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Building Permit #475-2011 - 163 FARNUM STREET 12/10/2010
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: y7 Date Received - Date Issued: /� RTAT:Applicant must complete aitems on this page CATION l (0 3 w^nv S�: N�- Lt Print, PROPERTY OWNER /V` 6s,r.L P c,a: Le Print MAP NO;07�PAR CEL: G63 ZONING DISTRICT: HlStorlc District yes Machine Shop Village yes II' OF IMPROVEMENT PROPOSED USE TYPE Residential Non- Residential ❑ New Building One family 11 Add. t.on _ -� - - ❑Two or more family Y 11 Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ElDemolition - ❑ Other ood° a;n ®wetl as t❑ Wat ishfed Dis ict } ae F tics' ®Tell _ ❑El p _ _ s � , tiw' # t f�w ss er .P�+s!: -=.c����.+f.�.let-- f�4 p,3(,\pXDESCRIPTION OF WORK TO BE PERFORMED: /�E�rDt/a v/ 01 Z �CE�rmvt- SLE B 0Q�1 ► w stogy %"IAD cr et r/lwmt 1, ltf' �4d�iJ`e' /Tc��•✓ �'i/QNa • � ' /Act A �E b� des 61 cc74*- a /wrSAUL Ree.-f l Id {ification Please Type or Print C1earIy) OWNER: Name: Bs.,, P,. ; LLL Phone: "� Address: 7 No-dde f obl tq5 CONTRACTOR Name: Loom Pape Phone: Affw",MA 01813 _ - Address: Supervisor's Construction License: MC 129184 Exp. Date: CS 84192 Home Improvement License: Exp. Date: . ' ARCHITECT/ENGINEER e�ld Phone: Address: Reg. No. FEE SCHEDULE.BULDING PEWIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7 oG"FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty- und ct r - `o:contra :-i °Si nature f 3 erJ ---Wj�-- --- — Location L } Gly V ' No. �/7 S" o /� Date MORTN TOWN OF NORTH ANDOVER F w 9 a y Certificate of Occupancy $ Building/Frame Permit Fee $ �3f� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # or5�7 2.3775 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic fafi ;; '-`[l .. ' t erm�nent Dempster on Site r. THE FOLLOWING"SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNINGA DEVELOPMENT ❑ ❑ •�ti COMMENTS CONSERVATION Reviewed on Signature .5 a� 4.y yFiR':1 e,;.�`° e� c4' .2'i,', µ ,.�•v Z,e t P_p, : •w 0. ..� .• ?. ,.` , V 3 .` ..r� ,s.:�.'./t� .r'`-'�4,�`:.� '� x'R' y+,.*.: :,';-:►•SL i,`z�-a�,l, ` �``" .��n+.i, .R���.''� ' S 14EALTH Reviewed on COMMENTS4, T, �_ Zoning Board of Appeals VaCiancp, Petition No: Zoning-Decision/receipt submitted yes R Jt Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main.Street Fire Department signature/date COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: , ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use - i . ® Notified forp ickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of.H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks • Building Permit Application ❑ Certified Surveyed Plot Plan i ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit I o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals fat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi ORTiy Tovm of Andover No.-, -K 1.0 dover, Mass. f2��a-Z� COC MI CKEWICK ' ' V oRATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT......... !"..7 �.�'......151`-�� ................................................................................................................... Foundation has permission to erect.................. � ��N ��� buildings on ..../� ..... .../ ..........:......................................................... Rough to be occupied as...........................5.�.. ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough t` ... . ... Service ��DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR I Display in a .Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Need AHandyman? Leslie A�Page 161 Kimball lload � O �W Ameshurv, MA 01913 (978) 388-7143 December 6,2010 North Birch Properties; 1..,1..:C. Paul Swartz / Hidden Court 9 North Andover, "VIA 01845 Service Work Agreement 163 Farnum 5t,North Andover tti1A Replace Existing.LandingAnd Stairs Off Exterior Kitchen boor « Digfootings fi)r end of landing and stairs « Build f(stn• foot.by four IOot(4` X 4 ).landing one step down from door « Build stairs from landing to ground level, (approximately v%- o steps) « l a�tire landing, stringers and stair treads will be pressure treated lumber « Fix or replace siding in area around deck. Replace Bottom Eighteen Inches 18" Of Six (6)Support Post On Front Deck « Cut and take off rotted section of trim on post. Replace with new PVC base trim eighteen inches(18")high can Pasts If bean) in middle of ti-im is rotted it will be stock and labor to fix Wall In Rasement/Garage Sheetrock Basement Side • Insulate Aall with at least RA i unlaced insulation • Sheets>ck wall with moisture resistant sheetrock • Coal scams with one (I)coat of tape and Joint compound • Install one(1)door in opening under basement staircase to make a closet • N nig,a shelf an coat,bar in Basement closet Remodel fart Of Kitchen Removepocket doors and re-trim opening ® Build and install ons (I ) ettstOrn panel around refrigerator to match cabinets as close a possible, build out shallow cabinet above refrigerator and attach to neu panel :and Arrall. At the end of sink base cabinets, make a lal;se base cabinet and install betv%cen s*,)ve a lies Wail « Re-trim with wood around dishwasher installed in base cabinets, « Take offold laminate countertops and prep for new canes « Remotie. Formica from backsplash and skim coat the back wall to repair. Remove old e:xtet-ior wall/fan vent in Kitchen and patch wall on both sides slang new stove.vent of na crow`atie hood j Homeowner ovill provide stave vera or microwa e frc►rrd 1 I _ • r Remodel Bathroom �' � CD I '=-'J Remove fixtures from bathroom (toilet,tub, sink) 1'€ry-1'lutaaber LJ Remove tile froni walls up to four feet (4 )outside ofshower. Remsheptj.:ac k or patch walls up to old file lira€;as needed outside of shower. lnsta11 ,1,ainscrr tip to old the line on walls outside of shower. tapprosimate IV f()ur Ieet (4') high'ana new,baseboard and top cap. ■ Bathroom door may meed to be removed and reinstalled to het new fixtures in room • Assist plumber with install of new shower surround ■ S.heetrock around bathtub area as needed ® Smooth all neve she;etrock. caulk seams and prep for paint Saco d ?"`r Bathroom • Assist plumber in removing and replacing sinkr'vanily Miscellaneous Protide a li f`teen and (l 5yd)dumpster at jobsite ci Based can two (2) ton weight limit any overage. will be an added cast s,l' rrplrrc>;iraaaatLly. One lluracheCl Fifty Dollars and zero cents-, $150.00 per t€gra Clean wood out ofgarage e All material is `guar€anted to be as specified, and the above. ",ork to be perfbi-need in accordance; with the specifications submitted for the above work and completed in a substantial workmanlike manner for "Fera Thousand One Hundred Seventy Dol lar s- and zero cants; $10,170.00. l O`('E,- We. Need A Ilandymai% erre not responsibly for•materials that are provided by Ga honwi gtrer and any problems that are connected. This includes problems between homeowner and thcit` supplier with regards to missing parts, breakage: or availability ofsaid materials. Ifany %NErrl; is necessary due to these occurrences or delays then the homeowner is responsible to die additional charges of materials and/ oi- I alit' Dollars and zero cents. $50.00 per narrrzwhou labor rate. Respectfully subrnilted by Leslie A. Page dba l` eed A Handyman? (.MA license 1,129180)(CS 0841 )2) Need .A Handyman? - 11 slie A. Page C� 161 Kimball 14aad A csl)uErtit, MA 01.913 (978)388-7143 Acceptance of Proposed Work. The above prices, specifications and conditions are satisfactory and are hereby accepted- You are authorized to do the work as specified. The followin terms tin acc pittnc:c dare: I. Initial deposit prior to start of work will be $5,085.00..1,F1,ve Thousand Fight\--fis c I:)ollars and rcro cents. 2. At cc:xmpletion of ,all %,ork a payment will be due of S5.08-5.00. Five Thousand l3ty-fine Dolltars rand zero cents. 1,[lie customer. understand and agree to the following: All jobs are considered to be stock and our hourly labor rate; the only exception is t signed contract or.sib-ned agreernent for 0112•serVices. Quoted .lobs are not:subject to change based on tinge spent and do:, fie]ly agree it) pa the chit>ted job price should one be tendered t'or this job. ✓ Mat.]ate payment or non-payment of this hill will result itz a 1 L2% month lydrat+nce chare or a nurnmurn charge of$2,50 - hich ever is greater. ✓ "l here will be a charge o:f 3% fear collection or the: outstanding debt.. All Attorney fees incurred in collection. The homeowners (3) three-dray cancellation rights under MGG. c 93- s 48: MGL c 1401) s 10 or MGG-c 255D s 14 as may be applicable. DO NOT SI(.i:tl THIS C°C)N RAC;"t IF T]1171RE,ARE ANY BLANK SPACES. Date Signature Date Signature_. Date _ ....... Signature Dat€ Signature..._ } i I w O Notice All home improvement contractors and subcontractors shall be 'registered and that inquiries about.a contractor or subcontractor relating to a registration shall be directed to: Director, I Ionic Improvement C'can aact��a 1 .a istrtatitata Office<�{�(: onstan er A1�1'airs and BusinessIte��ulatic�aas I tI,Park Plaza, Room 5170. Boston,:N4A 02116 ((�1.7)973-8787 or(888)2831-31757 Notice "I'lae contractor anti the homeowner hereby rnUtually agreee in adva:ncc that in the evcm that the contractor has a dispute concerning this contract, the contractor rear stahaa�ait such dispute to a private arbitration service which as been approved Iry the Office of'Consumer r' Hairs and Business Regulation and the; consumer shall lir; required to submit to such arbitration as Iarc:rt icl h 1 in ?l�{;,I c, 142N., fr-'�?r-3 d3wneir: Date: Contracto Date: p ,.. /" �� V .� t NO ICI 1"1e 5a&taatUres is parties above apply only to the agreement aii'the parties tt alternate dispute resolution initiated by the contractor. I'he owner may initiate :altcrnati� I resolution even where this section is not sioned separately by the partics, 1. ...:................ ........................ ................ .......... nse �;<)tjstruction Supervisor Lice License: CS 84192 to,, 00. . LESLIE A PACE 161 KIWIBALLRD ............... .............. A'MESBUkY,MA,01913 4124=11 135-52 X y, i11 B, � T 4-mENT C4;3JkAd,OR IMPRO 129180 Tyi+ 315! ExPrr .7,4201201 ititin. Leslie Al-�Pagd-"w:,�-, Leslie P 181 Kimball 4ii- Z' Amesbury,MA HIC 129180 84192 NEED A HANDYMAN? Leslie Page 161 Kimball Road Amesbur)& MA 01913 978-388-7143 pORTH O��tt eo �6'�4� 1 .6 O O �* i Co' 4~ 0� COC Ic"aw— 1' SAC HUS�t�y PUBLIC HEALTH DEPARTMENT Community Development Division RTj1FjCXrrrF O F COJVl�1'.GI.�Jrvff As of: May 25 2010 This is to certify that the individuaCsu6su ace disposalsystem received a SA27S FAC70RT INSPECg70X of the: ftairlft&cement o an - .f On Site Sewage OisposalSystem Bv: J ,john 2: ,Shaw, III At: 163 Tamum Street 911 ap-107.A; TarceC 3 7 North Andover, qv g 01845 The Issuance of this certificate shad not 6e construed as a guarantee that the system TOT function satisfactoriCy. S, n 7 Sau ye A, Pu66ic9Leaft Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com E 40RT#1 g e!a t_ • O e s' SSAfNUS� PUBLIC HEALTH DEPARTMENT :11AY �ANDOVERCommunity Development Division EPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed;( )repaired; n t By: Jog u 49 040 / 2 (Print Name) Located at: i 6e — FA V,+J U W ��E� (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 0'"61-0 1 and last revised on 2-Z-10 with a design flow of r9'7® gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 2/PC—/V Engineer Representative(Signature) P2 IL.L.- And—Print Name Final Construction Inspection Date: _ Engineer Representative(Signature) And—Print Name Installer: (Signature) Date: �o ,/,, And—Print Name Enginer: �N 1AZ" &jQilf��/�*"Signature) Date: And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, May 26, 2010 10:20 AM To: Sawyer, Susan; DelleChiaie, Pamela Cc: 'Isaac Rowe'; 'Randy Burley'; 'Marianne Peters' Subject: Construction Inspection, 163 Farnum Street Attachments: Construction Inspection Form 163 Farnum Street.doc Construction inspection form attached. I had sent an e-mail last week with the issues found during construction that needed attention at the final grade inspection. Dan ill River< , cons ulti ng Daniel Ottenheimer,President Mill River Consulting,Inc. 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014 fax: 978-282-1318 www.millriverconsulting.com danogmillriverconsulting com Member: Yankee Onsite Wastewater Association, Massachusetts Environmental Health Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association, Cape Ann Referral Group 1 NORTIH " 0��1LEo sq�0 OL O C-11 R KK �9SSAC PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 163 Farnum Street MAP: 107A LOT: 37 INSTALLER: John Shaw DESIGNER: Merrimac Engineering PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: May 12, 2010 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan Bottom of tank hole has 6" stone base Weep hole plugged ® 1500 gallon tank has been installed h-10 loading 2-part construction ® Water tightness of tank has been achieved by visual testing 1600 Osgood Street,North Andover,Massachusetts 01845 . Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 pORTiN D*�t ,ED 16�tiO 6 OL o ti g� ey AO LOCMIL�WKIy� 7�p0R�Teo �SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ® 16" inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Tank had two risers, both had 16" diameter covers. Instructed contractor to replace with 20" covers PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed ® h-10 loading monolithic 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 ® 20" cover at final grade installed over pump access port ® Watertightness of tank has been achieved by visual testing ® Hydraulic cement around inlet & outlet Comments: recommended extension handle on effluent filter to ease access for maintenance CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: garage ® Alarm signal located inside: garage 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandoveram Inspection Form June 2008 NORTH O� st�Eo 16�� '6 SOL O O Coe-lWKK y1. �4A0" TeD 0�` �SSAC HUS�t PUBLIC HEALTH DEPARTMENT Community Development Division Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: Inlet pipe to d-box was 2" sweep which did not have an elbow. Contractor asked to repair this SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan Z Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 10 ® Number of rows (trenches): 5 Comments: Total Chambers = 50 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 �. NORTFf ,611q�0 a OL O tL 1 A � A- coda«ewncw�1• 79 q�AATED SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division SYSTEM ELEVATIONS ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 93.0 Building Sewer OUT Septic Tank IN 3.96 90.41 90.50 Septic Tank OUT 4.21 90.16 90.25 Pump Chamber IN 4.20 90.15 90.20 Pump Chamber OUT Distribution Box IN 2.43 92.10 91.97 Distribution Box OUT 2.49 91.88 91.80 Lateral 1 TOP 2.60 92.10 92.10 Lateral 1 INVERT 2.62 91.75 Lateral 2 TOP 2.63 92.13 92.10 Lateral 2 INVERT 2.60 91.77 Lateral 3 TOP Lateral 3 INVERT 2.60 91.77 Lateral 4 TOP Lateral4.INVERT 2.59 91.78 Lateral 5 TOP 2.60 92.10 92.10 Lateral 5 INVERT 2.63 91.80 Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 i .t NORrw Commonwealth of Massachusetts Map-Block-Lot 107.A0037 04 Board of Health Permit No • North Andover BHP-2010-0552 • @, s. P.I. FEE F.I. $250.00 s�, as ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John-T. Shaw, III --------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 163 FARNUM STREET as shown on the application for Disposal Works Construction Permit No. BHP-2010-055 Dated Apr il-16,-2010------- I------------------------- Issued On:Apr-16-2010 ��—y- "Board of Health k 'bORTp l � of ,�,•j,,ao Application for Septic Disposal System411 (P 3?•��' µ °c TODAY'S DATE -Construction Permit — TOWN OF O , MA 01845 $250.00—Full Repair RTH ANDOVER �4S••••o�'° $125.00-Component Important: Application is hereby made for a permit to: When fining 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 ❑ Repair or replace an existing system component—What? cursor-do not . use the return key. A. Facility Information 14 3 Farwvr Ir-11 Address or Lot# ISI City/Town 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) V4 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 Name o;2 Address(if different from above) / City/Town State Zip Code 97 1'7s e-l�9iG Telephone Number, ���w^� 3. Installer Information a 5 _,:(yGar "��l�u� �',✓l/�✓oay� GA'CGdc Tio�/ jh�� -Name Name of Company . Address � City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town n State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 i '� pORTp Application for Septic Disposal System 3r•�` �'a°i TODAY'S DATE ' =Construction Permit - TOWN OF ORTH ANDOVER MA 01845 $250.00—Full Repair SAt1i115Et b,,.,o��' H $125.00-Component �S PAGE 2 OF 2 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, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date Application roved By: (Boar, IF Health Representative) Na - Date Application Disapproved for the following reasons: For Office Use Only: / L Fee Attached? Yes,- No 2. Project Manager Obligation Form Attached. Yes No t/ 3. Pum�Svstem. If so,Attach cowofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes—\X 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: AA rte/vim► 1-7 (Address of septic system) For plans by /45t, (Engineer) Relative to the application of �(��� G4® (Installer's name) And dated 0 ngina ate Dated 17 / b o ay s ate With revisions dated (Last revised date) . I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved glans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspectionwithout 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 ori-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 a12roved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) ame—Print) ai6ee—Signe Department of Fire services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code(MECL27MR 12.00 K (PLEASE PRINT INM OR TYPE ALL INFORMA YYOA9 Date: City or Town of NORTH ANDOVER To the I ect r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) --- , Owner or Tenant O Owner's Address Telephone No- .19 1s this permit in conju4pction with a building permit? Yes Purpose of Building S-- - --- ❑ No 0� (Check Appropriate Boa) �.t'' e �l� L� Utility Authorization No. Existing Service L�v Amps Overhead t_ —' and d �' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgtd ❑ No.of Meters Number of Feeders and.Ampacity Location and a Date......% Ilowin table may be waived the Inspector of Wires. :s` :.. .P':'. No.of Total Transformers KVA „ORT" Generators KVA o�,,,�o;•:'+oTOWN OF NORTH ANDOVER 3: , ... ... 0. r7 0.o mergency ° p PERMIT FOR WIRING Batt Units I=ALARMS No.of Zones • s +'a y •,,r„,..� 0.-of Detection and ,SSACMUS� ,-,f Initis ' Devices . T ` f f This certifies that t' ! .r o. o ening Devices . of elf-Contained F f Detection/Ale De"em- has permission to perform ......�Fv .? ::..... J•r �=j Local❑ Municipal �� ,✓ r Connection ❑ wiring in the building of .. ......................................... Security Systems. "" No.of Devices or Equivalent K at.. '' ' ..... / .��.1� '........ r ..........................North Andover,Mass. Data Wiring: d; No.of Devices or Equivalent Fee....'..'.. .................... Telecommunications Wiring: ......... Lic.No. . J Et+i E-mcni II+sPEceoa No.of Devices or E uivalent ....r I Check I< if desired, or as required by the Inspector of Wires. O "e 41 aicipal policy.) € I Wim MEC Rule 10,and upon completion. unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance' luding "completed operation"coverage or its substantial equivalent The undersigned certifies that such coverage ' orce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperlu►y,that the inform FIRM N ation on this application is true and complete- LIC. ompleteLIC.NO.: Licensee: /r Signature LIC.NO.:� (If appkcab e, enter "exempt"in the license number Line. Address: p Sr �Sf" ,� t ) Bus.Tel.No:: ?ef 73 © 9 Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: ety ense: Li OWNER S INS c.No. INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance covers required by law. By my signature below,I hereby waive e) coverage normally > Y e this requirement I am Owner/Ase q the(check one) ❑ owner owner' a „ nt ❑ s agent Signature Telephone No. PERMIT FEE: $ i TOWN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACI IUSETTS 01-845 it Date Issued Expiration Date • i n Jackie's Law — Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MIDST BE PULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant 2 Phone Cell Street Add s °r8— 7S--o 14 ct 6 City/Town Mry ZIP Name of Excavator(if different from applicant) Phone Cell 5��ot,e Street Address City/Town MA ZIP Name of Owner(s)of Property Phone Cell Street Address City/Town MA I ZIP e0. 4N2a & Other Contact Permit Ree Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. 0 /d i ff Insurance Certificate#: �'j j> `Z. (p Cf Q 13 Name and Contact Information of Insurer: J G A/M l e O N o- Pogg Expiration Date: 1,7Wj 1 .L `? .i Dig;Safe#: .2 Q a Q r Name of Competent Person(as define4,by 520 CMR 7.02): riN-et.Qwo C-►2 l7 r 6 S® IV Massachusetts Hoisting License# -I_ O 03 6 5 9 License Grade: l 79' Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK TROPOSED,INCLUDING OSHA REGULATIONS,G.L.a 82A,520 CMR 7A0 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED.OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIMS PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADIE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES.FROM ANY AND ALL-LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANT SIGNATURE . � -DATE EXCAVATOR SIGNA'TU (IF DIFFERENT) DATE. OWNER'S SIGNATURE( F DIFFERENT) DATE: 2 1 P a g e DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, December 01, 2009 2:18 PM To: 'esgdst@comcast.net' Subject: FW: Septic- 163 Farnum Street-Plan Disapproval- 10/5/09 Attachments: SKMBT_60009111810250.pdf Per your request, here is a copy of the letter. Bill just needs to send a revised plan that meets the outlined points, and depending on staff schedules,there should be no problem getting it approved within 24-48 hours after the revised submission. Fejt W"14, Paate& �eQQe "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pages/index-Website Notes. If copied to BOH Members-Reference Copy Only-no response requested at this time From: DelleChiaie, Pamela Sent: Wednesday, November 18, 2009 9:35 AM To: 'brdufresne@comcast.net' Subject: FW: Septic - 163 Farnum Street- Plan Disapproval - 10/5/09 From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Wednesday, November 18, 2009 10:26 AM To: DelleChiaie, Pamela Subject: Septic- 163 Farnum Street- Plan Disapproval - 10/5/09 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, October 07, 2009 4:06 PM To: Sawyer, Susan Subject: Task Status Report: FW: Septic- Plan Review Submission - 163 Farnum Street -----Original Task----- Subject: FW: Septic - Plan Review Submission - 163 Farnum Street Priority: Normal Start date: Wed 9/30/2009 Due date: Mon 10/12/2009 Status: Waiting on someone else Complete: 0% Actual work: 0 hours Requested by: DelleChiaie, Pamela 10/7/09—Received letter from Mill River—on Susan's desk. Mailed 9/30/09. MR will address any lacking forms in their review. From: DelleChiaie, Pamela Sent: Wednesday, September 30, 2009 2:37 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Marianne Peters; 'Randy Burley' Cc: 'brdufresne@comcast.net' Subject: FW: Septic- Plan Review Submission- 163 Farnum Street Attachments: SKMBT 60009093014200.pdf Hello, I am going to go ahead and submit this plan without Forms 11 and 12, so as not to hold it up any further. I have let Bill Dufresne know. Sending in the mail today. Pamela DelleChiaie Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20; Suite 2-36 i NpRTN q p _ �.95^ono��,•t5 - . SACHUSE Health Department October 5, 2009 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 163 Farnum Street, Map 107A, Lot 37 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated August 4, 2009 and received on September 24, 2009 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: t/ 1. Two tests pits are required at every proposed disposal area(310 CMR 15.102(2)). Please submit a new soil testing application and fee for the additional test pits and percolation test required for new construction. �! 2. One percolation test is required at every proposed disposal area(3 10 CMR 15.104(4)). 3. In accordance with the DEP General Use approval for the Infiltrator Chambers,the infiltrator system can be installed on a facility where a system in compliance with 310 CMR 15.000 could be built. Please demonstrate that a system,in compliance with 310 CMR 15.000 could be built on this property. 4. Please show the location of the existing system that will be abandoned. 15. Please indicate the brand and model number of the effluent filter that is proposed in the septic tank(3 10 CMR 15.227(7)). 6. The bottom elevation of the septic tank is below the estimated seasonal high groundwater � table. Please provide buoyancy calculations (3 10 CMR 15.221(8)). 7. Please indicate that the distribution box will be equipped with a riser if buried greater / than nine inches below grade (3 10 CMR 15.232(3)(f)). 8. A pump performance curve is required(3 10 CMR 15.220(4)(r)). 9. It is unclear if the proposed pump chamber is a 2-piece tank or monolithic. Also,please indicate that the tank shall be watertight(3 10 CMR 15.221(1)). i'10. The leaching facility excavation is required to extend 6" into the natural soil (NA 9.02). 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.cam North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely; Susan Y. Sawyer, REHS/RS Public Health Director cc: The Estate of Robert E. Anderson File DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Monday, October 05, 2009 4:00 PM To: 'Daniel Ottenheimer'; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 163 Farnum Street Attachments: 163 Farnum Street Disapproval Letter 10-5-09.doc Susan, Please find attached the disapproval letter for the above referenced property. This was understood at the time of soil testing to be an upgrade for the existing 3 bedroom house. Bill is now proposing a 5 bedroom design/new construction standards. He added a note on the site plan to perform the additional test pits and perc test upon construction of the system. I did not think you wanted to get into the habit of this so I requested additional soil testing. Other that just the usual comments. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street i 1 t NORT11 N /O p �9SSACHUS Health Department October 5, 2009 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 163 Farnum Street, Map 107A, Lot 37 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated August 4, 2009 and received on September 24, 2009 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. 1. Two tests pits are required at every proposed disposal area(3 10 CMR 15.102(2)). Please submit a new soil testing application and fee for the additional test pits and percolation test required for new construction. 2. One percolation test is required at every proposed disposal area(3 10 CMR 15.104(4)). 3. In accordance with the DEP General Use approval for the Infiltrator Chambers,the infiltrator system can be installed on a facility where a system in compliance with 310 CMR 15.000 could be built. Please demonstrate that a system in compliance with 310 CMR 15.000 could be built on this property. 4. Please show the location of the existing system that will be abandoned. 5. Please indicate the brand and model number of the effluent filter that is proposed in the septic tank(3 10 CMR 15.227(7)). 6. The bottom elevation of the septic tank is below the estimated seasonal high groundwater table. Please provide buoyancy calculations(310 CMR 15.221(8)). 7. Please indicate that the distribution box will be equipped with a riser if buried greater than nine inches below grade (3 10 CMR 15.232(3)(f)). 8. A pump performance curve is required(3 10 CMR 15.220(4)(r)). 9. It is unclear if the proposed pump chamber is a 2-piece tank or monolithic. Also,please indicate that the tank shall be watertight(3 10 CMR 15.221(1)). 10. The leaching facility excavation is required to extend 6" into the natural soil (NA 9.02). 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, c�celU� Susan Y. Sawyer, REHS/RS Public Health Director cc: The Estate of Robert E. Anderson File Commonwealth of Massachusetts f RECEIVED City/Town of R - Form 11 - Soil Suitability Assessment forOn-SiteSewage Disposa OCT 0 2 2009 y= TOWN OF NORTH ANDOVER ,MassDEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information Owner Name Street Address PIA; Map/Lot -� I CA G✓Iy� J, 1'�I A` 0L / City State zip Code B. Site Information 1. (Check one) ❑ New Construction Upgrade ❑ Repair 2. Published Soil Survey Available? ['Yes ❑ No If yes: Iflb G'O�c� Year Published Publication Scale Soil Map Unit Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes EKNo If yes: Year Published Publication Scale Map Unit 74(— Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? �es ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name t5form11.doc-rev. 10/07 Form 11-Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8 _4N Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal B. Site Information (Continued) r 6. Current Water Resource Conditions (USGS): Mo th/Year Range: ['Above Normal ❑ Normal ❑ Below Normal 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole: -� Location (identify on plan): L L^j 2. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >-ee4v Drainage Way tl�� Possible Wet Area et Property Line feet Drinking Water Well �ee� Other feet 4. Parent Material: /&<- Unsuitable Materials Present: ❑ Yes [�-Ro If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ER"y-es ❑ No If yes: JZ-; ,r /Z'-3 /Y Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: -75 �(' l inches elevation t5form11.doc-rev.10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 Commonwealth of Massachusitts City/Town of h Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal w C. On-Site Review (Continued) Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Sol[Texture %by Volume Soil Soil Depth(in.) Moist Munsell Consistence Other Layer y (Munsell) (USDA) Cobbles& Structure Depth Color Percent Gravel (Moist) Stones 'ZAP._ 'z.5 705 .5. � pis yip- Additional Notes: t5forml 1.doc-rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Continued) / Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): 2. Land Use & kl/d .) (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation —� Landform Position on Landscape(attach sheet) > 0-20 i ' / ,! f 3. Distances from: Open Water Body -feet Drainage Way � � Possible Wet Area eetfeet Property Line —afee' l Drinking Water Well Other feet feet 4. Parent Material: �� c-' Unsuitable Materials Present: ❑ Yes [?lo If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: []'Yes ❑ No If yes: /®Z'/( /zk/! Estimated Depth to High Groundwater: 7y`/ 616, 6 Depth Weeping from Pit Depth Standing Water in Hale inches elevation t5form11.doc-rev. 10/07 Form 11–Soil Suitability Assessment for On-Site Sewage Disposal -Page 4 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Continued) Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Depth(in,) Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Sol[ Soil Munsell Layer Moist Y (Munsell) (USDA) Cobbles& Structure Consistence Other Depth Color Percent Gravel Stones (Moist) ke, Additional Notes: t5form11.doc-rev. 10/07 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 5 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ,rf D. Determination of High Groundwater Elevation 1. Method Used: / ❑ Depth observed standing water in observation hole A. B. Inches inches ❑ Depth weeping from side of observation hole A. B. inches �� inches 2---Depth in epth to soil redoximorphic features (mottles) 7� �� " inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil abso ption system? les El No b. If yes, at what depth was it observed? Upper boundary: inch 2� Lower boundary: inches� t5form11.doc•rev. 10/07 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal wM F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluator Date 121 i.C, VA1 5 KfA- 4yo e--ie-1-IC" Typed or Printed Name of Soil Evaluator/Lice se# Date of Soil Evaluator Exam Name of Boar of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. t5forml 1.doc•rev. 10/07 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts N. City/Town of Percolation Test Form 12 4M- 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. Important: When filling out A. Site Information forms on the ' , y CI computer,use I E E!�975A i Oe }�C1 !�1` A22EW�`'7�) only the tab key Owner Name to move your I/';� r-� � ��T cursor-do not Street Address or Lot# use the return /� y / key. f�0 Qvr� � Igo�� ��!`J7C✓ ate--- City/Town State Zip Code_J Contact Person(if diff re t from Owner) ne e-phon6 Number $M—An B. Test Results Date p Time Date Time Observation Hole# P .Depth of Perc Start Pre-Soak 101 cf7 End Pre-Soak t 0-2- Time at 12" 1 10_z_ Time at 9" ` l Time at 6" ' ,l Time (9"-6') Rate(Min./Inch) Test Passed: [� Test Passed: ❑ i r Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, September 30, 2009 2:37 PM To: 'Daniel Ottenheimer; 'Isaac Rowe'; Marianne Peters; 'Randy Burley' Cc: 'brdufresne@comcast.net' Subject: FW: Septic- Plan Review Submission - 163 Farnum Street Attachments: SKMBT_60009093014200.pdf; image001.gif Hello, I am going to go ahead and submit this plan without Forms 11 and 12, so as not to hold it up any further. I have let Bill Dufresne know. Sending in the mail today. Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com-Website Notes: If copied to BOH Members-Reference Copy Only-no response requested at this time From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Wednesday, September 30, 2009 3:21 PM To: DelleChiaie, Pamela Subject: Septic- Plan Review Submission - 163 Farnum Street 1 �� _ - $/�� �� //�i�, � �� �� v TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES � b0 HEALTH DEPARTMENT � A 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 4SsacHusEt 978.688.9540—Phone Susan V.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL: healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: -- 'i1- p `( S E P 2 4 2009 Site Location: �' �A (,� }�) /�IL•G TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Engineer: New Plans? Yes ✓$225/Plan Check#. 1071 (includes I"submission and one re- review only) Y Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? i A.Yes No Telephone#,(A'—M 7S 7j 5i5;!5 Fax#: (17P)) q-75— E-mail: 75—E-mail: - r7U FW-e�1�•�% C�1 ,e ��zT- !� •—T Homeowner Name: TA C La c P Fa ecit'r I � Atft [2a d 0A.- .� IC OFFICE USE ONLY en the submission is complete(including check): ^ P� Date stamp plans and letter When u P P ,-'—complete and attach Receipt p ➢ ,Copy File; Forward to Consultant Enter on Log Sheet and Database i Fab-cmation: 1�° �!: Ovaces ftmt: 4 5ffj� �4e-2xg5g) , E ST.A e. y� ATTY• baM oNtC. -rVZVAW0V.4 rcel: 0 7 A 3'T Addres� �P. 7 7 ,, � Installer: Tel .175-4 h� New allq.__Rcpslr v'" MMMMMMM on =] Date: !o-I I.Oq Wetland:-ao Z ueU — Son Symboi_C--k_Sou Rhm Sou Q= Deep.Obsan ign Sole Logs Ele Non Depth Soil nprlioa Sou TcxMM Sou Color Sofl hiottlla= '/.Gravel,Stones eta i� L � 20 X5.00 Maive, p.r:�e utww_ .��a e.aar�""' �tr.�am aKs.� �`�..�u.o.rn F.a�cty ►, .� ��`•� �!:(.jam + �-- r j(.tlW PatttttMaterial 1., DepQie.Bdnd� �"St�Iut�Ilatea•1atheHaa iNeeptnt Fax XMG'V, Date percoiation Tests TOWN OF NORTH ANDOVER ObservadcuHalef I HEALTH DEPARTMENT Depth of Pere Sort Peesoile lin f Tiara at 1.24 TM' r.at 9" Time nt 6" a Time(9"-6") -Rate&iiollnch--. Performed 13t��j, fit)► „ d�Vitnrssed B�^_.�t� _---•-- DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, May 19, 2010 11:16 AM To: Bill Dufresne(brdufresne@comcast.net) Cc: Sawyer, Susan Subject: FW: Septic As Built- 163 Farnum Street Hi Bill, Attorney Terranova dropped off the As Built this morning for 163 Farnum Street that you dropped off to him. Please note that I still need the certification form with your signature and the installer's signature. As soon as we receive that, the COC can be issued. I will forward the As Built to Susan for review in the meantime to get the process going. Your soonest response is appreciated. Thank you. &ue& ne& "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pales/index-Website Notes: If copied to BOH Members-Reference Copy Only-no response requested at this time From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Wednesday, May 19, 2010 11:41 AM To: DelleChiaie, Pamela Subject: Septic As Built- 119 Liberty Street SKMBT_600100519 10400.pdf Tracking: 1 Sawyer, Susan From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, May 12, 2010 2:11 PM To: Sawyer, Susan; DelleChiaie, Pamela Subject: 163 Farnum Street Not sure I am going to have a chance to type up inspection report today and I am out in the field the next two days so I wanted to give you a quick update on 163 Farnum Street. Generally construction was acceptable. Components and elevations were acceptable. Two items you'll need to check(or have us check)at the final c rade i ection: - The manhole covers on the septic tanks w Ye not the 0" di meter required in Title 5 (the one over the pump chamber was). He is going to change th have h ready for the final grade inspection. - The distribution box had a pipe"elbow" diverting the wn into the box. However Title 5 requires there to be a"tee"or something comparable (I m pretty sure a inte of this in Title 5 is to prevent entrapment of air in the pipe and possible operational pro lems wit the p mp). H said Bill Dufrense told him he could build it that way. 1 There is not a ton of room inside th d-bo o cut that off and add a tee so we agreed he would drill a hole in the side of the elbow. It is a bit of a Mickey ouse solution but I do not expect problems associated with that approach as a solution in this instance. He was asked to keep the d-box open for examination at the final grade inspection. Best, Dan Mill River< cons uUti ng timil �'h,�ir}��rii+� +� I�i�MS��tSCFierit49 �'�:r.r� Ciirt,( fi+IaRigi�y9 F,assrFr��Pi?e'r5�,�! !?s,�1t13 P,,4n,a4:1(in,C Daniel Ottenheimer,President Mill River Consulting,Inc. 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014 fax: 978-282-1318 www.millriverconsulting_com danogmillriverconsulting com Member: Yankee Onsite Wastewater Association, Massachusetts Environmental Health Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association, Cape Ann Referral Group I i Sawyer, Susan From: brdufresne@comcast.net Sent: Thursday, April 29, 2010 10:11 AM To: Sawyer, Susan Subject: 163 Farnum Street Susan, I was out in the field laying the leach field out at the above referenced site. While there, I was asked by John Shaw to transfer the benchmark from the front stairs to the rear of the house. In doing so, discovered that due to the front porch, the surveyors were unable to shoot the actual top of concrete foundation and so the Bench mark elevation shown on the plan of 101.3 is actually the threshold elevation. I transferred the benchmark to the front right house corner and the actual top of concrete foundation elevation is 99.93. Please note this on your file copy of the plan for your inspections. Sorry for any confusion this may have caused. Billl Dufresne i NORiTtl ,- 7 O� tIHO $6 ��t1.1�- 1 '6 OL / t: �y ti M' . � ea � T R4 COtnil lwKx`y1 ��SSAC HUsy PUBLIC HEALTH DEPARTMENT Community Development Division February 11,201 Estate of Robert E.Anderson c/o:Domenic S.Terranova P.O. Box 778 Andover,MA 01810 North Andover,MA 01845 RE: Septic System Design, 163 Farnum Street,Map 107A lot 37 Dear Attorney Terranova: The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property, submitted on your behalf by Merrimack Engineering Services,dated August 4,2009,last revised February 2,2010.This plan has been approved.This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of an onsite septic system for a 5-bedroom house (maximum 11-room).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 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. 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 or imply compliance with any of the aforementioned requirement. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. ely, C Q Michele E. Grant Public Health Inspector Encl: list of licensed septic system installers Cc: Merrimack Engineering Services 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Y TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 "Ssaci+us 978.688.9540—Phone Susan V.Sawyer,RENS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept(c_,townofnorthandover.com WEBSITE:http://www.townofnortliandover.com SEPTIC PLAN SUBMITTAL FORM air /7, Date of Submission: Z-�� —10 � �� �� Site Location: L(z'* Fad a" TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Engineer: 06 New Plans? Yes $225/Plan Check# (includes I"submission and one re- . review only) / Zcoq- FPS 'tet/ Revised Plans?Yes✓ $ Check# Site Evaluation Forms Included? Yes V No Local Upgrade Form Included? VA,Yes No Telephone#: 77t5j Fax#: E-mail: �� �.� Homeowner Name: e7*T "r rl F C� �F 1& 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 y Commonwealth of Massachusetts - - City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disp salt �M Town OF NQFtTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Owner Name 1 s � A 1 1�J Map/Lot "7 Street Address tw City/Town I ®� � � � State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade [ Repair ❑ 2. Published Soil Survey available? Yes E�' No ❑ If yes: 141'70 Year Published Publication Scale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No E�/ If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: o '� Above the 500 year flood boundary? Yes ❑ No ❑ Within the 100 year flood boundary? Yes ❑ No ❑ Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No ❑ 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 7 ` Commonwealth of Massachusetts City/'Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal G 6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal 1?11� Below Normal ❑ Mont /Year 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: _T_-5 11 ;e6? t�' Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) �• 2. Land Use: L4, JK (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) ( 10 41 Vegetation �andpo"' Position orf landscape(attachshe 3. Distances from: Open Water Body> Drainage Way �t Possible Wet Area >l®4 feet feet ® feet l Property Line� Drinking Water Well ofIC0 Other feet feet 4. Parent Material: Unsuitable Materials Present: Yes [/No If Yes: Disturbed Soil❑ Fill Material Impervious Layer(s) ❑ Weathered/Fractured Rock[:] Bedrock❑ 5. Groundwater Observed: Yes L`j( No ❑ 80 #m If Yes: Depth Weeping from Pit Depth Standing Water in Hole { Estimated Depth to High Groundwater: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 2 of 7 Commonwealth of Massachusetts - City/Town of a ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones r ,�/weap 1,00 Ll 7,CPTA_416pV1 Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 4 M C. On-Site Review (Cont.) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole m Location (Identify on Plan ) 2. Land Use: (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) C 019 MMA&Z A 0l� Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way � r 4 Possible Wet Area -7 ' feet feet feet Property Line Drinking Water Well a Other feet feet 4. Parent Material: Unsuitable Materials Present: Yes o❑ If Yes: Disturbed Soil[] Fill Material1mpervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock[:] 5. Groundwater Observed: Yes 2/'No ❑ If Yes: Depth Weeping from Pit #� Depth Standing Water in Hole Estimated Depth to High Groundwater: `' �w inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 4 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones Lj V° ✓ 4 ' ��� �� Fru . rt) -��� �.- ,4,,i ave -7,50Y Y1,1/ Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts H City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 4� e D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. gi_ inches 2/Depth to soil redoximorphic features (mottles) A. B.inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes 2"' No❑ it " b. If yes, at what depth was it observed? Upper boundary: a Lower boundary: I'7,. r' inches inches F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation,as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 thr ugh .1.07. �� ® Signa a of of Evaluator- Date 6 Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 6 of 7 c , Commonwealth of Massachusetts } City/Town of Percolation Test Form 12 �M 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. Important: A. site Information When filling out forms the computer,use only the tab key Owner Name to move your I q�e� cursor-do not Y -- �' c use the return Street Address or Lot# g key. A- N e�+tr,v Cityrrown State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results jz. 9 Date Time Date Time Observation Hole# Depth of Perc e e Start Pre-Soak End Pre-Soak Time at 12" I Time at 9" ?s r Time at 6" I?' t S*7 Time(9"-6") Rate(Min./Inch) Test Passed: [ Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ -- all Test Performed By: — - -- ----..._..--------- Witnessed By: -� --_'------------ Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 u 'TOWN OF NORTH ANDOVER f NORYy Office of COMMUNITY DEVELOPMENT AND SERVICES 3ro`,+ � HEALTH DEPARTMENT ► 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 "", ::.. ,A► NORTH ANDOVER, MASSACHUSETTS 01845 "Ssac►l Susan Y.Sawyer,R EHS,,RS 978.688.9540-Phone Public HealthDirector 978.688.8476-FAX ftECEIVED- healthde t townofnorthan over.com www.townofnorthandover.c m Dy 2 �..��09 1 APPLICATION FOR SOIL TESTS TOWN OF NORTH'ANDOVER HEALTH DEPARTMENT DATE: `J, L �j -'� MAP&PARCEL: 10-7 A 3 7 LOCATION OF SOIL TESTS: r-A 12-11 L1 P1 /-/fo OWNER:��h'T`✓Tm�. � �• AIVk�ntact#: APPLICANT:AIT"Y., t7d aAee- -r-� )AAContact#: ADDRESS: PO_ OW- 779 400a9E0 PIA &I f!D— 001 � ENGINEER HMNOAC*„ At-1 Contact#: CERTIFIED SOIL EVALUATOR ✓1(� %Yl �j 61 7802-(�Zp Co Intended Use of Land: Residential Subdivision S:ingle �IyHo�mFaCommercial Is This: Repair Testing: ✓ I Jndeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No ✓ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) . .. - ➢ S"x 11"Plot plan&Location of Testing Lnlease indicate test nit 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$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. 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'''ch�" t'7'a tf cf e+t 5 , f I .Y—- FF 7?il }v t rt t'_"""'� + PF r ylc-" t I- r r N' i a 4' h 1.! rx ! .tr ,Y, f l� 1 J r 1 f i I r } w- '✓,se s i k S n"Si I 1 w l t i+��.l t rI r ,r I st .., x�sf�`r_Y T 1 > Fz t r e.�,+'VrlrFsy r1 'Ir a y flf fq,W1 *�' 4"' �Y4 . r N,7 J . 's i f r+' JjE 1 i. A ea. + tJ tJI,. f 1 M ,4? r v 's x ! i' y%'.` Pt,,{ r!A F i ..)'.. L +s- i,M I niK 7 f t,tt� ar i i I I>}r^ `�tl r v t{ . ! { k - .919 , d�4 f sr "'I 1 f rk r a r+), ] I 1 l I J M ''d f l �I '.},d1 1 1 y i r ,.t 1 *7 n, t 5 a`.S a f� J Y y y �, I ��$n ta+ i �;' Ix9i II"t{fi S t 1� s''"_'_ J 'r yqx h tiN�� r +�: y'^-* �r•]'t',y RC2 Lnyr'N s �2 vn�? t}a 1 E I ���1('j! �, rs 7 :.,$+Ii n ftify ,__.,Ssbi DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Thursday, June 04, 2009 10:39 AM To: DelleChiaie, Pamela; Sawyer, Susan; Grant, Michele Cc: 'Randy Burley'; 'Isaac Rowe'; dano@millriverconsulting.com Subject: Soil Eval: 163 Farnum St scheduled for Thu/June 11th at 9:30 a.m. Soil Evaluation for 163 Farnum Street with Bill Dufresne has been scheduled for 6/11 at 9:30 a.m. (We were available sooner on the 9th and 10th, but Bill had commitments on those dates). - Please call if you have questions. MH1 River coflSLlltlf ' Marianne Peters Office Manager Mill River Consulting, Inca 2 Blackburn Center Gloucester, MA 01930-2268 ph: 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com mpetersp,miliriverconsultin .com i DelleChiaie, Pamela From: Isaac Rowe [irowe@millriverconsulting.com] Sent: Friday, June 12, 2009 8:12 AM To: 'Daniel Ottenheimer'; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 163 Farnum Street Attachments: Soil Testing Results 163 Farnum Street 6-11-09.pdf Susan, Please find attached soil testing results for the above referenced property. Upgrade of an existing failed system. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting 2 Blackburn Center 1 t' Ncu 20-3Z IZ s r _ �L isM "I M t- 7-5- - 7 130 C Z SSL Z s s F M Y - 4i 74' X3 I' Z3 :3s -- � CL i gb — 9 /a-47-�► September 5, 1957 Miss Mary Sheridan R. N. Health Agent . Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the sub- surface disposal of sewage on the proposed Farnham Street building site of Mr. Robert E. Anderson. The subsoil in the area was of a sandy clay con- tent and a 12-minute percolation test was conducted. The land in general is high. 1t is recommended that a 750 gallonconcrete septic tank be installed together with 2001 lineal feet of drain pipe in a 210" wide trench in order to take care of an automatic washer. Very truly your William J. Dr s oll _ r r June 8, 1957 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Massachusetts Dear Miss Sheridan: An examination was made as requested in order to determine the suitablility of the soil for the sub- surface disposal of sewage on the proposed Farnham Street building site of Mr. Robert E. Anderson. The subsoil in the area was of a clay content with a mixture of a little gravel and rock and a 15 minute percolation test was conducted. The land in general is low and damp, but will be high enough above the water table to allow for the construc- tion of a subsurface sewage disposal system. It is recommended that a 1000 gallon concrete septic tank be installed .together with 250 lineal feet of drain pipe in order to properly take. care of the automatic washer and garbage grinder. Very trul yours, Philip L. Pattison .r Robert Anderson e" Farnham. St. APPLICATION FOR SEIRtAGE DISPOSAL INSTALLATION HUMH DEPARV ENT--NORTH ANDOUR, LASS. I hereby make application for a permit for a sewage disposal installation at Farnham St. . I will install this system .in accordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. FZirther$ I will construct the house sewer of bell and spigot pipe. the minimum diameter being 4 inches.!-and will maintain a minimum grade of 1% until 10 feet preceding the septic tank# where the grade shall not exceed 2%. I will install a concrete septic tank of 1000 ,gal. in size. A manhole (s) permitting easy cleaning wilt be provided with removable cover (s) of iron or concrete within 22 inches of the ground surface. I will provide subsurface disposal field with open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches, the bottom of which will provide a minimum of 250 ..lineal (Kdpumw* feet of effective absorption area. The pipets will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches .(dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench$, 2 inches of gravel or stone 1/811 to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed..at a grade of 4 to 6 inches/100 feet. No single tile line will exceed -100 feet in length and in any casep two lines of tile w= be installed. A minimum of 6 foot will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the in- stallation will be less than 100 feet from any private water supply$, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I f asree not to -cover- any RgIftIgn of this irytallatlon =tij =roved, by the inspection off o , as provid®d 'below# and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE l' Signatdre of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover$ Massachusetts. DATE Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as 'described. " �Z 5 � DATE 1 �, {... . / ,'� • CJ0 W signitture Inspecting Offic Pbreolation Test 1 min. Soil- eja with little mixture gravel rock Garbage Grinder , _es - 9/12/ 7 tpmatic washer- yes SEE RECOMMENDATIONS DATED 9/5/57 PLOT PLAN DATED 5/9/57 Caste �o�� ®^�� he,ednd �t IGS than BOARD OF HEALTH fee,+ A Goys ov a�r b�.!4 N .CMF NORTH ANDOVERV MASS. o� p�p e. �.o C f�'8"f� �? �-�,��V G�„p ��o►tet o v T det x 'dfi0. n � Gkc� 13 S111.�IL.C{ „ 0 f Zoo 4 }�sl+ weeghi' o* to 4e/ T'ksQ -14 to e NAME . . . . . . DATE 2. .ADDRESS 9. °.r �.d 1. . ._ . LUP NO. o . . . . . TEL. o . Mu r 3. NO. OF BEDROOPI,S T. P . DEN jr-'. NO. AGE GRINDER YES N0. 4. GARB 5. SHOW DIDIENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DILENSIOTE OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAN6, DITCHES.. LEDGE OUTCROP, ETC. 1`a 31. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. z �V � r i BOARD OF HEALTH TOffN OF NORTH ANDOVER, MASS. 7 pjptG r4L/ 7 /7t 4 (p+f414). riT EZN INa's r 1. NAPa . . . . . . . . DA'T'E . . . 2. ADDRESS . �. .* . LOT NO. . TEL. . �. NO. OF BEDROOIZ . DEN YES . . . . . NO.. . 4. GARBAGE GRIIv'DER YES NO.. . 5. SHOW DI?'IENSIONS OF HOUSE 6. SHUN DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DIP1ELLSIONS OF LOT 8. SHOVE LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NUPE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10,, SHOW LOCATION OF BROOKS V STREA16 9 DITCHES., LEDGE OUTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIOIS SHOULD BE READ WIEFULLY. r r �h o rte,, � - - - - ,-_- - -- _ -•. - - - - _ - - - - — - � F. �� j4•'�� , �j J 7 _ ��-fig ✓ �,�.r r � . q {t io y �y�; _ � - � `, p, � _ 1!. 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