HomeMy WebLinkAboutMiscellaneous - 97 SAW MILL ROAD 4/30/2018 (2)%,� , II
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Lot & Street Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: ES
Plan Approval: Date:
Designer:__. by fl -e- -5 oo p
Conditions:
Watr Supply Town Well
Well Permit: Driller:
Well Tests: Chemical
Bacteria I
Bacteria II
Plumbing Sign -Off:
Comments:
Form "U" Approval
Date Issued
Conditions:
Final Approval:
NO Permit#
Approved by:
Plan Date:
Date Approved
Date Approved
Date Approved-,
Wiring Sign -off:
Approval to Issue: YES
By:
NO
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other? YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
f
r..
SEPTIC SYSTEM INSTALLATION
CONDITIONS:
Is the installer licensed?
Type of Construction:
New Construction: Certified Plot Plan Review
Floor Plan Review
Conditions of Approval from Form U
Issuance of DWC permit:
DWC Permit Paid? (,�
DWC Permit # Installer: .J
Y�E�$�,y
IVEW
YES
YES
YES
S
h t _
NO
`ARE INAI
NO
NO
NO
NO
NO
Begin Inspection:
ES
NO
Excavation Inspection:
Needed:
Passed: 71131,06 By:
Construction Inspection:
Needed:
(QCs Built Plan Satisfactory:
AYES:/
7TT-
Approval of Backfill: Date: �s�Da By:
Final Grading Approval: Date: �� t� _ By
Final Construction Approval: Date:
Certificate of Compliance:
Approval: Date: Is
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
8/23/00
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired (X)
by
John Soucy
at
97 Sawmill Road
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The dersigned hereby certify that the Sewage Disposal System ( ) construde' d;
( repaired:
by JE" 0 c -
located at 7 '�A" f -j j ; VoA0
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # dated , with an approved design
flow of 4qc 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: 7 /
Final inspection date: 7— /-E'1�
Installer:
Design F
_j,-�2 r 2,,,l ,
Engineer Represent ive
-1
JUL 2 0
leer repre"'s�ent tive
Date:
Date:. 1+w
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO
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:
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 r/
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 90° change
10. 10' minimum offset to water line
Comments:
D. Septic Tank
1. Level
2. 1,500 gal minimum
3. Gas baffle present on outlet
4. Manhole to grade
L
5. Manholes over center and each tee L `
6. 3-20" manholes 1
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 %" crushed stone under tank
14. Tank is watertight
Comments:
Comments:
F. Distribution Box
1. D -box level
2. Minimum 0.1 T' (2") drop from inlet to outlet
3. Minimum 6" sump
4. Outlet pipes show equal distribution
5. Compact base with 6" of stone beneath box
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 -'/."-- 1 ''/z"
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. ✓
Comments:
H. Leach Trenches /
1. Minimum 2 trenches ✓
2. Length of trenches agree with plan. (Max. length 100') -7
41/
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". y
IM
Yes
E. Pump Chamber
1.
If separate from tank, compact base with 6" of 1/4" 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
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 -'/."-- 1 ''/z"
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. ✓
Comments:
H. Leach Trenches /
1. Minimum 2 trenches ✓
2. Length of trenches agree with plan. (Max. length 100') -7
41/
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". y
IM
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
Yes NO
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AS -BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
!/
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
G/
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D -BOX
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS
(/
AREAS - DRIVEWAYS, ETC.
NORTH
(/
ARROW
LOCATION & ELEVATIONS OF BENCHMARK USED
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APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: I b 00 Cti-RREiNT ENSTALLER'S LICENSE
LOCATION: (17 17� Q/2 .
LICENSED LV"ST-ALL C
�o-
SIGNATURE: TELEAONEr-rL'j'7e
CSE CK ONE: /'
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
Administrative Use Only
575.00 Fee Attached? Yes t,"� No
Foundation As-Buiit? Yes No
Floor Plans? Yes bio
Approval �z�V
Date: 7
JUL I 0 r }
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the property
at '� �oeti��yy. ��.Qo relative to the application of
c '
dated for plans byMg,,,yjnk c • Y d dated with
revisions dated
I understand and agree to the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger, or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable .
2. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without completion
of the items in accordance with Title 5 and the Board of Health Regulations may result in a
$50.00 fine being levied against my company.
a) Bottom of Bed — generally first inspection unless there is a retaining wall which should be done first. Installer
must request the inspection but does not have to be present.
b) Final Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from
engineer must be submitted to BOH, after which installer calls for inspection time. Installer must be present
for this inspection. With pump system all electrical work must be ready and able to cause pump to work and
alarm to function.
c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company to complete the installation of the system
identified in the attached application for installation. I further understand that work by others
unlicensed to install septic systems in North Andover can constitute reasons for denial of the
system, and/or revocation -or suspension of my license in the Town of North Andover plus
significant fines to all persons involved.
4. As the Installer I understand that I must be on site during the performance of the following
construction steps:
a) Determination that the proper elevation of the excavation has been reached
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components.
5. As the installer I understand that I am solely responsible for the installation of the system as per
the approved plans. No instructions by the homeowner, general contractor, or any other persons
shall absolve me of this obligation.
Undersigned ensed Septic I alley
Date: v dh
CHECKLIST FOR NORTH ANDOVER
SEPTIC SYSTEM PLANS
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant:
Plan Date: 1061 Revision Date:
Property Address: eel % 1 J
BOH Reviewer:
Name of Designer:
Date of Review:
Map: Lot:
Type of Plan (new or upgrade):_
Number of Bedrooms in Assessor' s Records: gpd) Garbage Disposal Allowed:
General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5
OProblem N/A
M
t/
Street number and map/lot - 220(4)(u)
Maximum scale of 1 "=40' for plot plan - 220(4)
Maximum scale of 1 "=20' for profile and component details - 220(4)
Legal boundaries of the facility being served - 220(4)(a)
Names of abutters from recent tax map - NA 8.02j
Number of bedrooms, design calcs., - NA 8.021
Name & address of record owner & applicant - NA 8.02k
Name & address of designer - NA 8.021
Holder and location of all easements - 220(4)(b)
Date plan drawn & any revision date - NA 8.02m
All dwellings and buildings, existing and proposed - 220(4)(c)
Location of all existing or proposed impervious areas - 220(4)(d)
All distances on site plan — NA 8.03a -c
Elevation of proposed driveway - NA 8.02t
Location and elevation of foundation drain - NA 8.02y
Location and dimensions of the system incl. reserve (new const.) - 220(4)(e)
Limits of excavation of leach area on site plan - NA 8.02z
Locus plan - 220(4)(t)
North arrow - 220(4)(g)
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)
Elevation of percolation tests — N.A. 8.02n
Name of approving authority representative - 220(4)(h) & (i)
Name of soil evaluator - 220(4)0)
Soil logs and perc test logs match BOH records
Locations of waterlines, drains, and subsurface utilities - 220(4)(m)
Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n)
Complete profile of the system to scale - 220(4)(o), NA 8.02c
Cross section of leaching facility - NA 8.02w
Location of benchmark(s) within 50-75 feet of facility - 220(4)(q)
Note listing all variance requests with proper citations - 220(4)(p)
Local upgrade approval request form submitted - 403(7)
Original R.S./P.E. stamp, signature & date - 220(1) & (2)
If P.E., discipline specified within stamp. MGL C. 112 s. 81M
sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w/in 150') - 220(4)(
Location of watercourses, wetlands, wells, etc. w/in 150' of system – NA 8.02r
Wetland disclaimer – NA 8.02s
Land surveyor plan reference required (property line setbacks) - 220(3)
Plan contains designer's certification statement
Use approvals / standards checked for I/A system - DEP docs.,
Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3)
Perc rate > 60 MPI - must use modified tight tank or IIA technology - 245(4)
Proposed system qualifies as "shared" system - 002 (definitions)
Flow is over 2,000 gpd - No R.S. allowed - 220(1)
Design flow was set in accordance with code - 203
Existing system location and note on proper abandonment - 354
Leaching facility at least 1' above Base Flood elevation – NA 9.05
All piping Sch 40 minimum – NA 10.01
Basement floor minimum 1' above groundwater elevation – NA 5.04
Foundation drain present with elevation – NA 8.02y
On-site Soil and Groundwater Review
OK 'Problem N/A
Proper deep observation hole logs on plan - 220(4)(h)
All deep holes and peres shown, including aborted tests – NA 8.02n
Soil evaluation forms submitted within 60 days of field work - 018(2)
Proper percolation test log - 220(4)(i)
Ample deep observation holes in primary disposal area (minimum 2) - 102(2)
Ample deep observation holes in secondary disposal area (minimum 2) - 102(2)
Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4)
Deep hole testing conducted within two years – NA 7.05
ground elevation el.
acceptable soil el.
Leach facilitv invert el.
ground water el.
refusal el.
bottom of leach facility el.
thickness of acceptable soil
before & after soil R&R
separation to groundwater
separation to refusal
soil class
perc rate
Hole Identification Numbers:
Z
1S/ Z
15A.7
I -W
—��
V
c.�
l5Z, 17
If P.E., discipline specified within stamp. MGL C. 112 s. 81M
sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w/in 150') - 220(4)(
Location of watercourses, wetlands, wells, etc. w/in 150' of system – NA 8.02r
Wetland disclaimer – NA 8.02s
Land surveyor plan reference required (property line setbacks) - 220(3)
Plan contains designer's certification statement
Use approvals / standards checked for I/A system - DEP docs.,
Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3)
Perc rate > 60 MPI - must use modified tight tank or IIA technology - 245(4)
Proposed system qualifies as "shared" system - 002 (definitions)
Flow is over 2,000 gpd - No R.S. allowed - 220(1)
Design flow was set in accordance with code - 203
Existing system location and note on proper abandonment - 354
Leaching facility at least 1' above Base Flood elevation – NA 9.05
All piping Sch 40 minimum – NA 10.01
Basement floor minimum 1' above groundwater elevation – NA 5.04
Foundation drain present with elevation – NA 8.02y
On-site Soil and Groundwater Review
OK 'Problem N/A
Proper deep observation hole logs on plan - 220(4)(h)
All deep holes and peres shown, including aborted tests – NA 8.02n
Soil evaluation forms submitted within 60 days of field work - 018(2)
Proper percolation test log - 220(4)(i)
Ample deep observation holes in primary disposal area (minimum 2) - 102(2)
Ample deep observation holes in secondary disposal area (minimum 2) - 102(2)
Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4)
Deep hole testing conducted within two years – NA 7.05
ground elevation el.
acceptable soil el.
Leach facilitv invert el.
ground water el.
refusal el.
bottom of leach facility el.
thickness of acceptable soil
before & after soil R&R
separation to groundwater
separation to refusal
soil class
perc rate
Hole Identification Numbers:
Z
1S/ Z
15A.7
I -W
1,53-7
l5Z, 17
loading rate r 13
septic tank below g.w. table v D (yes or o)
pump tank below g.w. table •n p (yes no
1.f in fill -3 D YVI -P- -255(1)
Setback Distances (Given in feet)15.21 1
OK Problem N/A
3
I
V
Is the lot in the Lake Cochiewick Watershed? NA
6.00 & 5.02
Septic Tank
Leach Facility
/
i/
Property line
10
10
Cellar wall
10
20
Inground pool
10
20
Slab foundation
10
10
r/
Deck, on footings, etc.
5
10
v
Waterline
10
10
Private drinking well
75
100
Irrigation well
Wetlands
75
75
100
i/
100
Public
well
400
400
Wetlands bordering surface
150
150
water Supply or trib.
(in Watershed)
L/
Trib. To Surface Water supply
325
325
d�
Reservoirs
400
400
Tributaries to reservoirs
200
200
Drains (wat. supply/trib.)
50
100
Drains (intercept g.w.)
25
50
V
Foundation drains
10
20
V
Drains (Other)
5
10
Drywells
20
25
Downhill slope
15' to 3:1 slope
w/o barrier
3
I
Building Sewer
OK Problem N/A
_Lf
Septic Tank
OK Problem N/A
Grease trap required for certain uses (check 230 for details)
Pipe diameter listed (4" minimum) - 222(1)
Pipe schedule listed - 222(3)
Pipe cast iron or Sch 40 PVC — NA 11.02
Watertight joints specified - 222(3) & (4)
Pipe laid on compact, fin base - 222(5)
Pipe laid on continuous grade in straight line - 222(7)@
Cleanouts precede all changes in alignment and grade - 222(8)
Cleanout provided every 100 feet - 222(8)
Manhole at any 90 degree alignment change - 222(8)
Invert elevation at building:
Invert elevation at septic tank:
Length of run:
Slope: (minimum of 0.01 - 0.02 desired) - 222(6)
10' offset to private well or suction line - 222(2)
Tank is accessible - 228(3)
Tank can accommodate both primary & reserve — NA 9.04
200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a)
2-3" drop from inlet to outlet - 227(5)
Minimum of 4' liquid depth - 223(2)
3" air space above tees/baffles (minimum) - 227(4)
9"air space above flow line (minimum) - 227(4)
Tees are not to be replaced by baffles - 227(1)
Tees extend 6" above flow line - 227(1)
Inlet tee extends 10" below flow line (minimum) - 227(6)
Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6)
Gas baffle installed on outlet - 227(4)
Access manhole cover above center of tank & each tee (except 2 compact)
228(2)
3-20" manholes - 228(2)
1 childproof, 24" riser/manhole to final grade if <1000gpd- 228(2)
Inlet and outlet tees on center line - 227(1)
Soil compaction below tank specified (if soil is non-native) - 221(2)
6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(l)
If> 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. - 223(1)(b)
If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c)
Buoyancy calcs. required if tank at or below water table - 221(8)
Tank is watertight - 221 (1)
9" of cover over tank (minimum) - 228(1)
H- 10 loading (min.) - H-20 if traffic - 226(3)
Top of tank <=36" below grade - 221(7)
All pumping to tank (if applies) in accordance with - 229
Tank is set to keep old system in service during install if possible
Tight Tank (Check here if not present: v )
OK Problem N/A
500% of deisgn 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
A/V alarm set at 3/5 tank capacity — 260(2)(c)
Min. 1-24" frame w/cover at finished grade — 228(2)(f)
Year round access for pumping — 228(2)(g)
Distribution Box (Check here if not present:
OK Problem N/A
Inlet elevation:
Outlet elevation: /c:'$ 3
0.17' drop from inlet to outlet (minimum) - 232(3)(b)
c/ 6" sump (minimum) - 232(3)(e)
t/ All outlets at same elevation - 232(3)(b)
t/ Outlet pipes laid level for first 2 ft. - 232(3)(c)
Pipe Sch 40 - NA 10.0
Number of outlets: Number of laterals:
i✓ Size of outlets: `/ "r
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)
l.✓ 6" of stone beneath distribution box specified - 221(2)
✓ Box is watertight - 221 (1)
Top of box <=36" below grade - 221(7)
L✓ 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: / yg, 220(4)(r)
Alarm on elevation: / - 220(4)(r)
L/ 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 1. 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) -
sC 24 hour storage capacity above pump on elevation - 231(2)
cf Number of pumps: �_ 2 if system serves >2 dwelling units - 231(6)
rol
Leaching Facility (general - complete for all designs)
OK Problem N/A
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50% larger if garbage disposal - 240(4)
Trenches to be used whenever possible - 240(6)
No vehicle access or imperv. area above IT unless unavoidable - 240(7)
Vented if under impervious cover - 241 (1)
Vented through same pipes as distribution system - 241 (1)(a)
Vent protected from precipitation/animal entry - 241 (1)(b)
Vent is placed beyond traffic or impervious area - 24 1 (1)(c)
All lines connected to vent if bed or trenches - 241(1)(d)
9" cover over peastone - 240(9)
Reserve area provided (new construction) - 248(l)
Reserve 4' from primary leach area - NA 9.04
4' (5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b)
4' (down to 2' with variance or I/A -upgrades only) of natural soil under 1. f.
GW separation is adjusted to highest existing grade if facility cuts into a hillside J
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)
Final grade over 11 minimum 0.02 ft/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)
Toe of fill slope stops 5' from property line or swale installed - 255(2)
Impermeable barrier if < 3:1 slope or < 15 feet to -3:1 slope - 255(2)
Impermeable barrier/retaining wall poured concrete - NA 9.02
Retaining wall stamped by P.E. - 255(2)(b)
Top of retaining wall >= top of peastone elevation - 255(2)(f)
10' offset from edge of leach facility to edge of ret. wall - 255(2)(g)
Perc test(s) done in most restrictive layer - 104(2)
_ Perc test 4' below -leaching elevation - NA 7.06 — Y1 O e I
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
_ Leach lines capped, vented, or connected together - 251(9)
✓ Pressure dosing guidance followed if pressure distribution - 254(2)(c ),
v
Capacity of pump(s) - 40 gpm @ 1 / ' TDH - 220(4)(r)
1/
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)
c✓
Pump performance curves included - 220(4)(r) - rvl� t:5 5 `�' ck
Manual operating switch - NA 12.01
L,-'--
Check valve, bleeder hole - NA 12.01
1 childproof, 24" riser/manhole to final grade - 2'31(5),
:l
Soil compaction beneath pump chamber specified (if soil is non-native) - 221(2)
c�
6"of <=3/4"stone beneath chmbr. specified - 221(2) & 228(1),
S C nQ
Buoyancy calculations if chamber is at or below water table - 221(8)@ M 1 S
c/
9" of cover over chamber (minimum) - 228(1)
.f
H- 10 loading (min.) - H-20 if traffic - 226(')), no
Chamber is watertight - 221 (1)
Top of chamber <=36" below grade - 221(7)
Leaching Facility (general - complete for all designs)
OK Problem N/A
_sem
y-.
�f
J�
cf
50% larger if garbage disposal - 240(4)
Trenches to be used whenever possible - 240(6)
No vehicle access or imperv. area above IT unless unavoidable - 240(7)
Vented if under impervious cover - 241 (1)
Vented through same pipes as distribution system - 241 (1)(a)
Vent protected from precipitation/animal entry - 241 (1)(b)
Vent is placed beyond traffic or impervious area - 24 1 (1)(c)
All lines connected to vent if bed or trenches - 241(1)(d)
9" cover over peastone - 240(9)
Reserve area provided (new construction) - 248(l)
Reserve 4' from primary leach area - NA 9.04
4' (5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b)
4' (down to 2' with variance or I/A -upgrades only) of natural soil under 1. f.
GW separation is adjusted to highest existing grade if facility cuts into a hillside J
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)
Final grade over 11 minimum 0.02 ft/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)
Toe of fill slope stops 5' from property line or swale installed - 255(2)
Impermeable barrier if < 3:1 slope or < 15 feet to -3:1 slope - 255(2)
Impermeable barrier/retaining wall poured concrete - NA 9.02
Retaining wall stamped by P.E. - 255(2)(b)
Top of retaining wall >= top of peastone elevation - 255(2)(f)
10' offset from edge of leach facility to edge of ret. wall - 255(2)(g)
Perc test(s) done in most restrictive layer - 104(2)
_ Perc test 4' below -leaching elevation - NA 7.06 — Y1 O e I
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
_ Leach lines capped, vented, or connected together - 251(9)
✓ Pressure dosing guidance followed if pressure distribution - 254(2)(c ),
v 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
L-11
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.): 51 - 251 (1)(b)
Length of trenches (100' max.): q - 25 1 (1)(a)
E/
Trenches are vented (when > 50') - 251 (11)
Trenches follow contour lines - 251(2)
Trench spacing 3 times effective width or depth - 251 (1)(d)
✓
In fill or reserve between trenches, 10' min. - NA 14.01& 14.03
~�
Available leach area given (Min. 500 s.f.) - NA 9.01(2)
y 7
Bottom = L�fq x W 3 x#_= s.f.
Sidewall = L 7 9 x D i x# _'L x 2= 3/% s. f.
�—
Effective leach area given
Loading factor: ' d—G
[/
Effective area = total area 790 s.f. x LTAR- ��_ g/day
!i
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
7
# 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 P (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
Number of fields: (need dosing chamber if > 1, 231 (1))
Length (100' max.): - 252 (2)(b)
Width:
Total area: L x W S. f.
Minimum 900 square feet - NA 9.01(1)
Distribution lines connected with solid pipe — NA 15.01
Effective leach area given
Loading factor:
Effective area = total area s.f x LTAR = g/dav
Effective area is >= design flow of facility being served
Minimum of two distribution lines - 252(2)(a)
6' line separation (max.) - 252(2)(d)
4' maximum separation from edge of field to line - 252(2)(e)
10' minimum separation between adjacent leach fields - 252(2)(0
Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2)
2"of 1/8"-1/2" 2x washed peastone.- 247(2)
8/28/98
N° DTI{
Town of North Andover
F? 4�=` ryb ekOOA
Community Development & Services William J. Scott
27 Charles Street Director
(978) 688-9531
�9SSACHUS
North Andover Massachusetts 01845
'
fax 978-688-9542
July 7, 2000
Robert Fredette
Board of 97 Sawmill Road
Appeals North Andover, MA 01845
(978) 688-9541
Re: Septic design 97 Sawmill
Building
Department Dear Mr. & Mrs. Fredette:
(978) 688-9545
Conservation
Department
(978) 688-9530
Health
Department
(978) 688-9540
Public Health
Nurse
(978) 688-9543
Planning
Department
(978) 688-9535
This letter comes to notify you that the proposed septic system design plans for the
repair of the system at the above -referenced address have been approved. Please
feel free to call me at 978-688-9540 with any questions you may have.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
Cc: W. Dufresne
File
Town of North Andover, Massachusetts Form No. 2
NORTq BOARD OF HEALTH
o
F �
A
• -
M """`" DESIGN APPROVAL FOR
sSACHUSEI SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant ATest No._ 9*/
Site Location
- J-4
Reference Plans and Specs. z
ENGINEER DESIV DATE
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 M15 l' Site System Permit No. ll
LE40=SERIES
PUMP
The pump(s) shall be model
as manufactured by Liberty Pumps, Bergen, NY,
or equal.
The pump(s) shall have a capacity of %O GPM at
a total dynamic head of LL feet. Motor size shall
be 4/10 horsepower, single phase, 60 hz. and 115
volt operation.
MOTOR
The pump motor shall be of the submersible
type, oil filled, hermetically sealed and shall be
thermally protected. The overload element shall
automatically reset when motor cools.
Motor windings shall be of the class B insulation
rating. The rotor shaft shall be made of 416 stain-
less steel and shall be supported by lower bronze
and upper sleeve bearings.
The power cord shall be of the quick -disconnect
design allowing replacement of the cord without
breaking seals to the motor and/or oil chamber.
TECHNICAL SPECIFICATIONS
IMPELLER
The pump shall have a VORTEX style
impeller capable of passing a minimum
2" spherical solid.
SEAL
The shaft seal shall be of the carbon/ceramic
unitized design, with BUNA N elastomers and
stainless housings.
EXTERNAL CONSTRUCTION
The pump volute, legs and motor housing
shall be heavy gray iron castings, class 25 or
better. All castings shall be enamel coated before
assembly. All fasteners shall be of 300 -series
stainless steel or brass.
LEVEL CONTROL
The pump shall be controlled by an adjustable,
mercury -free, wide angle float switch. Float cord
shall be equipped with a series plug for manual
by-pass operation.
MODELS HP VOLTS PHASE AMPS DISCHARGE AUTOMATIC IMPELLER
LE41 M 4/10 115 1 13 2" FNPT NO VORTEX
LE41A 4/10 115 1 13 2" FNPT YES VORTEX
10' cord standard on above models.
For 20' option, add a "-2" suffix to model number. Example: LE41 A-2
DIMENSIONAL DATA:
Weight: LE41 M: 39 LBS.
Height: 13.25"
Major Width: 10.75" (manual models)
Maximum fluid temperature 140 degrees F.
@01 -Certified
City of LA certification available ......
PERFORMANCE CURVE
1 24
20
6--
e m 16
a •-
12
m
x t
0 0 8
~ 2 i2
0— 0
1550 RPM
10 20 30 40 50 60 70 80
U.S. Gallons Per Minute )
0 1.4 2.8 4.2 5.6
Liters Per Second
Liberty Pumps • 7307°Lake Rd • Bergen, New York 14416 • Phone (716) 494-1817 Fax (716) 494-1839 7291-2/93
Jul - 1 06-00 12:43P Paul D. Turbide, PE/PLS 978-465-0313 P.02
July 6, 2000
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MA 01845
RE: Title V second review for 97 Sawmill Road
Dear Sandra,
I find that the design plans with revision date of 29 June 2000 adequately addresses our
concerns outlined in the fax we recently sent you.
One other item that I discovered is that since the leaching trenches are longer than 50
feet, a vent is required to be connected to the ends of both distribution lines (3 10 CMR
251(11) and 310 CMR 241(d)). In my professional opinion, moving the proposed vent
shown on the plans from the dbox area to the ends of the distribution lines will
accomplish this (or the vent by the dbox could be left as is, and a second vent could be
added at the end). If this change is made I do not have to review the plans again.
If you have any questions or comments please feel free to contact me.
Sincerely
Carlton A Brown, PE/PLS
Sawmi1197.doc
PORT
MINFERING
Civil Engineers 8
Land Surveyors
One Harris Street
Newburyport, NIA
01950
1978)465-8504
JUL 3
Commonwealth of Massachusetts
PAGE 1 OF 5
Application for Local Upgrade Approval
Title 5, 310 CMR 15.000
DEP Approved form required by 310 CMR 15.403(1)
To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or
nonconforming system `with a design flow of < 10,000 gpd, where full compliance, as defined in
310 CMR 15.404(1) is not feasible.
To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design flow
of 10,000 up to 15,000 gpd and/or for upgrade of a state` or federal -facility, where full
compliance, as .defined in 310 CMR 15.404(1), is' not feasible.
NOTE; Local upgrade approval shall not be granted for an upgrade proposal that includes the
addition of new design flow to a cesspool or privy or the addition of new design flow above the
existing approved capacity of a system constructed in accordance with either the 1978 Code or 310
ItMR 15.000.
1)
2)
Facility/system owner
Name
Address
Phone #
Address
Applicant *(if different from above)
Name hAil cam- -
Address
Phone #
3) Type offac ty
_ residential _ commercial _ school
institutional
(Specify)
iiDFP APPROVED FORM - urnns
PAGE 2 OF 5
4) Type of existing system
_privy cesspools) conventional system
Other (describe)
Type of soil absorption system (trenches, chambers, pits,etc.)
5) Design flow based on 310 CMR 15.203
a) Design flow of existing system gpd
Approved? __�.J2s approval date 19 60
no why?
b) Design flow of proposedu graded system *o gpd
c) Design flow of facility Z H7gpd
6) Proposed upgrade of existing system is
a) __L/ Voluntary
Required by order, letter, etc. (attach copy)
Required following inspection required by 310 CMR 15.301 (provide date
inspection form was submitted to the approving authority) (date)
b) . Describe the proposed upgrade to the system
fScrynNcez 11m
AN N
„� � lilvl,✓a
c) Which of the following are applicable to the proposed upgrade?
a Reduction of setback(s) (list setbacks to be reduced with proposed setback distances)
OA Percolation rate of 30-60 minutes per.inch (state actual perc rate)
11 00 APMOVW POEM - IVOI95
PAGE 3 OF 5
Up to 25% reduction in subsurface disposal area design requirements (state required
& proposed size)
0A Relocation of water supply well (identify well, describe relocation)
Reduction of required separation between bottom of SAS & high groundwater
(specify proposed reduction & perc rate) z -e 4,p---7' 6 12 t el, )
Ah Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the
Code)
System upgrades that cannot be performed in accordance with 310 CMR 15.404 &
15.405, or in full compliance with the requirements of 310 -CMR 15.000, require a
variance pursuant to 310 CMR 15.410-15.417.
7) If the proposed upgrade involves . a reduction in the required separation between the bottom
of the soil absorption system -and the.high groundwater elevation, an Approved Soil
Evaluator must determine the. high ground water elevation pursuant to 310 CMR
15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority:
Distance from soil absorption system to high groundwater
'5,a feet
As determined by:
Evaluator's name
Evaluator's signat
Date of evaluation
DEP APPROVED FORM - IV$7195
PAGE 4 OF 5
8) Notice to Abutters
No application for upgrade approval in which the setback from property lines or a
private water supply well is reduced shall be complete until the applicant has
notified all abutters whose property or well is affected by certified mail at least ten
days before the Board of Health meeting at which the upgrade approval will be on
the agenda. Such notice shall include the date, time and place where the upgrade
approval will be discussed.
If the Department is the approving authority, then such notice to abutters must be
completed prior to the date of submission of the application to the Department.
The notices to abutters shall include a copy of the completed application form and
shall reference the standards set forth in 310 CMR 15.402 through 15.405.
List of affected Abutters:
Abutter Name
Date notified
Address
Abutter Name
Date notified
Address
Abutter Name
Date notified
Address
Abutter Name
Date notified
Address
9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each
section must be completed):
a) an upgraded system in full compliance with 310 CMR 15.000 is not feasible:
V1, b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible:
DEP APPROVED FORM -12/07/!3
c) a shared system is not feasible:
d) connection to a sewer is not feasible:
PAGE 5 OF 5
10) An application for a disposal system construction permit, including all required attachments
(e.g. plans & specifications, site evalyation forms), must accompany this application. Is the
DSCP application attached? _yes_no
11) Certification
"I, the facility owner, certify under penalty of law that this document and all
attachments, to the best of my knowledge and belief, are true, accurate, and
complete. I am aware that there may be significant consequences for submitting
false information, including, but not limited to, penalties or fine and/or
imprisonment for knowin"olations-)"
owner's signature
i2I Favi e
Print Name
5q
Name of .preparer
�0 011 14
Telephone # & address of preparer
Date
Date
la --00
NOTE: Title 5, 310 CMR 15.403(4), requires. the system owner or operator to submit to the
Department a copy of the local upgrade approval upon issuance by the Board of Health and prior
to commencement of construction.
DU "MOVM FORM - 12MI95
61P
SEPTIC PLAN SUBMITTAL FORM
LOCATION: 9-7 4�4w o j� , ea�
NEW PLANS: (._ �' $125.00/Plan [y Sr-�O�-►F'
REVISED PLANS: YES
SITE EVALUATION FORMS INCLUDED:
DATE: -2�. ✓�
$ 60.00/Plan
YE NO
DESIGN ENGINEER:
DATE TO CONSULTANT:
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
SEPTIC PLAN SUBMITTAL FORM
LOCATION: 7 �ar,�/�1✓ii// J/
NEW PLANS: S $125.00/Plan t"
REVISED PLANS: YES
$ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: dv NO
DATE:
DESIGN ENGINEER: G%��/V//yrae'&
DATE TO CONSULTANT:
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
L OCr, 01\1: '
�0 Hl`Ni N=E�.
iA
0 7-1 0 N i E: 0 F S, T. 14L
TME OrI- z 7„ire :__ cr_
IMC r-. I
I
I INI` .— I _
CVC=,NIL^
i- "_-
,.-.i .=__. . - ;....
J
4 Q
r
FORM 11 - SOIL EVALUATOR 1?0jM1
Page 1
o ace..... � ..:...........
Commonwealth of Massachusetts
, Massachusetts
Performed By: ..._..w��.�•.�_..r� ................................
witnessed 9y:
Owwromm-
Adkug. WA
NOW 9
so L- 115-14
New Construction ❑ Repair
Published Soil Survey Available: No ❑ Yes l�
Year Published .�.%f,�. Publication Scale /!Z Soil Soil Map Unit ......C��
Drainage Class ....,z��.... Soil Umitations............................................................_.__......
Surficial Geologic Report Available: No Yes ❑
Year Published ..._............. Publication Scale ..................
GeologicMaterial (Map Unit) .................... ...... ._................................................................ _ ... .......... .......................
Landform................ ..... .................. ..... _.......................... ................ ..................................................................................................................
Flood Insurance Rate Map:
Above 600 year flood boundary
Within 600 year flood boundary
Within 100 year flood boundary
No ❑ Yes
No lam" Yes ❑c - -
No L7 Yes ❑ � JUN 2 2
Wetland Area:
National Wetland Inventory Map (map unit).........._.................._...._._._.�
Wetlands Conservancy Program Map (map unit)....-..-.�...-.-.-....-..�- --.-..�--.,..._...._ _ ._� - ._.__
Current Water Resource Conditions (USGSI: Month
Range : Above Normal ❑ Normal ❑ Below Normal
Other References Reviewed: W56!577 i�?cam
.
NORM It - SOIL EVAWA'DOR VORM
Plige Z
Deep Nola Number T-:.L...w Data: --'f .. nma:Weather 5�0
Loostlon Odentffy on elte plenl -� ,�� ...__ __ ._ _____..__._ ..._..... �..__._____ _
Land Use 2 s -..w --- _. slope J%j 1' „ Surface stones ....per......_
Vegetation �.......�.....�.��"�........L.. �.�,r�ti_......._....._..___..._..............__..�._....__._.�.. _ w.._..
landform
Position on landscape [sketch on the back) ....._.........
_
Distanoet from' •
Open Water Body 2--�P--oo feet Drelnege way? �a? � feet,
Possible Wet Area ?ice feat Property Una ._. �� feet '
Drinklnp Water Web Z9_:. feet Other
0
IMpth from WAGS ea italmn ed T � Colcx 61A MuVAft
llealNel � WSh � 18tn�, � e,
• r
V.
r
Parent Material [peologlol -7/�L� _ _ . - —~w .__ ...-....... Depth to Bedrock:
a
•___..
neeth to Groundwater. Standing Water In the Hole. �1�A�••••�- Weeping from Pit Face:
i
Estimated Seasonal Hiah Ground Water: 5z
VORM 11 - SOEL EVAWATOR FORM
Page Z
•
On-fik Redew •
Deep Hole Number ._1:� Z;- Date: -�tL 2'0o Time: Weather
Loostlon lidentlfy on site plan( -
Land Use `t :-------- --. Glop& 1461 Surface Stones ...1 :......__.._
l.at►dform -Lr�._
posltlon on landsoape (sketch on the back( -------- . •••.
Olstanoel from:
Open Water Body ? « feet Drsinade wav,?- _. feet, t
Possible Wet Area feet Property Una ._ w feet '
Drinking Water Wes :;,ldcr_'. feet Other - -� • -�. •-
moth f(d `WAGO 6oNNal�on lU8DA) BotlIAatWna
119
parent Material (geologic! -.--. t _ _ _ _-_- .--....-....... Depth to lledrook:
pe� nth tg arqundwater: Standing Water in the Hola: _r� r� Weeping from Pit Face: _
Estimated Seasonal Hich around Water: ..�.... . ...
FORM 11- SOIL, EYAWATOR PORM
Page 3
Method d:
❑ Depth observed standing in observation hole --- inches
' ❑ Depth weeping from side of observation hole _ Inches
Depth to son mottles � inches 6�, f -lir 2/
❑ around water adjustment.:..._ feet
Index Well Number _ .. Reeding. Data _ Index well level
Adjustment factor w_�_.__ Adjusted ground water level
Does at least four feet of naturally occurring pervious material exist in.eli areas
+ observed throughout the area proposed for the soil absorption system?
A
If not* what is the depth of naturally occurring pervious material?
baa
Ll
1 certify that on f2� Metal l have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 910 CMR 16.017.
Signature Date
FORM 12 - PERCOLATION IST
COMMONWEALTH 'OF MASSACHUSETTS
Massachusetts
Site Passed CJ Site Failed
�...�_......_......................_......_....._.............._.......__.___•___............_........._.._.........._.._.
Performed By:
Witnessed By: /It -9 r -v"
Comments:..... ...................... :.
Fax 978-688-9542
Board of
Appeals
(978) 688-9541
Building
Department
(978) 688-9545
Conservation
Department
(978) 688-9530
Health
Department
(978) 688-9540
Public Health
Nurse
(978) 688-9543
Planning
Department
(978) 688-9535
Town Of North Andover
Community Development & Services
27 Charles Street
North Andover, Massachusetts 01845
June 29, 2000
Robert Fredette
97 Sawmill Road
North Andover, MA 01845
Re: Septic System Design plans
Dear Mr. Fredette:
William J. Scott
Director
(978) 688-9531
I have reviewed the proposed septic system design plan for the repair of the
septic system at 97 Sawmill Road. There are some items of information
that are missing from the plans that must be submitted before final
approval; however, the basic design and engineering are appropriate for the
site. I can assure you that this plan will be approved once these items are
addressed. There may be very slight modifications to the plan, but it will
essentially be this design.
With the July 4th holiday and the vacation plans of our consultant, I believe
that the plan could be approved as early as July 7th or by July 10th at the
latest. I hope that all the involved parties in this real estate transaction
understand that there will be no lengthy delay in this approval process. It is
straightforward and simple. If I can help you in any way, please feel free to
call me at 978-688-9540.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
Cc: W. Dufresne
C. Brown
D. Stewart
File
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
sQ��y
O'�^LED Ib q4,� 1.79
O u¢r;N,• m70
APPLICATION FOR SITE TESTING/INSPECTION
��SSACHUs���y
Applicant
-,;�we-�
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME p ADDRESS TELEPHONE
Test/Inspection Date and Time ri� 1,7.
CHAIRMAN, BOARD OF HEALTH
Fee 7 Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
BOARD OF HEALTH
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
CK 6563
TEL. 688-8540 7 5 �
q0
DATE: 3-16--y-a
r
LOCATION OF SOIL TESTS. �jcc >' , _=s /z t&CL-145;P
Assessor's map & parcel number/,� 1 to 7
OWNER: TEL. NO.: 6/'-7-- c,10`11p
ADDRESS:_ 950''f
ENGINEER: -",rt,.', TEL. NO.:3 5-57�
CERTIFIED SOIL EVALUATOR:
Intended use of land: idential subdivision, single family home, commercial
Repair testing Undeveloped lot testing
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of L216.00 per lot forep_y_v construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of $75,00 per lot for
repairs or upgrades.
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.
MAR 17 r
S 0 T
Scale: 111
5
August 4,1980
PLOT PLAN
Lot # 45 Sawmill Road
North Andover, Massachusetts
Buyer: Steven Leone \
,PePer to N.E,P. D. Book IW, Page 10
and Plan 7588. "�lrrri o t 6rq�)'
OT 4
0101'
'0
uo0
�
;�
�f
O bp.fi'
s N-beli
eco o
SOT VK .A
NOTE: This is not a survey and is to be
used for mortgage purposes only.
N.B.- Do not use offsets for establishing
lot lines for the erection of fences,
walls, hedges, etc.
I hereby certify that the building on this
property is located as shown on plan and complies with
the zoning set back requirements of the Town of North
Andover.
# NOT APPLICABLE TO FLOOD PLAIN ZONING.
CYR ENGINEERING SERVICES, INC.
300 CANAL STREET
LAWRENCE, MASSACHUSETTS
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFIC E 0 F ENVIRONMENTAL AFFAIRS
DEPARTMM OF ENVIRONMENTAL P.ROTWnON
ONE WINTER STREET, BOSTON MA 02108 (617) 2924500
TRUDY CORE
A/��R�GG�[!T
E��O��PAUL CELLUCCI DAVID B. STRUHS
WVCiIIir.N711T11Q41f1TPT •
SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM
PART A
CER7ffICATION
Property Address: 97 Saw Mill Road, North Andover Name of Owner: Robert Fredette
Address of Owner: 97 Saw Mill Road, North Andover, MA. 01845
Date of Inspection: 311412000
Name of Inspector: Neil J. Bateson
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Bateson Enterprises Inc.
Mailing Address: 111 Argilla Road Andover, MA 01810
Telephone Number: ( 978 ) 475-4786
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fail
Inspector's Signature: Date: 3/14/2000
The System Inspector sha I b it a copy this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page I of 11
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/1412000
INSPECTION SUMMARY: Check A, 8, C, or D.
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or move 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.
Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 314/2000
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 the
public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water.
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH AND PUBLIC WATER SUPPLIER, IF ANY) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 sal absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and sal absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/1412000
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
X 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
_X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
_X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
_X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_X Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
_X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
_X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_X Any portion of a cesspool or privy is within a Zone I of a public well.
_X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_X 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile
organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS -
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area @ IWPA) or a mapped Zone 11 of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the
Department for further information.
revised 912/98 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/14/2000
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
_X Pumping information was provided by the owner, occupant, or Board of Health.
_X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_X As built plans have been obtained and examined. Note if they are not available with NIA.
_X The facility or dwelling was inspected for signs of sewage back-up.
_X The system does not receive non -sanitary or industrial waste flow. The site was inspected for signs of breakout.
_X_ All system components, excluding the Soil Absorption System, have been located on the site.
_X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_X Existing information. For example, Plan at B.O.H.
_X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
[I 5.302(3)(b)]
X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/14/2000
FLOW CONDITIONS
RESIDENTIAL:
Design flow _ 150_ .g.p.d./bedroom.
Number of bedrooms (design):_ 4 Number of bedrooms (actual-4—
Total
actual4_Total DESIGN flow _600 _
Number of current residents:
Garbage grinder (yes or no): _No _
Laundry (separate system) (yes or no):_ No_ If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use (yes or no):_ No_
Water meter readings. N/A
Sump Pump (yes or no): _ Yes_
Last date of occupancy: _Current
C OM M E RC IA LI I N D U ST R IA L:
Type of establishment:
Design flow: god ( Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)
Non -sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe) _
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: Pumped 1998 - owner
System pumped as part of inspection: (yes or no)_No _
If yes, volume pumped: _gallons
Reason for pumping:
TYPE OF SYSTEM
X_ Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: 20 Years old, Nov. 7/ 1980
Sewage odors detected when arriving at the site: (yes or no)—
No-
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 97 Saw Mill Road
Owner: Fredette
Date of Inspection: 3/14/2000
BUILDING SEWER: X
(Locate on site plan)
Depth below grade: 24"
Material of construction: _X cast iron X_ 40 PVC _ other (explain)
Distance from private water supply well or suction line:
Diameter: 4"
Comments: 4" cast iron thru wall. 3" PVC in House.
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 12"
Material of construction: _X concrete _metal _Fiberglass _Polyethylene _other (explain)
If tank is metal, list age _Is age confirmed by Certificate of Compliance ____ (Yes/No)
Dimensions: 10' x 5' x 4' x 7.5 =1500 gallons.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: N/A
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: N/A N/A = water level above outlet tee.
Distance from bottom of scum to bottom of outlet tee or baffle:N/A
How dimensions were determined:
Comments: Inlet tee ok. Outlet tee ok. Depth of liquid above outlet invert 6". No evidence of leakage
GREASE TRAP: None
(locate on site plan)
Depth below grade:
Material of construction: concrete _metal _Fiberglass _Polyethylene_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/14/2000
TIGHT OR HOLDING TANK: _None_ (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade:
Material of construction: concrete _ metal _Fiberglass Polyethylene _other(explain)
Dimensions:
Capacity:gallons
Design flow:_gallons/day
Alarm present
Alarm level: Alarm in working order. Yes _ No
Date of previous pumping:
Comments:
DISTRIBUTION BOX.: X
(locate on site plan)
Depth of liquid level above outlet invert: 8"
Comments: D -box level & distribution equal. Water level above d -box when cover removed. Evidence of carryover. No leakage.
PUMP CHAMBER: —None, gravity system_
(locate on site plan)
Pumps in working order. (Yes or No)
Alarms in working order (Yes or No)
Comments:
Revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued))
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/14/2000
SOIL ABSORPTION SYSTEM (SAS): X
(locate on site plan, if possible; excavation not required, location may be approximated by non -intrusive methods)
If not located, explain:
Type
leaching pits, number
leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions: 1 Field 30'x 30'
overflow cesspool, number:
Altemative system:
Name of Technology:
Comments: Soil mushy at end of field. Vegetation ok. Signs of hydraulic failure, water above outlets in d -box.
CESSPOOLS: None
(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 (cesspool must be pumped as part of inspection)
Comments:
PRIVY: None
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
revised 9/2/98 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/14/2000
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
A to 1 = 3412"
•to2=34'
•to3=36'
A to D -box = 38'4"
Bto1=13'4"
Bto2=17'7"
B to 3 = 22'3"
R to P-hnx = 1?.'
revised 9/2/98 Page 10 of 11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 97 Saw Mill road, North andover
Owner: Fredette
Data of Inspection: 3/14/2000
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 4 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_X Obtained from Design Plans on record
_X Observed Site (Abutting property, observation hole, basement sump etc.)
—X—Determined from local conditions
_X Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed) As per design plan.
revised 9/2/98 Page 11 of 11
O
BATESON ENTERPRISES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 97 Saw Mill Road, North Andover
Owner: Fredette
Date of Inspection: 3/14/2000
Tel: (978) 475-4786
Fax: (978) 475-5451
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system.
N it J. Ba son
Bateson Enterprises, Inc.