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Miscellaneous - 93 WINTERGREEN DRIVE 4/30/2018 (3)
N 0 .?w O � G1 Mo m m o z 0 N• = C � N Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q ,else RECEIVED Commonwealth of Massachusetts JUN p 8 2015 Title 5 Official Inspection Form Subsurface Sewage Disposal tem Form - Not for Voluntary AssessmentsTOH OF NORTH ANDOVER 9 Pia � ry HEALTHDEPARTMENT 93 Winterareen Drive Property Address Jon Maren Owner's Name North Andover City/Town MA 01845 State Zip Code 5/30/2015 Date of Inspection/ 1,1' / e Inspection results must be submitted on this form. Inspection forms may not be altered in aby way. Please see completeness checklist at the end of the form. A. General Information GLS 1. Inspector: Neil Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Amilla Road Company Address Andover MA Cityrrown State 9784754786 S115 Telephone Number B. Certification License Number 01810 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4C � A- )119) 5/30/2015 Inspecto s tignature V Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector -and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection acid under the conditions of use at that time. This inspection does not address how the system ill perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner Owner's Name information is required for North Andover MA 01845 5/30/2015 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Owner information is required for every page. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover MA 01845 5/30/2015 City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 ficial Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover MA 01845 5/30/2015 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 to Commonwealth of Massachusetts UyTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner Owner's Name information is required for North Andover MA 01845 5/30/2015 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System •Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,p 93. Wintergreen Drive Property Address Jon Maren Owner Owner's Name information is required for North Andover MA 01845 5/30/2015 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 6 of 17 Commonwealth of Massachusetts zikWjTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner Owner's Name information is required for North Andover MA 01845 5/30/2015 every page. Cityrrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) 2 E Yes ❑ No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No Yes ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owners Name North Andover MA 01845 5/30/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Pumped 2013, owner 1500 gallons Measured tank Inspect tank & tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Yes ❑ No ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3113 Title 5 official Inspection Forth: Subsurface Sewage Disposal System • Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,p 93 Wintergreen Drive Property Address Jon Maren Owner owner's Name information is required for North Andover MA 01845 5/30/2015 every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Septic tank original, d -box & leach area was replaced 6/2/2003, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 1.4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall, 3" PVC in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal ❑ fiberglass If tank is metal, list age: .4 feet ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 4" t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner owner's Name information is required for North Andover MA 01845 5/30/2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 29" 3" 8" 12" 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 Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins • 3/13 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Owner information is required for every page. Commonwealth of Massachusetts Tithe 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover Cityrrown MA 01845 State Zip Code 5/30/2015 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive ,p Property Address Jon Maren Owner Owner's Name information is required for North Andover MA 01845 5/30/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & distribution equal. Evidence of carryover, pumped d -box to clean. No evidence of leakage. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover MA 01845 5/30/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system 1 field 24'x 38' 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 solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover MA 01845 5/30/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 5/30/2015 State Zip Code Date of Inspection Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately Q tr , rt '.4 3 = LAC a-3s'to`I t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Owner information is required for . every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover MA 01845 5/30/2015 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: '4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 10/31/2002 ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Wintergreen Drive Property Address Jon Maren Owner's Name North Andover MA 01845 5/30/2015 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3113 Title 5 Official Inspection Form:. Subsurface Sewage Disposal System •Page 17 of 17 :AI;N l-PU(T MUnWUM11l UI IVIU55aIvIlll5�lt5 City/Town of . System Pumping. Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be'used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Locatio• � / Rig front of housed -eft / Right rear of house, Left / right side of house, Left / Right side of building, Left / Rig ron o uildirig, Left / Right rear of building, Under deck aaaness A-Ab� / "Y/Town state 2. System Owner. Name' HCA�-e-Aj�, Tp Code Address (if different from location) CityiTown ' State � Zip Code • , Telephone Number a i B. Pumping 1. Date of Pumping 3. Type -of system: ❑ 4. l S gate 2. Quantity Pumped: Canons Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System -�� o, 6. System Pumped By.- Nell. y: Neil. Bateson Name Bateson Enterprises Inc Company 7. Locafi%.where contents -were disposed: Waste Water F5821 Vehicle License Number 5" Data t5form4.doa 003 System Pumping Record • Page 1 of 1 ' 7 Summary Record Card generated on 5/26/2015 2:41:55 PM by Maureen McAuley Town of North Andover Tax Map # 210-104.6-0199-0000.0 Parcel Id 16523 93 WINTERGREEN DRIVE MAREN, JONATHAN C. 93 WINTERGREEN ST NORTH ANDOVER, MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.76 Acres FY 2015 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until MAREN, JONATHAN C. Payor 93 WINTERGREEN ST NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 18046.0 - 93 WINTERGREEN DRIVE Last Billing Date 4/16/2015 3180075 03 Cycle 03 Active UB Services Maint. Account No. 3180075 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5/8 7.82 1/ WTR WATER ' 61`ALL METER SIZE 68.40 /1 UB Meter Maintenance Account No. 3180075 Serial No Status Location Brand Type Size YTD Cons 13242755 a Active 00 METE METE w Water 0.63 0.63 1035 Date Reading Code Consumption Posted Date Variance 3/18/2015 1634 a Actual 18 4/28/2015 -65% 12/15/2014 1616 aActual 50 1/15/2015 -30% 9/16/2014 1566 a Actual 76 10/15/2014 224% 6/12/2014'. 1490 a Actual . 22 7/16/2014 -17% 3/14/2014, 1468 aActual 26 4/11/2014 -7% 12/16/2013 1442 aActual 30 1/17/2014 16% 9/13/2013 1412 a Actual 25 10/15/2013 -19% 6/14/2013 1387 a Actual 29 7/24/2013 -4% 3/20/2013 1358 a Actual 34 4/22/2013 10% :.12/13/2012 1324 aActual 27 1/9/2013 -55% 9/19/2012 1297 a Actual 65 10/15/2012 103% -16/18./2012 1232 aActual' 31 7/16/2012 6°j, :3/20/2012 1201 a Actual 30 4/14/2012 14% 12/19/2011 1171 aActual 27 1/17/2012 9% 9/16/2011 1144 a Actual 25 10/13/2011 -28% 6/1.3%2011 1119 a Actual 33 7/20/2011 0% 3/15/2011 1086 a Actual 33 4/13/2011 -33% 12/15/2010 1053 aActual 49 1/12/2011 -38% 9/16/2010 1004 aActual 83 10/15/2010 151% `6L14/- 010 921 a Actual 31 7/15/2010 0% 3/18/2010 890 a Actual 33 4/14/2010 -20% 12/14/2009 857 aActual 39 1/12/2010 10% 9/16/2009 818 a Actual 39 10/15/2009 -3% 6/10/2009 779 a Actual '35 7/20/2009 15% 3/17/2009 744 a Actual 33 4/29/2009 1% 12/15/2008 711 aActual 32 1/20/2009 -27% 9/16/2008 679 a Actual 48 10/10/2008 35% 6/10/2008 631 a Actual 32 7/16/2008 14% 3/14/2008 599 a Actual 28 4/11/2008 -15% Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Susan Y. Sawyer, REHS/ RS Public Health Director 978.688.9540 - Phone 978.688.9542 - Fax CYFR71FICA�E OFC091�1�LIA9VCE As of: ,dune 2, 2003 'This is to cert that the individuafsubsurface disposafsystem repaired (X) — �Fuf�System by John Soucy at 93 Wintergreen Drive North Andover, JKA 01845 has been installed in accordance with the provisions of Titfe V of the State Sanitary Code and with the North Andover 0oard of-7feafth regulations. She issuance of this certificate shaff not 6e construed as a guarantee that the system will function satisfactorify. .: Susa `Y. Sawyer, REif IW S Pu6fc Ifeafth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 RECEIVED JUL 13 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; repaired; located at_ Gl U lviT - was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , plan dated , with a design flow Of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 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: �; J Z Z.o3._ Final inspection date: Engineer Representative Engineer Representative Date: Date: L INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches, sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments:/"� `� ac'S � I . M(,-1 B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10' to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8" per foot minimum 6. Pipe properly set on compact firm base - 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 900 change 10. 10' minimum offset to water line r Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20" manholes 7. Inlet tee minimum 12" under invert 8. Outlet tee minimum 14" under invert 9. Outlet line cemented 10. Air space 3" above tees 11. 2" - 3" drop from inlet to outlet 12. Pipe set 13. Compact base with 6" of 3/4" crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber 1. If separate from tank, compact base with 6" of '14" stone underneath 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size, agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D -box level 2. Minimum 0.1 T' (2") drop from inlet to outlet 3. Minimum 6" sump 14 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double -washed -'/4" = 1 ''/i" - pea stone Bucket test, done? 2. Minimum 2" of pea stone above distribution lines 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope 6. Minimum of 9" of fill graded over system 7. Toe of slope stops minimum 5' from edge of property; if not, then Swale. � I Comments: H_ Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan - Minimum 2'; maximum - 4'. 4. Vent present if <50 feet or specified 5. Distance between trenches minimum 4' and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6" per 100' 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: 1. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipe 6' maximum 4. Pipes connected at end 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: I Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: Name ofDesigner: Plan Date: Revision Date: Date of Review: Property Address: z� �1/� % 46*�'�6/ V/ Map: Lot: BOH Reviewer: Type of Plan (new or upgrade):_ Number of Bedrooms: gpd) Garbage Disposal Allowed: General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5 OKE Problem N/A Street number and map/lot - 220(4)(u) "=40' Maximum scale of 1 for plot plan - 220(4) i/ Maximum scale of 1 "=20' for profile and component details - 220(4) Legal boundaries of the facility being served - 220(4)(a) Names of abutters from recent tax map - NA 8.02j ✓ Number of bedrooms, design calcs., - NA 8.02i Name & address of record owner & applicant - NA 8.02k Name & address of designer - NA 8.021 Holder and location of all easements - 220(4)(b) V , Date plan drawn & any revision date - NA 8.02m L/ All dwellings and buildings, existing and proposed - 220(4)(c) Location of all existing or proposed impervious areas - 220(4)(d) All distances on site plan — NA 8.03a -c Elevation of proposed driveway - NA 8.02t Location and elevation of foundation drain - NA 8.02y _ Location and dimensions of the system incl. reserve (new const.) - 220(4)(e) Limits of excavation of leach area on site plan - NA 8.02z Locus plan - 220(4)(t) (Not to scale) North arrow - 220(4)(g) y Existing and proposed contours - 220(4)(g) Locations and logs of deep holes - 220(4)(h) ✓' Locations and logs of percolation tests - 220(4)(i) ✓ / Date(s) of soil testing - 220(4)(h) & (i) Existing grade elevation of each deep hole - 220(4)(h) f Elevation of percolation tests — N.A. 8.02n Name of approving authority representative - 220(4)(h) & (i) - Name of soil evaluator - 220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines, drains, and subsurface utilities - 220(4)(m) Observed in / . and adjusted g.w. elevation the vicinity of the system - 220(4)(n) Complete profile of the system to scale - 220(4)(o), NA 8.02c Cross section of leaching facility - NA 8.02w (Not to scale) r Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) t/ Note listing all variance requests with proper citations - 220(4)(p) `� Local upgrade approval request form submitted - 403(1) On-site Soil and Groundwater Review OKE , Problem N/A Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests — NA 8.02n Soil evaluation forms submitted within 60 days of field work - 018(2) ✓/ Proper percolation test log - 220(4)(1) Ample deep observation holes in primary disposal area (minimum 2) - 102(2) Ample deep observation holes in secondary disposal, area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) Deep hole testing conducted within two years — NA 7.05 Hole Identification Numbers: ground elevation el. ff G' 15"q! acceptable soil el. 2 Xi ✓/ Original KS./P.E. stamp, signature & date - 220(1) & (2) ,i , % P.E., discipline specified within stamp. MGL C. 112 s. 81M refusal el. ✓ sfc. supplies (w/in 400'), pub. wells (w/in 2501), pvt. wells (w/in 150') - 220(4)( bottom of leach facility el.�� Location of watercourses, wetlands, wells, etc. w/in 150' of system — NA 8.02r / �� ✓� ` Wetland disclaimer — NA 8.02s before & after soil R&R separation to groundwater Jl �f RLS plan reference & certification required (prop line setbacks) - 220(3) Plan contains designer's certification statement L--- Use approvals / standards checked for I/A system - DEP docs., r/ ,r Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3) Perc rate > 60 MPI - must use modified tight tank or UA technology - 245(4) Proposed system qualifies as "shared" system - 002 (definitions) Flow is over 2,000 gpd - No R.S. allowed - 2200) Design flow was set in accordance with code - 203 Existing system location and note on proper abandonment - 354 ✓/ Leaching facility at least 1' above Base Flood elevation — NA 9.05 J All piping Sch 40 minimum — NA 10.01 Basement floor minimum 1' above groundwater elevation — NA 5.04 c/ Foundation drain present with elevation — NA 8.02y On-site Soil and Groundwater Review OKE , Problem N/A Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests — NA 8.02n Soil evaluation forms submitted within 60 days of field work - 018(2) ✓/ Proper percolation test log - 220(4)(1) Ample deep observation holes in primary disposal area (minimum 2) - 102(2) Ample deep observation holes in secondary disposal, area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) Deep hole testing conducted within two years — NA 7.05 Hole Identification Numbers: ground elevation el. ff G' 15"q! acceptable soil el. Leach facilitv invert el.D ground water el. , % refusal el. '3/ 1-7 bottom of leach facility el.�� 1_ thickness of acceptable soil before & after soil R&R separation to groundwater Jl �f 1 separation to refusal 1. W,• soil class 2 perc rate loading rate septic tank below g.w. table pump tank below g.w. table 11 in fill off (yes or no) (yes or no) -255(l) Setback Distances (Given in feet) 15.211 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02 OK Problem N/A Septic Tank Leach Facility Property line 10 10 v Cellar wall 10 20 / Inground pool 10 20 f +� Slab foundation 10 10 1/ Deck, on footings, etc. 5 10 Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 F' Public well 400 400 Wetlands bordering surface 150 150 'water Supply or trib. (in Watershed) Trib. To Surface Water supply 325 325 r/ Reservoirs 400 400 Tributaries to reservoirs _ 200 200 v Drains (wat. supply/trib.) 50 100 v Drains (intercept g.w.) 25 50 �r Foundation drains 10 20 f Drains (Other) 5 10 Drywells 20 25 Downhill slope 15' to 3:1 slope K 3 4 to w/o barrier Building Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) ,_Pipe diameter listed (4" minimum) - 2220) Pipe „schedule listed - 222(3) Pipe cast_#on or Sch 40 PVC — NA 11.02 Watertighfjoints specified - 222(3) & (4) Pipe laid on compact, fin base - 222(5) Pipe laid on continu`bus grade in straight line - 222(7)@ Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 106'fept - 222(8) Manhole at any 90 degree alignm'egt change - 222(8) Invert elevation at building:-------------------------- `. Invert elevation at septic tank: `i,, Length of run: Slope:(minimum of 0.01- 0.02 desird) - 222(6) 10' offset to private well or suction line - 222(2) Septic Tank 0K, Problem N/A Tank is accessible - 228(3) �., No structures above tank — (228(3) Tank can accommodate both primary & reserve — NA 9.04 200% of flow (required & provided given. 1500 min.) - 220(4)(f) &-223)(1)(a) ` 2-3" drop from inlet to outlet - 227(5) Minimum of 4' liquid depth - 223(2) `Y' air space above tees/baffles (minimum) - 227(4) 9" air space above flow line (minimum) - 227(4) Tees e not to be replaced by baffles - 227(1) Tees extend 6" above flow line - 2270) Inlet tee extends 10" below flow line (minimum) - 227(6) Outlet tee extends.14" below flow line (more for deeper tanks) - 227(6) T Gas baffle installed oa,outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compart) 228(2) \, 3-20" manholes - 228(2) 1 childproof; 24" riser/manholc`whn 6" of final grade if <10009pd- 228(2) Inlet and outlet tees on center line`, 2270) Soil compaction below tank specified (if soil is non-native) - 221(2) 6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(1) If> 1,000 gpd AND not a single fain. dwell. must be 2 tks or 2 comp. - 223(1)(b) If plan specifies disposal must be 2 tanks `in series or 2 compart. tank - 223(1)(c) Buoyancy calcs. required if tank at or belo"ater table - 221(8) Tank is watertight - 221 (1) 9" of cover over tank (minimum) - 228(1) H 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) All pumping to tank (if applies) in accordanc\install Tank is set to keep old system in service durinible Fight Tank (Check here if not present: ) OK Problem N/A 500% of design flow or 2000 gallons provided - 260(2)(a) 3- 20" manholes - 228(2) Soil compaction below tank specified (if soil non-native) - 221(2) 6" of <=3/4" stone beneath tank specified - 221(2) & 228(1) Buoyancy calcs. Required if tank at or below water table - 221(8) Tank is watertight - 221(1) 9" of cover over tank specified (minimum) - 228(1) H 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <= 36" below grade - 221(7) All pumping to tank (if applies) in accordance with - 229 AN alarm set at 3/5 tank capacity - 260(2)(c) Min. 1-24" frame w/cover at finished grade - 228(2)(fl Year round access for pumping - 228(2)(g) Distribution Bog (Check here if not present: , OKE Problem N/A Inlet elevation: , - Outlet elevation: 7 Z-' 0.17' drop from inlet to outlet (minimum) - 232(3)(b) ./ 6" sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) Outlet pipes laid level for first 2 ft. - 232(3)(c) Pipe Sch 40 - NA 10.01 , ` Number of outlets: Number of laterals: Size of outlets: 11 ' Inlet baffle/tee min. 1" over outlet invert for all d -boxes - 232(3)(a), / Soil compaction below distribution box specified (if soil is non-native) - 221(2) ✓ 6" of stone beneath distribution box specified - 221(2) Box is watertight - 221 (1) 'Top of box <=36" below grade -221(7) Buoyancy calculations required if box is at or below water table - 221(8) Pump Chamber (Check here if not present: OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day - 220(4)(r) (also 254(1)(d) if gravity from d -box) Minimum 2" delivery line to d -box if gravity - 254(1)( c) Pressure dosed l.f. if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a) Cycles per day is consistent with chamber volume - 23 1 Volume calculations include flowback volume - 2') 1(2) 24 hour storage capacity above pump on elevation - 231(2) `,,` Number of pumps: 2 if system serves >2 dwelling units - 231(6) 'Capacity of pump(s) - gpm @ ' TDH - 220(4)(r) Pump,can pass 1 1/4 "solids (minimum) - 231(7) Pump controls specified - 220(4)(r) Alarm equipment specified - 231(2) Alarm is in building and powered on separate circuit from pump - 2') 1(9) Pump sequence correct (off-lead on-lag on-alan-n on) - 231(8) Pump performance curves included - 220(4)(r) Manual operating switch - NA 12.01 Check valve, bleeder hole,- NA 12.01 1 childproof, 24" riser/manhole to final grade - 2'31(5), Soil compaction beneath pump: chamber specified (if soil is non-native) - 221(2) 6"of <=3/4"stone beneath chmbr&pecified - 221(2) & 228(1), Buoyancy calculations if chamber is\at'or below water table - 221(8)@ 9" of cover over chamber (minimum) 228(1) H- 10 loading (min.) - H-20 if traffic - 226(')), Chamber is watertight - 221 (1) Top of chamber <=36" below grade - 221(7),, Leaching Facility (general - complete for all designs) t_ OK Problem N/A 50% larger if garbage disposal - 240(4) Jl Trenches to be used whenever possible - 240(6) No vehicle or imperv. area above 11.. unless unavoidable - 240(7); NA 13.02 Vented if under impervious cover.- 241 (1) t--- Vented through same pipes as distribution system - 241 (1)(a) Vent protected from precipitation/animal entry - 241 (1)(b) Vent is placed beyond traffic or impervious area - 24 1(1)(c) All lines connected to vent if bed or trenches - 241(1)(d) ✓` 9" cover over peastone - 240(9) ✓� Reserve area provided (new construction) - 248(1) Reserve 4' from primary leach area — NA 9.04 4' (5' if pert rate <=2 MPI) separation to g.w. - 212(a) & (b) 4' (down to 2' with variance or UA - upgrades only) ofnatural soil under 11 i -f GW separation is adjusted to highest existing grade if facility cuts into a hillside ✓/ r Pipe slope minimum of 0.005 - 251(9) Require 5' removal and replacement if in fill - 255(5) '✓ / Top of leach facility <= 36" below grade - 221(7) 7 : Final grade over 11 minimum 0.02 ft/$ -240(10) Surface & subsurface drainage away from l.f. - 240(1 1) & 245(5) Minimum design flow 440 gpd without deed restriction — NA 13.01 3:1 slope where grading required - 255(2) e� Toe of fill slope stops 5' from property line or swale installed - 255(2) (/ Impermeable barrier if < 3:1 slope or < 15 feet to—3:lslope - 255(2) ✓ Impermeable barrier/retaining wall poured concrete — NA 9.02 Retaining wall stamped by RE: - 255(2)(6) Top of retaining wall >= top of peastone elevation - 255(2)(f) L/ 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) Pere test(s) done in most restrictive layer - 104(2) Pere test 4' below leaching elevation — NA 7.06 Design flow listed and required/provided leach area given - 220(4)(f) Leach pipes SCH40 PVC — NA 10.01 Leach pipes minimum 4" diameter except for dosed system — NA 14.04 M Leach lines capped, vented, or connected together - 251(9) pP g Pressure dosing guidance followed if pressure distribution - 254(2)(c ), Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1) Leaching Trenches (Check here if not present: �' ) OK Problem N/A Number of trenches: Minimum of 2 trenches - NA 9.01(2) Depth of trenches (max eff. 2'): -247(l) Width of trenches (2' min., 4' max.): - 251 (1)(b) Length of trenches (100' max.): - 25 1 (1)(a) Trenches are vented (when > 50') - 251 (11) Trenches follow contour lines - 251(2) Trench spacing 3 times effective width ordepth minimum- 251 (1)(d) In fill or reserve between trenches, 10' min. - NA 14.01& 14.03 Available leach area given (Min. 5.00 s.f.) - NA 9.01(2) Bottom = L x W x # = s.f. Sidewall = L x D x# x2= s. f. Effective leach area given Loading factor: Effective area = total area s.f. x LTAR = g/day Effective area is >= design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.- 247(2) Trench depth of 3/4" to 1 1/2" double washed stone - 247(1) Leaching Pits (Check here if not present: ) OK Problem N/A # of pits/pit systems: (dosing chamber if > 1, 231 (1)) Dimensions of each pit or system: L W D Depth of pits (max eff. 2'): - 253(1)(a) Available leach area given Bottom = L x W x # of systems = s.f. Sidewall = L+ W x D x 2 x# of systems = s.f. Total area = bottom + sidewall = s.f. Effective leach area given Loading factor: Effective area = total area s.f. x LTAR = g/day Effective area is >= design flow of facility being served Minimum of 2 pits at least 13'X16' — NA 9.01(3) Distribution for galleries/chmbrs. in trench config. - pipe every 20' - 253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves <= 40 s.f.-253(6) Spacing - 2 times the effective width or depth (the greater) - 253(1)(c) 2"of 1/8"- 1 /2" 2x washed peastone.- 247(2) 3/4" to 1 1/2" double washed stone - 247(1) Each pit has at least one 20" access cover. 24" CI to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1' (min.) and 4' (max.) - 253(1)(b) Vents, if necessary, extend under covers of pit(s) - 241 (e) Leach Fields (Check here if not present: OK /Problem N/A l/ Number of fields: ' (need dosing chamber if> 11 231 (1)) OK Problem N/A VSlope over leach area minimum of 0.02 feet/foot — 240(10) Grading shall divert drainage away from leach area — 240(l 1) Grading slopes away from dwelling 5/24/01 f r Length (100' m .): - 252 (2)(b) Width: Total area: Lx W = �� s. £ ` Minimum 900 square feet - NA 9.01(1) y : Distribution lines connected with solid pipe — NA 15.01 Effective leach area given Loading factor: & Effective area = total area s.fx LTAR= g/dav r 7.r Effective area is >= design flow of facility being served Minimum of two distribution lines - 252(2)(a) 6' line separation (max.) - 252(2)(d) - 4' maximum separation from edge of field to line -'252(2)(e) 10' minimum separation between adjacent leach fields - 252(2)(f) Between 6" and 12" of 3/4 - 11/2" stone beneath field 252(2)(g) - & 247(2) 2"of 1/8"-1/2" 2x washed peastone.- 247(2) Final Grading OK Problem N/A VSlope over leach area minimum of 0.02 feet/foot — 240(10) Grading shall divert drainage away from leach area — 240(l 1) Grading slopes away from dwelling 5/24/01 f NEW ENGLAND ENGINEERING SERVICES INC Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 93 Wintergreen Drive, North Andover Dear Sandra.: May 22; 2003 e:F tl.L:s;� MAY 2 $ 2003 This office has inspected the bottom of bed excavation at the above referenced property. The knob of ledge that was found at the east side of the excavation has been determined to be at elevation 92.99 at its highest point. This point lies within the overdig of the leach field. A small portion of the rock lies under the leach field at an elevation of 92.2. The area under the leach field is no larger than 3' by 8' and will have over 4 feet of sand between the ledge and the bottom of the leach field. It is the opinion of this office that the treatment ability of the system will not be compromised by the presence of the minor amount of ledge and the system will function as designed. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, Benjamin C. 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NEW ENGLAND ENGINEERING SERVICES INC January 23, 2003 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 93 Wintergreen Drive, North Andover, Septic system design Dear Sandra: Enclosed are the following documents for the above referenced property 1. 5 copies of septic system design plans, one with an original stamp. 2. Application for approval and required fee. 3. Copy of soil evaluator sheets. This plan is being submitted for approval. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, 1=' a4Bentom/ C jaZi mC. OsgJT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 SEPTIC PLAN SUBMITTAL FORM LOCATION: �3 D21O NEW PLANS: CE) REVISED PLANS: YES $160.00/Plan $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: 111 N I o 3 DESIGN ENGINEER: N tw EN "AN o i ti 6-YA-,' a�,v 6 --- DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. Town of North Andover, Massachusetts Form No. 2 G1 Mop*MBOARD OF HEALTH 00c F a s s♦ +' DESIGN APPROVAL FOR „"Usft� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant.I/L �/ .% L/ esto.� Site Location Reference Pla Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee Site System Permit No.O% BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS TUiVN OF HANDO RBOAR EALTH OCT $ 2002 a DATE: , 2 MAP &PARCEL: � t�I ►ori, 0- * Ql as -C)o C)0 - LOCATION OF SOIL TESTS: i,, T,V G f-ec A 2►vc' OWNER: -3--b of Mc, r rev TEL. NO.: ADDRESS: ` re j o— A l p axu kin 00c /L- ENGINEER: 1VG,.y ry(rLJ9,�0 �N G, -c N Fz- 2Mv fr-- TEL. NO.: '27 8 - 6 -h -1 ' 3 CERTIFIED SOIL EVALUATOR: 6e^ I2 "c- c�Lt Intended Use of Land: Residential Subdivision g1e Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $200.00 per lot for repairs or u rades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: l v f Date Received: Check Amour/ Date: 7 4 W PRo ,. pox �r GRADING. FASENIt" `N 1 00 6AL h sbPT� rA►�I< ai IV 14• .. G IELI Pp paSr P. o l� tid i l ti/I/ �� C a� �i )Gs 11 ? i W'l I AY � F' G,6 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH ,,,ED '6� O I 3 6 �d ti ,. ,� •ifs"'.:. m DQ "AT ".ED ' APPLICATION FOR SITE TESTING/INSPECTION ACHUSEt�y Applicant JQ N NAME ADDRESS Site Location -592 � TELEPHONE Engineer 82E5 NAME ADDRESS TELEPHONE Test/Inspection Date and Time J CHAIR AN, BOARD OF HEALTH G'o� cTl Test No. �O _D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. /'�e `2 Date: // //o 2 -- Commonwealth of Massachusetts Ala. , jk,��� , Massachusetts Soil Suitability Assessment for On-site ewa a Dis osal Date: Performed By:,.'�hl�................�........ _ .��� Witnessed B ..................... _.__... . Local Address a �� / [Y ` '* r v� `^^ Owt= 4 Name, /� ���� Address, and �r' �'"� La A /V ©� �iD� / " v1 Telephone I 9� W// "r, New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes Year Published / 1.9e / ............... ... Publication Scale �'. Soil Map Unit .. . Drainage Class %'�'�4,4........... Soil Limitations leg Surficial Geologic Report Available: No R1 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) ............................................ ..................... .. Landform...................................................... . 4 Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: .......... National Wetland Inventory Map (map unit) ................................ .... ... --................ . _. Wetlands Conservancy Program Map (map unit) . Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal [�Belcw Normal ❑ Other References Reviewed: DEP APPROVED FORM - 12/07/95 Location Address or Lot No. 0 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 On -site -Review Deep Hole Number Date:- /4r/ -7//O 2- Time-. Weather Zwv— 44 Location (identify on site plan) Land Use -;2 Slope Surface Stones Vegetation . . .... Landform ---.49 Position on landscape (sketch on the back) Distances from; Open Water Body,/995� feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other ... 7�7 .. . . . . . .. ...... ... DEEP OBSERVATION'HOLE LOG* Depth from Surface (inches) Sol] Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 4 'e -i5 MINI :b Ktu pfjaputj�,u DISPOSAL AREA Parent Material (geologic) eolv-&- Z74:� Dapthto Bedrock: -- Depth to Groundwater- Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Waten- DEP APPROVED FORM - 12/07/95 9 FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot No. On-site Review a Deep Hale NumberZ" T e:.f�-.lid Weather/..�o ,: 77 .::iii ::.....:::.: Location (identify on site plan) � .. Land Use /.X9.%4, Slope (%} ....., urface Stones 7dy Vegetation. .:.w/G�.....:....... Landform ---- Position Position on landscape (sketch on the back) Distances from: Open Water Body . feet Drainage way feet li Possible Wet Area �'. 7. feet Property Line feet Drinking Water Well f'"D feet Other LEEP OBSERVATION HOLE LOG" Depth from Soil Horizon Soil Texture Soil Color Soil other Surface (lnches) (USDA) (Munsell) Mottling {Structure, Stones, Bouleders, Consistency, % Grav ANV MINIMUM 0 71RED AT EVERMOPOSED DISPOSAL MT Parent Material (geologic) �•`�.�" l ' L Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water:� / DEP APPROVED FORM . 12/0719S DepthtoSedrock: Weeping from Pit Face: FORM 11 - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. ! �/.,c�.,9d2.. Method Used: ❑ Depth observed standing in observation hole ............. inches ❑ Depth weeping from side o observation hole. inches ,� /- Depth to sail mottles ....::....:.: inches -�2 ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date .................. Index well level ................ g J Adjustment factor ................... Adjusted round water level ...................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist i;Ai eas 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 �9 (date) l have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed byme 1 s Qt17 t with the required training, expertise and experience described in 310 Signature Date DEP APPROVED FORM • 12/07/95 . r 45 oc,= Io N: 3 . �.✓ 1��e , .. ...........80. "M -IN S. 'U O L=. i I.C� N i i .= Cl - 17 r., -,c I Vii: i NI TIME i`IA''Ii �. ! 3 OVE=NICD iIrNiE S T = N l- y - T NIS•.; 0 1/1 �(3 G INV PIPE INTO T,4NIl �O INV. PIPE OUT OF 74 -NK IZ6. 0 124,94 INV PIPE INTO D. BOX sLOPF 2Qvr2E�ENT (/50) X = 150 - _ ........................... DESION C4EMTION .4T ......... (FOR OF STONE) _ ............................. EY15TINC ELEvdrlolv QT......... 2EQUIeEO FILL = ........................... . z�LEl�.�1T/ONS oE5iGN Qsaur�r �,�. eS R//// T /NV PIPE OUT OF 11011,5E INV PIPE INTO T,4NIl 12, 6, g3 INV. PIPE OUT OF 74 -NK IZ6. 0 124,94 INV PIPE INTO D. BOX 6. 4 , z 4 , 6 INV PIPE OUT OF D. BOX , -7 INV END OF PIPE 12 o o z4, z4 GVd TE2 a EVQ TION 1170 ,4 VERWOE STONE DEPT11 47 ReOBE 6 qC. GoT IV � SUB-SU2F.4CE Poeo-s—.4—t .0 � SYSTEM //v ,loarH q"co „E2 NOTE: T11I5 PLAN /S NOT ,4 141,41e1e41VTY of T11E SYSTEM BUT ,4 !/E2IF/C,1T/ON OF TXIE I-OCMTION OF 71-1E EY/STING STPUCTU2ES. FOA' &/\J //\/A -G©/v5-rkuC ION 0.4rE: /2-21-87 641,e/ST/,4N5EN ENC/NEEo'/NC,11W 114 ACENOZ.4 .4 VE., 114VEeN/L L, 1W,4. Q