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HomeMy WebLinkAboutMiscellaneous - 940 JOHNSON STREET 4/30/2018946 3c10t)m- S1. N O oo D "-I- _ rf fi North Andover Board of Assessors Public Access Page 1 of 1 http://csc-ma.us/PROPAPP/display.do?linkld=1708444&town=NandoverPubAcc 10/7/2011 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 940 Johnson Street Property Address Steven Diamond Owner information is required for every page. Owner's Name North Andover City/Town MA 01845 State Zip Code 5/17/2016 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out RECEIVED forms on the computer, use Inspector: 1only ✓ op the tab key MAY 2 4 2016. to move your Neil J. Bateson cursor - do not use the return Name of Inspector TOWN OF NORTH AN key. Bateson Enterprises Inc. HEALTH DEPARTMENT Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town state Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification 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 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 4 5/17/2016 Inspectors ignatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover MA 01845 5/17/2016 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover MA 01845 5/17/2016 Cityrrown 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • 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 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover MA 01845 5/17/2016 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 '/2 day flow t5ins - 3/13 Title 5 Official inspection Form: Subsurface Sewage Disposal System - Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M �' 940 Johnson Street Property Address Steven Diamond Owner Owner's Name information is required for North Andover every page. Cityrrown MA 01845 5/17/2016 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 Fonn: Subsurface Sewage Disposal System • Page 5 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover Citylrown C. Checklist RAA n1lQAA 5/17/2016 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 550 t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts jTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner Owner's Name information is required for North Andover MA 01845 5/17/2016 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins - 3113 Title 5 Official inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner Owner's Name information is required for North Andover MA 01845 5/17/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: Never pumped 1500 gallons Measured tank. Inspect tank & tees. ® Yes ❑ No ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3113 Title 5 Official Inspection Form: 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 "t 940 Johnson Street Property Address Steven Diamond Owner information is required for every page. Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01845 State Zip Code 5/17/2016 Date of Inspection Approximate age of all components, date installed (if known) and source of information: 4 years old, 6/3/2012, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Finished cellar unable to see piping leaving foundation. 4" PVC to septic tank. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 1 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 4" ❑ Yes ❑ No t5ins • 3/13 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 940 Johnson Street Property Address Steven Diamond Owner Owner's Name information is required for North Andover MA 01845 5/17/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 4" 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 9" 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.): Inlet tee ok. Outlet tee ok. Depth of liquid above outlet invert, found clogged outlet filter. Cleaned filter, level back to normal. No evidence of leakage. Inlet cover has riser 6" deep. Outlet cover has riser to grade. Pumped septic tank. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal feet ❑ 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: 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover MA 01845 5/17/2016 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover MA 01845 5/17/2016 Cityfrown 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, has flow levelers. No evidence of carryover. No evidence of Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No" Alarms in working order: ® Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump tank ok. Pump ok. Floats ok. Pump tank 2' deep. Has riser cover to grade over pump & floats. Alarm has both audible & visual. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner Owners Name information is required for North Andover MA 01845 5/17/2016 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 40 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign ponding to surface. 40 infiltrators, 4 lines 10 chambers per line. Opened up inspection port, no liquid present. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owner Owner's Name information is required for North Andover every page. Cityrrown MA 01845 State Zip Code 5/17/2016 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 • 3113 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 Forth - Not for Voluntary Assessments 940 Johnson Street Property Address Steven Diamond Owners Name North Andover MA 01845 5/17/2016 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketICh in the area below ❑ drawing a ached separately RE C, 0-1— 56 IP7 11 P .i, t C ac"' rv" 3<9' Li / 1'7 1, iQ F, t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 940 Johnson Street Property Address Steven Diamond Owner information is required for every page. Owner's Name North Andover MA 01845 5/17/2016 Cityfrown 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: 10/31/2011 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 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 940 Johnson Street Property Address Steven Diamond Owner's Name North Andover Cityrrown MA 01845 5/17/2016 State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 Commonwealth of Massachusetts 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 submitied.to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/ Right front of house Rig ear of hous Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Ctlylrown State Zip Code 2. System Owner. Name Address (if different from location) CiVrown B. Pumping record 1. Date of Pumping 3. Type -of system: ❑ ❑ Other (describe): Telephone Number ; I Date 2. Quantity Pumped: Gallons y Cesspool(s) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? �[]No' If yes, was it cleaned? es ❑ Na 5. Condition of Syste . -1 Glc 6 6: System Pumped By: Neil. Bateson F5821 Name Vehicle license Number Bateson Enterprises Inc Company 7.JS!gne 5H&uI tents -were disposed: Lowell Waste Water `7 --�,� Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 " Summary Record Card generated on 5/4/2016 2:39:09 PM by Karen Hanlon Town of North Andover Tax Map # 210-107.A-0091-0000.0 Parcel Id 17916 940 JOHNSON STREET STEVEN DIAMOND 940 JOHNSON STREET NORTH ANDOVER MA 01845 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.01 Acres FY 2016 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until STEVEN DIAMOND Owner 940 JOHNSON STREET NORTH ANDOVER MA 01845 TAYLOR, CARROLL H. Previous Customer Inactive 12/7/2011 940 JOHNSON STREET N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14307.0 - 940 JOHNSON STREET Last Billing Date 3/14/2016 2100305 02 Cycle 02 Active UB Services Maint. Account No. 2100305 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 53.20 /1 UB Meter. Maintenance Account No. 2100305 Serial No Status Location Brand Type Size YTD Cons 16336887 a Active ERT METE METE w Water 0.63 0.63 666 Date Reading Code Consumption Posted Date Variance 2/3/2016 1559 a Actual 14 3/28/2016 -4% 11/2/2015 1545 a Actual 14 12/30/2015 -15% 8/5/2015 1531 a Actual 17 9/14/2015 _62% 5/5/2015 1514 a Actual 44 6/22/2015 1% 2/3/2015 1470 a Actual 44 3/20/2015 118% 11/3/2014 1426 a Actual 20 12/15/2014 -11% 8/4/2014 1406 aActual 22 9/11/2014 42% 5/7/2014 1384 a Actual 16 6/12/2014 39% 2/4/2014 1368 a Actual 12 3/17/2014 -49% 10/31/2013 1356 aActual 22 12/20/2013 -58% 8/2/2013 1334 a Actual 54 9/18/2013 253% 5/1/2013 1280 aActual 14 6/18/2013 23% 2/5!2013 1266 a Actual 13 3/13/2013 -61 10/31!2012 1253 a Actual 29 12/13/2012 -1% 8/7/2012 1224 a Actual 33 9/26/2012 141 5/3/2012 1191 a Actual 13 6/20/2012 729% 2/2/2012 1178 a Actual 1 3/14/2012 _83% 12/6/2011 1177 f Final Bill 13 12/6/201170% -70% 8/2/2011 1164 a Actual 31 9/14/2011 5/4/2011 1133 a Actual 14 6/13/2011 _42% 2/7/2011 1119 a Actual 30 3/15/2011 -5% 11/1/2010 1089 aActual 29 12/13/2010 95% 8/3/2010 1060 a Actual 15 9/13/2010 p% 0% 5/4/2010 1045 a Actual 15 6/9/2010 2/2/2010 1030 aActual 16 3/11/2010 25% 11/2/2009 1014 aActual 21 12/11/2009 16% NOTE: 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 "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. SIGNATURE OF DESIGNER DATE NEW Lm t �yG JOHNSON STREET AS BUILT PLAN IONAL�� OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN 0 NORTH ANDOVER, MASS./940 JOHNSON STREET >Z ;7 AS PREPARED FOR �o z o DAVE TAYLOR TM: 107A gg a m DATE: 6-3-12 TL 91 SCALE: 1"=40' m S v 0 20 40 80 A MERRDUCK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 • PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CeniLicate o f Compliance As of ,dune 21, 2012 This is to cert that a SATISFACTO TI-AVS1TECT105Y Was completedfor the: Installation(placement of an a ■ On Site Wastewater OisposalSystem (By. Ali a at: 940lohnson Street Parcel ID :210/107.A-0091-0000.0 Xorth .,Andover, 51(A 01845 The Issuance of this certificate shaff not be construed as a guarantee that the On Site Sewage 1Disposaf System wifffunction satisfactorify. usa 'Y. Sawye M& Yfeafth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthondover.com HORtp O�t,aao .��•1C 3r �! . r ., •. OG i. i i � • w+�.o .Atg9 34C"Wo PUBLIC HEALTH DEPARTMENT Community Development Division JUN e 412 TOWN OF NORTH ANDOVER _ HEALTH DEPaaTn seg« TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( constructed; ( ) repaired; By: (Print Name) Located at: q-© JeH 0 *PN (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated I ff7 and last revised on �� 2l '� , with a design flow of 17 lO 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:r7' �' 1 2 17A,L.L, " FyL6y0e And – Print Name Final Construction Inspection Date:^77�' And – Print Name Installer: J C,Q� ` (Signature) Enginer: 0401 (Signature) 22-L2J_,-�- Engineer Representative (Signature) Engineer Represen tive (Signature) Date: 6 – 22— 0 And – Print Name Date: 6�_'f – /Z And – Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com t , RECEIVED AS-BUILT CHECKLISTA, CHECKLIST, JUN •: L Ll.l2 All changes to the design plan have been reflected on thas-buit;/�iomod TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Is of suitable scale; (one inch = 40 feet or fewer for plot plans and one inch = 20 or fewer for details of system / components) ✓/ Lot number, Street Name, Assessors Map and Parcel Number ✓ Lot Lines and Location of Dwellings served by the system ✓ Locations & Dimensions of system, including reserve (if applicable) Ties to dwelling or Permanent Structure & Wells a. From Septic Tank b. From Leach Area As of: Wednesday, April 27, 2011 ✓ Ties to Lot Lines from leach area Locations of Deep Holes & Peres Elevations of Disposal System r/ Top of Foundation Elevation Locations of Wells, Drains, Watercourses within 150 feet of system Location of water, gas, electric lines, cable -- Distances from Corners of House to Center of Tank & D -Box Location of Structures within 6 Inches of Finished Grade Original Stamp & Signature Location and holder of any easements which could impact the system Impervious Areas; Driveways, etc North Arrow ✓ Location & Elevations of Benchmark used STATEMENT ON PLAN (NA 5.3) "I certijly 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. " Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT (NA 4.9) Letter or statement on the as -built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of: Wednesday, April 27, 2011 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, June 12, 2012 10:08 AM To: 'Bill Dufresne (wrdufresne@comcast.net)' Subject: Septic - 940 Johnson St - Need As Built and Final Certification Form Attachments: Construction Inspection 940 Johnson 6-1-12.doc; L field at 940 Johnson.JPG Hi Bill, Michele did the Final Grade for 940 Johnson Street. She checked the grading and pipe, and all is okay. So .... we are all set for the As Built and final certification form that you and Mike need to sign. Thank you! O --Pamela From: Randy Burley jmailto:rburley(abmillriverconsulting.com1 Sent: Friday, June 01, 2012 3:19 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 940 Johnson St Hi All, The system installed by FP Reilly was installed properly. I cautioned the installer to be mindful of the grading when backfilling and that 3 feet was the maximum allowable cover; he acknowledged. You can see from the attached photo, the system is deep near the vent. It is not greater than 3 feet and should be fine unless the contractor is not careful and puts too much fill on. As always, feel free to contact me should you have any questions. Randy Burley Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsulting.com rburleygmillriverconsulting 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/ore/l)reidx.htm. Please consider the environment before printing this email. North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 940 Johnson St. MAP: 107A LOT: 91 INSTALLER: F.P. Reilly DESIGNER: Merrimack PLAN DATE: 11-13-11 BOH APPROVAL DATE ON PLAN: 12-12-11 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 6-1-12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by Visual testing ® Inlet tee installed, centered under access port Comments: PUMP CHAMBER ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ® Hydraulic cement around inlet & outlet ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ❑ cover at final grade installed over pump access port ® Water tightness of tank has been achieved by visual testing ® Hydraulic cement around inlet & outlet Comments: Only visual water test to pump float elevation. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: 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: 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 ❑ 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 ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: Warned contractor to not have more than 3' of cover over system; it appears to be somewhat deep in portions. SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers LP ® Number of chambers per row: 10 ® Number of rows (trenches): 4 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 100.00 100.00 Building Sewer OUT 91.47 91.5 Septic Tank IN 90.53 90.13 Septic Tank OUT 90.17 89.88 Pump Chamber IN 89.76 89.70 Pump Chamber OUT pressure pressure Distribution Box IN 97.45 97.40 Distribution Box OUT 97.26 97.23 Lateral 1 INVERT 97.21 97.18 Lateral 2 INVERT 97.21 97.18 Lateral 3 INVERT 97.20 97.18 Lateral 4 INVERT 97.20 97.18 Bottom of Bed/Chamber 96.91 96.90 FINAL GRADEINSPYx ON / c - Date: Cv Address: ❑/ LOAMED? oNEEDED? o COVER PER PLAN? r V -V' r .` �-�. � , Pati � � - ,+�.' � �"� . � a� E , • -:`��" t�'� �, � J -,, +1+. fi,,,s�"' �' y'."� �," < til. /S {�•, ��t��'��' +: r '��"t,i � fA ��.. J � � '1� t♦'S�i:�. 'r♦'r' ` 41�� ; r r, "� . M 1 �' q � �� 4 r ].'Y �''�+♦ �:W��J/ ^'" �.I'-'�n �CYTR •..i,� A�`�I'f� ,rr'� _ � ra at:�,A .� / za" „- ��� 'y,. ^®.' '",� f . ` •� ftp :�,se+�V1 r, •l� �+r� � � Y it f /' _ � �1• .� � J, y�'� .. t+ X44. r.,. •� iy i- r � `5r y} ,y .. .:� ` �.. � ,� h,_ L•. ♦y�y'�vf �`{��,�ta'j .'`fit _�eM`� X M'� �. �. '!tel .✓ J •• � , � r �.'r! *j., �, .1� � t r , •� ' , • ;t •' , r tea, �1 ��%' �%�i ,'+'"� f i t { r�, , 1"lt�• •..``' ��. 1��'ir 41, �`•i.frri Y' ii 'r'. �. b+y� w704' •f"' may' �� 1* ,lk � _ � T� %-%, a �i f:.� .� i�L' +Rg � -7i+� � •�. r+ {• 1` J i /''f ` 1 x.�'r4 `µ �K" �� ri` i 04, gtv 4't��� j]`'`��r'�aA=a 1, 1 '"�*•�r , Commonwealth of Massachusetts Map -Block -Lot �'����"'� • 107.A0O091091Lot _ BOARD OF HEALTH North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair -FULL SYSTEM) by---Mike R_e_i_ll__y------------------------------------------------------------------------------------------------------------ -- Installer at No 940 JOHNSON STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2012-054__ Dated ___April03 _,_2012___-___ ------------- - ----------------------------------------------------------------- Printed On: Apr -03-2012 BOARD OF HEALTH A N°Rt„ Application for Septic Disposal System ..Construction Permit —TOWN OF ORTH ANDOVER. MA 01845 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rah mrtm Application is hereby made for a permit to: ❑■ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information 940 Johnston Street Address or Lot # North Andover City/Town TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component RECEIVED TOWN OF NORTH ANDOVER HEALTH PARTMENT� 2.- *,TYPE OF SEPTIC SYSTEM*: ump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ rn ventionatl System (pipe and stone system) trator 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 Dave Taylor Name 12 Souhegon Dr. Address (if different from above) Nashua Citylrown 3. Installer Information Michael W. Reilly Name 206 Andover Street, Suite 11 Address Andover City/Town 4. Designer Information Name 66 Park Street Address Andover City/Town NH 03063 State Zip Code 603-315-3864 Telephone Number F. P. Reilly and Sons, Inc. Name of Company MA 10 State Zip C de 978-475-1237, 8-375-4811 Telephone Numb r (Cell Phone # ff ossi /e please) 6'-(,>V 1-t'e'L-� Merrimack Engineering Name of Company MA State 978-475-3555 01810 Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Pape 1 of 2 JUN-1-2004 10:55P.FROM: T0: 19784753102 Date...... *OA/q Of�°°.e , .�,. �} TOWN OF NORTH ANDOVER PERMIT FOR WIRING I . This certifies that has 'on to form ' >�� per .......:..,��.....U� ............... r� wiring in the building of..........:!................................................. at .........9W.... ........ ................ -,NcrthAndoveL Man. -=�Fee............. Lic. No.K73r •... ....... .................. ..... ... ..........,:..... �j [CAL INSIEi� R Check N tae P. 1/1 f Application for Septic Disposal System (Construction Permit -TOWN OF NORTH 1 PAGE 2OF2 A. Facility Information continued.... D] 5. Type of Building: ❑■ Residential Dwelling or ❑Commercial B. Agreement 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,i4scped �y this Board of Health. Name / Date Applic i n Approved By, oard of Health Representative) 7e' ' Date Application Disapproved for 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): Yes r/ No Yes l/ No Yes_ No Yes_ No Yes_ I No Application for Disposal System Construction Permit • Page 2 of 2 f SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: q yp T®hn,5m St �r�aC1 (Address of septic system) For plans by e r - c -L (Engineer) Relative to the application of % 17 fp l (Installer's name) And dated rigina ate Dated o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved glans 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. ompanya. Bottom of Bed — Generally, this is the first (P) 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: healthdel2t@townofnorthandover.co 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* complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consmitant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer. I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) ir, / L P (Name — rint T ' are —'Signed) DelleChiaie, Pamela From: Sent: To: Cc: Subject: Sawyer, Susan Monday, October 24, 2011 11:51 AM DelleChiaie, Pamela 'Marianne Peters' RE: Soil Testing for 940 Johnson scheduled for Mon/Nov 7th @ 9:30 I suspect this means we will have a plan in here by Nov 2nd and then we'll be the bad guys. I had also had ag ood conversation with the son of the deceased 2 weeks ago and told him they should focus on selling with an approved plan, as the end of the season is near. So as not to push everyone. We will not push for a review just to get an installation permit pulled by the Nov. 15th deadline. If they have to come to the Nov. 17th meeting for out of season installation so be it. Or even December. Thx ' S From: DelleChiaie, Pamela Sent: Monday, October 24, 2011 11:29 AM To: 'Marianne Peters' CC: Sawyer, Susan Subject: RE: Soil Testing for 940 Johnson scheduled for Mon/Nov 7th @ 9:30 Thank you!!! @ r�iat ,�igetrda, Pamela DelleChiaie From: Marianne Peters Lmailto•moeters@millriverconsultin Sent: Monday, October 24, 2011 11:27 AM "" ��ml To: DelleChiaie, Pamela; Sawyer, Susan; Grant, Michele CC: wrdufresne(c Comcast net; 'Randy Burley' Subject: RE: Soil Testing for 940 Johnson scheduled for Mon/Nov 7th @ 9:30 Rescheduled for October 31St, same time; all moved up! Q -----Original Appointment ----- From: DelleChiaie, Pamela Lmailto•odellech@townnfnorthand Sent: Monday, October 24, 2011 10.13 AM overcoml To: 'Daniel Ottenheimer'; 'Isaac Rowe'; 'Peters, Marianne'; 'Randy Burley'; Sawyer, Susan Subject: Soil Testing for 940 Johnson scheduled for Mon/Nov 7th @ 9:30 When: Monday, November 07, 20119:30 AM -12:30 PM (GMT -05:00) EasternTime (US &Canada). Where: 940 Johnson Street, North Andover, MA 01845 Monday — October 24, 2011-10:12 a.m. Hello Mill River, 1 received a call from - 603-315-3864 — David Taylor — Trustee for 940 Johnson Street —who called to that this soil testing be scheduled ASAP, and not wait until Nov. 7th. Is there anyway in our all ed o request could happen? Bill Dufresne told Mr. Taylor that it had to do with Mill River's availability. Please let m Y e that this if any sooner scheduling is possible. Thank you. tY e know Pamela NAHD i From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Friday, October 21, 20111:41 PM To: DelleChiaie, Pamela; Sawyer, Susan; Grant, Michele Cc: 'Randy Burley';'Isaac Rowe' Subject: Soil Testing for 940 Johnson scheduled for Mon/Nov 7th @ 9:30 Soil testing for 940 Johnson w/Bill Dufresne scheduled for Monday, November 7'^ @ 9:30 with Randy. Marianne Peters Office Manager 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 Fax: 978-282-1318 www.millriverconsulting.com mpeters@miliriverconsulting.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. << Message: Soil Testing for 940 Johnson scheduled for Mon/Nov 7th @ 9:30 (23.0 KB) >> 2 P North Andover Health Department (ommunity Development Division December 12, 2011 Vladimir Nemchenok c/o: Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 940 Johnson Street, Map 107A, Lot 91 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated November 13, 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. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested. Please submit the Form 9A Local Upgrade Approval request or revise the design plan (3 10 CMR 15.405(1)(k)). 2. A local variance will be required to be requested to have the tank(s) less than 75' to the wetland resource area NA Table 1. Please submit request to be on the next BOH meeting. List all variance and LUA's requested. 3. Please note all LUA and local variance requests on plan NA 3.2 4. The notation in the "Deep Test Results" calls for the C material in T-1 to be GR. SL. The soil logs call for a GR. LS. Please clarify 5. Please illustrate the distance from the pool to the tank (I Wmin. or LUA) 6. Please provide a pump curve 15.220(4)(r) Page 1 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 P 7. The soil log and "Deep Test Results" call for the ground elevation of T -I to be 98.8 but there appears to be a spot grade of 99x9 right next to the test pit on the site plan. Also scaling between the contours it appears the 99.9 is more accurate of a grade than 98.8. Please re-evaluate design parameters. 8. In the "Design Calculations" the perc rate is referenced to be, "3 M.P.I. *SEE SIEVE ANALYSIS BY TERRA FILTER". The sieve analysis reference appears to be have been inadvertently copied from another plan. Please clarify. recommendation, though not required by the codePlease note the reviewer has observed a repeated problem in the field, and has the following . Depict a gas baffle 15.227(4); while Title 5 says for an effluent filter or gas baffle, the preference is for both, for the reason that if the effluent filter is removed and not reinstalled, the gas baffle feature is also lost. This is not a deficiency only an observation. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, cc: File Homeowners — CARROLL H & MARY A TAYLOR TRUSTEE, TAYLOR FAMILY TRUST Attach: Page 6 of the local septic regulations I I I 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 3.4 Design plans for a tight tank shall require approval of the Board f hearing' oHealth at a public 3.5 All drilled or dug wells shall meet all setbacks and be considered of wells. potable water supply 3.6 Wetlands resource area setbacks as described in these regulations and in Title measured from the resource as may be jurisdictional under federal, state or North Ando ale to be requirements. are 3.7 No well shall be constructed or placed within the distance specified from the component of an existing onsite wastewater system, p fled in Table 1 3.8 if a variance to the North Andover Board of Health regulations, Title S Approval and/or Title 5 variance can be met with the incorporation of a Massachusetts Upgrade Department of Envir onmental Protection (DEp)_approved device which reduces usetts levels below 30 irzg/L BUD and 30 l;rg/L TSS, then the design plan can be approved wastewater to Health Department and does not require a hearing before the Board of Healtunless by the required. otherwise 3.9 1'er the current fee schedule, the fee for the onsite wastewater system la Paid upon initial submission and will cover the first rev►sion if applicable. Each subsequent shall be revision will require a separate fee, eluent TABLE 1 -SETBACK DISTANCE TABLE Resource Bilild Septle Tanks, Primp Tanks, iug Soil Ti-catinelit Units, Tigiit Sewrel' H"Its, Grease Tl'R ) 13 ( feet Absol' tion h ) System (feet) Deck on footings—"" Tributaries to Surface S r 10 Water Supply Watercourses or Wetland 325 Resource Areas Wetlands Bordering 75 100 Surface _ Water Supply or Tributary 150 150 in watershed district) Private Well 50 (setUacks are s1400"Ient4d to MAD,CPL 310CM-JR 1 S) Page 6 -- /TACK ENGINEERING SERVICES, INC, !AL ENGINEERS LAND SURVEYORS PLANNERS ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL info@merrimackengineering.com Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 RE: 940 Johnson Street Dear Ms. Sawyer, TOWN O HEALTH Qom' We received your review letter dated 12-12-11 for the above referenced site. We revised the plan with regards to item #I through 6 and #8. With regard to item #7, the reviewer is incorrect. T-1 was performed on the side of the lot which had steep slopes and undulating topography with several small knolls and hills. The test pit was performed in a saddle at the base of a knoll. Please note that equally as close to T-1 is a spot elevation of 98.4. Why would the reviewer not assume that the test pit was closer in elevation to that spot grade? The fact is that the slope is not consistent between the two contour lines and so it is incorrect to interpolate grades between the two contours. The grade in reality drops quickly then flattens before T-1 so the elevation of T-1 is closer in value to spot elevation 98.4 than it is to elevation 99.9 as suggested by the reviewer. Additionally we checked our survey notes and confirmed the elevation. Please note that we revised the plan such that a local variance is no longer required for the setback distance to a wetland for the pump tank or the septic tank. We did however request an additional LUA for the distance from the septic tank to the foundation from 10 ft. to 7 ft. All LUA requests are noted on the revised plan. We feel we have adequately addressed your concerns and respectfully request that the plans be approved as re -submitted. Yours truly, William Dufresne Merrimack Engineering services. TOWN OF NORTH ANDOVER f N°RTk Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 ��SSACHus try Susan Y. Sawyer, REHS/RS Public Health Director SEPTIC PLAN SUBMITTAL FORM Date of Submission: 11 — 1'7— Site Location: q q o Engineer: 0 978.688.9540 — Phone 978.688.8476— FAX E-MAIL: healthdept@townofnorthandover.com WEBSITE: hlip://www.townofnorthandover.com New Plans? Yes--A$225/Plan Check #_ 4 410�kincludes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes (/ No Local Upgrade Form Included? PA-�es No ' Telephone Fax #: E-mail: i cl I�YI U i� 1��N l's� IIT Homeowner Name: Ali, TKYL-a w' OFFICE USE ONLY When the submiss' n is complete (including check): ➢ 7"Date stamp plans and letter ➢ Complete and attach Receipt ➢ ��6py File; Forward to Consultant );o Enter on Log Sheet and Database O N 0 CL t� 4) d v/ 1 O L O 4— E N N CD d � t � Q m V- 0 0 Z 1 0 r. 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Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. A. Site Information Dave Taylor Owner Name 940 Johnson Street Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Street Address or Lot # North Andover City/Town Contact Person (if different from Owner) B. Test Results MA 01845 State Zip Code (603) 315-3864 Telephone Number Test Performed By: Randy Burley Mill River for NA BOH Witnessed By: Comments: Time Test Passed: ❑ Test Failed: ❑ t5form12.doc• 06/03 Perc Test • Page 1 of 1 10-31-11 10 am Date Time P-1 Observation Hole # 67" Depth of Perc 10:29 Start Pre -Soak 10:44 End Pre -Soak 10:44 Time at 12" 10:53 Time at 9" 11:02 Time at 6" 9 Time (9"-6") 3 Rate (Min./Inch) Test Passed: Test Failed: ❑ William Dufresne Test Performed By: Randy Burley Mill River for NA BOH Witnessed By: Comments: Time Test Passed: ❑ Test Failed: ❑ t5form12.doc• 06/03 Perc Test • Page 1 of 1 TOWN OF NORTH ANDOVER NORTy Office of COMMUNITY DEVELOPMENT AND SERVICES 3r '''' `• of HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH - ACHUSETTS 01845 d� v111p� Susan Y. Sawyer, RENS, RS 978.688.9540 -Phone Public Health Director978.688.8476 - FAX ,-,OCT .� 4 2011 ! 1 healthdepi(-townofnorthandover.com 'ff• '5 lv www.townofnorthandover.com TOWN OF NORTH ANDOVER APPLICATION FOR SO HEALTH DEPART ENT DATE: 10 --'72— f I MAP & PARCEL: LOCATION OF SOIL TESTS: Jcfl K)Gen `� _ OWNER: Com, Y� !ej� Contact #: 77 (2 6j (e APPLICANT: y6 �7� `i'C w'__ Contact #: ADDRESS: '2--7 VL- Vpj5PGV_�<� ^ �-V ENGINEER:�j � ��� ( �� Contact I ) q7 5- jG CERTIFIED SOIL EVALUATOR: Intended Use of Land: Reside 'al Subdivision SinglpFamily a Commercial Is This: Repair Testing: Undeveloped Lot Testingade for ition:F In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11"Plot plan & Location of Testing (please indicate test nit sites on the elan) ➢ 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 $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approva Date. ) / 7 //j Signature of Conservation Agent: Lc - Date back to Health Department. (stamp in): J v t � \ NO THIS PLAN & CERTIFICATION IS NOT A WARRANTY OF THE SUBSURFACE DISPOSAL SYSTEM. 1T 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. SIGNATURE OF DESIGNER To DZ EiOT � C m = 0 � n 0 _. D� D�. C sZ m m o '� p 'i m X JOHNSON STREET AS BUILT PLAN 6V/�Olelf�lle_ DATE OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./940 JOHNSON STREET AS PREPARED FOR DAVE TAYLOR TM: 107A DATE: 6-3-12 TL: 91 SCALE: 1"=40' 0 20 ao ao MEgRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 0 BOARD OF HEALTH TOWN OF NORTH ANDOgR, MASS. TeX, I 7 �4i 'o 4wM p, :;,T, wtjK- ZL,1-6 X) A<- /� , 1. NAME `7'/.�_ � ►�``, � � DATE 2. ADDRESS % p LOT NO. TEL. 3. N0. OF BEDROOMS__ :L DEN YES d"' NO 4. GARBAGE GRINDER YES NO --~--� 5• SHOW DIMENSIONS OF HOUSE b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT S. SHOW LOCATION ANIS SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LQCATIONNI3 DT�STACE OF-4JEhL FR6M-SEWERACTE"SYSTEM- 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. + 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.