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Miscellaneous - 793 FOREST STREET 4/30/2018 (4)
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I U N � I ti y I •ca 1, � I I � ICI i of �• O �I yip Cl ' zl� �i� RIS bl �iVl c cl � 31a,a' Qla'A O C I E O p a� tn O 00 O � zcd C o d y _IA o ti y A U .7 0 O C O p U y a�c o •� ami c a m O O O C Lr -y 0 E m L � o_x c ej o � � a O Q C � a Op O n v, Y y 0 G 0>U M 00 00 G C 0 > > U r C, m a� o �•°o � G C y U a 3 E D U N O (, C,H U oo 00 0 O z •w m R, i 0 0 v PHONE CALL A.M. FOR DATE TIME P.M. d PHONED, O F p�^-� �y b PHONE 5 O 6074c/ :�YbmcALL AREA CODE NUMBER EXTENSION PLEASE CAL MESSAGE �L AGAIN ILLCALL _ TS TO SSI NED �nive'S51 48003 1-4 t �V N A c.i 4 c 3 I w 0 y 0 O m a I i z I zl y xo� o Iww�w�l I a�z°`zj I L v I I oI I I ��.]I •�I I I L � N II I G. CaIG.A��3wa:l I pl I T � Qi I v� I oo z ° �y eCI�I OO O fs,G71I�ia!N!�LL) o l 3 I w 0 y 0 O m a N M O O N C4 c.i d 3 O r It rr� _1 r 0� Q 00 0 0 0 z d J a 0 U w o� r� I — W O U� a L O 3 I 0 C I 0 'a �L u , O N d O 0 .O N L � a I L i u , C Q U I L O d L O 3 w I o I, Q °z 7 I o � N Q d � U c ,o I o � o �= c. o a m i U � cO L .a � Q � U h � o o o ConU d C7 N M ti O O N t I w, O II �. a C J c I 3 I o i 0 c 0 � •L U y ti y d I y I � .0 wO c O = d o 3 n o N �• c, I Q C C R o a.. ? v L y ob o ` •: U ¢ N L C O U •D Y L a I C 0 o 0 z Lti CO Q � U] z y 0 � r 0 o C m x r = rpm � 5 cn o = r, oo -� 0 53 N 7 I o aC U �� •� N d I O 4? /yU r'Yj O 0 U avi Q E o cD v � � a°' C7 00 0 0 R a Lot &Street Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit#_ Plan Approval: Date:/ZDI Approved by: Designer: fipboyc-Z- 6p,U6U[Ti4,c )T Plan Date: IJ_ z j99 Conditions: WVMAr ,z MAI,*-) %6 &C--/4)5,7W46L-30`x, Waz6 I97- 76- aW ZV197&1�f 72gE; �D,6'5r- -D&k',7 /j50 Water Supply: Town Well Permit: Well Tests: Chemical Bacteria I Bacteria II Plumbing. Sign -Off: Comments: _.Driller: Date - Approved Date -Approved Date Approved Wiring Sign -Off - Form "U" Approval: Approval to -Issue: YES NO Date Issued By: Conditions: Final Approval: .All Permits Paid? Well Construction Approval? Septic System Construction Approval? Certification? Other l Any Variance Needed? FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: YES NO YES NO YES NO YES NO YES NO YES NO s SEPTIC SYSTEM INSTALLATION Is the installer licensed? Type of Construction: YES NO New Construction: Certified Plot Plan Review ��EW REPAIR —Floor Plan Review YES NO Conditions of Approval from Form U YES YES NO _Issuance of DWC permit. - :3,g�5s I -10A)6 �" YES NO _.DWC Permit Paid? �O --DWC Permit # - YES NO. Installer: — -----_ .. Beg-nInspection:_ _ YES NO _.-E.Ycavation Inspection: —Needed: Passed: By: _._Construction Inspection: Needed: .As_Built-Plan Satisfactory: YES': -- Approval of Backfill: Date: By: ---Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: ~ _ Date: PHO, CALL FOR- OF OR OF PHONE- AREA HONE AREA CODE NUMBER EXTENSION MESSAGE SIGNED ( jpiversal 48003 FINAL GRADE INSPECTION Date: Address: r_ ; OAMED? SEEDED? ❑ COVER PER PLAN? Other I~' Town of North Andover MORTH Office of the Health Department o a',.�•° .. +ti` Community Development and.Services Division ` �a 400 OSGOOD STREET North Andover, Massachusetts 01845 ��s "° Susan Y. Sawyer, REHS/ RS Public Health Director 978.688.9540 - Phone 978.688.8476 - Fax CEg71'FIC�A�E of C09yevrIA9VCE As of: ,dune 16, ZOOS This is to cert that the individuafsubsurface dzsposalsystem Constructed "v'or Repaired—(---> 'By George .7fenderson At 793 (aka -Got A) Forest Street North Andover, JKA 01845 91as been installed in accordance with the provisions of Tztle v of the State Sanitary Code and with the North Andover Board ofifealth regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 4 r' Sus Sawyer, REXSIQU (Public Yfealth (Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTI-1688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System N, constructed; ( ) repaired; by George Henderson Co Inc located at #793 Forest St North Anr9ntrcr, MA (Subd Lot #A-1) was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , plan dated Dee . 8 , 2 0 0 3 , with a design flow of 440 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title S 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: 7-1-04 Final inspection date: 11-18-04 Joseph Burke, P.E. Engineer Representative Joseph Burke, P .'E Engineer Representative Installer: �o� c� �� Lic.#: G /O/ Date: _o Engineer: _ g Date. 6-1-05 William S. MacLeod, R.S.,P.L.S. JH OF WILLIAM yG J S. MACLEOD A NO. 742 QN iTEs RECEIVED JUN 16 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Town of North Andover Health Department Date:�d ✓�� Location: /l�J%�� i�0��CiT `/✓ , (Indicate Address, if Residential, or Name of Business) Check #: / !al Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indic 223 Heait Agent Initials White - Applicant Yellow - Health Pink - Treasurer I' TOWN OF NORTH ANDOVER Ot �10RTq 1 Office of COMMUNITY DEVELOPMENT AND SERVICES•'I1�A� HEALTH DEPARTMENTAM 400 OSGOOD STREET NORTH ANDOVER MASSACHUSETTS 01845 ''�s''e � SwCHCMUg Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX ADDRESS: 795 Forest Street (aka Lot A) MAP:105D LOT: 39 INSTALLER: George Henderson DESIGNER: Andover Consultants PLAN DATE: 12/8/2003 BOH APPROVAL DATE ON PLAN: 12/10/2003 DATE OF BED BOTTOM INSPECTION: 9/22/2004, again on 10/8/04 DATE OF FINAL CONSTRUCTION INSPECTION: 11/29/04,12/2/04 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Gravity Distribution COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = n/a LOADING OF PUMP CHAMBER = n/a TYPE OF SAS = Trenches DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS ❑Existing septic tank properly abandoned ®Internal plumbing all to one building sewer ®Topography not appreciably altered Comments: Page 1 of 3 TOWN OF NORTH ANDOVER ` J pORTM Office of COMMUNITY DEVELOPMENT AND SERVICES or �`so� HEALTH DEPARTMENT t 400 OSGOOD STREET NORTH ANDOVER MASSACHUSETTS 01845CHU s�cNus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading 2 -Piece construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle) installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: 11/29 requested tank to be filled to outlet invert to check for watertightness. 12/2 found water level 1" below invert of outlet pipe. D -BOX Comments: ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Page 2 of 3 TOWN OF NORTH ANDOVER Of NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET 1 60 NORTH ANDOVER MASSACHUSETTS 01845 ''�s "" CH s�cNus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SOIL ABSORPTION SYSTEM ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 3/4-1 Y2" double washed stone installed ® 1/8-1/2" (peastone) double washed stone installed ® laterals installed and ends connected to header (and vented if impervious material above) ® Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SYSTEM ELEVATIONS Benchmark: 152.41 Rod at Benchmark: 0.42 Height of Instrument: 152.83 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 148.60 149.00 Septic Tank IN 148.40 148.64 Septic Tank OUT 148.15 148.72 D -BOX IN 147.99 148.22 D -BOX OUT 147.82 148.08 Trench High End 147.73 147.96 Trench Low End 147.50 147.78 High End 147.73 147.76 Low End 147.50 147.78 High End 147.73 147.76 Low End 147.50 147.78 High End 147.73 147.76 Low End 147.50 147.78 Page 3 of 3 f ` f Page 1 of 1 C \1/ Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsu►ting.com] Sent: Friday, December 03, 2004 1:40 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: Forest Street Folks, Attached are the inspection reports for Lot A and Lot C Forest Street. We did the final inspection earlier this week and then a water tightness test (no charge) for the tanks yesterday. The two leach fields are now properly constructed. The tank for 785 Forest Street is fine, the one for 795 Forest Street appears to not be watertight. I will contact George about this to get him to figure out what is going on. Dan i 0 Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriv_erconsulting.com dano@millriverconsulting.com 12/3/2004 f Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Friday, November 26, 2004 1:51 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: inspections Folks, We will be inspecting Forest Street Lot 2 (Os old), Forest Street Lots A C (Henderson) and 70 Oakes Drive (Whyman) on Monday morning 11/29. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano@millriverconsulting. com 11/29/2004 A r Town of worth Andover ` Health Department Date: Location r (Indicate A dre Residential, or Name of Business) Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ tic - Design Approval $ ❑ Se��fic Disposal Works Constru ion (DWC) $ UT.�Q LlSeptic Disposal Works Installers (DV). $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasIVSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 248 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 4. TO: Susan Sawyer, Health Director FROM: Dan Ottenheimer, Mill River Consulting DATE: November 15, 2004 RE: Forest Street Lots A &C (also known as approximately 795 & 895 Forest Street) This memo is to document the findings of two construction inspections performed on November 11, 2004 at the above sites. Present were installer George Henderson, owner or developer Jason Stanichuck and myself. The inspections were performed beginning at 1:00 p.m. and the weather was clear and cool. LOT A This site had the benchmark removed during site clearance. At the previous inspection it was indicated to Mr. Henderson that a new benchmark would need to be established by the designer with a site plan sent to your office prior to a final construction inspection. Upon arrival, a triangular stake was nailed to a tree with an elevation reading. It was determined through a telephone conversation with the designer from the site that this was not placed by the designer and he accepted no responsibility for this benchmark. He had not been requested to establish a new benchmark at the site. Accordingly, no final grade inspection could be performed. It was unclear who placed this benchmark on this tree though Mr. Henderson claimed no knowledge. The building sewer exiting the dwelling was not straight from the house to the septic tank. Mr. Stanichuck indicated he would core a hole in the foundation, install a building sewer which runs straight to the tank. When questioned how he would change the route of the internal plumbing he indicated he intended to remove the new building sewer pipe and revert to the old one once the inspection was complete. The septic tank was found to have about 6" of water standing in the bottom. As the bottom of the tank likely intercepts the ground water table, it was requested they pump this tank dry so it could be examined if this might be ground water entering into the tank. This was to be performed and your office notified. The distribution box did not have even flow to all laterals and DEP-approved flow equalization devices were suggested to Mr. Henderson. The trenches were the correct length and spacing between them was correct. The sand and stone used appeared adequate. Page 1 of 1 LOT C The septic tank was found to have about 6" of water standing in the bottom. As the bottom of the tank likely intercepts the ground water table, it was requested they pump this tank dry so it could be examined if this might be ground water entering into the tank. This was to be performed and your office notified. The distribution box generally had even flow to all laterals but DEP-approved flow equalization devices were suggested to Mr. Henderson. The trenches were the correct length and spacing between them was correct. The sand and stone used appeared adequate. Mr. Stanichuck established his optical level and indicated it was satisfactory to utilize. Readings were observed and recorded at key pipe connection points. It was noted that the readings at the beginnings of the four pipes in the soil absorption system were 0.27' (3.2") different and the readings at the ends of the four pipes in the soil absorption system were 0.13' (1.5") different. Mr. Henderson declined the opportunity to confirm these readings and indicated he would contact your office to schedule an additional inspection once he had corrected this matter. Page 2 of 2 Dellechiaie, Pamela From: Pam Dellechiaie [pdellechiaie@townofnorthandover.com] on behalf of Dellechiaie, Pamela Sent: Wednesday, November 24, 2004 10:43 AM To: 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Sawyer Susan (E-mail); Grant, Michele Subject: Lots A & C Forest - Final Inspection Importance: High Sensitivity: Confidential 0 Monday, I wrote down a message that George Henderson is requesting a Final inspection of the above. Please call him at 978.807.6079 to schedule. You may want to double check with Joe Burke of Andover Consultants to be sure everything ready for final — 978.687.3828. 1 am sorry, my computer has been on the fritz, and I have lost e-mails, and not up to date in my database tracking due to computer issues, so if you already received this, I apologize. Tx, P Clear Day Page 1 of 2 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Thursday, November 11, 2004 8:03 PM To: pdellechiaie@townofnorthandover.com; 'Lisa LeVasseur (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: 'Sawyer, Su ichele' Subject: RE: Lot Forest Street -request for Final Inspection Sensitivity: Private Sue, Pam & Michelle, 2 I went to both o C today and found quite the situation. A bit too complex to try put into an e-mail at this hour but suffice i to say that neither site was given the permission to backfill and that further work needs to be done by the contractor before a final inspection can occur by us. As to the neighbors concerns about grading - it does generally appear that the systems are going in as per the design plans. This might not assuage her concern, but in theory a properly designed, built and maintained onsite system should not pose a risk to a neighbors property from things like drainage. We'll know more after the final inspection. Dan 1 Mill 71River '��consultin {' Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverco.psulting.com dano @millriverconsulting. com 11/15/2004 Clear Day r Page 2 of 2 From: Pamela DelleChiaie [ma i Ito: pdellech ia ie@townofnortha ndover.com] Sent: Monday, November 08, 2004 1:34 PM To: 'Daniel Ottenheimer (E-mail)'; Lisa LeVasseur (E-mail); 'McBrearty Andrew (E-mail)' Cc: Sawyer, Susan; Grant, Michele Subject: Lot C Forest Street - Request for Final Inspection Importance: High Sensitivity: Private Hi, Per Joe Burke of Andover Consultants and George Henderson, Lot C is ready for a final inspection. Please schedule. Lot A is not quite ready yet -- maybe after tomorrow. Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development & Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover. com Tel. 978-688-9540 Fax 978-688-9542 11/15/2004 I Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, October 12, 2004 2:06 PM To: amcbrearty@millriverconsulting.com; Lisa LaVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: Forest Street inspections Sue and Pam, Attached please find bed bottom construction inspection reports for 78 & 7 5 orest Street. oth jobs were generally found to be acceptable. Dan ..�,Mill River/ consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano@mill_riverconsulting.com 10/12/2004 U �J TOWN OF NORTH ANDOVER f NORTF Office of COMMUNITY DEVELOPMENT AND SERVICES %'p69D ,`'°°p HEALTH DEPARTMENT �: 27 CHARLES STREET ^,�•_._, ,r`: NORTH ANDOVER, MASSACHUSETTS 01845 ''�s'' SACNUS Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX ADDRESS: 7,5 Forest Street (aka Lot A) MAP: 105D LOT: 39 INSTALLER: eorge Henderson DESIGNER: Andover Consultants PLAN DATE: 12/8/2003 BOH APPROVAL DATE ON PLAN: 12/10/2003 DATE OF BED BOTTOM INSPECTION: 9/22/2004, again on 10/8/04 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Gravity Trenches COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = n/a LOADING OF PUMP CHAMBER = n/a TYPE OF SAS = Trenches DIMENSIONS AND DETAILS OF SAS: 4 each 46' Long SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ®Topography not appreciably altered Comments: 9/22/04: Stockpile of sand adjacent to SAS excavation. Well on adjacent property which plan indicates needs to be abandoned. Contractor indicated this was performed already. 10/08/04: Sand stockpile no longer present on site. Page 1 of 1 r" l� TOWN OF NORTH ANDOVER J Cf NO9, A Office of COMMUNITY DEVELOPMENT AND SERVICES �r `'p�o HEALTH DEPARTMENT 27 CHARLES STREET ^,"s. ,a•' NORTH ANDOVER, MASSACHUSETTS 01845 C ,,,,s Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK ® Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading 2 -Piece construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: 9/22/04: 1500 gallon tank on site, no stone beneath tank. Contractor reports tank will be removed, a stone base installed, and then the tank replaced. 10/08/04: Appears that stone has been placed beneath tank as evidenced by stone visible on one side. Stone provided was smaller peastone. Measured tank from house, 10' offset met. 2 part tank will need watertightness test. D -BOX Comments: ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Page 2 of 2 L.� TOWN OF NORTH ANDOVER 0 t NoarN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT � 27 CHARLES STREET► NORTH ANDOVER, MASSACHUSETTS 01845 ��ss;;C U Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SOIL ABSORPTION SYSTEM ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 '/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: 9/22/04: Excavation down to C horizon — OK. Size of trenches not adequate. Dimensions are 521 x 34'W. 10/08/04: Size of trenches now correct. SYSTEM ELEVATIONS Benchmark: 145.83 Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 148.60 Septic Tank IN 148.40 Septic Tank OUT 148.15 D -BOX IN 147.99 D -Box OUT 147.82 Trench High End 14T73 Trench Low End 147.50 Page 3 of 3 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, October 05, 2004 3:18 PM To: amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; Susan Sawyer Subject: Forest Street ...So I call George Henderson to set up the bed bottom inspection, he says "oh, is it ready? I haven't even been by the site yet" Sure gives me a lot of confidence. We set up an inspection for Friday 10/8 at 12:00. 1 will call Mr. Stanichuck to let him know too. Dan 1---,,MillXIver,`/ consulting.. Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano@millriv_erconsulting.com 10/5/2004 Town of North Andover Health Department Date:' /,Oj 0// Location:G9�' (Indicate Address, if Residential, or Name of Business) Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction S ➢ OTHER: (Indicate . 223 Healt Agent Initials White - Applicant Yellow - Health Pink - Treasurer f .1 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, September 28, 2004 5:14 PM To: amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; Susan Sawyer Subject: Lot A Forest Street Sue and Pam, Attached please find the bed bottom inspection for 795 Forest Street, also known as Forest Street Lot A. As discussed previously, all kinds of problems were found. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info millriverconsulti g,com 9/29/2004 r !1 TOWN OF NORTH ANDOVER f NoaTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER MASSACHUSETTS 01845 s�cNus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX ADDRESS: 795 Forest Street (aka Lot A) INSTALLER: George Henderson DESIGNER: Andover Consultants PLAN DATE: 12/8/2003 BOH APPROVAL DATE ON PLAN: 12/10/2003 DATE OF BED BOTTOM INSPECTION: 9/22/2004 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Gravity Trenches COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = Trenches DIMENSIONS AND DETAILS OF SAS: 4 each 46' Long SITE CONDITIONS MAP: 105D LOT: 39 ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: Stockpile of sand adjacent to SAS excavation. Well on adjacent property which plan indicates needs to be abandoned. Contractor indicated this was performed already. Page 1 of 1 1 r TOWN OF NORTH ANDOVER Ot NORTN Office of COMMUNITY DEVELOPMENT AND SERVICES F? •'a`•�°ap HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �C U Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑. 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: 1500 gallon tank on site, no stone beneath tank. Contractor reports tank will be removed; a stone base installed, and then the tank replaced. SOIL ABSORPTION SYSTEM 701 Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 Y2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan Comments: Excavation down to C horizon — OK. 521 x 34'W. Size of trenches not adequate. Dimensions are Page 2 of 2 TOWN OF NORTH ANDOVER f 0ORT11 Office of COMMUNITY DEVELOPMENT AND SERVICES Fr %';.+`tc. HEALTH DEPARTMENT 27 CHARLES STREET *°'+ NORTH ANDOVER, MASSACHUSETTS 01845 ACIWS Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SYSTEM ELEVATIONS Benchmark: 145.83 Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 148.60 Septic Tank IN 148.40 Septic Tank OUT 148.15 D -BOX IN 147.99 D -BOX OUT 147.82 Trench High End 147.73 Trench Low End 147.50 Page 3 of 3 r f 1 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, September 28, 2004 7:55 AM To: amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; Susan Sawyer Subject: FW: Forest Street Lot A Had trouble sending this yesterday, trying again today. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com inf @millriverconsultina.corn From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Monday, September 27, 2004 11:18 AM To: amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; Susan Sawyer (ssawyer@townofnortha ndover.com ) Subject: Forest Street Lot A Sue and Pam, Attached please find the bed bottom inspection for 795 Forest Street, also known as Forest Street Lot A. As discussed previously, all kinds of problems were found. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultina.com info millriverconsulting.com 9/28/2004 � r 1 �J �J TOWN OF NORTH ANDOVER f N°RTS Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director 10 ADDRESS: XForest Street (aka Lot A) INSTALLER: George Henderson DESIGNER: Andover Consultants PLAN DATE: 12/8/2003 BOH APPROVAL DATE ON PLAN: 12/10/2003 DATE OF BED BOTTOM INSPECTION: 9/22/2004 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Gravity Trenches COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = Trenches DIMENSIONS AND DETAILS OF SAS: 4 each 46' Long SITE CONDITIONS 6- 978.688.9540 — Phone 978.688.9542 — FAX MAP: 105D LOT: 39 []Existing septic tank properly abandoned []Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: Stockpile of sand adjacent to SAS excavation. Well on adjacent property which plan indicates needs to be abandoned. Contractor indicated this was performed already. Page 1 of 1 Comments: 1500 gallon tank on site, no stone beneath tank. Contractor reports tank will be removed, a stone base installed, and then the tank replaced. SOIL ABSORPTION SYSTEM ml Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 Y2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan Comments: Excavation down to C horizon — OK. 521 x 34'W. Size of trenches not adequate. Dimensions are Page 2 of 2 l 1 TOWN OF NORTH ANDOVER NORTH Of 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��sS'"°'" ACNU5� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if.effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: 1500 gallon tank on site, no stone beneath tank. Contractor reports tank will be removed, a stone base installed, and then the tank replaced. SOIL ABSORPTION SYSTEM ml Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 Y2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan Comments: Excavation down to C horizon — OK. 521 x 34'W. Size of trenches not adequate. Dimensions are Page 2 of 2 � f � �J �J TOWN OF NORTH ANDOVER °e NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES H p HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS Ol 845C"U Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SYSTEM ELEVATIONS Benchmark: 145.83 Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 148.60 Septic Tank IN 148.40 Septic Tank OUT 148.15 D -BOX IN 147.99 D -Box OUT 147.82 Trench High End 147.73 Trench Low End 147.50 Page 3 of 3 0 � ptlRTf� TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ° . 27 CHARLES STREET ` *i � 09 b<winvrc. 1�q, NORTH ANDOVER, MASSACHUSETTS 01845° •�'"� SSAGHUSES Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax FAX DanielOttenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: 8' 1.800.377.3044 or Phone: 978.282.0014 Re: Request for Soil Testing or Septic Plan Review Date: CC: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle :eptic Comments: Plan Review Soil Test—(OTHE Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address 11/26/1995 12:05 19788516c-13 S�s4tJ Tue Aug 31 10:16:55 2004 STANICHUK GIOT6CHNICAL LAWRATORY TEST DATA r � project : FOREST STREET SEPTIC 15 / " Project No. 04.340 NN Depth : N/A coring No. N/A Test Date : 8-31.04 Sample No. : L040830 Test Method : A Location : NORTH ANDOVER MASS Soil Description : TITLE 5 SAND Remarks A6AP FINE SIEVE SIT 01eve Sieve Openings "eight Cumulative Mesh Inches Millimeters Retained Weight Retained (gm) (gm) 04 0.187 4.75 0.00 0.00 p10 0.079 2.00 19.20 19.20 020 0.033 0.95 $9.90 79.10 040 0-017 0.43 96.50 175.60 050 0.012 0.30 56.30 231.80 060 0.010 0.25 24.10 356.10 0100 0.006 0.15 50.70 306.00 $I00 0.003 0.07 32.40 339.30 Pan 19.90 359.10 Total "eight of Sample . 399.1 Tare "eAght . 0 Moisture content - 0 D&S 1.2109 mm D60 0.5347 mm D50 0.4141 mm D30 0.2590 me 11 piS 0.1534 nm D10 0.1049 mm Bout clseeification ASTM Group Symbol N/A ASTM Group Name N/A AASNTO Group Symbol < A-3(0) AABNTO Group Name : Fine Sand Filename L040920 Elevation N/A Tested by : DM/RM Checked by BC percent Finer 14) 100 PAGE 01 Page : 1 RECE V� 0 SEP 14 2004 TOWN.OF NORT HEALN, , DF, H AND()VER ARTft�Er\iT 95 7e 51 3$ 1Q - 100 29 15 • aV 6 � Q o, t cktb Qx 0-4 O/ a .v 4 S �•e V s Q�oN No-� *-CCA. Sf cc- ( '.9 fA � kk 5TA/v1c,14L,,1& 03NIV138 ,I,N3063d C) 0 0 0 o o m rn o O01 c0 rO to M N lHo13M X9 83NIJ 1N3083d N a o< v a C Z0 39bd mnHOINVIS Eh-t)41988LU 90:Zi S66L/9Z/ii ti H 3 N a s a a w z WCj 4 .�.� W m G C,4 ea, � 2 o 0 o �n 4 N to7 W O Q O Z h_r C � �► U.. u °1 ,. - W > S y, CW—/1 a a o 0 w Co o0 � Q �yy G m o ul 1 � Z' � G J (!) w p z Z �. O� Ot a p G E �i z z 03NIV138 ,I,N3063d C) 0 0 0 o o m rn o O01 c0 rO to M N lHo13M X9 83NIJ 1N3083d N a o< v a C Z0 39bd mnHOINVIS Eh-t)41988LU 90:Zi S66L/9Z/ii 11/26/1995 12:05 1978851'43 STANICHUK PAGE 03 Page 1 Tut Aug 31 10:13:40 2004 GWMC ICAC, LABORATORY TCCT DATA Filename : L040020 Project : FOREST STREET SEPTIC Depth ; W/A Elevation N/A Project No. 04.340 NH Tested by DM/BM �� w0• N/A Tebt Date 8-31-04 Test Method : AB7T► Checked by % 9C sowle No. L040620 Location : WORTH ANDOVER MASS Boil pescriptien + TITT.B 5 BAND Remarks : ASAP FINS SAVE S2T Comwe sisM UT Weight Cumulative Percent keiyh[ Cumulative Percent 9leve Slave opening Retained Weight Retained finer mesh Inches Milllmetere (4) (4) (lb) (lb) ------' -- ...... -"- --^ 19-10 11.9D - 11,90 100 0.75' 0.752 12.30 17.70 99 0.81 0-500 12.70 74 12.60 99 0.375' 0•)75 9.52 12.20 13.80 95 06 0.187 4.75 13.10 711.80 34 iso Total. Weight ox Sample . 54 0.30 56.20 2-1 Tare Weight - 11.9 0.010 0.25 24.30 FINS SAVE S2T Weight Cumulative Percent Breve Sieve openings Retained weight Retained Finer Mesh Inches Mi1liMetere (4) (ya) (gw) ----------- 0.079 2.00 ....... 19.90 19.20 90 810 0.85 59.90 79-10 74 670 0.033 16.50 115.60 i9 Mao 0.017 0-41 711.80 34 iso 0.012 0.30 56.20 2-1 0.010 0.25 24.30 256.10 Bbo 0.15 50.90 306.80 14 8100 0.006 339.20 5 *700 0.003 0.07 32.40 19.90 359.10 0 Pan Total weight of Sample ■ )59.1 Tare weight . 0 Moisture Content - 0 DES : 1.4979 mm D60 : 0.5752 'M DSD 0.6191 MM D30 : 0.2691 mm DIS + 0.1563 mm D10 0.1089 mm Soil Classification AST" Group Symbol : N/A ASTM Group tame : NIA AA814TO Group Symbol A -1-b(0) AA6HT0 Group Name Stone fragment@. Gravel and Sand 11/26/1995 12:05 1978851,F':',33 Tue Sep 07 10:)1:15 7006 Project : FOFXST STREET SEPTIC project No. : 04.340.1111 Boring No. N/A Kemple No 1.040830 Location : WORTH A1400VER MASS Soil Description ; TITLY 5 SAND Remarks : ASAP STANICHUK coo GSOT£CHNICAL LABORATORY TEST DATA Depth ; 01A Test Date : 9.7-04 Test Method ; ASTM Filename L040830 elevation N/A Tested by WON Checked by ; BC PAGE 04 Page ; 1 FINE SIEvS SET Sieve sieve Openings Neight Cumulative Percent Inches Millimeters Retained Weight Retained finer Mean (g'^) (gm) leI Yat O.1B7 4.75 0.00 0.00 100 130 0.079 2.00 5.70 8.70 97 120 0.033 0.55 12.40 41,10 Be 140 0.017 0.4) 56.10 97,20 72 ,4 0.012 0.30 41-90 139.10 60 150 Iso 0.010 0.25 20,10 159;60 54 1100 0.006 0.15 62.40 242.20 30 ~ 6200 0.002 0.01 68.60 310.60 10 - 33.70 344.50 0 Pan Total Weight of Sapple - 344.5 Tare weight 0 Moisture Content - 0 Des 0.7469 no ` D60 0.30)3 mM D50 0.2314 an 12 C'- r' V 030 0-1510 mm 015 0.059% mm O! /A 1 1 010 0,0746 mm _Jr[. ��1 ��� 0.4 U O l� �f� V V.S �i►�Y Soil Classification ASTM Croup Symbol ASTM Group Name : N/A AASHTO Group Symbol A-)(0) AASHTO Group Name : Fine Sand 11/26/1995 12:05 19788516F-13 STANICHUK PAGE 05 t,J Tue Sep 07 10:28:50 2004 page ` 1 GEOTECHNICAL IASOSATORY TEST DATA Project : FOREST STREET SEPTIC Filename : L040830 Project No. 04 340-MM Depth i N/A Elevation N/A Boring No, N/A Test Data : 9-7-04 Tested by DM/BM Sample No. L040630 Test Method : ABTM Checked by SC L4eation : NORTH ANDOVSR "ASS Soil Description : TITLE 5 SAND Remarks : A9AP MARGE SIEVE SET Sieve Sieve openings Weight Cumulative Percent Mesh Inches Millimeters Retained Weight Retained Finer (lb) (ib) f1) 1• 1.000 29.40 11.90 11.90 100 0.75" 0.752 19.10 12.00 12.00 99 O.S" 0.500 12.70 12.00 12.10 99 0.375" 0.375 9.52 12.00 12.20 98 44 0.187 4.75 12.10 12.40 97 Total Weight of Sample a 29.6 Tare Weight - 11.9 FINE SIEVE SET Sieve Sieve Openings Weight cumulative Percent Mesh Inches 141111metere Retained Weight Retained Finer (gm) (9m) (4) 010 0.079 2,00 5.70 8.70 95 020 0.033 0.65 22.40 11,10 66 440 0.017 0.43 56.10 97,20 7D 050 0.012 0.30 41.90 129.10 54 060 0.010 0.25 20.70 159.80 52 0100 0.006 OILS 82.40 242.20 29 4200 0.001 0.07 68,60 310.80 10 Pan 33.70 344•So 0 Total Weight of Sample - 344.5 Tare Weight . 0 moisture content - 0 D85 0.0266 mm 060 0.3184 mm 050 0.2387 on 030 0,1538 mm DIS 0.0904 mm DID 0.075) mm Soil Classification ASTM Group Symbol. N/A ASTM Group Name N/A AASNTO Group Symbol A-3(0) AASHTO Group Name Fine Sand 03 0 S 4 43I a r4 `1 �« J <--• 0 rn t N -i a; o-., Z J G J v z L, ti C T UO C Qi c m v°, U - Z Z W 3 90 39Vd 0 031,11VO6 IN3083d 0 o co a) o w 0 0 ;... ........... ........... .. ....,.... '..__.,...........;..... ............. :..... ....... .. k-. ! � 1 i_ ............. CK i t.__._..-�-.._-___.•.... .... ...._.................. �.. W LLI I I ! I ! i..i i ....................�........ _.._...._.....t.......-.... Q LO _... ' �.... I • � I i I toI . ...... .......... ...... . ...._. y .. .... ......�, ....... ........... . 1 I 1 _... Ir _ ------ __: .... ...... .: .._. 7 .................... Q O Q O 0 O 1 C 0 O O Ln � aQ1 N 1H`_)13M A.8 83Ni3 IN3063d AnHOI NGIS I Q Y EF--j9T988L6T 90:ZT 966T/9Z/TT r� �1 310 CMR: E ARTMENT OF ENVIRONMENTAL PROTECs.JN 15.255: continued z z in 60 a o_ W 50 a Z 40 W cr LU 30 0 10 (a) The retaining wall shall be constructed of reinforced concrete, shall have no weep holes, and shall be waterproof. (b) The retaining wall shall be designed by a Registered Professional Engineer, who shall certify that the above condition is met by the submitted design. (c) The upgradient side of the retaining wall shall be waterproofed. (d) Construction of the retaining wall shall be supervised by the design engineer. (e) An as -built plan shall be prepared and certified by the design engineer that the wall has been constructed in accordance with his approved design plan. (f) The elevation of the top of the retaining wall shall be no lower than the "breakout" elevation, which is the elevation of the top of the two inch layer of 'A inch to 1/2 inch washed stone aggregate cover. (g) The distance from the wall to the edge of the leaching area should be at least ten feet. (3) Fill material for systems constructed in fill shall consist of select on-site or imported soil material. The fill shall be comprised of clean granular sand, free from organic matter and deleterious substances. Mixtures and layers of different classes of soil shall not be used. The fill shall not contain any material larger than two inches. A sieve analysis, using a #4 sieve, shall be performed on a representative sample of the fill. Up to 45% by weight of the fill sample may be retained on the #4 sieve. Sieve analyses also shall be performed on the fraction of the fill sample passing the #4 sieve, such analyses must demonstrate that the material meets each of the following specifications: SIEVE SIZE EFFECTIVE % THAT MUST PARTICLE SIZE PASS SIEVE # 4 4.75 mm 100% # 50 0.30 mm 10%_100% #100 0.15 mm 00/o- 20% #200 0.075 mm 00/0- 5% A plot of the sieve analyses of the portion of the sample passing the #4 sieve shall fall on or between the lines on the following graph: PARTICLE SIZE DISTRIBUTION 12/27/96 310 CMR - 531 TOWN OF NORTH ANDOVER -f Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director July 27, 2004 S & R Realty Trust Jason Stanichuk 75 Raymond Road Tewksbury, MA 01876 Dear Mr. Stanichuk, 978.688.9540 — Phone 978.688.9542 — FAX healthdeptktownofnorthandover.com www.townofnorthandover.com This letter is in regards to two of your properties kno as :Lot! A (793 and Lot C Forest Street, North Andover. As the owner or trustee of these properties, i important that you understand the current situation at the site. On Thursday, July 22°d, the Health Department was notified that work was being done in the area on both of the septic systems. This information prompted a visit to the sites. Please see the attached photographs taken on Friday, July 23, 2004 that shows the conditions observed on that day. Both areas of the septic systems had been excavated and were in different stages of system installation. Also, both had concrete septic tanks installed. One tank was backfilled and the other was not. All work being done on these septic systems is in violation of the MA Department of Environmental Protection Title V regulations, and the North Andover Subsurface Disposal Regulations, Section 3.01. The plan was approved on December 12, 2003. A septic Disposal Works Construction permit was applied for on June 7, 2004, but to date no permit to install has been approved. The Health Department had a discussion with a North Andover licensed septic installer Mr. George Henderson on June 7, 2004 concerning the application for two disposal works construction permits. In attendance with Mr. Henderson was Ryan Scott. Mr. Scott, is not a licensed installer with the Town of North Andover, but was intending to work with Mr. Henderson on this project. Mr. George Henderson applied and paid for two Disposal Works Construction Permits for the above named properties. However, the permits and approved plans were not issued as we were waiting on additional paperwork, i.e., foundation plans in the correct scale, and proof that 781 Forest Street had the water main installed and the well abandoned and had tied into town water. This initial directive was made on July 12, 1999 by the former Health Director. r \ On June 29, 2004, we received copies of the Certification Plans foi-_"ch lot, not to scale as initially requested. However, they have been accepted in this case. To date, we have not received the paperwork regarding the house next door. Please see attached septic plan approval letter for additional details. In the meantime, Mr. Scott went ahead and began working on the system without a permit or approved septic system plan, and did the work without the attendance of a licensed septic installer. Please be advised that any work completed under the construction of a system without a permit, without the required inspections or without a licensed installer cannot be accepted by the Health Department and will have to be removed. No person other than the licensed installer should be supervising and conducting the work on these septic systems. Working without a permit or license within the Town of North Andover may result in fines, which have yet to be determined in this case. Please have your licensed installer contact the health department with regard to obtaining the approved permit. At that time the health department will discuss the actions that are expected in this case. Under no circumstance will the applicant be allowed to subcontract the septic installation. Upon permit issuance a pre -construction inspection will be scheduled with the Town's Consultant's, Mill River Construction to determine the course of action. The initial permit fee covers a set number of inspections. Extra inspections and oversight deemed necessary by the consultant would require additional fees. You will be notified prior to any extra inspection as to the amount that must be paid to the "Town of North Andover" prior to that next inspection. The North Andover Health Department will continue to work hard with you to ensure a proper installation of the septic systems on your lots. A copy of this correspondence is being sent to the North Andover Building Department to inform them that the Health Department will not be able to sign off on the building permit until the septic systems have been installed, certified and a certificate of compliance has been issued in each case. Please contact the health office if you have any additional questions in regards to this correspondence. ?an Sawyer, REH RSealth Director Cc Robert Nicetta, Building Commissioner William S. MacLeod, Registered Sanitarian, P.E., Andover Consultants George Henderson, Septic Disposal Works Installer Heidi Griffin, Community Development Director IAn Gl' Alno•rzA'ni "C FOREST STREET \99-04\CERT.dwg 23.92' S11'33'35"W CERTIFICATION PLAN LOT A-1, FOREST STREET NORTH ANDOVER, MASS. \andover Prepared for areon su I tan is , p . S & R REALTY TRUST Inc.''y', SCALE:1 "=40' DATE:12-30-03 1 East River Place, Methuen, Mass. Town of North Andover/J:: Health Department � Location: (Indicate Address, if R _idential, or Name of Business) Check #: a Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ L,- --tic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 089 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER of NORT►1 9 Office of COMMUNITY DEVELOPMENT AND SERVICES `•o° HEALTH DEPARTMENNO T 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01.845 9SSACHUSE Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 — Phone 978.688.9542 — FAX healthdept@townofnorthandover.com www.townofnorthandovei-.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:—,f- 4 - 6 y LOCATION: LICENSED LICENSED INSTALLER NAME: Pin d.c PLEASE PRINT SIGNATURE,,J, TELEPHONE# 9>,9 129 l S__25 "S � CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: L -- * i * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $2SO:fl0 Fee Attached? Project Manager Obligation From Attached? Foundation As -Built? Floor Plans? Yes No Yes No Yes No Yes No Approval of Health Agent Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North ,Andover licensed installer for the construction of the septic system for the L property at , % — l relative to the application Of dated �= 9l for plans by&agave and dated .Y -'5- —9 9 with revisions dated ,# -t y -p.9 -e Vtn _ 8 w 2 a a 3 I understand the following obligations for management of this project: I . As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with 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. 4. As the installer I understand that only I may perform the work (other than simple excavation) required 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 to operate in the. Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as 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: Disposal Works Construction Permit # i 1. TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System VQ' constructed; ( ) repaired; by George Henderson Co Inc located at #793 Forest St North Ando pr., MA (Subd Lot #A-1 ) was installed in conformance with the North Andover Board of Health approved plan, System Design Permit. # , plandated D e e . 8, 2003 , with a design flow of 440 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: 7-1-04 Final inspection date: 11-18-04 Installer - Engineer: En .� Joseph Burke, P.E. Engineer Representative Joseph Burke, P.E. Engineer Representative 0 0i Date: Date: 6-1-05 William S. MacLeod, R.S.,P.L.S. OF WILLIAM yG S. U MACLEOD A NO. 742 \ isES RECEIVED JUN 16 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired; by George Henderson Co Inc located at #793 Forest St North Andlover R MA (Subd Lot #A-1) was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# , plan dated Dec . 8, 2003 , with a design flow Of _A4 0 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: 7 -1 -04 - Final inspection date: 11-18-04 Joseph Burke, P.E. Engineer Representative Joseph Burke, P.T. Engineer Representative Installer �. Lic.#: G / D/ Date: - _o En 'neer: �� � Date. 6- 1- 0 5 William,S MacLeod, R.S.,P.L.S. iN of r WILLIAM yG v S. MACLEOD N NO. 742 Po 'p, T f ANAL SA� RECEIVED JUN 16 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT andover consultants 1 East River Place info Methuen, Massachusetts 01844 Tel. (978) 687-3828 Fax (978)u686-5100 August 26, 2003 Town of North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: Town Map 150 D, Town Lot 39 (Lot A) To Manw p _150D, Town Lof 71 (Lot D) Forest St., North Andover, Mass. Dear Members of the Board: This office conducted percolation tests and test pits on the above referenced lots on April 7, 1999. We prepared plans for sewage disposal systems in April of 1999 and after review by Port Engineering, your consultant, we revised the plans on May 12, 1999. Your office issued design approvals on May 20, 1999 for Lot `A' and May 27, 1999 for Lot `C'. On behalf of our client, Forest Glen Development, Inc., we request the Board of Health re- issue design approvals for these lots. I have inspected the sites and no work has occurred on site that would change the soil characteristics. It is my opinion that additional testing on the lots would only further disturb the parent soil in the area of the absorption trenches. I will attend your meeting on August 28, 2003 to answer any questions you might have. Sincerely, OdPA— ANDOVER CONSULTANTS INC. Z04�;"� William S. MacLeod, P.E., P.L.S. President WSM/bsn C/MyDoc/TownofNA Civil E'r ginaars a hand Si irveyors o land Planners fr1 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 May 7, 1999 Andover Consultants Inc. 1 East River Place Methuen, MA 01844 Dear Mr. MacLeod: 27 Charles Street North Andover, Massachusetts 01845 This is to inform you that the plans for the proposed septic systems at Lot A and Lot C (Map 105d 39 & 71) have been disapproved for the following reasons: 1. For both lots, aggregate under the d -box to be 6" of stone. (3 10 CMR 221(2)) 2. The bottom of the bed is less than 4' above groundwater. (3 10 CMR 15.212 a & b) (GW was calculated as 34" below ground surface throughout the system mirroring surface topography.) If you have any questions of comments, please feel free to call the Health Department at the number below. Please keep in mind that all revisions require a $60.00 per lot. Sincerely, Sandra Starr, R.S. Health Administrator Fax(978)688-9542 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 J ` r, Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 -July 12, 1999 William MacLeod Andover Consultants, Inc. 1 East River Place Methuen, MA 01844 Re: Lot A, Forest Street 27 Charles Street North Andover, Massachusetts 01845 .o ,a Fax(978)688-9542 No. Andover, MA 01845 Dear Mr. MacLeod: Y This is to inform you that the proposed septic syste plans for the site referenced above have been approved for a dwelling with a maximum;of nine (9) rooms. Please note that the water main is to be installed and the well at 781 /Forest Street is to be abandoned and tied into town water before a Disposal Works Construction Permit will be issued. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S. Health Administrator SS/smc cc: Linda Emro File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Apr -2I5-99 10:51A Paul, n. Turbide, PE/PLS I �J PORT ENGINEERING Civil Engineers & Land Surveyor3 One Harris Streei Newburyport, MA 01950 (978)465-8594 April 25, 1999 508-465-0313 P-02 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for Lot A Forest Street (Map 105d Lot 39) Dear Sandra, Enclosed find the "Checklist for North Andover Septic System Plans" for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. 3I0 CMR 247(2) states that a minimum of 2" of 1/8 to 1/2 inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer of untreated building paper to be laid on top of this stone. There is no regulation that I could find that allows untreated building paper to be laid over the peastone, and therefore I would recommend that the untreated building paper be removed from the design. The d -box detail calls for 6" gravel sub -base beneath the d -box. This should be a 6" stone base. 31 OCMR 22) (2) Note that the existing water supply for the existing dwelling that abuts locus to the north is a well that will only be 94 feet from the proposed leaching field on locus. The design plans show that about 450 of 8" water main is proposed to be constructed on Forest Street that will not only service the locus lot, but will also service the said existing dwelling owned by Emro_ The proposal is that Emro will abandon the said well afler hooking up to the municipal water main. A condition of approval should be that the water main will be installed and that the said well will be abandoned. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS Forest Ord-39.doc BOARD OF HEALTH NORTH ANDOVER, MA 01845 APPLICATION FOR SOIL TESTS DATE: March 22, 1999 LOCATION OF SOIL TESTS: Assessor's MAP & PARCEL NUMBER: OWNER: Linda M. Emro, Trustee Lot A. Forest Street Map 105D. Parcel 39 TEL. NO.: 975-0453 ADDRESS: 781 Forest Street, N. Andover, MA ENGINEER: Andover Consultants Inc. TEL. NO.: 687-3828 CERTIFIED SOIL EVALUATOR: David Jordan Intended use of land: Residential subdivision, single family home, commercial Repair Testing X Undeveloped lot testing N.A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (tax bill, deed, or letter from owner permitting tests) 2. Plot plan !AR 2 4 1999 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 disposal area. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100) shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing, soil evaluation forms shall be submitted. 03/19/1999 11:21 508989FI' GERARD r� PAGE 03 I'M oll C November 3, 1998 RE: Lot & Forest Street No. Andover Massachusetts To Whom It May Concern: I, Linda M. Emro, owner of the above property hereby authorize and assent to William P. Johnson, Trustee of W. P. J. Development Trust, filing for and testing my property for septic system designs. Sincerely, Linda M. Emro 781 Forest Street No. Andover, MA 01845 s M Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - da not use the refum key. ILS Commorlviiealth of Maesach'usetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner's Name North Andover City/Town MA 01845 State Zip Code RECEI -- TOWN OF NOrR1•Bi HEALTH 1/18/2012 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered lAnV way. Please see completeness checklist at the end of the form. A A. General Information 1. Inspector: Neil James Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address - Andover Cityfrown 9784754786 Telephone Number B. Certification MA State S115 License Number 01810 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Nee Further Evaluation by the Local Approving Authority ` 1/18/2012 Ins or' ignatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner's Name North Andover MA 01845 1/18/2012 CityrFown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y El N ❑ ND (Explain below): t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 � _am Owner information is required for every page. E t5ins • 11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner's Name North Andover Cityrrown B. Certification (cont.) B) System Conditionally Passes (cont.): MA 01845 State Zip Code 1/18/2012 Date of Inspection ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the sy$tem is failing to protect public health, safety or the environment. I. 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 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "< 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" -or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/ day flow t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 11110 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '< 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or,privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 11110 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of . this, inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ®. ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins -11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 793 Forest Street E D. System Information Description: Number of current residents: 1/18/2012 Date of Inspection Does residence have a garbage grinder? Property Address Yes Aylssa Lim Owner Owners Name information is required for North Andover MA 01845 every page. Cityfrown State Zip Code E D. System Information Description: Number of current residents: 1/18/2012 Date of Inspection Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No ,Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins -11/10 Title 5Offiaal Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) E Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Never pumped 1500 gallons Measured tank Inspect tank & tees ® Yes ❑ No Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. Cityrrown D. System Information (cont.) State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 7 years old, 6/13/2005, as built plan. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.6 feet Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast iron thru wall in garage, 3" cast iron in garage, 3" PVC in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: .5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: - years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 21' ❑ Yes ❑ No t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System . Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 19" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at invert. No evidence of leakage. Riser cover over center cover, 1" deep. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness . feet ❑ fiberglass ❑ polyethylene ❑ other (explain). 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: t5ins • 11/10 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..'� 793 Forest Street Property Address Aylssa Lim Owner Owner's Name information is required for North Andover MA 01845 1/18/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: . Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner owner's Name information is required for North Andover MA 01845 every page. City/Town State Zip Code D. System Information (cont.) 1/18/2012 Date of Inspection Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & distribution equal, has flow levelers. No evidence of leakage. Evidence of carryover, pumped d -box to clean. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 11/10 Idle 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts tjgTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Owner information is required for every page. E Property Address Aylssa Lim Owner's Name North Andover Cityrrown State D. System Information (cont.) Type: 01845 Zip Code 1/18/2012 Date of Inspection r ❑ leaching pits number: ❑ leachingchambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4 trenches 46' 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.): . Soil ok. Vegetation ok. No sign of ponding. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater Inflow ❑ Yes ❑ No t5ins - 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner's Name North Andover MA 01845 1/18/2012 Cityrrown D. System Information (cont.) State Zip Code Date of Inspection Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): .Privy (locate on site plan):. Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Owner information is required for every page. IE Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner's Name North Andover MA 01845 1/18/2012 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately nn �cog & /\ _ D �GC A -�-v ��� - LtV1'IS I( t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 5, Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 793 Forest Street Property Address Aylssa Lim Owner's Name North Andover MA 01845 1/18/2012 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: r ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/7/1999 Date :-E] Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17 ' Commonwealth of Massachusetts d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 793 Forest Street Pro a Addre s rty p s Aylssa Lim Owner Owners Name information is required for North Andover MA 01845 every page. Cityrrown State Zip Code F E. Report Completeness Checklist 1/18/2012 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information.— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the forrn they use. The System Pumping Record must•be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house,/ Righ rear of hou ,Left /right side of house, Left / Right side of building, Left / Right front of building, Left / Rlg rear of building, Under deck Address jq-�) t -a --e Q Cityr town 2. System Owner. Name Address (if different from location) Cityfrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ State Zip Code State Zip Code L4 a©--��0``l Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No' 5. Condition of System: kj&V�j 6. System Pumped By: Neil,Bateson Name - Bateson Enterarises Inc Company 7. If yes, was it cleaned? ❑ Yes ❑ No 14k&k � V\ 4:5�,,- -�, (4- contents were disposed: Lowell Wactp Watar F5821 Vehicle License Number '/ -- I N --1 A, t5form4.doc- 06103 System Pumping Record • Page 1 of 1 Summary Record Card generated on 1/17/2012 11:06:09 AM by Karen Hanlon Type Size Town of North Andover Serial No Status Tax Map # 210-105.D-0039-0000.0 Location Parcel Id 17026 1/17/2012 793 FOREST STREET Date ALYSSA P. LIM Code KEVIN LE , 1378 793 FOREST STREET 9/14/2011 NORTH ANDOVER, MA. 01845 Class 101 Single Family Property Type Zoning2 1 Residential Zoning3 Size Total 1.02 Acres 1230 FY 2012 12/9/2010 UB Mailing Index a Actual Name/Address Type Loan Number Active/Inact. From ALYSSA P. LIM Owner KEVIN LE a Actual 793 FOREST STREET 961 NORTH ANDOVER, MA 01845 12/10/2009 S & R REALTY TRUST Previous Customer Inactive 7/29/2005 781 FOREST,STREET 883 NORTH AN66VER, MA 6/8/2009 01845 a Actual UB Account Maint. Account No Cycle Bldg Id. 9834.0 - 793 FOREST STREET 3170651 03 Cycle 03 UB Services Maint. Account No. 3170651 Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Occupant Name Active/Inactive Last Billing Date 1/7/2012 Active Rate Charge Multiplier/Users 1 1 9.18 1/1 01 ALL METER SIZE 137.05 1/1 Account No. 3170651 Type Size b Badger Serial No Status Consumption Location 19525370 a Active 1/17/2012 ERT HH Date Reading Code 12/9/2011 1378 a Actual 9/14/2011 1347 a Actual 6/8/2011 1277 a Actual 3/8/2011 1230 a Actual 12/9/2010 1206 a Actual 9/13/2010 1180 a Actual 6/7/2010 1049 a Actual 3/10/2010 961 a Actual 12/10/2009 926 a Actual 9/10/2009 883 a Actual 6/8/2009 820 a Actual 3/12/2009 776 a Actual 12/10/2008 751 a Actual 9/9/2008 695 a Actual 6/5/2008 617 a Actual 3/11/2008 581 a Actual 12/10/2007 563 a Actual 9/5/2007 522 a Actual 6/15/2007 421 'a Actual 3/13/2007 353 a Actual 12/12/2006 338 a Actual 9/12/2006 308 a Actual 6/13/2006 238 a Actual 3/6/2006 157 a Actual 12/21/2005 144 a Actual Brand Type Size b Badger w Water 1 1 Consumption Posted Date 31 1/17/2012 70 10/13/2011 47 7/20/2011 24 4/13/2011 26 1/12/2011 131 10/15/2010 88 7/15/2010 35 4/14/2010 43 1/12/2010 63 10/15/2009 44 7/20/2009 25 4/29/2009 56 1/20/2009 78 10/10/2008 36 7/16/2008 18 4/11/2008 41 1/22/2008 101 10/12/2007 68 7/20/2007 15 4/16/2007 30 1/19/2007 70 10/20/2006 81 7/10/2006 13 4/17/2006 22 1/17/2006 8989 Of- . O h S Town of North Andover `�'•�:; ;o :. HEALTH DEPARTMENT ,SSAC NU�+E4 CHECK #: 31 1 Z LOCATION: H/O NAME:31; 6, a CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ c" Title 5 Report $-,t-a a ❑ Other: (Indicate) $ (Health vet Initials White - Applicant Yellow - Health Pink - Treasurer MAX /IygoM O /CJ / �66H5 s" Town of North Andover, Massachusetts Form No. 2 f NOItTh BOARD OF HEALTH ?0�4�1-- '4,�C • of � DESIGN APPROVAL FOR �SsACHUSSOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ��'�--��'� — /�r7rL- t� Test No, Site Location__ Ckk t /9 Reference Plans and Specs.' ENG NEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee 495-- Site System Permit No. %U W" SEPTIC PLAN SUBMITTAL FORM LOCATION: M ek k) / 0C NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGINEER: DATE TO CONSULTANT: rf �/" OF AjO OF AjD�V hi �N *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. 1 i SEPTIC PLAN SUBMITTAL FORM LOCATION: Lot A_ Forest Street NEW PLANS: YES X $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES X NO DATE: 4/20/99 DESIGN ENGINEER: William S. MacLeod DATE TO CONSULTANT: • If you want your plans expedited, please submit four plans and include a stamped envelope with the correct amount of postage and mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. Town of Nd 'Andover, Massachusetts 'Form No. 1 N RTH BOARD OF HEALTH -' 19� APPLICATION FOR SITE TESTING/INSPECTION 7a _ R4TED PP`i'�y Applicant LAAF;GC1` NAME ADDRESS TELEPHONE Site Location 46T %9 t410E-57- '_ .32 Engineer / iJboVe,P :sUG %% NAME ADDRESS TELEPHONE Test/Inspection Date and Time -7 T? ZIQ CHAIRMAN-, BOARD OF'HEALTH Fee 4Q 7L5-- Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of NC 'Andover, Massachusetts r1ORTH AA-- BOARD OF HEALTH O�t IES ib O L F (11 APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee - CHAIRMAN, BOARD OF HEALTH Test No S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of N( Andover, Massachusetts '\Form No. 1 BOARD OF HEALTH `f �,ORTF.� A � 9 �110�`"ED ib"6-Y0 19 Q �4 <o< <.Ew<, ti * APPLICATION FOR SITE TESTING/INSPECTION SACHUs���y Applicant � IV � /V1Qv (0 NAME �AD RESS TELEPHONE Site Location Engineer L NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 - SOL'�,.�VALUATOR FORM Pagel of 3 Date: April 7, 1999 Commonwealth of Massachusetts North Andover, Massachusetts Soil Suitabili f y Assessment for On-site Sewage Disposal Performed By: David Jordan Date: April 7,1999 Witnessed By: Carlton Brown Location address or Lot # Owner's Name, Address, and Tel. # Lot A Linda M. Emro, Tis. Forest Street 781 Forest Street, North Andover, MA Town Map 105D, Lot 39 975-0453 New Construction ® Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published 1981 Publication Scale 1:15,840 Soil Map Unit CbC Drainage Class WD Soil limitations Permeability, stones Surficial Geologic Report Available: No ® Yes ❑ Year Published Publication Scale Soil Map Unit Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ® Yes ❑ Above 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 March Range: Above Normal ❑ Normal ® Below Normal ❑ Other References Reviewed: FORM 11 - SOIL VALUATOR FORM Page 2 of 3 Location Address or Lot No: Lot A, Forest Street On-site Review Deep Hole Number 1 Date: 4/7/99 Time: 12:30 AM Weather: 60° Sunny Location (identify on site plan) Land Use: Wooded Slope (%) 0-3 Surface Stones Few 1-3' scattered Vegetation: Pine Landform: Ground moraine Position on landscape (Sketch on back) Distances from: Open Water Body: >100 Feet Drainage Way: >100 Feet Possible Wet Area: >100 Feet Property Line: 50 Feet Drinking Water Well: 129 Feet Other: DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Mottling Other Surface (USDA) (Munsell) (Structure, Stones, boulders, (inches) Consistency, % Gravel 0-4 A Sandy Loam 10YR3/4 4-16 Bw Sandy Loam 7.5YR4/6 16-31 C1 Sandy Loam 10YR5/6 Massive, friable 15% gravel & cobbles 31-75 C2 Cobbly Sandy 2.5Y5/4 33" Massive, friable, Loam 20% coarse Extremely gravelly, cobbly 10YR5/6 Parent Material (geologic) Basal Till Depth of Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 33" CC) FORM 11 - SOIL ----,;VALUATOR FORM Page 3 of 3 Location Address or Lot No. Lot A, Forest Street Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles 33 inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on Fall 1996 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 0r FORM 11 - SOD; VALUATOR FORM Page 2 of 3 Location Address or Lot No: Lot A, Forest Street On-site Review Deep Hole Number 2 Date: 4 799 Time: 12:15 AM Weather: 60° Sunny Location (identify on site plan) Land Use: Wooded Slope (%) 0-3 Surface Stones Few 1-3' scattered Vegetation: Pine Landform: Ground moraine Position on landscape (Sketch on back) Distances from: Open Water Body: >100 Feet Drainage Way: >100 Feet Possible Wet Area: >100 Feet Property Line: 70 Feet Drinking Water Well: 123 Feet Other: DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Mottling Other Surface (USDA) (Munsell) (Structure, Stones, boulders, (inches) Consistency, % Gravel 0-4 A Sandy Loam 10YR3/3 4-14 Bw Sandy Loam 10YR4/6 14-29 Cl Sandy Loam 10YR4/4 Massive, friable 20% gravel & cobbles 29-84 C2 Cobbly Sandy 2.5Y4/4 30" Massive, friable Loam 15% coarse extremely gravelly, cobbly 2.5Y6/6 Parent Material (geologic) Basal Till Depth of Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 30" Cf� FORM 11 - SOIU-VALUATOR FORM Page 3 of 3 Location Address or Lot No. Lot A, Forest Street Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles 30 inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on Fall 1996 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date Location Address or Lot No. Lot A, Forest Street Commonwealth of Massachusetts North Andover, Massachusetts Percolation Test* Date: April 7, 1999 Observation Hole # 1 2 Depth of Perc 42" 40" Start of Pre-soak 1:06 12:05 End of Pre-soak 1:22 12:22 Time at 12" 1:22 12:22 Time at 9" 1:44 12:39 Time at 6" 2:12 1:02 Time (9"-6") 28 23 Rate (NEn./Inch) 10 6 *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ® Site Failed ❑ Performed By: David Jordan Witnessed By: Carlton Brown Comments: � 1 TOWN OF NORTH ANDOVER BOARD OF HEALTH Location (,�T h �' C, Permit # ?K113 Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing ,,/ Z $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ —L5—S:6' (v 4505 0 Heal&lj Agent White - Applicant Yellow - Dept. Pink - Treasurer WILLIAM P. JOHNSON 53-7047/2113 389 P.O. BOX 615 190212054 TEWKSBURY, MA 01876 -2—PA.._1 DATE � (-2— PAY Y TO THE l ORDER OF nn � DOLLARS 8 -® Andover Bank Andover, mo, 01810 MEMO 1: 2 1 1 3 7 0 4 7 7i'----- --—----_— —_ — --- - -- L 9 0 2 L P n q t. j,• n e n r, that all necessary approv ;permits from INSTRUCTIONS: This form is us�.u�to verify Departments having jurisdiction have been obtained. This �: �zs not relieve Boards and p applicable or requirements. the applicant and/or landowner from compliance with any pp *****************************APPLICANT FILLS OUT THIS SECTION*********************** PHON APPLICANT PARCEL LOCATION: Assessor's Map Number r A LOT (S) SUBDIVISION ST. NUMBER STREET Ui�� ( 77 ***************** ®F F 1C fAL USE 0 N LY******************************** RECOMMENDATIONS OF TOWN AGENTS: �� (ov Lu DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED_ COMMENTS v TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH Sl DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED. DATE APPROVED DATE REJECTED 7 2 COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS �� j ^ ` _ DRIVEWAY PERMIT W FIRE DEPARTMENT , � DATE__ RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm NORTH ANDOVER BOARD OF HEALTH AUTHORIZATION FOR SOIL TESTS LOCATION ENGINEER TEL # PAID DATE TO PORT Lot A Forest St Andover Consultants 978-687-3828 Yes March 25, 1999 Lot C Forest St Andover Consultants 978-687-3828 Yes March 25, 1999 ���1�. td ���' �`c� ��� BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: J D " L- ,- � '� LOCATION OF SOIL TESTS: 1 oRes{ 5-{ ' Assessor's map & parcel number: 105' D l.of 3q OWNER: J/ ,4i(( _ . TEL. NO.: 9?�( 9.-/ .36%0 ADDRESS: 9S S �okc K s-� ( e-L'iUs�ue � (AA A- - ENGINEER: 6%S -Q- �. VtQ6we -ta 1 TEL. NO.: q 7 S(- 6`4 � 93a CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing L ----- N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 10"Z6- l'� LOCATION OF SOIL TESTS: Assessor's map & parcel number: ioS b kbf 39 OWNER:_.'/ dl# `/ �__�,d1�1%G� TEL. NO.: 97�( 9.57/ -5670 ADDRESS: 9s-5- � Ik` K St ( + -Lou-S Use cM L _ ENGINEER: TEL. NO.: -.q CERTIFIED SOIL EVALUATOR: mm, c yl�t Intended use of land: residential subdivisi Repair testing L N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. 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