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Miscellaneous - 889 JOHNSON STREET 4/30/2018 (2)
oma`` Co m a 9 g�a��ol �� �sa�1 6, � 00 ON O O O N t of N z P". C oai A • R M Lo ^ O Q 0 V 7 > � CC • Q w w � Q LL7 � LLJ NO 00 00 O N o ill on to C Q Q Q o 0 0 0 z o 0 0 0 0 Q O O C O O acn rx > 0 v) m m m m m a O C/) C O ~ N 0°°z d � O > y O O U v CC U '1 C4 - U rn O a, 00 0z� 00 T o 'o F n a a un rA ol x00. 001 = 3 0 y .a 4. .^ y •p N s 7 O �O 0 4 o„ o� �� �C 00 o C I0 N P". C oai A • R M Lo ^ O Q 0 V 7 > � CC • Q w w � Q LL7 � LLJ NO Q 00 CO N o on to Q Q P". C oai A w w 00 w 00 0 0 0 0 0 0 u o 0 0 0 0 OO O N O O L C O 0 0 z w m o • R M Lo ^ O O 0 O 7 > � CC • Q w w � Q LL7 � LLJ NO Q 00 CO N o on to Q Q o 0 0 0 z o 0 0 0 0 Q O O C O O z rx a 0 v) w w 00 w 00 0 0 0 0 0 0 u o 0 0 0 0 OO O N O O L C O 0 0 z w m o • R M ^ O O 0 O 7 > � CC • Q 7 O O O 7 > � CC • Q w w � Q LL7 � LLJ NO Q 00 CO N 7 O O O R N N NO Q 00 CO N on to Q Q o 0 0 0 z o 0 0 0 0 N N N N N m m m m m a O d � O > y � CC c T o 'o F n a a un rA Town of North Andover Office of the Health Department Community Development and Services Division 400 OSGOOD STREET North Andover, Massachusetts 01845 Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 - Phone 978.688.8476 - Fax CEWFIGA2E OF CO�I�GIANCE As of: ,dune 9, 2005 This is to cert that the ind viduafsu6surface dzsposafsystem Constructed--- or Repaired—( -14v)1 by Ralph Simard at 889,7ohnson Street North Andover, 9lA 01845 has been installed in accordance with the provisions of Tztle v of the State Sanitary Code and with the North AndoverBoardofYfealth regulations. 7lie Issuance of this certfcate shall not 6e construed as a guarantee that the system wilt function satisfactorily. .Sj*an 2'. Sawyer Tu6lic 9fealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 . CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 N\ LETTER OF TRANSMITTAL North Andover Health Department 400 Osgood Street North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax healthdei)WtownofnorthnndavPr n.., v' 10 43 Veal 'A o /t«MKMwKw _ 7� We are sendin ou: OCoo Letter OPlans Other all in below These are transmitted as c ked below: OApproved as Noted 191s Requested DAs Required OResubmit copies for approval OFor approval OFor Review and comment OFor Your Use OSubmit copies for dist. REMARKS: -2 COPY TO: COPY TO: COPY TO: SIGNED: Town of North Andover s Office of the Health Department • ` Community Development and Services Division 400 OSGOOD STREET North Andover, Massachusetts 01845 Susan Y. Sawyer, REHS/ RS Public Health Director 978.688.9540 - Phone 978.688.8476 - Fax CE " �7CA�E OF CO�1�1'LIANCE As of: ,dune 9, 2005 This is to cert that the individual subsurface dia posal system Constructed( - � or Repaired—(,_14v' 6y Ralph Simard at 889 Johnson Street NorthAndover, WA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Yfealth regulations. 1Ilie Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Salsan 7 Sawyer Public Yfealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (/Constructed; ( ) repaired; by wel located at15 S9 7Y6� n So n St l P -e 4— was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , plan dated VW K 10, aob , with a design flow of 5—J gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: l PL- 9" O y Final inspection date: / ;! - 3 / -6 Lnstaller: Engineer: Engin Representative Enginee epresentative Date: Date: Commonwealth of Massachusetts !! gt City/Town of TOWN OF NOR I HANDOVER System Pumping Record HEALTH DEPARTMENT Form 4 DEP has provided this form for use= by local Boards of Health. Other forms may be'used, but the information must be substantially the same as that provided here. Before using -this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location:( e4 / Rig o , Left/ Right rear of house, Left/ right side of house, Left/ Right side of buil Id ng, Left / Right front of building, Left / Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner. Address (if different from location) Citylrown B. Puimping Record 1. Date of Pumping 3. Type of system: ❑ Date K3 04J�IAA State ^ � � � r de ; Telephone Number 2. Quantity Pumped: Cesspool(s) []-1Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition o#SXstem: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locationiere contents were disposed: /c-L's.R/ _ Lowell Waste Water C� Gallons f ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No. F5821 Vehicle License Number Date t5form4.doa 06/03 System Pumping Record • Page 1 of 1 AS -BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS CCAFTTDX&T*-D�7�1!S OF SYSTEM, O LOT & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA r LOCATIONS OF DEEP HOLES & PERC TESTS V ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION V LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW t,LOCATION & ELEVATIONS OF BENCHMARK USED W OL Z z J o c�Gcts yeti W N 0 a o - in S FN in D V)= p N t~n w Q ova ao• Lo 11 � � d: io � z r�v',yy W Q Q p > �o 11 .��� 0 0� R U 1 w czOn a lol II II II 00 Z °° 0000 11 00 � noo � 1}�,-� z zz 0 z r- II II II a J _3 J In 0 Q 011 F-zz �z II �za w Z W Q = J� --3 --t `o o b in i� oo "a, _ ao Q z_ p ia- 00 F— w Z W M a Z V1 m r„ O 0 N o0 o6 N N O X X m W F w 0 z v1 00 MN (I M AMM M� �Z Zm mmmww Q C9 w N W Q Q: Z N� :- tl II II 11 fl II �Fa-Hmm00J? Z FJa a N) W = zz 0 D U w U O w F- F- F- F- F- F- F- F- F- � a N orn (7 nn w 00OOORQ:wa_w�wwofX �zw (n Z Q w F— I— I— w W W w W w w w 0 U Q U»»»> 0W O k W r^ © O N QQQmmmZZZZZZZZZ _OZ m Q a. I- o Lm 0 W N Q�- C4 -Ta Q (,� c 0 o CJ W z oQ W °_ } cr- ,ce'zZ 4.58 oR`Wp,Y Y G a � N � o Go N M ,\ CIO44 11 H � C9 Z O O J Q Z z 3 O ao 0 x —a 0 a 0_� L Z O U W /\ F m Z N Q Z r,, 2m m O -J Y oZO ►- NO3acn o Z ;�O Q Q. o Q ``' Q o .ZS ZS Z .96'£x' W g O 0 FINAL GRADE INSPECTION Date: Address: LOAMED? SEEDED? COVER PER PLAN? Other: I r, TOWN OF NORTH ANDOVER of NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES o= HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 1. 845 �9SSACHUSE�t� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: <l J h✓�5c1'15 j MAP:I OT: 1'� INSTALLER: ,l P 1 \ DESIGNER: ' e_ QAA -\ PLAN DATE: 7 a. BOH APPROVAL DATE' ON PL N: DATE OF BED BOTTOM INSPECTION: I Z -1 DATE OF FINAL CONSTRUCTION INSPECTION: 1 2 -2 3 "2,V DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 7 -�% LOADING OF SEPTIC TANK GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS Comments: Oil k - I i f f ' ; % . I 04 — P1.) S Crr' S +t�. V ,v `1 Existing septic tank properly abandoned LJ Internal plumbing all to one building sewer P g 9 ❑ Topography not appreciably altered vsrC'� 0 Page 1 of 2 f O `\ i TOWN OF NORTH ANDOVER NORTy Of ,,tee° ,°'�,y Office of COMMUNITY DEVELOPMENT AND SERVICES 3r *° :'° °4� HEALTH DEPARTMENT t 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��SSAGHUS t�9 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK - `I -D� - A, ,z) S �C GIL---Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ .5 oo gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER Comments: ❑ Bottom of tank hole has 6" stone base Weep hole plugged ❑ Cho gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) t7 Inlet tee installed, under access port 91 Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Watertightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Page 2 of 2 TOWN OF NORTH ANDOVER 4 NORTH 9 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'"Ss�CN„sEt`y Susan Y. Sawyer, R.EHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM �K ❑ �r Comments: PRESSURE DISTRIBUTION Bottom of SAS excavated down to soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-11/2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan ❑ Z inch manifold ❑ laterals installed with end sweeps size: material: ❑ uirt test ft in height ❑ Equ distribution to all laterals ❑ orifice si inch as per plan Comments: Page 3 of 3 TOWN OF NORTH ANDOVER gORTFI 1 O SLID Iy Office of COMMUNITY DEVELOPMENT AND SERVICES '° ° HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��SS^Ar CHUSEt� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX CONTROL PANEL Alarm & Pump are on separate circuits Alarm sounds when float is tripped Location of control panel: f ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: Page 4 of 4 INVERT ON DESIGN PLAN ELEV @TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D -Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 Dellechiaie, Pamela From: Sawyer, Susan Sent: Monday, December 13, 2004 9:28 AM To: Dellechiaie, Pamela L889 Subject: RE: Bottom Of Bed Inspe on hnson S reet & Tank Inspection - 135 Candlestick Sensitivity: Confidential set for this AM @10:30. 1 called him Susan -----Original Message ----- From: Dellechiaie, Pamela Sent: Friday, December 10, 2004 12:38 PM To: Sawyer, Susan Cc: Grant, Michele Subject: Bottom Of Bed Inspection - 889 Johnson Street & Tank Inspection - 135 Candlestick Importance: High Sensitivity: Confidential Hi Susan, Ralph Simard is requesting a BB inspection for 889 Johnson Street on Monday. Please call him with a time. Also, needs tank inspection for Candlestick. He has pulled the tank and relocated. The electrician is pulling a permit on Monday.a.m. to do his part. Please call him at 508.958.2002. Thanks, P zz4 a, Tqwn of North Andover Health Department Date: �DZ Location: �v ��� /;�:y.�tiJ_]p. (Indicate Address, if ROidential, or Name of Business) Check #: Tvve of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ QiSij;tic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ Swimming Pool $ ➢ Tobacco $ ➢ TrasIVSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) C/ tJ/•. 3 2 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer i TOWN OF NORTH ANDOVER MOR7H Office of COMMUNITY DEVELOPMENT AND SERVICES 0� q s '``•� °. HEALTH DEPARTMENT n 27 CHARLES STREET . �,�� .•' ; NORTH ANDOVER, MASSACHUSETTS 01845 �95S�1L HUSE�� Susan Y. Sawyer, REHSIRS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX healthdePt.a towndhorthandover.com www.townofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION: Ser 70 7Jv17 f LICENSED INSTALLER NAME: &/ J_i.,n0±5 41 PLEASE PRINT SIGNATURE: TELEPHONE# j 4 0 4 CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $250.00 or $125 Fee Attached? Yes Z No Project Manager Obligation From Attached? Yes '� No Foundation As -Built? Yes�� No Floor Plans? Yes No Approval of Health Agent r Date: J ($250) ($125) INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at r 7 �-7 Jdl � relative to the application ofh� IT'/with ated ' ' " �� for plans by �,y�. ��,� - and o' dated /v revisions dated , f� 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 other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction. steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: a5 Disposal Works Construction Permit # APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I` herebya application for a p t f a sewage disposal installation at ���,���G r� �rmi� I will install this system in ac - c dance with all the laws o the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 290. I will install a con- crete septic tank of / o—r--c' in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of -e lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of'2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection _officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE CLA G Sigfiature of ApplicaW I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signat a of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Inspecting Officer Percolation Test'/' " b Garbage Grinder 46 I BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 114 Y Ot �A !•V71 , m 4 Z I �. A tit" I .ov._ .1" A1. I+AidE Y -�1 ✓ l f / "I DATE / J IL Z Z 2. A.)rREE S Ne i N %Lt, II q j)LOT N0._ TEL.�35,32 3. NO. OF BEDROOMS DEN YES NO � 4. GARBAGE GRINDER YES N0_,�_ 5. SHOW EIRENSIONS OF HOUSE b. SHow rl TANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SWk WCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE `t CATIC17 A;dD DISTANCE 0: L FROM �; WERAGE SYS7 M 1C. 'HC'd "ION OF BROOKS, STREAMS, DITCHIS, LEDGE OUTCROP, ETC. 11. SHOW ._:LANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NO'T'E: LCCtaL REGULATiC •;S SHOULD BE READ CAREFULLY. S r, BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE 9-23_t72 NAME OF APPLICANT Harvey Wald, M, D. LOCATION Johnson St. (Rt. side 500ft. from Mill Rd.) Address of lot no. BUILDING: Dwelling X, Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay Gravel Sandy C1a� X PERCOLATION TEST h minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. William J. D scoll, Engine Board of Health VQ1 I �_ Pj_ William J. D scoll, Engine Board of Health /Ale- 7. A.� if } �', C APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I,.hereby m e/ application for a p rmit f a sewage disposal installation at '�1��'(�: ��j rz�L�,J� %cC' ` I will install this system in ac- cpraance with all the laws of th6 Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of ird -c in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of'2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/$" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Sia5fiature of Applic ,/ I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signat a of 'Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Inspecting Officer Percolation Test _" -'.z'�� Garbage Grinder I BOARD OF HEALTH TOWN OF NORTH ANDOVER., MASS. Al 9.0 t V ! tAmJ, kiij 1. NAME, zr W . t , DATE�- 2. ADI'1ZESS_s. t1. i�� /y�?dl leis�� _,/LOT NO. TEL. 3. N0. OF BEDROOMS � •}� DEN YES NO 4. GAWtGE GRINDER YES NO 5. SHOW EIKENSIONS OF HOUSE 6. SHOW D1,11CAACES OF HOUSE TO ALL PROPERTY LINES 7. SHOW D:fYZNSIONS OF LOT 8. SHOk LOCATION AND SIZE OF SEPTIC TANK OF CESSPOOL a. NOTE ' iCATICN AND DISTANCE 0. '.,L FROM J �dvERAGE SYS"' M 10. t� ,'ION OF BROOKS, STREAMS, DITCH—r-H-r -w , LEDGE OUTCROP, ETC. 11.SHOW i'*..TANCE OF SEPTIC TANK OR CESSPOOL E'WOM HOUSE NOTE: L�XAL REGULATIiA'iS SLOULD Bre READ CARM, , LLY. I BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE q-23_s�2 NAME OF APPLICANT Harvey Wald, M. D. LOCATION Johnson Sts (Rt. side 500f t, from Mill Rd.) Address of lot no. BUILDING: Dwelling X' Other SYSTEM: New x Repair GENERAL DESCRIPTION OF LAND high. SUBSOIL: Clay Gravel Sandy 1_av PERCOLATION TEST h minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1.000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. l illiam J. D 'scoll, Engine Board of Health 3 ef F -7121 ?3 I /b3 ./0 i-) I I ra ♦ ID Tr, v /b3 ./0 I i-) I I ra ♦ Tr, v rA I l< F- sT F. A 0 Rr",Ir, , i-) I Tr, v mr tj AJC.- k" Iv k 'IN 'lei it* l< F- sT F. A 0 Rr",Ir, , 3 mr tj AJC.- k 'IN 'lei o Lj 3 j r 4 TOWN OF NOR fH ANDOVER of NOR*►+ , Office of COMMUNITY DEVELOPMENT AND SERVICES ,t�•° �° p HEALTH DEPARTMENT 41 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ,SSACHUbtt 978.688.9540 — Phone Susan Sawyer, .REHS/RS 978.688.9542 — FAX Public Health Director healthde t a,townofnorthandover.com - E-mail www.townofnorthandover.com - Website 1 Is 41 Ta (Natte) z ja � From: Company Fax: Pages: ll;7;5 Phone: Date: Re: � / CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Please contact the Health Department at the above numbers for further assistance if } required. HP Fax K 1220xi Last Transaction Date Time T Identification Log for NORTH ANDOVER 9786889542 Nov 30 2004 9:40am Duration Pages Result Nov 30 9:39am Fax Sent 819785560284 1:25 2 OK TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o? •', �O°A HEALTH DEPARTMENT ~ 400 Osgood Street sem. '•+,riagel NORTH ANDOVER, MASSACHUSETTS 01845 CHU Susan Y. Sawyer 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX November 2, 2004 McCue Residents 889 Johnson Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 889 Johnson Street, Map 107A, Parcel 157, North Andover, Massachusetts Dear Homeowners, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Engineering & Surveying Services dated October 20, 2004. The design has been approved for use in the construction of the upgrade of an onsite septic system for a 5 -bedroom dwelling (not greater than a total of 11 rooms). 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. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. 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 (310 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 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. 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. Sincerel san�Yl./Sawyer, REHS/R Public Health Director cc: Engineering and Surveying Services File Dellechiaie, Pamela From: Sawyer, Susan Sent: Monday, November 29, 2004 3:56 PM To: Dellechiaie, Pamela Subject: RE: 889 Johnson Street Sensitivity: Confidential IM `' 889 Johnson Street 11.2.04 OK.... I did this quick. Check this out. -----Original Message ----- From: Dellechiaie, Pamela Sent: Tuesday, November 23, 2004 3:26 PM To: Sawyer, Susan Subject: 889 Johnson Street Importance: High Sensitivity: Confidential Hi Susan, Did you generate an approval letter for the above? It looks like you approved plans on 11/2, but no letter. Jim MCCut called today for a Title 5 copy, but I don't have one in the file. If you have the letter, please forward to me asap. Thanks! P J�ih 977(C/�� c7L j 8�y %oLi�svr, st, ,G O 0 D " � c 7�) Town of North Andover Health Department q' t Location: / (Indicate Address, ,iifgRessi Check #: Type of Permit or License: (Circle) W" " Name of Business) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic -=Boil Testing $ oox� c2_ Septic -Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ] Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) r 238 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Town of North Andover 'Health Department Date: ��Location• (Indicate Address, if Res; ial, r Name of Business) Check #: Tvve of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septi o;1 Testing Sept;c -Design Approval $ $A OW ❑ Septic Disposal Works Construction (DWC) $ ;❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 238 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer A 0 i Town of North Andover HEALTH DEPARTMENTT;tlV J 27 Charles Street North Andover, MA 01845 OCT 2 2 2004 978.688.9540 healthdentnatownofnorthandover..com TOWN OF NUR i H ANDOVER HEALTH DEPARTMENT IC PLAN SUBMITTAL FORM DATE OF SUBMISSION: 161ZZ(�q SITE LOCATION: Sb ENGINEER: F " S ' <� , NEW PLANS: rad fon YES $225.00/Plan ✓ Check #: 3 (Includes 10(NE"L" and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES N Telephone #: 9 7b r ,3-4 `02 -Sy Fag #: E-mail: HOMEOWNER NAME: K'1 c. C -G( F— OFFICE USE ONLY When the submission is complete (including check): 1. Date stamp plans and letter 2. �Cofkplete and attach Receipt 3. Co y'File; Forward to Cons ant 4 Enter on Log Sheet and Database OCT -22-2004 02:20 PM ES S 9785560284 9-.o, 70 Bailey coult HOMM, MA 01832 9?&Gw.OM -�;Imo wor; A 1be S k 5A'A) SAu From Greg Saab fsoc 978.688.9542 Paaosa 6 OF ZO NtA OV DEPFr Pbwm 978.688.9540 Deft Z 2 /a 41 no 889 Johnson St CCs 0 thin! 0 For Btrlaav 0 Ptpw Conn and 0 Plast "&Plly a PN~ "Gyd* • Coerrnsets: Please find the aaaChed forms regarding the soil testing results for 889 Johnson Street in North Andover: K you have any questions, please give me a call. 978.556.0284. OCT -22-2004 02:23 PM ES S 9785560284 Y.eb �• 508689 39 P.02 0 - PERCOLATION Lccition Addrsss or Lot Plc, 5d/V COMl i%iloNWcAL-h,' of MA Sp-rp" RECEIVE® OGT 2 � 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT f QL; l am � i4- Q"'e M • • , assachuse t;s PercoL•tioa Te, -f' Date: lme ... �:3 . . Qbserraticr, hcle.• I Jr rj.fQ Star: Fre-soak J�.a t : _3 3- - F. -,d Pre-.scak ` 5--c) I —~-- -------4---- rime at 12" Tune at °' - • , a 1 Time at 6' , � 1 a� Time PJM min Ar.&v • Minimum aLt.percalatko ta9t rwe, be performed in both tho primary area AND reSer.v arEd Site Pawed omits Faikd ❑ Witrt•ssod Or Commenu: a" AJPPnora NAM i OCT -22-2004 02:22 PM ES S 9785560284 P.05 V N. l. Nowa It - SOII; LVALUATAR FORM Page 3 of 3 L.oatlea Addrai or Lot Ma -OCT 2 x'2004 &ftrmiag&u tar Stasonal MW Water TOWN OF NORTHANDOVER HEALTH DEPARTMENT ❑ Depth observed standing in observation hole . inches epth weeping from aide of observation hole inghes Depth to soil mottles inches ❑ Ground water adjustment . ..... feet Index Wall Number .._.._..._.._ Reading Date Index well levo! ......_.__.. Adjustment factor ........._. Adjusted ground water level ...._.... Does at least four feet of naturally occurring pervious materiel exist in all $fees observed throughout the area proposed for the soil absorption system? Q 19 �, If not, what is the depth of naturally occurring pervious material? Ca fi iemboon, I certify that on V116 ldatel I have passed the *oil }vsluator examination approved by the Dowimint 01 Environmental Protection and %hot the above analysts was performed by me consistent with the required training, expertise end emnrience described in 310 CMA 15.017. Signature Dete �a o is oe ArmwMroiw. 8vn n OCT -22-2004 02:22 PM ES S 9785560284 P.04 FORM 11 JIL EVALUATOR FORM Page 2 or 3 egg �'h5p., ST Location Address or Lot 140. nn -site Beview Z; 3b Weather �s` 2'41AJ 9—� Date:.. 1... Time: Deep Hole Number .., a (w .....-...:....... Location (identify on 'te plan) So •-n wDp S Slope M 9 -10f -Surface Stones Land Use Vegetation ) RECEIVED Landform Position on landscape (sketch on the back) . { 1 2 004 Distances from: pu OCT 2 2 �f- feet Drainage way 7, feet Open Water body 1 Od ert Line" feet Possible Wet Area Jc?4?t feet Prop Y TOWN OF NORTH ANDOVER Drinking Water Well . Jb 60- feet Other -. HEALTH DEPARTMENT LJ � j,.r jJ Oepthtotieoroc� - Parent Material (geologic) Water in the Hole: Weeping tram Pit face: Oepth to Groundwaer Standing y o rr Estimated Seascnat High Ground Wster: V VEP APMOVED FORM - 11167195 OCT -22-2004 02:21 PM ES S 9785560284 P.03 FORM 11 ,OIL EVALUATOR FORM Page 2 of 3 Location Address or Lot IJo. q FI T` h 5- 1 ST Qn-site Review Z, ov Weather Deep Hole Number Date:..., Time: Location {identify on ' e plan? wi Land Use ..�'`�©pO Slope Surface Stones Vegetation .�.P.f^�.�,-yx..d�4rCLR�- Landform Set pI •, Position on landscape (sketch on the back) 1 2004Distances from:Ov feetOpen Water Body J�d'N feet Drainage way Possible Wet Area !�?�" feet Property Line �feet H'� ' r _...1 Drinking Water Well . JP feet Other ..,.._ . DEEP OBSERVATION HOLE LOG other �Dep:thqfr:zSoil Horizon Son Texture Soil Color Soil Moalin iStructure. Stones. Boulders. Consistency. % tUSDAi (Muntelll 9 Gravel) Ap vY� -7,5 &A, 156 41 Depthto8edroi Parent Material tgeologid _�=-- Oepth to 6raurdwet Standing Water in the Hole- Weeping from Pit Face: Fstirnatad Seasonal Hl Ground Water: VEP APPROVED F001- 11107/95 OCT -22-2004 02:21 PM ES zS 9785560284 mrnonwealth of Massachusetts AMY �, t ,Massachusetts Pesfonaed BY: -. Gr..._. Wttncssed BY: - ALV -- So• a � Ce�ficadan fA Q~'@ tjow. j�-- old Tat. r ;;;;OrTK �'g� �. w-ijoou re , w► A- No New Caurvetion 1�� ❑ P. 02 DateZ3 a ur: u -T-2.2 2004 TORNE OTH. U p ff Wa.9avi= .-� No Yes: Pub'fshed Sda Sur A.veUeble: yt3 Map Unit � . Publication 'Sos Year Published 11 -SP �m'�ct Drainage Class' --M oa- a.........._. ❑ Surficial Geologic Report Available: No [a' yes . Year Published Publication Scab Unit) ....... Geologic Material (Map - • - ••••-� Landform ; ........_.... _ _ . _ ..._. �.... �..,/ Flood Insurance Rate Map: Yes t� Above 500 year flood boundary NO Within goo Year flood boundary No (�Yes ❑ Within 100 year flood boundary No Yes Ci Wetland Area: _.._.._........__ .............. • National Wetland Inventory Map (map unitf ....-.._�...........�....._..._._.._. _ Wetlands Conservancy Program Map .map unit) MQMi1 Current Water Resource Conditions'USGSt: Below Normal ❑ Range: . Above Normal ❑ Normal�... _ .... father References Reviewed: .. : _ .._.........-. N . RECEIVED COMMONWEALTH OF MASSACHUSETTS UUL 2 2 2004 I Board of Health, Mofe-1W kt1NOJEP— , MA. FEE LnHEALTH OF NOR 1f �T�Tr�TT�T 1� DE IO FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application a Permit to Construct(*] Repair( ) pgrad Abandon() - IJ Complete System ❑ Individual Components Location 681 o HA SON� S-Rtr;T— Owner's Name McCue R -e . d -ea Cc- Map/Parcel# i O"1 A Address g?s (I Lot# k 5-1 Telephone# Installer's Name Scc%—k CC4�aot� Designer's Name C , s .s . Address Address '10 3A' Lz GT t vetrl '0 (Nlik Telephone# Telephone# c'1b s (O. D 1 1 r Type of Building �e5�de(1"TlA 1, Lot Size sq. ft. Dwelling - No. of Bedrooms Garbage grinder( ) Other - Type of Building No. of persons Showers ( ), Cafeteria ( ) Other Fixtures Design Flow (min. required) 4Lt U gpd Calculated design flow (. 20 Design flow provided 55l• 2d gpd Plan: Date JU he 23. ZooNumber of sheets t Revision Date Title �1 tY�(� S�%s�r%c+CP_ SewaGe �c�D:t5AL �59S� l-kDR` Je Description of Soil (s) Gf'0AJ „(k4 GAyr�y �P�N� Soil Evaluator Form No. Name of Soil Evaluator GIM S Date of EvaluationIJ DESCRIPTION OF REPAIRS OR ALTERATIONS gN\OvJ -Dumc) +Cxvoc an The unr further Signed Inspections i Soo Gnitor3 Seortc -�anY- a t, W6 0. 36 Lw\:f Vn1 S `� agrees to install the above described Individual wage Disposal System in accordance with the provisions of TITLE 5 and ,off ce the systtem ation u a Cer 'f cate of Complian a has bt07 n is d by the Board of Health. D e l No. COMMONWEALTH ih ALTH ®F MASSA 14USETTS FEE Board of Health, , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. COMMONWEALTH OF MASSACHUSETTS Board of Health, , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT FEE Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date Board of Health I N Ta TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 3?�`'°4�� °� 0� HEALTH DEPARTMENT Y } 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01.845 Ac USES 978.688.9540 — Phone Susan Sawyer, REHS/RS 978.688.9542 — FAX Public Health Director healthdept@townofnorthanclover.com www.townofnorthandover.coni From: Fax: Pages: Phone: paw; Re: CC: v ❑ Urgent ❑ Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Please contact the Health Department at the above numbers for further assistance. It TOWN OF NORTH ANDOVER °t NORry 7 Office of COMMUNITY DEVELOPMENT AND SERVICES o? •`;+��� ` "`�O HEALTH DEPARTMENT ' . t 41 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 CMuS°t Susan Y. Sawyer 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX August 18, 2004 The McCue's 889 Johnson Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 889 Johnson Street, Map 107A, Parcel 157, North Andover, Massachusetts Dear Homeowners, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Engineering & Surveying Services dated June 23, 2004 (Last Rev. August 10, 2004). 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 mat the acceptable criteria in the state regulations. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the time period for which this plan is valid may be reduced by the North Andover Board of Health. 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 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. 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. Sinlce ayer,H Public Health Director cc: Engineering and Surveying Services HP Fax K1220xi Last 30 Transactions Log for NORTH ANDOVER 9786889542 Aug 23 2004 2:28pm Date Time Twe Identification Duration Pages Result Aug 19 12:15pm Received 9786889522 4:56 9 OK Aug 19 12:21pm Received 9786889522 1:06 2 OK Aug 19 2:23pm Received 978 557 8633 0:35 1 OK Aug 19 3:43pm Fax Sent 89787771594 1:07 1 OK Aug 19 4:08pm Fax Sent 818883346733 1:03 1 OK Aug 20 8:02am Received 1:47 3 OK Aug 20 8:16am Received 9783563218 1:17 3 OK Aug 20 9:16am Received 0:38 0 No fax Aug 20 11:13am Fax Sent 816179834380 0:20 1 OK Aug 20 11:14am Fax Sent 816179834380 0:28 1 OK Aug 20 11:50am Received 978 794 1793 1:02 4 OK Aug 20 11:51am Received 978 794 1793 1:02 4 OK Aug 20 12:27pm Received 819786889563 0:54 1 OK Aug 20 2:23pm Fax Sent 89786238320 0:48 2 OK Aug 20 3:06pm Received 978 851 7270 1:01 1 OK Aug 20 4:19pm Fax Sent 816179836990 0:38 0 Error 420 Aug 20 4:20pm Fax Sent 816179836990 0:27 1 OK Aug 23 9:26am Fax Sent 816173380122 0:58 4 OK Aug 23 11:07am Received 19786854490 0:55 1 OK Aug 23 11:49am Received 148 687 6808 0:42 2 OK Aug 23 12:08pm Fax Sent 816172526899 0:32 2 OK Aug 23 12:20pm Fax Sent 819786679106 0:52 3 OK Aug 23 12:28pm Received 0:39 0 No fax Aug 23 12:36pm Fax Sent 89786851099 1:52 2 OK Aug 23 1:15pm Fax Sent 816173380122 0:33 2 OK Aug 23 1:38pm Fax Sent 816173380122 1:09 5 OK Aug 23 2:20pm Fax Sent 89786890839/ 2:05 2 OK Aug 23 2:23pm Fax Sent 89786821712 1:01 2 OK Aug 23 2:24pm Fax Sent 819784824196/ 0:00 0 No answer Aug 23 2:27pm Fax Sent 819784824196 ,/ 1:06 2 OK i TOWN OF NORTH ANDOVER of µORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES , HEALTH DEPARTMENT 27 CHARLES STREET • �, .a..M�.. ,• NORTH ANDOVER, MASSACHUSETTS 01.845 978.688.9540 — Phone Susan Sawyer, REHS/RS 978.688.9542 - FAX Public Health Director healthdept@townofnorthandover.com www.townofnorthandover.coni Ta From: A— Fax: Pages: Phone: / Date: 9�%' ,SSrI ❑ Urgent t -For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle Please contact the Health Department at the above numbers for further assistance. X86: F y�� yea yi9� 'HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Aug 10 2004 2:24pm Last 30 Transactions Date Time a& Identification Duratio P= Rgsult Aug 6 S:OOpm Fax Sent 816173380122 2:35 10 OK Aug 6 5:03pm Fax Sent 816173380122 2:37 9 OK Aug 9 7:55am Fax Sent 89786641713 1:47 1 OK Aug 9 8:42am Received 19784590368 0:29 2 OK Aug 9 8:54am Received 617 258 2942 1:31 4 OK Aug 9 10:21am Fax Sent 819782765910 0:00 0 No answer Aug 9 10:29am Fax Sent 819782765910 0:00 0 No answer Aug 9 10:35am Fax Sent 819782321195 2:49 7 OK Aug 9 10:53am Fax Sent 89782765910 0:00 0 No answer Aug 9 12:12pm Fax Sent 89786871147 1:23 5 OK Aug 9 12:16pm Fax Sent 89786871147 1:15 3 OK Aug 9 12:37pm Received 5086563078 1:28 3 OK Aug 9 1:38pm Fax Sent 819782765910 4:34 4 OK Aug 9 3:05pm Received Happ 0:39 1 OK Aug 9 5:57pm Fax Sent 819785328410 1:08 4 OK Aug 10 8:1lam Received 9786646052 0:49 2 OK Aug 10 8:13am Received 9786646052 0:35 1 OK Aug 10 8:52am Received Via Fax 0:42 1 OK Aug 10 10:28am Fax Sent 819785328410 1:13 3 OK Aug 10 10:40am Received 9784755401 0:27 1 OK Aug 10 10:54am Received 9787747816 0:49 2 OK Aug 10 10:56am Fax Sent 89786889556 0:30 2 OK Aug 10 11:07am Received 19787721591 2:27 3 OK Aug 10 11:11am Received 0:38 0 No fax Aug 10 11:12am Received 1-978-470-5219 0:53 2 OK Aug 10 11:17am Fax Sent 89786890839✓ 2:43 3 OK Aug 10 11:25am Fax Sent 89786821712 1:11 3 OK Aug 10 11:37am Received EASTERN INSU NCE 1:14 3 OK Aug 10 11:40am Fax Sent 819784824196 1:18 3 OK Aug 10 12:59pm Fax Sent 816172428150. 0:56 2 OK TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES o? +'_ - ` '• °°' HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �1SSACMUs�ly Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX August 9, 2004 Clayton A. Morin, P.E. Engineering and Surveying Services 70 Bailey Court Haverhill, MA 01832 RE: 889 Johnson Street, North Andover, MA Dear Mr. Morin, The proposed septic system design plans for the above site dated June 23, 2004 and received on July 22, 2004 has been reviewed. Unfortunately, it cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000, or North Andover regulations, which is not met by this design. Foundation drain elevation information is required on plan. If there are no foundation �-- drains, then a note to that effect is needed. — NA 8.02y There is less than 4' (41") of C -horizon material in TP -1. Plan may need to call for use of B -horizon (see DEP policy on the DEP website), otherwise a treatment unit or variance request is required. — 240(1). All piping must be Sch 40 minimum, please specify. — NAI 0.01 0' Is the bottom siding the benchmark? If so, please so indicate. NS-'' A notation is required stating that all outlets of the d -box are at the same elevation - 232(3)(b) 16'' A notation is required stating that the d -box is watertight. — 221(1) 3! For Class I soils, 4 doses per day is required for gravity distribution. -254(1) Calculations of pump dose volume must include flow back volume. 231(2) 9✓ 24 hour storage capacity above alarm elevation requires 1.8' between alarm and outlet invert. There is only a 1.43' difference between the two elevations. 231(2) 46' The pump controls must have a manual operation switch. — NA 12.01 1° If manhole cover of pump chamber is to be set to grade as stated on profile, then the pump detail should also show cover to grade. 12. Stone beneath pump chamber must be %" according to North Andover regulations. 43' Deep observation hole logs should state whether refusal was encountered. — 220(4)(h) i'4 Percolation tests results should state depth of percolation shelf and hole. — 220(4)(i) X1.5'' Trenches are to be used whenever possible and recommended whenever dosing to a d - box. — 240(6) and 254(1)(c) Please explain why you cannot use trenches. 16--' Leaching pipe diameter must be 4" diameter minimum. N.A. 14.04 1.7,-'- If end of distribution lines are tied together, a solid pipe must be specified. - 251(9), NA 15.01 Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system that will be in compliance with all regulations and assure protection of public health and the environment of North Andover. 7san Sawyer, REHS/RS Public Health Director cc: Owner File 14 Town of North Aindover O Health Department -�—'Date: �- Location:�i'✓�� (Indicate Address, if Residential, or Name of Business) Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ - Soil Testing $ "tic �YSeptic - Design Approval $� ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 1 6 O Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover, MA 01845 978.688.9540 healthdept( lownofnorthandover. com SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: ZZ�_A& f SITE LOCATION: D �So✓� �/� ENGINEER: G v��/� 'i�%�� �� lzler"l e _9 111 NEW PLANS: YES $225.00/Plan L/ Check #: (Includes J INEwP""O and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone #: Fax #: E-mail: Vii/ HOMEOWNER NAME:74/ '4, i 71, 0- f _�Z OFFICE USE ONLY When the submission is complete (including check): 1. 1/ Date stamp plans and letter 2. �omplete and attach Receipt 3. Py File; Forward to Consultant 4. Enter on Log Sheet and Database JUL-22-2004 10:52 AM ES 70 Miley Court Fl—owl 1, AN OIW2 97e.Qbe OM 9785560284 P.01 To Pam from Grey Saab Fmc 878.888.9542 PoOw 6 + ower 'Noble 878.888.9540 Dmft 7f2? M4 Ho fS Johnson St. CCl D t7t p i Id Far Rsvlow D Were CernoM Q pft am* la Ni� IIeajM • COAlIr owel PWw &W the o0sched tbmrs regarding the coil besting results for 889 Johnson Street In Nom Andtsrer If you have any questions, please give me a cal, 978,556.0284. RECEIVED JUL 2 2 2004 ITOWN OF NORTH ANDOVER HEALTH DEPARTMENT JUL-22-2004 10:52 AM ES 9785560284 P.02 M0 S. Dreft Prfued September 20, 1993 Appendix I Page J Dote L.. Commonwealth of Massachusetts AAh . , Massachusetts Site Suittr ility ase sMent for _O„n=ASg)gage D r oval Performed ey: _ _.. ...,_.,--... -.-. »w. Cwdifadm Numbs: WltttessodBy. t1 _......... _.».._.»..... .».»..._.... _»»»......, »....».,»,.»_..._... _.._ 1MMM ASO M N to to. Oww1'� NNM. AIOnp ��/ TN. e, �� New Ceasauedon ❑ Nair ,- Publletad W SWVW "W"M No 0 Yes `.'ear Published JI S/ PONOMn S:1SIe j = !:8Yd 5011 Map Unit. �..�• : Surficlal Geologic Report AvaNabfe: No Yee ❑ Year Published Publication 6w11 Geologic Material IMap Unit) Landform. »,.,._ ... .. ...._.. ».........» _. _ .»»..... r Rood Insurance Rate Map: No Yet 03001" Above 600 Veer flood boundery Within 500 year flood boundary No Yes ❑ - Within 100 year flood boundary No Yee ❑ Wetiand Arev National Wetland Inventory Map lmap unit) _.... ......... Wetlands ConOw" cY Program Map %+nap until Current Water Resource Conditions IUSGSI: Montt .. Range: . Above Normal ❑ Normal Below Normal ❑ �..�. Other References Reviewed: JUL-22-2004 10:53 AM ES S 9TS5560284 P.03 PERCOL,4TICW TT•ST Location Address or Lot No, COMMONWEALTH dF MASSA CHUSEi'1'S Massaciuset� �9cGladon Test' Qom' Qbaarvadon Mote.# De� of Fere - - E.-Id Pre-mak /D 4004 Titrte at g• ' 3 "lane �Y-�,�' .. y ...„ 45 Art - (j,{ Y Meese area: P�'cotatior� bat nwat ba performed in boar IN Primary area AND Site Passed . stye recd ❑ Pfftmed a:1 S whnessw or. JUL-22-2004 10:53 AM ES S 9785560284 P.04 FORM I SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. _f��9��„Sex ���A" A"We Qn-site ReEiew Deep Hole Number Dste:...611'6%S' Time: ej Oa Weather edlny ° vocation (identify on eke plant . $44—C � �... ,...._, ...... .. Land Use -.. CW.1lyL�.!� . Slope ( 1 O'Z Surface Stones vegetation . ,w . , 1r46 .. , ,.,... _ - . . , .... ...... . .. . . . . Landform . _ .... _.. , .. ... v ... Position on landscape (sketch on the back) . ,... Distanced from: Open Water Body /DD t feet Drainage way /OG �r feet Possible Wet Area ./O t feet Property line .ZQ, feet Drinking Water Well ..k. f. feet Other .�......... , ...Y.,.. . DEEP OBSERVATION HOLE LOG` Dapm from Surface tntheal $a Heft" Sol Taxture JUSDAI so" cow Mama SeE . Moulins other tstrucwre. Star".�8a" e, conalstaney, X 0,# /Z„ Fill I " Yr 41, /oYx31L r044A �, SYR WIV .. , 4P. 06m 'arent L44"das Upmovici .., &AI o.Pthtoeedroek: �� gv22 to DSM st ri ft Waterin the Mos.: At Waepin'aam Ph rte: Estlmated $,agonal High Ground Water:�� - iitJri Armovo 7001-13071" JUL-22-2004 10:53 AM ES S Location Address or Lot No. _gag n56,91 u., _ 9785560284 P.05 FORM ii - SOIL EVALUATOR FORM Pagc Z of 3 On-site Review Deep Hole Number ..: Oats:..w�r/010# Time: i Weather M1AA1j e Location (Idenjify on site plan) Land Use .. d&�-j4l.!'t5 .. Slope 1%} O -Z- Surface Stones - -440--. , Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body 16d't' feet Drainage way feet Possible Wet Area /40s feet Property Line ,. feet Drinking Water Well . 7:Qd l.. feet Other ....,._ ...� . DEEP OBSERVATION HOLE LOGO Depth from Surface anehas) Sod fwhmn Soil TexUwa (USDA) Soft Color IMunNlq Sox Mottling other 15trueturs, StoMs. Boulders. Consietsncy. 6►waq Ar ®H2 4' 4"Y /0 614 v5Y'Yj 5 � .. PL. r Parent Material Ideologic) S Depthto9edrock: -Log Dpoth to GroungtMM Standing Water in the Hole; Weeping from Pit Face: 6tinuted Samonal Nigh Ground Water:_ �� a VEP APPROVED POPAI.13401,#1 JUL-22-2004 10:54 AM ES S 9785560284 FORM 11 - SOIL )EVALUATOR FORM page 2 of 3 Location Address or Lot Oo. g n�4,4/t.Stw _ A " 4dwr On-site &E&w Deep Hole Number .-j — Dat*:...!/14*Y Time: 9 3d Weather!'i IAY Location (Identi on site plan) ... �V.,14A, Land Use 2aJaI I" Slope M Q -L Surface Stones Vegetation Landform Position on landscape (sketch on the backs Distances from: Open Water Body NO feet Drainage way feet Possible Wet Area 100 feet Property Line 2014.1. feet Drinking Water Well Z *' t - feet Other ..,....._,. . DEEP OBSERVATION HOLE LOG` Flom Sunc�e pr" 9) SM Gal Horten Soil Te t es (USOAI Soil color IMunsom Sao Motti"v Other IStrueturs, Stones. %Wdws, CanW ateney, S ore�tn 2A " w il/t �t.�tt�i i jA 4/4 y a(9a++t 0 r /1A j t V 1. 1014 �.sy� ► . Z7 5ko Z.S Patent Materiel Ipeolepic) SL«i Depthso8ed►oek: SR h toh G� ►atxdweter: SteMN Watar In the Note; Weeping hon Pit Fact EWdnrted SaoonN NO Ground Water: ii - M APPROM Fool - 01071a a JUL-22-2004 10:54 AM ES S 9785560284 p•07 r 1. ar FORM i l - SOIL LVALUATOR FqIW_ h9c3a:[J t�. } Location Address or Lot No. �1,._•�D�N�SoK �� '•�� ��� . c • ii:ir.►'.�� Y.Siil�t ❑ Depth obsorved standing In observation hole ..... inches x ❑ Depth weeping from side of observation, holo inches ~; RoD epth to soil mottles 42--'1 inches tc '+ ❑ Ground water adjustment feet ti Index Well Number ...,..... Reading Oate . index well levet _.. ,...., Adjustment fetor Adjusted ground water level GIPItf N�St,del.�LQFSI�'ri�8,'�r.YQ�,Siet(a1 Does at least four feet of naturally occurring pervious material exist in 4V areeg observed throughout the area proposed for the soil absorption system? r If not, what is the depth of naturally occurring pervious material? ) certify that on (dote) I have passed the soil evaluator exerhlnetlo approved by the epa tment of Environmental Protection and that the above Onety8ia was performed by me consistent with the required training, expertise and experfent..b. described in 310 CMR 16.017. Signature etc _ DEP APPROVED F001 • ahoyin Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, September 14, 2004 5:47 PM To: amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; Susan Sawyer Subject: soil tests Sue and Pam, We are all set for soil testing at Lawrence Airport (9:00)nd 899 JohnsonStreet (1. 0) on 9/28. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting. com info@millriverconsulting.com 9/16/2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ° 27 CHARLES STREET • xi ; NORTH ANDOVER, MASSACHUSETTS 01845 3^GHU`� Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax FAX DanielOttenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: 1.800.377.3044 or Date: Phone: 978.282.00141D11-:9; Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address HIP Pax K 1220xi Log for NORTH ANDOVER 9786889542 Sep 10 2004 3:46pm Last Transaction Die, Time Tie. Identification Duration Pages &auft Sep 10 3:43pm Fax Sent 819782820012 2:56 3 OK TOWN OF NORTH ANDOVER °f N°nTH Office of COMMUNITY DEVELOPMENT AND SERVICES o �° HEALTH DEPARTMENT n x } 27 CHARLES STREET x s w °off .? r NORTH ANDOVER, MASSACHUSETTS 01845 �'ss�CHU Susan Y. Sawyer, REHS, RS Public Health Director 978.688.9540 - Phone 978.688.9542 - FAX healthdept@townofnortliandover.com www.townofnorthandover.com APPLI�C`ATION FOR SOIL TESTS / DATE: -1 6— U 4/ MAP & PARCEL: Q 7,4 /5-7 LOCATION OF SOIL TESTS: 0-0 Iq TO A n 5 G h S-re� T OWNER: D i;N ✓► `P � 1 LO r f0 Z2 Contact#: / / 3/ `17 APPLICANT: Pi ai e �- '✓� L©� e�' Zy Contact #: �7� ��� 7 3 �' ADDRESS: � $1 Sd� `� S�� 5 e e �- ENGINEER: �G� Y%N t �//L'/Contact #: ? 70S 2,8V CERTIFIED SOIL EVALUATOR: 61- e �� Intended Use of Land: Residential Subdivisioningle Fam�Hom�! Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: V In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11" Plot plan & Location of Testing (please indicate test pit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. RECEIVED Please Do Not Write Below This Line P 16 2004 N.A. Conservation Commission Approval Date: -:r,- -t(MVN OF `� Q NORTH ANDOVER HEALTH DEPARTMENT Signature of Conservation Agent: Date back to Health Department: (stamp in): 10 Town -of f*4orth Andover /�1C,521 Health Department Date: Location: (Indicate Address, i R se ential, or Name of Business) Check #: ZOO Tvpe of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing �— $ -7 ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 2C5 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax FAX DanielOttenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review L,C� ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: ,� Septic Plan Review Soil Test � OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: ��ZZ, Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address P Pax K1220xi Last 'Transaction Date Time Twe Identification Log for NORTH ANDOVER 9786889542 Sep 10 2004 3:46pm Duration Pages Result Sep 10 3:43pm Fax Sent 819782820012 2:56 3 OK TOWN OF NORTH ANDOVER of NOR�T ,Ati Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'S �` 0 2004 Susan Y. Sawyer, REHS, RS 978.688.9540 - Phone TOWN OF NORTH ANDOVcR Public Health Director 978.688.9542 - FAX HEALTH DEPARTMENT healthdept@townofnorthandover.com _ www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: q 6 — e-) 7 MAP & PARCEL: 107,4 /5-7 LOCATION OFF SOIL TESTS: Oy 41�� r 5ej h OWNER: D 1A h Lo r Q�1 Zc-� Contact -4t: %3' Jnr 3l �p APPLICANT: i i Q✓l e /yI. '0' L©/ Contact #: • _5, -25-- 3 / ADDRESS: 'Sal S-T�—Ie e -j -- ENGINEER: (f L A y�ToN T &e"?'/Contact #: / 7c6 --0 2.z8y CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential SubdivisionSingle Family Home 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 ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) SEP 10 2004 ➢ 8.5" x 11" Plot plan & Location of Testing (please indicate test pit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep hole T1IWN,�'{-Ni RTH ANDOVER two percolation tests required for each disposal area. Fee of� per lot for repai-uDtradeEPARs. DEPARTMENT GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ 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). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department: (stamp in): rN, j C 4 T ,..n of Nortl"An�iover//1:7 /,,A Health Department Date: Location: nq-,7 (Indicate Address, if Residential, or Name of Business) Check #:��� Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type. $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: Septic Soil Testing - ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) - $f ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 092 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Friday, June 11, 2004 8:39 AM To: Susan--Sawyer;amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Sub'ct: 889 Johnson Stree Page 1 of i Sue and Pam, Attached please find soil and percolation test resul for 889 Johnson eet. oor quality till soils but we dug 3 test pits to give us a good sense where ledge was. Loo ave suitable area and suitable depth for a system without variances. Dan 0 Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultinii.com. info millriverconsulting.com 6/11/2004 I I 1 V i �s • T� I 777 Al I � I "a • • s V i n 1"" �- I � j + I I I I I I I I r + r I �s • T� 777 �► . � "a IntLN t I I In F 1 t+ 1 + t '4 I iiii I I I I � I I II I I I 1 + I I i I f � I I I i I i + p wt ICA a i I f � I I I i I i Town of North An over Health Department Date: / Location: ,/ COW (Indicate Address, if Residential, or Name of Business) Check #: "4 19 / Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice j $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp V a ➢ SEPTIC PERMITS: f „U% �� W j �I �iSeptic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 056 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Town of North An over Health Department Date: / Location: (Indicate Address, if Residential, or Name of Business) Check #: "4es�/ en Type_of_Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: eCSeptic - Soil Testing $ 6 ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) , A /ly 05.6 CL Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer tipRTi� " TOWN OF NORTH ANDOVER °:�_�`° ;•�`"� HEALTH DEPARTMENT 27 CHARLES STREET # X i NORTH ANDOVER, MASSACHUSETTS 01845 9S�� sACHU`�� Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax FAX Daniel Ottenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: 1.800.377.3044 or Date: Phone: c /�Z91 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Tes OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: /9,0� V� jle. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address R� 69--1-7THi)�5AKF, y TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET 14 NORTH ANDOVER, MASSACHUSETTS 01.845IL I i..d r� Uri Susan Y. Sawyer, RENS, RS Public Health Director APPLICATION FOR SOIL TESTS DATE: _ C MAP & PARCEL: 978.688.9540 – Phone r 978.688.9542 – FAX I ;`X 1 2 healthdept@townofnorthando ver.com www.townofnorthandover.cohi �---- - L— LOCATION OF SOIL TESTS: OWNER: 71'-,\ P'Me_ G e APPLICANT: S A m iC 861 `.S 0� n son f a 7,+ , 1.x -7 - Contact #: 4e l?— 119 a 0 O 4 Contact #: ADDRESS: <g%69 �C+ ENGINEER: S `, \f e- "� �' Contact #: q'76 CERTIFIED SOIL EVALUATOR: Sa�6 ^��� —v °1 37q Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: V Undeveloped. Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5" x M" Plot Plan & Location of Testing (please indicate test pit sites on the plan ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $225.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department: (stamp in): Q�Q K47 1$ I so Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Wednesday, May 19, 2004 3:02 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: date change, new soil date Sue and Pam, Bill Dufrense reques change in date ,soittesting at 248 Bridgeane from 5/27 to 6/4 at 10:00 a.m. Greg Saab is se or 889 Johnson St r n June 10th at 9:30 a.m. \l Dan a 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 _ millriyerconsultinaxom 5/19/2004 r TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director FAX Daniel Ottenheimer To: Mill River Consulting From: Pamela 978.688.9540 - Phone 978.688.9542 - Fax Fax: 978.282.0012 Pages: + .�J�' � 1.800.377.3044 or Date: Phone: / 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Tes OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Address: Please call 978-688-9540-foT-assistance with anyquestions. Thank -you:,` Cc: File - Address `7 "PI v ;5 Sit F -F. TOWN OF NORTH ANDOVER 4 pORTH Office of COMMUNITY DEVELOPMENT AND SERVICES O 'K�.o .6�ti pL HEALTH DEPARTMENT 27 CHARLES STREET � �, _. • NORTH ANDOVER, MASSACHUSETTS 01.84.5 ' s" Susan Y. Sawyer, RENS, RS 978.688.9540 — Phone' .n.R Public Health Director 978.688.9542 — FAX t IVi "! healthdept@townofnorthandqv,er.com www.townofnorthandover.cofl •_� APPLICATION FOR SOIL TESTS..Rr.. DATE: _ I I ` OL) MAP & PARCEL: LOCATION OF SOIL TESTS. 36""l ' -S cy}l k)SO IA OWNER: T1V\ h L 6-t C Contact #: 1�c l % — 11 '1 - a G L 4 APPLICANT. S A r"1 t—L- Contact #: ADDRESS: G �"L. ", S c ✓1 `�- /- �-{ ENGINEER: � . s , S , L l.&' `�{ "'� c� r `1 Contact #: '9 CERTIFIED SOIL EVALUATOR: C� f 'i 7e' —(:!,;L Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: V Undeveloped. Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5" x ]]"Plot plan & Location of Testing (please indicate test nit sites on the Plan) ➢ Fee of $425.00 per lot Sor new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $225.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ 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). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: ! F0 !iv OF NORTH ANUG '' :R/ + r , F NF�LTN Signature of Conservation Agent: 04 1 . 24 Date back to Health Department: (stamp in): Q h IWO ore Q ee t � � w�5tii1S a v �S�N YOAWoo e ai 0 m1 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILEI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNau ht 111 L Owner's Name ,a North Andover MA 01845 5/19/2015 Citylrown State Zip Code Date of Inspection � �" � 'C' v� d Inspection results must be submitted on this form. Inspection forms may not be altered in a6 way. Please see completeness checklist at the end of the form. RECEIVED A. General Information MAY 2 7 2015 1. Inspector: TOWN OF NORTH ANDOVER Neil Bateson HEALTH OUARTty ENT Name of Inspector Bateson Enterprises Inc. Company Name 111 Arailla Road Company Address Andover Citylrown 978-475-4786 Telephone Number B. Certification MA State S115 License Number 01810 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority C 5/19/2015 lnsfpectbrs tignatureV 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 • 3113 Title 5 official Inspection Forth: Subsurface Sewage Disposal System - Page 1 of 17 6 Commonwealth of Massachusetts luTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owner's Name information is required for North Andover MA 01845 5/19/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System •Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 State Zip Code 5/19/2015 Date of Inspection ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Pege 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught111 Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 5/19/2015 State Zip Code Date of Inspection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System •Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner information is Owner's Name required for North Andover MA 01845 5/19/2015 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owner's Name information is required for North Andover MA 01845 5/19/2015 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 550 t5ins • 3/13 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 889 Johnson Street Property Address John MacNaught 111 Owner Owner's Name information is required for North Andover MA 01845 5/19/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner's Name North Andover MA 01845 5/19/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: Date Pumped 2014, owner 1500 gallons Measured tank Inspect tank & tees ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner's Name North Andover MA 01845 5/19/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 10 years old 6/10/2005, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast iron through wall, 3" PVC in house, No leaks visible Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: Z concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 2° ❑ Yes ❑ No t5ins • 3113 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System •Page 9 of 17 Commonwealth of Massachusetts Title 5 official .Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owner's Name information is required for North Andover MA 01845 5/19/2015 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 31" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Inlet cover has riser 8" deep. Outlet tee ok. Outlet cover has riser to grade. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 3113 1 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owner's Name information is required for North Andover MA 01845 5/19/2015 everypage. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: Alarm present: Alarm level: Date of last pumping: gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner's Name North Andover MA 01845 City/Town State Zip Code D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 5/19/2015 Date of Inspection 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. No evidence of leakage. No 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.): Pump tank cover has riser to grade. Alarm has both audible & visual. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: -3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owner's Name information is required for North Andover MA 01845 5/19/2015 every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: 1; leaching pits number: ® leaching chambers number: 35 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil Ok. Vegetation ok. No sign of ponding to surface. 7 rows of 5 chambers per row Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth, of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow t5ins • 3/13 ❑ Yes ❑ No Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner owner's Name information is required for North Andover MA 01845 5/19/2015 every page. Cityrrown 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.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owneft-Name. North Andover MA 01845 5/19/2015 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 3 S 17- 3 �3a►q cr t► a-'3 4 ( a 3= 4S1 D,P_x7,,_=37 t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts .1 a U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owners Name information is required for North Andover MA 01845 5/19/2015 every page. Cityrrown -State,.—._., Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 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: 6/10/2004 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 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage swag Disposal poral System •Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 889 Johnson Street Property Address John MacNaught 111 Owner Owners Name- information on is required North Andover MA 01845 5/19/2015 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 - 3113 Tice 5 Official Inspection Form Subsurface Sewage. Oispogal,System • Page 17 of 17 :f\ VVIIIIIIVIIVMM1L11I VI IVIi%**i2 11U*C111 9 U1 Citj /Town of . System Pumping Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be'used, but the information, must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted.to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/ Right front of house, Left/ Right rear of house/ righ side of house Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under ec c Address o �c Cityrro" State Zip Code 2. System Owner. -------------- c Address (d different from location) City/rown ' . Telephone Number B. Ppmping 1. Date of Pumping 3. Type -of system: ❑ ❑ Other (describe): Cesspool(s) — 2. Quantity Pumped eptic Tank Gallons y ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Y" D -bo If yes, was it cleaned? ❑ Yes ❑ No '5. Conditio of stem: 6: System Pumped By.- Nell. y: Neil. Bateson Name ` Bateson Enterprises Inc Company 7. Lo where contents were disposed: Lowell Waste M F5821 Vehicle License Number Date t5formCdoo- 06/03 System Pumping Record • Page 1 of 1 Summary Record Card generated on 5/11/2015 9:40:30 AM by Maureen McAuley Town of North Andover Tax Map # 210-107.A-0157-0000.0 Parcel Id 17982 889 JOHNSON STREET JOHN MCNAUGHT 889 JOHNSON STREET NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.03 Acres FY 2015 UB Mailina Index Name/Address JOHN MCNAUGHT 889 JOHNSON STREET NORTH ANDOVER, MA 01845 MCCUE, JOSEPH 889 JOHNSON STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 14293.0 - 889 JOHNSON STREET 2100288 02 Cycle 02 UB Services Maint. Account No. 2100288 Type Loan Number Owner Previous Customer Active/Inact. From Inactive 2/8/2005 Occupant Name Active/Inactive Last Billing Date 3/5/2015 Active Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 125.57 /1 UB Meter Maintenance Account No. 2100288 Serial No Status Location Brand Type 29821548 aActive ERT HH b Badger w Water Date Reading Code Consumption Posted Date 5/5/2015 1289 a Actual 27 2/3/2015 1262 a Actual 29 3/20/2015 11/3/2014 1233 aActual 28 12/15/2014 8/4/2014 1205 aActual 29 9/11/2014 5/7/2014 1176 a Actual 28 6/12/2014 2/4/2014 1148 a Actual 28 3/17/2014 10/31/2013 1120 aActual 28 12/20/2013 8/2/2013 1092 a Actual 32 9/18/2013 5/1/2013 1060 aActual 23 6/18/2013 2/5%2013 1037 a Actual 30 3/13/2013 10/31/2012 1007 aActual 26 12/13/2012 8/3/2012 981 a Actual 38 9/26/2012 5/3/2012 943 a Actual 24 6/20/2012 2/2/2012 919 a Actual 29 3/14/2012 11/1/2011 890 aActual 26 12/15/2011 8/2/2011 864 a Actual 32 9/14/2011 5/4/2011 832 a Actual 28 6/13/2011 2/7/2011 804 a Actual 29 3/15/2011 11/1/2010 775 aActual 31 12/13/2010 8/3/2010 744 a Actual 37 9/13/2010 5/4/2010 707 a Actual 30 6/9/2010 2/2/2010 677 aActual 28 3/11/2010 11/2/2009 649 aActual 32 12/11/2009 8/5/2009 617 aActual 46 9/11/2009 5/4/2009 571 a Actual 32 6/16/2009 2/5/2009 539 a Actual 33 3/16/2009 Size 0.63 0.63 Until YTD Cons 830 Variance -6% 2% -6% 7% 4% -6% -10% 27% -13% 6% -29% 57% -15% 9% -20% 9% 10% -14% -15% 23% 8% -15% -27% 36% 1% 8%