HomeMy WebLinkAboutMiscellaneous - 109 FOREST STREET 4/30/2018 r 109 FOREST STREET
210/106.A-0172-0000.0
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Lot & Street
Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES
NO Permit#
Plan Approval: Date: a --
Approved by:
Designer:_ .
Plan Date:
Conditions: - T-----
Water Supply: -
- -- WelL _.
Well Permit:
--Driller:
Well Tests: Chemical Date'Approved =-
Bacteria I Dai
Bacteria II PProved
Date Approved` _
Plumbing.Sign-Off. _
Comments: Wiring Sign-Off
Form "IT'Approval:
Date Issued Approval to-Issue. VES NO
Conditions: By:
.. Final Approval: - _
All Permits Paid?Well Construction Approval? - NO
Septic System Construction Approval? YES NO
Certification? NO
Other YES.- NO
YES NO
Any Variance Needed?
YES NO
FINAL BOARD Ok'HE
ALTg APPROVAL:
DATE: {'
APPROVE
SEPTIC SYSTEM INSTALLATION
Is the installer licensed? YES NO
Type of Construction: NEWp�AIR
New Construction: _ .-Certified Plot Plan Review YES NO
—Floor Plan Review YES NO
_ Conditions of Approval from Form U YES NO
_Issuance of DWC permit: YNO
_DWC Permit Paid? YES _ NO .
--DWC.Permit# - 1/ / — Installer: o v,
..BegimInspection:_ __ — NO -
_Excavation Inspection:
—Needed:
--Passed:. By:
...-Construction Inspection:
Needed:
As_BUilt--P�n Satisfactory:
1zz..
—_ Approval of Backfill: Date: 911Z y By:
---Final Grading Approval: Date: y By:
Final Construction Approval: Date: 1 By:
- .
Certificate of Compliance: Approval: Date:
Commonwealth of Massachusetts
REc
City/Town of EYED
System Pumping Record JUN 3 0 2014
Form 4
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
DEP has provided this form for use-by local Boards of Health. er forms M-aTbe-used,but the
information,must be substantially the same as that provided here. Before using.this form,check with your
local Board of Health to determine the form they use.The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left/Right front of house, Left/Right rear of house, Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address ----
City/Town State Trp Code
2. System Owner.
Name'
Address(d different from location)
City/Town ' State
1--,7jp Codez
Telephone Number a ;
B. Pumping Record
1. Date of Pumping um
p 9 date eepfic
tity Pumped: Gallons
3. Type of system: ❑ sspool(sank ❑ Tight Tank
Other(describe):
4. Effluent Tee Filter present? ❑ Yeas No If yes, was it cleaned? ❑ Yes ❑ No:
5. Condition of System:
6. System Pumped By.
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Loc ')ro contents were disposed:
GAIL S. Lowell Waste Water
Sig Haul Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
i
DATE-
LOCATION.
ATE:LOCATION. �J\�
E E Ez
BOH WITNESS:
PE°C0L470N TEST
SOTTOM DEPTH H OF , ERC TEST-
TIME
EST:TIME OF SOAK: _ ` .� (A� least 5- minutes Icnc)
Yl ' 3 �
T 1 Nl E AT
TIME AT S"
TIME AT ��
CVE„NIG'r,T SOr,K
TIv1ES T ,-`.P, TED
NEXT D,,=," c K. (.-.i ie2s 1 r inures)
7 NI E -,'IT 12
T N1 E AT S"
TIME AT
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Address o2 sT Title of File Page of E
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
4
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department i
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I
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
January 5, 2000
This is to certify that
the individual subsurface disposal system
constructed () or repaired (X)
by
John Soucy
at
109 Forest Street
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
ti
TOWN' OF NORrM ANDOVER SERV:kGE DISPOS T. S"vS.. 'E\-i '
IN-5TALLAnON CERTIFICATION
The unde:si�!ned nerc--y cerizv that t,te 5eware Cispos•.l System i
f X) repaired:
located at.._� _S,z5`�_=_ .._,_. -7� .. ,7
was instatkd in cor c:-mance with,the No:ih Aftdover Board ol'Henith azprovedP lan,
System De$io Permt W!/00 y dated with ar arcroved desiau
,lbw or _f ga?loris pe.day The rnaiena!s used were in conformar c'� \.vith tlsme
speclz cd bh the apVroved plan; the system, was installed in acwor6r.ce .Nish the prcvisions
of 310 CNS l5 000, Title 5 and local :cmdations, and the Final gradin; aarees
y % ' approved ,work is accuratciv represented ar: the As-built
sucstaxttiall, wt!t the porn ed puri. .�.sf p
which has been subrtutted to the Board oz Health.
Ezd inspeciioa fate' Ai -- —
' 1`.nQtnaer Rior�S�:�ativc
Final i mection date
RICHARD
tnstal:Kr: _ _„� a C. M�' �� Date' - - -------
U
I' I�
Cesian EnQireer; Date
DEC 2 2 1999
: Town of North Andover, Massachusetts Form No.2
°f,14ORTN BOARD OF HEALTH p
DESIGN APPROVAL FOR
pS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No. /�17
: Site Location
Reference Plans and Specs.
ENGINEER DESIGU DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CHAIRMAN,BOARD OF HEALTH
• � Moc
Fee ✓ Site System Permit No.
�D
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUNMER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
3. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAMS, WATERCOURSES
W/N 1 50' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
/ TANK & D-BOX
v STANIl' & SIGNATURE
IMPERVIOUS,AREAS - DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
V
r � LOCATION & ELEVATION OF BENCFCiMARK USED
y LOCUS PLA-Ni
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD OCT 2 5 2001
DATE:
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
`` _ (example: left front of house)
C_ k-1,\Atl`G�
(o LA
DATE OF PUMPING: Lc"--�� I)t-4ANTITY PUMPED f GALLONS
CESSPOOL: NO S SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
.COMMENTS:
CONTENTS TRANSFERRED TO:
DAJE
LOCATION-
E,
OCATION:
I, , - _��
iJ01 I wl I N��,.. �
FE=COQ-,i ION TEST =.
E0 T10M UC-.1 '1-', Or c'-:: C ICS T: a �j� �' Is
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IME Or �Jr.l).. �r,t I`GJl f CrC\
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LOCATION,
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cc.zlCOL,�!,TION T=ST = _
EOTT OM OF F-EERC TEST:
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Town of North Andover, Massachusetts Form No^3
+ '• NpRTN BOARD OF HEALTH �#
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qb1 ���. Otitr.ao ,a1
k„ 19
40
DISPOSAL WORKS CONSTRUCTION PERMIT
AcHUS
4+.
Applicant
_N AM AD ESS TELEPHONE
/D .�1
x Site Location 9 '
Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption ?
-' t �• Sewage Disposal System as shown on the Design Approval S.S. No.
Y/
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CHAIRMAN, BOARD OF HEALTH ;
f
F Fee s - - D.W.C. No. ///l .
_ . . ............ .
_ 4 *!, .1 d [ •'�.. �4asfky�itigps,��r}TFr^ifFnlx.t
�g �l'd r.�` ^•-t• n , tw' ,.. s(3F.
T. �' + a. •t { i* ,;,.}.cy:r { .� xt-.:l:A .x. l.s h' i! t ,i ,� `75 a
J�r.,:.i + ��y,.
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: CURRENT INSTALLER'S LICENSE#._______
LOCATION: I o n FG R-ec,,+ S:f-I
LICENSED INST�4ER:
SIGNATURE: IALA�-_ TEL HONE#
CHECK ONE:
REPAi2: NEW CONSTRUCTION:
r
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
i
Administrative Use Only
1
$75.00 Fee Attached? Yes No
Foundation As-Built? Yes No
Floor Plans? Yes No
Approval '/���-� Date: /�Ul
i
rom� RI®�IV�P+/
~ TC 4v:oF�. 0,-A f
-
- 91999 �
i
Town of North Andover HORTp
OFFICE OF ,.?o `�a �o0
COMMUNITY DEVELOPMENT AND SERVICES °
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# +1
27 Charles Street :�4 °"x
North Andover, Massachusetts 01845 �q'°4,.Eo
WILLLAM J. SCOTT SSAcm
Director
(978)688-9531 Fax(978)688-9542
July 29, 1999
Ben Osgood,Jr.
New England Engineering
33 Walker Road
North Andover,MA 01845
i
RE: 109 Forest Street
Dear Mr. Osgood:
This letter is to notify you that the proposed septic plans dated July 20, 1999 for the
repair of the system at 109 Forest Street have been approved. Please feel free to call the Health
Department at 688-9540 if you have any questions.
Sincerely,
Sandra Starr, R.S.
Health Administrator
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Cc: Joseph Messier
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Jul-29-99 11 :45A Paul D. Turbid e, PE/PLS 508-465-0313 P.04 1
Post-Wo brand fax transmittal memo 7671 #of a e
TO. P g s ►
ICour s,¢,�j Fro
910. imh sTi9P
Co.
` 4dministrator
Dept. /V-/�N DpV
Phon c2 S 0 ent and Services
Fad,#796—X17'6—3Yy Fax 7e �6��� 9S-uzy
RE: Title V revie tor'ivy,ru,est Street
I
Dear Sandra,
I find that the design dated July 22, 1999 adequately addresses the regulations.
If you have any questions or comments please feel free to contact me_
Sincerely f
Carlton A. Brown, PE/PLS
Breckendridge 1 a.doc
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P ORT
ENGINEERING
Civil Engineers&
Land Surveyors
One Harris Street
Newburyport,MA
01950
(978)465-8594
Jul -29-99 11 :45A Paul D. Turbide, PE/PLS 508-465-0313 P.03
July 29, 1999
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MA 01845
RE: Title V review for 109 Forest Street
Dear Sandra,
I find that the design dated July 20, 1999 adequately addresses the regulations.
If you have any questions or comments please feel free to contact me.
Sincerely �:s)
Carlton A. Brown,PE/PLS
Forest 109a.doc
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PORI
''� f�GINffRI�G
Civil Engineers d
Land Surveyors
One Harris Street
Newburyport,NLA
01950
(978)465-8594
e"114
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N May-27-9912 : 45P North Andover Com. Dev . 5O8 688 9542 P . 01
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Z SEPTIC PLAN SUBMITTAIL FORM
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Q LOCATION: 1C''� ^,,�zsi S� - ✓__t N ��Z�____-...
Qz NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/P1an_ ______
Z
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> SITE EVALUATION FORMS INCLUDED: YE NO
DATE: Z 7
W --
Z DESIGN ENGINEER: �fy _ � _ ��crLL��_��, -7—�
DATE TO CONSULTANT:
*If you want your plans expedited, please submit three plans and included a JUL 2 1999
stamped envelope with the correct amount of postage to mail plans to Port
Engineering.
When the submission is all in place, route to the Health Secretary.
t i
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
No.
Date:
I 1 I
commonwealth of Massachusetts
Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Date: ��/9C.. ...:......
Performed By: ..�.�../..���.����.� ........................-��.... .�....
WitnessedBy: �.l .59.�-/......................��...................... ................................................................................... .. ..... ... ..............
Location Address or /Q� 7�� ' owner's Name.
LotA li /� �jC l F/G / / A6dress,and
Tckphom/
I /Y
eW Construction ❑ Repair 1
Office Review
Published Soil Survey Available: No ❑ Yes Q
Year Published Publication Seal//� Soil Map Unit
L!
Drainage Class GSL.`.--.............. Soil Limitations ,?�1�.....��!��� ......�.................._............_.......
.... .
Surficial Geologic Report Available: No ❑ Yes
Year Published Publication Scale
GeologicMaterial (Map Unit) ....................................................................................................................... .............. ...............
Landform .........f ................................................................. ........................................................................._................
. ..... ....._....
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes 9
Within 500 year flood boundary No ❑Yes ❑ - .
Within 100 year flood boundary No ❑Yes ❑
Wetland Area:
unit) ................................._......
National Wetland Inventory Map (map n ) ••.................•� ��••��......•�� �� '�"� "'
Wetlands Conservancy Program Map (map unit) ................................................................................
Current Water Resource Conditions (USGS): Month 14'rr4-
Range :Above Normal ❑Normal ❑Belciv Normal
t Other References Reviewed: -----
DEP APPROVED FORM•12I07J9S
4
FORM II - SOIL EVALUATOR FORM
Page 3 of 3
Locution Address or Lot No. / ` �
Determinadon for .Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole............ ... inches
❑ Depth weeping from side f observation hole........... ... inches
® Depth to soil mottles ..::.::....... inches
Z- 3v�
❑ Ground water adjustment .................. feet -
Index Well Number .................. Reading Date .................. Index well level ..................
Adjustment factor ................... Adjusted ground water level ........................................................
Depth 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 certifythat on �`� (date) I have passed the soil evaluator examination
approvd by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature
Date
i
DEP APPROVED FORM-12/07/95
i
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No. 1� � ��_Tj AD.
On-site Review
/9 .�� Weather
Deep Hole Number ..: ::. Date:.. � � . ... . .. :..
/� T...: Time:
..:....: ....: :..:.:. ..... .:..::......:. ...
Location (identify on site platy �--
Land Use .:. '� � Slope M . L. Surface Stones .
Landform .. ::..:. .:. .. ... ...
Position on landscape (sketch on the back) •.:
Distances from:
Open Water Body l2 feet Drainage way 2� feet
Possible Wet Area ! feet Property Line ..:..TC.. feet
Drinking Water Well _ feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, %
Gravel)
75
s c�3 l
MINIM REQUIKEU A I EVERY PMMSED DISPOSAL AREA
Parent Material (geologic) DepthtoBedrock:
D•g tp h,to Groundwater: Q
'nin Water in the Hole: l� ` Weeping from Pit Face:
Sts � , t
Estimated Seasonal High Ground Water: ••—•—
DEP APPROVED FORM-12107/95
i
I.
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot IJo.
On-site Review
Dee H l� �l//
Deep ole Number Date:.. Time: Weather
Location (identify on site plan) ....................:...:.:.:. '
Land Use . ��r G Slope M Surface Stones .
.... . ......
�
Vegetation :. .:G%"'S�'/�� .:.. ::..:.:.::.:,...:::....:.::.:.. . ... ....ice, . ..
Landform ... ::. . .2?/ ...::.. ...... �.:... .:. .
Position on landscape (sketch on the back)
Distances from: �2
Open Water Body/ feet Drainage way ` * feet
Possible Wet Area X30 feet Property Line . -5... feet
Drinking Water Well feet Other . ..: ..:..::...::
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Bounders, Consistency, %
Grave
8 K
G
�T d
Parent Material(geologic) �� � �L ` DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water: —
DEP APPROVED FORM-12107/95
FORM 11 - SOIL EVALUATOR MIMI
Page 2 of 3
Location Address or Lot No.
On-site Review
_ o _
Date:: . Weather:/. .: Time � . � .
Deep Hole Number
Location (identify on site plan)
Land Use .T/�L Slope M Surface Stones ..... ...
Vegetation .. ...,o .......:..
Lald m •.. �l?
Position on landscape (sketch on the back) •.:. �-7 . •.5'Gof
Distances from: Zd�'
Open Water Body 120 feet Drainage way . . ... . .. feet
Possible Wet Area y'c-51 feet Property Line -:��... feet
Drinking Water Well .:5- feet Other
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Bounders, Consistency, %
Grav
.3
GS
NIMUM OF.2 HOLES REQUIRED-A I EVERY PROPOSED DISPOSAL AREA
Q—T��
Parent Material (geologic) �.��� _ !�
DepthtoBedrock: _
✓ y
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water: !`
DEP APPROVED FORM-12107195
Town of North Andover, Massachusetts Form No. 1
r10RTfj BOARD OF HEALTH
3�0��5`ED lb��OL
19�L
APPLICATION FOR SITE TESTING/INSPECTION
7 ADRATED PPP`.�y
�SSACHUS��
r
Applicant
/hCAME ADDRESS TELEPHONE
Site Location
r
Engineer
NAME ADD"S TELEPHONE
Test/I nspection Date and Timefly
CHAIRMAN,BOARD OF HEALTH
Fee Test No. !92117
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
O�SSLED Ib
16oL 19
F
nD?8�T 0h
APPLICATION FOR SITE TESTING/INSPECTION
/,9 ADRATED PPp�.��J
SSACHUSE
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
BOARD OF HEALTH TEL. 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
l ,
DATE:
LOCATION OF SOIL TESTS: c
/ $7
L: {
/ / s ✓L/ .L�
Assessor's map & parcel number: e6 f
OWNER:_ TEL. NO.:
ADDRESS: /V<
r
ENGINEER:/�I,, ilk/�P �<..✓cit�, TEL. NO.:_l7 '- ��;6,- 17 6 '
CERTIFIED SOIL EVALUATOR:
v t/
Intended use of land: residential subdivision, single family home, commercial
Repair,testing Undeveloped lot testing
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of 275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of$75.00 per lot for
repairs-or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to
the Board of Health showing the location of all tests (including aborted_tFe, OF NORTH ANDOVER/
7. Within 60 days of testing soil evaluation forms shall be submitted. BOARD OF HEALTH I--W— ---1
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BOARD OF HEALTH TEL. 688-9540
NORTH ANDOVER, MASS. 01845
" i
APPLICATION FOR SOIL TESTS
DATE.-
S 3
LOCATION OF SOIL TESTS: -es T
Assessor's map & parcel number: /c6 /7-2
OWNER:_ TEL. NO.:
ADDRESS:
ENGINEER-/ �r�u 1����0 ',,��.2 TEL. NO.: C .
f; - �76�;
CERTIFIED SOIL EVALUATOR: 6"", rlsq'6 J'2 i! K'C`C«0(: %��Z-c(
Intended use of land: residential subdivision, single family home, commercial
Repair testing47
Undeveloped lot testing
N. A. Conservation Commission Approval.
THE FOLLOWING MUST'BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of$75.00 per lot for
repairs or uparades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At;least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to
Board of Health s win (including abort d t�`t .:),
the o rd ho g the location of all tests (mc ud g ,y `o�-„ � ; _
7. Within 60 days of testing soil evaluation forms shall be submitted. `:`
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BOARD OF HEALTH `
No.Andover, Mass .
SUBSURFACE DISPOSAL DESIGN CHECK .,IST W L'pa N
LOT 21
APPROVED DATE — - 6e- A�/ DISAPPROPED DATE q S y{
Provided: Reasons:
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Reg 2.5 The submitted plan must show as a minimum:
a) the lot to be served-area,dimensions lot #,abutters
b location and log deep observation hoes-distance to ties
c location and results percolation tests-distance to ties
d design calculations & calculations showing required leaching area
(e) location and dimensions of system-including reserve area
f) existing and proposed contours
(g) location any wet areas within 1.00' of sewage disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface drains within 1001 of sewage disposal
system or disclaimer
(i) location any drainage easements withir IMI of sewage disposal
system or disclaimer-planning Board fres
(3) known sources of water supply within 2)01 of sewage disposal a
system or disclaimer
(k) location of any proposed well to servr lot-100, from leaching facility
(1) location of water lines on property-10 ' from leaching facility
(m) location of benchmark
- -- (n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
(q) profile of system-elevations of basemen,;, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution yield piping and
Otter elevations
(r) maximum ground water elevation in area sewage disposal system
(s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capac t es- 50% of flc►w, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 101 from cellar wall or inground swimming pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
(a) Mpe greater 0.08
Reg 10.4 b} p
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4 �'�_.andards
To be placed in the text of the Residential 1 , 29 3, and 4 Districts
as follows:
(20) Bed and Breakfast
Shall be allowed by Special Permit provided that the
following standards are met :
a. Not more than twenty-five (25) percent of the
existing gross floor area of the principal
dwelling is devoted to such use.
b . Not more than two (2) separate sleeping rooms will
be used for boarders.
C . The owner of record must reside within the
dwelling used as a bed and breakfast facility .
d . Dwellings which contain bed and breakfast
facilities shall be separated by a minimum
distance of 1 ,000 ' linear feet .
e. Parking must be provided for one ( 1 ) car for each
unit rented to boarders. Said parking area-shall
be properly screened and required in addition to
the parking called for by the original use of the
dwelling .
f. There shall be no alterations, accessory buildings
or displays which are not customary with the
utilization of residential buildings.
g . A business certificate must be obtained by the
applicant from the Town Clerk .
h . A single sign may be displayed upon the primary
structure not to exceed six (6) inches by
twenty-four (24 ) inches in size.
i . Must be inspected by the Board of Health before
permit is issued and two (2) times a year c
thereafter .
j . Must be inspected by the Fire Department to insure
compliance with the NAFD requirements.
Definition of a Bed and Breakfast use placed in Section 2 of the Zoning Bylaw.
Section 2.23. 1 Bed and Breakfast
Any owner of an existing structure who utilizes it as his primary
residences and rents a portion of the structure to boarders for a
specified period of time not to exceed one ( 1 ) week .
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DIGITAL CONSULTING HEADQUARTERS ORDER OF CONDITIONS D.E.Q.E. #242-415
12. The work shall conform to the following plans and additional conditions:
a. Notice of Intent submitted by Dr. George and Sandra Schussell,
prepared by Merrimack Engineering Services, Inc. , dated
May 30, 1987 - Twelve (12) pages.
b. Letter from NACC to Mr. Steven Stapinski dated June 29, 1987
One (1) sheet. '
c. Letter from Merrimack Engineering Services, Inc. , dated `
June 30, 1987. Two (2) sheets.
d. Plan entitled "Site Development Plan" - Headquarters Building
Digital Consulting," prepared by Merrimack Engineering Services
Inc. , Dated May 1987, revised June 29, 1987. Two (2) sheets.
e. Letter from North Andover Fire Department to NACC, Dated .
June 26, 1987. One (1) sheet.
f. Letter from North Andover Fire Department to NACC, Dated
July 22, 1987 One (1) sheet.
13. The following wetland resource areas are affected by the proposed
work: bank, and land subject to flooding (bordering) . Land under
water and bordering vegetated wetlands also exist on the site.
These resource areas are significant to the interests of the Act
and Town Bylaw as noted above. These resource areas are also
significant to the wildlife and recreation interests of the Bylaw.
The applicant has not attempted to overcome the significance of
these resource areas to the identified interests.
14. The NACC agrees with the applicant's delineation of the wetland
resource areas at the site.
15. In advance of any work on this project the applicant shall notify
the NACC, and at the request of the NACC, shall arrange an on-site
conference among the NACC, the contractor, and the applicant to
ensure that all of the conditions of this Order are understood.
This Order also shall be made a part of the contractor's written
contract.
16. The applicant, or its successors, shall notify the NACC in writing
' of the identity of the on-site construction supervisor hired to
coordinate construction during the work on the site and to ensure
compliance with this Order.
• Omplet-
+Cu items d and/or 2 for additional services. i also WISh t0 receive the
• Complete items 3,and 4a&b. following services (for an extra
• Print your name and address on the reverse of this form so that we can fee):
return this card to you.
• Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address
does not permit.
• Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery
• The Return Receipt Fee will provide you the signature of the person delivered
to and the date of delivery. Consult postmaster for fee.
3. Article Addressed to: I 4a. Article Number
Joseph Messier, Jr. P 844 208 159
I 9 �>k , 4b. Service Type
11Registered ❑ Insured
Certified ❑ COD
❑ Express Mail ❑ Return Receipt for
Merchandise
7. Date of Delivery
3. SA' nature (Addressee) 8. Addressee's Address (Only if requested
and fee is paid)
3. i u (Ag nt)
'S Form 3811, N vember 1990 *U.S.GPO:1991-287-066 DOMESTIC RETURN RECEIPT
UNITED STATES POSTAL SERVICE
Official Business 13.
PENALTY FOR PRIVATE
USE, $300
Print your name, address and ZIP Code here
N. ANDOVER BOARD OF HEALTH
120 MAIN STREET
N. ANDOVER, MA.01845
P 844 208 1.59
Certified Mail Receipt
No Insurance Coverage Provided
Do not use for International Mail
,mgps rATEs (See Reverse)
VOSTAI SERVICE
Sent to
Joseph Messier, Jr.
Street&No.
109 Forest St.
P.O.,State&ZIP Code
No. Andover. MA 01249
Postage
2. 2
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
O Return Receipt Showing
p, to Whom&Date D
m
Return Receip
Date,&Addr s livery
7
TOTAL Post-
get i
p &Fees 2, 2 9
Postmark or
M
E \
LL
to
tL
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
1.If you want this receipt postmarked,stick the gummed stub to the right of the return address
leaving the receipt attached and present the article at a post office service window or hand it to
your rural carrier(no extra charge). y
m
2. If you do not want this receipt postmarked, stick the gummed stub to the right of the return
address of the article,date,detach and retain the receipt,and mail the article. Sc
0
3.If you want a return receipt,write the certified mail number and your name and address on a M
return receipt card,Form 3811,and attach it to the front of the article by means of the gummed
ends it space permits.Otherwise,affix to the back of article.Endorse front of article RETURN
RECEIPT REQUESTED adjacent to the number. -�
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, p
endorse RESTRICTED DELIVERY on the front of the article.
5.Enter fees for the services requested in the appropriate spaces on the front of this receipt. If E
return receipt is requested,check the applicable blocks in item 1 of Form 3811. 0 li
W
6.Save this receipt and present it if you make inquiry. *U.S.G.P.o.1990-270-153 rL
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of koRTII 1
D BOARD OF HEALTH
„FD "ty 120 MAIN STREET TEL. 682-6483
9SSACHUS�t NORTH ANDOVER, MASS. 01845 Ext. 32 or 52
June 25, 1991
Mr. Joseph Messier, Jr.
109 Forest St.
No., Andover, MA 01845
Dear Mr. Messier:
On June 25, 1991, I observed what appeared to be the
reconstruction of your septic system. The State Sanitary Code,
310 CMR 15. 02 (2) states that any alteration to an existing septic
system requires a permit from the Board of Health. A permit to
alter your system has not been issued by this office, therefore,
you are in violation of the State Sanitary Code. You are hereby
ordered to terminate the construction.
Also from the site inspection, it was apparent that your
leaching facility has failed and has been discharging effluent to
the surface of the ground. This is in violation of 310 CMR 15. 02
(20) . This condition must be corrected in a manner satisfactory
to the Board of Health.
Please contact me in the office to discuss your situation on
Tuesday or Thursday. Failure to - comply with this order within
seven (7) days may result in further action by the Board of
Health.
Please be advised of your right to a hearing before the
Board which must be made, in writing, within seven (7) days.
sSincerely,
Michael J. Rosati
Health Agent
MJR/rel