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Miscellaneous - 7 SULLIVAN STREET 4/30/2018 (2)
7 SULLIVAN STREET ' ,:- 210/107.8-0015-0000.0 7 SULLIVAN STREET JS-2003-0789 Project Detail Report Printed On:Thu Jun 03,2004 Project Name: GIS#: 7612 Project No: JS-2003-0789 Owner of Record FORGOSH,ARI&MARGARET K Map: 1073 Date Submitted: Sep-11-2001 7 SULLIVAN STREET Block: 0015 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 7 SULLIVAN STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail. Subdivision Description DWC Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0058 6/2/04-Received a call from Jon Whyman. He is requesting a Final Grade Inspection. Please call him at 781.334.2323. This is a convoluted file that goes back to 2001. I will upgrade to the new folder for easier review.--p.d. 6/25/03-Wed.Letter prepared to Mr.Forgash re:Septic System Installation.Given to SS with file for sign-off.--p.d. Tues.6/17/03-h/o,Ari Forgosh sent a letter. Summary is as follows: The contractor who installed his septic system has filed a misdirected lawsuit against h/o in small claims court for non-payment. J.Whyman Construction was hired by Kevin Travers,previous h/o to install a Title 5 compliant septic system. The plans,which were submitted to and approved by BOH called for the area of construction to be restored with laom and seed. Mr.Travers did not feel it was necessary to plant in the leach field area and pd.J.Whyman only half the cost of the loam and seed. The contractor,on Mr.Travers instruction,filed suit against Mr.Forgash for the remaining balance. Request is for something in writing by the BOH to require the construction area of a septic system to be restored. Runoff would be a health hazard. Property is surrounded by wetlands. Please respond in written form to Mr.Forgash. Letter is in file. If ' necessary,he can be reached at:978-691-5663.--p.d. Wed.6/11/03-h/o Ari Forgosh called asking about the legality of final grade done at his property. Sandra Starr said to sent a letter,and we will respond. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Septic System BHP-2003-0138 Dec-20-2002 Open' JS-2003-0789 Construct-Complete GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 r Lot & Street Y,, Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been YES NO Permit# Z/ pJ //w Plan Approval: Date:_pai C/�/ proved by: Designer:/j� �. 5A . D�s b Plan Date: Conditions: C-7 61- D�6D D ®/= Water Supply:_--.__ Town �n►�� AX /J 6,5iz3A,-7< 7G) M 11 06 17711V11,10M 'D65 4, 0 qO uo vNLL Ira U e 767e7 4- �� -��- � J Lot & StreetY-.///,la, Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been pai YES NO Permit# O Plan Approval: Date: W// proved by: 2&21b Designer:& Plan Date: Conditions: jQ WaterSupplyTown Well Well Permit: ~�`�'� Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved_ Bacteria II Date Approved Plumbing g 9 9 Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: 1 r SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? AYE NO Type of Construction: NE EPAI New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: NO DWC Permit Paid? ip � N DWC Permit# Installer: n Begin Inspection: YES NO Excavation Inspection: r Needed: Passed: By: Construction Inspection: Needed: ,2/.c) TiUY1 G rei�� �Plan ,� � r s na �eAs Built Satisfactory: YES: 2 �f Approval of Backfill: Date: By: Final Grading Approval: Date: S Z� , b `2� By: Ji Final Construction Approval: Date: By: Certificate of Compliance: Z 2 064e.: TOWN OF SYSTEM PUMPING RECOI RECEIVED r DATE: JAN 13 2005 TOWN OF NORTH ART�DOTER HEAL )- SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) — DATE OF PUMPING. QUANTITY PUMPED : � GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIl,4) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: ge -�C�.��2C'cl �,�. 01-L .. CONTENTS TRANSFERRED To: G.L.S.D Lowell Waste - � OT- O'R'N.OF NORTH ANDOVER UALTH DEPARTMENT 27 CHARLES STREET tt NORTH ANDOVER, MASSACHUSETTS 01.845 SgACP0U5ES Sandra Starr,R.S., C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 June 25,2003 Mr.Ari Forgash 1 7 Sullivan Street c� `"� /��~'' North Andover,MA 01845 RE: SEPTIC SYSTEM INSTALLAI Lv Dear Mr.Forgash: �5 �' ! / (��►�j With reference to the new septic syste: �",��' ved the project file and have the following comments: �� 4 1. The installer was Jon Whyrm L 2. There are two items of concei 9�� GDS a. As far as inspections went,there were problems with the bottom of bed depth. The BOH staff was required to perform two inspections. b. On the system final,the installer did not follow the approved plan. He substituted an unapproved D-box for the one specified. The pipe was not set properly,and the D-box was not level,and the lines did not show equal distribution. The lines into the box were not cemented,the stone was dirty and had to be replaced. 3. Note 6 of the construction notes on the approved plan states that all disturbed areas are to be finish graded,topped with 4'of topsoil,raked and seeded. 4. The installer acted as contractor and was required to also see that a deed restriction was filed,limiting the dwelling to its current number of rooms. This was not done. Issues with payment are not in the purview of the BOH,but if you have further questions about the septic system, please notify our office. Sincerely, Sandra Starr,R.S.,C.H.O. Health Director SS/pfd . _ CiORTh ` .TOWN OF-NORTH ANDOVE�t HEALTH DEPARTMENT 10 27 CHARLES STREET s n NORTH ANDOVER, MASSACHUSETTS 0 1.845 sMCHUs Sandra Starr,R.S., C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 June 25,2003 Mr.Ari Forgash 7 Sullivan Street North Andover,MA 01845 RE: SEPTIC SYSTEM INSTALLATION Dear Mr.Forgash: With reference to the new septic system at your property on 7 Sullivan Street,I have reviewed the project file and have the following comments: 1. The installer was Jon Whyman. 2. There are two items of concern: a. As far as inspections went,there were problems with the bottom of bed depth. The BOH staff was required to perform two inspections. b. On the system final,the installer did not follow the approved plan. He substituted an unapproved D box for the one specified. The pipe was not set properly,and the D-box was not level,and the lines did not show equal distribution. The lines into the box were not cemented,the stone was dirty and had to be replaced. 3. Note 6 of the construction notes on the approved plan states that all disturbed areas are to be finish graded,topped with 4'of topsoil,raked and seeded. 4. The installer acted as contractor and was required to also see that a deed restriction was filed,limiting the dwelling to its current number of rooms. This was not done. Issues with payment are not in the purview of the BOH,but if you have further questions about the septic system, please notify our office. Sincerely, Sandra Starr,RS.,C.H.O. Health Director SS/pfd 7 SULLIVAN STREET JS-2003-0789 Project Detail Report Printed On.Tue Jun 17,2003 GIS#: 7612 Project No: JS-2003-0789 Owner of FORGOSH,ARI&MARGARET K Map: 107.13 Date Submitted: Sep-11-2001 Record: FORGOSH 7 SULLIVAN STREET Block: 0015 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 7 SULLIVAN STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Subdivisio Description DWC of Work: Department OGeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0058 Tues.6/17/03-h/o,Ari Forgosh sent a letter. Summary is as follows: The contractor who installed his septic system has filed a misdirected lawsuit against h/o in small claims court for non-payment. J.Whyman Construction was hired by Kevin Travers,previous h/o to install a Title 5 compliant septic system. The plans,which were submitted to and approved by BOH called for the area of construction to be restored with Isom and seed. Mr.Travers did not feel it was necessary to plant in the leach field area and pd.J.Whyman only half the cost of the loam and seed. The contractor,on Mr.Travers instruction,filed suit against Mr. Forgash for the remaining balance. Request is for something in writing by the BOH to require the construction area of a septic system to be restored. Runoff would be a health hazard. Property is surrounded by wetlands. Please respond in written form to Mr. Forgash. Letter is in file. If necessary,he can be reached at:978-691-5663.—p.d. Wed.6/11/03-h/o Ari Forgosh called asking about the legality of final grade done at his property. Sandra Starr said to sent a letter,and we will respond. Permit History Type: Permit No: Issue Date Status Work Category Project No: Description of Work: Septic System BHP-2003-0138 Dec-20-2002 Open JS-2003-0789 Construct-Complete 0 •6eoTMS9 2003 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 � q June 11, 2003 U Ari R. Forgosh,DMD 7 Sullivan St. North Andover, MA 01845 Ms. Sandra Starr _ Health Director �TM iN OF 111c"TY A,I,- 2nd Floor _ _ __ 27 Charles St. North Andover, MA 01845 FJUN 17 2003 Dear Ms..Starr, - -- - � I am writin-g to gather some information=regarding Title 5. I.had hoped that the last time we spoke about my septic system would indeed be the last. However, I have recently been informed that the contractor who installed my system has filed a misdirected suit against,me in small claims court for non-payment. I Whyman Construction was hired by Kevin Travers, the previous owner of 7 Sullivan St. to install a Title 5 compliant septic system. The plans, which were submitted to, and approved by, your office called for the area of construction to be restored with loam(topsoil) and seed. Mr. Travers, however, did not feel it was necessary to plant grass in the area of the leach field and has paid J. Whyman only half the cost of the loam and seed. The contractor then, on Mr. Travers' instruction filed suit against me for the remaining balance. This lawsuit clearly has little merit, but is nonetheless, a nuisance. I would like to know if the regulations stipulated by the Board of Health require the construction area of a septic system to be restored. I would think that the run-off from a leach field that is nothing more than a mud pit would constitute a health hazard. Furthermore, my property is surrounded by protected wetlands. Would an unfinished leach field pose a threat to these areas? What about my neighbors who get tli ..I do .not.believe .that 1VIr_ Travers .has the septic system, nor do I feel responsible for the ps if Mr. Travers' attempt to leave the septic plat threat to public health or environmental safety. Thank you for your-help_ Sincerely, Ari Forgosh Q Q June 11, 2003 /lJ Ari R. Forgosh, DMD 7 Sullivan St. North Andover, MA 01845 Ms. Sandra Starr Health Director TOk m O 2"d Floors 27 Charles St. North Andover, MA 01845 JUN 17 2003 Dear Ms. Starr, I am writing to gather some i-n#or-mation-regarding Title S. 1. had hoped that the last time we spoke about my septic system would indeed be the last. However, I have recently been informed that the contractor who installed my system has filed a misdirected suit against,me in small claims court for non-payment. J. Whyman Construction was hired by Kevin Travers, the previous owner of 7 Sullivan St. to install a Title 5 compliant septic system. The plans, which were submitted to, and approved by, your office called for the area of construction to be restored with loam(topsoil) and seed. Mr. Travers, however, did not feel it was necessary to plant grass in the area of the leach field and has paid J. Whyman only half the cost of the loam and seed. The contractor then, on Mr. Travers' instruction filed suit against me for the remaining balance. This lawsuit clearly has little merit, but is nonetheless, a nuisance. I would like to know if the regulations stipulated by the Board of Health require the construction area of a septic system to be restored. I would think that the run-off from a leach field that is nothing more than a mud pit would constitute a health hazard. Furthermore, my property is surrounded by protected wetlands. Would an unfinished leach field pose a threat to these areas? What about my neighbors who get their water from a well? I do .not believe.that Mr_ Travers.has..the -authority.to.alter.approved-plans-for a septic system, nor do I feel responsible for the payment of his debts. Please let me know if Mr. Travers' attempt to leave the septic plans unfinished would have constituted a threat to public health or environmental safety. Thank you for your_help. Sincerely,. An Forgosh Dec-04-02 09:050 P.02 0 i, TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed; ( repaired, by by C located at�.� , V t V Gk- C--, '_ S was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# ,plan dated , with a design flow of gallons per day_ The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.00),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: _v z& / G3V 91 C v u 2 -_.-_— Engineer Representative Final inspection date: -)z`s Z S'C© (Te-z_ Engineer Representative Installer: L l ic.#: Date: .. Engineer: Date: a � C. " k 7 NGARD Co 4�01- Fss�O � Q O NEW ENGLAND ENGINEERING SERVICES INC December 10, 2002 Sandra Starr, Administrator _r North Andover Health Department77 Town Hall Annex �SO, 27 Charles Street DEC 1 6 ?009 North Andover, MA 01845 Re: 7 Sullivan Street,North Andover, Septic system design Dear Sandra: above referencedproperty. Enclosed is an as built plan and certification for the abo p ins regarding the information submitted lease do not hesitate to If you have an uest o , Y any g g p contact this office. Sincerely, 9 c 0'Z/ Benjan2 C. Osgo , Jr., EIT President D 40 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 C 0 Town of North AndoverViORTlf Office of the Health Department Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 Sandra Sty Telephone(978)688-9540 Public Health Director Fax(978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 22/20/02 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by J. Whyman Construction at 7 Sullivan Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Aodn .Ladrasse Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PI G 688-9535 0 PHONE: 978-688-9540 North Andover FAX: 978-688-9542 Board of 27 Charles Street I North 1 Andover, Fax To: /c�� G;���-�/L.Q G ��i From: ✓` /��JC��� Fac /- �3� ��3c� Pages: Phones Date: Rc-. CC: ❑Urgent ❑'For Review ❑Please Comment ❑Please Reply ❑Please Recycle • Comments: I f r✓ `IV" � n S 0A) Civ�A M`�N 0 i PHONE: 978-688-9540 North Andover FAX: 978-688-9542 Board 'North Andover, MA ` 27 Charles Street 1 : - Fa x Ta / �� G�Z�L, �C� G"/1'.�G��✓ From: AV Pages: Phone: Date: �- G52 ❑Urgent ❑ or Review ❑Please Comment ❑Please Reply ❑Please Recycle • Comments: 1 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( )constructed; ( ) repaired; by located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# ,plan dated , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: Lic.#: Date: Engineer: Date: N CALL) FOR DATE /� MIME M M HONED ' OF �j RETURNED PHONE YOUR CALL AR NU R EXTENSION LEASE CALL MESSAGE WILL CALL AGAIN CAME TO SEE YOU WANTS TO SEE YOU S I G N E D , Ofln—l;e Sal" 48003 NOTES i li f Nov 25 02 11 : 18a jon why.man 7813344330 P. 1 E 11-25-62 11 = 16 MCLAUGHLIN CU.�110E ID-1 781 6�H P01/H1 .7un,7%7.-02 0gi:14 P.02 Bw 7137 P 18 U is**mpandbiltty of the&"None to maid tho mgatnd deed naMclian per 310 CMR IUM Thk& The following is s saggdded(wat;but the final document should be appwed by yaw&dwMW pfbt tc acog * NOTICB Of VARIANCIVDBED RW MICTION Ptt to 310 usutttt CMR 15A00 Title 5,and a9 a oOMiticul of tl+e North Andover Boasd of Re d)(h Disposal Works ccnd wtwn ttiutit 0 Jj-<)r,elated(t� �j Troths is het:eby given thrt:9s1 e>t tats located st t rqv. .?'t ..,Nath AnQooq', yMassscltt��etbe.(aka Assessor's MaP lz _ �r eta der mUd in a deed It m C�ih�r,4wGA.r�.�., to YA" ana retarded is the Emx Comely R&Wgry of Deeds m aack.4M and pW �.. wd as d _(�... Lloepmsat ,:8 Ibs wlgra of a vtanswce:fiVtu itYa Town of ATOrdi Aadwm Minimwa Requiraosanla tar die 3abttnfbw Di"WEd of Ss buy SOWW A 1,01 and 5L C901(4). Raid vnim mo limia the nwdmam tambw otbsOr000u st"dwWft to three b-Aoaata. This vanlmm is whin'ht jwitdictioo of",Nw&Ard ww Bond of ncWtk, 54med and Hailed this_ ( day of co,,2, r �awxer�s � �! _ .. DCT 2102 tm+10:5T COMMONWBALTHOf MASSACIn3SB('T'B lK�ddler e� Dots: 19 p� 7ben personally appusred cite above-tlametl,�r ciAR !?d�c4bdbre eck>rowh�dRed ttu foregoing baft uM to be bb/halthe�u� aar. Name NotaryPabbc Wt�lia,mr J SA-ell --a - - �?1e Co C 13 2- i ' TOWN Or �IORfl-I ANDOVER SENVAGE DISPOSAL SZ�'STEIm I-,STALLA-fMIN CERTIFICATION The unce:sig:,ed here�v verity that the Sewage Disposal System ( ) cor.su,ict :d; ( .) re�airzd: by located at was installed in conformance with the NL ,,.th Andover Board of Hoa ith z!--proved plan, Svstem Desis,-,n Pewit = dated: With an speroved design flow of `ailons per day The mate a:s;used were in conformar.:e xit`t those specinea oh the app'rovea plan; the system was installed in accordar cc ��.ith the previsions of 3110 CNfR 15.000, Title 5 and local res-zilations, and the anal szradira agrees substantially with the approved plan. :til :Cork, is accurateiv represented or the As-built :vhich has been submitted to the Board c-Health. Bed inspection date: 07,L Ensineer Rc:)rese:::anve Final inspection date Engirecr Representar.:e Instaiier: � �:c ::: Date: CesiszTr. Ens_ineer. �_ Date: S m T t ` � �/ANAL ��� O0O O TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( ) constructed; ( )repaired; by W located atm C) was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 0vM 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: icA Date: 0 Z Design Engi e r: Date: co 00 AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER -� LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM INCLUDING RESERVE TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA y LOCATIONS OF DEEP HOLES &PERC r / TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED OWN OF NORTH ANDOVER OFFICE OF THE HEALTFI DEPARTMENT COMMUNITY DEVELOPMENT AND SERVICES DIVISION 27 CHARLES STREET NORTH AND O V E R , M A S S A C H U SETT S 0 15 8 4 5 FACSIMILE TRANSMITTAL SHEET TO:o FROM:COMPANY: DATE: FAX NUM ER: TOTAL NO.OF P GES INCLUDING COVER: PHONE NUMBER: PHONE NUMBER: � f/w V/i'J/T]-/ b "' RE: YOUR REFERENCE NUMBER: De e ILC) ❑URGENT X FOR REVIEW ❑PLEASE COMMENT ❑ PLEASE REPLY ❑PLEASE RECYCLE cAA\1�, s. L4 �` �l(�Ws �L7C P-"\ �Q rrjS i Q 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.412: continued (3) No work shall be done under any variance request for which Department approval is required until the Department has approved it or 30 days (or any extension thereof pursuant to 310 CMR 15.412(2)) has elapsed without its comment. (4)_ No Department review of the following variances is required where the variance has been approved by the local approving authority: (a) Reduction of system location setbacks otherwise established in 310 CMR 15.211 for property lines, provided that a survey of the property line shall be required if a component is to be placed within five feet of the property line, and no such reduction shall result in the soil absorption system being located less than 10 feet from a soil absorption system on an abutting property; (b) Reductions of system location setbacks from cellar wall, swimming pool, or slab foundations. (c) With the exception of those watersheds (Ware, Quabbin and Wachusett) to which the provisions of 350 CMR 11.00 (MDC Watershed Protection regulations) apply, local approving authorities may, after consultation with the local water supplier, issue variances for the siting of systems within the setbacks to surface water supplies or to tributaries to surface water supplies and may exempt tributaries consistent with the standards and procedures of 350 CMR 11.00 without Department approval provided that no such variance or exemption shall result in the siting of'a septic tank or soil absorption system within 200 feet of said surface water supplies or 100 feet of said tributaries, or siting of a septic tank within 25 feet or a soil absorption system within 50 feet of any surface water. Copies of all such variances for uses and exemptions of tributaries shall be submitted to the Department. 15.413: Conditioning of Variances (1) The local approving authority or the Department may issue variances subject to such conditions, including, but not limited to, monitoring and reporting requirements, deed recordation requirements, financial assurances or other qualifications on the use of the system, as it deems necessary to protect public health and safety and the environment. Any conditions shall be expressed in writing in allowing the variance. (2) Any denial of a variance by the local approving authority or the Department may direct the applicant to upgrade an existing system consistent with the requirements and standards of 310 CMR 15.404 and 15.405. Failure to do so may be the subject of enforcement action by the local approving authority or the Department. 15.414: Variances for Increased Flow to Existing_S stem Local approving authorities and the Department may vary the application of any provisions of 310 CMR 15.000 with respect to any particular case involving increased flow to an existing vstPm._only�x1bPnJp_t6- N:)Andover Health Dept. 27 Charles Street North Andover, MA 01845 • Tel. 978-688-9540 Fax 978-688-9542 facsimile tan mi�tal To: Kevin Travers Fax: 781-665-5717 From: Sandy Starr Date: 5/31/2002 Re: Septic plan approval letter Pages: 2 CC: [Click here and type name] ❑ Urgent ❑For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • • • • • • • • • • I will fax over the section of Title 5-relative to local Board oMealW authority as soon as-I can locate-tW—reference. /'e v/1l Andover Health Dept. • 27 Charles Street a ; North Andover, MA 01845 • Tel. 978-688-9540 Fax 978-688-9542 facsimile transmittal To: Kevin Travers Fax: 781-665-5717 From: Sandy Starr Date: 5/31/2002 Re: Septic plan approval letter Pages: 2 CC: [Click here and type name] ❑ Urgent ❑For Review ❑Please Comment ❑ Please Reply ❑ Please Recycle I will fax over the section of Title 5-relative I I Board of Healttauthorit as soon as-1--can locate-the reference:--'"� ' c 01) 7" VOL) CSUR IA)5 PO 71 1 '� =� N&M Job number 1770/ 0 . S TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Site: Final Date: Installer: r/ , tU Tel: ' Date Yes No Initials A. Bottom of Bed 1. Excavation to proper depth 2. With.trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. Comments: (Use back of sheet for diagrams.) B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Inlet tb tank cemented 4. Slope minimum 0.01 or 1/8"per foot minimum 5. Pipe properly set on compact firm base 6. Pipe laid on continuous grade in straight line 7. Cleanouts precede all change in alignment and grade -- 8. Manholes at any 900 change 9. 10'minimum offset to water line v" Comments: D. Septic Tank ff 1. Level 2. 1,500 gal minimum — -� 3. Gas baffle present on outlet 4. Manhole to w/in 6"of grade .�- 5. Manholes over center and each tee - 6. 3-20"manholes 7. Outlet line cemented 8. 2"—3"drop from inlet to outlet 9. Pipe set 10. Compact base with 6"of 3/4"crushed stone under tank 11. Tank is watertight 12. Tees 12"off side of tank .4Job number 1770/ O O i Date Yes No Initials Comments: E. Pump,Chamber 1. If separate from tank,compact base with 6"of%"stone underneath 2. Minimum 2"pipe to d-box if gravity system �' 3. 20"access manhole 4. Tank level 5. Watertight ,. 6. Tank size agrees witltpl'an/specification 7. Manhole to grade,,,°` 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit ---------------- 10. Alarm Mctions 11. Manuql operating switch 12. Pump delivers liquid to d-box" Comments: F. Distribution Box 1. D-box level 2. Minimum 0.1 T'(211)drop from inlet to outlet 3. Minimum 6"sump �„► 4. Outlet pipes show equal distribution 5. m ry Co act base with 6 of stone beneath box Compact � 11. 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe 9. First 2'from box laid level — Comments: G. Soil Absorption system r l 1. All stone double-washed-%"—1 ''/z" -pea stone �► Bucket test done? i, 1< (1/0 2. Minimum 2"of pea stone above distribution lines r 3. Minimum 6"stone beneath pipe �—_--. ) 4. Distribution lines capped or connected together 5. Toe of slope stops minimum 5' from edge of property; 5a. if not,then swale. Comments: ' •��'��"e0 �... i)/�"=.-i�v/ ,...-... ��.��--.'�".�,;`'f�-'`tea'd"�,J �%'J'�rr!� � �• �„� f�f&M Job number 1770/ _ Date Yes No Initials H. Leach Trenches I. Minimum 2 trenches 2. Length of trenches a ees with plan. `'�_ �',_ p (Max.„length 100') --�� 3. Width of trenches agtees with plan–WGum 2';maximum–4'. 4. Vent present i f>5 feet or specified". 5. Minimum Otance between trefiches 10' 6. Pipe slope minimum 0.9,05'or 6"per 100' 7. Depth of trenches below outlet invert minimum of 6". 8. Pipes set on stable base. Comments: I. Leach Field u/J j �/ - ? L Maximum length of field 100' — 2. Pipe slope minimum 0.005 or 6"P. ' er 100 3. Separation betweeni es 6' p p maximum �– 4. Pipes connected at end&fiend raised 5. S aration'be ep tween adjacent fields 10 minimum 6. Pipes set on stable base �'- 7. Maximum 4'separation from edge of field to first line 8. Minimum two distribution lines Comments: <. J. Leaching Pits r 1. Min < Unum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48",a e 4. Access manholes on eac p t 5. Pipes cemented with-1lydraulic cement 6. .� -- Comments: – K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 6. Grading meets 3:1 slope ' 7. Minimum of 9"of fill graded over system _r II Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTH �� I NORTH • ptt«ao ib,tip • 3: dad,'_�.,_a pL O A ♦�o ?' DISPOSAL WORKS CONSTRUCTION PERMIT �SSACMUS Applicant- v TELEPHONE • pp NAME C ADDRESS Site Location / Permission is hereby granted to Construct ( ) or Repair an Indiv�u�l Soi Absorption Sewage Disposal System as shown on the Design Approval S.S. No.------- CHAIRMAN, o.CHAIRMAN,BOARD OF HEALTH Fee I 6 D.W.C. No. a INSTALLE O R PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the l \ property at � � � 1 f / Q, a'�\ relative to the application e--,-,, of I&A Q A dated b for plans by datedWte with revisions dated I undwing obligations for man ge ent 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 Tile 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 besubmitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I 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 Licensed Septic Installer Date: p s © i Disposal Works Construction Permit#�oz� 0 0 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 10 IS- 0 ( CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED IN LLER: SIGNATURE: TELEPHONE# I S3 ' CHECK ONE REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION,PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $160.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval Date: Q/ NEW ENGLAND ENGINEERING SERVICES INC September 14, 2001 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 7 Sullivan Street,North Andover, Septic system design Dear Sandra: Enclosed are revised plans, additional review fee, and application for approval for the above referenced septic system design plans. The following changes have been made. 1. Some portions of the segmental block retaining wall have been eliminated and replaced with a 3:1 slope that meets the requirements of Title 5. This has been done to lower the expense of the wall. If you have any questions regarding these revisions please do not hesitate to contact this office. Sincerely, Benj2nm C. Osgc(0-1 , Jr.,EIT President f� f` '�"� --- �. BOAS OFHEA�H��s�/ �. SEP f � - �ER/TONNN I:jaORTI AQ®� BOARD OF HEAL FSS TH Crp 4 60 BEEGHWOOD DRIVE— NORTH ANDOVER, MA 01845-(978)686-1768—(888)359-7645—FAX(978)685-1099 0 0 ,y iix }-< a a r F. Na.? L Massachusettse {c �r down of North Andover,, Z a P,u�3N , 4 I x£ r� 4 BOARD��OFWALTW` k t '} " v'", .Ff t p h. `t t O...`spa• M h`n � ,c. w € ro-:€ 7Y �.� P i +� � - Fc .u- ' f «� a.a°�. '- f L � �J' .r�><3;.r ,� :-: �P z .g,sd� s� P .f < � .�a,_a k`}t,� -�a �5 'n k'R a,kl � - ' L f 9 a a s " g P r-, 4., r 'P'} t � r'� �✓ �r e# .tt,�.�,�P t+`.�++�",� 1 7 2'�a�� '�`sgc,� „�":.�,�-4 '. ♦ :t,• �' 1'( r Ir`"kY ro �" ♦i.� • pe „%. 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The following local variances have been granted: 1. - Reduction:insetback lo wetlands from 100'to 72'. 2. Reduction:in leach field size from 900 feet minimum to 630 feet. 3. Use of segmental block wall with impervious liner instead of poured concrete. 4. Minimum design of 330 gallons per day instead of 440 gallons per day. Note:Proof of deed restriction prohibiting additions unless septic system enlarged or house connected to sewer. 5. Separation to ground water from 4 feet to 3 feet. If you have any questions,please do not hesitate to call the Board of Health Office at 978-688-9540. . Sincerely, Sandra Starr,RS.,C.H.O. Health Director SS/smc cc: J. Whyman Construction File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC June 22, 2001 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 7 Sullivan Street,North Andover, Septic system design Dear Sandra: Enclosed are revised plans for the above referenced property. The following changes have been made. The numbers below correspond to the concerns in the consultants letter dated 6/11/2001. 1. The second sentence of note#7 has not been removed. We do not guarantee the functioning of the system. We only design what the regulations require. 2. The rubber membrane is still on the plan. Title 5 allows a concrete wall or any other suitable engineering solution. These walls have been accepted by DEP on other designs. 3. Note 3 remains. See item# 2 4. The septic tank sizing calculations have been revised. 5. The 12" t maximum distance has been shown on theP lans. 6. The contours have been adjusted. 7. The logs have not been changed. All of the material in question will be removed. 8. The soil class has been revised. 9. The D-Box has been"redesigned to show the 2 feet of level pipe on the profile. 10. The lengths of pipe and slope has been added. 11. The local upgrade approval form is enclosed. 12. The stamp is compliant. The discipline and registration can be written by the engineer. 13. The requested wording has been added under general notes. The 200 feet to tributary note was not added since the more restrictive local requirement of 325 feet is noted. 14. The water line has been labeled as a pressure line Y 15. The soil evaluators certification is on the soil sheets. z 5, 16. The floor elevation of the garage and the material of construction have been added. 60 HEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686.1768-(888)359-7645-FAX(978)685-1099 0 0 17. The invert at the house has been noted as was requested. 18. The riser notes have been revised to address this note. 19. The local variance note has been added. 20. The requested wording has been added. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. O d, Jr.,EIT President o 0 NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm(a,netway.com Date: June 11, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/012 7 Sullivan Street Assessors Map 107B, Parcel 15 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated May 25, 2001,by New England Engineering Services, Inc. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the'following is addressed: 1) Remove second sentence of General Note 7. 2) Unless the designer can provide a D.E.P. policy statement, remove Construction Note 16 and all references to the use of EPPM rubber membrane. Current written policy only allows concrete or a 2 ft. thickness of clay, 10 ft from leaching area. 3) Remove Note 3 in local variance request. 4) Revise septic tank sizing calculations 2 x 330=660. 5) Add maximum distance of tees in septic tank to inside wall. (12 inches in 6) Add proposed contours over leaching area to ensure 2% slope, 220(4)g. 7) First 3 ft. of test pit#1 does not match Board of Health log. 8) Revise soil class to Type II. 9) Revise D-Box location on plan and profile to ensure first 2 ft. is set level 232(3)c. 10)In profile, add length and slope of pipe from house to septic tank and septic tank to D- Box. 11)Provide local upgrade request form. 12)Endorse plan with compliant registration stamp, which identifies discipline and registration number. 13)Provide a note stating no tributaries within 325 ft., no reservoirs within 400 ft.,no tributaries to reservoirs within 200 ft., and no drains within 50 ft. to the leaching system. 14)Label water lines as either pressure or suction. 15)Provide soil evaluators certification 220(4)0. 16)Provide type of floor in garage and elevation. Land Surveyors Civil Engineers Environmental Planners 0 0 17)Invert at house should be 10 1.78 minimum. 18)Provide riser on center cover of septic tank to ensure 9-inch minimum cover over tank and no more than 6 inches over center riser 228(2). 19)Add local variance note for design less than 440 GPD.NA 13.01. 20)Add to note in profile that connected pipe ends shall be done using solid pipe. Respectfully, John L. Noonan,P.L.S.-P.E. Qoffice/forms/tonarev012 Land Surveyors Civil Engineers Environmental Planners �I 2 NEW ENGLAND ENGINEERING SERVICES INC May 29, 2001 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street ' North Andover, MA 01845 Re: 7 Sullivan Street,North Andover, Septic system design "" - Dear Sandra: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of design plans, 1 with original signature. 2. Submittal form for approval. 3. Soil evaluator sheets. 4. Check to cover the fee. If you have any questions please do not hesitate to contact this office. Sincerely, Benja in C. Osgo0Jr.,EIT ! President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 o 0 tA Town of IV`ortti An ov r, Massachusetts Form N' " NORTN A BOARD O H ALTFI j S�O6�TtED I646A,0.'. / 1 ��SsgcHaeE���. APPLICATION FOR SITE TESTING/INSPECTIO' Applicant �— NAME AD6RESS TELEPHONE i Site Location a I f EngineerNa, O , . ADDRESS TELEPHONE F TesV 11 nvect1'on Date and Tim-'e 5 j. CHAIRMAN;BOAKIJ F HEALTH Test N'o. .:.. ... . S S Permit No. D.W:C No. - C.C. Date _- 'P � - _ ermit i I� f Q BOARD OF HEALTH —.0 NORTH ANDOVER, MA 01845 978-688-9540 D APPLICATION FOR SOIL TESTS FEB 2 6 2001 EQ I H ANDOVER DATE: Z 2-3).(>1 MAP &PARCEL: )0 -7g LOCATION OF SOIL TESTS: ] ��I<<uav� SfiZ E OWNER C'�r,s{�wes �� ��� Tc ,e�zs� TEL. NO.: ADDRESS: -1 S��1iya^ S`t-r,e e c ND aa( A-,.) m, ENGINEER: NFw E�q' n ee ' . TEL.NO.: 2 7 P— CERTIFIED SOIL EVALUATOR: , �P�,',Aw-; C DS C)o vrL IntendedUseof Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: ( _ Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No 1, THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Loeation.of Testing 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$75.60 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 percolatioii°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 S'i-"i tted ta:ahe Board of Health showing the location of all tests (including aborted tests): 7. Within 60 days of testing soil evaluation forms shall be submitted. :.`s� 6 TOS Please Do Not Write Below This Line AMAi N.A. Conservation Commission Approval: m o Date Received: Check Amount: Check Date: Nortidover Health Dept. : 27 Charles Street North Andover, MA 01845 Tel. 978-688-9540 Fax 978-688-9542 facsimfle.trammittal To: Kevin Travers Fax: 781-665-5717 From: Sandy Starr Date: 5/31/2002 Re: Septic plan approval letter Pages: 2 CC: [Click here and type name] ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle I will fax over the section of Title 5.relabto local Board ofMealtl-i authon y as soon as I can locate the reference: V 77 015 7D 7 i N&M Job number 1770/ TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Site: 7 S r-- z- Final Date: Installer: r/ , t-V �� Y.�,� Tel: -- ;3 19i- — Date Yes No Initials A. Bottom of Bed 1. Excavation to proper depth 2. With.trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. Comments: (Use back of sheet for diagrams.) B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" -- 2. Schedule 40 pipe ✓ 3. Inlet to tank cemented 4. Slope minimum 0.01 or 1/8"per foot minimum --•--- 5. Pipe properly set on compact firm base 6. Pipe laid on continuousgrade in straight line f-~ 7. Cleanouts precede all change in alignment and grade �-- 8. Manholes at any 90°change 9. 10'minimum offset to water line Comments: Aa- D. Septic Tank eP _. 1. Level a✓G!t _ L - ..,N. 1 "- � _ 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to w/in 6"of grade - 5. Manholes over center and each tee 6. 3-20"manholes 7. Outlet line cemented - 8. 2"—3"drop from inlet to outlet 9. Pipe set 10. Compact base with 6"of crushed stone under tank 11. Tank is watertight 12. Tees 12"off side of tank .--� M lob number 1770/ Date Yes No Initials Comments: E. Pump.Chamber 1. If separate from tank,compact base with 6"of7 st no a underneath 2. Minimum 2"pipe to d-box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade,,-' 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm fufictions 11. Manual operating switch 12. Pump delivers liquid to d-box's `y Comments: ' i F. Distribution Box 1. D-box level 2. Minimum 0.1 T'(2")drop from inlet to outlet 3. Minimum 6"sump r 4. Outlet pipes show equal distribution L.• �/ 5. Compact base with 6"of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe 9. First 2'from box laid level fto Comments: G. Soil Absorption system 1. All stone double-washed,—V— 1 ''/z" r -pea stone +�► / ��01 Bucket test done? r t 2. Minimum 2"of pea stone above distribution lines 4-- 3. Minimum 6"stone beneath pipe �_------ �--' , 4. Distribution lines capped or connected together 5. Toe of slope stops minimum 5' from edge of property; _ 5a. if not,then swale. Comments: d&M Job number 1770/ O Date Yes No Initials H. Leach Trenches 7- 1. Minimum 2 trenches 2. Length of trenches agreeswiih plan. ((Max. lefigt 100') 3. ' Width of trenches agfees with plan-liriunum 2';maximum-4'. i 4. Vent present if>50 feet or specified ,-'`-- 5. Minimum istance between trenches 10' 6. Pipe slo eminimum 0.005 or 6"per 100' 7. Depth of trenches below outlet invert minimum 8. Pipes set on stable base. Comments: I. Leach Fields Df ate.. 1. Maximum length of field 100 / 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipes 6'maximum 4. Pipes connected at end&voWend raised r 5. Separation between adjacent fields 10'minimum { 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line �--- 8. Minimum two distribution lines Comments: J. Leaching Pits 1. Minimum inlet pipe 4 2. Pits of concrete 3. Sidewall between 12"and 4�" e 4. Access manholes on eaoepit 5. Pipes cemented with draulic cement 6. Comments: - K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond _ 6. Grading meets 3:1 slope 7. Minimum of 9"of fill graded over system o Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTH L I NORTH pt t �e° 4611'0 OL O 9 f DISPOSAL WORKS CONSTRUCTION PERMIT • 1SSACMUS�� ' w �" TELE-HON E Applicant NA E ADDRESS Site Location '`7 ' Permission is hereby granted to Construct ( ) or Repair an Indu�l Soil Absorption iv : Sewage Disposal System as shown on the Design Approval S.S. No. I CHAIRMAN,BOARD OF HEALTH / D.W.C. NO. r7 Fee 9 9 tl �p 4 1 j r c i 0 o INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at Uj ( ('I// c 2 relative to the application r'—,- Of dated (D for plans by l v �dl nd dated with revisions dated I underst nd t llo e fowing obligations for man ge ent 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 Tile 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 Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I 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 Licensed Septic Installer Date: Q S © I Disposal Works Construction Permit# 7` I I 0 o BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 10 IS- 0 CURRENT INSTALLER'S LICENSE# LOCATION: V ck- LICENSED IN LLER:_ c, t �I v-.�, SIGNATURE: TELEPHONE# 1 cA CHECK ONE REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $160.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval _ --' Date: 0 0 NEW ENGLAND ENGINEERING SERVICES INC September 14, 2001 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 7 Sullivan Street North Andover Septic n stem design > P Y g Dear Sandra: Enclosed are revised plans, additional review fee, and application for approval for the above referenced septic system design plans. The following changes have been made. 1. Some portions of the segmental block retaining wall have been eliminated and replaced with a 3:1 slope that meets the requirements of Title 5. This has been done to lower the expense of the wall. If you have any questions regarding these revisions please do not hesitate to contact this office. Sincerely, 9. C/' 0 Benja C. Osg� Jr.,EIT TOWN OFF PNOR7fi AfVDp President BOAR OF HEALTH SEP r-T0-Vf F Q ANDOVER/ 4 �,RD OF HEALTH ;i =00 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 O CQ Form o,2 NOW Massachusetts':, Town of North Andover, _ ., BOA,RD OF HEACTH FOR' DESIGN APPROVAL ... , 1' ��SSAcwusESOIL»ABSORPTION SEWAGE DISPOSAL SYSTEM J e yfi4 4 Test_No �: q plcant p r: 'z -f Site Location Q I DATE :Reference Plans and Specs ENG NEE DESIGN ; s - a .; is ranted for anrrdividual soil absorption sewage disposal system to be installed Permon gr, m oard of Health _ `7--=•� with re ulations of B n. A. n accordande g P CFFAIRMAN,BOARD OFME LTH k µ Ste£5ystem Permit N.o ��• Fee' �` � A � n} , I• 0 Town of North Andover „ORT►, OFti�to t'9q. Office of the Health Department I Community Development and Services Division . 27 Charles Street �Sg North Andover, Massachusetts 01845 �9SSACHUS Sandra Starr Telephone(978)688-9540 Fax (978)688-9542 Health Director July 2,2001 Ben Osgood,Jr. New England Engineering 60 Beechwood Drive No.Andover,MA 01845 Re: 7 Sullivan Street Dear Ben: This is to notify you that the revised plans dated 6/21/01 for 7 Sullivan Street have been approved. The following local variances have been granted: 1. Reduction.in setback to.wetlands from 100 to 721. 2. Reduction in leach field size from 900 feet minimum to 630 feet. 3. Use of segmental block wall with impervious liner instead of poured concrete. 4. Minimum design of 330 gallons per day instead of 440 gallons per day. Note: Proof of deed restriction prohibiting additions unless septic system enlarged or house it connected to sewer. 5. Separation to ground water from 4 feet to 3 feet. If you have any questions,please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, , C 7- Sandra Starr,RS.,C.H.O. Health Director SS/smc cc: J. Whyman Construction File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 O NEW ENGLAND ENGINEERING SERVICES lk INC June 22, 2001 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 7 Sullivan Street,North Andover, Septic system design Dear Sandra: Enclosed are revised plans for the above referenced property. The following changes have been made. The numbers below correspond to the concerns in the consultants letter dated 6/11/2001. 1. The second sentence of note # 7 has not been removed. We do not guarantee the functioning of the system. We only design what the regulations require. 2. The rubber membrane is still on the plan. Title 5 allows a concrete wall or any other suitable engineering solution. These walls have been accepted by DEP on other designs. 3. Note 3 remains. See item#2 4. The septic tank sizing calculations have been revised. 5. The 12"maximum distance has been shown on the plans. 6. The contours have been adjusted. 7. The logs have not been changed. All of the material in question will be removed. 8. The soil class has been revised. 9. The D-Box has been to redesigned g show the 2 feet of level pipe on the profile. 10. The lengths of pipe and slope has been added. 11. The local upgrade approval form is enclosed. 12. The stamp is compliant. The discipline and registration can be written by the engineer. 13. The requested wording has been added under general notes. The 200 feet to tributary note was not added since the more restrictive local requirement of 325 , feet is noted. _ 14. The water line has been labeled as a pressure line 15. The soil evaluators certification is on the soil sheets. JUN 2 5 2001 16. The floor elevation of the garage and the material of construction have been added. 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 0 0 17. The invert at the house has been noted as was requested. 18. The riser notes have been revised to address this note. 19. The local variance note has been added. 20. The requested wording has been added. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. O d, Jr.,EIT President Q O NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nmOnetway.com Date: June 11, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/012 7 Sullivan Street Assessors Map 107B, Parcel 15 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated May 25, 2001,by New England Engineering Services, Inc. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws" if the following is addressed: 1) Remove second sentence of General Note 7. 2) Unless the designer can provide a D.E.P. policy statement, remove Construction Note 16 and all references to the use of EPPM rubber membrane. Current written policy only allows concrete or a 2 ft. thickness of clay, 10 ft from leaching area. 3) Remove Note 3 in local variance request. 4) Revise septic tank sizing calculations 2 x 330= 660. 5) Add maximum distance of tees in septic tank to inside wall. (12 inches max.) 6) Add proposed contours over leaching area to ensure 2% slope, 220(4)g. 7) First 3 ft. of test pit#1 does not match Board of Health log. 8) Revise soil class to Type II. 9) Revise D-Box location on plan and profile to ensure first 2 ft. is set level 232(3)c. 10)In profile, add length and slope of pipe from house to septic tank and septic tank to D- Box. 11)Provide local upgrade request form. 12)Endorse plan with compliant registration stamp,which identifies discipline and registration number. 13)Provide a note stating no tributaries within 325 ft., no reservoirs within 400 ft.,no tributaries to reservoirs within 200 ft., and no drains within 50 ft. to the leaching system. 14)Label water lines as either pressure or suction. 15)Provide soil evaluators certification 220(4)0. 16)Provide type of floor in garage and elevation. Land Surveyors Civil Engineers Environmental Planners 0 0 17)Invert at house should be 101.78 minimum. 18)Provide riser on center cover of septic tank to ensure 9-inch minimum cover over tank and no more than 6 inches over center riser 228(2). 19)Add local variance note for design less than 440 GPD.NA 13.01. 20)Add to note in profile that connected pipe ends shall be done using solid pipe. Respectfully, John L.Noonan, P.L.S.-P.E. G:office/formshonarev012 Land Surveyors Civil Engineers Environmental Planners 2 .. - fl O NEW ENGLAND ENGNIc EERING SERVICES May 29, 2001 Sandra Starr Administrator North Andover Health Department Town Hall Annex 27 Charles Street - North Andover, MA 01845 r Re: 7 Sullivan Street,North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of design plans, 1 with original signature. 2. Submittal form for approval. 3. Soil evaluator sheets. 4. Check to cover the fee. If you have any questions please do not hesitate to contact this office. Sincerely, Benja C. Osgow, Jr.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 o E Town `of North An` ov"r; Mas`sacfi setits Form Na. 1 s. a r :.:! '�f OR n BOARD'O H ALTH J �.Og SS,ED 6 ��SSa ."k. APPLICATION FOR SITE TESTING/INSPECTION cH s o Applicant NAME ADDRESS � ATE LEPHONE d Site Location _ at-It 'ILA Engineer ... . NAM . . AD DRESS TELEPHONE Test/Inspection Date and Time 164.0 .- _, w CHAIRMAN BOARD OF HEALTH Fee- . , Test Na. t rh S S Permit No / � D W:C. No. C.C. Date Plbg. Permit No. O BOARD OF HEALTH NORTH ANDOVER, MA 01845 . 978-688-9540 -ICEIVED APPLICATION FOR SOIL TESTS FEB 2 6 2001 t FIRTH H ANDOVER DATE: Z l 23) D 1 MAP &PARCEL: J .7 J-; �� T: .. ::�¢����Ic ;��� ,< N LOCATION OF SOIL TESTS: SfR E OWNER:CTEL. NO.: ADDRESS: 0c, Sfre e cc /1D f-17 t A7A.) e , ENGINEER: IUFVj F_,,u G-I-A,v,,-) i=�q„n ee 2&.e TEL.NO.: !17 S 17 6 �3 CERTIFIED SOIL EVALUATOR: c, C Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: ( _ Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Locition.of Testing 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.Q0 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,submztted 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. ,�ro 2QQ` Please Do Not Write Below This Line ^� N.A. Conservation Commission Approval: 7o l Date Received: Check Amount: Check Date: • Town of North Andover F „ORT., Office of the Health Department o? Community Development and Services Division ;, ^ y 27 Charles Street ' °4°� � • "° 4S North Andover, Massachusetts 01845 SACHUSE Sandra Starr Telephone(978)688-9540 Health Director Fax (978)688-9542 July 2,2001 Ben Osgood,Jr. New England Engineering 60 Beechwood Drive No.Andover,MA 01845 Re: 7 Sullivan Street Dear Ben: This is to notify you that the revised plans dated 6/21/01 for 7 Sullivan Street have been approved. The following local variances have been granted: 1. Reduction in setback to wetlands from 100'to 72'. 2. Reduction in leach field size from 900 feet minimum to 630 feet. 3. Use of segmental block wall with impervious liner instead of poured concrete. 4. Minimum design of 330 gallons per day instead of 440 gallons per day. Note:Proof of deed restriction prohibiting additions unless septic system enlarged or house connected to sewer. 5. Separation to ground water from 4 feet to 3 feet. If you have any questions,please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, f ,5 r Sandra Starr,R.S.,C.H.O. Health Director SS/smc cc: J. whyman Construction File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PL:A0NNrNG 688-9535 FORM 9B - LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts ' lllo eTl�f-�V b6V4C, Massachusetts LOCAL UPGRADE APPROVAL ISSUED PURSUANT'TO 310 CMR 15.404 & 15.445 Facility/system owner: Name:-1•W11N ) Address: Address of facility �506G/ZZM/ Type of facility: residential _institutional _ commercial school _ design flow per 310 CMR 15.203 3,3 b_gpd r <� J System designer: Nam c Address �j , / Phone No.&g�'f7 f c5 n Ora'�� Local Upgrade Approval granted for: i reduction in setback(s) (specify) i pert rate of 30-60 thin./inch (specify rate) reduction in SAS area of up to 25 (specify % reduction & size of SAS) l f i reduction in separation between P-1 SAS & high groundwater (specify reduction &pert rate) relocation of a well (explain) List local--variancesgranted (no DEP approval required per 310 CMR 45.4120)) List variances granted requiring DEP approval Board of Health Approval of proposed upgrade Q fik3 L o V� Name& Title /, / Signature � City/town / Dau THE SYSTEM OWNER OR OPERATOR SHALL PROVIDE A COPY OF THIS LOCAL UPGRADE APPROVAL TO THE APPROPRIATE REGIONAL OFFICE OF THE DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF WATER POLLUTION CONTROL UPON ISSUANCE BY THE LOCAL APPROVING AUTHORITY & BEFORE COMMENCEMENT OF CONSTRUCTION. i M"MOVFM FORM-Y2W/fs O NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice(978) 667-9736 Fax (978) 671-9565 Email: nm(a),netway.com Date Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 I-r 07 RE: Subsurface. Sewag isposal System Plan Review, / 471 --o- -2 1 --o--2 5✓LL1V'"N Assessors Map /070 Parcel �S Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated �,,111 ' z �', 7 Via/ It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the following is addressed: Y®V l'i�iJ ��c�r//ISG` /J -ice i�G G iC /- 47G� C-- C aN S j'8L V L%! �'v Cd c7 015r- /��,07 /�Ae, C- 7 -- _ 4w �7!�=T cls yv atr-.s 1 /e of iVC /J O ` Respecitfully, 4' John L. Noonan, P.L.S.-P.E. G:office/forms/tonarev Land Su eyors Civil Engineers Envir ental Planners 7-,'47 7-© -�vsr/mac �� o�= -7,00 er e411 r174 � � 7'a� //� �r/hrZ ��'—� 7i✓P�'"i�r mac.. � .� � %/ .✓� Iz� .i��I�P,riz �' Gv sT—isci�tJ �c.c�� �-- T— �/ � i 77[' 5�,,) Pic<IV 7-0 �/ �'��� 9 f O O CHECKLIST FOR NORTH ANDOVER N&M Job 1770SEPTIC SYSTEM PLANS / � � � The following is a checklist that incorporates all Title 5 and local regulations for septic plans. .iJdz*tJ &i G L�•'+�/� Name of Applicant: d, Aq/yhe-v tcrsuYr*&c. Name of Designer: 4!F-,Ve,/,V Plan Date: eo"V Ino 1 Revision Date: Date of Review: JBOHProperty Address: 5 Map: /07 r3 Lot: 15-- BOH Reviewer: Type of Plan(new pgrade . Number of Bedrooms in-Assesse-''-sRecQrds: gpd)Garbage Disposal Allowed: General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) �^ Legal boundaries of the facility being served-220(4)(a) Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.02i Name&address of record owner&applicant- NA 8.02k r-� Name&address of designer-NA 8.021 �- Holder and location of all easements-220(4)(b) a Date plan drawn&any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) All distances on site plan-NA 8.03a-c ek- Elevation of proposed driveway-NA 8.02t G—' Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system incl.?terve-(nom const.)-220(4)(e) Limits of excavation of leach area on site plan-NA 8.02z Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) /�9#0i Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) L'- Existing grade elevation of each deep hole-220(4)(h) ✓ F4evaition of percolation tests-N.A. 8.02n G� Na ire orapproving authority representative-220(4)(h)&(i) �p4&-we' Name of soil evaluator-220(4)0) 7-17# / - _ Soil logs and t logs match BOH records �I fn s ��`�" Locations aterlin ;drains,and subsurface utilities-220(4)(m) Observed an a ' sted g.w.elevation in the vicinity of the system-220(4)(n) Complete profile of the system to scale-220(4)(o),NA 8.02c c Cross section of leaching facility-NA 8.02w (Not to scale) Location of benchmark(s)within 50-75 feet of facility-220(4)(q) o Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) �- Original R.S./P.E.stamp,signature&date-220(1)&(2) f Z If P.E.,discipline specified within stamp. MGL C. 112 s. 81M sfc.supplies(w/in 400');pub.wells(w/in 250'),pvt.wells(Win 150')-220(4)( Gam' Location of watercourses,wetlands,wells,etc.w/in 150'of system-NA 8.02r Wetland disclaimer-NA 8.02s y� RLS plan reference&certification required(prop line setbacks)-220(3) Plan contains designer's certification statement Use approvals/standards checked for I/A system-DEP docs., i 2 �PrP rc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&(13) rc rate>60 MPI-must use modified tight tank or IIA technology-245(4) oposed system qualifies as"shared"system-002(definitions) t Flow is over 2,000 gpd-No R.S.allowed-220(1) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment-354 Leaching facility at least 1' above Base Flood elevation—NA 9.05 All piping Sch 40 minimum—NA 10.01 Basement floor minimum 1' above groundwater elevation—NA 5.04 Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK Prpblem N/A Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown,including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(i) 7 Ample deep observation holes in primary disposal area(minimumm 2)- 102(2) Ample deep observation holes in sec 102(2) Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: ground elevation el. ��- acceptable soil el. Gr i Leach facility invert el. I ground water el. G� refusal el. bottom of leach facility el. thickness of acceptable soil before&after soil R&R separation to groundwater �^ 1 separation to refusal soil class - j't perc rate F/ loading rate septic tank below g.w.table � (yes or pump tank below g.w.table (yes or no 11 in fill ei" -255(l) Setback Distances(Given in feet) 15.21 1 YES NO Is the lot in.the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility �— Property line 10 10 Cellar wall 10 20 2 r d3 Inground pool 10 20 j Cin• b Slab foundation 10 10 Deck,on footings,etc. 5 10 S Waterline. 10 10 Private drinking well 75 100 ✓Irrigation well 75 100 Wetlands 75 100 f-�Public well 400 400 — Wetlands bordering surface 150 150 water Supply or trib.(in Watershed) Trib.To Surface Water supply 325 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains(wat.supply/trib.) 50 100 - Drains(intercept g.w.) 25 50 Foundation drains 10 20 Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) v Pipe cast iron or Sch 40 PVC-NA 11.02 Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) , Pipe laid on continuous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) Cleanout provided every 100 feet-222(8) �— Manhole at any 90 degree alignment change-222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) 3 4 b Septic Tank OK Problem N/A Tank is accessible-228(3) No structures above tank=(228(3) Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) 2-3"drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) �T— 3"air space above tees/baffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6"above flow line-227(1) Inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 compart)228(2) 3-20"manholes-228(2) 1 childproof,24"riser/manhole Win 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) (/ Soil compaction below tank specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath tank specified-221(2)&22 8(1) If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp.-223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart.tank-223(1)(c) Buoyancy calcs.required if tank at or below water table-221(8) Tank is watertight-221 (1) ' 9"of cover over tank(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(3) Top of tank<=36"below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible Distribution Box(Check here if not present: ) OK Problem N/A _ Inlet elevation: �i Outlet elevation: 0.17'drop from inlet to outlet(minimum)-232(3)(b)' 6" sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b) Outlet pipes laid level for first 2 ft.-232(3)(c) Pipe Sch 40-NA 10.01 Number of outlets: Number of laterals: Size of outlets: �.� Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6"of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36"below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8). Pump Chamber(Check here if not present: 1 OK Problem N/A Volume specified- 220(4)(r) Pump goation- 220(4)(r) p off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box) Minimum 2"delivery line to d-box if gravity-254(1)(c) 4 O 0 5 1 Press so ed l.f.if flow>=2,000 gpd-254(1)(a)&254(2)(a) c es per day is consistent with chamber volume-231 Volume calculations include flowback volume-2') 1(2) 24 hour storage capacity above p p on elevation-231(2) Number of pumps: system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4" olids(minimum)-231(7) Pump controls s 'fled-220(4)(r) Alarm equi ent specified-231(2) Alarm i i building and powered on separate circuit frn�pump-2') 1(9) P sequence correct(off-lead on-lag on-alan-n -231(8) p performance curves included-220(4) Manual operating switch-NA 12.01 Check valve,bleeder hole-NA 1 1 childproof,24"riser/manh to final grade-2'31(5), Soil compaction benea ump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone b eath chmbr.specified-221(2)&228(1), Buoyancy cal ations if chamber is at or below water table-221(8)@ 9"of covqKover chamber(minimum)-228(1) H- 10 -ading(min.)-H-20 if traffic-226(')), Ch ber is watertight-221 (1) Top of chamber<=36"below grade-221(7) Leaching Facility(general-complete for all designs) OK Problem N/A —50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) No vehicle or imperv.area above 1.£unless unavoidable-240(7);NA 13.02 Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9"cover over peastone-240(9) ice"Reserve area provided(new construction)-248(1) v Reserve 4' from primary leach area—NA 9.04 i/ 4'(5'if perc rate<=2 MPI)separation to g.w.-212(a)&(b) 5 4'(down to 2'with variance or UA-upgrades only)of natural soil under It GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 -251(9) Require 5'removal and replacement if in fill-255(5) L-- Top of leach facility<=36"below grade-221(7) L^ Final grade over l.f.minimum 0.02 ft/ft-240(10) v Surface&subsurface drainage away from l.f.-240(1 1)&245(5) --- Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) v Toe of fill slope stops 5'from property line or swale installed-255(2) -- Impermeable barrier if<3:1 slope or< 15 feet to—3:1slope-255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E.-255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret.wall-255(2)(g) Perc test(s)done in most restrictive layer- 104(2) Perc test 4' below leaching elevation—NA 7.06 Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4"diameter except for dosed system—NA 14.04 Leach lines capped,vented,or connected together-251(9) L--Pressure dosing guidance followed if pressure distribution-254(2)(c), ---,-----Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) 5 O6 Leaching Trenches(Check here if not present: ) OK Problem N Number of trenches: Minimum of 2 trenches-NA 9. (2) Dep of trenches(max eff. -247(l) W' th of trenches(2'min. 'max.): -25 /(1)(b) ngth of trenches(10 'max.): -25 (1)(a) Trenches are vented hen>50')-251 (11) Trenches follow c ntour lines-251(2) Trench spacin times effective width or dep minimum-251 (1)(d) In fill or res a between trenches, 10' min. NA 14.01& 14.03 Available ac h area given(Min.500 s .f. -NA 9.01(2) Bo om=L x W X# — s.f. idewall=L x D x# x 2= s.f. Eff ctive leach area given Loading factor: Effective area=total a s.f. x LTAR = g/day Effective area is>=desi flow of facility being served 2"of 1/8"- 1/2"2x was d peastone.-247(2) Trench depth of 3/4"to 1 1/2"double washed stone-247(1) Leach Fields(Check here if not present: ) OK Problem N/A Number of fields: (need dosing chamber if> 1,231 (1)) Length(100'max.): -252(2)(b) Width: Total area:L x W = s.f. Minimum 900 square feet-NA 9.01(l) -- Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: Effective area=total area s.f x LTAR = g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) } 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(f) Between 6"and 12"of 3/4- 1 1/2"stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2"2x washed peastone.-247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feet/foot—240(10) _",,,,Grading shall divert drainage away from leach area—240(11) Grading slopes away from dwelling 5/24/01 f:/office/forms/tonackltr.doc 6 o Project Request Record Town of North Andover Date: O Client Id:ToNA Card Id:ToNA Client/Company Name:Board of Health oC�ntact_Name_ Ms:Sandia Title_Director -- State Ofher contacts�f applicable a En mee Installer Fax:. - _Address Project: Project Id: 1770 Project Title: Town of North Andover,Board of Health (JOB NO) (PROJECT NAME&STREET ADDRESS) Manager:NOW Billing Group: f 2- Billing Code:Fixed Fee, S4 Contract-fnfo Project Descnptton for each billing group;= --- = _ BG/=ll'r Applicant J:#=—' — _ - Asses-"sors=Map t4 7-13I:bt_.— TypeAf ser,:�tce - _ - - . Office/forms/jbrqutona 12 FMS-Noonan McDowell, it 'Edi Toad Data Ma�'utirr `Pr 6 i Re dr,' !H W d BillingGroPEE ups Pttt' 1770 INa attf�i e a ¢ ar ' i T�f Fixed Fee W. 1} 150.00 ToNA , a ra b b • Gtrac DaterF T, 6/712001 w U6�ar Sta Dat 6/7/2001 f : -�t` F ni t 1 I �• mo I � Survey engineering services required for plan.review. m / Engineer: `L �? New England Engineering_ 3 60 Beechwood Drive No.Andover,MA 01845 `; Applicant: J.Whyman Construction ' i 7 Sullivan Street,Assessors Map 1078,Lot 15. 017 to rzI mmil I Town of North Andover, Massachusetts Form No.2 o� A0*T►14 BOARD OF HEALTH r ._:r. AL � w DESIGN APPROVAL FOR • *.fib++ro•��� ss"CHUsft SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. : Site Location • Reference Plans and Specs. • a E N GI NEE DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. 7 • CHAIRMAN,BOARD OF HEALTH • /� 4 Fee Site System Permit No. O 0 SEPTIC PLAN SUBMITTAL FORM LOCATION: 7 NEW PLANS: YES $160.00/Plan REVISED PLANS: $ 60.00/Plan 620 SITE EVALUATION FORMS INCLUDED: YES No DATE: 61z', DESIGN ENGINEER:// DATE TO CONSULTANT: w� When the submission is all in place, route to the Health Secretary. -� rN&M Job number 1770/ O Y TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Site: 7 5 c1 z- e-- Final Date: %;�r Installer: �l �V N y.�.f-� Tel: 7e'-5� 19- —2,3 Z' Date Yes No Initials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. Comments: (Use back of sheet for diagrams.) B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leachingfacility ty 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Inlet to tank cemented �A. 4. Slope minimum 0.01 or 1/8"per foot minimum 5. Pipe properly set on compact firm base 6. Pipe laid on continuous grade in straight line 1 7. Cleanouts precede all change in alignment and grade 8. Manholes at any 90°change i 9. 10'minimum offset to water line Comments: D. Septic Tank � 1. Level ✓1 "'-Lz - __f2 ��v�. 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to w/in 6"of grade - 5. Manholes over center and each tee 6. 3-20"manholes z_--- 7. Outlet line cemented �-- 8. 2"-3"drop from inlet to outlet 9. Pipe set e/ 10. Compact base with 6"of 3/4"crushed stone under tank -�- 11. Tank is watertight �- 12. Tees 12"off side of tank �.� 0 0 N&M Job number 1770/ Date Yes No Initials Comments: E. Pump Chamber 1. If separate from tank,compact base with 6"of/e"stone underneath 2. Minimum 2"pipe to d-box if gravity system 3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size agrees with.plan specification 7. Manhole to grade.-' 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm fiiiictions 11. Manual operating switch 12. Pump delivers liquid to d-box/ Comments: 9 / s F. Distribution Box �• _� !�� 1. D-box level L� 2. Minimum 0.IT'(2")drop from inlet to outlet 3. Minimum 6"sump M 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement —� 8. Schedule 40 pipe 9. First 2' from box laid level Comments: G. Soil Absorption system Ila 1. All stone double-washed–%"–1 'V' r pea stone a► Bucket test done9 r 1 2. Minimum 2"of pea stone above distribution lines �► 3. Minimum 6"stone beneath pipe -- ) 4. Distribution lines capped or connected together v--� 5. Toe of slope stops minimum 5' from edge of property; 5a. if not,then swale. Comments: _ 'S J?'Js�/ � ,f�/,c.z"'� --'_ ���`"�f�-J/V /��z�Q CJ � •7-J` I { I r a � .N&M Job number 1770/ f. Date Yes No Initials H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agrees"with plan. (Max.,l gth 100') 3. Width of trenches agrees with plan-Mirfimum 2';maximum-4'. 4. Vent present if;4 feet or specified ,.^~ 5. Minimum di9tance between trefiches 10' 6. Pipe slol5e'minimum 0.005`or 6"per 100' / 7. Depth of trenches below outlet invert minimum of 6". 8. Pipes set on stable base. . Comments: I. Leach Field 1. Maximum length of field 100' / `�' 7 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipes 6'maximum 4. Pipes connected at end&venfend raised 5. Separation between adjacent fields 10'minimum " 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines Comments: J. Leaching Pits 1. Minimum inlet pipe 4" y 2. Pits of concrete 3. Sidewall between 12"an148", ide 4. Access manholes on each,prt 5. Pipes cemented hydraulic cement -�'• 6. Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 6. Grading meets 3:1 slope 7. Minimum of 9"of fill graded over system I i NEW ENGLAND ENGINEERING SERVICES INC May 29, 2001 Sandra Starr,Administrator North Andover Health Department Town Hall Annex { 27 Charles Street North Andover, MA 01845 Re: 7 Sullivan Street,North Andover, Septic system design ~ Dear Sandra: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of design plans, 1 with original signature. 2. Submittal.form for approval. 3. Soil evaluator sheets. 4. Check to cover the fee. If you have any questions please do not hesitate to contact this office. Sincerely, 13, �.. Benja un C. Osgo , Jr.,EIT President �I I 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 SEPTIC`'PLAN SUBMITTAL FO Q ? LOCATION: 2 NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan t SITE EVALUATION FORMS INCLUDED: YES NO DATE:_-;')Z-yl;.)l DESIGN ENGINEER: G- DATE TO CONSULTANT: f *If you want your plans expedited, please submit three 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. 2 t ,:•.>i:?;l;oft.i:,?jtp,i,�,�,.,.14..f�.y>2f,,;,i1(12.,>?!�•„?,?.2.,•..,.2.... s,>...,,,s's`;>ii8?....u(>h(,,.(...2�(.............:>(!?::f,ii+'• :<.. ,{ �•127(',1'` ?i i:`i i-� 'i2: ,.2.2':`x;:?j;<t;. i>2;:. .a3ia•;+>2.:.; .3at.(,giSKi>y12�113jt?t�,liiiao(>i>i>t>oi+ _ ( ��`:i:?t.2,!•2,.ii.2>tr_,2$2?;>.,.i... 2.• .. .. .. v ti N(-I ONA 9 N & Mc DOWELL, ZINC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: mm�a,netway.com Date: June 11, 2001 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/012 .7 Sullivan Street Assessors Map 107B, Parcel 15 Dear Members of the Board, Please be advised that Noonan&McDowell, Inc. has reviewed the plan dated May 25, 2001, by New England Engineering Services, Inc. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health`By-Laws"if the following is addressed: -'-T-)--Remove second sentence of General Note 7. �lnless the designer can provide a D.E.P. policy statement, remove Construction Note 16 and all references to the use of EPPM rubber membrane. Current written policy only allows concrete or a 2 ft. thickness of clay, 10 ft from leaching area. L,--31--Remove Note 3 in local variance request. `,,4y"Revise septic tank sizing calculations 2 x 330 =660. ,!, i5j--Add maximum distance of tees in septic tank to inside wall. (12 inches max.) Add proposed contours over leaching area to ensure 2% slope, 220(4)g. G/ First 3 ft. of test pit#1 does not match Board of Health log. 8) Revise soil class to Type H. 9) Revise D-Box location on plan nd profile t6'eijvsure first 2 ft. is set level 232(3)c. k,,10SIn profile, add length and slope of pipe from house to septic tank and septic tank to D- Box. (tel<Provide local upgrade request form. , dorse plan with compliant registration stamp,which identifies discipline and registration number. 13 de a note stating no tributaries within 325 ft., no reservoirs within 400 ft., no tributaries to reservoirs within 200 ft., and no drains within 50 ft. to the leaching system. L,447Eabel water lines as either pressure or suction. v1-:5'yProvide soil evaluators certification 220(4)0. c--4,6-Provide type of floor in garage and elevation. Land Surveyors Civil Engineers Environmental Planners tiO L14nvert at house should be 101.78 minimum. Provide riser on center cover of septic tank to ensure 9-inch minimum cover over tank and no more than 6 inches over center riser 228(2). _ . 9)Add local variance note for design less than 440 GPD.NA 13.01. L_20)-�Kdd to note in profile that connected pipe ends shall be done using solid pipe. Respectfully,, John L. Noonan, P.L.S.-P.E. Qoffice/forms/tonarev012 Land Surveyors Civil Engineers Environmental Planners 2 1 I -01 LC) ^ -ION: z-.. L=i ION I i = I iNIE =. i IiNIcI ,p C- T Iii =.I IN iiNl TIME A t I INi` .^. i 71 -)IN - I •- SIN! � p� �L1 i7?, IS I -- - - l -^I I IN - DC i 1 1 111 111 1 Illnl • i���, / r n 1 Illllnllllllll � ,��,� 111 111 n 1111111 ;��- - _ �' � 11� �' i �` •11� �. 1 IIIIF� �C1�11 ��� .• 11 nl � �, rmlll u■1 1 111 111 1 �- �pi- ME1111111111i a O FORM 11 - SOIL, EVALUATOR F OIZNI Page 2 of 3, Location Address or Lot No. ����e/ 9n-site Review r Deep Hole Number Date:. 3 /�� Time:/er-1 Weather/��d a Location (identify on site plan) _am? T.,..-„ Land Use .; ... f ? L.. Slope (%) . ... .. . Surface Stonesw. Vegetation Landform ...::. .... ...-.: ... .�.,.... �Jd � ,� .... Position on landscape (sketch on the back) Distances from: - Open Water Body ��'� feet Drainage way feet Possible Wet Area ��a, feet Property Line :.. feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG' Depth from Sail Horizon Sof(Texture Sall Color Soil Other Surface(Inches) (USDA) (Munsell Mottiing (Structure,Stones,Boulders, consistency, % Gravel) vY Parent Material(geologic) C-► Depthtot3edrock Depth togroundwater" Standing Water In the Hole: `— Weeeping from Pit Face: . Estimated Seasonal High Ground Water; DEP APPROM FolNi•12/07/95 0 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. �� �l/LG/�r�/ S?' AIO,11A.D�,�ap, On-site Review / a Deep Hole Number .,27 Date:.� Time:/��-� Weather �2O Location (identify on site plan) Land Use .._. . moi/..: G.. Slope (%) . ..Z Surface Stones .. ... Vegetation . !/�� ... .. . .. ,. . Landform ...:6r!'S`�..... �T .t/E-.-:..: :. ...... ....... . ... . ... Position on landscape is ketch on the back) Distances from: open Water Body feet Drainage way .75�' -.: feet Possible Wet Area 9a. feet Property Line .,3 .. feel Drinking Water Well '' 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, % Graveq !2� ZyGv �L Jr�7-v47- �-•✓ T� �=S Parent Material(geologic} La'Q'S 77 t,L. DepthtoBedrock. peath to toundwater; Standing Water in the Hole: 0 Weeping from Pit Face: Es>limated Seasonal High Ground Water: DEP APPROVED FORM•12t07r95 VOM 11 - SOIL EV ALUATUIJ V©RNI Page 3 of 3 Location Address or Lot No. ` Det rminat�'on or Seasonal fli h Water ?"able Method Used: EJ Depth observed standing in observation hole................... inches ❑ Depth weeping from side of observation hole............ .... inches Depth to soil mottles ✓..: inches -70"/ — ,ova, ❑ Ground water adjustment ................. feet 6e y Index Well Number .................. Reading Date Index well level Adjustment factor................... Adjusted ground water level ..................... Depth Qf Nalgrally Occurring Pery us er' t Does at least four feet of naturally occurring pervious material exist in so areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? _ Oertification { certify that on (date) I have passed the soil evaluator examination approved by thekepmentofEnvironmental Protection and that the above was performed ve analysis m s p ed by me consistent with , y th the requJced training, expertise and experience described in 310 CMR 15.017. Signatur �! Date o� DEP"PROM FORM-12107/9S 0 FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 . Date: Commonwealth of Massachusetts Massachusetts soil Sattabzlzty Assessment for On rite Sewage DisnosaZ Performed By• . �,r,� .. ............................. ....... . Date: � Witnessed By: ............ 1 r �.... ..... ......... ....... TZ�, ........................................... L«aciaa naarua a /!LG/ �� owe.,:wft. nddrut.and Tckphow ew Construction ❑ Repair C� Office Review Published Soil Survey Available: No ❑ Yes Q Year Published I`R�l.............. ./,�' p Publication Scale �.,. lG�Gx.. ............... . Soil Map Unit Drainage Class ................... Soil Limitations Surficial Geologic Report Available: No •Q Yes ❑ Year Published --, Publication Scale Geologic Material (Map Unit) . ....................................... ........ ........................ Landform � .. . ............................................. Flood Insurance Rate Map: ................. ..._ _._..�. . Above 500 year flood boundary No ❑Yes �] Within 500 year flood boundary No EJ Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit y ........... Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal RIBelc �N . ormal ❑ Other References Reviewed: DEP APPROYM FORM.11/07/93 f r O FORM 11 - SOIL EVALUATOR FORM Page X of 3 No. /JK Date: v Commonwealth of Massachusetts Massachusetts Soil itabWN Assessment for On-site Sewage 13isnos rr Performed By: .......... ................ .... ...... , � Date: Witnessed By: ................ G 'r ....... Tz .... .......................................................................... . ......... L=tioa Add=or `•°" nlm. �,vr��-2, �lhr AECrai.and Ttkphom ew Constructlon ❑ Repair C� Office Review Published Soil Survey Available: No ❑ Yes ❑ Year Published .............. Publication Scale Soil Map Unit Drainage Class ...... Soil Limitations ®.:7 ..•. -�� ........,rad?....................... Surficial Geologic Report Available: No 10 Yes ❑ Year Published Publication Scale Geologic Material (h1ap Unit) . ......................................... Flood Insurance Rate Map: _................................................... ....... ............................................ ..._ _._.�.... Above 500 year flood boundary No ❑Yes 21 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 2113elcn Normal ❑ Other References Reviewed: DEP APPROVED FORM•111o7/93 . FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot No. 17 C/ JCIB• ,l�,v l)m�/, , _On-site Review Deep Hole Number �. . Date:. Time-J. .' Location (identify on site plan) :. 11-10'r -. .: Land Use . ?Nf %`L.. Slope (%) . '�.... Surface Stones 'cw:.. ... Vegetation .. ... :Gf� lam• . . .:... . .,.,,. w. Landform -.. .. Position on landscape (sketch on the back) Distances from: 0 Open Water Body ��'� feet Drainage wa . P 9 Y feet Possible Wet Area feet Property Line ., :.. feet Drinking Water Well feet Other .. DEEP OBSERVATiON'HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (MunselO Mottling (Structure,Stones,Boulders, Consistency, % Gravel) 3e Parent Material i4eolooic) Depthto8edrock• ` Depth to Qroundwater: Standing Water in the Hole: `— Weeping from Pit Face: . _ Esornated Seasonal High Ground Water: DEP APPROVED FORM-12407/95 0 0 FORM 11 - SOIL EVALUATOR b'ORM Page 2of3 Location Address or Lot No. -7 Location �!/�G/ /�✓ 5?' /�10,,�,4Pck!5 On- ate Review ��/�/ /o' � �i2 804' Deep Hole Number ., Date:. . Tama: . �... Weather , Location (identify on site plan) ...:. '-7 ..,.....:..� .,.....w _.. Land Use Slope M . .,- 7 Surface Stones .. .., Vegetation :......: ..:...:.. . .... Landform Position on landscape (sketch on the back) ....., ��. .:. �� �_. . Distances from: Open Water Body .� feet Drainage way feet Possible Wet Area feet Property Line .,---F 5- . feet Drinking Water Well �77 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, % Graveq Parent Material(geologic) LDepthtoBedrock: Depth to Qroyndwater: Standing Water in the Hole: T_ 90 Weeping from Pit Face: ,�Jr Estimated Seasonal High Ground Water: DEP APPROVED FOPM•12107195 A Q O FORM 11 - SOIL EVALUATOR ROPM Page 3 of 3 Location Address or Lot No. Jap, moo _ Determination for on .high Water fiable Method Used: ❑ Depth observed standing in observation hole................... inches ❑ Depth weeping from side of observation hole............ .... inches Depth to soil mottles .......✓..: inches -;o-/ — '0�, — --5-1 ❑ Ground water adjustment ................. feet - Z — 6e v Index Well Number ................. Reading Date ................. Index well level Adjustment factor................... Adjusted ground water level ........................................................ Depth gf N rail ccurrin Egry jQusJ0A1e jrp t Does at least four feet of naturally occurring pervious material exist in aU areas 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 (date) I have passed the soil evaluator examination approved by theAepns of Environmental Protection and that the above analysis was performed by me consistent with the re u' d training, expertise and experience described in 310 CMR 15.017. Signatur �! Date m UMP"PROM FORM.12107/95 - 1 NIII 11 11 N 1111 � IIIIInI11 WINE MWI ' y -� , 1 INIIIN NIElm IIII IN 1 NIn 11111111111111 ��� � ;� ..� l InlNMINE MINI �� HEM 1 111111111 1111 . 1 1111 NilllN � 1 1 11 1 =NO111 _ - N111 n 11 111111 �MEN 011111 - 1 III N 1 IIIN VIII -r a ., 11 H. 11111111 _,► III �,� �� ►::' 1111 in I INI IIIIIIINICIN1 ��_ t 1 11111 nlll 11 111111 1 MRRNNN�, NNRNNN� 1' IN n 1 111 111111 1 SEE� Nmn 11111111111111 r 11 IINII 111111 � - ' IIIIIINIINIIIIIIINI ' ' � 1 1 11 IINNINIIIIII 1 1 N IIIIIIINIIIII p� N IIIIINI Ilin SWIM 1 1 1 1 11 11 1111 .. 1 1 1 1 111111 ' iW N n 1111111111101 011111 1 1 11� 111 1111 ��1� j 1 C ► , IUPIIIIn 1 1 ���111 1111111 � 111111 E 1 N 1 11 EIRON 11 1 1 11 111111 �, � o u.11 11 111 111111 1 1� 111111111111111 ,� �� _ } a j,. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 2) 236•C'1 MAP &PARCEL: J U -7 f� I LOCATION OF SOIL TESTS: u a o O WNER:C6AwcC" RCu.-, T(�u m&c TEL. NO.: ADDRESS: ock^ e cc -7 No/1-77-( -,y-C>22If 6A ENGINEER: /U�:W TEL.NO.: !E1 7,3- CERTIFIED SOIL EVALUATOR: Ph' OL C c�o� J2 Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: ( Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$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 up rg ades. 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). 160F�`?: "M 7. Within 60 days of testing soil evaluation forms shall be submitted. ,L 6 TO -eck Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: 0 Town of I ,hh Andover, Massachusetts Form No. 1 }NORTH BOARD OF HEALTH 3�0 ��Eo bgti�L �j '� 19 APPLICATION FOR SITE TESTING/INSPECTION �9SSACHUS���h Applicant /-' �.1'��;: 10 NAME ADDRESS TELEPHONE Site Location Engineer I !%�'� I's. %�� .V11i 74- �a NAME .j /J ADDRESS / / TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH l Fee / `� Test No. / S.S. Permit No./�!� D.W.C. No. C.C. Date Plbg. Permit No. x y BOARD OF HEALTH � 1 NORTH ANDOVER, MA. 01845 978-688-9540 '." EIVE APPLICATION FOR SOIL TESTS FEB 2 6 2001 i P'rr RTH ANDOVER DATE: 2) 23� D 1 MAP &PARCEL: :v,a= va�Tiosv coMng4r,�tf, LOCATION OF SOIL TESTS: oa✓j 54Z E OWNER:(!: r65�we� I�cu, TEL. NO.: ADDRESS: {{1;yck^ S-1-re e cc /1/� 6 jrt A—.cJ z>,`-,.l P/1 ENGINEER: /kyj i,j 6A-AN o &'4a 1 Vn ee 24.y4 TEL.NO.: 972- (_-)P G-17 6 E CERTIFIED SOIL EVALUATOR: CJcz- Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: ( Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$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 besubmitted to:the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line rl N.A. Conservation Commission Approval: Va o/ Date Received: Check Amount: Check Date: r � t D GA i . t,JB. 0 COMMONWEALTH OF MASSACHUSETTS C-0 ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Al V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_7 Sullivan Street _North Andover_ Owner's Name: Kevin Travers_ Owner's Address:_7 Sullivan Street _North Andover Ma. 01845 Date of Inspection:2/13/2001_ Name of Inspector: Neil J.Bateson Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority la-i lsInspector's Signature: ! Date: -2/13/2001` The system inspector shall submit a copy this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 'Notes and Comments CP ****This report only describes conditions at the time of inspection and under the conditions of use at that p time.This inspection does not address how the system will perform in the future under the same or different conditions of use. o Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i Property Address: 7 Sullivan Street _North Andover— Owner: Travers Date of Inspection: 2/13/2001_ 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: o 0 Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 Sullivan Street _North Andover_ Owner: Travers Date of Inspection: 2/1312001_ 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 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 su_rface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 0 0 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Sullivan Street _North Andover— Owner: Travers Date of Inspection: 2/13/2001_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`�no"to each of the following for all in. Yes No _Yes_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool T No Liquid depth in cesspool is less than 6"below invert or available volume is less than%z day flow No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. o 0 Page 5 of 1 I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 Sullivan Street _North Andover— Owner: Travers Date of Inspection: 2/13/2001_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ — Pumping information was provided by the owner,occupant,or Board of Health No_ Were any of the system components pumped out in the previous two weeks? Yes _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? N/A _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Yes_ _ Was the facility or dwelling inspected for signs of sewage back up? Yes — Was the site inspected for signs of break out? Yes — Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No N/A _ Existing information.For example,a plan at the Board of Health. _Yes_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] o 0 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 Sullivan Street _North Andover_ Owner: Travers Date of Inspection: 2/13/2001_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): N/A_ Number of bedrooms(actual):^3_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_N/A_ Number of current residents:_4 Does residence have a garbage grinder(yes or no):—Yes— Is es_Is laundry on a separate sewage system(yes or no): No_ [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no):_No_ Water meter readings_March 99 to March 00=34,400 fe x 7.5=258,OOGals.1730 Days=353 Gals./Day Sump pump(yes or no):—Nom- Last o_Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped 1991,owner._ Was system pumped as part of the inspection(yes or no): 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) _Tight tank _Attach a copy of the DEP approval X Other(describe):_Septic tank to single trench._ Approximate age of all components,date installed(if known)and source of information:_House built 1850.Septic sytem age unknown._ Were sewage odors detected when arriving at the site(yes or no):_No O O Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_7 Sullivan Street _North Andover_ Owner: Travers Date of Inspection: 2/13/2001_ BUILDING SEWER(locate on site plan)X Depth below grade: 24" Materials of construction:—X—cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"cast iron thru wall.3"PVC in house. No leaks._ SEPTIC TANK: X locate on site plan) Depth below grade:—12" Material of construction:—X—concrete metal fiberglass__polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: T x 5'x 4' Sludge depth 6" Distance from top of sludge to bottom of outlet tee or baffle: 21" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle:—8"— Distance "Distance from bottom of scum to bottom of outlet tee or baffle:_15" How were dimensions determined:_Subtract scum&sludge depth to tee length. 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 baffle ok.Outlet tee ok.Depth of liquid above outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction: concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 0 Q Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_7 Sullivan Stmt North Andover_ Owner: Travers Date of Inspection: 2/13/2001_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow:^ gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_(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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 0 0 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Sullivan Street _North Andover_ Owner: Travers Date of Inspection: 2/13/2001 SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: X leaching trenches,number,length: One trench 70'long._ 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.):_Sign of hydraulic failure.Camera leach fine.Found leach pipe full of water.Excavate hole at end of pipe found water above invert&stone. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): o o Page 10 of 11 ti OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_7 Sullivan Street North Andover_ Owner: Travers Date of Inspection:_2/13/2001_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Septic Tank 70' Test 3 2 1 Hole A C D Garage Water Meter B Rouse Driveway Ato1=9' Ato2=11' Ato3=13' Bto1=41' Bto2=42' B to 3=42'6" C to Test Hole=34'7" D to Test Hole=10'10" Q Page 11 of 11 ti OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_7 Sullivan Street _North Andover Owner: Travers Date of Inspection: 2/13/2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water >6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain:_Essex County Soil Map._ You must describe how you established the high ground water elevation: Essex County Soil Map. Sheet#36. Charlton Soil.Water>6'Deep. ' Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 11 I Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 7 Sullivan Street, North Andover Owner: Travers Date of Inspection: 2/13/2001 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc.