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HomeMy WebLinkAboutMiscellaneous - 91 JOHNNY CAKE STREET 4/30/2018t5formCdoc- 06/03 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED AUG 2 1 Z012 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 q figh�ign Left / Right rear of house, Left / right side of house, Left / Right side of building, Left ilding, Left / Right rear of building, Under deck Address City/Town 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): Statebe - � r 3s'p Code Telephone Number 1 Date 2. Quantity Pumped: Cesspool(s) Septic Tank l�S Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition qf System:� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio��ere contents were disposed: G.L AS. Lowell Waste Water a F5821 Vehicle License Number Date System Pumping Record • Page 1 of 1 t5form4.doc- 06/03 Commonwealth of Massachusetts CitylTown of RECEIVED System Pumping RecordF Form 4 OCT 2 0 2009 DEP has provided this form for use by local Boards of Health. Ot isofor 11rr�tay�b-edu�s�d�,�buti!the information must be. substantially the same as that provided her 4666TI�h9fom1; gipck with your local Board of Health tQ determine the form they use. The System Pumping Recor mus bZs submitted to the local Board of Health or -other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of ho , Right front o�iiotls , Left rear of house, Right rear of house. Left rear of building. Right rear of bul Address Citylrown State Zip Code 2. System Owner: Name Address (if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 1 . Date of Pumping . Quanti Pum - - � - Date Quantity ped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): - - - 4. Effluent Tee Filter present? ❑ Yes d'No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: _ X10 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio ere contents were disposed.- L.S.D. isposed:L.S.D Lowell Waste Water Signature of Hauler F5821 - Vehicle Lioense Number Date System Pumping Record . Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _Q Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other f inforitation must be substantially the same as that provided here. Bef local Board of Health to determine the form they use. The System Pu the local Board of Health or other approving authority. A. Facility Information RECEIVED ns may be usedhthe e usl. �tti9f ,,check your ging Record must be ed to TOWN OF NOTH A PAR-FSENT" HEALTH Dom. 1. System tion: (J� Address \—n r U 14-\(\(� City/Town 2. System Owner. Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Otter (describe): State IN Tip Code Stat�,,� 8 �� t Zip Code Telephone Number l ��/�� 7 -3 c --RFs Date 2. Quantit PPumped. Cesspool(s) eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [-I�lo if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: +� V\—ezkt1 E�XLaj vt 6. System Pu "I �By: Name Company 7. Locatio ere contents re disposed: %� -S - Z7- P-SFYC"'� Vehicle License Number -7 -31-SG- Date t5fonn4.doc• 06103 System Pumping Record • Page 1 of 1 1\ Important: When filling out fon-ns on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts City/Town of I !ti=- :; System Pumping Record Form 4 APR 2 3 2007 DEP has provided this form Sy�rY for use by local Boards of Health. The �tRPu'ffip4$er lhgC�bd ' ust be submitted to the local Board of Health or other approving authorilty HEALTH DE PAF, �VIBN A. Facility Information 1. System Location: c Jo V\ - f )- Cityrrown ( f State 2. System Owner: v v�JGf'� Name -- Address (if different from location) Z Zip Code City/Town'' Stat Zip Cade Telephone Number B. Pumping Record -07 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of.system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): — 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. ConditionSystem: � 6-jiA o_R�� (A 4-1:55LA 6. Syst m Pumped By Name �� Vehicle License Number Compan -- 7. Location re contents di ed: V Signatur of au r Date http://www.mass.ggv/dep/water/approvals/t5forms.htm#inspect t5fonn4.doc• 06/03 System:Pumping Record • Pagel of 1 �^ 1 TOWN OF NORTH ANDOW,;�_� SYSTEM PUMPING R1,,C 01&""'I;�. r N� _J DATE: SYSTEM OWNER & ADDRESS - --r SYSTEM LOCA710N (saniple: left front of h0u5c) leis�c & n 91 oXnfi DATE OF I'(i11iPCNG.�� UANTITY PUINUED ! V GALLONS CESSPOOL; NO � XES S£PTi:C '1ANK: NO / YES NATURE OF S.E RV10E: ROUTINF v EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE i1AiFTLl.S IN PLACC ROOTS LEACtiF11.LD RUNBACK _ EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) ?UPv1I'EJ iii': �( Z/V /V INA &Z COMMENTS: CONTENTS TRANSFEILRED 'l I' BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: TULy I Z Zo©Z CURRENT INSTALLER'S LICENSE# /EI -Z LOCATION: 9 f0 Hhty/ CaXE POAV LICENSED INSTALLER: ON J V LL1v*'1 SIGNATURE: ELEPHONE#4 179, Y0 ( 3 CHECK ONE: REPAIR: NEW CONSTRUCTION: (—, (JaA IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT 160.00 Fee Attached? Project Manager Ob. Foundation As -Built? Floor Plans? Administrative Use Only Yes �! No Yes No Yes No Yes f No Approval - u Date: 7 I�`5 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 1 �ou��y�x r`bYQ� relative to the application of �O�ll�l SVuly ted ,1ULI 12 2 002 for plans by M�EreRl>and U� dated S 10/0 Z with revisions dated N A 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 ohlihation. Undersigned Li Date: 7/1 Z Lo � Disposal WorWConstruction Permit 4 To: Sandra Starr, North Andover Board of Health Agent From: John (Jack) Sullivan III — Licensed Septic Installer Date: July 12, 2002 Subject: Application for D. W. C.P. — 91 Johnnycake Road Septic System Upgrade Sandy; Enclosed are the following for your review: 1) Completed Application for Disposal Works Construction Permit 2) Completed Installer Project Management Obligations form 3) A check for $160.00 payable to the Town of North Andover The most recent sewage disposal plan that my client provided me was prepared by Merrimack Engineering Services, dated 5/10/02. Please let me know if this is the most recent approved plan. Thanks. Jack Sullivan Town of North Andover, Massachusetts Form No. 3 Of,NOpTh BOARD OF HEALTH p ♦' aaaw��a ......DISPOSAL WORKS CONSTRUCTION PERMIT S�CMUSE Applicant AME DDRE55TELEPHONE Site Location A Permission is hereby granted to Construct ( ) or Repair ( Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. % Fee CHAIR N, BOARD OF HEALTH D.W.C. No. TD'vVN OF NORTH SEPTIC PLAN SUBMITTAL FORM Mpy 1 7 2002 LOCATION: C V—E 5 F y NEW PLANS: S $160.00/Plan� REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: S NO DATE: DESIGN ENGINEER: M Ei21t,1 �.le6C� E1�6Gt1ll�l 5 _!//Gi DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. N MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS LVI 1 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555,373-5721 • FAX (978) 475-1448 • E-MAIL: merreng@aol.com June 17, 2002 Ms. Sandra Starr Public Health Director Community Development Division 27 Charles Street North Andover, MA 01845 RE: 91 Johnny Cake Road Dear Ms. Starr: We are in receipt of the letter from Noonan & McDowell, Inc. dated June 10, 2002 regarding review of the subsurface disposal system plan for the above referenced site. We have revised the plan to address item 3-7 of the letter. 'With regards to item #1, no water table adjustment is required as the area above T-1 is obviously mounded as a result of fill placed at the time of original construction and it would be inaccurate to assume a higher water table in this situation. `With regards to item #2, this statement is required for sites within the watershed district which this site is not. Lastly, with regards to item #8 the reviewer has misread the plan, both the profile and end section shown 10 in. of crushed stone (6 -in. beneath and 4 -in. to the top of the 4" pipe) throughout the system. We have enclosed three (3) copies of the revised plan along with the submittal form and a $60 fee. We would appreciate your review and approval of this plan as quickly as possible as our client is anxious to begin construction on the proposed addition. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, 'Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm@netway.com Date 7 O 2 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/ 7 7 —,9/ STOffaLvyc.gk� ,-c o Assessors Map )0 711-, Lot/82 Dear Members of the Board, Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated byi,, -yc . E - It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health "By -Laws" if the following is addressed: I— �/b Z s �✓ r�/` ..-i z so �'4 �d s Sr 7- i41,- G-- c 0 6W f / f T& /`!,- Respectf)u 7? 1-- 7"' / �i✓L �—T % S 3 'r E S%/ lJ L �% � C? fid-`L�GtJ 4G✓ G PU% GST T�—� /¢ /�! %3�Goa✓ �c�w L �-�. Ei l��Tit' S/1c�tiGJ� John L. Noonan, P.L.S.-P. 2 E 77�.� / Z �N �1�—S 0 F G:office forms/tonarev ��"�/� ZZ- 7tl 7z71G)9 "37)/ v �- � �� r.. re��7 w i 7719� w U P Land S rveyors Civil Engineers Environmental Planners 1 -T ���c s�Q ��� vQ �o � P� � v�� � . �a�z �� LAIC - p c/ �� ��� �� � �zsv � �� O� citc�S/�`�� S T��e' J3�-�cnry. PGra ��L E s �-.�- :� � / Q � �/ o •� «v s � � S T72Q�v �� NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: mm@conversent.net June 10, 2002 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/077 91 Johnny Cake Road Assessors Map 107A, Lot 183 Dear Members of the Board, JUN 1 4 2002 1 j. Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated: May 10, 2002, by: Merrimack Engineering Services. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health "By -Laws" if the following is addressed: 1) Water table is not adjusted for highest grade. It appears the ESHWT should be 177.0. 220(4)(n) ) No statement regarding surface water supplies within 400 -ft and public wells within 250 -ft. 220(4) ✓3) Add a note regarding removal of existing leaching system. 5,r'D9TA11 A) Septic tank inlet is 3 in below outlet�nlet tee should extend 10 -in below flow line and outlet tee 14 -in below flow line. Both should be no more than 12 -in off inside face of septic tank. 227(5), 227(6) v 5) Ends of leaching lines to be interconnected. 4fst�Provfde-a-detail-indicating-this. NA 15.01 v6) Provide spot grade to ensure 2% grade over leaching system. 240(l 0) 7) Side slopes do not provide 15 -ft horizontal distance for break-out compliance. 8) Leaching field elevations indicate a 6 -in thickness of crushed stone beneath end of lines. Profile states 10 -in of crushed stone. Respectfully, John L. Noonan, P.L.S.-P.E. R/Oflice/boh/ l 770077.doc Land Surveyors Post -V brand fax transmittal memo 7671 # of pages ► % To ,:51dvLFrom L5RN a y S Co. Co.�y Dept. Phone # 6g$� /J y6 Fax Fax # /_ /T rayoc. Civil Engineers Environmental Planners AP f CHECKLIST FOR NORTH ANDOVER N & M Job 1770/ SEPTIC SYSTEM PLANS The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: 1`711U 4,11 L i10'A4-,-� Name of Designer: Plan Date: >0 47'z,Revision Date: Date of Review: Property Address: Map: / 0 74� Lot: '3 BOH Reviewer: t/ Z— Arx-/o0Type of Plan (new or grade): Number of Bedrooms in Assessor's Records: gpd) Garbage Disposal Allowed: General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5 OK P oblem N/A Street number and map/lot - 220(4)(u) Maximum scale of 1 "=40' for plot plan - 220(4) Maximum scale of 1 "=20' for profile and component details - 220(4) Legal boundaries of the facility being served - 220(4)(a) 1 Names of abutters from recent tax map - NA 8.02j Number of bedrooms, design calcs., - NA 8.02i f Name & address of record owner & applicant - NA 8.02k Name & address of designer - NA 8.021 Holder and location of all easements - 220(4)(b) Date plan drawn & any revision date - NA 8.02m All dwellings and buildings, existing and proposed - 220(4)(c) Location of all existing or proposed impervious areas - 220(4)(d) All distances on site plan — NA 8.03a -c Elevation of proposed driveway - NA 8.02t Location and elevation of foundation drain - NA 8.02y Location and dimensions of the system incl. reserve (new const.) - 220(4)(e) U Limits of excavation of leach area on site plan - NA 8.02z Locus plan - 220(4)(t) (Not to scale) North arrow - 220(4)(g) Existing and proposed contours - 220(4)(g) J P/ s=— Locations and logs of deep holes - 220(4)(h) 54W Locations and logs of percolation tests - 220(4)(i) Date(s) of "soil testing - 220(4)(h) & (i) v, Existing grade elevation of each deep hole - 220(4)(h) Elevation of percolation tests — N.A. 8.02n Name of approving authority representative - 220(4)(h) & (i) Name of soil evaluator - 220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n) Complete profile of the system to scale - 220(4)(o), NA 8.02c Cross section of leaching facility - NA 8.02w (Not to scale) Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) c/- Note listing all variance requests with proper citations - 220(4)(p) Local upgrade approval request form submitted - 403(1) - Original R.S./P.E. stamp, signature & date - 220(1) & (2) If P.E., discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies (Win 400'), pub. wells (w/in 250'), pvt. wells (w/in 150' 22 0(4)( !�— Location of watercourses, wetlands, wells, etc. Win 150' of system — NA 8.02r Wetland disclaimer — NA 8.02s RLS plan reference & certification required (prop line setbacks) - 220(3) Use approvals / standards checked for I/A system - DEP docs., Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3) Perc rate > 60 MPI - must use modified tight tank or I/A technology - 245(4) Proposed system qualifies as "shared" system - 002 (definitions) Flow is over 2,000 gpd - No R.S. allowed - 220(1) Design flow was set in accordance with code - 203 �— Existing system location and note on proper abandonment - 354 Leaching facility at least 1' above Base Flood elevation – NA 9.05 4G All piping Sch 40 minimum – NA 10.01 Basement floor minimum 1' above groundwater elevation – NA 5.04 —�� Foundation drain present with elevation – NA 8.02y On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests – NA 8.02n Soil evaluation forms submitted within 60 days of field work - 018(2) Proper percolation test log - 220(4)(i) Ample deep observation holes in primary disposal area (minimum 2) - 102(2) Ample deep observation holes in secondary disposal area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) Deep hole testing conducted within two years – NA 7.05 ground elevation el. acceptable soil el. Leach facilitv invert el. ground water el. refusal el. bottom of leach facility el. thickness of acceptable soil before & after soil R&R separation to groundwater separation to refusal soil class perc rate loading rate septic tank below g.w. table pump tank below g.w. table I.f in fill Hole Identification Numbers: - 41 V Setback Distances (Given in feet) 15.21 1 (yes or no) (yes or no) -255(l) YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02 OK Problem N/A Property line Cellar wall Septic Tank Leach Facility 10 10 10 20 ti 2 2 w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) _4 Pipe diameter listed (4" minimum) - 222(1) e-- Pipe schedule listed - 222(3) Pipe cast iron or Sch 40 PVC — NA 11.02 Watertight joints specified - 222(3) & (4) Pipe laid on compact, fin base - 222(5) �® Pipe laid on continuous grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) c� Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) 10' offset to private well or suction line - 222(2) M 3 Inground pool 10 20 Slab foundation 10 10 Deck, on footings, etc. 5 10 Waterline 10 10 Private drinking well 75 100 C Irrigation well 75 100 Wetlands 75 100 Public well 400 400 r--4-rt Wetlands bordering surface . 150 150 water Supply or trib. (in Watershed) Trib. To Surface Water supply 325 325 ��— Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains (wat. supply/trib.) 50 100 Drains (intercept g.w.) 25 50 Foundation drains 10 20 Drains (Other) 5 10 Drywells 20 25 Downhill slope 15' to 3:1 slope w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) _4 Pipe diameter listed (4" minimum) - 222(1) e-- Pipe schedule listed - 222(3) Pipe cast iron or Sch 40 PVC — NA 11.02 Watertight joints specified - 222(3) & (4) Pipe laid on compact, fin base - 222(5) �® Pipe laid on continuous grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) c� Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) 10' offset to private well or suction line - 222(2) M 3 Septic Tank OK Problem i/ 7 N/A Tank is accessible - 228(3) No structures above tank – (228(3) Tank can accommodate both primary & reserve – NA 9.04 200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a) 2-3" drop from inlet to outlet - 227(5) Minimum of 4' liquid depth - 223(2) 3"air space above tees/baffles (minimum) - 227(4) 9"air space above flow line (minimum) - 227(4) Tees are not to be replaced by baffles - 227(1) Tees extend 6" above flow line - 227(1) Inlet tee extends 10" below flow line (minimum) - 227(6) Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6) Gas baffle installed on outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compart) 228(2) 3-20" manholes - 228(2) 1 childproof, 24" riser/manhole w/in 6" of final grade if <1000gpd- 228(2) Inlet and outlet tees on center line - 227(1) Soil compaction below tank specified (if soil is non-native) - 221(2) 6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(1) If > 1,000 gpd AND not a single fam.`dwell. must be 2 tks or 2 comp. - 223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c) Buoyancy calcs. required if tank at or below water table - 221(8) Tank is watertight - 221 (1) 9" of cover over tank (minimum) - 228(1) H- 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) All ,pumping to tank (if applies) in accordance with - 229 Tank is set to keep old system in service during install if possible Distribution BOX (Check here if not present: OK Problem N/A Inlet elevation: Outlet elevation: 0.17' drop from inlet to outlet (minimum) - 232(3)(b) 6" sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) Outlet pipes laid level for first 2 ft. - 232(3)(c) Pipe Sch 40 - NA 10.01 Number of outlets: Number of laterals: Size of outlets: Inlet baffle/tee min. 1" over outlet invert for all d -boxes - 232(3)(a), Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of stone beneath distribution box specified - 221(2) Box is watertight - 221 (1) "�— Top of box <=36" below grade - 221(7) Buoyancy calculations required if box is at or below water table - 221(8) Pump Chamber (Check here if not present: ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off ele i� i �220(4)�(rAl elevation: ,_ mber of cycles per day - (r) (also 254(1)(d) if gravity from d -box) Minimum 2" deliv a to d -box if gravity - 254(1)( c) 4 4 46 Pressure dosed l.f. if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a) Cycles per day is consistent with chamber volume - 23 1 Volume calculations include flowback volume - 2') 1(2) 24hour storage capacity above urfip on elevation - 231(2) Number of pumps: 2 if system serves >2 dwelling units - 231(6) Capacity of pump(s) - gpm @ ' TDH - 220(4)(r) Pump can pass 1 "solids (minimum) - 231(7) Pump control pecified - 220(4)(r) Alarm eq ' ment specified - 231(2) Alarm ' in building and powered on separat cuit from pump - 2') 1(9) P sequence correct (off -lead on -la -alan-n on) - 231(8) ump performance curves includ - 220(4)(r) Manual operating switch - N 2.01 Check valve, bleeder ho - NA 12.01 1 childproof, 24" ris manhole to final grade - 2'31(5), Soil compactio eneath pump chamber specified (if soil ' on -native) - 221 6"of <=3/4" ne beneath chmbr. specified - 221(2) 8(1), Buoyanc calculations if chamber is at orbelow ater table - 221 9" o over over chamber (minimum) - 22 0 loading (min.) - H-20 if traffic 6(')), Chamber is watertight - 22 Top of chamber <=36" below grade - 221(7); Leaching Facility (general - complete for all designs) /Y Problem N/A 50% larger if garbage disposal - 240(4) �^ Trenches to be used whenever possible - 240(6) No vehicle or imperv. area above 11 unless unavoidable - 240(7); NA 13.02 Vented if under impervious cover - 241 (1) �'- Vented through same pipes as distribution system - 241 (1)(a) Vent protected from precipitation/animal entry - 241 (1)(b) �- Vent is placed beyond traffic or impervious area - 24 1 (1)(c) All lines connected to vent if bed or trenches - 241(1)(d) 9" cover over peastone - 240(9) Reserve area provided (new construction) - 248(1) Reserve 4' from primary leach area — NA 9.04 4'(5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b) 4' (down to T with variance or I/A - upgrades only) of natural soil under 11. t-2'* GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 - 251(9) Require 5' removal and replacement if in fill - 255(5) 1C Top of leach facility <= 36" below grade - 221(7) Final grade over 11. minimum 0.02 ft/ft -240(10) Surface & subsurface drainage away from 11. - 240(1 1) & 245(5) Minimum design flow 440 gpd without deed restriction — NA 13.01 3:1 slope where grading required - 255(2) Toe of fill slope stops 5' from property line or swale installed - 255(2) •*�' Impermeable barrier if < 3:1 slope or < 15 feet to—3:1slope - 255(2) -- Impermeable barrier/retaining wall poured concrete — NA 9.02 Retaining wall stamped by P.E. - 255(2)(b) Top of retaining wall >= top of peastone elevation - 255(2)(f) 1L 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) ✓ Perc test(s) done in most restrictive layer - 104(2) Perc test 4' below leaching elevation — NA 7.06 Design -flow listed and required/provided leach area given - 220(4)(f) s� Leach pipes SCH40 PVC — NA 10.01 Leach pipes minimum 4" diameter except for dosed system — NA 14.04 Leach lines capped, vented, or connected together - 251(9) — Pressure dosing guidance followed if pressure distribution - 254(2)(c ), �1 Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1) Leaching Trenches (Check her_ pot present: ) OK Problem Number enches: Mi ' um of 2 trenches - NA 9.01(2) epth of trenches (max eff. 2'): -247(l) Width of trenches (2' min., 4' max.): - 251 (1)(b) Length of trenches (100' max.): - 25 1 (1)(a) Trenches are vented (when > 50') - (11) Trenches follow contour lines - 1(2) Trench spacing 3 times a tive width or depth minimum- 251 (1)(d) In fill or reserve bet n trenches, 10' min. - NA 14.01& 14.03 Available leac ea given (Min. 500 s.f.) - NA 9.01(2) Botto = L x W x#. ewall=L x x# x2= E ctive leach area given Loading factor: Effective area = total area s.f. x LTAR = Effective area is >= desi flow of facility being served 2"of 1/8"- 1/2" x�hed peastone.- 247(2) Trench de of 3/4" to 1 1/2" double washed stone - 247(1) Leach Fields (Check here if not present: ) OK Problem N/A a� L�- ei� y� Q� Final Grading OK Problem N/A 5/24/01 s.f. s. f. g/day Number of fields: (need dosing chamber if > 1, 231 (1)) Length (100' max.): - 252 (2)(b) Width: Total area: L x W = s. f. Minimum 900 square feet - NA 9.01(1) _. Distribution lines connected with solid pipe — NA 15.01 Effective leach area given Loading factor: Effective area = total area s.f x LTAR = g/dav Effective area is >= design flow of facility being served Minimum of two distribution lines - 252(2)(a) 6' line separation (max.) - 252(2)(d) 4' maximum separation from edge of field to line - 252(2)(e) 10' minimum separation between adjacent leach fields - 252(2)(f) Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2) 2"of 1/8"-1/2" 2x washed peastone.- 247(2) Slope over leach area minimum of 0.02 feet/foot — 240(10) Grading shall divert drainage away from leach area — 240(l 1) Grading slopes away from dwelling f:/office/forms/tonackltr.doc 6 t Project Request Record Town of North Andover Date: Client Id: ToNA Card Id: ToNA Client/Company N e: Board of Health r Card Tvne-Chent. i'BG/ Q 7 Applicant %tlX6# T7Z /fQtti XontactiName Ms: Sandi•a.Starr.. Phone: 978=688-9540%:'' ' ' I:,..'. r Title: Director Fax: . .".••. ,. 978588=9542': &ess:: 27;Charles Street. Email: sstarr@townofnorthandover:com '. ; .1,1"j�-71,1 �i Notes: North•Andover , G ti,,l�lr, 'State MA Zip Code 01'845'•'l; i11: ..1, they; applicable '. contacts if ie ineer nstaller. �e ?a-�►. pp �;l`, `r' ";��;/�lr r ' f c e� L�z�.wF- Phon�e� rrTttle: Fax: Address: Email: 1, Notes: r ,jllr I' ' Town: "'':State: Zip Code:. Project: Project Id: 1770 (JOB NO) Manager: NOW Billing Group: Project Title: Town of North Andover, Board of Health (PROJECT NAME & STREET ADDRESS) Billing Cod - Fixed Fee Contract Info .Proiect Description for each- billing group i'BG/ Q 7 Applicant %tlX6# T7Z /fQtti �'Assessors;Map %a% Lot / Qi % Street % r -s ' Type of service oe P 4- � r,; r Officelforms/j brqutona TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Starr Public Health Director Bill Dufresne Merrimack Engineering Services, Inc. 66 Park Street Andover, MA 01810 Re: Septic Plan Approval — 91 Johnnycake St. Dear Mr. Dufresne: Telephone (978) 688-9540 FAX (978) 688-9542 This letter comes as notification that the proposed septic system plans dated 6/17/2002 for the upgrade of the system to 550 gpd flow at 91 Johnnycake Street, North Andover have been approved. Accompanying this letter is a completed Design Approval Form # 1187. No variances have been either requested or granted for this site. Please do not hesitate to call me at 978-688-9540 should you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: Owner File I SEPTIC PLAN SUBMITTAL FORM LOCATION: `11 co�F�,a�;' C'AY-C NEW PLANS: YES REVISED PLANS: C9 SITE EVALUATION FORMS INCLUDED: DATE: &` /Qi --07- DESIGN ENGINEER: DATE TO CONSULTANT: $160.00/Plan $ YES When the submission is all in place, route to the Health Secretary. TOWN OF NORTH ANDOVER/ BOARD OF HEALTH JUN '18 2002 r I N & M -Job number 1770/ TOWN OF NORTH ANDOVER INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Site: 9) I O I ��Il�lljlC�JK� Installer: JQC,G Date A. Bottom of Bed 1. Excavation to proper depth 2. With trenches, sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments: (Use back of sheet for diagrams.) B. Retaining Wall _ 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10' to leaching facility 4. Wall meets specifications of plan Comments: Final Date: Tel: Yes No Initials C. Building Sewer I. Pipe diameter minimum 4" v 2. Schedule 40 pipe 3. Inlet to tank cemented 4. Slope minimum 0.01 or 1/8" per foot minimum 5. Pipe properly set on compact firm base 6. Pipe laid on continuous grade in straight line 7. Cleanouts precede all change in alignment and grade 8. Manholes at any 90° change 9. 10' minimum offset to water line Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to w/in 6" of grade 5. Manholes over center and each tee 6. 3-20" manholes 7. Outlet line cemented 8. 2" — 3" drop from inlet to outlet 9. Pipe set L/ 10. Compact base with 6" of 3/4" crushed stone under tank S/ 11. Tank is watertight 12. Tees 12" off side of tank • N & M Job number 1770/ Comments: E. Pump Chamber Date I . If separate from tank, compact base with 6" of V stone underneath 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box Yes No Initials 1. D -box level 2. Minimum 0.17" (2") drop from inlet to outlet 3. Minimum 6" sump ✓/ 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box Z� 6. Box is watertight 7. All lines cemented with hydraulic cement t, 8. Schedule 40 pipe 9. First 2' from box laid level Comments: G. Soil Absorption system 1. All stone double -washed — V — 1 %z" r/ - pea stone Bucket test done? 2. Minimum 2" of pea stone above distribution lines - 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together 5. Toe of slope stops minimum 5' from edge of property;_ 5a. if not, then swale. Comments: N & M Job number 1770/ Date Yes H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agrees with plan. (Max. length 100') 3. Width of trenches agrees with plan — Minimum 2'; maximum — 4'. 4. Vent present if>50 feet or specified 5. Minimum distance between trenches 10' 6. Pipe slope minimum 0.005 or 6" per 100' 7. Depth of trenches below outlet invert minimum of 6". 8. Pipes set on stable base. Comments: I. Leach Field L Maximum length of field 100' / 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipes 6' maximum 4. Pipes connected at end & vent end raised 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines Comments: J. Leaching Pits I. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement 6. Comments K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 6. Grading meets 3:1 slope 7. Minimum of 9" of fill graded over system No Initials Town of North Andover, Massachusetts Form No. 1 pORTH BOARD OF HEALTH 2Ory,,,ED 16 %0 S� L /� � �<0Q: �+� p APPLICATION FOR SITE TESTING/INSPECTION 9SSACHUSE� Applicant NAME 1 ADDRESS Jd�/��vca&• TELEPHONE Site Location Engineer3-/'/�/ '0>0 T/ i:s/?�2 Test/Inspection Date and Time f7'.f7t'// /% a.ODa le"'3d c� CHAIRMAN, BOARD OF HEALTH Fee_?" Test No. %OJ S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No._`A� NOW .f BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 5-&-O MAP & PARCEL LOCATION OF SOIL TESTS: ,.I o 1J1J`i'CA" f U% OWNER: 1'j&M0 TEL. NO.:— ADDRESS: Q�J�,.S`T ]�• ENGINEER: H Vi?.41 WA�,i TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Is This: Repair Testing: (�Ie ay Home Commercial Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No 11-� THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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 $200.00 per lot for repairs or gpgLades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Date Received: Check Amount: Wj Iz- STRUCTURE LOCATION PLAN CLIENT. 00,-'-'W UM OLS. P� THIS CEIfiFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: '11 NI-�`�G�,r P.o. SCALE: I "- (0,0' DATE: 2.12.--07- COUNTY .IZ-DZ COUNTY LAND SURVEYS, INCia . Pmfeplonllyd&rvw wa'POBorsm GhweAw,, MA olml-"-WO282~ Gua"o" ' I CERTIFY THAT THE PRIAURY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICA17ON DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS, WETLANDS, EASEMENTS, ORDERS OF CONDITIONS, ETC.) THIS DRAWING SHALL NOT BE USED BY THE 'CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE, EXCEPT WITH THE WRITTEN PERMISSION OF COUNTY LAND SURVEYS INC. COUNTY LAND SURVEYS INC. TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFORMATION CONTAINED HEREON. I Location: l.i `( Owner's Name: El I la 1 J I W 1.4p wAay Map/Parcel: IO2A Address: I �O�i1.I1J`�C �j�•r' Installer. Tel ar: New lstsol Repair ✓ N. H nNTA' e Date: + HOZ. Wetlands%jfPVZone II •—" Soil Symbol59 Soil 1Qame jC 11'4+?tg Soil Class G Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil Color Soil Mottling % Gravel, Stones, etc 'r'1 0-�tt•t' P1 w _ ----- F ilt- I ve - �� r 4W �SYIG°� 10�U1y�,� Parent Material Al U- Depth to Bedrock• Standing Nater in the Hole: Weeping from Pit Face ESHGtiY:-0L A Kz/Z goo/,,( �, w kbJ i �1�1*'✓.t,� )�' (,�J•10�1 G '�i :L . Z.. SY syr rli v�- fru 40, Comm Patent Material L Depth to Bedrock:— Standing Water in the Hak- Weeping from Pit Face, (P? ESHGIV: Date Percolation Tests Observation Hole'r Deptl Start Time Time Time Time Rate Performed By: Witnessed By. ij .aa.s rr be as-.rt�l.iT+r } �l"�'�?'"L�k �+��i R'ii`�[i`�,A� � 'r, �. t+- .fr Y 1 } u- :'� � H � j _ :..,.. �. .� aSl�d���w � ry. err r ,e.`Sf ....,, �+. �; � i!!� s ... bt,. �,+.� 5. j .r �T �7 �I tI''. ~ � �Ct� .� ,a y�t4 y � `( 1 ' II r t f.{ .S: > �4�' '�, �_k'�:� J_. }t :1'r'r2�a",.*a �rj 3.:,. � r Y���.y �y� n� !, ly;t� w tri � T��:i � I ` i�n^ Y � � r Y �1vL't, r ar S;, .. r t � � i;- I • y � �� � .. .. . 1„'�; v 'V. t' y it;A . (� ♦wt. '.'` - O — A. — — .. _ �� 1 i I � /.. � . L 1111 �:� �� a ;, J ' .: 1�1 .4 �� �- ' ..I � lL' •�' . .. 11 1 111 '� � � �}: ,� 1 1 i °. , ;�. 1 �^ � � $r r 1 7 � �. •� ,�' � � .� +`�' '� Ili �,� �� � _ -�: ,.` �, roti �fi'� � �}{ ' � 1¢r �� �r • � ��� •:�:;.., s � .�;�. ;r , ,� �.�,� .¢. t . +. , , �.� �* .. t � � � !t,.. • ' �'�r rF'i � ` � as � �:`.z � Ma .. JQkI Q QY64 1!�C Owner's Name: -cel: I b7A Address: Tel 4:fj f ��' � i New (Siso)Repair ✓ 1-4• M VWT�' L Date: HOZ Wetlands7_LWZone II Soil Svmbol�Soil Rame jC11ru,0 r't Soil Class G_ Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Tenure Soil Color Soil Mottling % Gravel, Stones, etc: ri we F,5 L 10Y 110/G HArs i\jar-Fiz-b4 Parent Material Al LL Depth to Bedrock � Standin: Water in the Hole. weeping from Pit Facq_g:�:B$$G%V; !03„ -r- Z / _46 V t w ._. ..._ (,d•ll7`1 G 'y :L . 2.. SY 5/4 7�tf A`t�XiEitL, • Parent Material L Depth to Bedrock: -: Standin: Nater in the Hole- Wee pin: from Pit Face k , ESR GM L Date Observation Hole R Deptl Start Time Time Time Time Rate . Percolation Tests Performed Bv: Witnessed Bv­ qt L'T1 �f T• 'X •. tJ. �' � T'�_ ,. .. J! 'Tiled► - ._ k:..Y �.._ iY:+ ... i �x • .ti a u T, . w �Y h� r�rr t �i `ice t ti'•!r•. i a •oYm 0 0 e .A . w �Y h� r�rr t �i `ice t ti'•!r•. A FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT HlLbad .�) I ( 4 � PHONE LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) STREETq1 ST. NUMBER OFFICIAL USE ONLY'*' RECOMMDATIONS OF TOWN AGENTS: _ CONSERVATION ADMINISTRAT DATE APPROVED '7_ 25 _ q6 DATE- REJECTED COMMENTS ,(A)t`f —6,n d S C) " 1,4 ft , A),U10 - TOWN PLANNER r COMMENTS FOOD INSPE R -HI �lS•Ep�'(C I ECTOR-I COMMENTS DATE APPROVED DATE REJFCTED- UA I t AIJPKUVtU DATE REJECTED L p%I G RG.lGV I GU PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE r° �o14tiNy C AKF LoTg 44/ o4-,,,) S. F y 3 v, 7' f�rr� 374 (i n! 1 1TN tT EYA I 10N� Ai HOUSE FOUNMT1o,lq T� 172 Y3 �lK o UTLET'I sr -Box OU !lZT ST,3ox 1hILEi .. ��a•� FN . .e.. �.•� ryG� .:Y.'r�"���c.,�i=�dlVi`a :rC+CI:Y��f XNVG SJMAYS HOWShc :01 031=118-90 leej 08 = yOUf t ,37b0S L 66 t-8Z-P0=O3?�b'd3�ld "+wos /-uns ugisas (n) *661 133HIS 3)IVO kNNNHOr h6 _04Yt1 '3'S -NOtOtt � Avotse �. E809 -*d38 NV7d VYV 'HI3/IOONd HI&ON -31VIS `A-L/O LL/8L0k -'12 30/0330 133M1S 3)ivoANNHO!' l6 NOI1bO07 O&VMOH 'd 77N' 9 M 73b'HO1W .LNdOl7ddb' Xd3 9i9i-ztZ(LI9) Nlvw £I£I-Zt�Z(Li9) 6ZiZO VW 'UMOIS211LMD OZZ XO$ 'O'd Nvrld N k()I.LaadSN l a9wu L2IOLII ..-._ ,. - .. .. r_., nn.. me ^t•,1 s.n TT 'i - Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director February 22, 2002 Mr. and Mrs. Michael Howard 91 Johnnycake Street North Andover, MA 01845 Re: Application for an addition to an existing home Dear Mr. and Mrs. Michael Howard: Telephone (978) 688-9540 Fax (978) 688-9542 Your application for an addition at 91 Johnnycake Street has been reviewed by the Health Department. The application was denied on February 22, 2002 for the following reasons: 1. X Missing information 2. X Passing Title 5 inspection of septic system may be required 3. Location of structure not acceptable To address the problem(s): If #1 is checked, please supply: a. Floor plan of the existing dwelling and the proposed addition; b. Certified plot plan showing house, septic system and proposed project in scale, including any associate grading. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Department at 978-688-9540 with any questions you may have. Sincerely, pan . LaGrasse, Health Inspector Cc: Gerard Welch Inc., P.O.Box 248, North Andover, MA 01845 Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Town of North Andover Office of the Health Department o? •'�' ��' Community Development and Services Division i szo-0 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director February 22, 2002 Mr. and Mrs. Michael Howard 91 Johnnycake Street North Andover, MA 01845 Re: Application for an addition to an existing home Dear Mr. and Mrs. Michael Howard: Telephone (978) 688-9540 Fax(978)688-9542 Your application for an addition at 91 Johnnycake Street has been reviewed by the Health Department. The application was denied on February 22, 2002 for the following reasons: 1. X Missing information 2. X Passing Title 5 inspection of septic system may be required 3. Location of structure not acceptable To address the problem(s): If #1 is checked, please supply: a. Floor plan of the e3dstine dwelling and the proposed addition; b. Certified plot plan showing house, septic system and proposed project in scale, including any associate grading. If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project Please feel free to call the Health Department at 978-688-9540 with any questions you may have. Since ly, ri . LaGrasse, Health Inspector Cc: Gerard Welch Inc., P.O.Box 248, North Andover, MA 01845 -----+Building Department File BOARD 017 APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director July 12, 2002 Mr. & Mrs. Michael Howard 91 Johnnycake Street Re. Building Permit Application Telephone (978) 688-9540 Fax (978) 688-9542 Dear Mr. & Mrs. Michael Howard, Your application for an addition on 91 Johnnycake has been again reviewed by the Health Department. To date, our office has not received a floor plan of the existing house, although we do have a proposed addition. Before the Health Department can sign off on your application we must verify either through a walk through inspection or by floor plans, the number and layout of the existing rooms. Please either call the Health Department and schedule a time for a walk through inspection or submit existing condition floor plans. (Please note that existing layout plans do not have to be scaled nor drawn by an architect.) Should you have questions please call me at 978-688-9540 Monday through Friday between 8:30 AM and 4:30 PM. Sincerely, Sandy Starr, R.S., C.H.O Health Director CC: G. Welch Building File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 FORM U - LOT RELEASE Y EASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits fro' Boards and Departments having jurisdiction have been obtained. This does not retie n the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT_���jQi4le(O VY -w+ I N C_ PHONE 79 - 79 y LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET �'Yl /U /C /CE 57 ST. 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