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Home My WebLink AboutHealth Permit # 9/17/2015 leChiPamela From: De|eChiaie, Pamela Sent: Wednesday, June 02, 2010 2:27PM |m: pa/aj@penoent.nem Subject: FVV iR. '2201 Salem Street' Health Department File From: Ce|leChiaie, Pamela Sent: Wednesday, June O2, 2010 1:52 PM To: 'pa j@peddent.nat' Subject: I.R. ' 2201 Salem Street' Health Department File | / Dear Antony, Attached is a historical scanned copy of your Health Department file for 2201 Salem Street. You will find what you are looking for on the most recent Title 5 inspection performed on October 24, 2007 and March 12, 2008 (new tank and distribution box were installed) on page lO. This will provide you with all the necessary measurements from the house tu the Tank and Distribution box. Please call the Health Department with any questions that you may have. Enjoy the rest of your day. (9 Reference: phone number: 414.BG4.1U00 F~a -~9-~-4~ | Pwooe& Vcxuwm&mxw& � "We can never see thepath of'our&�feY'we art,too busy.focusingwn thapebbles under oarfemt."-_Anoit)mwwus 8ealtbIe/a/tzmcot Assistant � TOWN OF NORTH ANDOVER � Health Department InO0 Osgood Street Building ZO;Suite 2-3b North Andover,MA 01845 978.688.954O'Phone A7@.088.8476-Fax -Wc6eice Notes: lf copied u/BOH8ueo/6ei-s-/7rkirzmc(ly!y Only-xo/rspooac/zqorarrdat this time � � � Fromm: ndovercom [nnaUto: Sent: Wednesday, June O2, 2O1U2:O] PM lNm: DelleChka' Pamela I.R. - 2201 Salem Stneet- Health Department File i 1 map-Block-Lot Commonwealth of Massachusetts 6 090.B-0045- . Board of Health Permit No North Andover BHP 2008-0009 r P.J. t �o !��" � F.1. FEE 125.00 1 --- -- - --- .. Disposal Works Construction Permit Permission is hereby granted Todd Bateson jto(Construct)an Individual Sewage Disposal System. at No 22.0 SALEM STREET as shown on the application for Disposal Works Construction Permit No BHP-2008-000 Dated February 26,2008 � I Issued On:Feb-26-2008 Board of Health u« Commonwealth of Massachusetts Map-Block-Lot t Board of Health o9o.B-0045- _..-_ --- North Andover Certifi �C t cate of Compliance THIS IS T 1 O CERTIFY,That the Individual j dual Sewage Disposal System (Construct) by Todd Bateson nstaller — _ at No 2201 SALEM STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2008-000 Dated February 26,2008 - ----- -------- j Printed On:Feb-26-2008 — --- Board of Health 14,H 71y Application for S,eptiq__Qj§gp§ALqygjM gtio A TODAY'S DATE-- —- --- Constructi Permit = : 1 $ 250.00—Full Repair 1 $125.00 Component SSAC HUS t Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your epair or replace an existing system component cursor-do not use the return A. Facility Information key. ray Address or Lot# rehin City/Town c ., _J�r c.5z 2.- *TYPE OF SEPTIC SYSTEM ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information f� Name C) , L�_ -- Address(if different from above) Cityrrown State Zip Code s(" -- Telephone Number 3. Installer Information Name Name of Company Address City/Town State ��✓ Zip Code Telephone Number(Cell Phone#if posble please) 4. Designer Information �r Name Name of Company Address -— ----- -- --- - -------- State — Zip Ca--- --- ----de- -- ----------- - City/Town Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 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: d (.Address of septic s}-stem) For plans by / �(� Engineer) Relative to the application of Ty'-" � � `�d (Installer's name) rind dated ngpia ate) Dated �.� r —0 With n aT s ate revisions dated (Last re«sed date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a S50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (1'�inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdeptntownofnorthat tdover.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 ofHealth 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 121ans No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: ' �Ioday s Date) acne— rint i e—5igne I TOWN OF NORTH ANDOVER Y10RTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: �A 1 ❑ ev?1 'r' ", MAP: LOT: INSTALLER . DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑"Bottom of tank hole has 6" stone base � �❑ � s��'r'i ::� Weep hole plugged ❑ 1500 gallon tank h„as_been✓-in.&tatted--_ _ry_ H-10 loading onolithic construction.-.. Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over r"one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER TFJ Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX Installed on stable stone base "JIV Ell/,, Inlet tee (if pumped or >0.08'/foot) F 1,Hydraulic cement around inlet & outlets [a"',,,,Observed even distribution Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan F-1 Size of SAS excavated as per plan F-1 Title 5 sand installed, if specified on plan F-1 3/4-1 1/2" double washed stone installed F-1 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above E:1 Orifices @ 5 & 7 o'clock positions F-1 Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER @ �10RTH O St4eo •a H Office of COMMUNITY DEVELOPMENT AND SERVICES ar HEALTH DEPARTMENT A 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 l`rSNCHUSE� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 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 l01 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank3 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 I 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 Wastewater System Documentation—Feb 2006 Page 5 of 6