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HomeMy WebLinkAboutMiscellaneous - 81 LACONIA CIRCLE 4/30/2018I' 1 N T� ✓L� r vti� G may- � S j� �vC-v5 dLL 1�Y2 S i A r Lot & Street 81 L�'Gwiy <!,(�LL L� Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit# Plan Approval: Date: 3A31gg 3A3Approved by: Designer: Plan Date: Conditions: _ Water Supply: _gwvn Well Well P" -t: Driller: Well Tests: Chenuca`l ----,Date Approved Bacteria I lute -Approved - - - Bacteria II Date Approved.., Plumbing. Sign -Off: Wiring Sign -Off: Comments: Form "U" Approval: Date Issued Conditions: Approval to Issue: YES NO By Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval?.. YES NO Certification? YES NO Other YES NO Any Variance Needed? . YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: I If It SEPTIC SYSTEM INSTALLATION Is the installer licensed? YES NO Type of Construction: NEW p �' New Construction: Certified Plot Plan Review YES NO Floor - Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YE �_Ss _7NO — DWC Permit Paid? J NO _ DWC Permit # 47 Installer: Begin Inspection: C YES- ,- -- - NO Excavation Inspection: _ y Needed: Passed: �� By:� Construction Inspection: _ Needed:_©� �.,.-�� f, 6.�✓l �- -� .s ri - G L J��� c s i s e-, e-_1 IIi -Z As Built Plan Satisfactory: YES: Approval of Backfill: - Date: By:_— ZZ— A Final Grading Approval: Date: 7 7 � By: _.e!Z Final Construction Approval: Date: By: Certificate of Compliance: Approv : Date: 9 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 10/16/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of D -box and By: John DiVincenzo At: Sl Laconia Circle Map 105D Lot 0151 North Andover, MA 01845 The Issuae of this certiVe shall not be construed as a guarantee that the system will function satisfactorily. We Heal 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ri Commonwealth of Massachusetts RECE11 3 City/Town of NORTH ANDOVER�yt , .t L, Certificate Certificate of Compliance rc � wc, , ;,1j1 f Form 3 ��. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On -Site Sewage Disposal System El Construction of a new system t__ ❑ Repair or replacement of an existing system ® Repair or replacement of an existing system component �r v Has been done in accordance with Title 5 and the Disposal System Constructs -Rftr !b(DSQP}� HEAL"Irl DFP14 ITMEN' DSCP Number DSCP Date ROBERT & CHRISTINE KING Facility Owner #81 LACONIA CIRCLE Street Address or Lot # NORTH ANDOVERMA — 01845 Citytrown State Zip Code Designer Information: , BRIAN J. FARMER, R.S. - AS -BUILT ENGINEERING LAND SERVICES, LLC Name Name of Company . 09-18-2014 Signature Date Ins t�er Information: Name — Name of Company A/ �� 'bite— rseof Date his system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date — --'� A t5form3.doca 06103 Certificate of Compliance • Page t of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts LHEALTH ��City/Town of NORTH ANDOVER x'014Certificate of Compliance RTH ANDOVER Form 3 PARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On -Site Sewage Disposal System ❑ Construction of a new system ❑ Repair or replacement of an existing system ® Repair or replacement of an existing system component Has been done in accordance with Title 5 and the Disposal System DSCP Number ROBERT & CHRISTINE KING Facility Owner #81 LACONIA CIRCLE Street Address or Lot # NORTH ANDOVER City/Town Designer Information: BRIAN J. FARMER, R.S. - AS -BUILT Name Signature v Installer Information: Name DSCP Date MA State hECEIVED agnitt{ WNDOVER HEALTH DEPMENT 01845 Zip Code INEERING LAND SERVICES, LLC W" of Company -18-2014 Date Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date l t5form3.doc• 06/03 Certificate of Compliance • Page 1 of 1 Blackburn, Lisa From: Blackburn, Lisa Sent: Tuesday, October 14, 2014 9:32 AM To: J and S Development Corp. J and S Development Corp. Oandsdevelopment@hotmail.com) Subject: 81 Laconia Attachments: Installation Certification.doc Good Morning, We are still waiting for John to sign the Installation Certification form for 81 Laconia Circle. We are unable to send the homeowner the COC until we receive the form. Thank you. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn @town ofnorthandover.com Web www.TownofNorthAndover.com F xol+tw ti0 n• L4s`�'4C.ltVSt'� 1 01 '---%'. ✓' �•• �c S `STV �� Sc '✓ � l � a 7� North Andover Health Department Community Development Division -r-o ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 81 Laconia -rd t, INSTALLER: John DiVencenzo DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS MAP: 105D LOT: 0151 D -Box & pipe INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ❑ Installed on stable stone base ❑ H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: e V Commonwealth of Massachusetts Map -Block -Lot 105. D0151 - ------- BOARD OF HEALTH -- Permit No ---------- North Andover - BHP -2014-0740 -------------------- P.I. FEE F.I. $125.00 --------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John DiVincenzo to (Repair) an Individual Sewage Disposal System. at No 81 LACONIA CIRCLE ----------------------------------------------------------------------------------------------------------------- ---- --------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2014- 4 a 2014 -------------- I �.� - -------------------------------------------------------------- Issued On: Aug -13-2014 BOARD OF HEALTH ---------------------------------------------------------------------------------- f NOR7q ~ ?O`4 9 Town of North Andover HEALTH DEPARTMENT CHUS�� CHECK 41,1 I) i)ATF• LOCATION: H/O NAME: CONTRACTOR N Type of Permit or License: (Check box) ❑ Animal ❑ Body Art Establishment ❑ Body Art Practitioner ❑ Dumpster ❑ Food Service - Type: ❑ Funeral Directors ❑ Massage Establishment ❑ Massage Practice ❑ Offal (Septic) Hauler ❑ Recreational Camp ❑ Sun tanning ❑ Swimming Pool ❑ Tobacco ❑ Trash/Solid Waste Hauler ❑ Well Construction SEPTIC Systems: ❑ Septic - Soil Testing ❑ Septic - Design Approval Septic Disposal Works Construction (DWC) ❑ Septic Disposal Works Installers (DWI) ❑ Title 5 Inspector ❑ Title 5 Report ❑ Other: (Indicate) 69/-C 41A 01) Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ICS ISI M y Application for Septic Disposal System AQ0, (Construction Permit — TOWN OF TODAY' DATE KORTH ANDOVER MA 01845 $ 250. — Full Repair 3 25.00 - Carr Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ air or replace an existing on-site sewage disposal system* Repair or replace an existing system component — What? PQo2c &P --e A. Facility InformationOF/ — G 1, s` I 4_ Addressor Lot # City/Town 2.- *TYPE QUEPTIC SYSTEM*: ❑ Pump LTGravity (choose one) ***If pump system, attach copy of electrical permit to application*** conventional System (pipe and stone system) r AUG 13 2014 TOWN OF NORTH ANDOVER }I HEALTH DEPARTMENT ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Own r Information if/I �l fii A" Name Address (if different from above) City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company % Addr s Ia C.��Drr'C� City/Town State Zip Code Telephone Number (Cell Phone # if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number (Best# to Reach) Application for Disposal System Construction Permit - Page 1 of 2 µ°R,W Application for Septic Disposal System UQ 1 l d01 S ♦ TODAY' DAT Construction Permit —TOWN OF ORTH ANDOVER $ 250.00 — Full Repair , MA 01845 $125.00 -Component �sS1CHU PAGE 2OF2 A. Facility Information continued.... 5. Type of Building:Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of Norti, IAtueo over, v not 0 place the system in operation until a Certificate of Compliance has bee is br; rhi,� Bqdrd of Health. Date Application Approved By: (Board of Health Representative) Name Application Disapproved for the following reasons: For Office Use Only: Date 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump S sy tem? If so, Attach col;v ofElectrical Permit Yes No 4. Foundation As-Buik? (new construction ronly): (Same scale as approved plan) Yes No 5. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: //_ e � fer..i � ✓ (Address of septic system) For plans by Relative to the application of ::�CA.i % (A 1/ i )J (Installer's name) Dated / r o ay s a ate And dated With revisions dated I understand the following obligations for management of this project: (Engineer) rignna ate (Last revised date) 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans pdor 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 manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (1`) inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdeptktownofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D -Box, 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 a1212roved plans. No instructions by the homeowner. general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) (,�, Name —Print)(Name —Signed) Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine Ki Owner's Name North Andover City/Town Ma 01845 State Zip Code 11/14/13 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor - do not John DiVincenzo use the return key. Name of Inspector Stewarts Septic Serive ras Company Name 58 South Kimball street Company Address Bradford Cityrrown 978-372-7471 Telephone Number B. Certification MA State S113386 License Number 01835 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 ❑ Fans ,r ❑ N e/ Fu her aluati n by the Local Approving Authority DEC 16 2013 TOWN OF NCR -1 i I ANDOVER HEALTH ,EPARTMENT Ins a for s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner's Name North Andover Ma 01845 11/14/13 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 3/13 Ttle 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System For �M 81 Laconia Circle B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): Pipes leading out of dist box, lower then laterals to trenched all 3 trenches dry. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 ection Form m - Not for Voluntary Assessments Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 11/14/13 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): Pipes leading out of dist box, lower then laterals to trenched all 3 trenches dry. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner's Name North Andover Ma 01845 11/14/13 Cityrrown 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 Y day flow t5ins • 3/13 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. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name required fo is required for every North Andover Ma 01845 11/14/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 11/14/13 page. CitylTown 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 gpd t5ins - 3113 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 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 page. CityrFown State Zip Code D. System Information Description: Number of current residents: 11/14/13 Date of Inspection Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: ❑ Yes ❑ No Date Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 11/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Date Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallon tank. gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma page. City/Town State D. System Information (cont.) 01845 11/14/13 Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: El cast iron ® 40 PVC El other (explain): Distance from private water su I well or suction line 16" feet pp y feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ Yes ® No ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System . Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover page. City/Town D. System Information (cont.) Septic Tank (cont.) Ma 01845 State Zip Code Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 30" 0 6" 14" 11/14/13 Date of Inspection How were dimensions determined? tape measure & sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Outlet baffle good, inlet baffle in place pitching back towrds house needs to be replaced Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w� 81 Laconia Circle Property Address Robert & Christine Kin Owner Owner's Name information is required for every North Andover Ma 01845 11/14/13 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 11 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 81 Laconia Circle Property Address Robert & Christine King Owner's Name North Andover Ma 01845 11/14/13 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 2" 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.): Box needs to be brought back to level pipes from box pitching back to box installed levelersflow flowinq to trenches. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 11/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches 3-53' number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure, ponding in manifold lines to trenches. All 3 trenches are dry and working properly. 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 t5ins • 3/13 ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine Kin Owner Owner's Name information is required for every North Andover Ma 01845 page. City/Town State Zip Code D. System Information (cont.) 11/14/13 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 11/14/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ® drawing attached separately t5ins - 3f13 Title 5 Official Inspection Foran: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is North Andover Ma required for every page. City/Town State D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells 01845 11/14/13 Date of Inspection Estimated depth to high ground water: 40" to 48" feet Please indicate all methods used to determine the high ground water elevation: // I Obtained from system design plans on record If checked date of desi n Ian reviewed 1-5-98 ' g p Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Pulled files ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Ground water at elevation 91.7. Bottom of bed at elevation 95.7 4' foot seperation between water table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 81 Laconia Circle Property Address Robert & Christine King Owner Owner's Name information is required for every North Andover Ma 01845 page. City/Town State Zip Code E. Report Completeness Checklist 11/14/13 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Blackburn, Lisa From: Blackburn, Lisa Sent: Wednesday, October 15, 2014 8:12 AM To: 'J and S Development Corp.' Cc: Sawyer, Susan Subject: RE: 81 Laconia Attachments: 81 Laconia.pdf Hi Ashley, Susan Sawyer wanted me to remind John of our local regulations regarding Title V's. The final inspection done at this address is now over 30 days. Please have him sign the attached as soon as possible. Thank you. 5.2 The onsite wastewater system installer shall complete final grading or other construction and sign the required Certificate of Compliance within 30 days of completion of the final inspection by the Health Department. If more than two (2) Certificates of Compliance are outstanding, a thirty day notice will be sent indicating no further Disposal Systems Construction Permits will be issued until all outstanding Certificates of Compliance have been submitted. From: J and S Development Corp. [mailto:jandsdevelopment@hotmail.com] Sent: Tuesday, October 14, 2014 3:05 PM To: Blackburn, Lisa Subject: RE: 81 Laconia Lisa, John has not signed because we have not been paid for the job. Ashley J and S Development dba Stewart's Septic Service 58 South Kimball St Bradford, Ma 01835 Phone: 978- 372 -7471 Fax:978-373-6611 Email: Jandsdevelopment@hotmail.com The information contained in this e-mail message is intended for use by the recipients(s) named above. If the reader of this message is not the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify me immediately by email and delete the original message. W). 1 North Andover Health Department (ommunity Development Division August 28, 2014 Robert and Christine King 81 Laconia Circle North Andover, MA 01845 Re: Update; Title 5 Inspection Dear Mr. and Mrs. King, The Health Department received and reviewed a Title 5 Inspection report dated November 14, 2013, for the subsurface disposal system at the property known as 81 Laconia Circle. Subsequently a letter was sent to you detailing stipulations to achieve concurrence by the Health Department that this subsurface disposal system is not considered a failure. Please see the list below. Documents in response to the letter have been received. Having complied with the requests, this plan is approved. • A licensed Professional Engineer or Sanitarian must be engaged by the owner to review the items needing correction and determine whether they concur that a repair can be achieved as noted. Complete • A plan shall be drawn up by the engineer and submitted to the Health Department for review. There shall also be a written statement submitted, where the engineer provides their agreement that the system can be repaired and does not need full replacement. Complete • The plan will be reviewed and subsequently approved by the Health Department. Complete • A Town licensed septic installer shall then be able to be hired to install the system. The installer shall pull a permit with the Health Department, where they will receive a copy of the stamped plan. Complete The following items shall occur. • The installer shall install and have the corrective actions observed by the engineer and a Town representative prior to covering up the system. • The engineer shall submit an As -built to the Health Office, which will document the final locations of all components and their elevations. 1600 Osgood Street, Bldg 20 Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com w , . �► • The Health Department will receive an "installation certification" signed by both the engineer and installer and then will subsequently issue the final "Certificate of Compliance" which can be used at a sale closing or for proof of correction. The result of this will be a Certificate of Compliance that will accompany the Title V. This will not be a brand new system rather a system that "passes" the Title V inspection. Finally, it was noted you currently have a garbage grinder. The 1998 plan for the system did not allow for the use of a grinder. The final inspection will include an in house check to ensure the garbage grinder has been removed. Thank you for your continued cooperation. We look forward to working with you in an effort to install a wastewater treatment and dispersal system, which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Thank you, Susan Sawyer, RS/REHS Public Health Director Cc: John DiVincenzo, Stewarts Septic Service Engineering Land Services, LLC file 1600 Osgood Street, Bldg 20 Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Engineering Land Services, LLC P.O.Box 41 West Newbury, MA 01985 Tel:978-815-6744 & Fax:978-462-6800 Email: MASSPLSRG@AOL.COM. August 12, 2014 Ms. Susan Sawyer, RS/REHS Public Health Director 1600 Osgood Street, Bldg 20 Unit 2035 North Andover, MA 01845 978.688.8476 (office) RE: 81 Laconia Circle — Response to Letter dated December 18, 2013 from North Andover Board of Health related to Title V Inspection performed November 14, 2013. Dear Ms. Sawyer, Upon our assessment of the septic system and review of the referenced letter above, we have completed our survey of the existing conditions and have reached a conclusion that distribution box (d -box) has settled two(2) inches and needs to be replaced. We propose the following at 81 Laconia Circle in North Andover to bring the system into compliance: 1. Expose the piping from the septic tank to the d -box 2. Expose the piping from the d -box to the leaching field 3. Recommend Town inspection of existing conditions 4. Reset the piping from septic tank to a 1% pitch 5. Reset the piping from the d -box to a 1% pitch 6. Raise and set the d -box 2" higher than current elevation 7. After completion of the proposed work, Town inspection After successful inspections, an As -Built of the repaired components will be submitted for the completed work including septic tank location with elevations, piping from septic tank elevations and dimensions to d -box, d -box .elevations and plan, piping from d -box dimensions and elevations, and final connection to leaching field locations, elevations and details. Should you have any questions or concerns, please feel free to contact me. Sincerely, Brian Farmer, RS HS Engineering Land Services, LLC C.- 46A T BRIAN J FARMER SANITARIAN #9312 engineering Land Services, P.O.BOX 41 WEST NENBURY, MA 01985 TEL: 978-815-6744 EMAIL: MASSPLSRGQAOL.COM SKETCH OF SANTIARY DISPOSAL SYSTEM EXISTING INVERTS AT HOUSE 99.1' TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.15' D -BOX OUT 97.97' BEG LINE 1 98.09' (4"PVC) 2 98.09' 3 98.09' END LINE 1 97.82' (4"PVC) 2 97.82' 3 97.82' EXIST VEN T OWNER: ROBERT & CHRISTINE KING #81 LACONIA CIRCLE NORTH ANDOVER, MA DATE: 08-28-2014 SCALE: 1 " = 20' LLC PROPOSED INVERT TABLE AT HOUSE 99.1' EXIST TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.42' D -BOX OUT 98.25' BEG.LINE 98.09' END LINE 9 x.82' o� ROBERT M. GRASSO ll q NO. 40215 v i''- Z ?" / f 4�Sp,GHLIS��� T BRIAN J N FARMER SANITARIAN #1312 a3'— 2 Fr DWELLING#81 EXISTING 01845 STONE TRENCHES 3'W x 1'D x 53'L EXISTING 13'L.F. 4"PVC SCH40 TO BE AJUSTED FOR SAG IN LINE EXISTING D -BOX (TO BE RAISED) EXISTING 1500 GALLON SEPTIC TANK North Andover Health Department (ommunity Development Division December 18, 2013 Robert and Christine King 81 Laconia Circle North Andover, MA 01845 Re: Title 5 Inspection Dear Mr. and Mrs. King, The Health Department has received and reviewed a Title 5 Inspection report dated November 14, 2013, for the subsurface disposal system at the property known as 81 Laconia Circle. The State Certified Inspector was John DiVincenzo. The document indicates the system "Conditionally passed" for two reasons based on the observations he made at the site and research made of town records. u. 1) The notes included by the inspector on Page 3, section B. B) indicate that if certain actions are taken in regards to the distribution box, the system will then pass inspection. The caveat of that statement is that the Board of Health must concur with this observation. The statements explain the observation on page 12, section D, that notes that the depth of liquid above the outlet invert is "2 inches". Please be advised that a leaching system can automatically be failed based on any depth of liquid above the outlet invert, without further investigation. However, Mr. DiVincenzo finds that the pitch of the pipes etc. are the cause of the problem; rather than finding that the field is flooded. 2) Page 10 section D. under comments it is noted; "outlet baffle good, inlet baffle in place pitching back towards house; needs to be replaced." This identifies that somewhere between the house and the tank; the pipe is not pitching downward. How much of the pipe needs to be replaced/repaired has not been determined by this inspection. As your inspector may have informed you, this type of "conditional pass" is unusual. The following process will need to be followed to correct these issues and achieve support from the Board of Health. These are necessary to correct the findings noted above. • A licensed Professional Engineer or Sanitarian must be engaged by the owner to review the items needing correction and determine whether they concur that a repair can be achieved as noted. 1600 Osgood Street, Bid 20 Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com • A plan shall be drawn up by the engineer and submitted to the Health Department for review. There shall also be a written statement submitted, where the engineer provides their agreement that the system can be repaired and does not need full replacement. • The plan will be reviewed and subsequently approved by the Health Department. • A Town licensed septic installer shall then be able to be hired to install the system. The installer shall pull a permit with the Health Department, where they will receive a copy of the stamped plan. • The installer shall install and have the corrective actions observed by the engineer and a Town representative prior to covering up the system. • The engineer shall submit an As -built to the Health Office, which will document the final locations of all components and their elevations. • The Health Department will receive an "installation certification" signed by both the _engineer and installer and then will subsequently issue the final "Certificate of Compliance" which can be used at a sale closing or for proof of correction. I will be happy to answer any questions you may have regarding the requirements or associated fees. I apologize that these tasks may be a bit confusing; but unfortunately without them the Health Department cannot support the "conditional pass" finding. Note that completion of these tasks is still much less invasive than to have to install a completely new disposal system and they are very important to ensure the protection of current and future owners. Finally, it is noted you currently have a garbage grinder. The 1998 plan for the system did not allow for the use of a grinder. The introduction of food waste will shorten the life of any septic system and could void any septic installer warrantees. The grinder must be removed before this department can issue a Certificate of Compliance. Thank you for your anticipated cooperation. We look forward to working with you in an effort to install a wastewater treatment and dispersal system, which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Thank yokf. f s SawyerAS/RE S Pu lic Hea Direc r Cc: John DiVincenzo, Stewarts Septic Service file 1600 Osgood Street, Bldg 20 Unit 2035, North Andover, Massachusetts UI845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com -OE Filo No. ' r (To be provided by DEOE) • __ �City/Town : `o r 1:'• i `,rc' We Commonwealth r. of Massachusetts an trite Applicant Order of Conditions Massachusetts Wetlands Protection Act Gil. c.131, §4 . o.nd under the'Town•of North Andover Bylaw, Chapter 3.5 A'& B". t' From I'1nrt.1'1 l:r,;';w�l :nitig 1-y,, t :i n1.1 0, j . To (Name, of Applicant) (Na ne of property owner) Address ,^ '''�,'r :11` !11 '�/: /, Address This Order is issued and delivered as follows: ❑ iby hand'delivery to applicant or representative on .y w (date) ❑ 'by certified mail, return receipt requested on October. 3, ' (date) This project is located at ?nt� S;`_,. 1.'/�., �5��, '� ?1 l;n�'ri:l �GI �t�S Dr.,, The property is recorded at the Registry of x.14 Book Page Certificate (if registered) The Notice of Intent for this project, was filed on (date) The public hearin was closed on `' I `'' t P. ` (date) 9 Findings ' The has reviewed the above -referenced Notice of .Intent and plans and has held a public hearing on the project. Based orAhe information available to the at this time, the has determined that 'the area on which the proposed work'is to be done is significant t- the Following interests In accordance whht the Presumptions of Significance set forth in the regulations for each p. -a Subject to Protection Under the Act (check as appropriate): © Public.water supply M Storm damage prevention 0 Private water supply ® . Prevention of pollution • Lel Ground water supply ❑ ` Land containing shellfish ® Flood control ❑ Fisheries w LOT 5 co - 4\ f 14 Vp6d+i. 8 Z3`' FORM - U - LOT RELEASE FORM 1 INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ■■■.■■■■■■■■■■■■■_■■■■■■■■■■■■■■i1......■.■■■.....■■....................... �(-APPLXAN-T R0 Cd ickr4of-1 o HONE 2 7 2 L ASSESSORS MAP NUMBER D LOT NUMBER L:.�/ SUBDIVISION LOT NUMBER l c - Ira I I0.0 ... : m (.......` ......... STREET ... I........ OFFICIAL USE ONLY T RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CO SERVATION ADMINMTRA f> nem uFr�rr'F' F� TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSP TOR - TH DATE REJECTED DATE APPROVED �a CIN CTO - HEALTH DATE REJECTED COMMENTS o :�+: G t�� o �i XVAC PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CON%4ENTS RECEIVED BY BUILDING INSPECTOR DATE J Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH April 24 19 98 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X) by John Soucy INSTALLER at 81 Laconia Circle SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 1010 dated January 15 19 98 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. i BO RD OF HEALTH pakl)- S i 2s u1��1 e r �e cn Iwraete 4"[ D � Ik i�57 S f„Pt.- wn-n 0 �� � S-t��--pe'� �l`i�gl� FORM 11 - SOIL EVALUATOR FOMI Page 1 No. ...................................... Date.....-................ Commonwealth of Massachusetts 4&k�X v- , Massachusetts Performed By:.<..........pu.fx-j ................................................ ............................ ....�,I.. Witnessed By: ......... :..::.:J.................................................................................. ::::::Y::::: ::A::::::::::::::::::::::::::, London Address Of T/l �6 G��I� C� �� �%oww's 14M. Lot 8 Aftm. ud 1' �t C "t�` ^iu 7leo _C.0 New construction ❑ Repair l� Office Review Ef/ Published Soil Survey Available: No ❑ Yes �... Year Published ....t f Publication Scale/.'*/*"�W Soil Map Unit ...:G, DrainageClass ..... ..1J...... Soil Limitations......................................................................� ................... Surficial Geologic Report Available: No ET� Yes ❑ 'Year Published ................... Publication Scale .................. GeologicMaterial (Map Unit)........................................................................................................................................................... Landform................................................................. .................................................................................................................................. ................ Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500Y ear flood boundary No Yes El Within 100 year flood boundary No Yes ❑ Wetland Area: National Wetland Inventory Map (map unit)................................................................................................................. Wetlands Conservancy Program Map (map unit)................................................................................................... Current Water Resource Conditions (USGS): Month .................. Range : Above Normal ❑ Normal ❑ Below Normal ❑ Other References Reviewed: C Ll FORM 11 - SOL EVALUATOR FORM Page 2 0n -site Review or Deep Hole Number ...... Date:� Time: ..o,.. ..... WeatherC.l�:..�. �1�7��.�.�lQ... i�g Location(identify on site plan).............................................................................................................................................................. LandUse ............, ............................... Slope M Surface Stones ....dL....................................................................... Vegetation....... J&K- i............................................................................................................................................................................................................... Landform.........1 ^- r ............... ............................. .................................................................................................................................. I...................... Positionon landscape (sketch on the back)......................................................................................................................................................... Distances from: Open Water Body N.9q?.. feet Drainage way ... >P.24. feet Possible Wet Area .�..lo!... feet Property Line ...... �5;'� feet Drinking Water Well >�P.o..' feet Other ......................................... DEEP RVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 32 - 9`t, Kit. S.L. Z. Y Y/y Parent Material (geologic) ............ .......C..t:....'... ................................................ I .............. ......... Depth to Bedrock: .... r... F Depth to Groundwater: Standing Water in the Hole:... meping from Pit Face:...... . a � Estimated Seasonal High Ground Water:.....�/�. FORM it - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number ... �°'7/ Date:...' ?."f Time:.../0--, .... Weather Location(identify on site plan) .......... --:�1<:..-..�.................................................................................................................................... Land Use .........eA..,.............................. Slope 1 %1 .G..:- Surface Stones ........ h."'... .......... ............................................ Vegetation ...................................................................................................................................... .......................................................................... Landform ............................................................................................................................................................................... ..................... Positionon landscape (sketch on the back)......................................................................................................................................................... Distances from: Open Water Body ...?..IPO feet Drainage way...T...�AO� feet Possible Wet Area ..}.I°..t feet Property Line .....W.-4' feet Drinking Water Well Z.W.0.... feet Other ......................................... DEEP RVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 011 �r�y�,� �r• C' 44's 5,* Parent Material (geologic) ...................C:......:....................................................................... Depth to Bedrock: J7.....-.... Depth to Groundwater: Standing Water in the Hole:XWeeping from Pit Face: ... Estimated Seasonal High Ground Water: .....446 FORM 11 - SOIL EVALUATOR FORM Page 3 Method Used: ❑ Depth observed standing in observation hole ................... inches ❑ .Depth weeping from side of observation hole inches t Depth to soil mottles inches inches �. ❑ Ground water adjustment feet Index Well Number ................... Reading_ Date ................... Index well level .................. Adjustment factor .................. Adjusted ground water level ........................................................ Death 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? n -eS i If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the 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 W p4o4, JjZ164�, Date �' '� V FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Oa, 47,weos� , Massachusetts Percolation Test Date:.......1-1..?i5.g. Time:.........../......`:. Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time a� 6" Time (9"-6") Rate Min./Inch ' Site Passed a Site Failed ❑ Performed By: l7- ou 4�p_tt,- t Witnessed By: � d DATE: 7 9 LOCATION:IGd ENGINEER: BOH WITNESS: I G�_ PERCOLATION TEST # BOTTOM DEPTH OF PERC TEST: TIME OF SOAK: ori, (At least 15 minutes long) TIME AT 12" Aim, TIME AT 9" Z. _4 > 3,3 TIME AT 6" _2� 6 OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK. - TIME OAK:TIME AT 12" TIME AT 9" TIME AT 6" (At least 15 minutes) � ��c I_—� .ice i) "+,•' i i�\� \ I Tf'y7' P ��_ �i'"l � ti.`�y � I� 1 Nil- --------------------- I L ,-�� �'el �. •��� � � �I I`�y, `'`1'�� ' � }:may- �i.� . i I I I al � I,' � ; L? ; i� �. I �i :tom, � / � �•� I _- I I � , I i I � I Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director March 17, 1998 Mr. Bill Dufresne. Merrimack Engineering 66 Park St.. Andover, MA 01810 Re: 81 Laconia Circle. N. Andover, MA 01845 Dear Bill: 30 School Street North Andover, Massachusetts 01845 This is to inform you that the proposed plans for the site referenced above have been approved. 0 If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator S S/rel cc: Kenneth and Sandra Hoffman File �d� c 3 4-1 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 f ,AORTN O , w p • s AcMuSEt� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant_ _�� /70�`/�%/9/.1 Test No. Site Location /A d ledLt' Reference Plans and Specs.1 /Ph ENGINEER ic jli,-5-/q Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee "G- e) 11,319,9 ��CHAIRMAN, BOARD OF HEALTH OF HEALTH Site System Permit No. f O / 0 L s n �9 ocnicnewic• _ �'/ Applican Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 8c- 45Z 19 5? APPLICATION FOR SITE TESTING/INSPECTION Q(" 5l)-A),b Site Location Engineer Zv� Test/Inspection Date and Time 92d,. 65, d'98 CHAIRMAN, BOARD OF HEALTH Fee 070- Test No. ?21 S.S. Permit No. l�/� D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH i646N0 19 L k APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH F S.S. Permit No. D.W.C. No. C.C. Date Test No. Plbg. Permit No. PLAN REVIEW CHECKLIST ADDRESS C)/ Z466/)/1Q ENGINEER --'B - DVF46-SO4!� GENERAL 3 COPIES STAMP U LOCUS 6---' NORTH ARROW 1--' SCALE L� CONTOURS ✓ PROFILE[, -(Sc) SECTION L/ BENCHMARKc/ SOIL & PERCS ELEVATIONS ✓ WETS. DISCLAIMER WELLS & WETS WATERSHED?A16 DRIVEWAY WATER LINE L/ FDN DRAIN — M&P SCH40 L/� TESTS CURRENT? !/ SOIL EVAL - bUF4C=5V45 SEPTIC TANK MIN 150OG l/ .17 INVERT DROPL,-' GARB. GRINDER&(2 comps +200) 10' TO FDN MANHOLE L/ ELEV G—. GW C/ # COMPS. / GB Li D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLE'Iq7,1 ,7 - OUTLET 57 .DD = ` / ( 2" OR .17 FT) TEE REQ' D? //6 LEACHING / n MIN 440 GPD? v RESERVE AREA L/ 4' FROM PRIMARY?b'/C 20 SLOPE 100' TO WETLANDS `_ 100' TO WELLS4-- 4' TO S.H.GW"-' (5'>2M/IN) 20' TO FND & INTRCPTR DRAINS 400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER E"f FILL?`' y(15') BREAKOUT MET? TRENCHES MIN 440 gpd I'l/ SLOPE (min .005 or 611/1001) ` SIDEWALL DIST. 3X EFF. W OR D (MIN 6/') L--- RESERVE BETWEEN TRENCHES? L"-- IN FILL? MUST BE 10' MIN:QI� 4" PEA STONE?� VENT? (>3' COVER, INES 50 BOT � + SIDE c� _ % �-fJ X LDNG ' 66 = TOT -4-77 (L x W x #) (DxLx2x#) (G/ft2) Copyright Q 1996 by S.L. Starr SEPTIC PLAN SUBMITTALS LOCATION:�`-�- NEW PLANS: YES REVISED PLANS: YES DATE: DESIGN ENGINEER: 2;11 $60.00/Plan $25.00/Plan V _A_eS A -- When When the submission is all in place, route to the Health Secretary OMNIENVIRONMENTALCORPORATION 433 West Street Amherst, MA 01002 February 26, 1999 Board of Selectmen 120 Main Street North Andover, MA 01845 Re: Response Action Outcome Statement Public Involvement Release Tracking Number 3-17609 Dear Madam or Sir; Tel: (413) 256-0394 Fax:_( ) 256 06_ TOWN OF NORTH ANDOVER/ BOARD OF FIEALTH MR-8LV L:L� Pursuant to 310 CMR 40. 0000, the Massachusetts Contingency Plan, section 40.1403(3)(f), please accept notification that a Response Action Outcome Statement (RAO) is being filed with the Massachusetts Department of Environmental Protection (MA DEP), Northeast Regional Office, Bureau of Waste Site Cleanup, at 205A Lowell Street, Wilmington, MA 01887 regarding Release Tracking Number (RTN) 3-17609. This matter involved a spill of diesel fuel in the vicinity of 81 Laconia Circle. The spill has been cleaned up. A copy of this RAO has been sent to Mr. Michael Howard, Conservation Administrator for the Town of North Andover. If you have questions concerning this environmental concern please contact me or James C. Spencer, PE, LSP at (413) 256-0394. Sincerely, OMNI ENVIRONMENTAL CORPORATION F. Thomas Keefe, Project Manager cc: Ms. Sandra Starr, Director, Board of Health, Town of North Andover Mr. Christopher Bresnahan, MA DEP, NERO, BWSC Corporate Headquarters: 211 College Road East • Princeton, NJ 08540 • Tel: (609) 243-9393 • Fax: (609) 243-9297 Town of North Andover, Massachusetts Form No. 3 NORTH BOARD OF HEALTH OftT��oY6,tip wl ` 3? e - • .. e 19 �►'°���"� DISPOSAL WORKS CONSTRUCTION PERMIT ,S34CHUSEt Applicant ;J© �L e—, )e 7Z)% NAME ADDREYS TELEPHONE Site Location__ ( L a l Imo` / C •^Gl Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. ID / D 47. Fe 7-5 CHAIRMAN, BOARD OF HEALTH D.W.C. No. 913 % TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION nl a mdersigced hez+eby ca fy tbet the Sewage TMspos`t System ( ') constructed; (/ repaired; by �GLIG`f locatod at � i I�Go hJ lk U k�.l� . was iustallod m conformance with the North Andover Board of Health approved plan, System Design Peroait _ , dated , with an.approved design flow of,O ,gallons per day. -The materials used were in eonformaum 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 regdarlons, and a final grading agrees substarnially with the approved plan. All work is -accurately repr on theAs-built which has been submitted to the Board of Health. Installer:`1 Lic. #: Date: I� a 01, =71 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEiv1 INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; N repaired; by located at % Z— 2—':L was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # life_, dated l S ` with an approved design flow of. gallons per day. The materials— ed wefe in conformance with those specified on the approved plan; the system was installed in -accordance with the provisions of 310 CVLR 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. Installer: Lic. #: Date: Design Engineer: Date: rj APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 3 CURRENT INSTALLER'S LICENSE# w LOCATION: f L wcy'i (q CI 62 R LICENSED INST. SIGNATURE: /A'ATEL a6)-EPONE# 4t, REPAIR: I/1J NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -Built? Administrative Use Only Yes No Yes No Floor Plans? Yes No Approval Date: - y '40XT)' 11 s SAc/1U5�� BOARD OF HEALTH 146 MAIN STREET NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 7 LOCATION OF SbIL TESTS: Assessor's map & parcel number: TEL. 688-9 540 (L) OWNER: A IVPk# XAP/"�M�V TEL. NO.: ADDRESS: -� C,ik C - ENGINEER: // j �/ f' /1/� TEL. N0. __ fi 4/7-r CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home, commercial 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 $175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. 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. 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. r9nnr7r,r-�r-,r-. I - ` / -/ C7t7 dl�� ���j�o/J O `% 07 (�d jo� �/r/U o� G i>.ed i� e Gcirr� �a �,�-., � �� .]%//� U�/.✓c ��.tr.`� �/-r� r oo_s o �.� I/ goy c- v a:311Z /iL;L .rsv1� Gam' 3—iQ a,°�, i�� ltioAcQ COMPLAINT NUMBER DATE: #14 FEB. 19, 1992 COMPLAINTANT:ANONYMOUS CLOSE DATE: ADDRESS: PHONE: OWNER:MR. & MRS. HOFFMAN PHONE #: ADDRESS:81 LACONIA CIRCLE INSPECTION DATE: ORDER L DATE: COMPLAINT:PLACING TRASH OUT 5-6 DAYS PRIOR TO TRASH PICK-UP. THE TRASH IS ALL OVER THE STREET AND ANIMALS ARE GETTING INTO IT. ACTION: j� v I - ` / -/ C7t7 dl�� ���j�o/J O `% 07 (�d jo� �/r/U o� G i>.ed i� e Gcirr� �a �,�-., � �� .]%//� U�/.✓c ��.tr.`� �/-r� r oo_s o �.� I/ goy c- v a:311Z /iL;L .rsv1� Gam' 3—iQ a,°�, i�� ltioAcQ Engineering Land Services, P.O.BOX 41 WEST NEWBURY, MA 01985 TEL: 978-815-6744 EMAIL: MASSPLSRG@AOL.COM SKETCH OF SANTIARY DISPOSAL SYSTEM ( 08-28-2014 ) EXISTING INVERTS AT HOUSE 99.1' TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.15' D -BOX OUT 97.97' BEG LINE 1 98.09' (4"PVC) 2 98.09' 3 98.09' END LINE (4"PVC) 1 97.82' 2 97.82' 3 97.82' LLC ( 09-18-2014 ) AS -BUILT INVERT TABLE AT HOUSE 99.1' EXIST TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.43' D -BOX OUT 98.26' BEG.LINE 98.09' END LINE 97.82' AS -BUILT TIES TANK A -C 38.5' B -C 25.3' D -BOX A -D 50.0' B -D 33.0' T. B. M. A TOP DECK EL=101.70' r` (ASSUMED) *000 r tYR' V 'Ci y EXIST VENT \ '0' OWNER: ROBERT &CHRISTINE KING #81 LACONIA CIRCLE NORTH ANDOVER, MA 01845 DATE: 09-18-2014 SCALE: 1 " = 20' co BRIAN J N FARMER SANITARIAN #1312 DWELLING#81 EXISTING 13'L.F. 4"PVC SCH40 r '•> B \C O / EXISTING STONE TRENCHES 3'W x 1'D x 53'L 0 12'L.F. 4"PVC SCH40 EXISTING D -BOX EXISTING 1500 GALLON SEPTIC TANK OFlygs� oy o� ROBERT M. �+ GRASSO q NO. 40215 I--i8-i ¢ Engineering Land Services, LLC P.O.BOX 41 WEST NEWBURY, MA 01985 TEL: 978-815-6744 EMAIL: MASSPLSRGOAOL.COM SKETCH OF SANTIARY DISPOSAL SYSTEM ( 08-28-2014 ) EXISTING INVERTS AT HOUSE 99.1' TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.15' D -BOX OUT 97.97' ( 09-18-2014 ) AS -BUILT INVERT TABLE AT HOUSE 99.1' EXIST TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.43' D -BOX OUT 98.26' BEG.LINE 98.09' END LINE 9782' BEG LINE 1 98.09' (4"PVC) 2 98.09 AS -BUILT TIES 3 98.09' TANK A -C 38.5' END LINE 1 97.82' B -C 25.3' (4"PVC) 2 97.82 D -BOX A -D 50.0' 3 97.82' B -D 33.0' OWNER: EXIST VENT ROBERT & CHRISTINE KING #81 LACONIA CIRCLE NORTH ANDOVER, MA 018, DATE: SCALE: 09-18-2014 1 " = 20' PyspcHUs� BRIAN JN FARMER SANITARIAN #1312 DWELLING#81 EXISTING STONE TRENCHES 3'W x 1'D x 531 EXISTING 1500 GALLON SEPTIC TANK '?- Ir-/¢ Engineering Land Services, P.O.BOX 41 WEST NEWBURY, MA 01985 TEL: 978-815-6744 EMAIL: MASSPLSRG@AOL.COM SKETCH OF SANTIARY DISPOSAL SYSTEI ( 08-28-2014 ) EXISTING INVERTS AT HOUSE 99.1' TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.15' D -BOX OUT 97.97' BEG LINE 1 98.09' (4"PVC) 2 98.09' 3 98.09' END LINE 1 97.82' (4"PVC) 2 97.82' 3 97.82' EXIST EXIST VENT OWNER: ROBERT & CHRISTINE KING #81 LACONIA CIRCLE NORTH ANDOVER, MA 018, DATE: 09-18-2014 SCALE: 1 " = 20' LLC Received SEP 3Vvty VI• NUK IH ANUUVER HEALTH pEPARTINENT ( 09-18-2014 ) AS -BUILT INVERT TABLE AT HOUSE 99.1' EXIS TANK IN 98.80' TANK OUT 98.55' D -BOX IN 98.43' D -BOX OUT 98.26' BEG.LINE 98.09' END LINE 97.82' AS -BUILT TIES TANK A -C 38.5' B -C 25.3' D -BOX A -D 50.0' B -D 33.0' ySpCHUS 4QBRIAN J N FARMER ,.� SANITARIAN #1312 DWELLING#81 EXISTING STONE TRENCHES 3'W x 1'D x 531 EXISTING 13'L.F. 4"PVC SCH40 EXISTING 1500 GALLON SEPTIC TANK Commonwealth of Massachusetts FREI�Cityaown of No Andover ® 2013System Pumping RecordForm 4 MMTH �iv r DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When riling out forms 1. System Location: I on the computer,1 Ccs n � � i r � use on the tab lJ key to move your Address cursor - do not No andover use the return Ma key. City/Town stats Zip Code 2. System Owner: in Name a� Address (if different from location) CitylTown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping p g nate f --r � j 2. Quantity Pumped: Xallon� 3. Type of system: ❑ Cesspool(s) 0 Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: SteWarPs Pre-treatment Plant 20 So. Mill Bradford Ma 01835 Signature of Hauler Signature of Receiving Facility t5form4.doc• 03/06 Date Date System Pumping Record • Page 1 of 1 _ Commonwealth of Massachusetts 1 q City/Town of NORTH ANDOVER MASSACHUSETTS System Pumping Record Form 4 RECEIVED DEP has provided this form for use by local Boards of Health. The stem Pumping Record ut be submitted to the local Board of Health or other approving authori y. JUL 19 2006 A. Facility Information OWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: When filling out 1. System Location. forms on the - computer, use only the tab key 71— cursor �� -- - - - -- - - ----- ---- - - to move your - do not ----- City/Town - -- --- - use the return key. � 2. System Owner: State Zip Code Name -- ream ----- dress (if different from location) ----.- -. City/Town------------ - — Zip C de Telephone Number B. Pumping Record --- -- -- 1. Date of Pumping date -- 2. Quantity Pumped: ------- Gallons I Type of system: ❑ Cesspool(s) . tic Tank ❑ Tight Tank ❑ Other (describe): -.__-_.___._...__________ _._ 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yese-, 5. Condition of System: 6. Sy em Pumped By: - k1_. Name Vehicle License Number Company - 7. Location where contents were disposed: .. _ Si ature of Haul ------.___-_----_ _-- -. Date http://www.mass.gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page of t TOWN OFNOZTH ANDOVER SYSTEM PLWING RECORD DATE vwNtK & ADDRESS SYSTEM LOCATION y DATE OF PUMPIN(}_ QUANTITY PUMPED /, 0 J CESSPOOL NO �-�SL� SEPTIC TANK NO YES NATURE OF SERVICE;;,RO[7TINE EMERGENCY OBSERVATIONS: GOOD CONDITION -'FULL TO COVER HEAVY GREASE �„ T BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY igl TO" OF N ORTHANDOVER SYSTEM PUMPING RE C0%" T 4 A SYSTEM OWNER &ADDRESS SYSTEM 5TEM LOCATIO C' (C-UMPleo- l9ft 'front Of hlD..) <yj 11-11�*A 1p — '13, .......... G; 'QUANTITY PUMPED GALLONS • YES 'SEPTIC TANK: NO No YES "OF SERVIC E; ROUTINE EMERGENCY GOOD CONDITION: FULL TO COVER HEAVY GREASE BAFFLES IN PLACE E ...... moomoo EXCESSIVE SOLIDS LEACHMLD RUNBACK FLOODED. SPLEDSCARRiOVF,.k OTHER (EXPLAIN) ol EAY; am.-movo '17 J.. 41mom 9 7777=1 4RR