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Miscellaneous - 901 JOHNSON STREET 4/30/2018 (2)
I � �i11L1►1�, t I all Some� T M A �N �o D > • T Z i m Z. z 0 i M G C z c c M w M o O CA .� z z� Y m go v+ u 4� a I k �� 1 NN Summary Record Card generated on 9/22/2015 9:32:24 AM by Maureen McAuley Town of North Andover Tax Map # 210-107.A-0156-0000.0 Parcel Id 17981 901 JOHNSON STREET PAUL & RENATA ANDERSEN 901 JOHNSON STREET NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.32 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/inact. From Until PAUL & RENATAANDERSEN Owner 901 JOHNSON STREET NORTH ANDOVER, MA 01845 ELEANOR TURKE Previous Customer Inactive 5/23/2008 901 JOHNSON STREET NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14294.0 - 901 JOHNSON STREET Last Billing Date 9/4/2015 2100289 02 Cycle 02 Active UB Services Maint. Account No. 2100289 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 53.20 /1 UB Meter Maintenance Account No. 2100289 Serial No Status Location Brand Type Size YTD Cons 13242592 a Active ERT HH METE METE w Water 0.63 0.63 422 Date Reading Code Consumption Posted Date Variance 8/5/2015 773 a Actual 14 9/14/2015 15% 5/5/2015 759 a Actual 12 6/22/2015 -7% 2/3/2015 747 a Actual 13 3/20/2015 -14% 11/3/2014 734 aActual 15 12/15/2014 5% 8/4/2014 719 a Actual 14 9/11/2014 11% 5/7/2014 705 aActual 13 6/12/2014 4% 2/4/2014 692 aActual 13 3/17/2014 -36% 10/31/2013 679 aActual 19 12/20/2013 15% 8/2/2013 660 a Actual 17 9/18/2013 20% 5/1/2013 643 aActual 13 6/18/2013 6% 2/5/2013 630 a Actual 14 3/13/2013 -11% 10/31/2012 616 a Actual 13 12/13/2012 3% 8/3/2012 603 a Actual 13 9/26/2012 -20% 5/3/2012 590 a Actual . 16 6/20/2012 2% 2/2/2012 574 a Actual 16 3/14/2012 12% 11/1/2011 558 aActual 14 12/15/2011 7% 8/2/2011 544 a Actual 13 9/14/2011 24% 5/4/2011 531 a Actual 10 6/13/2011 -12% 2/7/2011 521 a Actual 13 3/15/2011 -20% 11/1/2010 508 aActual 15 12/13/2010 -24% 8/3/2010 493 a Actual 20 9/13/2010 54% 5/4/2010 473 a Actual 13 6/9/2010 1% 2/2/2010 460 aActual 13 3/11/2010 -45% 11/2/2009 447 aActual 23 12/11/2009 100% 8/5/2009 424 aActual 12 9/11/2009 -13% 5/4/2009 412 a Actual 13 6/16/2009 -15% 2/5/2009 399 a Actual 16 3/16/2009 -23% 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Johnson Street Property Address Paul Andersen Owner's Name North Andover City/Town Ma 01845 State Zip Code 9/24/2015 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information RECENED 1. Inspector: OCT 21 20154 Dean Dynan TOWN OF NORTH ANDOVER Name of Inspector KAM ARTM€NT Company Name 2 Suntaug Street Company Address Lynnfield City/Town 508-726-9935 Ma State S112837 Telephone Number License Number B. Certification 01940 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 anspectorr's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Johnson Street Property Address Paul Andersen Owner's Name North Andover Ma 01845 9/24/2015 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 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: 4 bedroom single family dwelling with infiltrator drainfield in working order Tank was pumped this year Zabel filter in tank outlet 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 901 Johnson Street Property Address Paul Andersen Owner's Name North Andover City/Town B. Certification (cont.) Ma n1RdF JLdW LIN I,Uut: 9/24/2015 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 distribution box is leveled or replaced ❑ Y ❑ Y ❑ Y ❑ N ❑ N ❑ N ❑ ❑ ❑ ND (Explain below): ND (Explain below): 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 • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Johnson Street Property Address Paul Andersen Owner Owner's Name information is required for North Andover Ma 01845 9/24/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 901 Johnson Street Property Address Paul Andersen Owner Owner's Name information is required for North Andover Ma 01845 9/24/2015 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. 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 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Johnson Street Property Address Paul Andersen Owner's Name North Andover City/Town C. Checklist Ma 01845 State Zip Code 9/24/2015 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): A 440 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 901 Johnson Street Property Address Paul Andersen Owner Owner's Name information is required for North Andover Ma 01845 9/24/2015 every page. City/Town State Zip Code Date of Inspection D. System Information Description: 4 bedroom sinqle familv dwelli Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: ❑ Yes ® No occupied Date 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 Number of current residents: 4 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 ears usage 9 ( Y 9 (gpd))� 135 GPD AVE Detail: see attached Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: ❑ Yes ® No occupied Date 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 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 901 Johnson Street Property Address Paul Andersen Owner information is required for every page. Owner's Name North Andover City/Town D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Ma 01845 9/24/2015 State Zip Code Date of Inspection General Information Date Source of information: Homeowner / Board of Health System was pumped this year Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: How was quantity pumped determined? Reason for pumping: gallons Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 901 Johnson Street Property Address Paul Andersen Owner information is required for every page. Owner's Name North Andover Ma 01845 9/24/2015 City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 2007 / as per plan on file Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: 1411 feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): buildinq sewer in qood condition no evidence of leakaqe Septic Tank (locate on site plan): Depth below grade: 15"feet Material of construction: ❑ Yes ® No ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) 1500 concrete tank in good condition with cast iron cover to grade 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 68" Sludge depth: 2"_4° ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts N d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 901 Johnson Street Owner information is required for every page. t5ins • 3113 Property Address Paul Andersen Owner's Name North Andover City/Town D. System Information (cont.) 9/24/2015 State Zip Code Date of Inspection Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 30" 0-2" 611 14" How were dimensions determined? infield with measure stick and tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 gallon concrete septic tank with PVC inlet and out T / Tank in working order with separation from inlet to outlet / no evidence of leakeage recommend pumping every two to four years depending on usage and number of occupant Tank has media filter that needs service see attached Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Johnson Street Property Address Paul Andersen Owner Owner's Name information is required for North Andover Ma 01845 9/24/2015 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 wo Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 901 Johnson Street Property Address Paul Andersen Owner's Name North Andover Ma 01845 9/24/2015 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" above invert 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.): 16" X 16" concrete D box level with four outlet pipes / little evidence of solids carryover / no evidence of leakage into or out of box D box in working order / good condition D Box is 6" below grade D Box has 2" diffuser T 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.): 1000 gallon pump chamber with cast iron cover to grade Pump chamber is 15" from grade in good condition * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 901 Johnson Street Property Address Paul Andersen Owner Owner's Name information is required for every page. t5ins • 3/13 North Andover City/Town Ma State 01845 9/24/2015 Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields 1 20'X40' 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.): drainfield found in lawn area / soils in good condition / no signs of hydraulic failure / no ponding/ no damp soil/ Drain field is constucted of quick four infiltrators in working order see plan on file Mound system with vent Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts N r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 901 Johnson Street Property Address Paul Andersen Owner information is required for every page. Owner's Name North Andover Ma 01845 9/24/2015 City/Town 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 Form: Subsurface Sewage Disposal System • Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 901 Johnson Street Property Address Paul Andersen Owner Owner's Name information is required for North Andover Ma 01845 9/24/2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ® drawing attached separately t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 901 Johnson Street Property Address Paul Andersen Owner information is required for every page. Owner's Name North Andover Ma 01845 9/24/2015 CityTrown 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: 68" + as per plan on file feet Please indicate all methods used to determine the high ground water elevation: // Obtained from system design plans on record If h kddt f 1 ' 1 d' 2007 c V%.,e, a e o esign p an reviewe . Date Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: soil data as per plans on file dated 2007 System is forced main mound Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM ..... 901 Johnson Street Property Address Paul Andersen Owner information is required for every page. Owner's Name North Andover Ma 01845 9/24/2015 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 - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 OTE; Ties P6A.- # Gtr f19-►aA-r` S; 15 �QT A IJj►64^417Y Of 14E 1i,40e7UeAeG9 "IF 097TSH , ZT ► s A EE cots or., -04g &OHrOWtrJ rV, r r� r pnE. ems ��' •1 � � AS BUI LT KLAN OF SUBSURFAC. a1SPOSA SYSTEMA LOCATED IN Nd¢ rel .o, U Dov Etz, AS PREPARED FOR ELG"a.F.1o2 Tusk..& DATE: 0-iq-v"*i SCALE: I "= 4 p ,:!*-I' MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS be PARK STREET 0 ANDOVER. MASSACHUSETTS 01110 TEL (617) 47S -35S5, 3MSMl v_ 4t1•av fed �O\ O ,. L `T Q 9_ c««KMw1t« •nM� � �/ _ 7• PUBLIC HEALTH DEPARTMENT (ommunity Development Division CE127I(jFICArrE OF' C09YPLIA9V(E As of: November 19, 2007 llhis is to certify that the ind viduaCsu6surface d4osal system received a S,4T1S FACT0RT IYS(PEC2 0Y of the - Complete Septic System Wgpair/12epincement By: 7ocfdBateson .At: 901 loFinson Street map 107,9; ('arcef1 56 .North-3ndover, 914A 01845 r1he Issuance of this cert f Cate shaCC not 6e construed as a guarantee that the system wiCC function satisfactorily. Susan T Sawyer it6Cic 9feaCth (Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com • s + KORYM r rt °peri° .�f 45 +SSRCHIlS�i PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION IIrG=((DF:NORTH ANDOVER i4f ALTH DEPARTMENT The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (repaired; By '1C) C?17-7�TI' '�;-o 10 (Print Name) Located Address) Was ijnsiaiied in conformance with the North Andover Board of Health approved plan, originally dated C—O'? and last revised on 6 — t Ir, --r51-7 , with a design flow of 6.11 c 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 Healthl Bottom of Bed Inspection Date:' J And — Print Name Final Construction Inspection Date: -a 7 And — Print Name Enginer: OF ' VLADIMIR L. ' NEMCHENOK A9o.c 9F��STV0���� NSS/0NAL ExG� (Signature) Engineer Representativere) Engineer Representative (Signature) Date: Q 01- � — 07 mac% dt PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 901 Johnson Street MAP: 107A LOT: 156 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering Services PLAN DATE: April 10, 2007 BOH APPROVAL DATE ON PLAN: INSPECTIONS OuIr TANK INSPECTION: DATE OF BED BOTTOM IN PECTION: DATE OF FINAL CONSTRUCTION INSPECTION: August 30, 2007 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ` Existing septic tank properly abandoned Internal plumbing all to one building sewer Topography not appreciably altered ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com O41�10RTF� $ -to �6'9ti0 O O M PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® 24" 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: One (1) compartment, Monolithic PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ® 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ® Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Hydromatic pump DISTRIBUTION -BOX Comments: ❑ 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) 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com � tT�:� esu"ry0 - A PUBLIC HEALTH DEPARTMENT Community Development Division SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil ® layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber Infiltrator Quick 4 Stnd ® Number of chambers per row 10 ® Number of rows (trenches) 4 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan Comments: CONTROL PANEL Comments: ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside ® Alarm signal located inside 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com INVERT IN FIELD PLAN INVERT ELEV. Benchmark 104.25 Building Sewer OUT 97.72 97.80 Septic Tank IN 97.60 97.50 Septic Tank OUT 97.27 97.25 Pump Chamber IN 97.16 97.20 Pump Chamber OUT 97.39 N/A Pressure Distribution Box IN 98.35 N/A Pressure Distribution Box OUT 98.21 98.20 Lateral 1 INV 98.17 98.17 Lateral 1 TOP Lateral 2 INV 98.18 98.17 Lateral 2 TOP Lateral 3 INV 98.17 98.17 Lateral 3 TOP Lateral 4 INV 98.18 98.17 Lateral 4 TOP Bed Bottom at 4" Port 97.47 97.50 Top of Chmbr #4 Mid 98.54 98.50 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com O ti�eo ,6• -yo O f� NIC IWK• PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fox 978.688.8476 Web www.townofnorthandover.com Tank SAS Sewer ❑ Property line 10 10 -- ® Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other) Foundation 10 (5) 20 (10) ❑ Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fox 978.688.8476 Web www.townofnorthandover.com 1 � •�°RTM , Commonwealth of Massachusetts Map -Block -Lot ° 107.A- 0156 - - to Board of Health Permit No 3 0 :•+ �� °� • • BHP -2007-0235 North Andover ______________--_____ P.I. FEE �ssAtwustt F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd Bateson ---------------------------------------- -------------------------------------------------- i to (Repair) an Individual Sewage Disposal System. at No 901 JOHNSON STREET ------------------------------------------------------------------------------------ as shown on the application for Disposal Works Construction Permit No. BHP -20077023 Dated July 05, 2007 F Issued On: Jul -05-2007 Board o Health °1 "�;' ;�, Commonwealth of Massachusetts Board of Health North Andover •°••�•�� Certificate of Compliance ,ssACMUStt THIS IS TO CERTIFY, That the Individual Sewage Disposal System (Repair) by Todd Bateson Installer Map -Block -Lot 107.A- 0156 - at No 901 JOHNSON STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No.BHP-2007-023 Dated July 052 2007 ------------------ --------------------- ------------------------------ --- Printed On: Jul -05-2007 Board of Health ------------------------------------------ --------- ---------- ----- A Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab re!mn M Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* Er Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component A. Facility Information _ Address or Lot # TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component City/Town -, V_C. )1'%A 2. -TYPE OF SEPTIC SYSTEM*: ®'Pump ❑ Gravity (choose one) *** If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information / .,/C A Name Address (if different from above) --- o — - City/Town 3. Installer Information State 17 7 r Telephone Number e/5�-f� Zip Code Name -- -- — Nc���'��, kiiilC. 111 Araiila -Rom Address Andover, MA 01810 City/Town 4. Designer Information Name Address City/Town State Zip Code -' Telephone Number (Cell Phone # ifpossible please) Name of Company f PA I State Zip Code -- 4115- 3 5S5 -fix f -- Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 Application for Septic Disposal System o' �H y Construction Permit - TOWN OF TODAY'S DATE , MA 01845 $ 250.00 -Full Repair ORTH ANDOVER $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building:esid ential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, agg not to place the system in operation until a Certificate of Compliance has been issued b Board of Health. � —,;- 9—.0 `) Name Date By: (Board of Health Representative) Date `Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? 2. Project Manager Obligation Form Attached? Yes Yes_ 3. Pump System? If so, Attach copgy of Electrical Permit Yes_ 4. Foundation As -Built? (new construction ronly): (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes_ Yes_ No No No No rE Application for Disposal System Construction Permit • Page 2 of 2 c Yes_ Yes_ No No No No rE Application for Disposal System Construction Permit • Page 2 of 2 f SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer f_o/r the construction for the septic system for the property at: 7 (address of septic system) For plans byr ��� �'� f• iyct o c.� Relative to the application of 1�r4 �-��/✓ (Installer's name) Dated r� — J? —d o ay s ate (Engineer) And dated LI -1 d -- O 17 ngma ate With revisions dated (Last revised date) 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 manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first`(1') inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept(2townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Heahb 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: �a (Today's Date) A7 QSt�e✓ (Name —Print) (Name —Signed) F 7,F"'EIVED J . JUL 0 2 2007 vmcku vst: only Permit Na 1... :. ". � �v �onsnionaavalw V X45SXeMS577S i7*40--t 4 5100 Occupancy & Fee Checked OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 ,RTH AI`.100 'FTCIr ATION FOR PERMIT TO PERFORM ELECTRICAL WORK _ ,C-PARTMEN91 to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1200 (Please Print in ink or type all information) Date To the inspector of Wires: Town of North Andover The undersigned applies for a permit to perforin the electrical work described below. Location (Street & Number Owner or Tenant I� .� ru`� �e'iy Owner's Address Is this permit in conjunction with a building perrnit Yes ❑ No 14-- (Check Appropriate Boot) Purpose of Buikfi Utility Authorization No. E)dsting Service Amps vols Overhead ❑ New Service Amps Vats Overhead ❑ .�- --�. .-�-,; •-,���..:--rte �..-_-..�-"'",�'.`m"' . Total No. of Transformers KVA Generators KVA Undgmd ❑ No. of Meters Undgmd ❑ No. of Meters Date ..... 7 - ..?-�........0 7 ~� c 00- _0 TOWN OF NORTH ANDOVER iL p PERMIT FOR WIRING certifies that Tl��.�!9-G.....� l 'flus ce u has permission to perform ....... � ................. .: % /s'%........................ °�y!i k wiring in the building of ........:............... ........................................................ E l ,%G2!.'`!/�� North Andover, Mass. ................ s ...,. ELL 1 INSPECTOR i Check # 7497 No. of Emergency Lighting FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Sounding Devices NoJ of Self Contained Detection/Sounding Devices ❑ Municipal ❑ other Low NO = overage by checking the appropriate box Date) Work to Startinspection Date Resgpested Rough Final Signed undera Penal of perjury: FIRM NAME Intl t'T c S �.a� u L '-i r UC. NO. UC.No. 29r% ►� 4 vi Bus. Tel No. -7-i! % - !J,:z g:— Orar Address Alt z OWNER'S INSURANCE WAIVER: I am aware that the Lice es does not have -the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No. PERMrrTEE 5 (Signature of Owner or Agent) f VtORTH q d tti6D Is.6OO O b fA � a �_ COCMCrgMKK _ q' SAC PUBLIC HEALTH DEPARTMENT Community Development Division June 26, 2007 Eleanor Turke 901 Johnson Street North Andover, MA 01845 RE: Septic System Design, 901 Johnson Street, North Andover, Map 107A, Lot 156 Dear Ms Turke, 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 Merrimack Engineering Services, dated April 10, 2007, last revised June 12, 2007. This plan has been approved. As this is a replacement septic system, this plan is valid for two years from the date of this approval. The design has been approval for use in the construction of a replacement onsite septic system for a 4 -bedroom house (maximum 9 -room). During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. 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. 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 or imply compliance with any of the aforementioned requirement. 3. The plan calls for a tee filter to be provided for the outlet of the septic tank. The Installer must provide the name and model number of the filter to the Health Department prior to issuance of the Disposal Works Construction Permit, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 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 may have. Sincerely', JSusan Y. Sawr, ZV Public Health Director Encl: list of licensed septic system installers Cc: Merrimack Engineering Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Th y tt1.a.. ,�a•-ryO\ Q41? � q_ cOc.wCMww.w . 7' epi PUBLIC HEALTH DEPARTMENT Community Development Division June 12, 2007 Mr. Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Proposed Wastewater System Upgrade Design 901 Johnson Street, Map 107A Lot 156 Dear Mr. Nemchenok: The proposed wastewater treatment and dispersal system design plan for the above referenced site dated April 10, 2007 and received in this office on April 23, 2007 has been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval, with the section of Title 5 (310 CMR 15.000) or North Andover Regulations (NA) noted: 1. Please indicate the required placement of magnetic marking tape or comparable means around the on-site wastewater system (310 CMR 15.221(12)) 2. Please indicate the names of abutters from the most recent Assessor's map (NA 8.02) 3. You have not chosen to use trenches. Please do so or provide a plausible explanation as to why they cannot be utilized within the note section. (3 10 CMR 15.240(6)) Trenches are to be used as the soil absorption system mechanism where possible. 4. Please clarify and provide buoyancy calculations for both tanks used for this design (310 CMR 15.221) Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain an onsite wastewater system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere san Y. Sawyer, REH blic Health Director cc: Eleanor Turke 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET • ANDOVER, MA 01810 • (978)475-3555,373-5721 • FAX (978) 475-1448 • E-MAILlnfo@merrimackengineedng.com June 21, 2007 Susan Sawyer Public Health Director 1600 Osgood Street Bldg 20, Suite 2-36 North Andover, MA 01845 Re: 901 Johnson Street Dear Ms. Sawyer: JUN 2 5 2007 T`00;,\�NORTH ANDOVER HEALTH DEPARTMENT We are in receipt of your review letter for the above referenced site. Enclosed please find 3 copies of the revised plans. We have addressed items 1-4 of your letter and respectfully request the plan be approved as re -submitted. Sincerely, MERRIMACK ENGINEERING SERVICES, INC. William Dufresne, Project Manager Cc: Eleanor Turke v �iLac 16'•NO\ , A of `' O G♦PKC J OCMtM MKK 9' PUBLIC HEALTH DEPARTMENT Community Development Division June 12, 2007 Mr. Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Proposed Wastewater System Upgrade Design 901 Johnson Street, Map 107A Lot 156 Dear Mr. Nemchenok: The proposed wastewater treatment and dispersal system design plan for the above referenced site dated April 10, 2007 and received in this office on April 23, 2007 has been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval, with the section of Title 5 (310 CMR 15.000) or North Andover Regulations (NA) noted: 1. Please indicate the required placement of magnetic marking tape or comparable means around the on-site wastewater system (310 CMR 15.221(12)) 2. Please indicate the names of abutters from the most recent Assessor's map (NA 8.02) 3. You have not chosen to use trenches. Please do so or provide a plausible explanation as to why they cannot be utilized within the note section. (3 10 CMR 15.240(6)) Trenches are to be used as the soil absorption system mechanism where possible. 4. Please clarify and provide buoyancy calculations for both tanks used for this design (3 10 CMR 15.221) Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain an onsite wastewater system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerel san Y. Sawyer, EHS/R Public Health Director cc: Eleanor Turke 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com . - TOWN OF NORTH ANDOVER Office of COMMUNITYDEVELOPMENT AND SERVICES t4 '�0 0 A HEALTH DEPARTMENT a_ 1600 OSGOOD STREET•' BUILDING 20; SUITE 2-36 ry�in4 NORTH ANDOVER, MASSACHUSETTS 01845 9ssaC USE�< Susan V. Sawyer, RENS/RS 978.688.9540 — Phone978.688.8476— FAX Public Health Director E-MAIL: health dept@townofnorthandover.corn WEBSITE: http://www.townofnortliandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: 4'.- Site Location: 610 ( ,J. Oj 4 0 Gf©hJ "!7rW C-_ 0 1 - Engineer: P Li'LIy1 o^cAC, 60 6 j 0Ft?0,! fj6 New Plans? Yes ✓ $225/Plan Check # (includes 1" review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes V/ No Local Upgrade Form Included? 0A . Yes No omission and one a re-_ APR 2 3 2007 TOWN OF r,tOR , )VER QEF f� ,. , :YT Telephone #: (�.� )1"7 -3 � � Fax #:�`� 7✓� ti.2 �' `t E-mail: ki E �K,606 p A r' 12" Homeowner Name: CL::CAU L OFFICE USE ONLY When the submis 'on is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ `/ Copy File; Forward to Consultant ➢ t1/ Enter on Log Sheet and Database is s a �" k is 4f � t f IN 4 X11 INS s a �" k is 4f � t f IN 4 4 f . •�-..._ .. ni r ri� 7 Locution: J01 -r»d&) 4- 2L ,;, _ �'N maplPaMel:_ L Vit" 7• .j Address: Installer. Tel#:_ g2_: Ot New muL__pepdr Date: 4- 192 - Q Wd=dt_ I_ &neII _ Soil Symbol. W2 .Sotl Rhine fop Clan Deep Observation Hole Logs Marc Elm-Rdon Depth Son H�rimn Soil Tenure Sail Color SOD Mottling. % Gravcl, Stones eter Stat Pregasl< O Time at I2't Time at 9" , LVO Time at 6" Time (9"-6'�� Rate MMngnch fA t Z La1L,e¢�aln1�. 34,4 1+14 *7, r2yva -� ��' Gr•� �%�'�'°�o �, � :fir, • rook; ce Pacsat �iatedat . Depth! B�c�Shgdin= �itsr la the Hales A O � Weeptn� fiea� Ph F�cz � � � ��r�" Q `. �"� {� rt} 2 -51 a+./N/ V p b! Parsat MatetW Depth to 8 swan wswiR cia Rolcs,__iRtpin= ft= rk Faea-! SLm Wt� Marc Percolation Tests Observation Hole �' I Depth of Pere C Stat Pregasl< O Time at I2't Time at 9" , LVO Time at 6" Time (9"-6'�� Rate MMngnch fA t Performed B�� , '1'% (�% !, ; i,, _.,. Witnessed Bt^ ti x a /.7 -TOWN OF NORTH ANDOVER Nort'rH Office of COMMUNITY DEVELOPMENT AND SERVICES ob,r..� O M HEALTH[ DEPARTMENT A 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 "ss�C u Susan Y. Sawyer, REHS, RS Public Health Director APPLICATION FOR SOIL DATE: %j ''10 -- a, -7 LOCATION OF SOIL TESTS: RECEIVED 97.688.9540 - Phone 97 .688.8476 - FAX c-4� MAR 2 3 2007 he Ithde t(@.townofnortandover:com -- w w.townofhorthandov r.com of NORTH ANE)(�)VER MAR 2 "%2007 SLH. Tr - MAP & PARCEL: I e_7 'a / ` 5,/' _ OWNER: E L 5:A,&W9 TU Iz" Contact #: -70) 4,V-7 •-'% �!� APPLICANT:_ E L l; �(, I2� 1 �t4 IZ" Contact #:_� -j 70 7 ADDRESS: I J00 05100 C ENGINEER: -I 11'L—'1 R / h-)iFlr intact #: —7,0 q7 -5 -?z55;%5 CERTIFIED SOIL EVALUATOR: ni bL, I�} �►Z. �al�� Intended Use of Land: Residential Subdivision Sin i y H e Commercial Is This: Repair Testing: ydeUndeveloped 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 11"Plot elan & Location of Testine please indicate test nit sites on the pla,.n) ➢ 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 $369,00 per lot for repairs or uperades. 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"-1.00') 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: i Date back to Health Department: (stamp in): W�avq'k (V '40k - vkosr 6 k tDA- q Nha.-'. Scale: ••'' 'fin Date of Plan: / a • ,-,y`� MORTGAGE INSRRCTI®N CYR ENGINEERING SERVICES, INC. 234 ESSEX STREET LAWRENCE, MASSACHUSETTS MORTGAGOR: %r1,,, -XE ADDRESS OF PRINCIPLE BUILDING DEED REFERENCE: BK.! PG. 6ff_ PLAN REFERENCE: eca 37,67' DATE OF INSPECTION: A -ZB •?A1 NOTE: This Mortgage Inspection was prepared spe- cifically for mortgage purposes and is not to be refied upon as a survey. Cyr Engineering Services, Inc, accepts no responsibility for damages result- ing from said reliance by anyone other than the said mortgagee and Its assigns in connection with its proposed mortgage financing to said mortgagor. CERTIFICATION TO: A.C/Lb[1E? .S'r7ui[iGS aa,u! This Mortgage inspection was prepared in accordance with the Technical Standards for Mortgage Loan Inspections as adopted by the Massachusetts Associa- lion of Land Surveyors and Civil Engineers, Inc. I FURTHER STATE THAT IN MY PROFESSIONAL OPINION the principle structure/s and accessory outbuildings, G 12N7FG JK with the setback requirements of the local zoning or- dinances, and that there are no encroachments of major Improvements either way across property lines except as shown. ALSO: 01. Property is not In a Flood Hazard Area. ❑ 2. Property is in a Flood Hazard Area. O 3. Information is insufficient to determine Flood Hazard. Flood Hazard determined from latest Federal Flood Insurance Rale Map. TOWN OF )v " SYSTEM PU DATE: 61 `C)q SYSTEM OWNER & ADDRESS �f G RECORD RECEIVED SEP 14 2004 TOWN OF SYSTEM LOCATION' (ezample: left front of house) � v DATE OF PUMPING: `C QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE IL EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D \/ Lowell Waste DATE: — ' TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD ,W1 i,tf 1�'2 ccb l JC�1✓lSbt� '� I' (example: left front of house) ti DATE OF PUMPING: QUANTITY PUMPED_ GALLONS CESSPOOL: NO /YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: l 5 , L - S - h i TOWN OF SYSTEM PUMPING RECO DATE: tt� 3 SYSTEM OWNER & ADDRESS -J-b,c- �Ie qtj � T41) VAA-�-/-S4- DATE OF PUMPING: k�-33-e� SYSTEM LOCATION ED DEC 022005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT (example: left front of house) �f QUANTITY PUMPED : CESSPOOL: NO L---�YES SEPTIC TANK: NO _ NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER C� GALLONS FULL TO COVER YES E'R"11-/ BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D well Waste j M- �Stlev �6} ryO� d PUBLIC HEALTH DEPARTMENT Community Development Division June 26, 2007 Eleanor Turke 901 Johnson Street North Andover, MA 01845 RE: Septic System Design, 23 Forest Street, North Andover, Map 107A, Lot 156 Dear Mr. Bogosian, 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 New England Engineering Services, dated April 10, 2007, last revised June 16, 2007. This plan has been approved. This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of a replacement onsite septic system for a 4 -bedroom house (maximum 9 -room). During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dweiling 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. 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 or imply compliance with any of the aforementioned requirement. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 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 may have. Since , '! Susan Y. Sawyer, REHS/RS Public Health Director Encl; list of licensed septic system installers Cc: Merrimack Engineering Services -1 nuu usgood Street, North Andover, Massachusetts 01845 Rhone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of System Pumping Record ` Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4:1 rtm 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: State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date State Zip Code Telephone Number 2. Quantity Pumped: Gallons Cesspool(s) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Syst� �" 7z:W � V\4—::)� �C meed y JAV\ Na Vehicle License Number Company 7. Locati e e con nts disposed: Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1