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Miscellaneous - 7 OLYMPIC LANE 4/30/2018
7 OLYMPIC LANE 210/106.6-0144-0000.0 r U 0 e. +s \ A. i 1 1 EL-F-VA-r I at, Y illy PIPE OUT OF NSE tfJ V D�j NTD-r4jILL -- 0T0-F LQ&U 16):5, 5 u R 1lO2.E.._NO D.Pox k - ----------- -- --------_ -_ -_---- -- f UMA vhPro e2i TD WY, ;".4L '��. -� � �..�•{ SGA,t_E i _ ,� � J � IFQANK C E- 4 A'�5cX:1[�.TEcj Nc- 1r.4E- t Arzc.a t i7 tic-r-S f � I l i t t i j , 1 f f� I { { x r , i e t 4 i y 1�1 SUMMARY OF INVERTS BUILDING TIES SEWER @ FDTN. PRE-EXIST BLDG. CORNER A B C D �I • THIS PLAN & CERTIFICATION Is NOT SEPTIC TANK IN 103.67 SEPTIC TANK OUT 17.0 41.5 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 103.44 DIST. BOX 33.5 45.5 - - SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 103.28 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 103.11 COMPONENTS. INV. IN CHAMBER 103.07 BOTT, CHAMBER 102.83 "1 HEREBY 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." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE VENT ZN OF h9 AS 1 O� VLADIMIR L. yG NEMCHENOK vs �, y A ,G Q INSPECTION PORT \ NAL T_ EN Ty 9 c � H L °EIEC "x50'=7 0 F.) D-BO)C \rX f 1500 GAL. SEPTIC TANK A 9� 0cmr, t i PORCH y 5 EXIST. 4 BORK , DWELL, (#7 EXIST.£ T F.g112.Q- FIT. GO�.G. DRIVE -� LOT 391 (43,711 S.F.) 'll 126.64' - i AS BUILT P OF SUBSURFACE DISPOSAL SYSTEM x LOCATED IN z NORTH ANDOVER, MASS./7 OLYMPIC LANE t' AS PREPARED FOR ;. U SALL MUCICA TM: 106B 7-1-14 TL: 144 7i: LNa SCALE: 1"=20' 0 10 ,20 40 2 2014 TOWN OF NORTH ANDOVER MERRIMACK ENGINEERING SERVICES HEALTH DEPARTMENT 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 t SUMMARY OF INVERTS BUILDING TIES ; SEWER 0 FDTN. PRE-EXIST BLDG. CORNER A I B C D NO THIS PLAN & CERTIFICATION IS NOT r SEPTIC TANK IN 103.67 SEPTIC TANK OUT 17.0 41.5 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 103.44 DIST. BOX 33.5 45.5 - - SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 103.28 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 103.11 COMPONENTS. INV. IN CHAMBER 103.07 BOTT. CHAMBER 102.83 "1 HEREBY 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." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE VENT ZOF N h3q�3�c. p� VLADIMIR L. yG NEMCHENOK Z s. . INSPECTION �FS�IONAL PORT W Lp LEACH FIELD (15'x50'=750 S.F.) D-BOX' 1500 GAL. n SEPTIC TANK DEM PDQ .. . *B.M. I EMST. 4 BDRM. yyryry``..pp// I) .. 07 EXIST. SIT. Ci lllc. � T.F-192.0- LOT 39 (43,711 S.F.) t J�' r vJ' r' /f 126.64" - - OL Kmpi cLANE AS BUILT PLAN � OF 0 SUBSURFACE DISPOSAL SYSTEM LOCATED ITS z NORTH ANDOVER, MASS./7 OLYMPIC LANE I. AS PREPARED FOR SALL MUCICA 7-1-14 TM: 1066 - TL: 144 SCALE: I"=20' 0 10 20 40 E AUG 12 2014 TOWN HEALOTH DEPAR ENT R f' RRIMACK ENGINEERING SERVICES - 66 PARK STREET W-0 ANDOVER, MASSACHUSETTS 01810 Commonwealth of Massachusetts Title 5 Official Inspection Form RECEIVED Subsurface Sewage Disposal System Form-Not for Voluntary Assessments APP 2 8 2014 ` 7 01 m is Lane Property Address TOWN OF NORTH ANDOVER Sall Mucica HEALTH DEPART NT Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 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. W ling out Whhenenfilling A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 Citylrown State Zip Code 978-475-4786 S115 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 ❑ Neepp Further Evaluation by the Local Approving Authority 4/22/2014 Inspector's SignatdW Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ***"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 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 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Citylrown 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: ❑ 1 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every 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): ❑ I 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owners Name information is required for North Andover MA 01845 4/24/2014 every page. Citylrown 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 bn overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran-Not for Voluntary Assessments r 7 Olympic Lane Property Address Sally Mucica Owner owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Cityrrown 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- 10,600gpd. ® ❑ 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Citylrown 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Yes Detail: 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owners Name information is required for North Andover MA 01845 4/24/2014 every page. Cityrrown 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: Pumped 1995, owner 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•3/13 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 v.Vr� 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 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: 34 years old, 1/2/1980, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.4 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4"Cast Iron through floor 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: .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: Tx 5'x 4' Sludge depth: 4" t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .�' 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Cityrrown 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 29„ Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Inlet baffle ok. Outlet tee corroded. Outlet tee not used, pipe exist side of tank. Outlet baffle corroded. Depth of liquid at outlet invert.No evidence of leakage. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Citylrown 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 MW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 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.): D-box level &distribution equal. Evidence of carryover. Evidence of leakage, box has corrosion at liquid 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.): * 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts q.-uVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Camera inside of pits, Pit#1 full of liquid 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 a. Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ° 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately warms k-ouSe- n ! I �c1n e� I P I rD 13 �11 C_ (, f t t5ins•3/13 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 M 7 Olympic Lane Property Address Sally Mucica Owner Owners Name information is required for North Andover MA 01845 4/24/2014 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: 4 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: 7/13/1978 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan. Deep hole shows water @ 7' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 7 Olympic Lane Property Address Sally Mucica Owner Owner's Name information is required for North Andover MA 01845 4/24/2014 every page. City1rown 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 Summary Record Card generated on 4/15/2014 2:09:16 PM by Maureen McAuley Page 1 Town of North Andover Tax Map # 210-106.B-0144-0000.0 Parcel Id 17548 7 OLYMPIC LANE MUCICA, GARY 7 OLYMPIC LANE N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2014 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until MUCICA,GARY Payor 7 OLYMPIC LANE N.ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17498.0-7 OLYMPIC LANE Last Billing Date 4/2/2014 3170168 03 Cycle 03 Active UB Services Maint. Account No. 3170168 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 30.40 /1 UB Meter Maintenance Account No. 3170168 Serial No Status Location Brand Type Size YTD Cons 40661680 a Active ERT HH RT b Badger w Water 0.63 0.63 70 Date Reading Code Consumption Posted Date Variance 3/12/2014 74 a Actual 8 4/11/2014 -1% 12/10/2013 66 aActual 8 1/17/2014 0% 9/10/2013 58 a Actual 8 10/15/2013 32% 6/11/2013 50 aActual 6 7/24/2013 -39% 3/13/2013 44 a Actual 10 4/22/2013 61% 12/11/2012 34 aActual 6 1/9/2013 -51% 9/13/2012 28 a Actual 13 10/15/2012 14% 6/11/2012 15 a Actual 11 7/16/2012 21% 3/12/2012 4 a Actual 4 4/14/2012 0% 2/1/2012 0 n New Meter 0 4/14/2012 0% 12/13/2011 1864 m Manual estimate 20 1/17/2012 -79% 9/13/2011 1844 m Manual estimate 100 10/13/2011 92% MSG 6/8/2011 1744 m Manual estimate 50 7/20/2011 137% MSG 3/7/2011 1694 m Manual estimate 20 4/13/2011 2% 12/9/2010 1674 m Manual estimate 20 1/12/2011 41% MSG 9/10/2010 1654 m Manual estimate 15 10/15/2010 -25% MSG 6/7/2010 1639 m Manual estimate 15 7/15/2010 26% 3/10/2010 1624 m Manual estimate 12 4/14/2010 1% 12/10/2009 1612 a Actual 12 1/12/2010 3% 9/10/2009 1600 m Manual estimate 12 10/15/2009 12% MSG ACTUAL SAYS 600. 6/8/2009 1588 a Actual 10 7/20/2009 -15% 3/12/2009 1578 a Actual 13 4/29/2009 17% 12/5/2008 1565 a Actual 10 1/20/2009 -15% 9/9/2008 1555 a Actual 13 10/10/2008 -2% Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Tuesday,June 03, 2014 3:37 PM To: Sawyer, Susan; Blackburn, Lisa Cc: 'Pam Lally'; 'Isaac Rowe' Subject: 7 Olympic Lane Attachments: 7 Olympic Lane - disapproval letter 6-4-14.doc Susan/Lisa, Attached is the disapproval letter for the above referenced property. Generally minor edits needed. LUA also needs to be requested with the Form 9A submitted. The leach field is over designed again but I did not make this an item in the letter. However, it is sized for a 5 bedroom even though the house is a 4 bedroom. Designers generally do not over design a leach field by this much unless there is another reason. Let me know if you want to review further. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(-c)-millriverconsultin.g.com www.millriverconsulting.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:hftp://www.sec.state.ma.us/Pre/preidx.htm. Please consider the environment before printing this email. 1 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ...... 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540-Phone Susan Y.Sawyer,REHS/RS 978.688.8476-FAX Public Health Director E-MAIL:healthdept(a�,townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: Gl-'0-1' 14' Site Location: -7 ( `(1--1 Plc LI OJI. Engineer: HET2JW 6jD61 L2CW j bA New Plans? Yes✓ $225/Plan Check# J � (includes I' submission and one re- review only) Revised Plans?Yes $75/Plan Check## Site Evaluation Forms Included? Yes V No Local Upgrade Form Included? , Yes No Telephone#(!!I-V qjS 3S55_ E-mail: it r2,L4 r` X?r p GoK4 )Uc—f— Homeowner Name: 'JQ GGdf OFFICE USE ONLY When the submission is complete(including check): RECEIVE® ➢ ✓ Date stamp plans and letter );0. _Complete and attach Receipt MAY L 3 2014 °jQSfiINUF NORTH ANDOVER ➢ —LCopy File; Forward to Consultant !'11zAR11i DEPARTMENT ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal RECEI!/E A. Facility Information MAY 2 a 2014 Owner Name QWE'ALT0WOF NORTH ANDOVER -7 otY �- 9�j DEPARTM Qom / Street Address Map/Lot# Cit 00�,, � �- HA a► Y State Zip Code B. Site Information 1. (Check one) ❑ New Construction pgrade ❑ Repair 2. Published Soil Survey Available? Yes El No If yes: ®cG I ZD)?j Year Published Publics ion Scale Soil Map Unit R I Ry Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? VYes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unitame 6. Current Water Resource Conditions(USGS): M ntn Range: El AboveNormal Normal El Below Normal 7. Other references reviewed: Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts lCityffown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: ( 5-14-14 1 l,ll xi oV Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): 2. Land Use Q-e--71 I?�7'rl �-� (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Low L) �I✓ Vegetation Landform Position on'L.anndscape(attach sheet) 3. Distances from: Open Water Body feet Drainage Way ?e� Possible Wet Area �et I Property Line f i� Drinking Water Well Other feet 4. Parent Material: Unsuitable Materials Present: ❑ Yes �Io If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: es ❑ No If yes: 9-71 1101, Depth Weeping from Pit Depth Standing Water in Hole �o ►r Estimated Depth to High Groundwater: 72,??inches elevation Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 IX Commonwealth of Massachusetts City/Town of r Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence Other y ) Depth Color Percent ) Gravel Cobbles 8 (Moist) Stones 0( tot rzoowa 27il2o G 2 , x`(5/3 �0 7 (, G7s% Sal►x� >15% !d-!S/e Si►. l.a I i Additional Notes: Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of s Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole: Z Location (identify on plan): h I t"�L h) 2. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) LA tit 0 TCI'-IIEIV� r�0 '7'e►cn.C:;;6 Vegetation Landform Position on Landscape(attach sheet) e l e 3. Distances from: Open Water Body feet Drainage Way eiA Possible Wet Area feet 71 Property Line *z_;t7 Drinking Water Well 7��1 Otherfeet feet { 4. Parent Material: '�" Unsuitable Materials Present: ❑ Yes to If Yes: ❑ Disturbed Soil ❑ FUI Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: [/Yes ❑ No If yes: I b e1 o-7 Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: e 7e 7i inches elevation I Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts Cityfrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T_Z, Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Munsell Consistence Other Moist Layer Y (Munsell) (USDA) Cobbles 8 Structure Depth Color Percent Gravel Stones (Moist) 3.) G� 7- Imo'° r:� IOYe44, _ 47,L. 715/, e e r �i�-`t�(so G rl•G� , 5 r�s��a• I.Ebs� Z G 2,5Y*7i t Additional Notes: Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts .UluCity/Town 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 ElDe h weeping from side of observation hole A. B. inches inches Depth to soil redoximorphic features (mottles) A. O° B' e inches inches ❑ Groundwater 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,! st four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil abso on system? _ 7Yes ❑ No Z b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: inches Soil Evaluation Forms.doc•rev. 1110 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal P` 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 EvVruafor Date Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam 5 ZD l&.l G 0 HI L.L" t Vey., Cary V KP INI::VY � Name of Board of Health Witne s Board of Health i 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. i i I Soil Evaluation Forms.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 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: When filling out A. Site Information forms on the computer,use 66i LA, `I' Lj Gt e-A only the tab key Owner Name to move your cursor- not use the return Street Address or Lot# key. I A Citylrown State L Zip Code VQ Contact Person(if different from Owner) I phone Number B. Test Results `5 - t�-- l Date Time Date Time Observation Hole# Depth of Perc .�.r Start Pre-Soak ( d Iota End Pre-Soak Time at 12" 74 CVS U-5�ib Time at 9" Time at 6" Time(9"-6") Rate(Min./Inch) Test Passed: Test Passed: ❑ Test Failed: Test Failed: ❑ Test Performed By. Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 ,I TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ' 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,REHS,RS 978.688.9540-Phone r:-)r �� Public Health Director 978.688.8476-FAX 1'x!6 EID healthde t townofnorth dover om www.townofnorthandover.com APR 2 61 01 A APPLICATION FOR SOIL TESTS TOWN OF NDRTH ANDOVER HEALTH DEPARTMENT DATE: �J- Z rj - MAP&PARCEL: LOCATION OF SOIL TESTS: 7OL�jce OWNER: .L�.(� }/��r} �,9t Contact#: APPLICANT: Contact#: ADDRESS: :7OLY- Id1'n 1G &� k 10,A0PaAQ?-- ENGINEER: � K=J�/����/� Contact CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision (!��me Commercial Is This: Repair Testing: vlenUndeveloped 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 II"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 1"-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. `N Signature of Conservation Agent. Date back to Health Department: (stamp in): P f } � t5 it f y qq P th ELE�/AT E-,) U! L..-T j.Al J Aj7SLP - �2AN1C C r EL-111 t— ASStK.rn.TES :�NC'aiNE.E 2S� L�C?L:4-tIT1=GTS:. �-p -- i ' J J 7L �t (. l n !it. I NORTF/ BUILDING PERMIT °����E° ;6 quo TOWN OF NORTH ANDOVER 0 - - . APPLICATION FOR PLAN EXAMINATION _ F no i ee � Permit No#: Date Received ��SSAc►+us���� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 1 D��I'►'1f�� LA ri C N Pnn# PROPERTY OWNER I IS��- f S� �� 6e r f Print f00 Year,Structure yes no MAP PARCEL: ZONING DISTRICT:- Historic District yes no ._ Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ' ❑ Demolition ❑ Other _ Septic El Well, 11Floodpiain [I Wetlands D Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED:P16U 41 I n cLboW, a 6 U 11d 9 / rcl Gy- C`✓U--1 aYLL Jdentification- Please Type or Print Clearly OWNER: Name: W660_' - - rle -- Phone: 1, r7V Address: Contractor Name: . _ _ Phone:. - - - Email: _ l Address:.[' S_` U isor's Construction License: _ _ Exp.� Date: Home Improvement License: _ Exp. Date:' ' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on i Si nature COMMENTS k.)("" HEALTH Reviewed on 4 o? Signature L COMMENTS I ' J Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water &Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street _FeIREDEPARTMENT Temp!®u_mpsteron site yes_ _ e__ _nos ___ tLocated at 124 Main Street Fire Depari:ine:nt signature/date..-__ ._. . - -- - -- � S�gTL'ED j6q�' • IL COPY PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 8/13/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Todd Bateson At: 7 Olympic Lane Map 106B Lot 144 North Andover, MA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Su a Sawy •4ublic Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com pORr#1 to SS44: PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER _ SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION �� The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired; AUG 12 2014 By: -rct7D (Print Name) t TOWN OF NORTH ANDOVE;I. R MZt:ALTH DEPARTt_X.Errf Located at: �7 f7 L��� i!/ (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated i / ((0— 14 and last revised on 4�-1&' 14 ,with a design flow of 440 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. Bottom of Bed Inspection Date: 4 V Engineer Representative(Signature) And—Print Name Final Construction Inspection Date:--17--1-14 Engineer Representative(Signature) And—Print Name Installer: ignature) Date: 7-1-4 �``� And—Print Name Enginer:JI�q tkl01"/ _(Signature) Date: '7--7--14 LA 12'k ki f tf�, l.l Co JA i5j 01 r- And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com • 5�,z�r�n'a�' • • North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 7 Olympic MAP: 106B LOT: 144 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering PLAN DATE: 5/16/2014, Rev 6/16/14 BOH APPROVAL DATE ON PLAN: 6/17/14 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 6/30/14 DATE OF FINAL CONSTRUCTION INSPECTI N: 7/2/14 DATE OF FINAL GRADE INSPECTION: 'I�aIL 1 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 NA Cleanouts per plan ® Bottom of tank hole has 6" stone base ® Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction X Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box NA Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan (stone) NA 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 NA Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: House to corner 37' of bed bottom over dig length 62"x27", FINAL GRADE rLoamed Seeded Cover per plan Comments: k C DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by /Engineer and installer ❑ As-Built Plan BM = 108.00 HR = 2.72 HI = 110.72 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 104.0 Septic Tank IN 6.72 103.65 103.65 Septic Tank OUT 6.94 103.43 103.40 Distribution Box IN 7.09 103.26 103.25 Distribution Box OUT 7.26 103.11 103.08 Lateral 1 TOP 7.30 / 7.55 Lateral 1 INVERT 103.07 / 102.82 103.05 / 102.80 Lateral 2 TOP 7.30 / 7.55 Lateral 2 INVERT 103.07 / 102.82 103.05 / 102.80 Lateral 3 TOP 7.30 / 7.52 Lateral 3 INVERT 103.07 / 102.85 103.05 / 102.80 Bottom of Bed 102.32 102.30 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 1001 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 i I -Block-Lot ap iial Commonwealth of Massachusetts MapB0144 --------- BOARD OF HEALTH Permit No North Andover BHP-2014-0628 PA. FEE F.I. $225.00 t ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-B-ateson --------------------------------------------------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No -7--OLYMPIC-LANE as shown on the application for Disposal Works Construction Permit No. BHP-2014-062 Dated June 18,2014 ----------------------------------------------------------------- Issued On:Jun-19-2014 _ BOARD OF HEALTH Application for Septic Disposal System Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $25 00-comp Repair Important: Application is hereby made for a permit to: RECEIVEU When filling out ❑ Construct a new on-site sewage disposal system* forms on the � computer,use 2-1repair or replace an existing onsite sewage disposal system* MAY L 9 2014 only the tab key to move your ElRepair or replace an existing system component—What? cursor-do not TOWN OF NORTH ANDOVER use the return A. Facility InformationJ� / HEALTH DEPARTMENT { key. ©l-vm Address or Lot# tab Cityffown 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump 2 Gravity(choose one) ***If pumps tem, 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) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ [P-Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? < (no further info. needed) NO=(installer must specify brand of filter before DWC issuance) What is the Make? "at is the Model. 2. Owner Information �A //V Name Address(if different from above) ,,,, ((�� 4y AA, A-S- � L,+' 4%91�'yS Citylrown State Zip Code Telephone Number 3. Installer Information Name Name of ComPOWESON ENTERPRISES,INC. 111 ARGILLA ROAD Address t ANDOVER,MA 01810 J City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer 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 4 Application for Septic Disposal Svstem 'S Construction Permit - TOWN OF TODAYDATE NORTH ANDOVER, MA 01845 $250.00-Full Repair $125.00-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: esidential Dwelling or❑ m Comercial 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. I understand that until a final Certificate of Compliance has been issued by this Board of alth, the installed system is not approved. Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: _.-..... �.�`.._.,._.._._...�.. _�,_._,��.�._ �..._....� L Fee Attached? Yes No 2. Project Manager Obligation Form Attached. Yes v-, No 3. Pump Svstem? Ifso,Attach copv ofElectrrcal Permit Yes No 4. Reviewed approvalletter, all paperwork received. Yes No Missing: 5. Foundation As-Bunt?(new construction only): Yes No (Same scale as approved plan) 6. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEP'PIC'SY.STEM.•INSTALhEK'PROJECT MANAGEMENT OBLIGATIONS As ihe•North Andovtr•licensed installer for the construction for:the septic systet a'.1 .the property at: 17 49 'G For p'lsna by (Addresd of septic sys (Engineer) Relative to the.applicatioa A>tid dated °— �e (in'staller's name) nguia date). . Dated -�Cj—(� With revisions dated (iocLayrs a4., .(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 offHealth approved plans.pd-oT to perfonjag any'work on a site: T must haoe rht •roti owed titans and the permit.on site when any work is being done, ' �. As the ing4er,.I. '—- call•for any and ali inspe-tion: If homeowner,contractor,•project manager, or any other person not associated withmy company schedules•an inspection and the system is not ready,then item three sh4b4 applicable. . As•tlie nstaller,'I aim'-iegtlired to.have.tlie pecessaty work tompteted prior;to the.applicable inspections as �+*d' +hand•that re4iit Q witho combletioil-df the items in accoidance itidicazed hel�iwY• I �1�1€:: p• 'ale 5 andlhe,$o r�lth*Z k, ns yresul inia$50:00 fiiYe'befng.le%ed'apainst:mc..andlor baa�QT : . a , Bo'tioYri f .ed ' Gen ,this is the fiCs. 1 J.t eddon-tYnless,,there is a(•retainin Wall, Bich ' �- y `� �' g sho&i eZ6n4<iYrst: The:jnsta4i iust tPque #lin inspect ds�but docs riot have to be present:• . b. Nnaj 'on '*+c.;Agpectiori—Engineer mvst'first da theix inspection for elevations;'tits,-etc. As-built of'verbal OK dor e-maEil•to:lieaYtlidg .to 0 orthaindoVer.c.oml:from the egaineet must be stibiiiitted tcs'.the.Board ofHealth,aftetwlneli inataLEer.calls for inspection time. Installer must bepresent for this.inspection, . ith'a pump Systttn,all'electrical work;must:be ready and•able to cause:pilr ap.t6-arork arid:alarcn'.to funktion.. c. Fina o Installer must request`inspection tvheh;M grading,is•complete:..Installer'does not have to be•on=site. 4. As-the installer,'I understand that only I.Iiiay perform the wofk•(other than:ti w e excavation)and'l am'regi*ed to complete the•installatian of the systemidentified in the.attached.applit:ation for installation.'j f4de undeittand:•that=- 'rk•done'l;v others ttnliceiis ; o:install tic:Wiems.ih North Andover cag'con'i4tute reasons for denial df the system and ca'oircir onosugbensi4ri of•niy license to operate in the Town of hT i dndbver si ficant fines to all persons.M'v_Qjy to also' 6i' e 5.. As tbe.instiUcr,•I understaird Ast.I tnti§i` e'on=,site during;t4-ptr 6=iance of the'following construction steps: a: Det"ruirlatiosi that.the prioper elevation of the rjrcavx on bas been reached - b. Inspection of the saad and agile to be used, ' c. Hadinspecdoa byBoar4ofAgeadth staffor consultant. d. Installation,oftank,DBox pipes,stone, vent,pump chamber,retarirrg wetland other . components. 6. As tbg insfallerj=AiisUnd that lam s6l*rhe pq c�isibl!;for the installation.of the syyftem as per the p p n�a No inslructi2as by the: } 4 � tr►Prai contra ley per, l �$ �t absolve me Qt's obi tion. Undersigned I:icensed Septic.Iastallcr: (Tpday'g Date) 0`1�/y - .. ... .. ., ~U '1,. y• •�"t..f•••.Wit.. ,''{? FF1 L1 I • SEK-� '� North Andover Health Department (ommunity Development Division June 16, 2014 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: 7 Olympic Lane,Man 106B, Lot 144 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated May 16, 2014 and received on May 23, 2014 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. ✓ 1. If a riser is proposed above the distribution box then please clearly indicate this requirement on the design plan. Please specify all system components shall be marked magnetic marking tape (3 10 CMR 15.221(12)). 3. Please clearly depict the benchmark on sheet 1 to better assist the installer. _,,4' There is only one deep observation hole located in the proposed leach field. Please request a Local Upgrade Approval and provide the DEP Form 9A (3 10 CMR 15.405(1)(k). V'5. On sheet 2 of 2,the profile indicates a proposed vent. The scaled profile and the site plan do not depict a vent. Please clarify this discrepancy. 6. The site plan view depicts the building sewer line at 17' but the profile view indicates a length of 15'. Please clarify this discrepancy and adjust the elevation of the septic tank if needed. �_,/7. On sheet 2 of 2,the scaled profile does not depict the bottom of the leach field to be level ✓ (3 10 CMR 15.246). On sheet 1 of 2, the design percolation rate is depicted incorrectly. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 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. Sincerely S an Y awye HS/RS Public Healt *rector cc: Sally Mucica File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ' LETTER OF TRANSMITTAL Bill Dufresne Merrimack Engineering Services,Inc. •66 Park Street • 907 Ocean Blvd. -Andover, MA 01810 • Hampton,NH 03 842 •(978) 475-3555 Ext. 20 • Cell: (978) 502-6206 �� i3 ` TOWN Or;NUt:41 �,Fax: (978)475-1448 HEALTH VefN1,FNT Email: brdufresne@comcast.net TO: North Andover Board of Health DATE: 6-17-14 RE: 7 Olympic Lane WE ARE SENDING YOU: ( )PRINTS ( x)PLANS ( )SPECIFICATIONS ( )COPY OF LETTER COPIES DATE NO. DESCRIPTION 3 Revised 6- Revised septic system plans 16-14 THESE ARE TRANSMITTED as checked below (x )FOR APPROVAL ( )FOR YOUR USE ( )AS REQUESTED ( )FOR REVIEW AND COMMENT ( )APPROVED AS SUBMITTED ( )RESUBMITTED REMARKS Plans have been revised per all comments with exception to#8 regarding the perc test. It is shown as 2 mpi on both shts.We do not understand your comment. SIGNE Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M 5 y DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use Sally Mucica Residence only the tab key Name to move your 7 Olympic Lane cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code tab 2. Owner Name and Address (if different from above): SAME Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 BDRM. House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Pits t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 t Y Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Total Replacement(see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: sa,s size,sq.ft. Bio reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 A Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval °µM DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: N/A 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: N/A t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 • a Commonwealth of Massachusetts City/Town of North Andover o Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: N/A 4. Connection to a public sewer is not feasible: N/A 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner'sSi ure Date Sall Mucica Print Name Bill Dufresne/Merrimack Engineering 6-16-14 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town Ma/01810 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 4 Commonwealth of Massachusetts City/Town of North Andover } Local Upgrade Approval Form 913 o^ M DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Sally Mucica residence key to move your Name cursor-do not 7 Olympic Lane use the return key. Street Address North Andover MA 01845 �y City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok x PE [:IRS Name 66 Park Street Andover MA 01810 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 7 Olympic Lane Local Upgrade Approval, Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover a o Local Upgrade Approval Form 9B �M B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer June 18, 2014 Print or Type Name and Title Signature Date 7 Olympic Lane Local Upgrade Approval* Page 2 of 2 • S4'S2L'ED']6g6 • • North Andover Health Department Community Development Division June 18, 2014 Sally Mucica 7 Olympic Lane North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 7 Olympic Lane, Map 106B, Lot 144 Dear Mr. Mucica: The proposed wastewater system design plan for the above site dated May 16, 2014 with a final revision date June 16, 2014 received on June 17, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom max 9-room home. This plan i - ( ) p s generally good for 3 years from the date of approval however, as this is for a repair system,this is reduced to 2- years. The plan received the following local upgrade approval. 1) Use of only one deep hole in the proposed disposal area During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the 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. This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records (attached) 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 7 Olympic Lane June 18, 2014 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. 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. /S,incerell� HS alt irector Encl. Form 913 Installers list cc: Merrimack Engineering Services File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Grant, Michele From: Grant, Michele Sent: Friday,June 27, 2014 9:26 AM To: Iwrdufresne@comcast.net' Cc: 'Isaac Rowe'; Sawyer, Susan Subject: 7 Olympic Lane Hi Bill, I've reviewed your verbal message.To make the file complete, please submit a letter in writing noting the plan showing the 5 foot over dig is optional base on 15.255(5). Please specify which area.( IE: North, South, East,West, as draw on your plan of either where trees are to remain or no over dig)The plan does not specify any trees. Please Red Line the plan, please scan and email it to me with the specific changes and we will forward it to Todd and Isaac, so we are all on the same page. Thanks very much, Michele E.Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com 1 Grant, Michele From: Blackburn, Lisa Sent: Thursday,June 26, 2014 2:41 PM To: Grant Michele Subject: 7 Olympic Bill Dufresne called and said that the plan for 7 Olympic has a 5' overdig that shouldn't be on it. It isn't a system in fill??? He said if Toddly digs the 5' overdig he will be in pinetrees. Do you get that? If not give Mr. Sunshine a call O Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.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:hftp://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 7 OLYMPIC LANE'- �1���� p� J 210/106.B-0144-0000.0 3N,p b 5 N11 I it I 1 1qv� 6� Legal Notice — Legal Notice TOWN OF NORTH ANDOVER TOWN OF NOP.TH ANDOVER MASSACHUSETTS MASSACHUSETTS BOARD OF APPEALS BOARD OF APPEALS NOTICE Jul 6 1987 NOTICE t NORTH,� y NORTH July 6,1987 o<<•�eD Mo Notice is hereby given that of II_�° "'D Notice is hereby given that the Board of Appeals will give a *� a -.e o ,. 3 the Board of Appeals will give F p a hearing at the Town F n a hearing at the Town * Building, North Andover, on * Building, North Andover, on Tuesday evening the 11th day * Tuesday evening the 11th day of August, 1987 at 7:30 y' ;;.r�., of August, 1987 at 7:30 SSACHUS o'clock, to all parties in- ySSACMUSE` o'clock, to all parties in- terested in the appeal of Gary M. and Sally J. Mucica re- terested in the appeal of Gary M.and Sally J. Mucica re- questing a variation of Sec. 4, Para. 4.121 &Table 2 & Special Permit of Sec.10.31,Para.2 of the Zoning By Law questing a variation of Sec. 4, Para. 4.121 &Table 2 & so as to permit relief for deck constructed by builder,the Special Permit of Sec.10.31,Para.2 of�the Zoning By Law corner of which is 26 feet from lot line on the premises so as cornertofwh permit 26 feetcfj om�otiine on theed by upremises located at 7 Olympic Lane. By Order of the Board of Appeals located at 7 Olympic Lane.By Order of the Board of Appeals Frank Sera,Jr.,Chairman Frank Serio,Jr.,Chairman Publish in North Andover Citizen July 9 & July 16, 1987 33912-3 Publish in North Andover Citizen July 9 & J33912 3 1987 LegalNotice TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NORpH NOTICE July 6,1987 e�ti Notice is hereby given that ? �`� •e °�'�. the Board of Appeals will give 3 ;-•-- ,� p a hearing at the Town a * Building, North Andover, on ` =i Tuesday evening the 11th day e, ;o,.r',h of August, 1987 at 7:30 HSSACHUsf` o'clock, to all parties in terested in the appeal of Gary M. and Sally J. TabMucle r& a variation of Sec. 4, Para. 4.121 &Table 2 & questing Special Permit of Sec. 10.31, Para.2 of tale Zoning By Law so as to permit relief for deck constrMed by builder,the corner of which is 26 feet from lot line on the premises located at 7 Olympic Lane. By Order of the Board of Appeals Frank Serio,Jr.,Chairman Publish in North Andover Citizen July 9 & July 16, 1987 33912-3 N �w t•• A►pL7A 1855 Aeriug .' TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS NOTICE . . . . . . July .6 . . . . .19.87 Notice is hereby given that the Board of Appeals will give a hearing at the Town Building,.North Andover, on. . . .Tuesday . . . . . evening. . . . the .11th day of . . . . August ... . . . . . . . . 19. 8,7at.7:.3®'clock, to all parties interested in the appeal of . . . . . Gary .M.&, Sall,y. .J.Mucic.a . . . . . . . . . . requesting a variation of Sec..4,. Para .4,121 &.of the Zoning Table 2 & Special Permit of By Law so as to permit. . . . . . . . . . Sec: 10.31; -Para 2 relief for deck constructed-by- builder; - the. corner of which .is ,26. feet from lot line. . . . . . . . . . . . . . . . . . . . . . . . . M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on the premises, located at. . . . . .7 .Olympic Lane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . By Order of the Board of Appeals Frank Ser o, r. , C Publish in N.A. Citizen on July 9 & Jul 16, 1987 • r i Unanimously granted a variance to Gary .and.,•Sally r Mucica, 7 Olympic ' NORTM Lang; for cahtihaed ex;stdnce of a deck 0t.. •^ ..,'�a 26-ft. from the lot line instead of the re- 0 a quired 30.ft.�-...-.W_;�._ .•_ �_ _ . '. •ono � '� - SACNu, - TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Date: Dear Applicant: Enclosed is a copy of the legal notice for your application before the Board of Appeals . c ce Kindly submit $ .3. i6 for the following: Filing Fee $ Postage $-J , Your check must be. made payable to the Town of North Andover and may be sent to 'my attention at the Town Office Building, 120 Main Street , North Andover , Mass . 01845. Sincerely, BOARD OF APPEALS i L Audrey Taylor, Clerk NORTH 0' -14, 60 0 R 4 --j AuG At .-1 0 'YSACH So TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Petition: #78-88 Gary & Sally Mucica 7 Olympic Lane DECISION N. Andover, MA 01845 The Board of Appeals held a public hearing on August 11, 1987 on the application of Gary M & Sally J. Mucica requesting a variance from the requirements of Section 4, Paragraph 4.121 and Table 2, also Special Permit of Section 10.31, Paragraph 2 of the zoning bylaws so as to permit relief for deck constructed by builder, the corner of which is 26 feet from lot line. The following members were present and voting: Frank Serio, Jr. Chairman, Augustine Nickerson, Clerk, William Sullivan, Raymond Vivenzio and Anna O'Connor. The hearing was advertised in the North Andover Citizen on July 9 and July 16, 1987 and all abutters were notified by regular mail. Mrs. Mucica spoke regarding the petition. Upon a motion made by Mr. Vivenzio and seconded by Mr. Sullivan, the Board voted to GRANT the variance as requested with the provision that a plot plan be submitted. The vote was unanimous. The Board finds that the petitioner has satisfied the provisions of Section 10, Para- graph 10.4 of the Zoning ByLaws and the granting of these variances will not derogate from the intent and purposes of the Zoning ByLaws nor will it adversely affect the neighborhood. Dated this 21st day of August, 1987. BOARD OF APPEALS Fr Serio, Jr.r.1o, . Chairman /awt '00 -AUG ZN 8 L13 1 407 TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD Of APPEALS NOTICE OF DECISION Gary M. & Sally J. Mucica 7 Olympic Lane Date August 21, 1987* . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, MA 01845 Petition No.. .78788. . . . . . . . . ... . . . . Date of Hearing. . August 11, 1987 Petition of . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . Premises affected . . .7 .9lYmP.# .Lane. . . . . . . . . . . . . ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Referring to the above petition for a variation from the requirements of$fie P!Ekq ,4, .P.?LTA .4..121 and Table 2, also Special Permit of Sec. 10.31, Para 2 . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so as to permit . .relief. f Q.r .deck. r_on,9trva.e.d .by.bvWAe-g, . Vhp. .qqrnivr. p.f .whjrh. Vis. . . . 26. feet .f rom. JLQt .line... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Board of Appeals voted to GRAXT . . . : the variance .and. special. permit. . . . . . . ]IN MjY4M*;&j6xffKK_AMYM g . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signed Frank Serio, Jr. , Chairman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Augustine Nickerson, Clerk . . . . .. . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . William Sullivan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Raymond Vivenzio . . . . . . . . . . . . . . . . . . .I. . . . . . . . . . . . . . . . . . . Anna O'Connor . . . . . . . . . . . . . . . . . . . . . . . . . . Board of Appeals ved by Town ClerkA `Rry [LO RTL _AER JULTOWN r" i'A 0 lu 12 AY P87 TOWN OF NORTH ANDOVER, MASSACHUSETTS BOARD OF APPEALS APPLICATION FOR RELIEF FROM THE REQUIREMENTS OF THE ZONING ORDINANCE Al i can tAddress 7 OLp -Ym -_q Lane ppQary_jL. - - Enai a �jca _____Address Andover , MA 1 . Application is her'(-,by made : a - For a variance from tlic requirements 'of Section 4.121 Paragraph and Table 2 of the Zoning By Laws . 1)) For a Special Permit under Section 10.31Paragraph 2 ,of the Zoning 13 Y Laws c ) As a Party Aggrieved , for review of a decision inadc by the Building Inspector or other authority.• 2 . a ) Promises affected I are land x -and building (s ) X numbercd_ 7 Olympic Lane Street.. b) Premises affected are projicrty with frontage on the North ( X) Last West side of Olympic- Lane South - Street , and known as NO. 7_01ymP_jc Lane Street . c Rremiscs affected 1fected are in Zoning District R2 and the premises affected have all area Of_j square feet and frontage 01 3 . ownership a ) Name and address of owner ( if joint ownership, givIc all names ) :. & Sally J .— mucica Date of Purchase 6-30-81 ___ Previous Owner wilmar Proper I ties__ b) If appLicant is not owner , check his/her interest in the promises : Prospective Purchaser Lcscc Other (explain ) 44 Size of proposed building :'--- front; feet deep; stories ; a Approximate date of erection:__________ b) occupancy or use of each floor : c ) Type Of construction:—_--- ---- 5 . size of existing building: 44 . 7 feet front ; 28 . 2 feet deep; lie i qh t 2---stories ; a Approximate date of crecLion :- 1) ) occupancy or use of each floor : R(Z_q_j.dea±,ial ryp- -)nstruction : Wood frame a previous appeal , v.11(jer zoning on these prernise.-;? No Description Uf relief. :.ought on this petition "i"Va.riance for deck ,,v, constructed by builder , the corner of which is 26 .�.eet from lot line , ou of romp-liance wi�-� oot r'equT—r5men`�, S . Deed r ecocdcd in the Registry of Deeds in Book `1 515 Page 3 Land Court Certificate No. __ Book 1515 Page 3 Th:.! principal points upon which I base my application are as follows : (must be stated in detail ) Deck was built by Wilmar Properties and included in d1riginal purchase of _house in 1981 . Problem was not uncovered until survey was conducted in Aril , 1.986 . Deck does not interfere with neighbors .•p,roperty. I agree to pay the filing fee, advertising in newspaper , and incidental expenses* Signature of-t'e- 1.0 erA s , Every applicati 1 for action by the Board shall be 'made on a form approved by the Board . These forms shall be furnished by the Clerk upon request . Any communication purporting to be an application shall be treated as mere notice of intention to seek relief: until such time as it 'is . made on the official application form . All inf•ormation ,'called for by the form shall be furnished by the applicant in the manner ' therein; prescribed . Every application shall be submitted with a list of '•"Part•ies In Interest'° which list shall include .the pet-itioner , , abutters , owners of land directly . opposite on any public , or private street or way, and abutters to the abutters within ' three hundred feet ( 300 . ) of the property line of the petitioner as they appear _ on the most recent applicable tax list , notwithstanding that the land of any such owner is located in another city or town , the Planning Hoard of the city or town, , and the Planning Board of ,, every abutting city or town . *Every application shall be submitted with an application charge cost in the amount of $25 . OQ. In addition , the petitioner shall be' responsibl.! • . for .any and all costs involved in bringing the petition before the. Board . ..' Such- costs shall include mailing and publication, but are not necessarily;.'':: :' limited to these . Every application shall be submi.tted with a plan of land approved by the Board . No petition will be brought before the Board unless said pian has been submitted . Copies of the Board ' s requirements regarding plans are attached hereto or are available from the Board of Appeals upon request . Lls•r or PARTIES IN INTEREST ' Name Address Paul & Marie Hudson , 1850 Salem St . Reginald W. & Margaret J . Peeress 19 Olympic Lane Steve & Mary Andreadakis 37 Olympic Lane v Anthony J . & Emma M .' Marino 71 Olympic Lane Olympic Lane Realty Trust - 10 Olympic Lane ij Norman & Sharon Kossayda 57, Olympic Lane • v Paul D . & Jean C. Finn 83 Olympic Lane ( use additional sh is if "necesaa W41 k� /ZI PLAN OF L1lN[) TO ACCOMPANY PETITION j / Fach .appLication and petition to the Board shall be accompanied by' y five ( 5) copies of the following described plan: T1ic size of the plan shall be .11 x 17, drawn to sc,:ale, L inch equals 40 feet ; it shall have a north point , names of streets , zoning districts , names and addresses of owners of properties Within a minimum of 200 fect • of the subject property, property lines and location of buildings on surrounding properties . The Location of buildings or, use of the property where a variance is requested and distances from adjacent buildings and property Lines shall. be verified in the field and shown on the plan . The dimensions of the lot and the percentage of the lot covered by the principal and accessory buildings and the required parking spaces .. shaLL be :;flown . Entrances , exits , driveways , etc. that are pertinent to the granting of the variance shall be shown . All proposer] data shall be shown in red . Any topographical feature of the parcel. of Land relied upon for a variance , such as ledge , rock peat , or natural condition of water , bcook, or river. , shall be shown on the engineering plan . When a variance is requested to subdivide a parcel of land , t1-he dimen- sions and area of the surrounding lots may be taken from the decd or lotting plan for comparison of the size of the lots in the neighborhood , noted on the plan as such, and marked "approximate" . The plan shall be signed and bear the seat of a .registered surveyor or engineer. . Any plans' presented with the petition shall. remain a part of the records of the Board of Appeals . If Living quarters are to be remodeled, or areas are to be converted into living quarters , in addition to the plot . pl_an, five ( 5) copies of the following described plans shall be furnished: 1 . 11 floor plan of each floor on which remodeling is to be done or areas converted into living quarters ; 2. n floor plan showing the stairways , halls , doors opening into the halls , and exit doors of: cacn floor or floors where no •re- modcling or converting is to be clone; 3. Tic pl...-ins' and elevations shall show all existing work . nl.I proposed worlc shalt be shown in _red . The size of each plan shall be 1 L x 17 or 17 x 22; it shall. be drawn to scale, 1/il inch nquals one foot . 711L plans and elevations prescnte_d with the petition shall, remain a part Of the records of the Board of Appeals . For petitions requesting variation (s ) from the provisions of Section 7, . Par. agrpahs 7. 1 , 7. 2, 7. 3, and 7. 4 and Ta`.)lc 2 of the Zoning Py Law for conveyance purposes only, a plot plan , certified b1i a registered enginccr or land surveyor , of the parcel of land With a structure thereon being conveyed , will. be accept:.�ble to t'Ze noar. d of Appeal.s provided: 1 . The -Eielling (s ) , structurc (s ) , or building (s ) were constructcd .?rior to March 14, 1977 . 2. The pcti. tion is not to allow construction or alteration to the dwc Mng (s ) , structurc (s ) , or building (s ) which will re- suLt in the need for the issuance of a building permit . 3. The size of the plan shall be no smaller than S 1/2 x 1.1 inches and must show the existing area of the parcel , the existing frontage , and the existing setbacks of the dwelling (s ) , structure( s ) , or building (s ) being conveyed . 4 . Pr.oper dace is provided on the plot plan for the Board ' s signatures , as w^ll as adequate space for the following information: date of filing , date of public hearing , ani date of.. approval . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) _ NORTH ANDOVER Mass. Date `._ k uilding Location d����"C �/- Permit # Owners Name • Y New -7 Renovation D Replacement Plans Submitted D N a O u! N Y z s Q N tC .O M = o usa ct a o o .o m z t- a to 11 W w 0 — a = W 4 tz W d — F- V7 > 0a v W -• to .t Q o a F- Yu W WW CC J z Q tL' Q tr WW U G's tt 2 d ul G d d " ¢ to > c m � - a W W o o o t- t= U G > Q a t.- O SUa—ESTAT. t SASEMEHT ZSTFLOOR ZKO FLOOR 3Rn FLOOR I 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STHFLOOR (Print or Type) Check one: Certificate Installing Company Name 19/1261 , !d Corp. Address so, Z10111-V-37-1 Partner. Firm/Co. Business Telephone: ') Name of Licensed Plumber or Gas Fitter a.�a,- 43� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy d Other type of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 0 Agent El I hereby certify that all of the details and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that aU plumbing worst and Installations performed under Permit issued to: this application will-be In compliance with all pertinent provisions of tho Massachusetts State Gas Code and Chapter 14:of Cho General Lawa. F "TYPE LICENSE: �- e— By Plumber Title npp I 1 trine Gasfi.tter Sig ature of Licensed 71"Master Plumb r or Gasfitter City/Town: Journeyman � APPROVED (OFFICE USE ONLY) License Number J `* TO 2166 Date. .. . ....... I t ,,ORrH TOWN OF NORTH ANDOVER I 3� '` • PERMIT FOR GAS INSTALLATLO 9SSACHUS�t C11 1 I This certifies that . .° ` �•�• . . (� i has permission for gas installation . . .��f'.H e • . . • • • • • • • M 1 C / « �. in the buildings of . . . . . .4 . . . . . . . . . . . . . . . . . . . . . . 7. . at . . . �.��?:���.�. �. . . .�.�`: . . . . , NAndover, I ass; Lic. No.. `$.�'. 3 . 4i'Z-'*• . . AS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File Board of Appeals �,`��``Ess4 Town Office Building R��PM a ,.. North Andover, Mass. 01845 0 0 �EY4�, j '�� 13 JUL 0` f'r /9$1 ungnni�F:;,,9 r0rWarddng Order C,Pir ed {::�{::{::. :{9 N tt I'(:11i.dt1 :alt:; t:){'�:{:)I:::Ii ON F:T{...I: -0 F:-OFZaWF1RD Legal Notice TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS „°RT„ NOTICE July 6,1987 o Notice is hereby given that the Board of Appeals will give IC s p a hearing at the Town y+ x �,�,� ► Building, North Andover, on Tuesday evening the 11th day M of August, 1987 at 7:30 HSSACHUSo'clock, to all parties in- terested in the appeal of Gary M. and Sally J. Mucica re questing a variallon of Sec. 4. Para. 4.121 &Table 2 & Special Permit of Sec.10.31,Para.2 of the Zoning By Law so as to permit relief for deck constructed by builder,the corner of which is 26 feet from lot line on the premises located at 7 Olympic lane. By Order of the Board of Appeals • Frank Serio,Jr.,Chairman Publish in North Andover Citizen July 9 & July 1 3 1987 M