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HomeMy WebLinkAboutMiscellaneous - 815 JOHNSON STREET 4/30/2018 (3)m North Andover Board of Assessors Public Access .., ..moo Page 1 of 1 Forth Andover Board of Assessors roperty Record Card Parcel ID :210/107.A-0027-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Location: 815 JOHNSON STREET Owner Name: APPLETON, WILLIAM B. ` APPLETON, SHERYL J. 4 Owner Address: 815 JOHNSON STREET i City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 3.52 acres j Use Code: 101-SNGL-FAM-RES Total Finished Area: 36961 Total Value: I NO WA W-3 t PREVIOUS YEAR i 522,300 522,300 Building Value: 277,500 277,500 Land Value: 244,800 244,800 Market Land Value: 244,800 Chapter Land Value: Price: 100 Sale 03/22/2006 Date: s Length Sale F-NO-CONVNIENT Grantor: APPLETON, WILLIAM Doc: Book: 10089 Page: 285 http://csc-ma.us/PROPAPP/display.do?linkId=1896018&town=NandoverPubAcc 6/13/2012 I 1�ts ,/fir... Lot & Street IK 3 Map/Parcel d % CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: Approved by: Designer: Plan Date: -- Conditions: Water Supply: Town.. ____ Well Well Permit: YES __Driller: Date Issued By: - Well Tests: Chemical Date Approved Bacteria I Date -Approved Bacteria H Date -Approved PlumbinzSign-Off: Wiring Sign -Off: Comments: Form "U" Approval: Approval to -Issue: YES NO Date Issued By: - Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO //-0 60 FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION I Is the installer licensed? 4-�/ No' Type of Construction: NEW &MAIR New Construction: -Certified Plot Plan Review YES --NO"�n --Floor Plan Review YES NO — Conditions of Approval from Form U YES NO _Issuance of DWC permit. -S NO _DWC Permit Paid? — ` NO ----DWC_Permit # Installer: JD hNu :5 /a-lc� Begin Inspection:_ NO _Excavation Inspection. --Needed: a —Passed: _ By: .� ._Construction Inspection: ' Needed: As Built -Plan Satisfactory: YES: Approval of Backfill: Date: �f� By: --Final Grading Approval: Date: - By:�=� Final Construction Approval: Date: Certificate of Compliance: Approval: Date: Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key, p �I 1�1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street 1 Main House William and Sheryl Appleton Owner's Name — North Andover Cityrrown MA 01845 State Zip Code 6-14-12 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. A. General Information 1. Inspector: Benjamin C. Osgood, Jr. �l 9109 Name of Inspector�— none TOWN OF NORTH ANDOVER Company Name HEALTH DEPARTMENT 16 Hillside Avenue, Unit 3 Company Address Amesbury City/Town ---- 978-834-6585 _ Telephone Number _ B. Certification MA State 870 License Number 01913 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 ❑ Needs Further Evaluation by the Local Approving Authority _ 6-17-12 _ Inspector's nature 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 some or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cant.) 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 0 ND (Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 ❑ 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 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 ' Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner Owners information is Name required for North Andover MA 01845 6-14-12 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall 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 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 '/2 day flow ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner information is Owner's Name required for North Andover MA 01845 6-14-12 every page. Citylrown _ 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. El ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 official Inspection Subsurface Sewage Disposal System For - No Form Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address Owner William and Sheryl Appleton information is Owner's Name ----- required for North Andover MA _ 01845 __ 6-14-12 every page. City,rown C. Checklist State Zi Code P Date of inspection 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)1 D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 550 Commonwealth of Massachusetts •• Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House _ Property Address William and Sheryl Appleton Owner Owner's Name information Is North Andover MA 01845 6-14-12 required for _ every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Yes 2 No ❑ 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): well Detail: Sump pump? ® Yes ❑ No _ Last date of occupancy: currentDate 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: Gallons per day (gpd) ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • ° 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryi Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every 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: Date Source of information: Pumped summer 7-14-10 per BOH records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: How was quantity pumped determined? Reason for pumping: gallons 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 !/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other (describe): PUMP Approximate age of all components, date installed (if known) and source of information: Built Sent 1998 Per As Built Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Dito fr t t 1 II tn line ElYes ® No 1.5' feet NIA s nce otrt pnva a wa ei I supe y we or suc o feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe looks good in basement Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 1' feet ❑ 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: 1500 gallons Sludge depth: 1" Commonwealth of Massachusetts Title 5 official Inspection Form c Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 _ 6-14-12 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Built Sent 1998 Per As Built Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Dito fr t t 1 II tn line ElYes ® No 1.5' feet NIA s nce otrt pnva a wa ei I supe y we or suc o feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe looks good in basement Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 1' feet ❑ 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: 1500 gallons Sludge depth: 1" Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments b • 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner information is owner's -Name required for North Andover MA 01845 every page. City/rown 6-1412 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 32" Scum thickness lit Distance from top of scum to top of outlet tee or baffle 5" _ Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measure tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Concrete Baffle and Tee intact Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet [,j 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: _ Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner owner's Name Information is required for North Andover MA 01845 6-14-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton _ Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" — Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box in OK condition. Distribution normal. No evidence of leakage in or out. No solids carryover. Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ® Yes ❑ No ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump and pump chamber appear to be in good working order Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.). Area of field is grass and looks normal No evidence of ponding, damp soil, or unusual vegetation 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 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address Owner William and Sheryl Appleton information is Owner's Name required for North Andover MA 01845 6-14-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 45'x 25' ❑ 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.). Area of field is grass and looks normal No evidence of ponding, damp soil, or unusual vegetation 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 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address — William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Corittments (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.): Commonwealth of Massachusetts leiTitle 5 Official Inspection Farm Subsurface Sewage Disposal System Foran _ Not for Voluntary Assessments 815 Johnson Street SYSTEM f Property Address William and She Appleton Owner Owner' Ns ame — ---- information is '— - -.-- ----- —---.-----.. _ required for North Andover every Page. Cityrrown MA 01845 6-14-12 __ —'— ----- - State Zip Code Date of Ins�per noct -- U. 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 Q drawing attached separately C fl, f 15-00 0 srt) Tx. W,., '2- i3 A GaZ>t•c,us sir rn U SySTc.�m t C71,ST�N[�5 A -ry k 5L �-rA,j it,. 3Y t i'.j-_ S> o' n v 13-J�,,� .571 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner Owner's Name Information is required for North Andover MA 01845 6-14-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 3 feet Please indicate all methods used to determine the high ground water elevation: ►:1 IN Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: ESHGW determined by Diotalevi, RS on 5-7-98. System built 3 feet above seasonal high ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 815 Johnson Street SYSTEM 1 Main House Property Address William and Sheryl Appleton Owner Owner's Name information is required for North Andover MA 01845 6-14-12 every page. Cityrrown State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: _ This is to certify that the individual subsurface disposal system constructed ( ) or repaired ( x ) by North Andover Licensed Installer John T. Shaw, III at 815 Johnson Street, North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # dated. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector I CICT-06-1`39'81, 01'--'; '11G, 0 G3 + rG, 9 7 .4; R 4, P Cl: PIC. of xQjt'Vh1V471'OVE.R stwAr-11 OMM&UAYSTEM LN -V ALIALT 10-1 CERTM-Arl'GIN vy I �WfA fa. wPh ftt K�N'* a go 1. vt Ao z Z,. v a, -A- viaz i Titk 5 Rpm, in C A Aq, WfW �gjgtjEql wiTt Z4 7111-� 11 V ttT D Ti ti Of 40RTPI � 0 F 9 SS^CHUSEt Town of North Andover, Massachusetts BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME Site Location 1?1 AUUKESS TEL Permission is hereby granted to Construct ( ) or Repair (C4—an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. Fee (OZ&— CHAIRMAN, BOARD OF HEALTH D.W.C. No. 1 y3 E 76 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: R 6 21 - CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER:— _94- � SIGNAT �,,.._�2 TELEPHONE# y 7 90,:3 g CHECK ONE: REPAIR: 4, NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval��J Date: / May 27, 1998 North Andover Board of Health 146 Main Street North Andover, MA 01845 Re: Septic System Repair 815 Johnson Street - Variance to 310 CMR 15.000 Title 5 and Local Regulation 9.04 Dear Members of the Board of Health: This letter is written on behalf of William R. and Claire A. Moody, owners of the above -captioned property, to request a variance to North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 310 CMR 15.000 Title 5 of the State Environmental Code. A septic system repair at the above -captioned property has been designed three feet above ground water with no reserve area design and requires a variance to local regulations 9.04 Reserve Area as well as to 310 CMR 15.212 Depth to Ground Water under 15.405(1) Content of Local Upgrade Approval. Local regulation 9.04 Reserve Area requires the testing and design of a reserve area for all proposed septic system repairs. In the area proposed for the leach facility repair, property line, dwelling setbacks and the presence of a swimming pool prevent locating a second leaching area without encroaching on these structures. Investigation of the rear of the property for potential sites was not done due to the likelihood of ledge between the present siting of the septic system and the rear of the property. In addition, testing at the rear of the property would further disrupt the landscaping and increase the cost of testing, design and repair. The septic system has been designed 3 feet above ground water to allow for grading required by 310 CMR 15.211 Down Hill Slope to remain within the limits of the subject property and to prevent the grading from trapping runoff against the dwelling. The alternative to this design requires construction of retaining walls on both sides of the proposed system with a total length greater than 70 feet. Constructing retaining walls on two sides of the leach facility has the potential of creating a ground water mounding condition, effectively reducing the ground water separation to even less than 3 feet. We believe that denial of these variance requests would be manifestly unjust to the owners of this property, considering the increased financial burden and potential adverse environmental impact. We request, on behalf of Mr. and Mrs. Moody, that a Disposal Works Construction Permit be issued for this repair. Thank you for your consideration. Very truly yours, Wendy Diotalevi, R.S. 815Johnson-5/28/98-Pg.2/2 two sides of the leaching facility has the potential of creating a ground water mounding condition, effectively reducing the ground water separation to even less than three feet. We believe that denial of these variance requests would be manifestly unjust to the owners of this property, considering the increased financial burden and potential adverse environmental impact. We request, on behalf of Mr. and Mrs. Moody, that a Disposal Works Construction Permit be issued for this repair. Thank you for your consideration. Very truly yours, �E*A4'�- Stacey J Abato Vice President Operations n9 you Sime 1 �. �GGS,1 May 28, 1998 North Andover Board of Health Town Hall Annex 146 Main Street North Andover, MA 01845 FTC. JUL 11A i 1 RE: Subsurface Sewage Disposal System Repair 815 Johnson Street Request for variance to 310CMR 15.000 and Local Regulation 9.04 Dear Members of the Board: This letter is written on behalf of William R. and Claire A. Moody, owners of the above - captioned property, to request a variance to the North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 310CMR 15.000 Title 5 of the State Environmental Code. A septic system repair at the above -captioned property has been designed three feet above ground water with no reserve area design and requires a variance to local regulations 9.04 Reserve Area as well as to 310 CMR 15.212 Depth to Ground Water under 15.405(I) Content of Local Upgrade Approval. Local regulation 9.05 Reserve Area requires the testing and design of a reserve area for all proposed septic system repairs. In the area proposed for the leaching facility repair, property line, dwelling setbacks and the presence of a swimming pool prevent locating a second leaching area without encroaching on these structures. Investigation of the rear of the property for potential sites could not be done due to the likelihood of ledge between the present siting of the septic system and the rear of the property. In addition, testing at the rear of the property would further disrupt. the landscaping and increase the cost of testing, design and repair. The septic system has been designed three feet above ground water to allow for grading required by 310 CMR 15.211 Down Hill Slope to remain within the limits of subject property and to prevent the grading from trapping runoff against the dwelling. The alternative to this design requires construction of retaining walls on both sides of the proposed system with a total length greater than 70 feet. Constructing retaining walls on RAGGS SEPTIC SERVICE, INC. d.b.a. E.A. COMEAU SEPTIC P.O. Box 1027 Concord, Massachusetts 01742 (978) 369-1100 (800) 287-5541 FAX (978) 897-3848 website: http://www.raggsinc.com e-mail: info@raggsinc.com 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 1 OF 5 Commonwealth of Massachusetts North Andover , Massachusetts Application For Local Upgrade Approval Title 5,310 CMR 15.000 DEP Approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or nonconforming system with a design flow of < 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of a state of federal facility, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15.000. 1) Facility/system -owner Name William R. and Claire A. Mood Address 815 Johnson Street, North Andover, MA 01845 Phone # (978) 686-8016 Address of facility 815 Johnson Street, North Andover, MA 2) Applicant (if different from above) Name Address Phone # 3) Type of facility x Residential Commercial (specify) DEP APPROVED FORM - 12/07/95 School Institutional 4) Type of existing system privy _ other (describe) 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 2 OF 5 cesspool(s) x conventional system Type of soil absorption system (trenches, chambers, pits, etc.) trenches 5) Design flow based on 310 CMR 15.203 a) Design flow of existing system N/A Approved? _______yes Approval date no why?, e b) Design flow of proposed upgraded system 550 gpd c) Design flow of facility 550 gpd 6) Proposed upgrade of existing system is a) Voluntary Required by order, letter, etc. (attach copy) X Required following inspection required by 310 CMR 15.301 (provide date inspection _ form was submitted to the approving authority) _ April 1998 (date) b) Describe the proposed upgrade to the system The proposed upgrade includes the installation of a 925 ft2 leach bed to accomodate a design flow of 550 g p d A septic tank and outlet line to the distribution box will lead to the 925 ft2 leach facility, c) Which of the following are applicable to the proposed upgrade? N/A Reduction of setback(s) (list) setbacks to be reduced with proposed setback distances) N/A Percolation rate of 30-60 minutes per inch (state actual perc rate) DEP APPROVED FORM - 12/07/95 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 3 OF 5 N/A Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) Relocation of water supply well (identify well, describe relocation) x Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) proposed reduction to 3' with percolation rate of 10 MPI. Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the Code) System upgrades that cannot be performed in accordance with 310 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410- 15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater 3 feet As determined by: Evaluator's name Susan Ford, North Andover Board of Health Evaluator's signature Date of evaluation 5/7/98 DEP APPROVED FORM - 12/07/95 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 4 OF 5 8) Notice to Abutters No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property or well is affected by certified mail at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the Department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the Department. The notices to abutters hall include a copy of the completed app[application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. List of affected Abutters: Abutter Name Date notified Address Abutter Name Date notified Addre Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: The down hill slope grading extends past the boundaries of the subject lot and also creates a ponding situation against the dwelling. The use of retaining walls to prevent these conditions would seriously increase the cost of the septic system repair as it would be necessary to place the walls along both lengths of the leach facility for a total distance of greater than 70 feet. b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible: DEP APPROVED FORM - 12/07/95 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 5 OF 5 c) A shared system is not feasible: Not available. d) Connection to a sewer is not feasible: Not available. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? x yes no 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." William R. and Claire A. Moody_ Print Name Wendy Diotalevi R.S. Mqy 25 1998 Name of preparer Date (978) 369-1100 Rams Septic Service P.O. Box 1025 Concord MA 01742 Telephone # & address of preparer NOTE: Title 5, 310 CMR 15.403(4), requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. DEP APPROVED FORM - 12/07/95 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director July 28, 1998 Raggs, Inc. Ms. Wendy Diotalevi P.O. Box 1027 Concord, MA 01742 Re: 815 Johnson Street Dear Ms. Diotalevi: 30 School Street North Andover, Massachusetts 01845 This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, *M,CLX- ar-f - Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 WILLIAM J. SCOTT Director Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 July 30, 1998 Ms. Wendy Diotalevi Raggs, Inc. P.O. Box 1027 Concord, N.H. 01742 Re: 815 Johnson Street Dear Ms. Diotalevi: This is confirm that the Board of Health, at their regularly scheduled meeting on July 23, 1998, voted to grant a variance 310 CMR 15.212 - Depth to Ground Water from 4 feet to 3 feet. If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, � -tl: Sandra Starr, Health Administrator S S/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH '�,M9540 PLANNING 688-9535 9 27 Charles Street North Andover, MA 01845 Telephone#(978)688-9540 Fax#(978)688-9542 FaX To: / <a S From: L..>-.&� G e� •-.,q Fac q % k �Icf i 3 Pages: Phone: Date: / //� -3/f` Re: CQ, E ❑ Urgent 9 For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: e- 2 pos s% b 1 e, wf f ado AS -BUILT CHECKLIST ✓ �OT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER 1� LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONSOF YSTEM; Town of North Andover, Massachusetts Form No. 2 NORTry BOARD OF HEALTH o �� .-�. -- . , O 19. � F DESIGN APPROVAL FOR S'ACHUSE1 SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant—WW J '" Uborr- i�A�� Test No. S-1 / Site Location E? (5 Reference Plans and Specs ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee ; 0 CHAIR , BOARD OF HEAETH Site System Permit No. /©ate 9 Town of North Andover, Massachusetts For No. 1 NORTij BOARD OF HEALTH 6gti0L o'%�i�/� /,— 19— — 0 APPLICATION FOR SITE TESTING/INSPECTION ��SSgCMUS �y Applicant &)/,W, Amit/ NAME / ADDRESS TELEPHONE Site Location 8l� ./O#,C)66AJ 17 Engineer 7-610" C,91;Q NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee_ Zj-- Test No. C9 V, S.S. Permit NoAdAg D.W.C. No. C.C. Date Plbg. Permit No: _ Apr -08-98 07:30A North Andover Com. Dev. 508 688 9542 BOARD OFTE-1-TEALTH 30 SCHOOL STREET NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: L/W98- LOCATION OF SOIL TESTS: Assessor's map & parcel number: TEL. 688-9540 APR 15 OWNER:6 ) -4 Cf 4t -e, TEL. NO.: _ 9-)S- 69(p Rn/ Co h2ct) Dy ADDRESS: RkS LIO H A) CQA--) _37`. /v , 4�A _(_VP1 Y2 DA) tea- G/9/ z0 ENGINEER:A�� ��v�TEL. NO.: 4 -7 P.02 CERTIFIED SOIL EVALUATOR: (A)a AJI) U 3)j hgC,P()) 2s- — (M66 S- A'.) , Intended use of land: residential subdivision, single family home. commercial THE OLLOWING MUST BE INCLUDED WITH T IS F RM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Piot plan 3. Fee of $175.00 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 cr upgrades. GENERAL INFORMATION 1. Only Certified Scii 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 fcr 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 pian (no smaller than V-1 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. PLOT PLAN 815 Johnson Street N-irth Andover, Massachusetts I `;. Sculg: in" - L�A� Buyer: William Jr. and Claire Moody 'j u1f. 2509$0' #'!o"� S>�06. LOT .. v: N 88°30'W r .� ... '. .338.28' -- .. , .. 0 I } (ROIF/d'? show/,79 on/y o P. l t' 40T io v ) � ,� lqc Total .s ... + 9/, �.. - .: � � � _ � lay, �°•` �> ..• 6.. � pan ° �� I ' „ 1 � � N4Y•fm. p�ll. � �v ern `�-j;-`� i r 487.56' �...-.. /I Rcfrmo,?d qA1 ► To OlAf SW - IN Aft '�, I:','•:' This o not 'a' survey and is to ' be used for mortgage -purposes only. aBomT 4 . ii.Do not use•offsets for establishing lot lines for the erection of fences, I w2L e, hedges, otc. .i her9by cartify that the balding -,on this proporty is located as e1:own on 1!7..an &,A comnli.ed 'V th tho vaon, ng cet back.requircmcnts .of the Tom of I:•�rth AnI � . t .;r�;��:�.cr,rrts:YrlQ c.�:;r.�Izdlr9, xr;c.��, 1' •. I : 1 ✓ .. LAJ 7 e�ftt pp •' • :,4r r r[li lA SEE PLAT N0. It '` 111 ,r \ I IIc I e* �• eF , V •tet � .• a v ,pi It" b +t'`' SM �t 2� t y b 4 �•'' � Sc t M► r ✓ ell c 240 -4 •, 43 /2 44 7 w i' 7C + µS'�a 4 •� lsi tt�34 44�?3 225 � r. P>>Oy - 4y •, �^ . sO' ts.r to � ,E ti s / ' t. � � te6 / , r t ..+. '4A rl Tj .-• .� •'' 2♦� a •; • ♦ z�" i `t �' ' n •p s0 S 1 0 `` ►► .� �y1, . .Q rs• i •� � TP ft, n • n \4♦`' \�` � P ^b Aa b� ae �` \ JY S4 a •�' 40 < LtttLAS�'a'do � � •i v tdt �\ dg �� " t \♦ 1 2' A; AD b � y I • v.t---�— u Arl Y 25 f+O. 2y It c i 3 b� 8 '719a t.y� ...,- t.wv t.wx t•stec. t.aa.. t.st,a t.otxl t.t¢x1 s..a,a _ JOHNSON t sc.�• o r-+ rz I ' 62 Q6 GS 1 67 2T � bt I'J? t7t t6 I. •=y dfo o►' i 't t� til t.u.•. wtc.. to 1�� `✓ SES PT !CALE — 200 FMon- '' SSESeI�s GOA ... _ ti..,.1-,. _ tY .;�,;yr _.. _� i::_ ;�'t tIS-:'+'r •»/J :�. >:. . f ., �':-..../ y. .e. Moody-3/26/98-Pg.2/2 We look forward to working with you on this project. Our work will begin subsequent to the receipt of written authorization to proceed. If you accept this proposal, please sign the two enclosed copies and complete the enclosed Client Authorization & Questionnaire and return one copy of this proposal and the Client Authorization & Questionnaire to this office. This will then constitute an agreement with Raggs Septic Service, Inc. that will be subject to the terms of the Standard Form of Agreement Between Owner and Engineer - EJCDC NO. 1910- 1 including all applicable appendices which are hereby made a part of this agreement by reference. Thank you for considering Raggs Septic Service, Inc. If I may be of additional assistance, please do not hesitate to contact me. Very truly yours, '1" Y 0' Stacey . bato Vice P ident, Operations I/we, 04116 W t U AM /-looby , aowners/ uthorized agents for owners of Sfs U o A &iDoye2 ,M4 ocF4 C have reviewed the foregoing and by my/our signature(s) below hereby approve and accept the proposal outlined herein: Date /�ogj 9P'P Date I (Indicate which one c a Owner/Agent (Indicate which one) Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director Raggs Septic, Inc. P. O. Box 1027 Concord, MA 01472 RE: 815 Johnson Street Dear Stacy: 30 School Street North Andover, Massachusetts 01845 On April 15, 1998 an application was submitted to the North Andover Health Department for soil tests at 815 Johnson Street. You were called for information about the engineer and were told that tests could be scheduled with Susan Ford for the week beginning April 27'h or the week beginning May 4'h if there were severe time constraints for the homeowners. Alternatively, if there was some leeway, tests could possibly be scheduled for the week beginning May I I'h with Sandra Stan. You were to discuss the issue with Wendy Diotalevi to determine whether she cared about whoever witnessed the tests and get back to us concerning the speed which was needed by the homeowners. Apparently it was decided that the testing time was not critical and Ms Diotalevi preferred to have Sandra Stan witness the tests because you left a message saying that May 12`h was fine. We had not discussed a particular day. Unfortunately, I have no available time on Tuesday, May 12'h and left a message stating this. You then, apparently, made a threatening call to the Health Department secretary, demanding a specific date and threatening repercussions if one is not set immediately. This method of doing business is not appreciated. Although extremely busy, this office makes every attempt to accommodate those residents with failed septic systems. We understand and sympathize with the strictures placed upon homeowners with respect to the Title 5 regulations and do everything in our power to ease the process and solve the problems. You were previously offered testing dates with Susan Ford. She has available time to do these tests on either Tuesday, May 5U' or Thursday, May 7'h at 9:00 A.M. I am not available for soil testing until at least May 14'h, if then. Please call the Health office at the number below if either May 5`h or 7`h will work for you or whether you again wish to wait for me to witness the soil tests. Sincerely, Sandra Starr, R.S. Health Administrator Cc: Wm. & Claire Moody File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 * I C, Zng �'ou Sime G. GGS,1 April 28, 1998 APR 3 0 Ms. Sandra Starr Board of Health Town of North Andover 120 Main Street North Andover, MA 01845 VIA FAX: (978)688-9542 RE: Scheduling of soil testing 815 Johnson St. Dear Ms. Starr: I am writing to you on behalf of the homeowners of the referenced property, Mr. and Mrs. William Moody. Their property has a septic system which was recently inspected. After consultation with you, it was determined that the system would not pass Title 5. As the homeowners hope to correct the deficiencies of the septic system on this site and, eventually, transfer title to their property in the coming months, they wish to start the .process to obtain the proper documentation which would allow them to have a Certificate of Compliance for the septic system on their property. After consultation with your office, we have submitted the Town of North Andover's form, "Application for Soil Tests." Included with the package was a check in the amount of seventy-five ($75.00) dollars for the soil testing fee, a copy of the plot plan with structures located and without structures located, the Assessor's Map, the deed description, and a copy of a section of our form which is signed by the client granting us permission to proceed with this project. This package was sent out on or about April Stn Subsequently, we had hoped to schedule a mutually convenient date for testing. To date, this has not been possible, as we have not been able to converse by telephone. After calls to your office, you had left a message at this office stating that the week of the eleventh of May, 1998 had availability. I returned the call and left a message asking if Tuesday, May 12, 1998 was still available and, if so, could testing be done that day. I also asked that if that date was not available to please let me know what date or dates were available and that I would try to coordinate the soil evaluator and the backhoe for the day you were to be available. I had also mentioned on the RAGGS SEPTIC SERVICE, INC. d.b.a. E.A. COMEAU SEPTIC P.O. Box 1027 Concord, Massachusetts 01742 (978) 369-1100 (800) 287-5541 FAX (978) 897-3848 website: http://www.raggsinc.com e-mail: info@raggsinc.com N.Andover815Johnson-4/28/98-Pg.2/2 message that if the twelfth of May was acceptable that you did not need to call me back that I notify the necessary personnel. Today, this office received a call from you during which you explained that May 12th was not a good date for you and that you would have to let us know when you could witness testing. My office immediately contacted me and I immediately returned the call. However, I was informed by your new assistant that you were in a meeting. I explained the situation as I have summarized in this letter. She explained that she would relay the information and would ask you to return the call or if you gave her the date perhaps she could return the call. We realize that this is an extremely busy time of the year. The homeowners of this property and I hope to have contact with you soon. Please contact me, either by phone at (978) 369-1100 or fax at (978) 897-3848, and let me know two dates and times for testing which you have available. Please let me know if you would like the test holes dug before you arrive at the site and if you would like to pre-soak started. I will check with the soil evaluator the day you send this information to me and will confirm which of the two days we can meet you on-site. As I am very aware that this is a very busy time of the year, I am hoping that this approach may help us to proceed to the next step of this project even if we do not speak to each other directly. We look forward to working with you on this project. It is hoped that this scheduling hurdle can be overcome by the end of the day Friday, May 1, 1998 as the homeowners involved are directly affected by the scheduling of the testing of this site. Thank you for your assistance in this matter. Very truly yours, Stace . Abato Vice esident Operations cc: Mr. and Mrs. William Moody APR 3 0 R +. FORM 11- SOIL EVALUATOR FORM Page 1 No Date 5/11/98 Commonwealth of Massachusetts_ North Reading, Massachusetts Soil Suitability Assessment for On-site Sewame Disposal Performed by: Wendy Diotalevi, R.S., Raggs, Inc. P.O. Box 1027 Concord, MA 01742 Witnessed by: Susan Ford, North Andover Board of Health Location Address or Lot # 815 Johnson Road North Andover,, Massachusetts New Construction ❑ Repair F� Office Review Owner's Name, Address, and Telephone # William R. and Claire A. Moody 815 Johnson Road North Andover, Massachusetts 01845 (617) 984-4721 (W) (978)686-8016(H) Published Soil Survey Available: No ❑ Yes ❑ Year Published Publication Scale Soil Map Unit Drainage Class Soil Limitations Sur ficial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale Geologic Material (Map Unit ) Landform Flood Insurance Rate Map Above 500 year flood boundary No ❑ Yes ❑ Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal ❑ Below Normal Other References Reviewed: `] FORM 11- SOIL EVALUATOR FORM Page 2a On-site Review Deep Hole Number 1 Date: 5/7/98 Time: 10:00 a.m Location (identify on site plan) Land Use Residential Slope (%) Vegetation Grass Soil Color (Munsell) Landform Drumlin Other (Structure, Stones, Boulders, Consistency, % Gravel) Position on landscape (sketch on the back) Distances from: Sandy Loam Open Water Body >100 feet Possible Wet Area >100 feet Drinking Water Well >100 feet 011511 Weather: Rainy, 60s Surface Stones few Drainage way >100 feet Property Line 15-20 feet Other DEEP OBSERVATION HOLE LOG Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 0" to 14" Fill Sandy Loam --- 14" to 18" Ap Sandy Loam 10YR 2/2 18" to 36" - B,„ Sandy Loam 10YR 5/6 36" to 86" C, Sandy Loam 2.5Y 6/6 10YR 5/8 and 40% cobbles & gravel, 5Y 6/2 @48" massive friable Parent Material (geologic) GlacialTill Depth to Bedrock: >86" Depth to Groundwater: Standing Water in the Hole: 84" Weeping from Pit Face: 84" Estimated Seasonal High Ground Water 48" FORM 11- SOIL EVALUATOR FORM Page 2b On-site Review Deep Hole Number 2 Date: 5/7/98 Time: 10:00 a.m. Weather: Rainy, 60s Location (identify on site plan) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) Land Use Residential Slope (%) 5-10 Surface Stones few Vegetation Grass Landform - Drumlin B,H Sandy Loam Position on landscape (sketch on the back) Distances from: 30" to 90" C, Open Water Body >100 feet Drainage way >100 feet Possible Wet Area >100 feet Property Line 15-20 feet Drinking Water Well >100 feet Other DEEP OBSERVATION HOLE LOG Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 0" to 18" Ap Sandy Loam 10YR 2/2 18" to 30" B,H Sandy Loam 10YR 5/6 30" to 90" C, Loamy Sand 2.5Y 6/6 10YR 5/8 and 40% cobbles and gravel, 5Y 6/2 @48" some stones, massive friable Parent Material (geologic) Glacial Till Depth to Bedrock: * Depth to Groundwater: Standing Water in the Hole: 84" Weeping from Pit Face: 84" Estimated Seasonal High Ground Water 48" * Refusal/boulder at east/roadside of deep test hole rising from 6' depth to 4.5' depth. FORM 11 - SOIL EVALUATOR FORM Page 3 Determination. for Seasonal High Water Table Method Used: [-1 Depth observed standing in observation hole inches Depth weeping from side of observation hole inches © Depth to soil mottles 48" 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 October 19941 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 Date 5/11/98 FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS North Andover, Massachusetts Percolation Test Date: 5/7/98 Time: 10A8 a.m. Observation Hole # 1 Depth of Perc 66" Start Pre-soak 10:48 a.m. End Pre-soak 11:03 a.m. Time at 12" 11:03 a.m. Time at 9" 11:28 a.m. Time at 6" 11:58 a.m. Time (9"-6") 30" Rate Min./Inch 10 Site Passed ❑X Site Failed ❑ Performed By: Wendy Diotalevi, R.S. Ragas Inc. P.O. Box 1027 Concord MA 01742 Witnessed By: Susan Ford, North Andover Board of Health Comments: DATE.- LOCATION ATE: LOCATION f r ENGINEER: BOH WITNESS: PERCOLATION TEST # / - It BOTTOM DEPTH OF PERC TEST: TIME OF SOAK a (At least 15 minutes long) TIME AT 12" TIME AT 9"' �" g TIME AT 6" OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK: TIME AT 12" TIME AT 9" TIME AT 6" (At least 15 minutes) RAGGS, INC., P. O. Box 1027, CONCORD, MA 01742 (508) 369-1100 OFFICIAL CERTIFICATION SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION IN ACCORDANCE WITH TITLE 5 (310 CMR 15.000) CERTIFICATION PREPARED FOR ADDRESS OF PROPERTY DATE OF INSPECTION: RESULTS: William and Claire Moody 815 Johnson Street North Andover, MA 01845 March 16, 1998 This property has PASSED the criteria set forth in 310 CMR 15.000. This property has CONDITIONALLY PASSED the criteria set forth in 310 CMR 15.000. This property has NEEDS FURTHER EVALUATION BY THE BOARD OF HEALTH according to the criteria set forth in 310 CMR 15.000. This property has FAILED the criteria set X forth in 310 CMR 15.000. RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ADDRESS OF PROPERTY: 815 Johnson Street North Andover, MA 01845 OWNER'S NAME: William and Claire Moody DATE OF INSPECTION: March 16, 1998 PART A CERTIFICATION Name of Inspector: Garry A. Harmon - Certified Title 5 System Inspector Company Name: Raggs, Inc. Company Address: P. O. Box 1027, Concord, MA 01742 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY CONDITIONALLY PASSES X FAILS - per Sandra Starr B.O.H. Inspector's Sig ature ' Garry A. Harm n - Certified Title 5 System Inspector Date Raggs, Inc. certifies that all work performed on the aforementioned property was done in accordance with the guidelines set forth in Title 5 (310 CMR 15.303). Fred T. Fish, President Raggs Septic Service, Inc. d/b/a E. A. Comeau File No.: 98-17205/MOODYWILLI Copies to: Payer of inspection Local Board of Health or its agent Date �9� C RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 U 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CINSPECTION SUMMARY CA. System passes: I have not found any information which indicates that the system violates any of the C failure criteria as defined in 310CMR 15.303 Any failure criteria not evaluated are indicated below. CB. System Conditionally Passes: One or more system components need to be replaced or repaired. The system, n upon completion of the replacement or repair, passes inspection. LI Indicate yes no or not determined (Y, N, or ND) Describe basis of determination in aall instances. If "not determined" explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally j� unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. Septic tank is: C Metal : Cracked: Structurally unsound: Substantial infiltration: Substantial exfiltration: Tank failure imminent: Tee(s) missing: L j The system will pass inspection if the existing septic tank is replaced with a cconforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution _ Ebox is due to a broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with the approval of the Board of Health): CBroken pipe(s) are replaced. aObstruction is removed: rI Distribution box is leveled or replaced: C C C RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 C98-17205/MOODYWILLI CSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM INSPECTION SUMMARY continued C The system required pumping more than four times a year due to broken or G obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): CBroken pipe(s) are replaced: Obstruction is removed: a CC. Further Evaluation Is Required By The Board Of Health: C 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, and the environment. L� 1. System will pass unless the Board of Health determines that the system is not functioning in a manner which will protect public health, safety and the aenvironment: Cesspool or privy is within 50 feet of a surface water: CCesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh: C C C o C C RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM INSPECTION SUMMARY continued 2. System will fail unless the Board of Health (and Public Water Supplier, if appropriate) determines that the system is functioning in a manner that will protect public health, safety, and the environment. The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply.: �I The system has a septic tank and a soil absorption system and is within a Zone 1 L of a public water supply well.: The system has a septic tank and a soil absorption system and is within 50 feet of a private water supply well.: C The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the Ewell is free from pollution from that facility and that the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.: Method used to determine distance: (approximation not valid). 3. Other: C C C C C C G RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978369-1100 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM INSPECTION SUMMARY continued D. System Fails: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria C as defined in 310CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.: L Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.: CStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS cesspool.: ELiquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.: CRequired pumping more than four times in the last year NOT due to clogged or obstructed pipe(s): r' Number of times pumped: Any portion of the Soil Absorption System, cesspool or privy is below the high El groundwater elevation.: Any portion of a cesspool or privy is within 100 feet of a surface water supply Cor tributary to a surface water supply.: Any portion of a cesspool or privy is within a Zone I of a public well.: 5 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. If C the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.: 5 G RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 C98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM F INSPECTION SUMMARY continued E. Large System Fails: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to.large systems in addition to the criteria listed above: L The design flow of the system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health, safety and the environment because Ell one or more of the following conditions exist: 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): The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department of Environmental Protection for additional information. C C C CI 6 G RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (9781369-1100 C98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM EPART B CHECKLIST n The following have been done - You must indicate "Yes" or "No" as to each of the following: 1. Pumping information was requested of the owner, occupant, and Board of Health: Yes 2. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not P been introduced into the system recently or as part of this inspection: Yes C 3. As -built plans have been obtained and examined (Note if they were not available with n/a.): Yes j� 4. The facility or dwelling was inspected for signs of sewage back-up: Yes 5. The site was inspected for signs of breakout: Yes 6. All system components, excluding the SAS, have been located on the site: Yes 7. The septic tank manholes were uncovered, opened, and the interior of the septic tank was C inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum: Yes C8. The size and location of the SAS on the site has been determined based on: Yes The facility owner (and occupants, if different from owner) were provided with information the proper maintenance of Sub -Surface Disposal System: Yes Existing information (example Plan at Board of Health): Yes Determined in the field (if any of the failure criteria related to Part C is at issue, Capproximation of distance is unacceptable) [15.305(3)(b)] Yes M C C C C f C C C C RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS Residential: design flow: gpd/bedroom for SAS number of bedrooms: 4 number of current residents: 3 garbage grinder: Yes laundry connected to system: No seasonal use: No Has drywell that is under brick patio, whereabouts unknown as homeowner does not want patio disturbed Water meter readings, if available (last two (2) year usage: private well: No sump pump: Yes Last date of occupancy: Occupied Commercial / Industrial: Type of Establishment: n/a design flow: gallons/day grease trap: industrial waste holding tank present: non -sanitary waste discharged to the Title 5 system: Water meter readings: Other: Last date of occupancy: Last date of occupancy: GENERAL INFORMATION Pumping records and source of information: Every 2 - 3 years per homeowner System pumped as part of inspection: Yes Reason for pumping: Inspect structure Type of system - Septic tank/distribution box/soil absorption system: Yes Single cesspool: Overflow cesspool: Privy: Shared system: I/A Technology etc. (Copy of up to date contract?): Other: Volume pumped: 1500 gallons C RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 19781369-1100 C98-17205/MOODYWILLI C C Ell, C E, I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued Approximate age of all components: 1982 Date installed: July, 1982 Source of information: As -Built plan prepared by Flynn Assoc. P.C. Sewage odors detected when arriving at the site: No BUILDING SEWER (locate on site plan) Depth below grade: 21 Material of construction: Cast Iron: 40 PVC: Other: Distance from private water supply well or suction line: Diameter: 4" Comments: Condition of joints: Venting: Good Evidence of leakage: No SEPTIC TANK (locate on site plan) -- Depth below grade: 12" - cover built up to 4" below grade Material of construction - Concrete: X Metal: Fiberglass: Polyethylene: Other (explain): If tank is metal list age: Is age confirmed by Certificate of Compliance: Dimensions: 4.75 w X 10.50 1 X 4'd Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: 18" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How dimensions were determined: Tape measure Recommendation for pumping: annually Condition of inlet and outlet tees or baffles: Good Depth of liquid level in relation to outlet invert: Good Structural integrity: Good Evidence of leakage: No Recommendation for repairs: 9 C1 RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CPART C SYSTEM INFORMATION continued GREASE TRAP (locate on site plan) -- n/a Depth below grade: Material of construction - Concrete: Metal: Fiberglass: Polyethylene: Other: CDimensions: 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: Recommendation for pumping: Condition of inlet and outlet tees or baffles: Depth of liquid level in relation to outlet invert: Structural integrity: Evidence of leakage: �j Recommendation for repairs: U TIGHT OR HOLDING TANK (locate on site plan) -- n/a Must be pumped prior to or at time of inspection Depth below grade: Material of construction - Concrete: Polyethylene Dimensions: Capacity: gallons Alarm level: Date of previous pumping: Condition of inlet tee: Condition of alarm and float switches: Recommendations: Metal: Other: Fiberglass: Design flow: gallons/day Alarm in working order (Y/N): DISTRIBUTION BOX (locate on site plan) -- Yes Depth of liquid level above outlet invert: 0" Level and distribution are equal: Yes Evidence of solids carryover: Yes Evidence of leakage into or out or box: No Recommendation for repairs: 10 G RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 E98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM El PART C SYSTEM INFORMATION continued 4 PUMP CHAMBER (locate on site plan) -- n/a Pumps in working order: Alarms in working order: Condition of pump chamber: C Condition of pumps and appurtenances: Recommendation for maintenance or repairs: SOIL ABSORPTION SYSTEM (SAS) -- Yes (locate on site plan, if possible; excavation not required, but may be approximated by non - intrusive methods). If not determined to be present, explain: Type: Leaching pits and number: Leaching chambers and number: Leaching galleries and number: Leaching trenches, number, length: Leaching fields, number, dimensions Overflow cesspool, number: Alternative system : Name of Technology: 3 pipes leaving "d" box 25' x 40' - see sketch Condition of soil: Gravel Signs of hydraulic failures: No Level of ponding: None Condition of vegetation: Grass Recommendations for maintenance or repairs: Probed hole next to leach pipe and there is standing water 5" below bottom of pipe. Stone was found to be clean next to the pipe C C' C11 RAGGS. INC.. P.O. BOX 1027. CONCORD. MA 0174219781369-1100 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued CESSPOOLS (locate on site plan) -- n/a 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: Inflow (cesspool must be pumped as part of inspection): Condition of soil: Signs of hydraulic failure: Level of ponding: Condition of vegetation: Recommendations for maintenance or repairs: PRIVY(locate on site plan) -- n/a Materials of construction: Dimensions: Depth of solids: Condition of soil: Signs of hydraulic failure: Level of ponding: Condition of vegetation: Recommendations for maintenance or repairs: 12 RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (9781369-1100 M 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM * Include ties to at least two permanent references, landmarks or benchmarks * Locate all wells within 100 ft. * Locate where public water supply comes into house THIS SKETCH IS NOT TO SCALE. J 0 h nl S 0 n S t N A n d 0 V e r DEPTH TO GROUNDWATER: 6+ feet METHOD OF DETERMINATION OR APPROXIMATION 13 in 1V Observation of site, local conditions and B.O. H. records RAGGS. INC.. P.O. BOX 1027. CONCORD. MA 01742 (9781369-1100 98-17205/MOODYWILLI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued Please indicate all the methods used to determine High Groundwater Elevations: Obtained from design plans on record: Observation of Site (Abutting property, observation hole, basement sump etc.): Yes Determine it from local conditions: Yes Check with local Board of Health: Yes Check FEMA Maps: Check pumping records: Check local excavators, Installers: Use USGS Data: Describe in your own words how you established the High Groundwater Elevation. (Must be completed): Basement 6' tall has sump pump, from ceiling of basement to outlet invert in "d" box approximately 6' iv RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 98-17205/MOODYWILLI APPENDIX A: HISTORICAL PUMPING RECORDS, REPAIR RECORDS Home owner indicates pumping was done every 2 - 3 years. 15 RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (978)369-1100 98-17205/MOODYWILLI APPENDIX B: SITE PLAN / AS BUILT PLAN Attached 16 a r 'I Li r1 u C _.�.. ..yN..i tfpip. J{7 -�+ .'vl.. � .. .. ... .. hq,._......,.. .ny.tutl ... .- .�_ ... ..._ .C-..-____... ...,..�. ....�.....•.�....-•- _ _. Y f r 77. IX = : 14) i. r m. `•� yer �' S. . cl .. the .� t O• � � ;� . W. •,J� •�1iG� ii `(li s�• v� •�� t S .� D��. �f'� �i� `. QIM / ILLY `� ) 1 ':t � •ti �Y �/�:� �. �'� �� � s• CCS O. tal la;{ to ul..t ' X� : LAJ Lu -Z t� x �. �.. +til o ::a•�ra�•oQN ,Y• - : ,� Q S 3, ' Qffi Vv -t z x ow LAJW �al � N Ut 0 'IN lk F E E vy-IR ,1) Ae: W Q Z� scu ILD oD r a, JZLU §po_ a ; : UJ ;F6. 'IT - a-F^�"�•y�'....�...�(.�i�. � ..�..-C. w=1-.�-.a: r.w-... _,.-.-. _.��. t a } q Lij Lu. --,. 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BOX 1027, CONCORD, MA 01742 (9781369-1100 98-17205/MOODYWILLI Appendix D: Water Usage Documentation Attached Mandatory Records Found (Y/N Applications, plans, and specifications Y Approved system capacity Soil Evaluation Data Disposal construction permits Certified As -Built Plan Construction Inspection reports Certificate of Compliance System Pumping Records Letters of Non -Compliance Enforcement orders Other Public Information Considered (Y/N) FEMA Flood Maps Soil Maps Assessors Map Map Block Lot USGS Topographical Map Local Conservation Map Builders Sketch �E: