- 5cxe: GRIE: itEi: 11-011 lL—L- t�ctn eel iiil� I31.lILn�l2 cel: FINE �-;QI�t�SEE1" : S� pI,M CONn �I.DOr? GRAYViJVY. EY4'ITIGNS: FORM U - LOT RELEASE FORI'A -- INSTRUCTFNform is used to verity that all necessary aoprovalslpermits from Boards ands having jurisdiction have been obtained. This does not relieve theapplicant ndand/or landowner from compliance with any applicable or requirements. PLIC ANT FILLS OUT THIS SECTION''' '`* ' '`* PHONE APPLICANT TI r /.��1 d- ��o� A /'oi✓ �l6=��8'Z PARCCEL yo LOCATION: Assessors Map Number L as' L A LOT (S) SUBDIVISION r. ST. NUMBER STREET USE ONLY* «*.�'� ""*� TCNSERVATION NIMENDATIONS OF TOWN AGENTS: DATE APPROVED Z �ADMINISTRATOR DATE REJECTED COMMENTS �"'5 < �r FP4N DATE APPROVED TOWNNER DATE REJECTED COMMENTS DATE APPROVED F000 INS T R-HEALTH PATE REJECTED DATE APPROVED C SPECTOR-HEALTH DATE REJECTED .. COMMENTS / PUBLIC WORKS -SEWER[WATER CONNECTIONS Nl DRIVEWAY PE MIT • , 2- 7-00 FIRE DEPARTMENT &11L ' r - DATE RECEiVED BY BUILDING INSPECTOR Revised 9197 im 01/28/2000 01:48 FAX 9783528434 VIERA WELL CO. fool J 1-27--200 9:SSAM FROM P. 1 f 1 jnn tl7-00 11:08 Narth Andover Coln. Dew_ 508 Ei88 9542 P.02 BOARD OF REAL" Z7 G&-a- 4r s .:�t. NORTH ANDOVIM, MASS. oiY•I5 APP TeATION I'0A WRLL AjjjZ p81= Permit t Date /-•- 7 - �_GC.LJ A perait is requested tot dtill a well�; install a Pump,.,„ ,--., took Ano ssAQ- owner Address11�44 Tel!Ezg well ContratriAi"&tmia-% &jc11 4opW•&.I ece-It Tel 2 X f 9.2- PUMP I(w►IM co ,Ad4 T41 �f iilawii►1,iwdr#r►ir►ar+s .! «a #w t iAi i • i wlrww #iaaaa#a*#dada• #www WZWJ ATo be COMPleted at time of puelp test-) Type of vell,- JeldZ Mb& \1-r Diameter of Moll. - 4- _ _ - Size at casing, c�_ _ Depth of bed rock 22 Depth casing into bedre�C)C . d / Seal been tested? Yea (r) No ( 1 DAte CC test. Depth or well ,j! water beating rocic Mcd &44 Depth to voter 4 Delivers GPU for ]ttQ+r 16n4 Draw t im_... feet atter punspinq. ours at GPK Data Of- Caapletlan.L �CLQ - awll contractor afaa#ata#a###iiAt#ar###w•#irw##t#�*#At *+ra#aaa#taa�►taaasstsar,r�f+ta+rt PUM (To be filled in before ifMtft11ati0n-) Hews i mine of size ..Of ta" , -1 vt, a —Vllp del ivere -- GPM pipe used in well: Cast iron (,_,.) Galvanized (._.) Dieevs us" to protect pipet Yes (� 110Type Mel l seal Date G ..c) 8i ase of p ata sr ##•A�Ait•t#•NI*•s+lfltlftlAAA#*aisrAAa##'I►iRi*ssassi##Aiaiasswwswtaa�R#sis Date nater analysis report wuboitted to hoard of Health Ylt> r x ring repaator osr o s 01/28/2000 01`:48 FAX 9783528434 VIERA WELL CO. p r vert �� A. `. •^ i s by '4 IDepartment of Environmental ManagementIDIvision of Water Resources r a WELL COMPLETION REPORT 1 � WELL LOCATION GEOGRAPHIC DESCRIPTION Address 4fA7_JS► �N 1/10 N W of INN/ (EirCMJ .. Cily/Town fJ K�i0I1� Well owner Address 2Tl/y _� S E W of /M.M i!^NN (02k) I Board of Health permlt obtained: yes® no❑ '^wed• f WELL USE WELL DATA 0 g. i Domestic IM Public ElIndustrial❑ Total well depth POeIt. Monitoring❑ Other_ Depth to bedrock ft. Waler-bearing rocWunoonsolidated material: t �f Method drilled fQ 1✓ Description #k4d eE� i i I Date drilled 2 6 'yC Water-bearing zonas: momC�O To 63':� I CASINO From tj ��t Type•AUL �� 2j From WO To It.Length y . Di O a(1.0.) 6 in. 3)From To i � a Length into bedrock, It. Gravel pack well. dia. Protective well seal: Screen: afoul ❑ Other Slot# length from to STATIC WATER LEVEL(all wells) •'• Static water levet below ISM surface c v ft. Date •'I; I WELL TEST(production welts) Drawdown ..�a�R_it- cher pumping hr, at min. ppm How medsvmd Recove tx. min. A111Z ry/O4�- R. after { I LOO C4 FORMATIONS COMMENTS Material6 From To I UKI I V O Driller { Firm 6 :<I Address —� S% Cfty/Town i✓ I� S isl ril r g.e ddMM 1i r 't0"" DRILLER COPY 1; j.•1-1 -07-00 11 :08 North Andover Com. Dev. 508 688 9542 P.02 1j • Pct 5 '."-' ,•'t<<' BOARD OF HEALTH 7 NORTH ANDOVER, MASS APPLICATION FOR WELL AND PUMP PERMIT Date /-- 2 - 2 A permit is requested to: drill a well ,"" ; install a pump_ v/?. LOCATION:LCA- n , II V\/L4 S4 t-+�v Lot '# �� Ar Owner Address_ k"7[ 1::F tA-:2f— Tel 5 5f (��s2 2 3 Z Well ContrctrViiyvA AyI;-;,w n Qe Ij rn,,Add.aTel 's--3 , Pump ContrctrWiIvY1jvto,�.o ajAQ�tffLldd.�54 b'bV� Telf7� WELLS (To be completed at time of pump test.) Type of well 1 `o+". .u( use Diameter of well (�Q - Size of casing Depth of bed rock Depth casing into bedrock ,coal been tested? Yes (_) No (�) Date of test D-pth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation. ) Name & size of pump Type size of tank Pump delivers GPM Pipe used in well: Cast iron ( ) Galvanized (r) Plastic (�) Sleeve used to protect pipe? Yes (!) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health JAN 1 0 1-06-200 5:31PM FROM P_ 2 • I r `VETLAND / rr F'ag932. / r / Lot R Area=50,200s.I. .��� irlagf3t ' ori. 1 I. Prop% WETLAND Wo 11. its s . C2 mrch pis 1 nvp. t rr � a' f . •w j g. _ I / C ",cc 01"' RW27 esJ yw�, ftagl�7� olJJe! � FI 94 .� 1 1 1 t rte. , 4 v 4^p ,\ + 1 Flag*15 16 Vt r , 1 ', �� , ,t �t '� � 'j� '1 � •�~• • C1iSM17 r4pfM8 rne, 1.. r BE t��h a t ZM1.� s 1 Bt `� ` �Flagr22 './-r►agrls ,�t \\` `l A �. �FIV020 8 tt. �\ , J� 'QQr. , \/ F's RgaZt 'Ol y ✓ ,», k lee Jan-07-00 11 :08 North Andover Cam. Dev. 508 688 9542 P.01 N.Andover Health Department 27 Charles Street • North Andover,MA 01845 (978)688-9540 fax(978)688-9542 facsirde tntmmitW To: Tom, Wilmington Well&Pump Fax: 978 658-3557 From: Susan Ford,Health Inspector , Date: 01/07/00 Re: 10 Duncan Drive j Pages: 2 CC: E3 Urgent X For Review ❑Please Ctxnment 0 Please Reply ❑Please Recycle Tom, I am fum"b*you the application as we discussed on the phone. I researched the file and it appears that there may be a slight change in the location of the well to meet all the setbacks. The change should not be more that 10 or 20 feet: The Consawafion and Health Depelhnents will work this art. We will discuss location when you puff the pe►mit,so there is no need to submit a plot plan with your aoication, You can pickup a copy of the local regulations at that time also. Please call me if you have any questions. Thank you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Town of North Andover NORTN OFFICE OF 3?0 y t ,BOOL COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street :^o North Andover, Massachusetts 018454 "o «�y WILLIAM J. SCOTT 4SSAcHUS�� Director (978)688-9531 Fax (978)688-9542 February 23, 1999 Joseph Serwatka 31 Kendrick Street Lawrence, MA 01841 RE: 10 Duncan Drive Dear Mr. Serwatka: This is to inform you that the proposed septic plan for Lot 10 Duncan Drive, dated February 2, 1999,has been approved for installation for a dwelling with a maximum of nine rooms. Please feel free to call the office should you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator Cc: J. Garon File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 : Town of North Andover, Massachusetts Form No.2 f 000t7h BOARD OF HEALTH E�3. `t�, L f w DESIGN APPROVAL FOR ;. �SS"C"°5SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 11 Test No. Site Location J Reference Plans and Specs. Z Z 1q INEER DESIGN DAT Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee /-!�-5 Site System Permit No.�Q � _ L -- i j �- i C �. OD -14 fD � � ' -•---tom _ _ � -Z4 _ Ln r - Lrl FWW/ l O 0 N a • a FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 I it AN OF FORTH A I,'DOV`-:,V RCI^RD OF HEALTH No. DEC 2 i998 Date: Commonwealth of Massachusetts 1j,o. ,4A)pa v,52 , Massachusetts Soil Suitability Assessment,for On-site Sewage Disposal Performed By: U-0 56-j9W . ... 36- e NAT7". Date: q"/� ' Witnessed By: po IT.... /Uc�r • ..... ..... ................... . . L=oan Address or 1 o P o NGA /--1 -PP—- o—rs N—. IC4TµL FE N -3-o s s P o GA teorJ ,a. Tc ,,° New Construction ® Repair P560-Z Office Review Published Soil Survey Available: No ❑ Yes Year Published �R� . . . Publication Scale j '1rCF416 Soil Map Unit y . Drainage Class , . Soil Limitations ..............�.................. Surficial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) .................................................................................................................I................. Landform ...................................................................................................................................................................................... _._... . . Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ....................................... Wetlands Conservancy Program Map (map unit) .................................. .............................................................. Current Water Resource Conditions(USGS): Month . .... . Range :Above Normal ❑Normal 2Below Normal ❑ Other References Reviewed: ki DEF APPROVED FORM-12/Q7/9S e FORM 11 - SOIL EVALUATOR FORM ` Page 2 of 3 Location Address or Lot No. )Q w tje,,}. A 12r . On-site Review Deep Hole Number 7 Date: 13-75—q? Time: Weather f0 r'✓o5 v n,�v �/ Location (identify on site plan) Land Use V) 00 Q S Slope (961 1�r Surface Stones Vegetation Landform p vTrvr�l S F-t Position on landscape (sketch on the back) Distances from: Open Water Body 7 ID 0 feet Drainage way -,-*o feet Possible Wet Area 7 roa feet Property Line Zd-r feet Drinking Water Well >roo feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling .Structure,Stones,Boulders,Consistency, % G(avel) 5,1 MINIMUM OF 2 HOLES REQUIRED—Al EVERY PROPOSED DISPOSALMEA M • v,4-N D Parent Material(geologicl _ F> 2 TW A-5 tf Depdvz8edrock:_ 7 j 0 Z, Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water. • i DEP APPROVED FORM-1210719S FOR%I 11 - SOIL EVALUATOR FOR.NI Page 2 of 3 Location Address or Lot No. _ j Oy Gam- DP_ , Oil-site Review Deep Hole Number 7- ?— Date: 9-1 q—qS_ Time: q 4 .61 Weather �o�� 5 u N N Location (identify on site plan) _ Land Use LV 06 05 Slope Surface Stones Vegetation -7- C-e-e Landform O(7T Position on landscape (sketch on the back) Distances from: Open Water Body 7/Q0 feet Drainage way7`v0 feet Possible Wet Area tad feet Property Line 3o f feet Drinking Water Well7 feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDAI (Munsell) Mottling .Structure,Stones,Boulders,Consistency, % Gravel) a -- �' �-P �✓L ►oy,�412 Z 5;Y414 Parent Material(geologicl Depftosadrock• 7�d Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP kPFROVED Font-1210717s F FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 044 0 PK- Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole.. inches ❑ Depth weeping from side of observation hole inches Pnepth to soil mottles+;/4-7 inches ❑ Ground water adjustment ................. feet Index Well Number .. .. ... .. Reading Date ................. Index well level ... .. Adjustment factor .... ....... Adjusted ground water level .. ............................. ...... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all ar as observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on f) gq_ (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date ��'' DFP APPROVED FORM-12107l9S FORM 12 - PERCOLATION TEST Location Address or Lot No. DV COMMONWEALTH OF MASSACHUSETTS 10PoV8-Massachusetts Percolation Test` Date: Time: `T 4 Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch z2 � Z ` Minimum of 1 percolation test- must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ .. ..... .............. Performed By: t-1 Witnessed By: Comments: AFP APPROVED FOR-,.I• 12/07/95 List of Innovative / Alternative Systems October 30, 1995 ELJEN IN-DRAIN SYSTEM Eljen Corporation, 15 Westwood Road,n CT 062 8� Tel . (203) 429-9486 g'a, l'4 Ca j -� �Zo Description: alternative leach field without stone The Eljen leaching system consists of In-Drain, each constructed of recycled cuspated plastic core, both large and small, and a high grade non-woven biofabric. The biofabric is continuous and wrapped over and under each piece of plastic core . Each In-Drain unit is banded using high strength plastic strapping to a final dimension, 31Wx411Lx711H. In-Drain units are placed on top of 6" of concrete sand end to end and the distribution pipe is placed directly on top of the units . The system is then covered with a geotextile fabric . It is intended to be used as a leaching system without the stone instead of a conventional soil absorption system. Status: The Eljen Leaching System Type B module has been Certified for *General Use. When used in a trench configuration, the system provides -an effective leaching area of 6 . 2 square feet per linear foot . Approval Process : 1 . Where a conventional Title 5 system can be installed on the property: Disposal System Construction Permit from the local approving authority. No application to DEP required, unless variances to Title 5 are needed in which case apply to the regional office of DEP using form BRP WP 59b. 2 . In areas subject to the nitrogen limitations of Title 5 : Loading on the lot cannot exceed 440 gallons per day per acre . If used with a nitrogen reducing technology, the nitrogen credit and the approval process for that technology apply. Disposal System Construction Permit from the local approving authority. 3 . Remedial situations : Disposal System Construction Permit from the local approving authority. If within the authority of Local Upgrade Approval, no application to DEP isrequired. If DEP variances are needed, apply to -the Regional Office of DEP using application form BRP WP 59b. SEPTIC PLAN SUBMITTAL FORM LOCATION: Ui /L NEW PLANS: YES $125.00/Plan 1/` rc, RWVI €3/ REVISED PLANS: - YES $ 60.00/Plan --�" SITE EVALUATION FORMS INCLUDED: CYES Np DATE: 4a- DESIGN ENGINEER S � DATE TO CONSULTANT.- --J� ktAq *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. ' e• List of Innovative / Alternative Systems October 30, 2995 Gr�LNy4.G'L ELJEN IN-DRAIN SYSTEM Eljen Corporation, 15 Westwood Road, CT 062 8� Tel . (203) 429-9486 /f� � Description: alternative leach field without stone The Eljen leaching system consists of In-Drain, each constructed of recycled cuspated plastic core, both large and small, and a high grade non-woven biofabric. The biofabric is continuous and wrapped over and under each piece of plastic core. Each In-Drain unit is banded using high strength plastic strapping to a final dimension, 3 'Wx4"Lx7"H. In-Drain units are placed on top of 6" of concrete sand end to end and the distribution pipe is placed directly on top of the units . The system is then covered with a geotextile fabric. It is intended to be used as a leaching system without the stone instead of a conventional soil absorption system. Status: The Eljen Leaching System Type B module has been Certified for *General Use. When used in a trench configuration, the system provides -an effective leaching area bf 6 . 2 square feet per linear foot . Approval Process: 1 . Where a conventional Title 5 system can be installed on the property: Disposal System Construction Permit from the local approving authority. No application to DEP required, unless variances to Title 5 are needed in which case apply to the regional office of DEP using form BRP WP 59b. 2 . In areas subject to the nitrogen limitations of Title 5 : Loading on the lot cannot exceed 440 gallons per day per acre . If used with a nitrogen reducing technology, the nitrogen credit and the approval process for that technology apply. Disposal System Construction Permit from the local approving authority. 3 . Remedial situations : Disposal System Construction Permit from the local approving authority. If within the authority of Local Upgrade Approval, no application to DEP is ,required. If DEP variances are needed, apply to -the Regional Office of DEP using application form BRP WP 59b. Page: 10 SEPTIC PLAN SUBMITTAL FORM LOCATION: /d NEW PLANS: YESD $125.00/Plan REVISED PLANS: YES $ 60.00/Plan . 0 2 Ma SITE EVALUATION FORMS INCLUDED: YES NO R DATE: DESIGN ENGINEER: DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. SCOTT L. GILES, R.P.L.S. 50 Deer Meadow Road North Andover, MA 01845 ,.� 683-2645 To: The Town of North Andover August 17, 1998 Board of Health From: Kathleen &Joseph Garon 18 Woodberry Lane North Andover, Ma 01845 (978) 681-8582 To whom it may concern, Being the owner of 10 Duncan Drive also known as Assessors Map 105C Parcel 40 (lotA) at the Northeast corner of Boxford St. North Andover, MA on plan#8525 at the North Essex Registry of Deeds and shown on plan submitted for soil testing as Lot A. I hereby authorize Frank S. Giles and nominee with Joseph Serwatka as the Soil Evaluator to draft and file any and all documents with the town of North Andover including; but not limited to the Soil Evaluators Application, relative to said matter. Contact for dates of testing: Joseph Serwatka, P.E. or Frank S. Giles 31 Kendrick St. 50 Deermeadow Rd. Lawrence, MA 01841 North Andover, MA 01845 (978) 693-6595 (978) 683-2645 Thank You; Sincerly, BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 8/17/98 N.E. corner @Boxford St. LOCATION OF SOIL TESTS: #10 Duncan Dr. North Andover, MA Assessor's map & parcel number: Map 106C Parcel 40 OWNER: Kathleen Garon TEL. NO.: (978)681-8582 ADDRESS: 15 Woodberry Ln. N.Andover, MA ENGINEER: Joseph Serwatka, P.E. TEL. NO.: (978) 683-6595 CERTIFIED SOIL EVALUATOR: Joseph Serwatka, P.E. Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. _e t SCOTT L. GILFS, R.RL.S. 50 Deer Meadow Road c North.Andover, MAO 184 5 683-2645 t - To: The Town of North Andover August 17, 1998 Board of Health From: Kathleen & Joseph Garon 18 Woodberry Lane North Andover, Ma 01845 (978) 681-8582 To whom it may concern, Being the owner of 10 Duncan Drive also known as Assessors Map 105C Parcel 40 (lotA) at the Northeast corner of Boxford St. North Andover, MA on plan#8525 at the North Essex Registry of Deeds and shown on plan submitted for soil testing as Lot A. I hereby authorize Frank S. Giles and nominee with Joseph Serwatka as the Soil Evaluator to draft and file any and all documents with the town of North Andover including; but not limited to the Soil Evaluators Application, relative to said matter. Contact for dates of testing: Joseph Serwatka, P.E. or Frank S. Giles 31 Kendrick St. 50 Deermeadow Rd. Lawrence, MA 01841 North Andover, MA 01845 (978) 693-6595 (978) 683-2645 Thank You; ; Sincedy, C%`/t l�� Ds Co 7 f,1 tl-V7� Orlia t �,y r��;{ `�4,�� V' — ��'{F �.�., J i � �j{+�' $ ,F `'.'�� .r•f+t� ����.'r'^ -�..� ' ���I�, .._mow t.K 4r/ -31 IN V1 F3- wd Ve I 4no Ilk kit 0 Sig IL C k3: 44 4 01$4 A- NY kN I A Copyright(C)1997,Maptech,Inc.