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Miscellaneous - 851 JOHNSON STREET 4/30/2018
Fff p ='- lrOtt h f 6; Too AJ for Al AS to nor oil I to X wn b H nAlOw r �a tt lit � ¢ f •s« `fir s,�t ,�... - �� * � .w y .$g . ' •- - •_� L ' y `.� � �' -' ,� 'Ya. a tea' -I - �. no new 04 3 FOX to SOUP �will " IN- Now ..y as {W -Rol 17- Atom; OW W J Fff Commonwealth of Massachusetts lJ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address I certify that l 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 12/20/2011 sped s Signat&6 Date The system inspector shall submit a copy of this inspection report to the Approving Authority ('Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if, applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 11/10 Title 5 Official :Inspection Fonn: Subsurface Sewage Disposal System •Page 1 of 17 Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the N �aAI *��� computer, use the tab keys'' 1. Inspector: ' TOWN only OF NORTH ANDOVER to move your Neil James Bateson HEALTH DEPARTMENT cursor - dq.mot use the return Name of Inspector key. Bateson Enterprises Inc. Company Name VQ 111 Argilla Road Company Address .Andover MA 01810 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that l 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 12/20/2011 sped s Signat&6 Date The system inspector shall submit a copy of this inspection report to the Approving Authority ('Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if, applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 11/10 Title 5 Official :Inspection Fonn: Subsurface Sewage Disposal System •Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 851 Johnson Street Property Address Elizabeth Christopher Owner owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ED N ❑ ND (Explain below): t5ins • 11110 Trtle 5 Official Inspection Force Subsurface Sewage Disposal System • Page 2 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Cityrrown 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 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 l5ins • 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Im Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner's Name North Andover MA 01845 12/20/2011 Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 1z 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 Y2 day flow t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 0 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins - 11/10 We 5 Official. Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „ 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a .cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 0 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins - 11/10 We 5 Official. Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been.determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 330 t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? Seasonaluse? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ® Yes ❑ No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No Yes ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): a General Information Pumping Records: Source of information: Pumped 2010, owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? -- Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ F Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Board of Health had no plan, home owner had design plan, 11/3/2003 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): ❑ Yes ® No 1.8 feet Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC thru wall, 3" PVC in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal J. 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) Dimensions: 10'x 5'x 4' Sludge depth: t5ins - 11/10 CJ ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts upnsonTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 JohStreet Property Address < Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 26 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8.1 Distance from bottom of scum to bottom of outlet tee or baffle 21" How were dimensions. determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser 2" deer). Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Commonwealth of Massachusetts 851 Johnson Street - Not for Voluntary Assessments Property Address Elizabeth Christopher Owner owner's Name information is required for North Andover MA 01845 12/20/2011 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: El concrete El metal El fiberglass El polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day El Yes [:1 No Alarm in working order: ❑ Yes El 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 F1 No l5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 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: El concrete El metal El fiberglass El polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day El Yes [:1 No Alarm in working order: ❑ Yes El 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 F1 No l5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .•''t 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Citylrown 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.): ' D -box level & distribution equal, has flow levelers. No evidence of leakage. Evidence of carryover. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 12 of 17 Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration. Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer .Dimensions of cesspool „ Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •'< 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries. number: ® leaching trenches number, length: 2 trenches with 5.5 Infiltrators ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Two trenches with 5.5 infiltrators per trench . Soil ok. Vegetation ok. No sign of ponding. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration. Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer .Dimensions of cesspool „ Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a Privy (locate on site plan): Materials of construction: Dimensions t5ins - 11/10 Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner owner's Name information is required for North Andover MA 01845 12/20/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system; including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately E 0 .S�ceQcn kl� C m - 'ra I �- , ► _ L4 'lot 3� 13'3tl t5ins -11110 TWO 5 Oficial Inspection Forth: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not,for Voluntary Assessments 851 Johnson Street Property Address Elizabeth Christopher Owner Owner's Name information is required for North Andover MA 01845 12/20/2011 every page. City[Town 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: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11/3/2003 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan, no water observed Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 I. , . 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 851 Johnson Street Elizabeth Christopher Owner Owner's Name information is required for North Andover MA _ 01845 12/20/2011 _ every page. City/Town 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 t5ins -11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 Summan,,.Record Catd generated on 1/10/2012 10:42:46 AM by Karen Hanlon Town of North Andover Tax Map # 210-107.A-0062-0000.0 • Parcel Id 17887 851 JOHNSON STREET PHILLIP & ELIZABETH CHRISTOPHER 851 JOHNSON STREET NORTH ANDOVER, MA 01845 Page 1 II, Class 101 Single Family Property Type 1 Residential Zoning2 11 Residential Zoning3 1 Residential Size Total 1.01 Acres FY 2012 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until PHILLIP & ELIZABETH CHRISTOPHE Owner 851 JOHNSON STREET NORTH ANDOVER, MA 01845 NAWROCKI, RICHARD T. Previous Customer Inactive 6/30/2005 851 JOHNSON STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14337.0 - 851 JOHNSON STREET Last Billing Date 12/8/2011 2100341 02 Cycle 02 Active UB Services Maint. Account No. 2100341 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 57.00 /1 UB Meter Maintenance Account No. 2100341 Serial No Status Location Brand Type Size YTD Cons 16335998 a Active ERT METE METE w Water 0.63 0.63 260 Date Reading Code Consumption Posted Date Variance 11/2/2011 729 a Actual 15 12/15/2011 -39% 8/2/2011 714 a Actual 24 9/14/2011 76% 5/4/2011 690 a Actual 13 6/13/2011 -1% 2/7/2011 677 a Actual 15 3/15/2011 -46% 11/1/2010 662 a Actual 25 12/13/2010 3% 8/4/2010 637 a Actual 25 9/13/2010 24% 5/4/2010 612 a Actual 20 6/9/2010 44% 2/2/2010 592 a Actual 14 3/11/2010 5% 11/2/2009 578 aActual 13 12/11/2009 -45% 8/4/2009 565 a Actual 24 9/11/2009 32% 5/4/2009 541 a Actual 18 6/16/2009 -1% 2/2/2009 523 a Actual 18 3/16/2009 2% 11/4/2008 505 a Actual 18 12/10/2008 2% 8/4/2008 487 a Actual 18 9/12/2008 3% 5/2/2008 469 a Actual 16 6/18/2008 -1% 2/6/2008 453 a Actual 18 3/14/2008 -10% 11/2/2007 435 a /actual 19 1/15/2008 10% 8/3/2007 416 a Actual 21 9/14/2007 4% 5/4/2007 395 a Actual 16 6/22/2007 24% 2/21/2007 .379 a Actual 20 3/23/2007 -22% 11/1/2006 359 •a Actual 21 12/22/2006 55% 8/1/2006 338 a Actual 10 9/13/2006 30% 5/25/2006 328 a Actual 12 6/20/2006 1% 2/8/2006 316 a Actual 11 3/13/2006 -7% 11/2/2005 305. a Actual 10 12/14/2005 8% 8/11/2005 295 a Actual 5 9/12/2005 -100% 6/27/2005 290 f Final Bill 0 6/27/2005 -100% Class. Zoning2 Size Total FY 5/3/2005 2/22/2005 11/16/2004 8/17/2004 5/17/2004 2/17/2004 11/4/2003 IF Summary Record CaYd generated on 1/10/2012 10:42:46 AM by Karen Hanlon Town of North Andover Tax Map # 210-107.A-0062-0000.0 Parcel Id 17887 851 JOHNSON STREET PHILLIP & ELIZABETH CHRISTOPHER 851 JOHNSON STREET NORTH ANDOVER, MA 01845 101 Single Family Property Type 1 Residential Zoning3 1.01 Acres 2012 290 a Actual 270 a Actual 269 a Actual 267 a Actual 259 a Actual 238 a Actual 217 n New Meter 20 6/8/2005 1 3/15/2005 2 12/17/2004 8 9/20/2004 21 6/14/2004 21 4/16/2004 0 11/4/2003 Page 2 1 Residential 1 Residential 2700% 54% -75% -63% 17% 0% 0% TOWN OF NORTH ANDOVER pf �10RTH Office of COMMUNITY DEVELOPMENT AND SERVICES ? b!,•t.'e p HEALTH DEPARTMENT p . . 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 851 Johnson St MAP: 107A LOT: 62 INSTALLER: James Kellett DESIGNER: Richard Tan4ard PLAN DATE: Revised 2/23/04 BOH APPROVAL DATE ON PLAN: 3/25/04 DATE OF BED BOTTOM INSPECTION: June 28, 2004 Susan Sawyer DATE OF FINAL CONSTRUCTION INSPECTION: July 1, 2004 Dan Ottenheimer DATE OF FINAL GRADE INSPECTION: 9, t SELECT SYSTEM TYPE X GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H10 GALLON PUMP CHAMBER -- LOADING LOADING OF PUMP CHAMBER = TYPE OF SAS = Chamber DIMENSIONS AND DETAILS OF SAS: 2 trenches with 5.5 chambers in each trench. SITE CONDITIONS ►� Existing septic tank properly abandoned Internal plumbing all to one building sewer © Topography not appreciably altered Comments: Page 1 of 4 a Q TOWN OF NORTH ANDOVER NOWN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845cMu ss"CHU 9 �s Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK Comments: D -BOX Comments: ❑ Bottom of tank hole has 6" stone base did not see 0 Weep hole plugged D gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) 0' Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) O Inlet tee installed, under access port 0 Outlet tee (gas baffle or effluent filter) installed, under access port 20 inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present . O Hydraulic cement around inlet & outlet ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'tfoot) D Hydraulic cement around inlet & outlets Observed even distribution ❑ Speed levelers provided (not required) Page 2 of 4 4-1 TOWN OF NORTH ANDOVER NOR*M Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p . . 27 CHARLES STREET w ._ NORTH ANDOVER, MASSACHUSETTS 01845�cH byss,CH us Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SOIL ABSORPTION SYSTEM 0 Bottom of SAS excavated down to 6" into C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan D 3/4-1 '/n double washed stone installed 1/8-1/2" (peastone) double washed stone installed 0 laterals installed and ends connected to header (and vented if impervious material above) 0 Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan 0 Elevations of laterals installed as on approved plan 0 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: Wall to be constructed, checked at final grade inspection Page 3 of 4 O TOWN OF NORTH ANDOVER °� NoerM Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT A 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845ss"CUD HU 4 ACHU�+ Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - FAX SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 8.27 Height of Instrument: 108.27 Page 4 of 4 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 104.29 104.14 Septic Tank IN 104.09 104.02 'Septic Tank OUT 103.29 103.92 Pump Chamber IN Pump Chamber OUT Distribution Box IN 103.71 103.74 D -Box OUT .103.54 103.55 Lateral 1 Bottom of Chamber 103.00 103.03 Lateral Invert 103.54 103.52 Lateral 1 Top of Chamber 104.00 103.98 Lateral 2 Bottom of Chamber 101.34 101.22 Lateral 2 Invert 101.88 101.89 Lateral 2 Top of Chamber 102.34 102.30 Page 4 of 4 I►w Q TOWN OF NORTH ANDOVER of paf+TH q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT } 27 CHARLES STREET n9 b* NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 — Phone 978.688.9542 — FAX . healthdept@townofnorthandover.com www.townofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION: Z D �A n c,� T LICENSED INSTALLER NAME: PLEASE PRINT SIGNA �I CHECK ONE v FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: TELEPHONE# 2 �1' 15 3— v I V � * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. ,. $250 fl0 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No " Foundation As -Built? Yes No Floor Plans? Yes No Approval of Health Agent Date: y TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( ) repaired; by l located at �5 �)a n Sa r, 5t2z�Fi was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , plan dated L— Z- 3 —O `-f , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title S and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: Engineer Representative Engineer Representative Installer:/ Dater®y Engineer: Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at4�S l � Tr_3� to the application ��A 6 �' lh(I' J dated F for plans by � '� and with revisions dated—2- Z-3 — OY I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any otherperson not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection - Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade - Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Disposal Works Construction Permit # SYSTEMS iNC lne var10 IeeGer In <n�m0�r tee�neln 9Y� This is to certify that: .lames KeUett Kellen Excavating LLC 1, has satisfactorily completed the required travtittg program for the installation of the INFILTRATOR' leaching chamber system for cm -site wastewater disposal applications. This person is certified to install the INFILTRATOR® charnber system as set forth by the Massachusetts DEP approval letter for INFILTRATOR drai afield charnbers. All other , erridelines as set forth by the latest revision of 310 CRM 15.00 of Title 5 will apply. This certificate was sealed and issued this 29th day of March 2004. Certification: MA1146 Lee Verbridge Atlantic Regional Manager j I 7 North Andover Board of Health-,, MEETING MINUTES DPW 384 Osgood Street Thursday — MARCH 25, 2004 7:00 p.m. New Business Meeting Minutes Approval of February 26, 2004 Board of Health Meeting presented for signature. Mr. Markey approved and Ms. Barczak seconded. All were in favor. . Mike Reilly of F.P. Reilly & Sons to meet with the Board of Health regarding 258 Bridges Lane. A presentation was given by Susan Sawyer regarding problems with the first excavation at which point the installer hit rock ledge. The engineer, Mr. Ben Osgood of New England Engineering called for a final inspection of the system. The Septic Consultant, Mr. Dan Ottenheimer, found some problems with the elevations in relation to the plan. Mr. Osgood changed a number on a pipe in the field, which did not match the plan. Two surveys were completed on this site: 1. Survey One was completed by an independent surveyor hired by the Town of North Andover; 2. Mr. Osgood also hired an engineer to have a survey done. The problem at hand for discussion is that the septic installer, Mr. Mike Reilly of F.P. Reilly & Sons should have immediately called the Health Department with any problems. It was stated that the field is too low at this site. A question was posed by Ms. Sawyer to the Board members as to whether there is anything that Mr. Reilly should be responsible for in terms of consequences with regard to building according to the plan. Mr. Osgood states that when the problems with the elevations arose, the sill elevations did not correspond with the benchmark in back. The new system is located in the woods. The benchmark was not set at the time, so it was stated on the plan, with the intention of setting the benchmark. The labeled elevation was mis-labeled on original plan. A rod reading was taken in back, and there was a foot and a half mistake. Mr. Osgood takes responsibility for the error, as Mr. Reilly was merely following the plan changes. Mr. Reilly should have called the Health Department instead of calling the engineer. Mr. Osgood stated that in the past, the Health Department did not always work this way. There have been changes brought about in how the department works due to the transition of a new Health Director, and two different septic consultants. In addition, Mr. Osgood states that a new plan has been done. The second issue was that installer needs to attend a training when using a new infiltrator system, and not just watch a video. Mr. Reilly states that the issue at hand with this particular location was that the cufflinks could not be pushed into the ground. Title V requires training on this system. Mr. Reilly took the training two years ago. Mr. Markey asks if there should be any disciplinary action. Ms. Barczak inquires as to what has been done in the past. Ms. Sawyer and Mr. LaGrasse state that there were other March 25, 2004 - North Andover Board of Health Meeting - Agenda Page 1 of 5 Board of Health Members: Cheryl Barczak, Clerk; Jonathan Markey, Chairman; Thomas Trowbridge, DDS, MD, Member; Health Department Staff: Susan Sawyer, Health Director, Brian LaGrasse, Health Inspector, Debra Rillahan, Public Health Nurse; Pamela DelleChiaie, Health Department Assistant issues that have come to the attention of the Board in the past. Mf* Markey suggests a probationary period for Mr. Reilly for three installed systems to be reviewed upon installation and to be sure that they are all completed properly. With regard to 258 Bridges Lane, there were a lot of issues with the buyers and sellers. Mr. Osgood said that he would pay for the cost of the surveyor in the amount of $500 payable to the Town of North Andover. There will be a probationary period of three (3) septic installations for Mr. Reilly, and the probation will be, lifted after that time. The Board of Health accepts the offer of Mr. Osgood to pay for the additional survey that was paid for by the Health Department. Mr. Ben Osgood of New England Engineering presents the following requests for variances for Local SepticUpgrades on the following properties: _ ➢ 851 Johnson Street 1. A local bylaw variance to use a segmental block retaining wall and; 2. A reduction from the leachfield and the house from 20 feet to 18 feet. Two test pits were completed. A system was designed to accommodate the current three-bedroom house. A membrane was used as a barrier to reduce the slope. The bylaw requires a poured concrete wall that is very expensive at approximately $100 per lineal foot. Part of the problem is that the septic contractor does not pour the wall — a separate contractor has to pour it in. The segmental block walls are four (4) feet in height, and can be installed by the septic installer. The segmental wall is pointing toward the neighbor. The segmental block wall will prevent effluent from breaking the barrier, and the system should be serviceable for a long time. The size of the blocks specified are the ideal blocks to use. As long as there is a four (4) foot wall, blocks from any manufacturer can be used. Ms. Sawyer commented that -the exposed rock is an issue during evaluation, as the consultant stated that there might be ledge. However, Mr. Osgood states that it is a large rock, and not ledge. Note: A certification form can be found online. The engineer will fax over a sheet, and plug in the values. We need this certification form before a permit will be issued. Mr. Markey stated that the exposed rock could be an issue. Mr. Osgood states that he thinks the rock will come right out. The rock in the back is probably very large, or bedrock. The system location is taken off of the As Built plan. Mr. Markey states that if the rock does not move, he can have the wall angled to make the grade. Ms. Sawyer inquired as to what the reserve area is in relation to the foundation. The soil tests were done at five (5) minutes per inch. Mr. Markey states that the topography is away from the foundation. Dr. Trowbridge asked if there was a barrier between the edge and the foundation. Mr. Osgood states that the installer goes down 10-15 feet to put in a barrier. Mr. Markey would rather not see a barrier around four (4) sides, just one. The porous soil would prevent risk to the foundation. Ms. Barczak made a motion to allow for reduction in the leachfield from 20 to 18 feet, and for segmental blocking. Dr. Trowbridge seconded the motion. All were in favor. March 25, 2004 - North Andover Board of Health Meeting - Agenda Page 2 of 5 Board of Health Members: Cheryl Barczak, Clerk; Jonathan Markey, Chairman; Thomas Trowbridge, DDS, MD, Member; Health Department Staff Susan Sawyer, Health Director; Brian LaGrasse, Health Inspector, Debra Rillahan, Public Health Nurse; Pamela DelleChiaie, Health Department Assistant It w a o M•� N N � O O 3 a0 0 Q N 0 I� o •' d Q r It Y w � w L N � O O 3 00 Q J 0 O x o Q CA W w z o cn a_ M •L W cC0 N O u O z a N bo M C c. cz O u�z¢z 00 O L 00 •00 b E p O z O q M q M q O U �+ C O O Y O •C � m o O Q z00Z N MC D o N L CL C D\ s oL. b oa 'oma O C M O E � O z ri �n a +•,cu•= y p•o Y,C C 40 a p m 00 0 ` N 3 0o v 0 O U N n. 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L a N Q. m m m m a O N _70 U O C Q O w 40 a W •U ,o �„ •up > E E_ C "v U O C i E o G a N C NC O C .b >° 0 N C ro o w Q °'1ow° s^ "c N U r U U 3 Q p Y aui "o ro cCu .� o. c °CX U CL'cC 0 O r o 11 0 o o E E L o N N N N ¢N N 00 N O O z Lt m 0¢ w Z H LU 7 W y� vl C7 o $ S Q o ob � q � m Y w � w L O � O O 3 0 Q 0 CA cl*j z o cn a_ M •L cC0 cCd O u a a c. O O 00 00 00 00 O z MM g q M q M q U �+ O O O O O o o O Q N N N N L Vl D\ 00 � 7 O N O N O M O a 3 m O w � w O � O 0 Q Q CA cl*j z o cn M O i O O O o Z N n 00 Vl D\ 00 � 7 O N O N O M O z o 0 0 0 0 0 0 0 •� N a N n. N a N Q. m m m m a L a .E E U CL'cC O ft CN fnN N MII 0 m r a, a, M M O O 7 O O O O N N V) cn N O O O N I N V O 7 O O N n Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Thursday, March 18, 2004 11:00 AM To: Susan Sawyer; Brian LaGrasse; 'Pamela Dellechiaie' Subject: two documents Sue, Brian and Pam, I have attached two documents for your review and use. First is an approval letter for 851 Johnson Street. I left an area of the letter blank so it can be filled in after the Board of Health meeting (assuming they approve the variance request and local upgrade approval request). Second is a document we have written which describes how Boards of Health should look to review variances and local upgrade approvals. The subject is somewhat dry so we put together an explanation at the beginning, and then put in appropriate sections of Title 5. The Title 5 sections are divided into two categories: factors to consider when reviewing a variance or LUA, and procedures to be followed with a variance or LUA. This is not in the same, numerical order as in Title 5, but I think is more easily understood this way. We also described what each section of Title 5 was before giving the actual text. Hope this is of use to the Board members. Feel free to share it with them in whatever format you see fit (paper or electronic). Dan x� Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com 4/6/2004 U 6 NEW ENGLAND ENGINEERING SERVICES lk INC. - February 24, 2004 NORTH AN©t Susan Sawyer BOARD OF HEALTI North Andover Board of Health 27 Charles Street r J FEB Z 4 2004 North Andover, MA 01845 Re: 851 Johnson Street, North Andover, Septic system design Dear Susan: Please accept this letter as a request that the Board consider the following local upgrades and variances included on the septic system design for the above referenced property. They are as follows: Local upgrade approval. 1. Reduction in the distance between a leach field and a foundation wall from 20 feet required by Title 5 section 15.211(1) to 18 feet. Local variances required 1. Allow the use of a segmental block retaining wall in lieu of a poured concrete wall as required by North Andover Regulation 9.02 If you have any comments or questions please do not hesitate to contact this office. I will plan on attending your next regularly scheduled Board, of Health meeting to address this matter. Sincerely, Benjamin C. Osgood, H., EIT President 60 BEECHWOOD DRIVE -.NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover, MA 01845 978.688.9540 health!tgX (),townoinorthandover.com SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: Z � z- `1 t 6,1 SITE LOCATION: 8,5( ENGINEER: c w E7 N cram A N o = N Cr -1 N CC - NEW C NEW PLANS: YES REVISED PLANS: YES $225.00/Plan_ Check #: E (Includes 1s` w and one Re -Review Only) $ 75.00/Plan iv 1+ Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone #: Fax #: % z E-mail: IVL LS 0 1v Cs- z�J 4'Dt-- � HOMEOWNER NAME: /(.J'} w Roc V, k OFFICE USE ONLY When the submission is complete (including check): 1. Date stamp plans and letter 2. Complete and attach Receipt 3. Copy File; Forward to Consultant 4. Enter on Log Sheet and Database NEW ENGLAND ENGINEERING SERVICES INC. February 24, 2004 Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 851 Johnson Street, Septic system design Dear Susan: Enclosed are 5 sets of revised septic system design plans for the above referenced property. The changes made address the comments in a letter from Mr. LeGrasse dated February 4, 2004. 1. The design has been modified to be for three bedrooms. 2. Construction note 4 has been modified to include removal of the first 6" of "C layer 3. All setback distances have been added to the plans.. 4. General note 6 has been revised to indicate that the dwelling does not have a foundation drain. 5. The distribution box detail as well as the system profile detail have been modified to indicate that all outlets are at the same elevation. 6. The septic calculations are for a three bedroom home which is what is now designed on the plan. 7. Form 12 is enclosed. 8. The walls have been revised as part of the reduced leach area size however the walls are still segmental block walls. A local bylaw variance has been noted as being required on the plans. 9. The septic tank loading has been specified. 10. Mmm 11. The leach trenches have been moved down hill in to the area that was previously used as the reserve areas. This enabled the barrier to be placed in a location that would accommodate both the primary and the reserve areas. It also enabled the septic tank to be lowered so the system could more easily be serviced by gravity. The upper reserve area will need a pump to enable future use. A note has been added to the plans reflecting this requirement. It is not possible to modify the interior plumbing to accommodate the upper reserve area trench being serviced by gravity. 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 12. The outcrops have been noted, however it is not the belief of this office that the outcrop adjacent to the proposed system is bedrock. It appears to be a large exposed rock. 13. This office does not agree with having to do an additional test pit prior to approval of the plans. The leach field is within 25 feet of the test pits that were excavated as part of the on site testing. A more appropriate method of insuring that there will not be a problem is to excavate a test pit at the south end of the system just prior to construction to confirm the presence of 4 feet of naturally occurring soil. These plans are being submitted for approval. A separate letter requesting that the board approve the local variance and local upgrades is enclosed. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., EIT President Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@milldverconsulfing.com] Sent: Thursday, February 05, 2004 8:45 AM To: Heidi Griffin; Brian LaGrasse; pdellechiaie@townofnorthandover.com Subject: 851 Johnson Street Attached please find the plan review letter for 851 Johnson Street. You will see that the design failed to depict the bedrock outcrop which appears to be located in or near the soil absorption system. The two test pits are also located very close to one end of the leach trenches and with the shallow depth to ledge at this site, we feel it prudent o have additional test holes dug at the other end of the proposed leach trenches. This will avoid problems like what we had at 258 Bridges Lane. It • Daniel Ottenheimer, President 0 Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 wwww.millriverconsulting com info@millriverconsultina com 2/5/2004 TOWN DA NORTH ANDOVER of AORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 0 n 4 y 27 CHARLES STREET s " � 9 e gOA�1lC tPPy,`y NORTH ANDOVER, MASSACHUSETTS 01 845 9SS�C,,,,�E�� Susan Y. Sawyer, REHS/RS 978.688.9540 Phone Public Health Director 978.6889542 — FAX April 5, 2004 Mary Ann & Richard Nawrocki 851 Johnson Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 851 Johnson Street, Map 107A, Lot 62, North Andover, Massachusetts Dear Mr. & Mrs. Nawrocki, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated February 23, 2004. The design plan was technically complete and the requested variances to state and local design standards were reviewed and approved at the Board of Health meeting of March 25, 2004 with regard to reducing the leachfield from 20 to 18 feet, and allowing the segmental block wall. The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance '• must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two.years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. The time period for which this plan is valid may be reduced by the North Andover Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation 0 Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 3. During the time of construction, confirmation of the availability of suitable soil on the Southern edge of the soil absorption system will need to occur. If soil conditions are found to be different as provided for on the design plan, work shall cease and the construction permit shall be void. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely 1� % Sus Y. Sawyer, REHS/R Pu lic Health Director encl: List of licensed septic system installers cc: file New England Engineering Services T Page 1 of 1 0 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Thursday, February 05, 2004 8:45 AM To: Heidi Griffin; Brian LaGrasse; pdellechiaie@townofnorthandover.com Subject: 851 Johnson Street Attached please find the plan review letter for 851 Johnson Street. You will see that the design failed to depict the bedrock outcrop which appears to be located in or near the soil absorption system. The two test pits are also located very close to one end of the leach trenches and with the shallow depth to ledge at this site, we feel. it prudent o have additional test holes dug at the other end of the proposed leach trenches. This will avoid problems like what we had at 258 Bridges Lane. Dan Daniel Ottenheimer, President -I Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millrivefconsultina.com info@millriverconsultina.com 3/30/2004 TOWN OF NORTH ANDOVER of pORip Office of COMMUNITY DEVELOPMENT AND SERVICES 10- 1 p HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �9ss^CHU Heidi Griffin 978.688.9540 — Phone Acting Health Director 978.688.9542 — FAX February 4, 2004 Richard Tangard, P.E. New England Engineering Services 60 Beechwood Drive North Andover, MA 01845 RE: 851 Johnson Street, Map 107A, Parcel 62 Dear Mr. Tangard, The proposed septic system design plans for the above site dated January 2, 2004 and received on January 20, 2004 have been reviewed. Unfortunately, the plans cannot be approved as submitted. 'The following items are in need of attention prior to approval: 1. The proposed design flow is for a 4 bedroom house while the existing dwelling has 3 bedrooms. The additional flow desired requires that the design meet new construction standards in state and local regulations. The use of the Infiltrator system requires the designer to demonstrate that a standard soil absorption system can be placed in the same location with a conventional primary and reserve area (See: DEP Infiltrator Modified Certification for General Use dated February 21, 2003: Section IV. Conditions Applicable to the System Owner, Paragraph 2). /2. Please indicate that removal of soil horizons A & B shall extend at least 6" into the suitable .soil of the C horizon or request a variance from this regulation. (NA 9.02) 3. Please provide setback distances on the site plan such as the septic tank & SAS to the dwelling & property lines. (NA 8.03) ZZ4. Please provide a note regarding whether a foundation drain does or does not exist within the setback standards indicated in the regulations. (NA 8.02) v15. Please specify that all distribution box outlets are to be at the same elevation. (3 10 CMR 15.232) 6. The calculations for the septic tank size do not reflect the design flow of 440 gallons per day. t/ 7. Please provide the percolation test results on DEP Form 12. 8. The retaining wall indicated on the design plan must be reinforced poured concrete. (NA 9.02) 9. Please specify the septic tank loading. G/ 10. Please clarify the notation for the elevation of Cr found in Test Pit #2. M 11. The proposed impermeable barrier installation will compromise the integrity of the reserve area soils. Please amend the location or configuration of either the barrier or reserve area to assure they do not coincide in location. 2 12. Please indicate the bedrock outcrops on the property in the vicinity of the proposed soil absorption system. 13. The parcel has shallow depth to bedrock present and the design of the soil absorption system is located a considerable distance from demonstrated suitable soils. In order to avoid costly problems during the construction phase, please arrange for additional soil testing to be performed to confirm the suitability of soils in the vicinity of the southern end of the proposed soil absorption system. Please feel ",free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations -and assure protection of public health and the environment of North Andover. rSincer ly, Brian LaGrasse Health Inspector cc: Homeowner CD&S Dir. File LOW 9 NEW ENGLAND ENGINEERING INC Brian LaGrasse North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 851 Johnson Street, Septic system design Dear Brian: SERVICES January 15, 2004 TOWN OF NORTH ANDUJIFIV BOARD OF HEALTH Enclosed are the following documents concerning the above referenced property 1. 5 sets of septic system design plans. 2. Copy of Form 11 soil evaluator sheets. 3. Application for approval. 4. Check to cover the review fee. These plans are being submitted for approval. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 0 0 SEPTIC PLAN SUBMITTALS LOCATION: 85 ')a NiV S AJ ST2 Map & Parcel %07 NEW PLANS: C-S� $225.00/Plan ✓ Check #: 3 REVISED PLANS: YES $ 60.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES c2D DATE: �' �� DATE TO CONSULTANT: DESIGN ENGINEER: kl&y EN 6--L A 1j o Telephone #: ! i,q - 6 8 6,' / 76- , 9 - When the submission is complete (including check), date stamp plans, COPY for Conservation, and place in existing file with green Design Approval form. No. / -e az - FORM 11 SOIL EVALUATOR FOR11*0 Page I of 3 Date: 12-Z Y/ ��,L Commonwealth of Massachusetts Ad� , Massachusetts Soil Suitability Assessment for On-site Sewagre' Dismal Performed By: .......... . Dat e': ��,�/0,3 . .Witnessed By: P9�...................................... .................................. .............. I ....................... .... .. L=a ion Address or eot,:r/ m. Los 1 14 owtv's NuAddress, A/0 ;::n,d A1 A/0- pew construction El Repair (Z �02,e 6,09- IWIA Office Review Published Soil Survey Available: No El Yes Z Year Published /?(0/ ............ Publication Scale Soil Map Unit Drainage Class ... 4 ............... Soil Limitations12,-AP14) .... ....................... ...... Surficial Geologic Report Available: No E Yes D Year Published Publication Scale GeologicMaterial (Map Unit) .............................................................................................................. ... .. Landform.......................................... I .................................................................................. .......................................... Flood Insurance Rate Map: Above 500 year flood boundary No 0Yes N Within 500 year flood boundary No 0Yes 0 Within 100 year flood boundary No 0Yes D Wetland Area: National Wetland Inventory Map (map un -it) .............................. ..................................... Wetlands Conservancy Program Map (map unit) .............................................I. ....... Current Water Resource Conditions (USGS): Month ec7v,64;2 Range :Above Normal ONormal QBelcw Normal D Other References Reviewed: WDEP APPROVED FORM - 12/07/95 FORM. 11 -SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. /4/,�, ?T n�4• ��d�� _On-site Review Deep Hole Number ..J w. Date::��./.3 Time:. T.' Weather Location (identify on site plan) Land Use % 6M, 117 4 Slope (%) .. Surface Stones Vegetation : .. „lis...:.. „ ...... :.. Landform .. ,..v�%Gl _....... , ,.. Position on landscape �i�PE-......w...:. ......, Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line 2...... feet Drinking Water Well/�!se . feet Other DEEP OBSERVATION *HOLE LOG' Depth from Soil Horizon Soil Texture $oll Color Soil Other Sutl.ece Unches).° (SDA) (Munsell) Mottling (Structure, Stones, Bouide(s. Consistency, S: G(avel) 12 � Y 14 Cdw 555 Patent Material ( solo Ic) ® / 1 G e_ DepthtoBedrock: Q#rth to (Houndweter; Standing Water In the Holes , Weeping from Pit Face: Eslimated Seasonal High (around Water Der APPROVED FOW -1110719$ -FORM 11 - SOIL )EVALUATOR FORM Page 2of3 Location Address or Lot No. 4/ On-site Review Deep Hole Number 2 :.: Date:.::.::... 3 �3 Time:. 7- �� Weather �7 Location (identif on site plan) " Land Use :.:.:..:...:..::,.. ../.ZW Slope (%) ..1'7 Surface Stones Vegetation ..5� LandformUlNC/� Position on landscape 5�rl�c �Cd Distances from: Open Water Body �/- 67 I feet Drainage way feet Possible Wet Area 404041. feet Property Line feet Drinking Water Well/ --f-0 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) k, ,30 GS Y �tiy Parent Material (geologic) /P' / / G L DepthtoBedrock: �! Depth to Groundwater: Standing Water in the Hole: — Weeping from Pit Face: Estimated Seasonal High Ground Water:_ J�r 11 P DEP APPROVED FORT!, 12/07/95 y FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal Hieh Water Table Method Used: ❑ Depth observed standing in observation hole .................. inches' ❑ Depth weeping from side of observation hole ................. inches © Depth to soil mottles -.,J, inches --4/- /— 2� ❑ Ground water adjustment ................... feet - 70�—Z Index Well Number .................. Adjustment factor ................... Reading Date ................... Index well level ................ 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? *;� If not, what is the depth of naturally occurring pervious material?' _ Certification I certify that on (date) I have passed the soil evaluator examination approved by 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 Z / 03 DEP APPROVED FORM • 12/07/95 EO 4 0 0 BOARD OF HEAC,)-H NORTH ANDOVERMASS. 0 978-688-9540 TION FOR SOIL MAP & PARCEL: .t 2003, h LOCATION OF SOIL TESTS: 1 c gip,,S. , ,OWNER:,/lLi/9-y door' S (`ztttt �y Ali wt^ r, i TEL.NO.:_f2 ADDRESS: 9-5-1 ENGINEER: Pe � , L , �� � , TEL. NO.: _j 7 - 6 w 6 -! `7 L CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Ingle Family Hom Commercial 'Is This: Repair testing )?— Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No 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 $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tes required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representa 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health she location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval:, ,Z4 Date Received: Check Amount: Check Date: Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsuibng.comj Sent: Wednesday, November 12, 2003 9:18 AM To: di riffin; Brian asse; Pamela Dellechiaie Su ect: 851 Johnson Street Heidi, Brian and Pam, __---- Attached please fi the soil test results for the roperty at 851 Johnson Street. Dan ----_ Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 info@millriverconsulting.com 11/12/2003 r C i ���:as"a-W^�- a+r r' a!n .$°."`_ .'.: .d.» -.,:r +,.,..�_,:=......�.,fi.._..,a_ � �.n -.' �e.tcr yew :*.�s.,. wn..•.:».a..w�� .�. OWNRIM Iw4w . r C i ���:as"a-W^�- a+r r' a!n .$°."`_ .'.: .d.» -.,:r +,.,..�_,:=......�.,fi.._..,a_ � �.n -.' �e.tcr yew :*.�s.,. wn..•.:».a..w�� .�. Location Address or Lot No. Q S� JaFttiS� r��� COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test` Date: .w . _ :l f 3e o3 Time:....g.;�'�....... . Observation Hole # Depth of Perc Start -Pre-soak 8" 5s - End Pre-soak Time at 12" Time at 9" 9")l Time at 6" _ 3�2 .Time W-61 ►3 min Rate Min./Inch *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ ............. _.......... _..... . _ _ .._._..... Performed By: n 05(,060 Witnessed By:___1, u L L e PS L A A)e- Comments: DEO DEP APPROVED FORM - 1210719S