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Miscellaneous - 82 RALEIGH TAVERN LANE 4/30/2018 (2)
1K Lot &Street_e2, jP;Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid.- 0 NO Permit# Plan Approval: Date: 13 /v, Approved by: _ Designer: // Plan Date:—?— Conditions: ate:_7Conditions: Water Supply.- own / - _- _ -- Well - i Well Permit: — Driller: Well Tests: Chemical Date Approved Bacteria I Date -Approved Bacteria II Date Approved Plumbing,Sign-Off: ` _ -Wiring Sign -Off Comments: Form "L"' Approval: Approval to -Issue: YES NO Date Issued By: - Conditions: Final Approval All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: \�* _ • ♦ • ! SEPTIC SYSTEM INSTALLATION Is the installer licensed? Type of Construction: New Construction: ..-Certified Plot Plan Review -Floor Plan Review _— Conditions of Approval from Form U _Issuance of DWC permit: - _DWC Permit Paid? ---DWC-Permit # Installer: Begin_Inspection:_ _ E.Ycavation Inspection: Needed: .—Passed:- . -Con structio -Passed:._Construction Inspection: Needed: res- uiltPlan Satisfactory: 1 D NEW RE AIR YES 1 YES NO YES NO NO NO. aS - NO _ - Approval of Backfill. Date: By. M-) ---Final Grading Approval: Date: /// 19C By: Final Construction Approval: Date: Z Z� By: / Certificate of Compliance: Approval:G /�' �1� Date: North Andover Board of Assessors Public Access NO Page 1 of 1 North Andover Board of Assessors am 7 roperty Record Card Pnri-Al Tr) •I1n/1117 A_nlnQ_nnnn n Rv•7n11 . - XT.,..+A A -A .. Location: 82 RALEIGH TAVERN LANE Owner Name: DEN BOGGENDE, ANTON MARY F DEN BOGGENDE Owner Address: 82 RALEIGH TAVERN LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 1.03 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2284 sqft Total Value: 479,600 505,600 Building Value: 253,700 279,700 Land Value: 225,900 225,900 Market Land Value: 225,900 Chapter Land Value: Price: 1 Sale 10/23/2001 Date: s Length Sale F-NO-CONVNIENT Grantor: ANTON DEN BOGGENDE Doc: Book: 06428 Page: 0108 http://csc-ma.us/PROPAPP/display.do?linkld=1708461 &town=NandoverPubAcc 10/21/2011 00 00 N N OO U 0CD—w u HE —I J_ m m E E O U O d m (6 m m m O O O @ LO N m C O to � S2WU c O 0 N Q LL. ? w F-a� Z W Q W O > W D m C ~ O N o Z �D V C w �U' 3 0 -acn mLL J2 c c x Q IL 30�caoZ 0 Q W J J (400 coo 0 w x 3 LO Y Y OO Z O W U) 311 ai o U co LU°o ma O U 0 v maU m Q Z L) Q W O O a W o Z >U N O m Q a oa Z .-�MLLQ a f6 U m = O Cp C C6 L: a0E->$ O OD m m m m C cc N F- U)(nUw0 O L6 L6 J HE —I J_ m m E E O U O Z o O O O � LO � W O o 0 OD ao J Q H N ? 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U o e e e o0 ope° ° T- I r E e o°000 o� I q° io e eo i r _ r Z fi w rri O 4 R (mom Re � O -OU vo ep° A z L 1 I! 1_ ^ N N T- I r E r t' I i r _ r fi w R (mom Re � A z L 1 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 10/18/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X ) by Todd Bateson at 82 Raleigh Tavern Lane 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 # 1061 dated 3/19/99. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. + t, . rte` ✓ �.+ter s Board of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby cerdfy that the Smagc Disposai System ( ) constructed; ' repaired; , .''ice► �� �..:rw i'/.� � <Ls �' was haalled in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated --) of — 9with an.approved design flow of .gallows per day. The materials used were in ednfornmce with those specified on the approved plan; the system was.installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substan ially with the approved plan: All work is -accurately represe ttd on the As -built which has been submitted to the Board of Health. Installer: Design E #: 0 w! -T Date: —(— L Date:22�� TUN OF NORTH ANS. BO,ORD OF HEALTH JUJ 2 1 1999 ' v Gy UP P, Qn r Oo�t�0 �v, r �in� �� aa• �n oma � n;-.c,.� 175 ... Tl� C) VY r.,• a Sa o Q rn tr ? .� p 70 rq ` z z o vi tn. s. v, c c r-Arrl (; rn Lfl�-x� z �; n• f � Cn _ j• ^:1 ."�.. i'4, ��u -' .-•----..�-..mow._ W zo -13 CA .tG � a r." •� rtn � . iii , 00 r - v Gy UP r Oo�t�0 �v, r ... Tl� VY r.,• a Sa o Q rn ? .� 000° d rq ` z z o tn. s. v, c c r-Arrl (; rn Lfl�-x� z �; n• f � Cn _ j• ^:1 ."�.. i'4, ��u -' .-•----..�-..mow._ W m 000° d �' s n• f _ j• ^:1 ."�.. i'4, ��u -' .-•----..�-..mow._ .tG � a r." •� � . iii , m f X 1 7)� T-3 351 -57 To s� =--', )C --//o -'? C---,, -zz-/ I C) Z-t o/I L3 -t--ad V C) Ic p 7s Cr " �L WILLIAM? F. WELD Governor ARGEO PAUL CELLUCCI Lt. Govemor COMMONWEALTH OF MASSACHUSETTS Ra 4- EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS c� DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 617-292-5500 TRUDY COXF Secretar% DAVID B. STRUIIS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CER TIFI TI N 41, Property Address:c-� �� 1avQ�( t� �' A o ress Owner: Date of Inspection: (If different) Name of Inspector: I am a D appro ed system inspector pu_ttpsua�nt to Section 15.340 of Title 5 (310 CMR, 1a".000) Company Name: �� Mailing Address: l S. I LQ r Telephone Number: _ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete'as of the time of 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 ki ditionally Passes s Fu r valuation By the Local Approving Authority 5 � 1--� Inspector's Signature: Date: !/J ��6 The System Inspector s4 6mit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D' AI SYSTEM PASSES: Ll_�l have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303 Any failure r.t�teria not evaluated areindi ted below. `� COMMENTS: C:i �C—S 9-c -" 1 wsiAzTi l- U t� D—GoLs= BI 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all 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 unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (rwvioad 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/ANww.mognet.stote.ma.us/dep 0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: (?ate of Inspection: Lk -1 -9� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) t It l r • /` r � (revised 04/25/97) Page 9 of 10 WILLIAM F. WELD Govemo: ARGEO PAUL CELLUCCI COMMON wEALTH OF MASSACH'U'SETTS EXECUTIVE OFFICE 'OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF OF IRONMENTAL PROTECTION ONE %VINTER STREET. BOSTON. MA 02108 617-293.5j00 Lt. Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A (�CERTIFICATI(?N�JOAAA 4A Uf` cess of Owner - Property Address: Date of Inspection: 10 -- 045—ty7 Of different) Name of Inspector: `mac 1 am a DE appr ved system inspeStor pursuant to Section 15.340 of Title 5 (310 CMR. 15.000) Company Name: rl _- Mailing Address: ll .0(2116 Telephone Number: TRUDY COXE Secretary DAVID B. STRUHS Commissioner CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete *as of the time of 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: Pass onditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ F ' Inspector's Signature: \ ���-' Date: (0 �a5^"�'7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15,303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all 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 unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection' if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. f: (revised 04/25/97) Naga 1 e! 10 DEP on the World t+►rde Web: h tp Hwww.n+apnet 1We.rN.uydeD 0 Printed on Recycbd Paper ►: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION (continued) Property Address: (6 i c(v ckk"X os L-.4\ Owner: H( Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled. or replaced _ The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD -OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil ab(brption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private seater supply well. The system has a septic tank and soil absorption system and the SAS 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 well is free from pollution from. that_fadlity and 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 0 - (revised 04/45/97) Dada 2 of 10 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: ►'� �'. �ti wr._[. -� rte/` > Date of Inspection: 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 as defined in 310 CMR 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. Yes No Backup of sewage into facility or system component due to an 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 1/2 day flow 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any.ponion of a 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 I 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. If 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. 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 above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well) 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 for further information. (revised 04/35/97) Page 3 of 10 0, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: e as Owner: Hi. "(�1� C�Z22V� Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. ✓_ — 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 been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note, if they are not available with N/A. v — The facility or dwelling was inspected for signs of sewage back-up.. 1/ T The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout. V _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The. size and location of.the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub -Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (sevined 04/25/97) la" 4 bt 10 A, W SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION • ccs -tct�tn Property Address. c� w� tA a . ��� Owner: • �-V ' Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design n—flow: t f O e.D d./bedroom for S.A.S. Number of bedrooms: `i Number of current residents: Garbage grinder (yes or no): Laundry connected to sys p (yes or no):1 Seasonal use (yes or no): 0 J /'� Water meter readings, if available (last two (2) year usage (gpd): ' J/ Sump Pump (yes or no): �V Last date of occupancy: &Vgxj2A1-* COMMERCIAIJI NDUSTRIAL: Type of establishment: Design flow:__gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non -sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: j„f o r System pumped as part of inspection: (yes or If yes, volume pumped: ttalions Reason for pumping - TYPE O TEM 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) VA Technology etc. Copy of up to date contract? Other e 0 O.YA-C� APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) Nv (swisad 04/25/97) Palo 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION onti ued) Property Address: `tom-" ��C Owner: Date of Inspection: to --a 5-9 1 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of constructi7o—n Lcast iron _ 40 PVC _ other (explain) Distance fromtfrivate water supply well or suction hr e Diameter L4 Comments: (condition of joints, venting, evidence of leakage, etc.) uualn� SEPTIC TANK:. (locate on site plan) it Depth below grade: 3 Material of construction: c✓oncrete _metal ,+Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance ._._ (Yes/No) Dimensions: t x L t /���,, y (3, 5) �(y) X Sludge depth: 1-7-01 (1 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_ t� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (recommendation for pumping, cond' 'o of inl t a d outlet tees or baffles, depth f iqui le �into outlet in struct ral �^ inteerity. evidence of leakage, elc.) ��;� C3 �2.�. V GREASE TRAP �_V.Q (locate on site plan) Depth below grade: Material of construction: _concrete _metal Fiberglass Polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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, etc.) s - (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued),) Property Address: Owner: (: �� Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete metal _Fiberglass _Polyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons/dav Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX. (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if leyel and distribution 's equ vVince of so ids carryover, ev'dence of leakage jgto or out of box, etc.) r PUMP CHAMBER: JWV\Q, -•(rCW (locate on site plan) V V Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) s� (revised 04/25/97) Papa 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address • f + ��auQ�Ct� Owner: F� c Mal Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan, if possible; excavation bot required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: �f. f leaching trenches, number,length. ` � leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note co ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 0"'J _ C CESSPOOLS: &� (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: E inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: V_b�w-, (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.) (revised 6V2S/97) Page 8 of 16 O - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) Property Address:] Owner. Inspection:p' . Date of SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) (revised 04/25/97) Page 9 of 10 m jk.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: . Obtained from Design Plans on record L . // Observation of Site (Abutting property, observation hole, basement sump etc.) 1.�Determine it from local conditions t ----'Check with local Board of health 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) f A. 1. (revised 04/25/97) page 20 of 10 j TEL: (508) 475-1474• FAX: (508) 475-5451 BATESON ENTERPRISES, INC. Excavating - Water & Sewer Lines - Septic Systems & Pumping Service 1 1 I Argilla Road a Andover, Mass. 01810 Title 5 Inspection Report Property Address:-------__�____ f . x%11 NaAk, C�C�vI Owner: ----------------------------- �`'---ate" Date Of Inspection: ---------- My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. r 11 of 11 Neil J. Bateson Bateson Enterprises Inc. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH �R E° 6ghoL"7 19� APPLICATION FOR SITE TESTING/INSPECTION ArED� ��SsaCHUS Applicant,44%7-6k)pI MAeYClea-526660,66 NAME ADDRESS TELEPHONE Site Location Engineer -C)/&4 _ NAME ADDRESS TELEPHONE Test/Inspection Date and Time. % 10 -CHAIRMAN, BOARD OF HEALTH Fee Test No. 9�1 S.S. Permit No.f©(!�/ D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH -TEL-M-954 'OWN 0"ORTH c NORTH ANDOVER, MASS. 01845 BOARD F H'0 - APPLICATION FOR SOIL TESTS 17 1998 DATE: + Z::-1 -c LOCATION OF SOIL TESTS: QZ?s 96L91414 Tom, Assessor's map & parcel number. lOZA / 16K OWNER: At7`Oo j-� ae j&EL. NO.:`'i 7 `�- 17 ADDRESS: --O,?, ItAlZ t6 k4 -rA,401 Q L.a•16 ENGINEER: Vi w rlfaIHWA EL. NO.: `I'7`i- ;SSS CERTIFIED SOIL EVALUATOR: Int LL— Intended use of land: esidential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 1275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Reg istered'San itarian s and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1'-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. S FORM 11 - SOIL EVALUATOR FORM Page 1 Date./ Z.- �v.'�r...8.... Commonwealth of Massachusetts & Massachusetts •f f" .. 1 • PerformedBy: ............................ Witnessed BY: ............................................................................................................................................ . Lacuim edam.or owia's r+M�i� ' %,y >7u" 40v i 9 tats �'�/ �hi•�.t �(� �Gcv.Gvv� Pow. NW 0z" $to,{C /e•vev,. --r L, tot New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes E1' Year Published ...1.101 Publication Scale `f° Soil Map Unit .......... 1$ DrainageClass .....L....... Soil Limitations.........................................................................................., ..... Surficial Geologic Report Available: No 9-11 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) .......................................................................... ................................................................................. Landform................................................................................................................................................................................................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes L� Within 500 year flood boundary No Q� 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: V61 QUA FORM 11 - SOIL EVALUATOR FORM Page 2 On-site R v� iew Deep Hole Number s • Date:.rl?l 'Time:.11.%Q° Weather ... _..( _...... _ ...._ ..... ,r.� . lu- !..................._....................................................................... ........_.............. Location (identify on site plan) �+'!�...........I........................ -j Land Use ......... ... Slope 1961 p..�a:.. Surface Stones .. ........__.._.................. svegetation (-4A,1-r+ _...................................................................................... ,................................................................. _............................ l2r't'+r`�...................................................................................................................................... Landform ....._ Position on landscape (sketch on the backl........ .........................................................................-•__._......._....... Distances from: ' Open Water Body . iaz feet Drainage way.Ttat..... feet, � Possible Wet Area ..110.`t fest Property Una ..Yr6 .j -t• feet Drinking Water Well ..?(� • feet Other ......................................... Parent Material (geotogic) ............... YZ I- - 41 ... ................. ........ Depth to Bedrock: n��'•••• Dooth to Groundweter: Standing Water in the Hole: ?!� Weeping from Pit Face:..... N Estimated Seasonal High Ground Water'. 57 .e 4 FORM 11 - SOIL EVALUATOR FORM Page 2 • On-site Review Is '�Time:... MMAwl Weather ...�.(e .1 Deep Hole Number ...�.-�'•-- Oate:..� ` •••••••�•- Location(Identify on site plant-•••.•.••........................................................................................................ ............................................................................................... _... _...................... Land Use .........____.._.... Stops (961 ..t9.:�lo Surface Stones .......k1 _._ __ Vegetation...........1,41 r!.. .......................... ..............................._..v................................................. .............�rrwr....i,a�..............................................................._...................................................................................._ Landform .......�....... Position on landscape (sketch on the back)........ .............. _....................................................................... ..__......... _..... Distances from: f Open Water Body fest Drainage way..719°•• feet, Possible Wet Area 1.1.p.,:± feet Property Line �L?:`.�y.••• feet Drinking Water Well . 1M.' feet Other .......................................... pepth from Surface Soil Horizon S l TextuSDAI e I Sol (Munsell) I Sol Mottling (Incheel Wyk lot' 7 rix Parent Materiel lgeologicl c_l _ �............... .....:................... ................................................ .. Depth to Bedrock. .��K'" Deao roun th t Standing Water in the Hole:.....Z. Weeping from Pit Face� ............. Estimated Seasonal High Ground Water:.. �!_c� ' FORM 11 - SOIL EVALUATOR FORM Pale 3 ❑ Depth observed standing in observation hole inches ❑ Mapth weeping from side of, observation hole .................. inches v `V Depth to soil mottles ....�►... inches ( SZ) ❑ Ground water adjustment ................... feet Index Well Number ................... Reading.Date .............. .... Index. well level ..........a....... Adjustment factor Adjusted ground water level .... ............... ..... ............ _.......... .... Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? (eS If not, what is the deptii of naturally occurring pervious material? I certify that on 5-' (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 16.017. c $, Signature FORM 12 - PERCOLATION TEST COMMONWEALTH 'OF MASSACHUSETTS Massachusetts Percolation Test Date: ...__...1z' ?. :........._ .. Tim..e:..................................... Observation Hole # Depth of Perc 5 �� Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" �d Time (9"-6") Rate Min./Inch /d Site Passed V Site Failed ❑ .............. _......................... _............................................................................................. ....................... APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ;% %J CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALL R: SIGNATURE: TELEPHONE# CHECK REPS: NEW CONSTRUCTION: IE NEW CONSTRUCTION, PLEASE ATTACH(OUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -built? Floor plans on file? Administrative Use Only Yes ✓ Yes Yes No No w Approval r �� Date: lz> S tel` LOCATION: �'1, e -b 14 1 -� —tet E i- Lj L,N e NEW PLANS: REVISED PLANS: YES SITE EVALUATION FORMS INCLUDED: DATE: $125.00/Plan $ 60.00/Plan NO TOW BOARD 0 HEAD ANDOVER/ DESIGN ENGINEER:_— i DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. SEPTIC PLAN SUBMITTAL FORM LOCATION: 82 -Raleigh Tavern Rd NEW PLANS: YES $125.00/Plan ; REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE:=z DESIGN ENGINEER: U 147R eS /U /= DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 February 2, 1999 William Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 27 Charles Street North Andover, Massachusetts 01845 RE: 82 Raleigh Tavern Lane Dear Mr. Dufresne: This is to inform you that the proposed plans for the repair of the septic system located at 82 Raleigh Tavern Lane, North Andover, have been disapproved for the following reasons: 0 ; A Fax(978)688-9542 1. Details of impervious barrier along sideline of street lacking details, such as bottom elevation, top elevation, etc. 2. Six inch stone base required under d -box, septic tank and pump chamber. (3 10 CMR 15.221(2) and 15.228(1)) 3. Force main not designated minimum 2 -inch diameter. (3 10 CMR 254(1)(c)). 4. Baffle in d -box missing. Proposed tee in Profile missing specifications. (3 10 CMR 15.232(3)(a)). 5. Toe of the slope must be at least 5' from the property line. (310 CMR 15.255(2)) If you have any questions, please feel free to contact the office at the number below. Sincerely, Sandra Starr, R. S. Health Administrator Cc: A. DenBoggende File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Feb -02-99 10:14A Paul D. Turbide, PE/PLS PORE' ENGINEIRIK Civil Engineers & Land Surveyors One. Harris Street Newburyport, AIA 01950 (978) 465 -MU February 2, 1999 Canna Ctatr WTn>+h _e_r.tnvPr I Roard of Health Administrator nor.-- .,rrnln.nllnity TIPvPlnnment and Services JV :7Li+,Tvi ..7i. ,r__1 i_ �___�. 19A AI OAC Aui Lfi iij!UV YGc, igu s v a v -- + _ • 1_ T._.... r ---- RE. i it. V review for oz. icaieI U i aviwj tc i IWIQz 508-465-0313 P.02 Dear Sandra, Enclosed find the "Checklist for North Andover Septic System Fians" for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Poli F.naineering has found. ---v-- - - w TL„ ,iLgrnnnenc on ;rrinPnr;nlic harrier xinna the sideline of the street. There is - A_._•1 c.L•_ L.,—'^- i..,,.,L, ..� L...n, dorm in t_hP arnlntti to nlaep the bottom_ how ito uCtULL OL ""S iitii..aa Tsui at as za.f .R as. , - �, ,,. a _ . r . _ _ _ - - e at-.. #--'% 'Ma Ape;ey"ar ghn�w,id fnllnw tho TYR close to the ground flit 1�i�iYi tai platin tuc wp j. a aaw "v� u.b..... 1.1_ A "Guidance on Maximum Feasiw.-�....r:nto o..ntifot;r �11rt Prt9�C o"It c,vtu�t.�LLLc . maybe allowed, provided that the appllcani uemofWiiiies tv utc IocaL ap1,.v %1 Lb authority that the material is impervious, is designed to be bolted wMAJUL uee. integrity of the material being affected, adequate provisions have been made iv ensure its support and to prevent puncture during instailation." • A 6 -inch stone base is required under a d -box, septic tank, and pump chamber ??1121 anti 22$(1) A note in the Profile states: "Septic tank, pump tank & d -box ;hail be gat tptrPl nn ine igi,rhed native soil or 6" - 3/, minus crushed stone beneath. /r.,+.+L,er;s• aAA.,A\ Met% the rlAtsO for numn chamber and septic tank show a 6" r- --r a,.a1 t,.,�e '., g11n1�;IA chr%w ;n all thPce area -r, a 6" stone base (NLLLflati.LCti &a-r%s vasa.. :Asv f"s . L L,- I t..-_. t;.- r.,+.t..-A n.ir"n �i1�mhPr grithn7lt pmrentinn. is requiiu-u3 beriewuh L11V u-VVA, scF%4-a ta.►aW uaa+.. }Fv... p v.+a..w+.• r----- • The force main is designed as a i -i2 iuch pipe, but ti -:e requirement is for a 2 -inch pipe 254(l)(c). (This must be changed in numerous places on the plan.) • A baffle is required in the d -box because of the dosed system. A proposed tee is shown in the d -box in the Profile detail but no specifications for its construction are shown. It should be designed as per 310 CMR 15.232(3)(a). c The toe of slope must be 5' from the property line 255(2). The slope appears to go right to the sideline of the street. • 310 CMR 247(2) states that for a minimum of 2" of 1/8 to 1 inch stone is to be placed on the top of the leaching bed. The plat, design calls for 4 inches of stone and a layer of untreated building paper over the stone. The 4 inches of stone appears to be allowed (a "minimum of 2 inches" would allow 4 inches). There is no regulation that I could find that allows untreated building paper over the stone (this was allowed in older regulations of Title 5 and Article 11), and therefore I would recommend that the building paper be removed. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS PAGE 1 OF 5 Commonwealth of Massachusetts North Reading, 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 or 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 6MR 15.000. 1) 2) Facility/system owner Name Addre Phon( Addr( Applicant '(if different from above) Name Address Ph # one 3) Type of facili _esidendal _ commercial _ school institutional (Specify) DEP APPROVED FORM - UW195 PAGE 2 OF 5 4) Type of existing system __privy cesspools) /conventional system Other (describe) Type of soil absorption system (trenches, chambers, pits,etc.) 5) Design flow based on 310 CMR 15.203 a) Design flow of existing system gpd Approved? _ yes approval date no why? b) Design flow of proposed upgraded systemogpd c) Design flow of facility gpd 6) Proposed upgg a of existing system is a) Voluntary Required by order, letter, etc. (attach copy) Required following inspection required by 310 CMR 15.301 (provide date inspection form was submitted to. the approving authority) (date) b) . Describe the proposed upgrade to the system c) Which of the following are applicable to the proposed upgrade? fig, Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) AK Percolation rate of 30-60 minutes per. inch (state actual perc rate) DFP APPROVED FORM -12107195 PAGE 3 OF 5 AjA_ Up to 25 % reduction in subsurface disposal area design requirements (state required & proposed size) _✓ Relocation of water supply well (identify well, describe relocation) 3/4 rwwo-w- 4.larro-r2 4 ErtAij" Lu. Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) 4' a -e '3 � 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 ?j' feet As determined by: Evaluator's name FA 0- (2u Evaluator's signature Date of evaluation 7 - —u DEP APPROVED FORM - 12/07/95 8) PAGE 4 OF 5 Notice to Abutters 01 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 shall include a copy of the completed 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 Address 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: A 0f f1f CV GS 0P Tft ek1TCr-FY � Cosi TO qui-ieoWAJet2 . b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible: DEP APPROVED FORM - 12/07/95 c) a shared system is not feasible: d) connection to a sewer is not feasible: PAGE 5 OF 5 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? _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." Facility owner's signature Date F-tSr15 Print Name Name of preparer Date orr ;5sTe61(1-- (kms / low Ki9r t::f>✓ MA X78:bO ?Zl 5;5s,,- Telephone lephone # & address of preparer D/?,��_ 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 - 12107195 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555,373-5721 • FAX (978) 475-1448 • E-MAIL: merreng@aol.com Ms. Sandra Starr, R.S. Health Administrator 27 Charles Street North Andover, MA 01845 RE: 82 Raleigh Tavern Lane Dear Ms. Starr: February 8, 1999;F We are in receipt of your review letter dated February 2, 1999 for the sewage disposal system upgrade plan for the above referenced site. Enclosed herewith are three (3) copies of the revised plans. Items 1-4 inclusive have been addressed and shown on the revised plans. Item 5 is with regard to the side slope being within 5' of a property line. The toe of the proposed fill is within I' of the right-of-way line of Raleigh Tavern Lane. There is, however, a 10' (approximate) grass shoulder between the bottom of slope and the paved way which provides an area twice that required by Title 5 to dissipate any potential run-off associated with the raised system. Additionally, there is an existing catch basin down gradient of the slope which will collect any run-off before entering the roadway or any abutting properties. In addition to this slope requirement, we are requesting a local upgrade approval to allow the system to be 3.0' above the estimated seasonal water table. This L.U.A. will help minimize both the cost of the repair and the adverse aesthetic affects the upgrade will have on the property. We appreciate your consideration of these matters and look forward to discussing them in greater detail with the Board during the meeting on February 24, 1999. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd Enclosure cc: Mary &Anton DenBoggende MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS •• PLANNERS 66 PARK STREET -ANDOVER, MASSACHUSETTS 01810 -TEL (978)475-3555,373-5721 -FAX (978) 475-1448 - E-MAIL: merreng@aol.com February 18, 1999 Ms. Sandra Starr, R.S. Health Administrator 27 Charles Street North Andover, MA 01845 RE: 82 Raleigh Tavern Lane Dear Ms. Starr: TOWN OF NORTH Aj',") _ BOARD OF ; r7 2 4 1999 We are in receipt of your review letter dated February 2, 1999 for the sewage disposal system upgrade plan for the above referenced site. Enclosed herewith are three (3) copies of the revised plans. Items 1-4 inclusive have been addressed and shown on the revised plans. Item 5 is with regard to the side slope being within 5' of a property line. The toe of the proposed fill is within 1' of the right-of-way line of Raleigh Tavern Lane. There is, however, a 10' (approximate) grass shoulder between the bottom of slope and the paved way which provides an area twice that required by Title 5 to dissipate any potential run-off associated with the raised system. Additionally, there is an existing catch basin down gradient of the slope which will collect any run-off before entering the roadway or any abutting properties. In addition to this, we are requesting a variance from your regulations to allow the following: • The S.A.S. to be 80' from wetlands (100' required). • Side slopes to be 10' and 20 ML Geomembrane (15' is required). • Geomembrane (concrete is required). • Local upgrade allowing the S.A.S. to be 3' from the E.S.W.T. These variances and upgrades will help maximize environmental protection while minimizing the cost and adverse aesthetic impacts on the property. Ms. Sandra Starr, R.S. February 18, 1999 J Page 2 We appreciate your consideration of these matters and look forward to discussing them in greater detail with the Board at their February Meeting. Very truly yours, MERRIMACK ENGINEERING SERVICES '9f-I&DIt r� William Dufresne Project Manager cd Enclosure cc: Mary & Anton DenBoggende MERRIMACK ENGINEERING SERVICES. INC. • 66 PARK STREET • ANDOVER. MASSACHUSETTS 01810 SEPTIC PLAN SUBMITTAL FORM LOCATION NEW PLANS: YES REVISED PLANS: 450 SITE EVALUATION FORMS INCLUDED DATE: "211 7/-7 c� DESIGN ENGINEER: DATE TO CONSULTANT: $125.00/Plan $ 60.00/Plan 601 �O YES NO *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. Town of North Andover, Massachusetts Form No. s NORT1y BOARD OF HEALTH A • DESIGN APPROVAL FOR ass'`""5`t SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant _m/4p—y , 29/ur4A> Test No. ( Site Location R—;?, �/tL�/Gid %/a�/�,�,�� 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. f CHAIRMAN; WARD OF HEALTH Fee-2� Site System Permit No. /G6l Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director (978)688-9531 March 10, 1999 Anton & Mary DenBoggende 82 Raleigh Tavern Lane North Andover, MA 01845 27 Charles Street North Andover, Massachusetts 01845 RE: 82 Raleigh Tavern Lane — variances Dear Mr. & Mrs. DenBoggende: '{D Fax(978)688-9542 This is to inform you that at their meeting of March 9, 1999, the North Andover Board of Health granted variances to sections 5.02 and 9.02 of the Town of North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage to permit the installation of a leach area 80' from wetlands, and to permit a Geomembrane to be installed instead of a concrete wall. In addition, under local upgrade approvals (3 10 CMR 15.405), the Board of Health approved a waiver request to allow the side slope to be adjusted to 10' with a geomembrane installation, and granted the request for the system to be 3 feet to groundwater instead of 4 feet. Please note that with the latter variance, depth to groundwater, there can be no increase of flow to the system, nor can there be an increase in the square footage of the building. In addition, these variances are granted with the requirement that within 6 months the existing toilets in the house that are not low -flush toilets be replaced with 1.6 gallon toilets. Please notify the Board of Health for an inspection when they have been replaced. If you have any questions, feel free to call the Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator Cc: W. Dufresne File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ! �/ CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTAL R: d tt �-e S d SIGNATURE: Z/4 TELEPHONE# CHECK ONE: REPAIR: �+ 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 T J 0K _rl-C, ,`.�sZ_je- , Date: �C i Town of North Andover, Massachusetts Form No. 3 t NORTIy BOARD OF HEALTH 19 O 9 + °o'_ •" /9STIo tom DISPOSAL WORKS CONSTRUCTION PERMIT : SACHUSE Applicant NAME ^ ADDRESS TELEPHONE Site Location— Permission is hereby granted to Construct ( ) or Repair (>4 an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee— D.W.C. No. )4 S Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 March 29, 1999 Mary DenBoggende 82 Raleigh Tavern Lane North Andover, MA 01845 RE: sprinkling system Dear Mrs. DenBoggende. Fax(978)688-9542 This letter comes in response to your questions of whether a sprinkler system can be installed on your septic system leach area. Although we often observe during field work on failed septic systems that a number of homeowners do install sprinkler systems over their leach areas, we strongly recommend against this practice. The sprinkler system over the leach area could introduce a significant amount of excess water into your septic system. This could result in a system failure. For this reason the Board of Health opposes the installation of sprinkler systems over leach areas. Sincerely, Sandra Starr, R.S. Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 October 8, 1999 Anton & Mary DenBonggende 82 Raleigh Tavern Lane North Andover, MA 01845 RE: low -flush toilets Dear Mr. And Mrs. DenBonggende: ,SO 4 Fax (978) 688-9542 This correspondence is in regards to the recent repair of your septic system at 82 Raleigh Tavern Lane. As you may recall, the Board of Health members voted to grant variances to the regulations for the construction of your system with the additional requirement of the installation of low -flush toilets within six months. I have attached a copy of the original letter for your convenience. To date, we have not had a request for an inspection of your premises. A final letter of compliance can not be issued until this requirement is met. Please contact this office as soon as possible so that we may discuss this issue. Thank you for your cooperation in this matter. Sincerely, /usanrd Health inspector cc: file +J - BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover, Massachusetts BOARD OF HEALTH NORTH -19L 0 " DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUS t Applicant / NAME ADDRESS �f TELEPHONE Site Location— Per . mission ocation Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S. No. ? i D T CHAIRMAN, BOARD OF HEALTH : WNCFN i BDARU Cir r1�h:.i � ' I I Jul -22-98 08:20A Paul D. Turbide, PE/PLS 508-465-0313 P.02 t CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS The ollowing is a checklist that incorporates all Title 5 and local regulations for septic pians 'dame of Applicant AP1V0 i VlAw`( a Ligg,66AName of Designer:_ �fgf f,IE 666 Et.Y .�g. QtaF►'1E51�� Plan Date 17!!f:'J :S E9.2 Revision Date. Date of Review Property address 02i I2 LE1614 klap: 102 A Lot. I Of�? BOH Revtewer Type of Plan (new or upgrade): u Ea cy_ Number of Bedrooms in Assessor's Records: _ gpd) Garbage Disposal .allowed W General Information: N A. = North Andover Septic Regulations Other numbers refer to -,'Air 5 OK Problem N/A — —_ -- —_ Street number and maptlot - 220(4)(u) Maximum scale of I "340' for plot plan - 220(4) Maximum scale of I "-20' for profile and component details - 220(4) Legal boundaries of the facility being served - 220(4)(a) Names of abutters from recent tax map - NA 8.02j Number of bedrooms, design calcs., - NA 8.021 '.Name & address of record owner & applicant - NA 8 02k Name & address of designer - NA 8 021 Holder and location of all easements - 220(4)(b) Date plan drawn & any revision date - NA 3.02m All dwellings and buildings, existing and proposed - 2200)(c) Location of all existing or proposed impervious areas - 220(4)(d) All distances on site plan - NA 8.03a -c Elevation of proposed driveway - NA 8.02t Location and elevation of foundation drain - NA 8 02y Location and dimensions of the system: ncl. reserve (new const) Limits of excavation of leach area on site plan - NA 8 02z Locus plan • 220(4)(t) North arrow - 220(4)(g) Existing and proposed contours • 220(4)(g) Locations and logs of deep holes - 220(4)(h) Locations and logs of percolation tests - 220(4)(i) Date(s) of soil testing - 220(4)(h) & (i) Existing grade elevation of each deep hole - 220(4)(h) Elevation of percolation tests - N. A. 8.02n Name of approving authority representative - 220(4)(h) & (i) Name of soil evaluator - 220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the iystem- ri n) Complete profile of the system to scale - 220(4)(o), NA 8 02c Cross section of leaching facility - NA 8 02w Location ofbenchmark(s) within 50-75 feet of facility -'_20(4)(q) Note listingall variance requests with proper citations - :�Oti'Kpi Lucal upgrade approval requesr form subm:rre l - 4030, Original R.S /P E. stamp, signature & date • 1-20(1) & ('-, Jul -22-98 O8:21A Paul D. Turbide, PE/PLS 508-465-0313 f y i ' Ou-site Soil and Groundwater Review OK Problem NIA Proper deep observation hole logs on plan -120(4)(h) Soil evaluation forms submitted within 60 days of field work - 0 1 3(2) _ Proper percolation test log - 220(4)(i) T-- Ample deep observation holes in primary disposal area (minimum 2) - 10:(2; ample deep observation holes in secondary disposal area (minimum 2) - :02(2; Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 10.3(4) Hole Identification Numbers: ground ele%,stion e! acceptable scil el Leach facility invert el ground water el refusal el botton: of leach iacilay el thickness of acceptable soil be -bre & arier soil R&R separation to groundwater separation to re-usal soil class perc rate loaeing rate septic :ank brow g w table pump tart below v.w (aole I ' in til; (yes or no) (yes or no) - 255(1) P. 03 ✓ sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w6n l:D@) - 220(41( Locarion of watercourses, wetlands, wells, etc. Win 150' of system - NA 8 02r Wetland disclaimer - NA 8.02s ✓ Land surveyor plan reference required (property line setbacks) - 220(3) Plan contains designer's certification statement ✓ 'Use approvals / standards checked for UA system - DEP docs., — _ Perc rate >30 NPI - not allowed for new, LUA for upgrade - 245(l)&('3) Perc rare > 60 MPI - must use modified nghr tank or I A technology - 'a.ir'al Proposed system qualifies as "shared" system - 002 (definitions) Flow is 2,000 No R.S. 220(l) over tgpd - allowed - Design flow was set in accordance with code - 203 Existing system location and note on proper abandonment - 600 3 1 (fl, 35.1 Leaching facility at least t' above Base Flood elevation - NA 9 05 Sch 40 NA 10.01 All piping minimum - Basement floor minimum 1' above groundwater elevation -!NA i 04 Ou-site Soil and Groundwater Review OK Problem NIA Proper deep observation hole logs on plan -120(4)(h) Soil evaluation forms submitted within 60 days of field work - 0 1 3(2) _ Proper percolation test log - 220(4)(i) T-- Ample deep observation holes in primary disposal area (minimum 2) - 10:(2; ample deep observation holes in secondary disposal area (minimum 2) - :02(2; Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 10.3(4) Hole Identification Numbers: ground ele%,stion e! acceptable scil el Leach facility invert el ground water el refusal el botton: of leach iacilay el thickness of acceptable soil be -bre & arier soil R&R separation to groundwater separation to re-usal soil class perc rate loaeing rate septic :ank brow g w table pump tart below v.w (aole I ' in til; (yes or no) (yes or no) - 255(1) P. 03 Jul -22-98 08:21A Paul D. Turbide, PE/PLS 508-465-0313 Setback Distances (Given in feet) 15 21 1 OK Problem N/A (s the lot in the lake Cochiewick Watershed) NA 6.00 & i 02 Septic Tank Leach Facility Property line 10 10 Cellar wall 10 20 J inground pool 10 20 .J Slab foundation 10 10 .T ✓ Deck, on footings, etc 5 10 Waterline 10 10 Private drinking well 75 100 In-tgation well 75 i00 Wetlands 75 100 Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib To Surface Water supply 335 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains (wat. supplyltnb.) 50 l00 Drains (intercept g.w.} 25 50 _ Foundation drains 10 20 Drains (Other) 5 0 Drywells 20 Downhill slope IS' to 3 1 slope wick barrier P.04 Jul -22-98 08:21A Paul D. Turbide, PE/PLS 508-465-0313 Builditte Suver OK P:aalem Grease trap required for certain uses (check 230 for details) Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) Pipe cast iron or Sch 40 PVC - NA 11.02 Watertight joints specified - 222(3) & (4) -- y Pipe laid on compact, fin base - 222(5) Pipe laid on continuous grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(5) Cleanout provided every 100 feet - 222(g) Manhole at any 90 degree alignment change - 222(3) Invert elevation at building: Invert elevation at septic tank: _w Length of run: Slope: (minimum of 0.01 - 0.02 desired) • '111 6) 10' offset to private well or suction line - 222(2) Septic Tank OK/ ProbiCm N,'A Tank is accessible - 228(3) !� Tank can accommodate both primary & reserve - NA 9.04 2009/6 of flow (required & provided given. 1500 min.) - 220(.6)(0 & 223)(1)(a), _ 2-3" drop from inlet to outlet - 227(5) .minimum of4' liquid depth - 223(2) 3" air space above teestbaffles (minimum) - 227(4) _ 9"air space above flow line (minimum) - 227(4) Tees are not to be replaced by baffles - 227(1) Tees extend 6" above flow line - 327(1) Inlet tee extends 10" below flow line (minimum) - 227(6) Outlet tee extends 14' below flow line (more for deeper tanks) - 227(6) _ Gas baffle installed on outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compan) 228('-) 3-20" manholes - 228(2) I childproof, 24" riser/manhole to final grade if <I000gpd• 323(2) Inlet and outlet tees on center line - 227(l) Soil compaction below tank specified (if soil is non-native) - 331(3) 6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(l) if > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp - 2=3i MID) If plan specifies disposal must be 2 tanks in series or 2 compart tank - 223(I)(c) _ Buoyancy talcs. required if tank at or below water table - 221(3) T Tank is watertight - 221 (1) 9" of cover over tank (minimum) - 228(l) H- 1 0 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) A11 pumping to tank (if applies) in accordance with - 229 Tank is set to keep old system in service during install if possible Tiyhi Tattk iCheck here if not present- P.05 Jul -22-98 08:22A Paul D. Turbide, PE/PLS 508-465-0313 P-06 Distribution Box (Check here if not present: OK ,Problem NIA Inlet elevation: Outlet elevation: 0. l7drop from inlet to outlet (minimum) - 232(3)(b) 2222 6" sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) --� Outlet pipes laid level for first 2 fl. - 232(3)(c) >/ Pipe Sch 40 - NA 10.01 Number of outlets: Number of laterals: s/ Size of outlets: ., Inlet baffle/tee min. V over outlet inven for all d -boxes - 232(3Xa), Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of stone beneath distribution box specified - 221(2) Box is watertight - 221 (1) Top of box <=36" below grade - 221(7) Buoyancy calculations required if box is at or below water table - 221(3) Pump Chamber (Check here if not present: OK Problem NIA Volume specified: 220(4)(r) Pump on elevation- _ 220(4)(r) _ Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) 220(4)(r) 254(I)(d) if from d Number of cycles per day - (also gravity -box) Minimum 2" delivery line to d -box if gravity - 254(1)( c) Pressure dosed Lf. if flow>- 2,000 gpd - 254(1)(a) & 254(2)(a) Cycles per day is consistent with chamber volume - 23 l Volume calculations include flowback volume - T ) 1(2) 2222 24 hour storage capacity above pump on elevation -'_31(2) �j Number of pumps: _ _ 2 if system serves >2 dwelling units -'_31(6) Capacity of pumps) - gpm Q4 ' TDH - 220(4)(r) / - Pump can pass 11/4 "solids (minimum) - 23 1(7) sL Pump controls specified - 220(4Xr) 222,2// .Alarm equipment specified - 231(2) :Yarm is in building and powered on separate circuit from pump - 2') 1(9) Pump sequence correct (of lead on -tag on-alan-n on) - 231(8) Pump performance curves included - 220(4)(r) .Manual operating switch - NA 12.01 — Check valve, bleeder hole - NA 12.01 1 childproof, 24" riser/manhole to final grade - 211(5), 2222: Soil compaction beneath pump chamber specitied (if soil is non-na, vet - (2 ) VoF <=314"stone beneath chmbr. specified • 221(2) & 223(1), _ Buoyancy calculations if chamber is at or below water table - 221(3)tc 9" of cover over chamber (minimum) - 228(1) H- 10 loading (min.) - H-20 if traffic - 226(')), Chamber is watertight - 221 (1) _✓ __ i op of chamber <=36" below grade - 221(7) /J/)ul-22-98 08:22A Paul D. Turbide, PE/PLS 508-465-0313 1 Leite� hind Facility (general - complete for all designs) OK Problem IViri/ 50% larger if garbage disposal - 240(4) _ Trenches to be used whenever possible - 240(6) No vehicle access or imperv. area above 11 unless unavoidable - 240(7) Vented if under impervious cover - 241 (l) _ Vented through same pipes as distribution system - 241 (I)(a) Vent protected from precipitationlanimal entry - 241 (l)(b) Vent is placed beyond traffic or impervious area - 24 1 (1)(c) . j Ali lines connected to vent if bed or trenches - 241(I)(d) 9" cover over peastone - 240(9) Reserve area provided (new construction) - 248(1) Reserve 4' from primary leach area — NA 9.04 _ a' (5' if pert rate <=2 WI) separation to g.w. - 212(a) & (b) a' (down to 2' with variance or UA - upgrades only) of natural soil under I.f. GW separation is adjusted to highest existing grade if facility cuts into a hillside Ptpe slope minimum of 0.005 - 251(9) Require 5' removal and replacement if in fill - 255(5) _ Top of leach facility <a 36" below grade - 221(7) Final grade over If tninimum 0.02 fl/ft -2400 0) Surface & subsurface drainage away from I.f. - 240(1 1) & 245(5) 3/8"-5/8" orifices specified (gravity system) - 25 1(8) Minimum design flow 440 ;pd without deed restriction NA 13.01 3:1 slope where grading required - 255(2) Toe of fill slope stops T from property line or swale installed - 255(2) Impermeable barrier if < 3:1 slope or < 15 feet to—3:lslope - 255(2) Impermeable barrier/retaining wall poured concrete — NA 9.02 Retaining wall stamped by P.B. - 255(2)(b) Top of retaining wall >- top of peastone elevation - 255(2)(0 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) Perc tests) done in most restrictive layer - 104(2) Perc test 4' below leaching elevation — NA 7.06 Design flow listed and required/provided leach area given - 220(4)(1) _ Leach pipes SCH40 PVC — NA 10.01 Leach pipes minimum 4" diameter except for dosed system — NA 14.04 Leach lines capped, vented, or connected together - 251(9) M Pressure dosing guidance followed if pressure distribution - 254(2)(c41 ), Pressure dosing required over 2,000 gpd or with IIA remedial use - 23 l(i ) Le2ebino Trenches (Check here if not present, _ ) OK Problem N A _ Number of trenches: Minimum of 2 trenches - NA 9.01(2) Depth of trenches (max eft' 2'): .247(l) Width of trenches (2' min., 4' max.): - 25 t (1)(b) Length of trenches (100' max.)- - 25 1 (I)(a) _ Trenches are vented (when > 50') - 251 (11) Trenches follow contour lines - 2 51(2) _ Trench spacing 3 times effective width or depth - 251 (1)(d) In till or reserve between trenches, 10' min. - NA 14.01& 14.03 Available leach area given (Min. 500 s.f) - NA 9 01(^_) P.07 Jul -22-98 08:24A Paul D. Turbide, PE/PLS 508-465-0313 Bottom = L x W x# = S. f Sidewall = L x D x# —x2= s f Effective leach area given Loading factor. Effective area = total area s.f. x LIAR = ;/day Effective area is >= design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.- 247(2) _T^ Trench depth of 3/4" to 1 1/2" double washed stone - 247(1) Leachina pits (Check here if not present- OK Problem NIA # of pits/pit systems (dosing chamber if > I, 231 (1)) Dimensions of each pit or system: L W D Depth of pits (max eff. 2'): - 253(I)(a) Available leach area given Bottom - L x W x if of systems Sidewall - L x D x # of systems = s. f. Total area - bottom + sidewall = s.f. Effective leach area given Loading factor: Effective area = total area sT x LTAR = s/dav Effective area is >= design flow of facility being served Minimum of 2 pits at least 13'X16' — NA 9.01(3) Distribution for galleries/chmbrs. in trench contig. - pipe every 20'- 253(6) Distribution for galleries(chmbrs, in bed config.-ea.pipe serves <= 40 s f -253;6) Spacing - 2 times the effective width or depth (the greater) - 253(1)(c) 2" of 1/3"- 1 /2' 2x washed peastone.- 247(2) 3/4" to 1 1/2" double washed stone - 247(1) Each, pit has at least one 20" access cover. 24" Cl to grade over 2,000 gpd •253(3) Surrounding aggregate thickness between I' (min.) and 4' (max.) - 2530)(b) Vents, if necessary, extend under covers of pit(s) - 241 (e) Leach Fields (.Check here if not present: ) OK Problem N/A Number of fields:(need dosing chamber if > I, 231 (1),J Length (100' max.): - 252 (2)(b) Width: Total area: L x W s. f. Minimum 900 square feet - NA 9.01(1) Distribution lines connected with solid pipe — NA 15 01 Effective leach area given Loading factor Effective area - total area s.fx LTAR Vdav Effective area is >= design flow of facility being served Animum of two distribution lines - 252(2)(a) 6' line separation (max,) - 252(2xd) 4' rnaximum separation from edge of field to line - 252(2)(e) 10' minimum separation between adjacent leach fields - 252(2)(t) Between 6" and 12" of3/4. 1 1/2" stone beneath field - 2:7(2)(g) & 247i2: 2"of 113%1/2" 2x washed peastone.- 247(3) P-08 s J o�N .•dam - N � Y ' a s, N N �1`� / cc. S • w O .S ii tj S N0.1 F, dI r d 4 M A1% / N v A� N 0 .n o tl '• •7 Nr" 1 Nb7M'y �'� � • a '� � � ^ � d r ol .r , 4 M N �P a � � V O. a IL a ' CA c. i mUto. . r �. • 1Y / Nlp ° r j O O . O • S 1 - j Z c`, M � g � i 0 • s t \ '� LA t C (r' / r TT � s h � � ♦ • 41 ♦ r�'C e / P a r� • o' y ♦ ♦ f 'mss i t° ? iu, •° 6 P �' 41 . �i d p i (• e Z o rol • T y� o i �� J" Q. ^' F T C 9 • A1+ k' 'Tsa lot, CO OP c19fk. w�11/�• � 3 c (r t• v w M n � • �y F9 wf. ' a �' •� n � y, c � r O � FY V� s/ C• a i�- ti o "'" 1 #, • G�2 ` • U ys � M � / 1 w a 4h2 8E 'ON 1`d1d 33S