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Miscellaneous - 976 TURNPIKE STREET 4/30/2018 (2)
.. ^ coL riQlA of NORrH q�'O � O COPY SSACHUS� PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 9/17/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On -Site Sewage Disposal System By: Robert Amor At: 976 Turnpike Street Map 107C Lot 44 North Andover, MA 01845 The:Issuan e of this cwtifieateKIs all not be construed as a guarantee that the system will function satisfactorily. a Michele Grant � Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Owner information is required for every page. Important, When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts Title 5 Official Inspection Form V-/,~ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner's Name North Andover Ma. 01845 September 19, 2014 City/Town State Zip Code 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. A. General Information 1. Inspector: Thomas Roux Name of Inspector Company Name 89 Mayflower Lane Company Address East Wareham Ma. City/Town State 774-678-9066 S14531 Telephone Number B. Certification License Number 1a 25 2014 TOWN OF NORTH ANDOVER 02538 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes to Fails ❑ Needs Further Evaluation by the Local Approving Authority �[�- Inspector's Signature q 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 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is North Andover Ma. 01845 September 19 2014 required for every P page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 I Owner information is required for every page. t5ins • 3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner's Name North Andover City/Town B. Certification (cont.) Ma. 01845 September 19, 2014 State Zip Code Date of Inspection El 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 Ej Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Form: Subsurface Sewage Oisposal System - Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s. 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is required for every North Andover Ma. 01845 September 19, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® 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 Commonwealth of Massachusetts Title 5 Official Inspection Form the system is within 400 feet of a surface drinking water supply Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ❑ 972 Turnpike St. ❑ Property Address the system is located in a nitrogen sensitive area (Interim Wellhead Protection Paul Copeland Area — IWPA) or a mapped Zone II of a public water supply well Owner Owner's Name information is required for every North Andover Ma. 01845 September 19, p 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year RIOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „ 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is North Andover Ma. 01845 September 19 2014 required for every p page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes” or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health 1O /1 OR 5 e -4 M 7 Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (if they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 for example: 110 +440 gpd ( p gpd x # of bedrooms): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ma. 01845 State Zip Code September 19, 2014 Date of Inspection Number of current residents: 0 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)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: June 2014 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 • 3/13 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is required for every North Andover page. City/Town D. System Information Description: Ma. 01845 State Zip Code September 19, 2014 Date of Inspection Number of current residents: 0 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)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: June 2014 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 • 3/13 Tide 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is North Andover required for every page. City/Town D. System Information (cont) Last date of occupancy/use: Other (describe below): ►•- -1• .I General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date September 19, 2014 Date of Inspection Town records ❑ Yes ® No gallons Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy El 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 o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is North Andover Ma. 01845 September 19 2014 required for every p > page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 55 vears. As -Built on file was dated: 3/23/59. 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: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal ❑ fiberglass 1' feet ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 7' in dia. and 5' in ht. Sludge depth: 1" t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 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 972 Turnpike St. Property Address Paul Copeland Owner's Name- North ameNorth Andover Cityrrown D. System Information (cont.) Septic Tank (cont.) Ma. 01845 State Zip Code Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? September 19, 2014 Date of Inspection 1" measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is 7 ft. in dia. and a total depth of 5'. The water was up to the top of the structure. (The outlet tee, which is not visible due to the fact that the structure has only one cover at its center, Has most likely fallen off sometime in the past.) This has allowed all of the solids to enter, and susequently fill the d -box and SAS with solids. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions:. Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is North Andover Ma. 01845 September 19 2014 required for every p , page. City/Town 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: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ; 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is p required for every North Andover Ma. 01845 September 19, 2014 page. City/Town 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 d -box was full. 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.): The d -box was filled to the top with solids. The soil surrounding the d -box was saturated. This indicates a total hvdraulic failure. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: The SAS is filled with solids as well. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was also in hydraulic failure due to the fact that the d -box was filled with solids. The solids entered the SAS then backed uD into the d -box. 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 s 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is required for every North Andover Ma. 01845 September 19, 2014 P page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches ,200'❑ number, length: 6,200- Elleaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was also in hydraulic failure due to the fact that the d -box was filled with solids. The solids entered the SAS then backed uD into the d -box. 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 R. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is North Andover Ma. 01845 September 19 2014 required for every P , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 972 Turnpike St. Property Address Paul Copeland Owner's Name North Andover Ma. 01845 September 19, 2014 City/Town 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 -sketch in the area below ❑ drawing attached separately t5ins - 3113 Title 5 Mid Inspection Fonn: Sussu&— Sewage Disposal Sysbn - Pane 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is required for every North Andover Ma. 01845 page, City/Town State Zip Code D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10'+/ - feet September 19, 2014 Date of Inspection 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: Date. ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: The backyard drops off in the back. There were no records of a soil evaluation being done for this site. The bottom of the adjacent slope would be close to the high groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 *6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments E. Report Completeness Checklist September 19, 2014 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 972 Turnpike St. Property Address Paul Copeland Owner Owner's Name information is required for every North Andover Ma. 01845 page. City/Town State Zip Code E. Report Completeness Checklist September 19, 2014 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 RECEIVED SEP 17 2015 TOWN OF NORTH ANDOVER ,. HEALTH DEPARTMENT � � \ PUBLIC HEALU CEPAUTEM t <t` 5 is ^rsur.;tti Q :wl tmess Minion TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION System constructed; ( ) repaired; ( 1nnt Name) 0 �" Located at:—q, �\r1/rv)4J� ( iALr (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on _ -7��7f , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR .15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All works s accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 10 Vc , j'wi/1 �Q4__ j And — Print Name QC Final Construction Inspection Date: Ifu//V) And — Print Name Engineer *prf'sentat&c'(Signat, ire) Installer: �� �� (Signature) A And — Print Name Engineer• L Signature) _ / Date: 6 t V IT And — Print Name 1600 Osgood Street, Porth Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http.,Ilwww.townofnorthandover.com 3) 4) 5) J 6) J 7) Town of North Andover - Septic System - AS -BUILT CHECKLIST changes to the design plan have been reflected and noted on the as -built ulan,d As -built plan has a suitable scale; (1 inch = 40 feet or fewer for plot .%) ✓ S et Address, Assessor's Ma and Lot Number P L ines and Location of Dwellings served by the system 10 Locations, Elevations and Dimensions of As -built system components, including reserve (if applic e) Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure S tba k di t ances are shown on the as - built plan from system components to: / ubsurface, interceptor & foundation drains dutch basins __, jroperty lines /Dwellings or,other structures Private water supply or irrigation wells —IZWatercourses or wetlands J8) Locations of Wells, Dra' , etland ResourceAreas ithin 150 feet of system 9) �VQL.ocation of water, gas, electric lines, cable, control panel (if applicable) 10) 'Z Location of Structures within 6 Inches of Finished Grade 11) V Original Stamp & Signature 12) Location ��ervious cation and holder of any easements which could impact the system i 13) Areas; Driveways, etc N 14) Xorth Arrow 15) Lotion & Elevation of Benchmark used /-1! 16) STATEMENT 0NIPLAN (NA 5.3) a."I certify the locations, elevations, ties, cover material, exposed component covers etc., shown on this as -built substantially agree ith the approved plan and have determined that the break out elevations, if applicab , have n met." Signatur of Designer Date iM b. "If a STUCTURAL WALL IS PRESENT (NA 4.9) a Letter or statement on the as -built indicating the wall - was, or was not, constructed in accordance with the intended design an"an manufacturer's specifications." /P Signature of Designer Date 2" Sch. 40 PVC Force Main 90x45 91x1 O 89x23 Tx7"Fol �a9x94O 92 9 / /1 ' 0• S' DECK 93 33 �' `r 2 CAR 1 x09 Goo° _-- -`� 95x38_ GARAGE on c. Pier yP� iT P l Plumbing internally connecte 96 — below slab 49 9 x'1 — 95x6 �— Gar. Slab Elev=97.35'/ TOP OF FOUNDATION = 98.40' BASEMENT — — `�`� Concrete FLOOR=91.4'± 311 96x3 1 1/2 STORY WOOD ..Z 97 31 FRAME STRUCTURE \ \\ FFE= 99.60' 0 x�x58`\ Bit. Conc. Ix Driveway i'9px78lConc- 60.41 �0000 1 Grassed North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 976 Turnpike St MAP: 107C LOT: 44 INSTALLER: Bob Amor DESIGNER: Jack Sullivan PLAN DATE: 6/22/15 BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: T,q DATE OF BED BOTTOM INSPECTION: -5 - (0 DATE OF FINAL CONSTRUCTION INSPECTION: 8/17/15 DATE OF FINAL GRADE INSPECTION:_ j S--, 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 N/A 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: Z Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ❑ 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 ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: 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 >0.087foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe 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 N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Low Profile Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 7 ® Number of rows (trenches): 6 Comments: Total Chambers = 42 FINAL GRADE M/Loamed / Seeded E" Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer signe and dated by Engineer a ' installer As -Built Plan BM = 97.35 HR= 3.18 HI = 100.53 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT *Elevations taken 88.22 89.5 Septic Tank IN with designer 88.14 89.30 Septic Tank OUT 87.89 89.05 Pump Chamber IN 87.87 ----- Pump Chamber OUT 87.60 ----- 2" Distribution Box IN 0.99 99.37 99.34 4") Distribution Box OUT 1.00 99.18 99.17 Lateral 1 TOP 1.10 Lateral 1 INVERT 99.08 99.08 Lateral 2 TOP 1.10 Lateral 2 INVERT 99.08 99.08 Lateral 3 TOP 1.10 Lateral 3 INVERT 99.08 99.08 Lateral 4 TOP 1.10 Lateral 4 INVERT 99.08 99.08 Lateral 5 TOP 1.10 Lateral 5 INVERT 99.08 99.08 Lateral 6 TOP 1.10 Lateral 6 INVERT 99.08 99.08 Top of Chamber 2.05 98.48 Bottom of Bed/Chamberl 98.81 98.83 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws �I(�I� Nixf4vj1` Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassagelBody Art ❑ Swimming pools ❑ Well ❑ Tobacco Sales ❑ ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Si nature COMMENTS COMMENTS_ '�V�-- Ifin I - Zoning Board of Appeals: Variance, Petition No; Zoning Decision/receipt submitted yes Planni7g Board Decision: Comments Conrvation Decision: Comments Water & Sewer Connection/signature pate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood StreetDEP ated at��24IVInStreet p �ul7ps;��nlS Fire:�Departm�ent�signature/dates � � a �; � - - _A _ moi tT 77 M01 Grant, Michele From: Jack Sullivan <jacksu1153@comcast.net> Sent: Wednesday, July 08, 2015 7:36 AM To: Grant, Michele Subject: Re: 976 Turnpike, NA - question on septic review Hi Michele, I am going to make the required changes to the 976 Turnpike Street per your review. Question ... the owner would like a deck ... I thought if a minimum of 5 feet was provided between the tank and the sonutubes of the proposed deck it could be permitted ... not sure if that is a rule of thumb? Jack From: "Michele Grant" <mgrant@townofnorthandover.com> To: "Jack Sullivan" <jacksu1153@comcast.net> Cc: "Isaac Rowe" <irowe@millriverconsulting.com> Sent: Thursday, May 7, 2015 12:55:02 PM Subject: RE: 674 Turnpike, NA - Updated Septic Repair Plans in pdf format Thank you Jack, Question .... Is that well being utilized??? Thx Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Jack Sullivan [mailto:jacksu1153@comcast.net] Sent: Thursday, May 07, 2015 10:53 AM To: Grant, Michele -�' Commonwealth of Massachusetts Department ®f Fire Services aM ,. BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 41ja � u Is City or Town of. NORTH ANDOVER To the Inspector of ices: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. w Location (Street & Number) V 7K 7 /j y I /lP l kz S Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes g No ❑ (Check Appropriate Box) Purpose of Building 4./ 2L z Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ('...%.tiny Hirth, inlln,uinn fnWT nH . 7— .,.T T,,. +T.,, Y ..+.,—,rT.TI,'Y No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- E] rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No, of Waste Disposers Heat Totals : Number Tons .... ......................."""""""""""""""" KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: So ri 01;7 7- 6 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 6 0 (When required by municipal policy.) Work to Start: Inspections tote requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVE] GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �4 BOND ❑ OTHER ❑ (Specify:) I certify, tinder ilie pains and penalties of perjury, that the information on this application is true anti complete. FIRM NAME:. G/,G1 /�� LIC -NO -::3-791,4;6 Licensee: 11710 'lf A LVP 1iz Signature Q, LIC. NO.: -3 (If applicable, enter "exempt in he license number line.) Bus. Tel. No. --7 9'a�i 0 Address: �Alt. Tel. No.: *Per M.G.L c *147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. Grant, Michele From: Jack Sullivan <jacksull53@comcast.net> Sent: Tuesday, August 11, 2015 1:17 PM To: Grant, Michele; irowe@millriverconsulting.com Cc: peg@jempropertygroup.com Subject: Re: 976 Turnpike - Septic Upgrade - Field Construction Michele & Issac.. Issac... I met with Michele onsite this morning to excavate and view the additional testhole required. The hole was consistent with the testholes we excavated/logged previous. I will prepare a memorandum with the soil log noted for the record. Additionally ... the following two changes were discussed onsite and verbally approved ... but I wanted to put the changes into an email for the record: 1) The contractor will be using peastone over the infiltrator units (instead of filter fabric) 2) In-place of Cast Iron risers on the septic tank and dosing chamber, poly risers/cover (green) (24" diameter) will be utilized.... the tanks are not subject to H-20 loads so there is no need for Cast Iron. Jack Sullivan 781-854-8644 From: "Jack Sullivan" <jacksu1153@comcast.net> To: peg@jempropertygroup.com Sent: Thursday, August 6, 2015 4:14:07 PM Subject: Fwd: 976 Turnpike - Septic Plan - Contractor minor plan changes Peg, This is what I sent to Michele today ... how did you make out on the deck? Jack From: "Jack Sullivan" <jacksu1153@comcast.net> To: "Michele Grant" <MGrant@townofnorthandover.com> Cc: "Isaac Rowe" <irowe@millriverconsulting.com>, "Lisa Blackburn" <LBlackburn@townofnorthand over. com> Sent: Thursday, August 6, 2015 4:07:45 PM Subject: Re: 976 Turnpike - Septic Plan - Contractor minor plan changes Michele, Attached are the red lined plans with the field changes. I will drop off paper copies to your office tomorrow morning around 9 am. I saw the septic tank installation this morning and this plan reflect the field septic tank location. Jack From: "Michele Grant" <MGrant@townofnorthandover.com> To: "Jack Sullivan" <jacksuI153@comcast. net> Cc: "Isaac Rowe"<irowe@millriverconsulting.com>, "Lisa Blackburn" <LBlackburn@townofnorthandover. com> Sent: Wednesday, August 5, 2015 9:21:36 AM Subject: RE: 976 Turnpike - Septic Plan - Contractor minor plan changes Hi Jack, Yes, Robert and I discussed it yesterday morning. I asked him to run it by you first. One pipe change seemed very reasonable, however the second pipe, from foundation to tank, I asked for your input. Thankyou emailing Isaac and I. Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Jack Sullivan [mailto:jacksull53@comcast.net] Sent: Wednesday, August 05, 2015 7:24 AM To: Grant, Michele Cc: Isaac Rowe Subject: Re: 976 Turnpike - Septic Plan - Contractor minor plan changes Michele, The site contractor for the septic installation contacted me yesterday saying he would like to slightly relocate the sewer force main near the proposed deck footing to avoid any conflict AND run the second building sewer line out of the house to the septic tank in a slightly different configuration than shown (contractor said pipe run would be less and pitch would improve which sounded reasonable). am ok with these changes and will accurately reflect them on the As -Built plan. I copied Issac on this as well not knowing if you or Mill River will be inspecting system prior to backfill.... Jack Sullivan From: "Michele Grant" <mgrant townofnorthandover.com> To: "Jack Sullivan" <*acksu1153(a comcast.net> Cc: "Isaac Rowe" <irowe(aD-mill riverconsulting.com> Sent: Tuesday, May 5, 2015 12:13:04 PM Subject: FW: 674 Turnpike - Septic Plan - Need for Town Input Hi Jack, Please see Isaac's response. Please feel free to contact Isaac, his'phone is listed below. Keep me apprised of any conversation and changes to the plan. Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com From: Isaac Rowe [mailto:irowe(a)millriverconsulting.com] Sent: Monday, May 04, 2015 3:05 PM To: Grant, Michele Cc: Isaac Rowe Subject: RE: 674 Turnpike - Septic Plan - Need for Town Input I would recommend the designer resubmit the revised design plan with the new wetland line and additional variance requests noted on the plan. MRC will review the revised plan and submit any questions/comments to the Health Department. Even though Title 5 variances will be requested the applicant does not need to submit a variance request application to DEP. The review of variances by DEP has been removed from Title 5 regulations and is no longer required expect in particular situations. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(a�,millriverconsulting.com www.millriverconsultin.g.com From: Grant, Michele [mailto:mgrant(�townofnorthandover.com] Sent: Monday, May 04, 2015 2:35 PM To: 'Isaac Rowe' Subject: FW: 674 Turnpike - Septic Plan - Need for Town Input Hi Isaac, Please see below and the attached.....What are your thoughts? Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrantCo)townofnorthandover.com Web www.TownofNorthAndover.com From: Jack Sullivan[mailto:iacksu1153Ccbcomcast.net] Sent: Friday, May 01, 2015 6:28 PM To: M Yamin Cc: Sawyer, Susan; Grant, Michele; Hughes, Jennifer; Gaffney, Heidi; Willett, Tim Subject: Re: 674 Turnpike - Septic Plan - Need for Town Input Mohammad & Town Staff; 4 I r6cently had Norse Environmental come out to the above property to clarify the wetland line based on in-depth soil probes to determine the limit of hydric soils. The previous wetland line used was taken from a plan by others for a proposed redevelopment of this property as a Roast Beef restaurant which never materialized. Upon review mutual review of the wetland line with Jennifer and myself it appeared the wetland line would need to be brought more upgradient, which was confirmed by Norse Environmental. The result of the wetland delineation performed by Norse Environmental presents a problem for use of an upgraded septic system... specifically almost the entire site is within the 50 foot buffer to the wetlands. State Title 5 code requires 50 feet from a wetland to a soil absorption system and North Andover requires 100 feet .... thus the problem. The existing septic system is failed and as you can see from the attached plan it appears at least one of the leaching pits is in the wetland area. So this email might be more appropriate for the Board of Health to comment on, but I wanted to keep all departments in the loop since this is an active wetland filing. I have never had a situation where I was unable to fit a septic system onsite. The Town sewer is over 400 feet away and furthermore individual sewer force mains are not allowed per DPW. Susan & Michelle .... I am not sure if you have run into this situation before. MY THOUGHT IS WITH THE MICRO FAST UNIT PROVIDING DE-NITROFICATION THE DEP WOULD PROBABLY GRANT A VARIANCE FROM THE 50 FOOT WETLAND SETBACK REQUIREMENT. This would also require a variance from the North Andover BOH and Conservation. I do not think DEP would allow a tight tank since they typically want to see some sort of soil absorption field if there is any land area that would allow some treatment, even with a setback variance. If you could forward this email and plan to Mill River for comment that might be helpful. If everyone agrees the best option is to pursue the DEP variance on wetland setback I can look to prepare the application and continue the public hearing process with Conservation. I would look to submit the variance paperwork to the NA BOH at the same time the DEP variance request is submitted. The owner and I would like to try to finalize some type of design to finally remedy the failed septic system... please let me know the best course of action to take. Thank you. Jack Sullivan 781-854-8644 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma Attached are the red lined plans with the field changes. I will drop off paper copies to your office tomorrow morning around 9 am. I saw the septic tank installation this morning and this plan reflect the field septic tank location. Jack From: "Michele Grant" <MGrant@townofnorthandover.com> To: "Jack Sullivan" <jacksu1153@comcast.net> Cc: "Isaac Rowe"<irowe@millriverconsulting.com>, "Lisa Blackburn" <LBlackburn@townofnorthandover.com> Sent: Wednesday, August 5, 2015 9:21:36 AM Subject: RE: 976 Turnpike - Septic Plan - Contractor minor plan changes Hi Jack, Yes, Robert and I discussed it yesterday morning. I asked him to run it by you first. One pipe change seemed very reasonable, however the second pipe, from foundation to tank, I asked for your input. Thankyou emailing Isaac and I. Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrantCDtownofnorthandove r.com Web www.TownofNorthAndover.com From: Jack Sullivan [mailto:jacksull53@comcast.net] Sent: Wednesday, August 05, 2015 7:24 AM To: Grant, Michele Cc: Isaac Rowe Subject: Re: 976 Turnpike - Septic Plan - Contractor minor plan changes Michele, The site contractor for the septic installation contacted me yesterday saying he would like to slightly relocate the sewer force main near the proposed deck footing to avoid any conflict AND run the second building sewer line out of the house to the septic tank in a slightly different configuration than shown (contractor said pipe run would be less and pitch would improve which sounded reasonable). am ok with these changes and will accurately reflect them on the As -Built plan. Commonwealth of Massachusetts BOARD OF HEALTH North Andover Map -Block -Lot 107.00044 ----------------------- Permit No BHP -2015-0331 ----------------------- FEE $250.00 ------------------ DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted RobertT. -Amor - ----------------------------------------------------------------------------------------- to (Construct) an Individual Sewage Disposal System. at No 976 TURNPIKE STREET as shown on the application for Disposal Works Construction Permit No. BHP -2015-033 ated August 03, 2015 --- --- --- - LF C� P ------- - ----------------- ssue On: Aug -03-2015 - ------------- BOARD OF HEALTH • �Application for Septic Disposal System Construction Permit —TOWN OF NORTH 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. :A ct 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 Address or Lot # TODAY'S DATE L5O-070- Full Repa .r $125.0 - omponent City/Town A;%�/ /Jb� 2.- *TYP OF SEPTIC SYSTEM*: ➢ V Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ➢ ❑ onventional System (pipe and stone system) )o. 6j or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes-V—/No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) 2. WhatistheMake? ,Z�j j �4 Wb.tistheModel. i�%41 b � D3� City/Town % State Zip de Email address Telephone Number 3. Installer Information Name Name of Company Address City/Town J State a f Zip h Telephone Numb&[ (Cell Phone # if possible please) 4. Designer Information / Name Name of Company Address 4t/e-V6`5e 4T f� City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 •,;�F,w- • Application for Septic Disposal System TODAY'S DATE • ':., Construction Permit —TOWN OF $ 250.00 — Full Repair NORTH ANDOVER, MA 01845 $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: residential Dwelling or ❑Commercial B. Agreement 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. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. ,✓ Name Date 1p atio Approve y: r'),and f e Ith Representa� ame Date Application Disapproved or the following reasons: For Office Use Only: Application for Disposal System Construction Permit • Page 2 of 2 1. Fee Attached? Yes V No 2. Project Manager Obligation Form Attached? Yes No 3. _ Pump System? If so, Attach DV ofElectrical Permit Yes V No Applicant received copy of "Electrical Inspection Notes tri Yes No Handout? 4. Reviewed approvalletter, all paperwork received. Yes " No Missing. 5. Foundation As`Built? construction only): Yes No (new (Same scat as approved plan) 6. Floor Plans? (new con tCuction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (address of septic sys m) For plans by �'!%�L.1 r1�iV /%✓%� /�1/�i �i�%N� (Engineer) Relative to the application of (Installer's name) And dated rigina ate Dated � (?-/s- o ay s ate With revisions dated 02- �• �� (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 plansrp for to performing any work on a site. I must have the approved plans and the12ermit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (ls� 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: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than 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 consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,zeneral contractor, or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) P— J` • - T D ame — Print --(TTa-7signe Blackburn, Lisa From: Jack Sullivan <jacksull53@comcast.net> Sent: Wednesday, July 01, 2015 11:25 AM To: Blackburn, Lisa Subject: Re: 976 Turnpike St. Lisa, must have left an old address on the plan ... sorry. Owner information: JEM Property Group 14 Chatfield Drive Litchfield, NH 03052 Thank you. Jack From: "Lisa Blackburn"<LBlackburn(cD-townofnorthandover.com> To: "Jack Sullivan" <jacksu1153(a),comcast.net> Sent: Wednesday, July 1, 2015 11:09:00 AM Subject: 976 Turnpike St. Hi Jack, Here is the disapproval letter for 976 Turnpike St. Can you give me the homeowners address? I have 39 Cotuit Street LLC, 733 Turnpike St. #217, No. Andover MA. I did notice Jem Property Group on the Form 11. 1 want to make sure I have it correct. Thanks. -----Original Message ----- From: noreply(cD-townofnorthandover.com fmailto:noreply(cD-townofnorthandover.coml Sent: Wednesday, July 01, 2015 11:11 AM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 07.01.2015 11:10:44 (-0400) Queries to: noreplyCcD-townofnorthandover.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com of X10 R Ty qti cop)4 0 a m SSAcH0 North Andover Health Department (ommunity and Economic Development Division July 22, 2015 JEM Property Group 14 Chatfield Drive Litchfield, NH 03052 Re: Subsurface Sewage Disposal System Plan for 976 Turnpike Street (Mau 107C, Lot 44) To Whom It May Concern: The proposed wastewater system design plan for the above site dated June 22, 2015 with a final revision date of July 9, 2015 and received on July 13, 2015 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a 4 -bedroom (max 9 -room) home utilizing a Quick 4 Plus Standard LP Infiltrator Chamber system. This design plan approval is valid until July 22, 2017. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 r a 976 Turnpike Street July 20, 2015 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,. Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 3. Since only one test pit is in the proposed soil absorption system the required Form 9A — Local Upgrade Approval request form is required to be submitted. Also, an additional test pit will be required at the time of the bottom of bed inspection to confirm the subsurface soil conditions prior to the installation of the leach field components. 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. S'ncerely, Michele Grant Health Inspector Encl. Installers list cc: Jack Sullivan, P.E. File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 it T OF NORT/1 � 4 3 E COPY �y North Andover Health Department (ommunity Development Division July 1, 2015 Jack Sullivan, P.E. Sullivan Engineering Group, LLC P.O. Box 2004 Woburn, MA 01888 Re: Subsurface Sewage Disposal System Plan for 976 Turnpike Street (Map 107C, Lot 44) Dear Mr. Sullivan: The proposed wastewater system design plan for the above site dated June 22, 2015 and received on June 25, 2015 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. 1. On sheet 1 of 2, the finished side slope of the mounded system is steeper than 3:1 horizonatal:verticial (310 CMR 15.255(2)). 2. On sheet 1 of 2, the proposed deck and pump chamber do not meet with minimum setbacks in the North Andover Board of Health regulations (NA BOH 3.9). 3. On sheet 1 of 2, although noted on the plan, the other building sewer line proposed into the septic tank is not depicted on the site plan. If bends are proposed in the building sewer line(s) a cleanout is required. 4. Annual maintenance of the effluent filter is required and should be noted on the design plan (3 10 CMR 227(7)). 5. On sheet 1 of 2, the site plan and profile do not provide adequate cover material above the proposed tanks (3 10 CMR 228(1)). 6. On sheet 1 of 2, the sizing calculations for the conventional system depicts the incorrect "leach area provided" for the trench length and square footage. 7. On sheet 1 of 2, if finish grades are proposed within 5' of the property line a swale is required (310 CMR 15.255(2)). 8. On sheet 2 of 2, pump calculation note #10 depicts the incorrect reserve capacity of 412 and 453 gallons based on the available volume above the alarm float of 33". Additionally the gallons/ vertical foot appear to be based on a smaller pump chamber. Please modify the emergency storage calculations as needed. 9. On sheet 2 of 2, pump calculation note #I I indicates a maximum operating point of 40 GPM with a total head of 14.22 feet. This operating point appears to be beyond the pump performance curve for the selected pump. Therefore indicating the pump may not be able to provide necessary flow Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 against the calculated head. Please confirm if the selected pump will meet the operating point or revise the pump selection as needed. 10. On sheet 1 of 2, the slope of the longest line from the distribution box to the Infiltrator Chamber inlet appears to be approximately 0.002' based on an 18ft+/- length of pipe. The design plan proposes a slope of 0.01'. 11. Although not a reason for disapproval, you may wish to minimize the force main length by proposing the distribution box on the northern side of the leach field. 12. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use" will apply. Please provide the following as required by the approval conditions Section H(18): c) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 5 EA technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; 2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); 3. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 4. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modem or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. 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. incerely, Michele Grant Health Inspector cc: JEM Property Group File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 July 9, 2015 Town of North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 976 Turnpike Street, North Andover Owner Certification for Septic Upgrade As owner of the above property I certfy that: RECEIVED JUL 2 12015 ?OHEAOF NORTH TH DEPARTME ANDOVER 1. have been provided a copy of the Title 5 IIA technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions: 2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CAIR 15.287(5),- 3. ifthe design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 4. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modem or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CAI? 15.303. Ve ruly o s, Peg aveline of JEM Property Group Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants July 10, 2015 RECEIVED Town of North Andover Board of Health JUL 13 2015 1600 Osgood Street, Suite 2035 North Andover, MA 01845 TOWN NORTH ANDOVER HEALTH DEPARTMENT Re: 976 Turnpike Street, North Andover Septic Upgrade Plan Board of Health; Enclosed are three (3) sets of the revised Septic Upgrade Plans for your review. All of the changes and/or revisions have been made to the plans. The numbered items below are the review comments and the changes I made are in italics. 1. On sheet 1 of 2, the finished side slope of the mounded system is steeper than 3:1 ho offal: vertical (310 CMR 15.255(2)). The finished side slopes have been adjusted to a 3:1 slope. 2. On sheet 1 oft, the proposed deck and pump chamber do not meet with minimum setbacks in the North Andover Board of Health regulations (NA BOH 3.9). The deck was reduced in size to 12'x12' and the pump chamber relocated to provide a Minimum of S feet from the deck to pump chamber. A note was added to the plan reflecting this as well. The deck is to be constructed on piers. 3. On sheet 1 of 2, although noted on the plan, the other building sewer line proposed into the septic tank is not depicted on the site plan. If bends are proposed in the building sewer line(s) a cleanout is required. The other building sewer exiting the foundation is shown and cleanouts depicted at the two bend locations. 4. Annual maintenance of the effluent filter is required and should be noted on the design plan (310CMR 227(7)). Note added... see Note #19 5. On sheet 1 of 2, the site plan and profile do not provide adequate cover material above the proposed tanks (3 10 CMR 228(1)). This has been corrected. In the profile a note has been added to provide a minimum 9" of cover over each tank. 6. On sheet 1 of 2, the sizing calculations for the conventional system depicts the incorrect "leach area provided" for the trench length and square footage. This has been corrected. 7. On sheet 1 oft, if finish grades are proposed within 5' of the property line a swale is required J w (310 CMR 15.255(2)). A proposed swale has been depicted and noted. 8. On sheet 2 of 2, pump calculation note #10 depicts the incorrect reserve capacity of 412 and 453 gallons based on the available volume above the alarm float of 33". Additionally the gallons/ vertical foot appear to be based on a smaller pump chamber. Please modify the emergency storage calculations as needed. This has been corrected to reflect the larger pump chamber. 9. On sheet 2 oft, pump calculation note #11 indicates a maximum operating point of 40 GPM with a total head of 14.22 feet. This operating point appears to be beyond the pump performance curve for the selected pump. Therefore indicating the pump may not be able to provide necessary flow against the calculated head. Please confirm if the selected pump will meet the operating point or revise the pump selection as needed. This is corrected....pump will run at 34 GPM at 14.22 feet of head which is sufficient For the pump selected 10. On sheet 1 of 2, the slope of the longest line from the distribution box to the Infiltrator Chamber inlet appears to be approximately 0.002' based on an 18ft+/- length of pipe. The design plan proposes a slope ofOOl'. The eleveations have been adjusted to insure a min. 1 % of pitch on the pipes 11. Although not a reason for disapproval, you may wish to minimize the force main length by proposing the distribution box on the northern side of the leach field. The d -box was moved to the northern side of thefield 12. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use" will apply. Please provide the following as required by the approval conditions c) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and This note has been added on Sheet I in the upper left corner ofpage If you have any questions please feel free to contact me. Very TI y -10 , Jck S van, PE 0 SEPTIC PLAN SUBMITTAL FORM Date of Submission: June 25, 2015 Site Location. 976 Turnpike Street Engineer: Jack Sullivan - Sullivan Engineering Group, LLC New Plans? Yes X $225/Plan Check # (includes I" submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes X No Local Upgrade Form Included? Yes No - N/A Telephone #: 781-854-8644 E-'mail:Jacksull53@comcast.net Fax #: Homeowner Name: JEM PROPERTY GROUP 603-493-0992 (CELL) OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database V3, . TOWN J TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES t" HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdeptLWtownofiiorthandover.com WEBSITE: hitp://www_townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: June 25, 2015 Site Location. 976 Turnpike Street Engineer: Jack Sullivan - Sullivan Engineering Group, LLC New Plans? Yes X $225/Plan Check # (includes I" submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes X No Local Upgrade Form Included? 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E� nW § cc � E & 0) a Tca CL m �w �a co o$ k« 0■ 2U I f % 00 /. � f m6� \0 |k a 2 § ƒ \ gJ k � f 2 02 4D � a- tm ° c � � :3�� ' 02 � $%_ Ljji aa: . e e U) d 2 2 ƒ 0 o cc 4D©� s k� �0® �- § c�oc k / /�/ Q o e| -■k � � 2 £ z m- 2 U) ca $ 00 \ k to / 17- 00 ° l _� � 4.0 - :E 2 / { ®CL k f U �(o J .� W _ LL: I ( N � N z i m N z m II II .I •I IIS i II :I II I� II II -I I I II II � 1 A21 Ij o �I :I II En 0 it o .i � IN : to 114 1 Important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. v ICS Commonwealth of City/Town of Percolation Test Form 12 Massachusetts 4 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal 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 the local Board of Health to determine the form they use. A. Site Information JEM PROPERTIES Owner Name 976 TURNPIKE STREET Street Address or Lot # North Andover city/rows PEG GRAVELINE Contact Person (d different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) John D. Sullivan III, P.E. MA State 603-493-0992 Telephone Number 6/9/15 10:00 a.m. Date Time PT -1 38"-56" 9:35 9:50 9:50 10:12 10:46 34 min 12 MPI 01845 Zip Code Date Time Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By. Issac Rowe, Consultant for Town of North Andover BOH Witnessed By: Comments: 1 t5form12.doc- 06103 Perc Test - Page 1 of 1 f �.......... _............... `�- C-' C e-� i `Aw TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS, RS Public Health Director APPLICATION FOR SOIL TESTS DATE: May 20, 2015 978.688.9540 — Phone p1 O R T/y OF q�Y 0, CH SSA C H U`�E RECEIVED 978.688.8476 — FAX MAY 2.0 2015 healthdeptt(a_townofnorthandover. com www.townofhorthandover.com TOWN OF NORTH ANDOVER HEALTH DEPARTMENT MAP & PARCEL: 107.0 44 LOCATION OF SOIL TESTS: 972 Turnpike Street (Assessor has address as #976) OWNER: JEM PROPERTY GROUP Contact #: 1-603-493-0992 APPLICANT: Same as Owner ADDRESS: 14 Chatfield Drive ENGINEER: Jack Sullivan Contact #: Litchfield, NH 03052 Contact #: 781-854-8644 CERTIFIED SOIL EVALUATOR: Jack Sullivan Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: X Undeveloped Lot Testing: Upgrade for Addition: In the Lake CV%1 %, ewi%, Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM a ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5" x 11 " Plot plan & Location of Testing (please indicate test pit sites on the plan) ➢ 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 Approval Signature of Conservation Date back to Health Department: (stamp in): R raM "X 11 Sullivan Engineering Group, LLC Civil Engineers & Land Development Consultants May 20, 2015 Town of North Andover Board of Health Re: 972 Turnpike Street, North Andover Owner letter authorizing soil testing Board of Health; This letter is prepared to authorize soil testing for a future upgraded septic system at the above property. I, Peg Graveline, operating under JEM Property Group, am the current property owner of 972 Turnpike Street (Town assessor has the property referenced as 976 Turnpike Street) and authorize the soil testing on my property. 5 ignature Date P.O. Box 2004 Woburn, MA 01888 (781) 854-8644 e-mail: jacksu1153@comcast.net Y North•• - .. k 0w.wff t , t w.� Gr _"'4�5w-i�Fc � I •k' y` f�'4y,4�5 OF.r 114 f t Interstates —I SR Roads ti Easements 0 MVPC Boundary ❑ Parcels 1"=70ft Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, May 20, 2ol �, �i q,- r t•• Ct ,`i V q� I North Andover. Additional data provided by the Executive Office of fa 00 Environmental ABairsfMassGIS. The Information depicted on this map is e(' L for planning purposes only. It may not be adequate for legal boundary definition or regulatory Interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION OF.r 114 f t Interstates —I SR Roads ti Easements 0 MVPC Boundary ❑ Parcels 1"=70ft Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack 'AORTN Valley Planning Commission (MVPC) using data provided by the Town of Ct ,`i V q� I North Andover. Additional data provided by the Executive Office of fa 00 Environmental ABairsfMassGIS. The Information depicted on this map is e(' L for planning purposes only. It may not be adequate for legal boundary definition or regulatory Interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION