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HomeMy WebLinkAboutBuilding Permit #671 - 305 BOSTON STREET 3/21/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -3dY- �OS 7-0 —J S �; Print PROPERTY OWNER �5.���-� �� �iP� 'lam T.. S L U it # Print MAP NO: f°&q %./) PARCEL: S ZONING DISTRICT: A A Historic District yes 455) Machine Shop Village yesv 100 year-old structure 4�p no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building X One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 19— Se tic ®Well' p ;� 4 ; - ❑ Eloodplam ; _ ❑ We land rshed ®Wat'` istrict , 1JPJL,rv1 ' I WD4 Ut' W UKK -1 V BE YEEFURM ED: (Identification Please Type or Print Clearly) OWNER: Name:�s�y�t ® �iPd�c � sEs _ C. e- Phone: 603 - W-6 X45-8 Address: 146 1,40-N ry I I c 0,314 d.3SVY CONTRACTOR Name: taw Z A 1,;-ac."a s 4 Phone: Address: Supervisor's Construction License: C S 6S'9 b3 (,o Home Improvement License: Exp. Date: Exp. Date: ARCHITECT/ENGINEER_p!}rost:� Gi=Lcrr _ Phone: Address:_ 8tt/-o SE -n T-1 MA- Reg. No. FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �Oweeo FEE: $_ � Check No.: Receipt No.: NOTE: Persons contracting wit nregistered co Tactors do not have access tie guaranty fund Plans Submitted ❑ Plans Waived ❑ TYPE OF SEWERAGE DISPOSAL Certified Plot Plan ❑ Stamped Plans ❑ Public Sewer ❑' Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well �y� Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMME CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed o COMMENTS 4-. ` s /- r Y V - Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 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 WE fit I _: ,s m Z N s cm N C 0 m Co m O cm C �C N CD Z 0 Z 0 cm F. O P-4 ., ON- U 0 s Q� •r.a a O O CD ■ L O o � Z CD CL O y C C Ico cm O 'O_ O 0 Mo O ■� ■E m m 0 CD t O � CO co o C.2 o a a �a c C* -*" c cc c Z ci C-7 ca C C c CL CO) LU W W W • C 0 - m C O i O N C C3 z .Q � C a m oCa� W EVic m c w o. N o -- t2 �. o c N A A d C C J to `° 1C� C CO)ME /a N m i 4 dV i o a 'y as r , a; rt°°° is ° U w a in w W .x, �: i� x w o O C N Q w° 1 a°' V y Z. w a°' co co m Z N s cm N C 0 m Co m O cm C �C N CD Z 0 Z 0 cm F. O P-4 ., ON- U 0 s Q� •r.a a O O CD ■ L O o � Z CD CL O y C C Ico cm O 'O_ O 0 Mo O ■� ■E m m 0 CD t O � CO co o C.2 o a a �a c C* -*" c cc c Z ci C-7 ca C C c CL CO) LU W W W • C 0 - m C O i O N C C3 .Q C m oCa� EVic m c w o. N o -- t2 �. o c N A C C J 1C� C CO)ME /a N m i 4 dV i O C N Q 0 s V y Z. O �.; . w- C d O Q i `-.m C = m : s F- w a o ~ COD.0. N m r0.. CD s m� _L 'dt e0 C N •ca cm B'D.O'm y d O.a aoti'9 x v = . aq m m Z N s cm N C 0 m Co m O cm C �C N CD Z 0 Z 0 cm F. O P-4 ., ON- U 0 s Q� •r.a a O O CD ■ L O o � Z CD CL O y C C Ico cm O 'O_ O 0 Mo O ■� ■E m m 0 CD t O � CO co o C.2 o a a �a c C* -*" c cc c Z ci C-7 ca C C c CL CO) LU W W W North Andover Health Department Community Development Division February 29, 2012 Robert Houghton 44 Ash Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 305 Boston Street, Map 107D, lot 5, North Andover, Massachusetts Dear Mr. Houghton, 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 the Christianson & Sergi Inc., dated January 23, 2012, last revised February 13, 2012. The design has been approved for use in the construction of a replacement, four bedroom (maximum 9 -room home), onsite septic system. This plan is generally good for 3 -years from the date of approval however since this is a repair to, the system must be installed within 2 years from the date of the approval, February 24, 2012. 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, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 305 Boston Street February 29, 2012 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. 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 might have. Sincerely, S san Y. Sawyer, REHS/R Public Health Director cc: Philip Christiansen, P.E. file Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 CHRISTIANSEN & SERGI, INC. C51 PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET, HAVERHILL, MA 01830 tel: 978-373-0310 www.csi-engr.com fax,,278-372:3960_„_,,,,--__,,, February 13, 2012 V1, , `l � Ms. Susan Sawyer LCH�NA� OF NORTH ANPovEa OF DePARTMENT Public Health Director - North Andover Health Department 1600 Osgood Street, Building 20, Suite 2-36 North Andover, MA 01845 Re: Subsurface Disposal System for 305 Boston Street Dear Ms. Sawyer: In response to the comments in your February 7, 2012 review letter, we have revised the Septic System Design for the above referenced lot. The revisions are as follows: 1. Randy Burley's name has been added as the soil evaluation witness on Sheet 1. 2. The proposed foundation drain, which is located off of the southwest comer of the house, has been added to the Site Plan on Sheet 2. 3. The distances from the septic tank and leaching area to the dwelling and property .lines .have .been ,added to the :Site Plan -on .Sheet.2_ 4. Notation has been added below the Profile on Sheet 2 stating that all outlets from the distribution box are to be at the same invert elevation. 5. Notation has been added below the Profile on Sheet 2 stating that the outlet distribution lines shall be level for a minimum of the first two feet of their length. 6. The proposed grading indicated on the Profile on Sheet 2 has been revised to indicate 9 inches of cover over the distribution box. 7. Notation has been added above the Cross -Section on Sheet 2 stating that the finish grade over the leaching area is to have a minimum slope of 2%. The proposed grading indicated on the Cross -Section has been revised accordingly. Please contact me if you have any questions regarding this matter. North Andover Health Department (ommunity Development Division February 7, 2012 Phillip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for 305 Boston Street Dear Mr. Christiansen; The proposed wastewater system design plan for the above site dated January 23, 2012 received on January 28, 2012 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Trtlo� 5: 310 CMR 15.000, or North Andover regulation that is not met by this design�gllows/eac}i item where applicable. l./Please indicate the name of the individual who witnessed the soil testing (It was Randy % Burley, from Mill River Consulting) <� 2. Please provide the location and/elevation'of � ieMoui dation drain. If there is no drain, please make a statement to that effect do thelplan. (NA 8.02) 3. Please provide distances from the septic tank and soil absorption system to the dwelling and property line. (NA 8 X03) f 4. Please provide notation the aputlets on the distribution box are to be the same elevation (232 (3)(b)) 5. Please provide notation that all the outlet pipes from the distribution box are to be level for the first 2 feet (232(3)(c)) 6. It appears the distribution box is deeper than 9". Please provide a riser (232(3)(0) 7. Please provide notation the final grade over the leaching area is to have a slope of at least 2% (240(10)) 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ` compliance with all regulations and assure protection of public health and the environment of North Andover. Sincer /Susan IZ Public Health Director cc: File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845' Phone: 978.688.9540 Fax: 978.688.8476 DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, February 07, 2012 3:52 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 305 Boston St Attachments: Disapproval letter.doc Dear All, Please find attached the disapproval letter for the above referenced property. The plan was generally very professional. Only minor notes was missing. While it is noted the bench mark is to be set prior to construction (note 14 sheet 1), this should be put in your file and/or highlighted some how. Sincerely, Randy Burley Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsultiniz.com rburleyna,millriverconsultin .com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, January 27, 2012 1:21 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: FW: Septic Plan Review - 305 Boston Street Attachments: 20120127120021053.pdf Hello, Here is a scanned copy of an application for a septic plan review for 305 Boston Street. It is being sent in the mail today. Best Regards, Pamela DelleChiaie Departmental Assistant I Community Development Division I Health Department Town of North Andover -1600 Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover, MA 01845 T Office - 978-688-9540 11 Fax - 978-688-8476 lwebsite-http://www.townofnorthandover.com/Pages/l*ndex -----Original Message ----- From: noreplv@townofnorthandover.com fmailto:noreuly@townofnorthandover.coml Sent: Friday, January 27, 201212:00 PM To: DelleChiaie, Pamela Subject: Septic Plan Review - 305 Boston Street This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 01.27.201212:00:20 (0500) Queries to: noreplly@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. TOWN OF NORTH ANDOVEROE gOR7p A Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ` �°►•h=''� NORTH ANDOVER, MASSACHUSETTS 01845 ��Ss^cMos t� 978.688.9540 — Phone Susan Y. Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdeotna..townofnorthandover.com WEBSITE: http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: 305 Boston Street (Assessors Map 107D, Lot 5) Engineer: Philip Christiansen, Christiansen & Sergi, Inc. New Plans? Yes X $225/Plan Check # review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes X Local Upgrade Form Included? Telephone #: 978-373-0310 E-mail: phil@csi-engr.com No Yes n/a No HEALTH ©F.p!R_TMl'N'T (includes l" submission and one re - Fax #: 978-372-3960 Homeowner Name: Owner: Robert Houghton, 43 Ash Street, North Andover, MA 01845 Applicant: KINGS OAK PROPERTIES, 17 HILLCREST DRIVE, HAMPTON FALLS, NH 03844 /Ds9 OFFICE USE ONLY y When the subm' ion is complete (including check): )0. Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database ' 4 - FORM 11 - SOIL EVALUATOR FARM _.. _._. ___...._ _._..... ........_.--- g No. Date: L�N'C;)V� N MTH ANPOVRR Commonwealth �' NORM ANDOV&�C, , Massachusetts Soil Suitabilitv Assessment for On-site Sewage Disposal Performed By: .......... tl...tP........ .............. Date: Witnessed By: ............. .... VER:.......CWOV .TAS.................................. . L tion Ad&m or /O5 BO STO" La / Of owx,'a N—m Pober t it -lath H o u,5 k +Pn Addreus, ud 0 Tckphox f K, ny Gk� Pr�pe��s �3o�c tG6 erzv Construction Po Repair ❑ Narnntnr5k As, to 14 603-?ff' Office Review Published Soil Survey Available: No ❑ Yes Year Published o ...... Publication Scale Drainage Class ................... Soil Limitations Surficial Geologic Report Available: No ❑ Yes ❑ Year Published _..._.. Publication Scale Geologic Material (Map Unit) tia I Ca nfn�, �r>✓ sa�rrd-�r ................... Soil Map Unit ...... ....................................... ye1^ y.....�.tf. afiy .......... ................... ......................................................................................................... Landform..................................................................................................................... a Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes a Within 500 year flood boundary No Ryes ❑ Within 100 year flood boundary No RYes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit). Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal 9Belc,.V Normal ❑ Other References Reviewed: DEP APPROVED FORAI - 32/07/95 ........................... I ........... .............. .................... ......................... ... ............ .......:. .............. .... ....................................... I.............................� i FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot: 305 BOSTON ST, NORTH ANDOVER, MA On-site Review Deep Hole Number:#1 Date:12/20/llTime: am Weather: CLEAR,40 Location: (identity on site plan) Land Use: LAWN Slope: 0-3% Surface Stones: none Vegetation: HEMLOCK Landform: TILL RIDGE Position on landscape: (sketch on the back) TOP Distances from: Open Water Body >100' feet Drainage way 1200' feet Possible Wet Area >100' feet Property Line >100' feet Drinking Water Well NO feet Other DEEP OBSERVATION HOLE LOG* Depth Soil Soil Soil Soil Other from Horizon Texture Color Mottles Structure Surface (USDA) (Munsell) Etc. (inches) 0-6 a FINE 10YR 3/4 GRANULAR, LOOSE SANDY COMM ROOTS LOAM 6-13 Bwl FINE 10YR 5/8 GRANULAR FRIABLE LOAMY COMM ROOTS SAND 13-37 Cl MEDIUM 2.5Y 5/6 HIGH: SL FIRM IN PLACE SANDY 5YR 5/8 LOAM 37-84 C2 MEDIUM 2.5Y 5/4 LOW: MASSIVE V FIRM SANDY 5Y 6/4 15% GRAVEL LOAM 10% COBBLES MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material: (geologic) Depth To Bedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: NONE Estimated Seasonal High Ground Water: 30" FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot: 305 BOSTON ST, NORTH ANDOVER, MA On-site Review Deep Hole Number:#2 Date:12/20/llTime: am Weather: CLEAR,40 Location: (identity on site plan) Land Use: LAWN Slope: 0-3o Surface Stones: none Vegetation: HEMLOCK Landform: TILL RIDGE Position on landscape: (sketch on the back) TOP Distances from: Open Water Body >100' feet Drainage way 1200' feet Possible Wet Area >100' feet Property Line >100' feet Drinking Water Well NO feet Other DEEP OBSERVATION HOLE LOG* Depth Soil Soil Soil Soil Other from Horizon Texture Color Mottles Structure Surface (USDA) (Munsell) Etc. (inches) 0-10 a FINE 10YR 3/4 GRANULAR, LOOSE SANDY COMM ROOTS LOAM 10-16 Bw1 FINE 10YR 5/8 GRANULAR FRIABLE LOAMY COMM ROOTS SAND 16-27 Cl MEDIUM 2.5Y 5/6 HIGH: SL FIRM IN PLACE SANDY 5YR 5/8 LOAM 27-84 C2 MEDIUM 2.5Y 5/4 LOW: MASSIVE V FIRM SANDY 5Y 6/4 15% GRAVEL LOAM 10% COBBLES MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material: (geologic) Depth To Bedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: NONE Estimated Seasonal High Ground Water: 28" FORM 12 - PERCOLATION TEST Location Address or Lot No 305 BOSTON ST. COMMONWEALTH OF MASSACHUSETTS North Andover, Massachusetts Percolation Test* Date: 12/20/2011 Time: AM Observation Hole # P #1 Depth of Perc 30" + 16" = 46" Start Pre-soak 9:47 End Pre-soak 10:04 Time at 12" 10:04 Time at 9" 10:38 Time at 6" 11:18 Time 9"-6" 40 min Rate Min./Inch 14 min/inch *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ® Site Failed ❑ Performed By: Philip Christiansen Witnessed By: Mill River Consultants DEP APPROVED FORM - 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 305 13OS7 QAJ ST N0R-n+- AN0dVE—PZ MA Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ................ inches ❑Qepth weeping from side of observation hole ........... inches Depth to soil mottles ...::., inches ❑ Ground water adjustment ............. I .... . feet Index Well Number ..............:... Reading Date .................. Index well level ..... _.. Adjustment factor .................. Adjusted ground water level ..................................................... IDepth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on �� j�`l (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with te required training, expertise and experience described in 310 CMR 15.21/f , Signatu 6C 3 `7 DEP APPROVED FORM - 12107195 Date S Z Town of North Andover Building Department 1600 Osgood Street Bldg 20, Suite 2-36 North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 DEMOLITION OF BUILDING AFFIDAVIT DATE OWNER'S NAME & ADDRESS: J�A� ..-) NORTkt Q��tyED 0M y s h T coc"Ic„ewicw q. 7 R^re o O AC7 9SSgCHUS�� LOCATION OF PROPERTY TO DEMOLISH DESCRIPTION: CONTRACTOR'S NAME & ADDRESS: 1 / I./_ _S *V// DEPT. OF PUBLIC WORKS - WA DEPT. OF CONSERVATI HEALTH DEPT: /✓// �! HISTORIC COMMISSION PLANNING GAS ELECTRIC TELEPHONE CABLE TAXES POLICE: FIRE: EXTERMINATOR: DUMPSTER — O OFF S BUILDING INSPECTOR: DEPARTMENT SIGN -OFF f SEPTIC V WELL DIG SAFE NUMBER 2d11,5'6031SX' TOWN OF NORTH ANDOVER t KORTN' Office of COMMUNITY DEVELOPMENT AND SERVICES �� u�� HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH AND 01845 �" s�cHuse Susau Y. Sawyer, REHS, RS978. 88.9540 - Phone Public Health Director /(� 978. 88.8476 - FAX QFC -` V TOWN OF NORTH ANDD .townot}torthandover.com HEALTH DEPARTMENT APPLICATION FOR SOIL TESTS DATE: f �Co (} MAP & PARCEL: 101 D e;) 1) LOCATION OF SOIL TESTS: _ fo6 de) -c' OWNER: Contact#: APPLICANT: 141 WI -)(71631 Contact #: &Q -T— f ly ADDRESS: 1 �1 1 u�� � ��w. 1s -o C -A i (S, IN) (4 03 9XY ENGINEER: rf S� ArJ Contact P Ag , -7 3 3 /0 CERTIFIED SOIL EVALUATOR: _ I\ 1 C r ; )-El R N >J Intended Use of Land: Residential Subdivision le Family Home ((LSingle Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for %Addition:_ In the Lake Cochichewick Watershed? Yes No t/ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM y Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8. S"x II "Plot Plan & Location of Testinnk (please ltttlicale test 1)11 sltes on the Platt ➢ 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 o►- 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 hvo 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. Cottservatiou Commission Approval Date: Signature of Cottservalion Agent: Date back to Health Department: (stamp in): & � � 2® ■§ $� p $ §� % p Q% $ & � � @ �) �kEZ . % k � }§� i� .2 (% ! § / 2 � 27 I ^t / 2® ■§ k p ! $ §� % § $ & � � @ 4 2 . % k � }§� i� I ^t / 2® ■§ � � }6' i (J§ � . / / � h 7 � w TOWN OF NORTH ANDOVER NORTH ANDOVER, MASSACHUSETTS 01845 ttoR1W SRCHus Permit Number Date Issued Expiration Date RECEIVED TOWN OftO Jackie's Law - Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST IBE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant ,,� G�'v s Phone 6, 0 3 ' yy Cell Street Address 505— City/Town MA I ZIP Name of Excavator (if different from applicant) Phone Cell Streett Address / (1 4a City/Town MA ZIP Me` (Ave.s 0A Name of Owner(s) of Property one Cell Street Address " 14- S7' CityiTown MA zIP )\ CW r fl, �y�C� s� •y v`^J4 c� ! a C l Other Contact Permit Fee Received No Yes Description, Iocation 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..) PIease use reverse side if additional space Is needed. pe v�rt• Insurance Certificate Name and Contact Information of I urer: Q Po)lcy Ex iration Date: Dig Safe #: Name of Competent Person (as defiued by $20 CMR 7.02); z4j r/ lt_�4111 Massachusetts Hoisting License # 'Oe"ln OIL?— License Grade; _ L7- Expiration Date: ,Z BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF TM WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. a 82A, 520 CMR 7.00 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, AUTHORIZES 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 TIRE 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 MADE TO ASSURE COMPLIANCE THERE'VVITH, 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 LIABILI'T'Y, 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. APPLIC - T SIGNATURE - DATE EXCAVATOR SIGNATURE (IF DIFFERENT) DATE O'WNER'S SIGNA RE (IF D FERENT) ✓�``" - DATE. 1 aL G, Il -2 j P a g e_—_.____ 9 Ladders must be used in trenches deeper than 41. o Ladders must be inside the trench with workers at all times, and located within 25' of unobstnrcted lateral travel for every worker in the trench. o Ladders must extend 3' above the top of the trench so workers can safely get onto and off of the ladder. a Inspections of every trench worksite are required: o Prior to the start of each shift, and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person (see below). a Competent Person(s) Is: o CIpable (i.e., trained and knowledgeable) in identifying existing and predictable hazards in the trench, and other working conditions which may pose a hazard to workers, and o Authorized by management to take necessary corrective action to eliminate the hazards. Employees must be removed from hazardous areas until the hazard has been corrected. a Underground Utilities must be: o Identified prior to opening the excavation (e.g., contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected, supported, or removed once exposed. a Spoils must be kept back a minimum of 2' from the edge of the trench. a Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. a Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by oreation of the trench, they must be underpinned, braced, or otherwise supported. o Sidewalks, pavements, etc. shall not be undermined unless a. support system or other method of protection is provided. a Protection front water accumulatlon hazards: o It is not allowable for employees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulation, this must be monitored by the competent person. o If the trench interrupts natural drainage of surface water, ditches, dikes or other means must be used to prevent this water from entering the excavation. a Additional Requirements: o Por mobile equipment operated near the edge of the trench, a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath loads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high -visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4' if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist (e.g., 02 <19.5% or >23.5%, 20% LEL, specific chemical hazard), adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with guardrails must be provided for crossing over trenches > 6' deep. o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. 5 1 P a g c DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, December 09, 2011 10:46 AM To: 'Daniel Ottenheimer'; 'Isaac-R=BostonStreet, nne; 'Randy Burley' Cc: Sawyer, Susan Subject: FW: Soil Test Applicatio - 3rth Andover Attachments: 20111207145006877(2). df Hello, Please schedule soil testing for 305 Boston Street. Engineer is Phil Chritiansen - 978.373.0310. Comments from 12/8/2011- Heidi in Conservation: "Testpits are more than 50 feet from the wetlands. " Thank you. &ec 2gs4, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 i Suite 2-36 North Andover, MA o1845 2 Office - 978-688-9540 2 Fax - 978-688-8476 Eil Email - ndellechiaieotownofnorthandover.com `�S Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous From: DelleChiaie, Pamela Sent: Wednesday, December 07, 20113:15 PM To: Gaffney, Heidi Cc: Hughes, Jennifer Subject: Soil Test Application - 305 Boston Street, North Andover Hello, Please let me know your feedback with regard to wetlands for Soil Test Application - 305 Boston Street, North Andover. I will leave a hard copy in your inbox. Thank you! O Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 2 Office - 978-688-9540 2 Fax - 978-688-8476 0 Email - pdellechiaieotownofnorthandover.com Website httn://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Wednesday, December 14, 2011 9:48 AM To: DelleChiaie, Pamela; 'Randy Burley'; Grant, Michele Cc: Sawyer, Susan Subject: RE: Soil Test Application - 305 Boston Street, North Andover Phil just got back to us; this has been scheduled for next Tuesday, December 20th @ 9:30 with Randy. From: DelleChiaie, Pamela[mailto:pdellech(�townofnorthandover.com] Sent: Friday, December 09, 2011 10:46 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: FW: Soil Test Application - 305 Boston Street, North Andover Hello, Please schedule soil testing for 305 Boston Street. Engineer is Phil Chritiansen - 978.373.0310. Comments from 12/8/2011- Heidi in Conservation: "Testpits are more than 50 feet from the wetlands. " Thank you. Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 2 Office - 978-688-9540 Fax - 978-688-8476 Email - ndellechiaie@townofnorthandover.com Website htto://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "--Anonymous From: DelleChiaie, Pamela Sent: Wednesday, December 07, 20113:15 PM To: Gaffney, Heidi Cc: Hughes, Jennifer Subject: Soil Test Application - 305 Boston Street, North Andover Hello, Please let me know your feedback with regard to wetlands for Soil Test Application - 305 Boston Street, North Andover. I will leave a hard copy in your inbox. Thank you! @ Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 'Y Office - 978-688-9540 M Fax - 978-688-8476 DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, December 20, 2011 3:54 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: Emailing: 305 Boston St soils.pdf Attachments: 305 Boston St soils.pdf Please find attached the results from soil testing today with Phil Christensen; good soil and a fine engineer. Sincerely, Randy Burley The message is ready to be sent with the following file or link attachments: 305 Boston St soils.pdf Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. f J -Ask 00 4 Lill)-� I I A01*6 IA -1"7'116% %-hj 9 Ro-m-MON: � 11, NNEW 0 I --- I I ----. . . -- — — — — — — — — -- -- ---- I: 1 IL Ll !a--...mss.... �'I�� V\ 79 71, TLvc.I L. mmmwcmgl=� MYO S z X: 0 z UL 0 z 3: 0 Ev Ol 6 00 iz go 7;q Rsc -Ask A01*6 IA -1"7'116% %-hj — mmmwcmgl=� MYO S z X: 0 z UL 0 z 3: 0 Ev Ol 6 00 iz go 7;q Rsc m ®I �Q�