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HomeMy WebLinkAboutMiscellaneous - 93 CRICKET LANE 4/30/2018North Andover, Board,of Assessors Public Access Page 1 of 1 4 v Kor+ry Tcxwn Of 14ort l AndkoVer Board of Assessors R SLE r 4 eNu g'� Property Return to the Home page click on logo Record Card Parcel ID: 210/107.A-0285-0000.0 Community: North Andover New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales PHOTO Location: 93 CRICKET LANE Owner Name: GUTHRIE, DOUGLAS GUTHRIE, ANNE Owner Address: 93 CRICKET LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.53 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 3144 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 711,000 741,700 Building Value: 482,200 500,900 Land Value: 228,800 240,800 Market Land Value: 228,800 Chapter Land Value: LATESTSALE Sale Price: 748,500 Sale Date: 08/21/2005 Arms Length Sale Code: Y -YES -VALID Grantor: CROWLEY, TIMOTHY Cert Doc: Book: 9718 Page: 163 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&LinkId=1181971 2/6/2008 CONDITIONS: Needed: rd Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: Is the installer licensed? NO Type of Construction: eES REPAIR New Construction . -:. Certified. Plot. Plan Review- NO Floor Plan Review NO =. Conditions of Approval feom Form U Y NO Issuance of DWC permit..YES : NO DWC Permit Paid?- _:, . YES ` - NO DWC Permit # =. Installer: 72) Begin Inspection: µ_ YES N0 Excavation Inspection: -.' Needed: rd Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: I 4 i • e r Lot & Street C'elG,re Z/9 Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: � S NO Permit f Z3 Plan Approval: Date: S Approved by:�z,,,, Designer: Sova „ Plan Date: Conditions: Water Supply - Well Permit Well Tests: own _ _ _ Well. -- - Driller: Bacteria I Bacteria II Plumbing' Sign -Off Comments: Date Approved, Date -Approved DateApproved Wiring.,` e Form "U' Approval: Approval to-Iss Date Issued /_a// 7 By: e: - `NO -� ^ Conditions: Final Approval: All Permits Paid? , YES NO Well Construction Approval? S NO Septic System Construction Approval? NO Certification?NO Other � NO Any Variance Needed? YES <:N�) FLNAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 owl J 2 2013 I o� „�. u,- ; ,COVE - 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 Righ ont of house eft / Right rear of house, Left / right side of house, Left / Right side of buil Ing, Left / Right front of building, Left / Right rear of building, Under deck Address /'� � �' � G�� � ,/ 1O •/`r�1 . Cityrrown l� C� State ,r V\ Zip Code 2. System Owner Name Address (if different from location) Citylrown Stat%� Zip1 de Telephone Number _ r B. Pumping Record c 1. Date of Pumping Date ;2. Quanti Pumped 3. Type of system- ❑ Cesspool(s) eptic Tank 4. ❑ Other (describe): Effluent Tee Filter present? es [3 No 5. Condi 'l of Sy tem: 0. System Pumped By: Neil Bateson Gallons ❑ Tight Tank If yes, was it cleaned? Yes ❑ No: VQDC �. Name Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: S. Lowell Waste Water 61 F5821 Vehicle License Number Date t5form4.doc• 06/03 1 System Pumping Record • Page 1 of 1 Commonwealth. of Massachusetts C.ity/Tvwn of 1 System Pumping Record Form 4 DEP has provided this form for use by local Boards�of Health.. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filing out 1. System Lopation, forms on the ta "-. 4— computer, use only the tab key Address / to move your (.-"Lv/�� dursor - do no use the em tut Cityrrown State Zip Code .key. 2_ System Owner. Name Address (if different from tocation) Cityfrown Sta e T Te hone Number B. Pumpin-g Record 1.. .Date. ofPum ping Date . Quantity Pumped: Gallons 3. Type of system: EJCesspooi(s) eptic Tank- ❑ Tight Tank. Q[ Other (describe): 4_ Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes E] No 5. Condition of.Systern, - 6. Syste Pt�mpel By Vehide i(L i ense Number Company 7. L-ocation ere rcontonts " are d - osed: _ Signatur of er - Date http:flwww.mass:gov/dep/wateriapprovaIS/t`5fotms.hbn inspect t OMA.doc- 06103 system t3ump Record • Page 1 of 1 TOWN OF L A vi Joycr SYSTEM PUMPING RECORD DATE: 10-30-03 SYSTEM OWNER & ADDRESS SYSTEM LOCATION C(-0 (example: left front of house). q3 C,I'C- DATE OF PUMPING: QuANTTTY PUMPED : _�d D e) GALLONS CESSPOOL: NO YESEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER. FULL TO COVER. BAFFLES IN PLACE LEACMULD RUNBACK FLOODED OTIiER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterpi iseS, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D ' / Lowell Waste TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: q-.3-0 'b z TEM OWNER & ADDRESS SYSTEM LOCATION ccow (example: left front of house) ct 3 Ot' C 4�. DATE OF PUMPING: - QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE I 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: r -s- - L ` J • � f PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 3/29/2013 This is to certify that the individual subsurface disposal system has been installed in accordance with the provisions of Title 5 of the State Environmental Code: Leaching Field Replacement By:Mike Reilly At: 93 Cricket Lane Map ]07A Lot 0285 North Andover, MA 01845 The Issu�ce of this ce / ificate shall not be construed as a guarantee that the system will function satisfactorily. S an Sawyer �. 'Public Health Agents "- _ �'� Y 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com t DelleChiaie, Pamela From: Isaac Rowe lirowe@millriverconsulting.com] Sent: Wednesday, July 11, 2012 5:53 PM To: DelleChiaie, Pamela; 'Daniel Ottenheimer'; 'Peters, Marianne'; 'Randy Burley' Cc: Sawyer, Susan Subject: RE: F.C. Inspection Request - 93 Cricket Lane, North Andover Attachments: 93 Cricket Lane - Construction Inspection 7-11-12.doc; IMG_1893.JPG; IMG_1899.JPG Susan, Attached is the inspection report and (2) photos for the above referenced property. The trenches and elevations are good but a couple issues with the D -box. 1. The 2" force main is leaking at the inlet to the D -box. The installer will re -seal with hydraulic cement. It appears the hydraulic cement just did not set properly. 2. Effluent flows through the seam where the cover meets the D -box when the pump is running. There is an inlet tee but due to the amount of pressure in the force main effluent is leaking out through the cover. I would recommend reviewing this with the designer. From a designer's point of view a couple of general recommendations are: a. Throttle back on the ball valve in the force main line inside the pump chamber to reduce the velocity. b. Install a 4" PVC section prior to the inlet of the D -box. I have recommended in many of Bill's plan but he never wants to do this. Let me know if you want to review these concerns. I told the installer it was ok to backfill the trenches but the D -box must remain open for re -inspection. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street S 666 l 13 6— j�ro74v C �. Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowea.millriverconsulting.com www.millriverconsulting.com From: DelleChiaie, Pamela Imailto:pdellech(abtownofnorthandover.coml Sent: Wednesday, July 11, 2012 11:15 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: F.C. Inspection Request - 93 Cricket Lane, North Andover Importance: High Hello, Per Bill Dufresne (10:30) and Mike Reilly (now) - 93 Cricket Lane, North Andover is ready for a Final Construction Inspection. Please call Mike Reilly - 978-375-4811 to schedule. Thank you-! --Pamela From: fpreil lya ndsons(abcomcast. net jmailto:fpreiIlya ndsons(a)comcast.netl Sent: Wednesday, June 20, 2012 11:57 AM To: DelleChiaie, Pamela Subject: 93 Cricket Lane Pam, Attached is the Project Obligation form for 93 Cricket Lane. Sorry I didn't bring it in.... Let me know if you get it. Thanks! Deb Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 93 Cricket Lane MAP: 107A LOT: 285 INSTALLER: Mike Reilly DESIGNER: Vladimir Nemchenok PLAN DATE: 4/25/11 BOH APPROVAL DATE ON PLAN: 9/28/11 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: j �- DATE OF FINAL CONSTRUCTION INSPEC ON: 7/11/12 DATE OF FINAL GRADE INSPECTION: �Q]IZ, SITE CONDITIONS N/A Contractor reports any changes to design plan N/A Existing septic tank properly abandoned N/A Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: EXISTING SEPTIC TANK ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port Comments: EXISTING PUMP CHAMBER ® Pump On/Off floats working ® 24" cover at final grade installed over pump access port Comments: The original pump was installed at the inlet side of the tank. The manhole cover is over the inlet of the tank. DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: 2" force main is leaking at the inlet of the D -box. Installer will reseal with hydraulic cement. Effluent flows through the seam of D -box when pump is turned on due to the amount of pressure in the force main. Consult with designer to resolve this issue. SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: BM = 193.20 HR= 3.52 HI = 196.72 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 3.52 193.20 Force Main 3.63 192.92 2" Distribution Box IN 3.00 193.55 193.53 4" Distribution Box OUT 3.00 193.37 193.36 Lateral 1 TOP 3.03 Lateral 1 INVERT 193.34 / 193.03 193.31 / 193.00 Lateral 2 TOP Lateral 2 INVERT 193.34 / 193.03 193.31 / 193.00 Lateral 3 TOP Lateral 3 INVERT 193.33 / 193.03 193.31 / 193.00 Bottom of Bed 191.03 191.00 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) z 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 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) z 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 a 11 El x P _ t F .t 4 �Ys� �- �� L � D �- P �- '� �, Z. o t Z ,, r �� �v� �� ��� zw µORTp x � x �,SSA�HUSES PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (constructed; ( ) repaired; By:_p I i F'7_4:;' Iae (Print Name) Located RECEIVED MAR 2 8 2013 TOWN OF NORTH ANDOVER -HEALTH'DEPARTMFNT Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on with a design flow of (V gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: --7;7—I2 And — Print Name Final Construction Inspection Date: f�i L.i, u ra__,% And — Print Name r - Installer:&, (Signature) Enginer: V'14,01g4l w,��ognature) Engineer Represents ive (Signature) i2.Z::244 Engineer Representative (S(ignature) Date: :��=177 And — Print Name Date: 7-/l-/.2 TALI .. /_ And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com 1. .WOM THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. IT IS A RECORD OF THE LOCATION AND ELEVATION OF THE EXISTING SYSTEM COMPONENTS. "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON ..THIS AS -BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. V WVZAZ Ne�W q4i4k0k, 0 /Z SIGNATURE OF DESIGNER DATE riga .0 V i.L i .- Lull OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./93 CRICKET DANE AS PREPARED FOR KEVIN & JEN FLUTH TM: 107A DATE: 7-18-12 TL: 285 SCALE: 1"=40' 0 20 40 80 �RIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 Map -Block -Lot Commonwealth of Massachusetts 107.AO285 ----------------------- BOARD OF HEALTH Perm it No North Andover -BHP-2012 - - - 06 - 75 ---- ----------- P.I. FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted -Mike Reilly --------------------------------------------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. at No 93 CRICKET LANE -------------------------------- ---------------------------------------- ----------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -201-2---067--- Dated— J-une-21-,-20-12 -------- ------------------------------------------------------------ Issued On: Jun -21-2012 BOARD OF HEALTH - ------------------------------------------ ------ ---------- r DelleChiaie, Pamela From: fpreillyandsons@comcast.net Sent: Wednesday, June 20, 2012 11:57 AM To: DelleChiaie, Pamela Subject: 93 Cricket Lane Attachments: 93 Cricket Lane.pdf Pam, Attached is the Project Obligation form for 93 Cricket Lane. --S n't bring it in.... Let me know if you get it. Thanks! Deb Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htta://www.sec.state.ma.us/ore/l)reidx.htm. Please consider the environment before printing this email. 1 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: q CrIC& (Address of septic sysrem) For plans by J(Engineer) Relative to the application of � r � J (Installer's name) And dated � / 01 OC.C� // �� � rigina atel Dated Z,2 Q ) L o ay s are) 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 Iealth 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: healthdept2townofnorthandover.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 shwple 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 Health staff or consultant. d. Installation of tang, 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 homeownerr, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) I P�(/Aaoame — PrintA-ffie_ — 5 gne At OR It 6127 0 1 own of North Andover HEALTH DEPARTMENT CHECK#: zrll) DATE- t" LOCATION: H/ 0 NAME: CONTRACTOR NAME: 4ft k -1 - Type of Permit or License: (Check box) 0 Animal $ 0 Body Art Establishment $ 0 Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type: $ 0 Funeral Directors $ 11 Massage Establishment $ 13 Massage Practice $ 11 Offal (Septic) Hauler $ 11 Recreational Camp $ 0 Sun tanning $ 0 Swimming Pool $ 0 Tobacco $ 11 TrashlSolid Waste Hauler $- 0 Well Construction $ SEP77C Systems: 0 Septic - Soil Testing $ 0 Septic - Design Approval "S tic Disposal Works Construction (DWC) 0 Septic Disposal Works Installers (DWI) $ 0 Title 5 Inspector $ 11 Title 5 Report $ 0 Other (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer s e Application for Septic Disposal System Construction Permit -TOWN OF ORTH Important: Application is hereby made for a permit to: When filling out forms on the ElConstruct a new on-site sewage disposal system* computer, use [Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component — What? cursor - do not use the return key. A. Facility Information >f-1 93 Cricket Lane W±_I Address or Lot # North Andover City/Town 06/11/12 TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component RECEIVED TOWN OF NORTH ANDOVER .-.. --- 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** 14 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 Kevin & Jen Fluth Name 93 Cricket Lane Address (if different from above) North Andover City/Town 3. Installer Information Michael W. Reilly Name 206 Andover Street #11 Address Andover Cityrrown 4. Designer Information Name 66 Park Street Address Andover City/Town MA State 978-665-3115 Telephone Number F. P. Reilly and Sons, Inc. Name of Company MA State (978) 375-4811 01845 Zip Code MA Zip Code Telephone Number (Cell Phone # if possible please) Merrimack Engineering Services Name of Company MA State 978-475-3555 01810 Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 V M°°TApplication for Septic Disposal System �AConstruction Permit -TOWN OF r ORTH ANDOVER. MA 01845 PAGE2OF2 A. Facility Information continued.... 5. Type of Building: 0■ Residential Dwelling or ❑Commercial B. Agreement 06/11/12 TODAY'S DATE $ 250.00 – Full Repair $125.00 - Component 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, and not to place the system in operation until a Certificate of Compliance has been js"9l by this Board of Health. Name ' \J Date Appli ion Approved Board of Health Representati e) SW Zt/Z //Application Date Application Disapprovedor the following reasons: For Office Use Only: 1. Fee Attached? 2. Project Manager Obligation Form Attached? 3. Pump System? If so, Attach copy of Electrical Permit 4. Foundation As -Built? (new construction ronly): (Same scale as approved plan) 5. Floor Plans? (new construction only): Yesv/ Yes Yes_ Yes— Yes— PAGE 2 OF 2 es_Yes_ �S No No t'7— e—v G J, Application for Disposal System Construction Permit • Page 2 of 2 01 RT 612 8 Town of North Andover HEALTH DEPARTMENT S s CHU CHECK#: ,PATE: PAN 140LANVAI Type of Permit or License: (Check box) $- 11 Animal $ 11 Body Art Establishment $- 0 Body Art Practitioner $ 0 Dumpster $ 11 Food Service - Type. $ El Funera I Directors $ 0 Massage Establishment $ C1 Massage Practice $ 11 Offal (Septic) Hauler $ 11 Recreational Camp $ 0 Sun tanning $- 0 Swimming Pool $ 0 Tobacco $- 0 TrashlSolid Waste Hauler $ 0 Well Construction $ SEP77C Sustems: 0 Septic - Soil Testing $- 0 Septic - Design Approval $ 0 Septic Disposal Works Construction (DWQ 0 Septic Disposal Works Installers (DM) 0 Title 5 Inspector 11 Title 5 Report ee UK--O'ther (Indicate) ��i . .. ... C - Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER NORTH AN -DOVER, MASSACHUSETTS 01845 Permit Number Date Issued Expiration Date F-�R�ECE�IVEB 'UN ZU12 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Jackie's Law — Permit Application Pursuant to G.L. e. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant F. P. Reilly and Sons, Inc. Phone Cell Street Address 206 Andover Street #11 978-475-1237 Cityrrown MA I ZIP Andover 01810 Name of Excavator (if different from applicant) Phone Cell Street Address City/Town MA ZIP Name of Owner(s) of Property Phone Cell Kevin & Jen Fluth Street Address 93 Cricket Lane 978-655-3115 City/Town MA ZIP North Andover 01845 Permit Fee Received No Yes Other Contact Description, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to be laid in proposed trench (eg; pipes/cable lines etc-) Please use reverse side if additional space is needed. Install Septic System Front of House Insurance Certificate #: CPA 0193900-14 Name and Contact Information of insurer: Acadia Insurance, P. O. Box 10159, Albany NY 12201 -PpAcy Expiration Date: 10/20/2012 Dig Safe #:20122402477 Name of Competent Person (as defined by 520 CMR 7.02): Michael W Reilly Massachusetts Hoisting License # HE 038183 License Grade: 2A Ex iration Date: 10/27/13 BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. c. 82A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INTDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLI nSIGNATURE i r DATE EXCAVATORS[ NATURE (IF DIFFERENT) DATE OWNER'S SIGNATURE (,(IF �yDIFFERENT) 6�.k? ICL'`. DATE: 2 1 P a g e Name and Contact Information of Insurer: Acadia Insurance, P. O. Box 10159, Albany NY 12201 PoRy Expiration Date: 10/20/2012 Dig safe #:20122402477 Name of Competent Person (as defined by 520 CMR 7.02). Michael W Reilly Massachusetts Hoisting License # HE 038183 ZA 10/27/13 License Grade: Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G -L. G 82A, 520 CMR 9.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH W ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERLNG SUCH WORK. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORT{ CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC 'WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AN'D EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANT SIGNATURE DATE EXCAVATOR SIGNATURE (IF DIFFERENT) DATE OWNER'S SI TITRE (IF DIF NT) DATE: 21Page CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application, the applicant understands and agrees to comply with the following: IV. vi. No trench maybe excavated unless the requirements of sections 40 through 40D of chapter 82, and any accompanying regulations, have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including, but not limited to, the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164 (DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the General Laws, an excavator shall not leave any open trench unattended without fust making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR 1926.650 et-seq., entitled Subpart P "Excavations". Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; By applying for, accepting and signing this permit, the applicant hereby attests to the following: (1) that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2) that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CMR 1926.650 et.seq., entitled Subpart P "Excavations" as well as any other excavation requirements established by this municipality; and (3) that he is aware of and has, with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application, complied with the requirements of sections 40- 40D of chapter 82A. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www.mass.aoy/dns 3 1 P a g e Summary of Excavation and Trench S fety Regulation (520 CMR 14.00 et seq.) This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L.c.82A and does not include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A, go to www/mass.gov/dps Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety, jointly with the Division of Occupational Safety, drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a trench made for a construction -related purpose on public or private land or rights-of-way. All municipalities must establish a local permitting authority for the purpose of issuing permits for trenches within their municipality. Trenches on land owned or controlled by a public (state) agency requires a permit to be issued by that public agency unless otherwise designated. In addition to the permitting requirements mandated by statute, the trench safety regulations require that all excavators, whether public or private, take specific precautions to protect the general public and prevent unauthorized access to unattended trenches. Accordingly, unattended trenches must be covered, barricaded or backfilled. Covers must be road plates at least 3/" thick or equivalent; barricades must be fences at least 6' high with no openings greater than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators may choose to attend trenches at all times, for instance by hiring a police detail, security guard or other attendant who will be present during times when the trench will be unattended by the excavator. The regulations further provide that local permitting authorities, the Department of Public Safety, or the Division of Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury; the failure to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The trench shall remain shutdown until re -inspected and authorized to re -open provided, however, the excavators shall have the right to appeal an immediate shutdown. Permitting authorities are further authorized to suspend or revoke a permit following a hearing. Excavators may also be subject to administrative fines issued by the Department of Public Safety for identified violations. Summary of 1926 CFR Subpart P -OSHA Excavation Standard This is a worker protection standard, and is designed to protect employees who are working inside a trench. This summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational purposes only and does not constitute an official interpretation by OSHA of their regulations, and may not include all aspects of the standard. For further information or a full copy of the standard go to www.osha.gov. Trench Definition per the OSHA standard: o An excavation made below the surface of the ground, narrow in relation to its length. o In general, the depth is greater than the width, but the width of the trench is not greater than fifteen feet. Protective Systems to prevent soil wall collapse are always required in trenches deeper than 5', and are also required in trenches less than 5' deep when the competent person determines that a hazard exists. Protection options include: o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices, the equipment manufacturer's tabulated data, or designed by a registered professional engineer. o Shielding (Trench Boxes). Trench boxes must be used in accordance with the equipment manufacturer's tabulated data, or a registered professional engineer. o Sloping or Benching. In Type C soils (what is most typically encountered) the excavation must extend horizontally 1 '/� feet for every foot of trench depth on both sides, I foot for Type B soils, and % foot for Type A soils. o A registered professional engineer must design protective systems for all excavations greater than 20' in depth. continued 4 1 P a g e • Ladders must be used in trenches deeper than 4'. o Ladders must be inside the trench with workers at all times, and located within 25' of unobstructed lateral travel for every worker in the trench. o Ladders must extend 3' above the top of the trench so workers can safely get onto and off of the ladder. • Inspections of every trench worksite are required: o Prior to the start of each shift, and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person (see below). • Competent Person(s) is: o Capable (i.e., trained and knowledgeable) in identifying existing and predictable hazards in the trench, and other working conditions which may pose a hazard to workers, and o Authorized by management to take necessary corrective action to eliminate the hazards. Employees must be removed from hazardous areas until the hazard has been corrected. • Underground Utilities must be: o Identified prior to opening the excavation (e.g., contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected, supported, or removed once exposed. • Spoils must be kept back a minimum of 2' from the edge of the trench. • Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. • Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by creation of the trench, they must be underpinned, braced, or otherwise supported. o Sidewalks, pavements, etc. shall not be undermined unless a support system or other method of protection is provided. • Protection from water accumulation hazards: o It is not allowable for employees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulation, this must be monitored by the competent person. o If the trench interrupts natural drainage of surface water, ditches, dikes or other means must be used to prevent this water from entering the excavation. • Additional Requirements: o For mobile equipment operated near the edge of the trench, a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath Ioads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high -visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4' if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist (e.g., Oz <19.5% or >23.5%, 20% LEL, specific chemical hazard), adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with guardrails must be provided for crossing over trenches > 6' deep. o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. 5 1 P a g e aIleCLaie, Pamela From: DelleChiaie, Pamela Sent: Friday, July 13, 2012 11:55 AM To: 'fpreillyandsons@comcast.net' Subject: 93 Cricket Lane, North Andover re: A90 Distribution Box Inspection Requirement Follow Up Flag: Follow up Flag Status: Flagged Debbie, Please make sure that Mike calls for a reinspection sometime next week (see below). Have a great weekend. --Pamela Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg. 20 1 Suite 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email odellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com From: Grant, Michele Sent: Friday, July 13, 2012 11:50 AM To: Sawyer, Susan; DelleChiaie, Pamela Subject: RE: 93 Cricket Lane Let me know From: Sawyer, Susan Sent: Friday, July 13, 2012 10:47 AM To: DelleChiaie, Pamela; Grant, Michele Subject: FW: 93 Cricket Lane This is Bill's solution to the d -box issue. Mike Reilly should be calling if he hasn't already. Isaac said he told him we should re-insp. the d -box. From: wrd ufresneCabcomcast. net mailto:wr Sent: Friday, July 13, 2012 9:37 AM To: Sawyer, Susan SuWect: Re: 93 Cricket Lane / Susan I understand the issue and it is not a new one. Systems with pumps are required to have tees at the entrance to the Dist. Box. A 90 is the better alternative. If the tee is faced up, the effluent shoots up against the cover and leaks out of the Dist Box cover which is not sealed to the dist. box. Installation of a 90 forces the effluent down and not up against the cover and the problem is eliminated. In addition, I specify a dual compartment dist box which allows the turbulance to settle in the first compartment and overflow into the second compartment with the distribution lines so the flow to the s.a.s. is much more controlled and even. Mike Reilly has removed the tee and installed a 90. The issue has been resolved. IM From: "Susan Sawyer" <ssawyer _townofnorthandover.com> To: "wrdufresneCcD-comcast. net" <wrdufresneCaD-comcast. net> Sent: Thursday, July 12, 2012 11:08:00 AM Subject: RE: 93 Cricket Lane Oh, sorry, the cart is before the horse. I thought Mike may have contacted you. Glad I wrote you. Thanks Susan From: wrdufresne0comcast.net rmailto:wrdufresne(o)comcast.net] Sent: Thursday, July 12, 2012 11:02 AM To: Sawyer, Susan Subject: Re: 93 Cricket Lane Susan, would like to see the problem, I an unaware ofthis issue. What seam does the effluent flow through? I will call Mike reilly for more details. From: "Susan Sawyer" <ssawyer(cDtownofnorthandover.com> To: "wrdufresneCa)comcast.net" <wrd ufres nea- com cast. net> Cc: "Pamela DelleChiaie"<pdellechCaDtownofnorthandover.com> Sent: Thursday, July 12, 2012 10:11:40 AM Subject: 93 Cricket Lane Hi Bill, Please, ,ee Mill River's comments regarding the d -box. Mike is fixing the leaking issue. Can you let me know what your Solution is for the overflow of effluent from the d -box. I want to let Michele know what to look for, as I am sure we both want to make sure all the liquid makes it to the leach area. Thx Susan DISTRIBUTION -BOX Installed on stable stone base H-20 D -Box Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Comments: 2" force main is leaking at the inlet of the D -box. Installer will reseal with hydraulic cement. Effluent flows through the seam of D -box when pump is turned on due to the amount of pressure in the force main. Consult with designer to resolve this issue. Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg. 20, Unit 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: hftp://www.see.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 D"elleChiaie, Pamela From: Sawyer, Susan Sent: Monda .-Juay-1-6-, 2012 -2:03 -PM To: eChiaie, Pamela; Grant, Michele Subject: FW: F.C. Inspection Request - 93 Cricket Lane, North Andover Attachments:X9.3-.JP- IMG 1&AA JPS__ I forwarded this to Mike. He said he was not on site because Mill River came at 4PM, so there was a communication problem and the fix was done and no one called us. Hence is has been loomed and seeded as I had feared. I was not happy that Mike was not on site, but he is generally trustworthy. However, the question is, who is going to be the one to vouch for it that the leak around the pipe was fixed. They will get back to us. From: Sawyer, Susan Sent: Monday, July 16, 2012 1:55 PM To: 'fpreillyandsons@comcast.net' Subject: FW: F.C. Inspection Request - 93 Cricket Lane, North Andover Susan, Attached is the inspection report and (2) photos for the above referenced property. The trenches and elevations are good but a couple issues with the D -box. 1. The 2" force main is leaking at the inlet to the D -box. The installer will re -seal with hydraulic cement. It appears the hydraulic cement just did not set properly. 2. Effluent flows through the seam where the cover meets the D -box when the pump is running. There is an inlet tee but due to the amount of pressure in the force main effluent is leaking out through the cover. I would recommend reviewing this with the designer. Let me know if you want to review these concerns. I told the installer it was ok to backfill the trenches but the D -box must remain open for re -inspection. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street f Glo ices&, MA 01930-2719 Pi'Ione: (978) 282-0014 Fax: (978) 282-1318 irowe .millriverconsultinQ.com www.miliriverconsultin-g.com From: DelleChiaie, Pamela [mailto:pdellech(abtownofnorthandover.com] Sent: Wednesday, July 11, 2012 11:15 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: F.C. Inspection Request - 93 Cricket Lane, North Andover Importance: High Hello, Per Bill Dufresne (10:30) and Mike Reilly (now) - 93 Cricket Lane, North Andover is ready for a Final Construction Inspection. Please call Mike Reilly - 978-375-4811 to schedule. Thank you-! --Pamela From: fprei Ilya ndsons(.acomcast. net [mailto: fpreillyandsons(d)comcast.net] Sent: Wednesday, June 20, 2012 11:57 AM To: DelleChiaie, Pamela Subject: 93 Cricket Lane Pam, Attached is the Project Obligation form for 93 Cricket Lane. Sorry I didn't bring it in.... Let me know if you get it. Thanks! Deb Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/r)reidx.htm. Please consider the environment before printing this email. DelleChiaie, Pamela V, I From: DelleChiaie, Pamela Sent: Tuesday, July 03, 2012 8:34 AM To: Grant, Michele Subject: BB Inspection Request - 93 Cricket Lane (Mike Reilly) Follow Up Flag: Follow up Flag Status: Flagged Michele, BB for 93 Cricket Lane requested for 11;00 a.m. today from Mike Reilly. Please confirm yes or no for today - 978-375-4811. Thanks. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg. 20 1 Suite 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie(cDtownofnorthandover.com Web www.TownofNorthAndover.com 1 North Andover Health Department Community Development Division September 28, 2011 Kevin and Jen Fluth 93 Cricket Lane North Andover, MA 01845 RE: Subsurface Disposal System Plan 93 Cricket Lane Mau 107A lot 285 Dear Property Owners, FILE COC^; 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 the Merrimack Engineering Services, dated April 25, 2011, last revised September 9, 2011. This plan has been approved and is valid for three years from the date of this approval. This system design is fully compliant with Title V's new construction design standards and has been approved for use in the construction of a new onsite septic system for a 6 -bedroom house (maximum 13 -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. 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. 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 y San Y. Sawy ,"REHSIZ Public Health Director Encl: list of licensed septic system installers Cc: Merrimack Eng. Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com dl e DelleChiaie, Pamela From: Isaac Rowe [irowe@millriverconsulting.com] Sent: Wednesday, August 17, 20113:57 PM To: 'Susan Sawyer(ssawyer@townofnorthandover.com)' Cc: DelleChiaie, Pamela; 'Randy Burley'; 'Marianne Peters'; dano@millriverconsulting.com Subject: 93 Cricket Lane Attachments: 93 Cricket Lane - Soil Testing Results 8-17-11.pdf Susan, Attached is the soil testing results for the above referenced property. The soil was consistent with the original soil logs. Also a sample of the Title 5 sand was taken for an analysis. The sand looked good but I have a sample of it here at the office as well. As noted on my soil log, the new house footprint should be added to the revised plan. Bill had a copy of the ZBA plan at the site and the wetland line looks a little different than the one on the septic plan. So the most recent wetland edge should be added to the revised plan as well. Please let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe _millriverconsulting.com www.millriverconsulting.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.see.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. r-` rm TOWN OF NORTH ANDOVER Oe pOR7N � Office of COMMUNITY DEVELOPMENT AND SERVICES V HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 #tot +* NORTH ANDOVER, MASSACHUSETTS 01845 �BSACHUSt� Susan Y. Sawyer, REIIS, RS 978.688.9540 — Phone Public Health Director 978,688.8476 — FAX fiealtlidept@to%vnoftiorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: MAP & PARCEL: (�� ( ZIP LOCATION OF SOIL TESTS: OWNER: Contact #: --z APPLICANT - 7 �- Contact #: ADDRESS: ENGINEER:--� j,.��� �Cr ti nl tlr3 . Contact #: �q CERTIFIED SOIL EVALUATOR: V Intended Use of Land: Residential Subdivision 'gIe Family Hoj :e Commercial Is This; Repair Testing:D Undeveloped Lot Testing Upgrade for ddition:Ei�l In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MIDST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or leiter from owner permitting test) 8,5" x 11"Plot plan & Location of Testlne 6* se Indieate test pit sites on the Fee of $425.00 per lot for now construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of 360.00 per lot for Mairs or upgrades. GENERAL INFORMATION Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. At least two deep holes and two percolation tests are required for each septic system disposal area. Repairs require at least -two deep holes and at least one percolation test, at the discretion of the -BOH representative. Full payment will be required for all additional tests within two weeks of testing. Within 45 days oftesting, a scaled plan (no smaller than 1"-I00') 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. Conserpatlon Commission Appro al Date: b Signature of Conservation Agent:S' I r Date back to Health Department: (stamp in): N exc _Q �� 4ToP-N (,Ely QA�OV �v'.'&4J.A L SYSrrRM PREPARED FORD��cinoplulV' ME EL0PAfENr • . 01..844 SALE: � =20' � D SES MBER MER ON 7 1382000 CK PRp� AL ENGyN�iNO i LAN se PAW ENGINEERS . �WCLrs ���/ r . �oov� �uQ SUR ��Q"ZM Talo S . PLANNERS otsro . "i. (978) 47��s • F (S78) 47, o.�NAA .rOWN OF NOKJY ;N�NT R 1 elleChiaie, Pamela From:- Randy Burley[rburley@millriverconsulting.com] Sent: Monday, September 12, 20112:50 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 2009 Salem St. Attachments: 2009 Salem Upgrade soils.PDF Hello again, Please find attached the soil results from today. Bill and I did not discuss any design information regarding what he might design and /or waiver(s) he may seek. Sincerely, Randy Burley Project Manager Mill River Consulting 6 Sargent Street . Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsultiniz.com rburley_kmillriverconsulting com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. ,I/ -o ° 13 ?� �5 LSSA C H135 North Andover Health Department Community Development Division June 20, 2011 Vladimir Nemchenok c/o: Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 0 18 10 Re: Subsurface Sewage Disposal System Plan for 93 Cricket Lane, Map 107A, Lot 285 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated April 25, 2011, and received on June 12, 2011 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable: The title of the submitted plan is for an "Upgrade." As this plan proposes to add bedrooms, it falls under new construction; please revise. 2. No existing or proposed contours are shown on the plan view (310 CMR 15.220(4) (g) and North Andover section 3.2). 3. Existing spot grades show the grade over the existing leaching trenches to be approximately 195-+. Elevations of the test pits are 188.0 and 189.6. a. There appears to be 7 feet of fill where the proposed leaching trenches are that has been added since the soil testing. b. As Title 5 requires 4 feet of naturally occurring pervious material beneath the entire leaching area for new construction, new test pits would be required to ensure the depth of natural soil exists below the fill, 4 or more test pits may be required. North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Page 1 of 2 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 im F c. Of course in the re -design, all of this fill w uld be required to be removed unless it can be proven to meet the fill staradard in Title 15.255(3). (15.240(1)) 4. A profile of the system to scale is to be shown (I" .,r -h Andover Section 3.2). 5. A note shall be added to the plan that all pipir ; is '.o b(-.1 minimum of schedule 40 PVC (North Andover Section 3.2) 6. The holder of the easement shown on the pian is not given (310 CMR 15.220(4) (b)). 7. Dimensions from the leaching facility to the exi ting water service line and the wetland are not shown (North Andover Section 3.2). 8. The manufacturer of the distribution box is not : iown on the plan (North Andover Section 3.2). 9. The distribution box shall have H2O loading (No; h Andover Section 3.2). 10. One of the reserve trenches is closer than 10' to t' e existing water service (3 10 CMR 15.211). 11. There is no note indicating that the outlets on the distribution box shall all be at the same elevation (3 10 CMR 15.232(3) (b)). 12. Please add the soil evaluator note to the plan. 13. Please provide the name of the individual who flagged the wetlands, and the date of the delineation. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Public Health Director cc: Kevin & Jen Fluth File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Town of North Andover, Massachusetts Form No. 3 f ,+QIF,M BOARD OF HEALTH QL O DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACMUSEt Applicant NAME Q AD RESS TELEPHONE Site Location ---9j 64 -IS -11— Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, 8 D OF H TH Fee D.W.C. No. TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET * �•• ,.L�s.. �p NORTH ANDOVER, MASSACHUSETTS 01845 sACIW� � 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.9542 — FAX Public Health Director healthdept(atownofnorthandover.com - e-mail www.townofnorthandover.com - website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 5' 0-5- 5 LOCATION:— LOCATION: LICENSED LICENSED INSTALLER NAME: /,q � �'-'_ A So e✓ PLEASE PRINT o, SIGNATURE: y TELEPHONE# J CHECK ONE: FULL SYSTEM REPAIR: ($250) ZCOMPONENT REPAIR (indicate what parts): _ l A���� ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $250.00 or $125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval of Health Agent Date: ft INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at__ G N L ��2 relative to the application OOL4 014 dated for plans by and dated with revisions dated 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 hall with my applicable company schedules an inspection and the system is not ready then item 3. As the installer I am required to have the necgssary 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 re4uest 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 ul licensed 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. be on site during the performance of the following 5. As the Installer I understand that I must 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.chamber, retaining wall and other d) Installation of tank, D -box, pipes, stone, vent, pump 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 Lic d Septic Installer 1`f -d5 Date: Disposal Works Construction Permit # r �3 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 93 Cricket Lane _ North Andover_ Owner's Name: _Ann Guthrie Owner's Address: _93 Cricket lane _ North Andover, MA 01845_ Date of Inspection: _4/5/2007 Name of Inspector: Neil J. Bateson Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810 Telephone Number: _( 978 ) 475-4786_ REE�`r APR 1 S 2007 TOWN OF N(j -' r A- DOVER HEALTH DEwr,ftI MENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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: _X Passes Conditionally Passes NTs"", Fter Evaluation by the Local Approving Authority 1`� ��� Date: 4/5/2007 Inspector's Signature: _ _ 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. Notes and Comments: ****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. .. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 93 Cricket Lane _ _ North Andover— Owner: _ Guthrie _ Date of Inspection: 4/5/2007 _ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the 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. ND explain: 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 ND explain: 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): ND explain: broken pipe(s) are replaced obstruction is removed Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _93 Cricket Lane _ _ North Andover— Owner: _Guthrie Date of Inspection: _4/5/2007 _ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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 he attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _93 Cricket Lane _ _ North Andover — Owner: _Guthrie_ Date of Inspection: _4/5/2007 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or `no" to each of the following for all inspections: No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6" below invert or available volume is 1/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No_ Any portion of the SAS, cesspool or privy is below high ground water elevation. No— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No) 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. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 'Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 93 Cricket Lane _ _ North Andover _ Owner: _Guthrie_ Date of Inspection: _4/5/2007 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks ? Yes_ — Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? _Yes_ _ Were as built plans of the system obtained and examined? Yes _ Was the facility or dwelling inspected for signs of sewage back up ? Yes_ _ Was the site inspected for signs of break out ? _Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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 ? _Yes_ _ 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: Yes No Yes_ _ Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 93 Cricket Lane _ _ North Andover_ Owner: _Guthrie_ Date of Inspection: _4/5/2007_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _R 4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CM15.203 _440_ Number of current residents: _2 Does residence have a garbage grinder (yes or no): No_ Is laundry on a separate sewage system (yes or no): _No _ Laundry system inspected (yes or no): _ Seasonal use: (yes or no): _No_ Water meter reading: Yes_ Sump pump (yes or no): –Nom- Last o_Last date of occupancy: _ Current _ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): _bpd Basis of design flow (seats/persons/sgft,etc.): _ Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: _ Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2005,owner _ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1500_ gallons -- How was quantity pumped determined? _Measured tank Reason for pumping: _Inspect tank & tees_ TYPE OF SYSTEM X 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) Tight tank _ Attach a copy of the DEP approval — Other (describe): Approximate age of all components, date installed (if known) and source of information _7 years old, 9/13/2000, As built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Cricket Lane_ _ North Andover _ Owner: _Guthrie_ Date of Inspection: _4/5/2007 BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _24"_ Materials of construction: _ cast iron _X_ 40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" PVC thru wall, 3" PVC in house, No evidence of leakage._ SEPTIC TANK: X Depth below grade: _12" _ Material of construction: X concrete _ metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of certificate) Dimensions: 10'x 5' x 4' Sludge depth3"_ Distance from top of sludge to bottom of outlet tee or baffle: _24" _ Scum thickness: _4" Distance from top of scum to top of outlet tee or baffle:-8"— Distance affle_8"_Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: _Tape Measure _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc _ Pumped septic tank Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of septic tank leaking. _ GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _93 Cricket Lane_ _ North Andover— Owner: _Guthrie_ Date of Inspection: 4/5/2007 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX X ( locate on site plan ) Depth below grade _12"_ Depth of liquid level above outlet invert: 0_ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.) _P -Box level & distribution equal. Evidence of light carryover. No evidence of leakage. _ PUMP CHAMBER: X (locate on site plan) Pump in working order (yes or no): Yes_ Alarm in working order (yes or no): Yes_ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): _Pump cycled on then off. Pump in working order. _ Wage 9 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Cricket Lane _ _ North Andover— Owner: _Guthrie_ Date of Inspection: 4/5/2007_ SOIL ABSORPTION SYSTEM (SAS): _X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: _ leaching galleries, number: X leaching trench, number, length: _2 trenches 65' long _ _ leaching field, number, dimensions: _ overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _Soil ok. Vegetation ok. No sign of ponding to surface. _ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: _ Depth of sludge layer: _ Depth of scum layer: _ Dimensions of cesspool: _ Materials of construction: Indication of groundwater inflow (yes or no): — 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.): Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _93 Cricket Lane _ _ North Andover— Owner: _Guthrie_ Date of Inspection: _4/5/2007_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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 A to D -Boz = 31'5" B to Septic Tank =19' B to Pump Tank = 26' B to D -Boz = 4014" 'Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _93 Cricket lane _ _ North Andover Owner: _Guthrie_ Date of Inspection: _4/5/2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _ 4' _ Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: _ 10/13/2000_ 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: _ As per design plan test pit data _ Summary Record Card generated on 411112007 3:55:34 PM by Use Warren - . Town of North Andover Tax Map # 210-107.A-0285-0000.0 93 CRICKET LANE DOUG & ANNE GUTHRIE 93 CRICKET LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type Size Total 1.53 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/lnact From DOUG & ANNE GUTHRIE Owner 93 CRICKET LANE NORTH ANDOVER, MA 01845 CROWLEY, TIMOTHY Previous Customer Inactive 8/22/2005 93 CRICKET LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13869.0 - 93 CRICKET LANE Last Billing Date 3/16/2007 2100712 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 53.21 /1 UB Meter Maintenance Serial No Status Location Brand Type Size 16371960 a Active ERT METE METE w Water 1 1 Date Reading Code Consumption Posted Date 2/21/2007 816 a Actual 17 3/23/2007 11/3/2006 799 a Actual 35 12/22/2006 8/21/2006 764 a Actual 50 9/13/2006 5/5/2006 714 a Actual 13 6/20/2006 2/8/2006 701 a Actual 18 3/13/2006 11/4/2005 683 a Actual 53 12/14/2005 8/19/2005 630 f Final Bill 45 8/19/2005 5/3/2005 585 a Actual 9 6/8/2005 2/15/2005 576 a Actual 10 3/15/2005 11/15/2004 566 a Actual 16 12/17/2004 8/16/2004 550 a Actual 45 9/20/2004 Page 1 1 Residential Until YTD Cons 0 Variance -67% 2% 206% -19% -73% 65% 256% 8% -38% -64% 395% Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 93 Cricket lane, North Andover Owner: Guthrie Date of Inspection: 4/5/2007 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. I/ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICF/OF ENVIRONMENTAL AFFAIRS DEPARTMENT O AL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _93 Cricket Lane_ North Andover_ Owner's Name: _Tim Crowley_ Owner's Address: _93 Cricket Lane_ _ North Andover, MA 01845_ Date of Inspection: 4/22/2005_ Name of Inspector: Neil J Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 4754786_ RECEIVED MAY 2 5 2005 TOvv, y . � H ANDOVER HEALTH DEPARTMENT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ils Inspector's Signature: Date: 5/13/2005 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. Notes and Comments: After permit from B.O.H. ,sealing seam on septic tank with hydraulic cement & foundation sealant, inspection from B.O.H., septic system now passes Title 5 Inspection. ****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. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _93 Cricket Lane_ North Andover_ Owner's Name: _Tim Crowley_ Owner's Address: _93 Cricket Lane_ _ North Andover, MA 01845_ Date of Inspection: 4/22/2005_ Name of Inspector: Neil J. Bateson Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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 X Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: _4/22/2005_ 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. Notes and Comments: ****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. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _93 Cricket Lane_ _ North Andover_ Owner: Crowley_ Date of Inspection: _4/22/2005_ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: X 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. Septic Tank Leaking. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. Y 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. ND explain: N 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 ND explain: N 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 93 Cricket Lane_ _ North Andover— Owner: _Crowley_ Date of Inspection: _4/22/2005_ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _93 Cricket Lane _ _ North Andover_ Owner: Crowley_ Date of Inspection: 4/22/2005 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6" below invert or available volume is 1/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS, cesspool or privy is below high ground water elevation. No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] _No_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 31.0 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- You must indicate either `yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 93 Cricket lane _ North Andover — Owner: _Crowley_ Date of Inspection: 4/22/2005 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No _Yes — Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks ? Yes_ _ Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes _ Were as built plans of the system obtained and examined? Yes_ _ Was the facility or dwelling inspected for signs of sewage back up ? Yes _ Was the site inspected for signs of break out ? Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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 ? _Yes_ _ 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: Yes no _Yes_ , Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _93 Cricket Lane _ _ North Andover Owner: _Crowley _ Date of Inspection: _4/22/2005_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): _440_ Number of current residents: _2 Does residence have a garbage grinder (yes or no): No Is laundry on a separate sewage system (yes or no): _ No_ Laundry system inspected (yes or no): Seasonal use: (yes or no): No_ Water meter reading: Yes _ Sump pump (yes or no): _No Last date of occupancy: — Current-COMMERCIAL/INDUSTRIAL Type of establishment: _ _ Design flow (based on 310 CMR 15.203): ___Md Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: _Pumped two years ago, owner Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1000_ gallons -- How was quantity pumped determined? _Measured liquid level in tank_ Reason for pumping: _Inspect tank & tees, tank leaking _ TYPE OF SYSTEM X 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) _ Tight tank _ Attach a copy of the DEP approval — Other (describe): _ _ Approximate age of all components, date installed (if known) and source of information: -5 years old, 9/13,2000, as built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Cricket Lane_ _ North Andover _ Owner: Crowley_ Date of Inspection: _4/22/2005 BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _24"_ Materials of construction:_ X_ cast iron _40 PVC other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) SEPTIC TANKS: X 4" PVC thru wall, 3" PVC in house _ Depth below grade: _12"_ Material of construction: _X concrete — metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 10'x 5' x 4' Sludge depth 1"_ Distance from top of sludge to bottom of outlet tee or baffle: 25"_ Scum thickness: _2" _ Distance from top of scum to top of outlet tee or baffle: _8" _ Distance from bottom of scum to bottom of outlet tee or baffle: 17" _ How were dimensions determined: _Tape measure_ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.)_ Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid below outlet invert. Evidence of tank leaking. Liquid 18" below normal GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Cricket Lane_ _ North Andover– Owner: Crowley_ Date of Inspection: _4/22/2005_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X Depth of liquid level above outlet invert: _0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.) _D -box level & distribution equal. No evidence of leakage. No evidence of carryover._ PUMP CHAMBER: X (locate on site plan) Pump in working order (yes or no): Yes_ Alarm in working order (yes or no): Yes— Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump cycled on then off. Alarm has both visual & audible Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Cricket Lane_ _ North Andover _ Owner: _Crowley_ Date of Inspection: _4/22/2005_ SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type _ leaching pits, number: _ _ leaching chambers, number: leaching galleries, number: _X leaching trenches, number, length: _2 trenches 65' long_ —leaching fields, number, dimensions: overflow cesspool, number: innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _ Soil ok. Vegetation ok. No sign of ponding to surface _ 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 sludge layer: _ Depth of scum layer: _ Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): 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.): Page 10 of 11 UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Cricket lane_ _ North Andover_ Owner• _Crowley _ Date of Inspection: _4/22/2005_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. D Boz House A B Pump H Septic Tank Tank A to Tank = 34'5' A to Pump Tank = 2617' A to D -Boz = 3115" B to Tank =19' B to Pump Tank = 26' B to D -Boz 40'4" Driveway Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _93 Cricket Lane_ _ North Andover Owner• _Crowley_ Date of Inspection: 4/22/2005_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater —4'— Please 4'_Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: _10/13/2000_ 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: As per design plan_ Summary Record Card generated on 4/20/2005 3:19:56 PM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-107.A-0285-0000.0 93 CRICKET LANE CROWLEY, TIMOTHY 93 CRICKET LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.53 Acres FY 2005 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until CROWLEY, TIMOTHY Payor 93 CRICKET LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 8041.0 - 93 CRICKET LN Last Billing Date 3/9/2005 2100712 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFECADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 28.00 /1 UB Meter Maintenance Serial No Status Location Brand Type 16371960 a Active ERT METE METE w Water Date Reading Code Consumption Posted Date 2/15/2005 576 a Actual 10 3/15/2005 11/15/2004 566 a Actual 16 12/17/2004 8/16/2004 550 a Actual 45 9/20/2004 5/17/2004 505 a Actual 9 6/14/2004 2/17/2004 496 a Actual 7 4/16/2004 11/14/2003 489 n New Meter 0 11/14/2003 Size 11 YTD Cons 0 Variance -38% -64% 395% 36% 0% 0% 4' 7 S Cm LP N Lj-' CN M w V M M M r4,0 0 O� SL% U -j MC N —.,- Ln n so mlo* C4 W MN CO Ln N 01 V M Le) V V CS m cl- = CM ch VIN x N' -i Ln M C ;.0 N �,O N. N M OD N -F-i N OZ M mw'� V r VH 0 N CR MO W C'- Or 4=Z wollm�.Zvs-�INLn= L4 Uc,= MMVVVV M ON, (S) m T -q a) -qN.,N N N m m m m z Lr N �o Cl Ln Ln 6,01) to w NN ul C' N en Ln W wriN Ll =,.q z I 'r-1 v -I 1-4 N N ml m M ml v v W NNNCNNNNNNNN.NNNN LU N CY)'T ul z N x 0, NMC ue} 0 CLI, ato a -a 60�' A 10 m w a Eye- E/A Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 93 Cricket Lane, North Andover Owner: Crowley Date of Inspection: 4/22/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Bateson Enterprises, Inc. FORM 11 - SOIL EVALUATOR FORM Page 1 No...................... Date....�.:.._---� Commonwealth of Massachusetts '--TOWN OF NORTH ANDD R/ BOARD OF HEALTH WO2 14 Ali WVr_-R , Massachusetts 2 6y 1999 /'11 • t 111 e. fOr*. • Performed By: .... W.L.LLI.A. t.......Du.)F ................ WitnessedBy:.::.:,5.... .t J:I :A:.:::.:.ST RR.1'...-"..:::....—.:.:.......-."..-:.".::::.:::::.:::..,:..:::..:............:...::rv,.v.:::::: ................................................................................................................................................................................................................................................................... LAwwn Aftes, or ^�-� 0*='a Name. do arm%/ LA / � �F� ('i� 1 LAWS—E Afteu. ud 1 Telephone r Sq COmos- f oe L v rsc MIF -Th v is Ili, H A. o 10444 New Construction Fr Repair - ❑ Office Review Published Soil Survey Available: No ❑ Yes 2' Year Published ...l.Q.S...J.. Publication Scale .11.15 Drainage Class .... ....... Soil Limitations .......HAD R ...... Surficial Geologic Report Available: No ❑ Yes ❑ Year Published ....... Publication Scale .................. ' M ' I M ' U 't) __--- Soil Map Unit .C..b..(- A .............:........................... � u�tTo. GeoUW L, ateria ( Up ni................................................................................................... Landform.......... ........ ........................................................................................................................................ Flood Insurance Rate Map: 200 qg OXtDCo G 4 G '(�- Above 500 year flood boundary Within 500 year flood boundary Within 100 year flood boundary No ❑ Yes No Yes ❑ No LJ Yes ❑ ....__............_................. Wetland Area: National Wetland Inventory Map (map unit) .......014.......S.0. .....11 .!uE Ti ,................. Wetlands Conservancy Program Map (map unit)................................................................................................... Current Water Resource Conditions (LISGS): Month Av6Q Range : Above Normal� ❑ ormal I Below Normal ❑ aSSuMED Other References Reviewed: V• S. MAPS Izo- FORM 11 - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number IZIJIEDate: RAH. 1-1 Time:..R.M., Weather Location (identify on site plan) .....�Ve . . .... ....... .....:P.. al' ...... aal' ..j ................ Lend Use Slope M Surface Stones .... H.A.14 - Y. ....................................................... Vegetation....W. - 0D. f.Z. .............................................................................. ............. LandformMO.W.1.4e .................. I ............................................................................................................................................................................. Positionon landscape (aketch.on the back) .................................................................................................. 1 ...................................................... Distances from: Open Water Body ....... 1004teet Drainage way ... feet Possible Wet Area ..... feet Property Line ..... feet Drinking Water Well feet Other 77= ................ VEEP OBSERVATION HOLE LOG Depth from Surface (inches) Sol[ Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Stru.ctdre, Stones, Boulders, Consistency, % Gravel) -7, !NP 6 S4 S -Y 445 S -0/c, C';Iza e- 3S- oil- AP C'- 33's RL,) Ila,41G 33,t- el" C, V. 61RAV, eaa Parent Material (geologic) .4 L .................... ... Depth to Bedrock: Depth to Groundwater: Standing Water in the Hole: ..04A... - Weeping from Pit Face: JA .... Estimated Seasonal High Ground Water: FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ..inches ❑D pth weeping from side of observation hole inches Depth to soil mottles 3S,.33." inches ❑ Ground water adjustment feet Index Well Number . Reading Date ................... Index well level ................... Adjustment factor � Adjusted ground water level .......'.....— ::............ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on — (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. c� ` �� Signature � Date l �� FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS W01ZT4 AQb0Yi54Q , Massachusetts Percolation Test Date: = i5-9:.7... Time:.... :y..{` ................ Observation Hole # lL Depth of Perc ') _ ze r �� ° : i4g ' Start Pre-soak l , 1!5-7 End Pre-soak Time at 12" Time at 9" 2, 12, Z3,Lt Time at 6" Time (9"-6") j �-( f•� 1 Il,.� • �(o �' � t �,i Rate Min./Inch i Site Passed Lel Site Failed ❑ ,� Performed By: (OS 60D 1 f i Witnessed By: Su S A 1J 50 C, D Comments:...... f MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS 66 PARK STREET - ANDOVER, MASSACHUSETTS 01810 - TEL (978) 475-3555,373-5721 - FAX (978) 475-1448 - E-MAIL: merreng@aol.com 8 FANEUIL HALL MARKETPLACE -THIRD FLOOR - BOSTON, MASSACHUSETTS 02109 - TEL (617) 973-6462 - FAX (617) 973-6406 April 28, 2011 Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 RE: 93 Cricket Lane Dear Ms. Sawyer, We have completed a design for expansion of the septic system at the above referenced site. The site has an existing 4 bdrm. house and functioning septic system which was constructed in 2000. The owner is proposing to finish the basement adding 3 finished rooms for a total bdrm. count of 6 bdrm.'s. We had hoped to be able to add one trench to the existing system, however the configuration of the existing trenches were such that the new trench would not fit without interferring with the existing easement. We therefore, are proposing to replace all 3 trenches in a new configuration, but in the same location and elevation as the original system. Because the soil testing was performed pursuant to the current Title 5 regulations, we are hopeful that new testing will not be required. Enclosed are 3 copies of the proposed plan, septic system submittal application and fee. On behalf of the owners, Kevin and Jennifer Fluth, we respectfully request you review the septic plan and application as soon as possible so that they may begin construction. We appreciate you prompt attention to this matter. Yours truly, William Dufresne Merrimack Engineering BUILDING TIES INVERT ELEVATIONS BUILDING CORNER A B C SEPTIC TANK SEPTIC TANK OUT 34.4' 19.4' PUMP TANK PUMP TANK OUT 24.2 28.4 DIST. BOX DIST. BOX OUT 31.5' 40.5' CORN. LEACH FIELD #1 43.1 49.7 CORN. LEACH FIELD #2 30.7' 38.9' CORN. LEACH FIELD #3 43.6' 30.9' CORN. LEACH FIELD #4 53.0' 43.9' 0 0 rn .0 3 0 0 n 0 / cn J_ m Q /T 0rn) 4/ 0 1 rn M c� 0 / km 4" PIPE ® FDTN. = 190.97 SEPTIC TANK IN = 190.64 SEPTIC TANK OUT = 190.58 PUMP TANK IN PUMP TANK OUT = 190.70 DIST. BOX IN = 193.51 DIST. BOX OUT = 193.35 IEND LEACH LINE #1 = 193.05 END LEACH LINE #2 1= 193.03 AS—BUILT OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MA.;.,s .F,^ AS PREPARED FOR COPLEY DEVELOPMENT 50 COPLEY DRIVE'n" METHUEN, MA. 01844 `�� ��V ;;'o SCALE: 1"=20'r— DATE: SEPTEMBER 13, 2000 SUBDIVISION LOT #1 CRICKET LANE MERRIMACK ENGINEERING SERVICES PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS ,� 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555• FAX (978) 475-1448 I/ qC COLLOPY 65 AYER STREET FRANCIS H. COLLOPY REG. PROFFESIONAL ENGINEEER ENGINEERING CONSULTANTS CIVIL STRUCTURAL P DXNAMICS 1e Ms. Sally Starr Board of Health Town of North Andover North Andover, MA 01845 Dear Ms Starr: METHUEN, MA 01844 RESIDENCE: (978) 685-7969 OFFICE I FAX: (978) 685-8069 August 19, 2000 I am writing in regards to the Title V Retaining Wall constructed on Lot #1 Cricket Lane, or Walnut Ridge Development in North Andover, MA. I was responsible for the structural design of this wall, and the Construction Plan and Details are shown on my drawing dated 5/13/00 and revised on 7/25/00 for the inclusion of construction of a portion of the walls on ledge. I visited the site on several occasions during construction. Initially, I visited the site in April 2000, on two different occasions to inspect the property on Lot 1 prior to the excavation along the location of the proposed retaining wall. I visited the site on June 16 for the purposes of meeting with Matt Laudani of Walnut Ridge Development and Dennis Pinet of P & G Foundation Contractors. The purpose was to inspect the ledge conditions and the type of soil on the site. This prompted a redesign of the retaining wall to meet this type of field condition. An updated and revised Drawing was issued on 7/25/00 to Mr. Laudani and Mr. Pinet. I revisited the site three times in August to inspect the construction of the footing forms and placing of the steel reinforcement, and during construction of the vertical section of the walls to inspect the steel reinforcing. During my last site visit I witnessed the pouring of the wall, and I was able to review the placement of the Greenstreak waterstop at the expansion joint as shown on the drawing. Therefore, this letter is to certify that the said retaining wall was built in accordance with the plan of Collopy Engineering, as enclosed. M r 4 If you have any questions concerning this matter, please do not hesitate to call this office. Sincerely, COLLOPY ENGINEERING CONSULTANTS Francis H. Collopy, P.E. Structural Engineer Attachment: Sheets 1 of 1: Retaining Wall Plan & Details cc: Matt Laudani, Walnut Ridge Development LE40=SERIES PUMP The pump(s) shall be model as manufactured by Liberty Pumps, Bergen, NY, or equal. The pump(s) shall have a capacity of GPM at a total dynamic head of feet. Motor size shall be 4/10 horsepower, single phase, 60 hz. and 115 volt operation. MOTOR The pump motor shall be of the submersible type, oil filled, hermetically sealed and shall be thermally protected. The overload element shall automatically reset when motor cools. Motor windings shall be of the class B insulation rating. The rotor shaft shall be made of 416 stain- less steel and shall be supported by lower bronze and upper sleeve bearings. The power cord shall be of the quick -disconnect design allowing replacement of the cord without breaking seals to the motor and/or oil chamber. (, S1 , t -fl_ A D - 30 6prr► = '7' t i,8'= B,S'Tbsi_ / . TECHNICAL SPECIEJ DNS N ERS �oARD . IMPELLER_ The pump shall have a VORTEX styk 2 6 19 impeller capable of passing a minim m 2" spherical solid. d SEAL The shaft seal shall be of the carbon/ceramic unitized design, with BUNA N elastomers and stainless housings. EXTERNAL CONSTRUCTION The pump volute, legs and motor housing shall be heavy gray iron castings, class 25 or better. All castings shall be enamel coated before assembly. All fasteners shall be of 300 -series stainless steel or brass. LEVEL CONTROL The pump shall be controlled by an adjustable, mercury -free, wide angle float switch. Float cord shall be equipped with a series plug for manual by-pass operation. MODELS HP VOLTS PHASE AMPS DISCHARGE AUTOMATIC IMPELLER LE41 M 4/10 115 1 13 2" FNPT NO VORTEX LE41A 4/10 115 1 13 2" FNPT YES VORTEX 10' cord standard on above models. For 20' option, add a "-2" suffix to model number. Example: LE41 A-2 DIMENSIONAL DATA: Weight: LE41 M: 39 LBS. Height: 13.25" Major Width: 10.75" (manual models) Maximum fluid temperature 140 degrees F. 6. P, t�1. I l ° T p,14 PMA Certified City of LA certification available MEMBER PERFORMANCE CURVE 1 24 20 s d y 16 4 - m 12 d a) = L m +d 8 0 ~ 2 9 0 4 1550 RPM 0 10 20 30 40 50 60 70 80 U.S. Gallons Per Minute I I 4 I 0 1.4 2.8 4.2 5.6 Liters Per Second Liberty Pumps • 7307 Lake Rd • Bergen, New York 14416 • Phone (716) 494-1817 Fax (716) 494-1839 7291-2/93 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 Wq, IM w_t 1(, d e. i, De u. /- /- '6 - PHONE LOCATION: Assessor's Map Number 8 PARCEL 46 z SUBDIVISION_ i1 � LOT (S) STREET Ce is e f L� Al ST. NUMBER ****** �********OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SE�I CTOR-HEALTH DATE APPROVED 9��K DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS 04G DRIVEWAY PERMIT �� o FIRE DEPARTMENT r ZL-remit �j - a, -?It ��-/o-9g RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 j Location Id C zA No. —/ Date -7 40wTh -1 TOWN OF NORTH ANDOVER 4, Certificate of Occupancy $ MU Building/Frame Permit Fee $ Foundation Permit Fee IF $ Other Permit Fee $ TOTAL 's Check # / 0 5-0 5 0 Building Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal Systemconstructed; ( ) repaired: by located at La.- w rr-, cO�ci 1 Vih-�, was installed in conformance with the North Andov r Board of Health approved plan, System Design Permit # Q , dated ) with an approved design flow of Y110 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health Bed inspection date: (? �;-'' 0,0 Final inspection date: f— Z' cLt_-_� Installer: = Engineer Representative l � Engineer Rep esentative /iy-U Date: `i' l3-l1a Date: _9-/3-00 2. 3. 4 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 4g- relative to the application of/,// S --- dated S -� Y ?,-Ooo for plans by .46 ^�ir1Qc and dated f - i o? – 99 with revisions dated I understand and agree to the following obligations for management of this project: As the installer I am obligated to 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 two shall be applicable . 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 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 BOH, 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. As the installer I understaind that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I finrther 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 in the Town of North Andover plus significant fines to all persons involved. 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. d) installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. 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 License Septic Installer d Date:Z�' ZO�� IM V 0 z LL0 w a> s U ro � � J _Q �w O LL c O Q p s � 0 O Z CO 4- O ' 3 0 w w z c ro U a a M1 C: O Z ro U O J a� mi ....................... i. a> (U LL APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: v�--2 Y-7.4Dd CURRENT r iSTALLER'S LICE; iSER %/ D LOCATION: Boz # / �/iC( T �crr./e LICENSED INSTALLER: /.4/// SIGNATURE: CHECK ONE: TELEPHONEM SBS' -15 3 NEW CONSTRUCTION: V IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only 5 3.00 Fee Attached? Yes No Foundation As -Built? Yes `' No Floor Plans? Yes No Approval Date: L� A 1 v J 1� CIO. 0%, uj k 7 --1 Zia c . C y 0 4b o c m � co � D o w -NeE y o c :moo, E aw E OC y m (D y... CT m y ' C co '0 y C C C.0 O � � COD CLC.) m L4 m C 00 r:50 rn y � m p CID O.� C7f d O C Q CO CO) m C O y m o CD C/) C cp = m r=.+ LL CO) C= C Z � m .y O v m o m c F - y G 0*5 O :5 g x �r?y'� O CZ_.. m 4 I cm C cn cis CD An O O 'E m m i O O CD D O L 0 M O O. CL =Q y C 0 Cc C d O D C Z 0 0 CL fJ y C — '� C _y D U) U) W w W VJ v 4r w o v Q o ro w I C zo ° .. w° C/) L uj k 7 --1 Zia c . C y 0 4b o c m � co � D o w -NeE y o c :moo, E aw E OC y m (D y... CT m y ' C co '0 y C C C.0 O � � COD CLC.) m L4 m C 00 r:50 rn y � m p CID O.� C7f d O C Q CO CO) m C O y m o CD C/) C cp = m r=.+ LL CO) C= C Z � m .y O v m o m c F - y G 0*5 O :5 g x �r?y'� O CZ_.. m 4 I cm C cn cis CD An O O 'E m m i O O CD D O L 0 M O O. CL =Q y C 0 Cc C d O D C Z 0 0 CL fJ y C — '� C _y D U) U) W w W VJ v 'joRT11 ACHUS Town of North Andover, Massachusetts BOARD OF HEALTH DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 7— Test No 7206 Site Location Z'or Reference Plans and Specs. ENGINEER DESIGN F orm No. 2 19 - DA Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee- '*Ad CHAIRMAN, BOARD OF HEALTH Site System Permit No. A!��D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I1WORTANT: Applicant must complete all items on this page MC.ATMN q3 Cr,,c-K'e4 laix _PROPERTY OWNER i� I 4 ;q -E'- (�t Print MAP NO: PARCEL: ZONING DISTRICT: Historic District . yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No, of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `�$'S eptic 0Welh s ' -� +Floodplaui, ®;Wetlands # 0 Watersfied District:: V �rWater/Sewer: DRSCR]PTION OF WORK TO BE PERFORMF,n- _ $ X115 J�SC fl'le �l't� �' ��� , �V: (,his' W® Identification Pleases Typp or Print Clearly) � n n 3Y' /r Address: 7,p ( n CONTRACTOR Name: /� l sQ � Phone: Zi/ eO 52f3 Address: 14 g�t)te r Woburn ► (Ci Q� �� Supervisor's Construction License: © Exp. Date: / - 131 - 2®``2 l Home Improvement License: Exp. Date: _2- ARCHITECT/ENGINEER qi Cl?a i�('1 _ Siv4' Phone: J Address: A114 42d0,119, IV'6. Reg. No. 31g2-14 2-14 FEE SCHEDULE: BULDINGPIfRMIT,• $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925,00 PER S.F. Total Project Cost: $ G 06(D FEE: $ Check No.: Receipt No.: AT/lTT1_ "- -- - - ---------tS_---...!1r--.------.-t --- --7 -----1-----e r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well El Private (septic tank, etc. N Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Wates' & Sewer Connection/Signature &Date Drivewa rLPermit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COA/AMNTS THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on � /:�3 Signature COMMENTS c- r- Or ,�a N� OU -Vlj r &r��ur a� HEALTH Reviewed on Si nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Wates' & Sewer Connection/Signature &Date Drivewa rLPermit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COA/AMNTS