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Miscellaneous - 1094 SALEM STREET 4/30/2018 (2)
F 1094 SALEM STREET y- 210/106.A-0057-0000.0 ..•- „ w r 1094 SALEM STREET ® � JS-2004-1061 Proiect Detail Report � �s�� Printed On:Tue Sep 14,2004 Project Name: _ GIS#: 6689 Project No: JS-2004-1061 Owner of Record STRINGER,JOSEPH&LORRAINE Map: 106.A Date Submitted: May-21-2004 1094 SALEM STREET Block: 0057 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 1094 SALEM STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Septic System Comments: r of Work: Department Status GeoTMS Module: Status File No. Comments: LCDatc: Board of Health GREEN FLAG BHJ-2004-0066 9/1.0/04-Final Grade complete. Pending As Built and Certification Forms. No COC until paperwork received. Jim Kellett is the installer.--p.d. 6/21/04-Soil Testing complete 6/1/04-Soil test application received from NEES.--p.d. Neil Bateson called to let S.Sawyer know that Mr.Stringer will not be hiring him to do the inspection. He hired somebody else. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2004-0605 Aug-27-2004 Open ��j JS-2004-1061 Repair-Complete j 1 Plan Review BHP-2004-0589 Aug-26-2004 SIGNED OFF JS-2004-1061 Plan Review Soil Testing-Repair BHP-2004-0399 Jun-01-2004 SIGNED OFF JS-2004-1061 Septic Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Grade DWC-System Repair BHP-2004-0605 Sep-10-2004 SIGNED OFF Susan Sawyer JS-2004-1061 Final Inspection DWC-System Repair BHP-2004-0605 Sep-09-2004 SIGNED OFF Dan Ottenheimer JS-2004-1061 Bottom of Bed Inspection DWC-System Repair BHP-2004-0605 Sep-01-2004 SIGNED OFF Susan Sawyer JS-2004-1061 GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 Town of North Andover N°STM Office of the Health Department �:•�' °� Community Development and Services Division « i 27 Charles Street " °* s—• •`�' North Andover,Massachusetts 01845 �BSACMus Susan Y.Sawyer,RENS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax CE1��II2�'ICA�I'E OF C014 As As of: September 16, 2004 This is to certify that the individual subsurface diisposal system repaired(X" — Full System by James Kellett at 1094 Salem Street North Andover, JKA 01845 has been installed in accordance with the provisions of Title v of the State Sanitary Code and with the North Andover Board of Yfeafth regulations. 7lie issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. Sus n IY. Sawyer, R SI Public Ifealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 r' NOTICE OF VARIANCE/DEED RESTRICTION Pursuant to 310 CMR 15.000 Title 5, and as a condition of septic plan approval by the North Andover Board of Health, notice is hereby given that real estate located at 1094 SALEM STREET,NORTH ANDOVER, ? MASSACHUSETTS, (a/k/a Assessor's Map 210-106.A-0057-0000.0), as ' described in a deed from JOSEPH STRINGER AND LORRIANE M. STRINGER TO JOSEPH STRINGER AND LORRAINE M. STRINGER AS cr, TRUSTEES OF THE STRINGER ONE FAMILY TRUST dated December 17, 2 C) �) z 1999 and recorded in the Essex County Registry of Deeds in BOOK 7835 and : _ PAGE 249, and as DOCUMENT# 32092, is the subject of a variance from the U' Town of North Andover Minimum Requirements for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01(4). Said variance limits the maximum number � o of bedrooms at this dwelling to three (3) bedrooms. This variance is within the 0 '-" jurisdiction of the North Andover Board of Health. Witness our hands and seals this le day of September, 2004. o i J117,&IMV) Jsep Stringer, Tru ee Lo�iaine M. Stringer Trustee The Commonwealth of Massachusetts .4�d�fss. �t�lGl�i On this tG day of September, 2004,before me the undersigned notary public, personally appeared Joseph Stringer and Lorraine M. Stringer, Trustees,to me known to be the persons described in and/or who provided to me through satisfactory evidence of identification, namely, j11A.z (form of identification)to be the persons whose names are signed on the preceding or attached document(s) and who executed the foregoing instrument, and acknowledged that they executed the same as their free act and deed, 6" Notary Pu lic: 6��=h Afic4ee My Commission Expires: JU3 2-�1,V? a ESSEX NORTH REGISTRY OF DEEDS LAWRENCE, MASS. A TRUE COPY: ATTEST: RFGIS7ER OF DEED Q, i TOWN'OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( j constructed; (X)repaired; by JIA4 Ile /LC7i .located at _1(2 q was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# ,plan dated ,with a design flow of gallons per day. The materials.used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR.1S.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. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: Lic.#: Date: 0 g En ineer: Date: 11 W BENJAMIN �, 0 GOOD,JR, CIVIL H NO.45691 �b AL RECEIVED SEP 16 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 09415/2004 14:54 9764759131 STONE WALL RE O PAGE 01 5T ®-NE WALL Real Estate Pro%sslenals FAX COVER SHEET 77 MainStreet, Andover, MA 01810 OFFICE: (978)475-0077 X202 ♦ CELL: (978)815-1336 * FAX: (978)475-9131 EMAIL: bbuck@stonewallre.com ♦ WEBSITE:www Stonewallre.com To:411ice orU 5 „ _ I S. yt FitoM: BILL BUCK COMPANY: DATE: 1// FAX N -7 i. 1U $ • �� CC: 7 ❑ VrgeM ❑RNy ASAP Please c w3W Please review ❑For your Worta dw REMARKS: �/ vli/ / � y/ Avloll� TOTAL PAGES (INCLUDING THIS COVER SHEET): If you have not received a complete copy of this fax or if you have received this fax in error, please call us back at the phone number listed above. Thankyou! 09415/2004 14:54 9764759131 STONE WALL RE PAGE 02 a o Frank M. DiMaria Atlt�171L!buJf-/,tiw Tel 1979)649-4699 150%nford Road 5utte 27i89Qi 349-7932 TYngRhOro, Magsschusetts 0.1.879 Fax f.978' 6a9 6315 Ernall� ltank�frankdt8ferin.COti1 Date: September 15,2004 To: Town of North Andover Office of Cmmunity Development and Services Health Department 27 Charles Street North Andover,Massachusetts 01845 Atte; Susan Y. Sawyn;r Re: 1094 Salem Strec:t.11d 106A Parcel 7 ' sP S ,Korth.Andover,ytassachuaetts .foscph Stringer Dear Susan: Please accept this letter as my intent to have the Notice of Variance/Dcad restriction recorded with the Essex Registry of Deeds regarding the property referenced above. Per your instzuctions dated August 26,2004 to Mr. kwO Stringer this document will ill be executed at the sale of the aforem.entiotaed property and recorded with the deed into Richard F.Miller andSusan E,Miller.(copies of documents enclosed for your review). If you have any questions,or comments,please do not hesitate to call me. S.incermel Attomcy Franc Michael DiMaiia Enclosures: 09415/2004 14:54 9764759131 STONE WALL RE PAGE 03 0 0 -'()TICE OF WJANCE/D&W,RE-MUCTION I Pursuant 1V 310 CMR 15.000 Title 5,anal as a condition of septic plan approval by the North.Andover Board Of liealth,notice is hereby given that real estate located at 1094 SALFIM STREET,NORTH ANDOVER, MAS5ACI`1GSF'iT$; (a/k,'a Assessor'slvisp 210-106.A-01,)57-0000.01,as described in a de d from,JOSEPH STRINGER AND LORRIA_NE . STRIN4ER TO.T05E1'H STI INQER AICD LO.RRAINE M.. STRNGER AS TRUSTEES OF 7HE STRINGER ONE FAMILY TRUST dated December 17, z 1999 and recordecl in ilia Essex County Registry of Deeds in BOOK 78?5 and cn PAOfi 249,and an DOCUMENT#32092,is the subject of a variance from the Town of North Andover Minimum Requirements for the Subsurfacc Disposal of Sanitatw Sewage'U.05 and C9.01(4). Said veance limits the maximum number of bedrooms at this dwelling to three(3)bedrooms. This variance is within the jurisdiction of the North Andover Hoard of Health. Witness our heads and seals this day of September,2004. 0 a. Joseph Stringer, Trustee Lorraine Nt.Stringer. Trusted The Commonwea1rh Of Ajassachusetfs ss. On this day of September,2004,before me the undersigned notary public,personally appeared Joseph Stringer and Lorraine M. Stringer,Trustees,to me known to be the persons dettcribed is and/or who provided to me through satisfactory evidence of i.dtntifcation,namely, (form of identificadon)to be the persons whose names are signed on the Preceding or attached document(s)and who executed the foregoing instrument, wid acknowledged that they executed the same as their fife act and decd. Notary.Public. My Commission Expires: 09415/2004 14:54 9784759131 STONE WALL RE PAGE 04 a O QUrrCLAlAd DEED *'E,JOSEPH SP�UNG}ER and LORRAINE M. STRINGER,TRUSTEES OF THE STRINGER ONE FAMILY TRUST UmI T DATED DECEMBER 17. 1999 AND RECORDED WITH ESSEX FORTH DISTRCIT REGISTRY OF DEEDS [N BOOK 7835,MAGE 235 OF NORTH ANDOVER,r-,SSEX COUNTY,MASSACHUSETTS FOR CONSIDER,4-TION PAID AND IN FULL CONSIDERATION OF THREE HUNDRED NINETY-FOUR THOUSAND AND 00ij00(5394,000.00) DOLLARS GRANT TO RICI:tARD F.MILLER and SUSAN E.MILLER,HUSBAND AND z WIFE AS TENANT BY THE ENTIFRTY ti OF 1094 SALEM;STREET,NORTH ANDOVER.ESSEX COT-NTY. MASSACHUSETTS a $ with quitclaim covenants THE LAND WITR THE BUILD,TNGS THEREON SITUATED IN NORTH ANDOVER IN TH'E COUNTY OF ESSEX AND COMMONWEALTH OF MASSACHUSETTS,AND BEING SHOwt ;AS LOT NO. 3 ON A PLAN OF LAND ENTIT.LEE, "PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS,FARWOOD ACRES NO. I DATED FEBRUARY 9, 1956 AND DRAWN BY C.J.KITSON,SURVEYOR,LOWELL, ' MASSACHUSETTS."SAID PLAN BEING DULY RECORDED WITH THE ESSEX COUNTY REGISTRY OF DEEDS FOR THE NORTHERN DISTRICT AS DESK PLAN NO.3204, THE SAID PREMISES ARE MORE PARTICULARLY BOUNDED AND DESCRIBED AS rOLLOWS: NORTHERLY BY LOT 4 AS SHOWN ON SAID PLAN A DISTANCE OF THREE HUNDRED AND NINETY-FOUR F.F.IiT MORE ORLESS. NORTHEASTERLY BY A PART OF LOT NO. j I AS SHOWN ON SA1D PLkN A DISTANCE OF NINETY FEET; EASTERLY BY PART OF LOT NO. 15 AS SHOWN ON SAID PLAN A DISTANCE OF THIRTY-FIVE FEET; SOUTHERLY BY LOT NO, 2 AS SHOWN ON SAID PLAN A DISTANCE OF FOUR k{UNDRED:4ND THIRTY-VWE FEET MORE OR LESS;AND 09/.15/2004 14:54 9764759131 STONE WALL RE PAGE 05 O O WESTERLY BY SALEM STREET AS SHOWN ON SAID.PLAN A DISTANCE OF 0�1E HUNDRED AND TWENTY-EIGHT FEET MORE OR LESS. CONTAINING 49,300 SQUARE FEET OF LAND. SUBJECT TO VARIANCE FROM THE TOWN OF NORTH ANDOVER 1KINIMUM REQ'MMENTS FOR THE SUBST WAC:E DISPOSAL OF SANITARY'SEWAGE A1.05 AND 09,01(4). SAID VARIANCE LIMITS THE MAXNUM NLMIBER OF BEDROOMS AT THIS DWEWLLEvG TO THREE (3)BEDROOMS AS RECORDED IMREW.TM THE UNDERSIa-MD TRUSTEES UNDER THE STR.TNGER ONE F � AMILY TRUST UNDER INDENTURE DAT CERTIFY THAT THE TRUST REED DECBMBEIt 1?, (999.HEREBY MALVS IN FULL FORCE AYD EFFECT AND THAT THEY ARE THE SOLE TRUSTF-ES Of TRUSTEES HAVE FULL AND ABSOLUTE POWER IN SAID TRUST THE AGREEMENT TCCONVEY ANY INTEREST IN REAL ESTATE AND LVlPROVE'MF-NT' THEREON HELD N SAID TRUST AND NO PERSON DEALING WITH THE TRUSTEES HEREUNDER SHALL BE UNDER ANY OBLIGATION OR.LT.ABR'n'y TO SEE TO THE APPLICATION OF ANY PURCHASE MONPy OR To ANY OTM MONEY OR OPERTY LOANED OR DEIJV.ERED OR TRANSFERRED O TH..L TRUSTE NOR TO SEE THAT THE TERMS AND CONDITIONS OF THIS TRUST HAVE BEEN COMPLIED W.ITH:. aEING THE SAME PREMISES CONVEYED,F O LS By DEED OF JOSE RIld PH ST C3BR AND I,ORRAINP M STRTNdER DATED DECEMBER 17, 1999 AND RECORDED WITl i ESSEX VORTH DISTRICT RF.,GISTRY OF DEEDS 1N BOOK 7$35,PAGE 249. 09115/2004 14:54 9784751 STONE WALL RE O PAGE 06 W'TN ES S OUR HANDS AND SEALS THIS`DAX OF SEPTEMBER.2004. Jaseph Stringer, r;mMee Lorraine,M. Stringer,Trustee Tke CommonHjeallh of Messacku red t 68. On this _day of September,2004,before me the intdersignad nota ry public,personally;tppeared Jusgh Stringer and Lorraine M. Stringer,Trustees, to me known to be the persons described in and/or who provided to me thr+otSh satisfactory evidcme ofidentification,namely, (form of identification)to be the persons whose names are signed on.the Preceding or attached document(s)and who executed u ed rho fore oin inetrunaent, and acknowledged that they executed the same as their free acct and deed. Notary Public: My Commission Expires: 1 a FINAL GRADE INSPECTION Date: Address: Azg1 ❑ LOAMED? ❑ SEEDED? ❑ COVER PER PLAN? Other: // / (1.> 2,l 6 z; ;;l �®1 0 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, September 08, 2004 2:32 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 1094 Salem Street Sue and Pam, Attached please find inspection report for 1094 Salem Street. All went well. The wall on the plans was not yet built and should be checked during the final grade inspection. Dan Mill Rioveir< consulting Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info millriverconsulting.com 9/8/2004 0 0 E TOWN OF NORTH ANDOVER Ot NOR7a Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT • s s+ 27 CHARLES STREET � °, .�:s:.. •r• °•T9TD rfiy� NORTH ANDOVER,MASSACHUSETTS 01845 9s3 CHuset Susan Y. Sawyer,RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ADDRESS: 1094 Salem Street MAP:106a LOT: 57 INSTALLER: James Kellett DESIGNER: NEES PLAN DATE:7/14/2004 BOH APPROVAL DATE ON PLAN: 8/20/2004 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 9/9/2004 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Pressure Dosing COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500/500 Combo LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER TYPE OF SAS = Infiltrator Field DIMENSIONS AND DETAILS OF SAS: 4 rows of 4.5 Infiltrator chambers SITE CONDITIONS Date & Initials Inspections ®Existing septic tank properly abandoned ®Internal plumbing all to one building sewer ®Topography not appreciably altered Comments: Page 1 of 1 0 0 TOWN OF NORTH ANDOVER f NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET " ^ • " o�+.rs NORTH ANDOVER, MASSACHUSETTS 0 184 �'sS CFNIU t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 2000 gallon tank has been installed H-10 loading 2-Piece construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged 500 gallon Pump Chamber installed H-10 loading '2-Piece construction) ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® 24" inch cover to within 6"of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Page 2 of 2 O n TOWN OF NORTH ANDOVER a NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 0 184 ��ss;;CHU <� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-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: w SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title '5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ® laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ® Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Wall to be installed/ checked at Final Const. Insp. CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: Basement ❑ Rated for exterior if placed outside Comments: Page 3 of 3 Q Q TOWN OF NORTH ANDOVER Ot ►ORT�� Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT41 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS Ol 845 ��Ss"4CN„5 t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 2.40 Height of Instrument: 102.40 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 98.17 98.37 Septic Tank IN 97.97 97.11 Septic Tank OUT N/A-Combo tank N/A Pump Chamber IN N/A N/A Pump Chamber OUT 97.72 97.94 Distribution Box IN 9947 99.46 Distribution Box OUT 9930 99.30 Manifold Infiltrator Invert 9921 99.20 Bottom of Bed 98.67 98.66 Top of Chamber HIGH 99.67 99.63 Top of Chamber LOW 9967 9966 Page 4 of 4 TOWN OF NORTH ANDOVER4 KpHTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET ^o NORTH ANDOVER,MASSACHUSETTS 01845 SAC NUSB Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTI°CG SYSTEM CONSTRUCTION NOTES ADDRESS:10 ,9,41- �� J�►-�- YMAP:�Oj,�LOT: S7 INSTALLER: DESIGNER: PLAN b �a PLAN DATE: -7Ii�/� BOH APPROVAL DATE ON PLAN: �- DATE OF BED BOTTOM INSPECTION: 6 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION X PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT O NT SUMMARY FROM PLAN GALLON TANK = 2_ 7 LOADING OF SEPTIC TANK = v �`� - �` D- GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer El not appreciably altered Comments: Page 1 of 4 r O 0 TOWN OF NORTH ANDOVER E ripFTN q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01.845 �qs SACNUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK Bottom of tank hole has 6" stone base El Weep hole plugged ❑ gallon tank has been installed L.6D (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of finalg rade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: Page 2 of 4 0 0 TOWN OF NORTH ANDOVER F pORTH O tiaP is qti Office of COMMUNITY DEVELOPMENT AND SERVICES o� HEALTH DEPARTMENT 27 CHARLES STREET A NORTH ANDOVER,MASSACHUSETTS 01845TV,SAC �(5 ACHUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-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: SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to C-soil layer, as provided on plan Size of SAS excavated as per plan Li Title 5 sand installed, if specified on plan ❑ 3/4-1 1/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: Page 3 of 4 I I . O Q TOWN OF NORTH ANDOVER oNORTH q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ` 27 CHARLES STREET r NORTH ANDOVER, U MASSACHUSETTS 01845 SS•reo r5�g9 ACH Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV @ TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 t �— Commonwealth of Massachusetts Map-Block-Lot 106.A-0057- Board Of HealthPer,,, ---- it No North Andover BHP-2004-0605 ----------------------- F.I. FEE F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted JAMES KELLETT -- - - - -------------------------- to(Repair)an Individual Sewage Disposal System. �! at No 1094 SALEM STREET ------------------------------------------------------------------------------------------------------------ ----------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2004--060 Dated August 27,2004 - ---------------------------- i i ----------------------------------------------------- -------- Issued On:Aug-27-2004 Board Of Health - - -- ----- ----------------- - ----- ----- - ............................................................................................................................................................................ Commonwealth of Massachusetts Map-Bldck-Lot 106.A-0057- Board Of Health - North Andover Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by JAMES KELLETT -------- ------------------------------------ ---------------------- ---------------------------------------------------- ----------------------- Installer at No 1094 SALEM STREET ------------------------------------- --------- ------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2004-060 Dated August 27,2004 ------------- --------------------- Printed On:Aug-27-2004 Board Of Health � r y �, f � WWI,I, I 5 S film 1l4 j & i MATH.k'db ' - ,�,o�` ' '. t 1 r� r��AS,..`} �^ •, �.d-Sty. x � w g ., ' z ot a^'.Y1a.4, of, t H� r j t P r � O,A Town of North Andover Health Department Date: n Location: (Indicate Address,if Residential) r Name of Business) Check#: f Gi Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ e ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic Design Approval $_�� eptic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) A 1 Health Agent Initials 95 White-Applicant Yellow-Health Pink-Treasurer t. �T O 0 TOWN OF NORTH ANDOVER F NORM►, Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ' ~ A 27 CHARLES STREET � qOq+rea nePy49 NORTH ANDOVER,MASSACHUSETTS 01.845 9SSACHusS Susan Y.Sawyer,REHSIRS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthdept @ townofnotthandover.com www.townofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: cs —Z5�_'6/1 LOCATION: LICENSED INSTALLER NAME: PLEASE PRINT SIGNATU �� ' TELEPHONE# CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION,please attach the Foundation As-Built Plan. $254.00 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent Date- O Q r ,. INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 4 0 S A(gyrelative to the application of dated for plans by/(/, and dated with revisions dated I understand the following obligations for management of this project: I. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work 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 1 must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. (JDos�al igned Licensed Septic Installer Date: C�` 2 C/ Works Construction Permit# � S10RTh.q TOWN OF NORTH ANDOVER HEALTH DEPARTMENT00p 2.7 CHA._RLES-STREET 1+ V NORTH AN,;OVER,MASSA:C"HUSETTS 01845 ��°R•=n hP'"i5 • . SSACHUSEi Susan Y. Sawyer,RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—Fax healthdept@townofnorthandover.com www.townofnoi-thandover.com FAX Benjamin C.Osgood,Jr.,EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES,INC. 60 Beechwood Drive North Andover, MA 01845 978-685-.1099 Pages: Fax: 978-686-1768 Date: �� Phone: Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been malted to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - a 0 HP Fax K 1220xi Log for NORTH AI bOV- ER 9786889542` Aug 26 2004 5.59pM Last Transaction Date Time Twe Identification Duration Pages Result Aug 26 3:55pm Fax Sent 89786851099 4:19 6 OK I a TOWN OF NORTH ANDOVER It Th Office of CONIMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ?7 CHARLES STREET •��^e�,T.eje� 4g* NORTH ;ANDOVER MASSACHUSETTS 01845 'SS,CH�SE` Susan Y. SiNvNcr 978.(188.9540—:Phone Public HcAth Director 978.688.9542 —FAX August 26,2004 Joseph Stringer 1094 Salem Street North Andover,MA 01845 V RE: Subsurface Sewage Disposal System Plan for 1094 deltmsan-Street,Map 106A,Parcel 57,North Andover, Massachusetts Dear Mr. Stringer, 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 New England Engineering Services dated July 14,2004. The design has been approved for use in the construction of a replacement onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations.In the event an immment health problem such as sewage backup into the dwelling is occurring,the time period for which this plan is valid may be reduced by the North Andover Board of Health. The following requests were approved at the Board of Health meeting. 1. To allow the construction of a leach field 93 feet from the edge of a wetland in lieu of 100 feet as required by the N.Andover local bylaw. 2. To allow the application for a Local Upgrade as requested,for a reduction in the separation between the soil absorption system and the high groundwater from the required four feet to three feet. With the granting of this reduction,a deed restriction must be placed on the property,which limits the maximum number of bedrooms of this dwelling to three bedrooms.The applicant must submit proof of recording,prior to the issuance of a Certificate of Compliance by the health department.This restriction shall remain on the property until such time that the dwelling is connected to a municipal sanitary sewer system and the soil absorption system is properly abandoned. This approval is subject to the following conditions: 1. The attached DEP Form 9b must be submitted to the appropriate Regional Office of the Department of Environmental Protection at One Winter Street,Boston MA by the property owner 2. 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)). 3. 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 ConstrucUon Permit shallnof construe and/or imply comP,_acewith 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, Susan Y. Sawyer,REHS Public Health Director cc: New England Engineering Services file I 0 0 It is the responsi6ifity of the applicant to record the requireddeedrestriction per 310 C91IR15.000 Title 5. The following is a suggestedonnat, 6ut the 6naldocument should 6e approved 6y your attoma prior to recording. NOTICE OT VARI.ANCE/DEED RESTRICTION Pursuant to 310 C5WR,15.000 Title 5, andas a condition of septic plan approval 6y the North Andover 0oard of Yfealth, notice is hereby given that real estate located at: , North Andover, Wassachusetts, (aka Assessor's 9Kap /Got ), as descri6edin a deedfrom to , dated , 20 and recorded in the Essex County*gistry of Deeds in 000(J andEage , andas Document # is the subject of a variance from the Town of North Andover 9Kinimum Rgquirements for the Subsurface Disposal of Sanitary Sewage A1.05 and C9.01(4). Said variance limits the maximum num 6erof bedrooms at this dwelling to bedrooms. This variance is within the jurisdiction of the North Andover(Board of 0ealth. Signedandsealedthis day of , 20 (Property Owner(s)Signatures C09YMONTVEAGW OT WASSACxvSETTS Essex s.s. Date: , 20 Tien personally appeared the above-named and acknowledged the foregoing instrument to be his/her/their free act and deed, before me. Name Notary Puflic I jf Commonwealth of Massachusetts Cityfrown of Local Upgrade Approval Form 9B DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection,Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. A. Facility Information When fing out 1. Facility Name and Address forms on the computer,use Joseph Stringer only the tab key Name to move your 1094 Salem Street cursor-do not use the return Street Address key. NorthAndover MA 01845 VQ Cityrrmm State Zip Code 2. Owner Name and Address(if different from above): Name Stred Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): X Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 330 gpd 5. System Designer: Ben Osgood Jr. Name x PE ❑ RS 60 Beechwood Drive North Andover 01845 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for. Reduction in setback(s)—specify: r ❑ Reduction in SAS area of up to 2596: SAS size,sq.ft. %reduction 1094 Salem St 9b prop•rev.5102 Local Upgrade Approval* Pape 1 of 2 Commonwealth 00.. Massachusetts Q Cityrrown of Local Upgrade Approval Form 9B B. Approval (continued) x Reduction in separation between the SAS and high groundwater. Separation reduction e Percolation rate 8 min.lmch Depth to groundwater e ❑ Relocation of water supply well (explain): List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Board of Health Approving Authority ObNATWW &/?-I LO Print or Type Nae and Tide Date' Name 1094 Salem St 9b prop•rev.SW Local Upgrade Approval• Page 2 of 2 310 CMR:OPARTMENT OF ENVIRONMENTAL PROTECON 15.405: continued (c) Placement of the leaching structure within an area where percolation rate is between 30 and 60 minutes per inch,in accordance with 310 CMR 15.242; (d) Up to a25%reduction in the required subsurface disposal area design requirements; (e) Where upgrade is required pursuant to 310 CMR 15.303(1)because it is within Zone I I of public well or within 100 feet of private well,relocation of the well. Any relocation of a public well shall be performed pursuant to 310 CMR 22.00(water supply source approval); (f) Reduction of system location setbacks from bordering vegetated wetlands; (g) Reduction of system location setbacks from surface waters,salt marshes,inland and coastal banks,certified vernal pools in'accordance with 310 CMR 15.211(1)[2],leaching catch basins,dry wells,or surface or subsurface drains other than those which discharge to surface water supplies or tributaries thereto; (h) Reduction of system location setbacks from water supply lines,private water supply wells(but not within 50 feet of the well),tributaries to surface water supplies,surface water supplies,but not within 100 feet of the surface water supply or tributary thereto or open,surface or subsurface drains which discharge to surface water supplies or tributaries thereto. (i) the local approving authority may reduce the required four foot separation(in soils with a recorded percolation rate of more than two minutes per inch)or the required five foot separation(in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the soil absorption system and the high groundwater elevation only if all of the following conditions are met: 1. An approved Soil Evaluator who is a member or agent of the local approving authority determines the high groundwater elevation. 2. A minimum three foot separation(in soils with a recorded percolation rate of more than two minutes per inch)or a minimum four foot separation(in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the soil absorption system and the high groundwater elevation is maintained. 3. The system is a failed or non-conforming system serving an existing building with a design flow of less than 2,000 gpd 4. No increase in design flow or square footage of the building is allowed. 5. No reduction in required leaching field size or setbacks from public or private wells, bordering vegetated wetlands, surface waters, salt marshes, coastal banks, certified vernal pools, water supply lines, surface water supplies or tributaries to surface water supplies,or drains which discharge to surface water supplies or their tributaries,is allowed. (2) No application for an upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property or well is affected by certified mail at his/her own expense at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. The notification shall reference the standards set forth in 310 CMR 15.402 through 15.405 and indicate the date,time and place where the upgrade approval will be discussed. (3) If the nonconforming system cannot be upgraded in accordance with 310 CMR 15.404 and 15.405(1)the owner shall: (a) obtain a groundwater discharge permit pursuant to 314 CMR 5.00 and 6.00, (b) apply to the Department to use a tight tank or modified tight tank in accordance with the provisions of 310 CMR 15.260 through 15.262, (c) apply for a variance pursuant to 310 CMR 15.410 through 15.415,or (d) abandon the system in compliance with 310 CMR 15.354. (4) Nothing in 310 CMR 15.405 shall authorize violation of M.G.L.c. 131,§40 and 310 CMR 10.00,or any other applicable provision of law. 11/3/95 310 CMR-554 o. . . � a . � ..is . '. i. , , , f. . , . � .' i . . . ,..... .. a'. . ,, .. ..i . •l�: ,_ ,. .. • ., ,i, .. � ,. >. ,,:✓ . o n � NEW ENGLAND ENGINEERING SERVICES INC August 17, 2004 Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, NLA,01845 Re: 1094 Salem Street,North Andover Dear Susan: Please accept this letter as a request to appear before the North Andover board of Health in regards to granting the local variance or upgrade for the above referenced property. The requests are as follows. 1. Allow the construction of a leach field with a separation to ground water of 3 feet in lieu of 4 feet as required by Title 5. 2. Allow the construction of a leach field 93 feet from the edge of a wetland in lieu of 100 feet as required by the North Andover local bylaw. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., T President 60 BEECHWOOD DRIVE-.NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 Page 1 of 1 Dellechiaie, Pam From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, August 11, 2004 8:41 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: Plans Sue and Pam, —� Attached please find the plan reviews for 100 Laconia Circle d�1094 Street. On both designs they are requesting a reduction in ground water offset. I am hard-presse a site would need such a reduction as it appears to be a very large area where a raised system could be well designed and look ok. The Salem Street site is pretty tight for space. Most communities around here would not approve the local upgrade approval for either site and would look for the designer to achieve full compliance with a conventional system and a wall (if needed)or a treatment unit. One item for you and/or the Board to consider would be requiring pressure distribution of the wastewater in the event a pump is needed and the LUA for only 3' to ground water is requested. This would provide some improved wastewater treatment to counterbalance the lack of 4' separation to groundwater. Dan I Mill ive consulting Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com. info millriverconsulting.com 8/12/2004 0 Town of North Andover /f Health Department Date: Location: / / (Indicate Address,if Residential,or Name of Business) r Check#: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ _ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic—Soil Testing $ ,-- ❑�Sept" is-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) � , 3 15 5 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover,MA 01845 978.688.9540 healthdW!gtownofnorthandover.com SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: J o� SITE LOCATION: L021-1 J�Gj SFreef ENGINEER: /V2w E✓01414c-S G"a(V,eeC 1 Ad S r Vl e-e s NEW PLANS: YES ✓ $225.00/Plan ` 019S`0 a Check#: G76r (Includes 1 Eand one Re-Review Only) REVISED PLANS: YES $75.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone#:�a�$�(�;[� f 768 Fag#: E-mail:_ 0eeseKQ un Qol eCom HOMEOWNER NAME: `,0,50 5f6C Je r OFFICE USE ONLY When the submission is complete(including check): 1. e/ ate stamp plans and letter 2. -cpmplete and attach Receipt 3. py File; Forward to Consultant 4. Enter on Log Sheet and Database a a NEW ENGLAND ENGINEERING SERVICES INC July 16, 2004 RECEIVE Susan Sawyer JUL 1 6 North Andover Board of Health 2004 27 Charles Street TOWN OF NURTH ANDOVER North Andover, MA 01845 HEALTH DEPARTMENT Re: 1094 Salem Street, Septic System Design Dear Susan: Enclosed are the following documents concerning the above referenced property. 1. 5 Copies of septic system design plans. 2. Copy of Form 11-Soil Evaluator Form. 3. Copy of Form 12-Percolation Test Form. 4. Local Upgrade Form. 5. Septic Plan Submittal Form. 6. Check to cover the approval fee. These plans are being submitted for approval. Please contact this office with any questions or concerns at(978)-686-1768. Sincere y, Thomas Hector Project Engineer 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 ., rin „'_tr LYJC14 .:1:�S!? 1 rS.:3.34 11� IFif'IIaF;KL�: � 1''FH7t tJl r FORIYf It SOIL EVALUATOR )''ORki Page I of 3 i Ido• c , Date: Commonwealth of Massachusetts Massachusetts oil 5' i z i a s e�srraet tOn-site-si S Disp—osal Performed By: , °` _ .. Date: Witnessed By: N'wloft. a,daU$'k"4 GAJ y ,/�L�'. �fYFr'� Tcirpnent f ,1d�y',q+�' �•' - �� i few construction 03 Repair Zj office Review Published Soil Survey Available: No ❑ Yes 'car Published le-?el............... Pub+Uation Scale �• f3/7-50 �-� � � I' ' / .. .. soil Map Unit Drainage Class Soil Limitations Surficial Geologic Report Available, No RJ Yes L J Yew Published Publication Scale ~ ..: . :.:...: Geologic Material (Tsgap Unity -- _...... . ............ .....:.. .. ...... ... Landform ................� F'looc Insurance Rats: Map. Above 500 year flood boundary No L-1,Yes T Within 500 year flood boundary No 1:Yes ❑ Within 100 year flood boundary N4 17,Y's t. Wetland Area: National Wetland Inventory Map (map unit) Voledands C'onsuvancy Program Map (map unit) Current Water Resource Conditions(GSGS): Month 'ic , GG'e�j* Range ;Above Normal ®Normal EBelc v Normal ❑ Other Referenecs Rcviewed: —" RECEIVED DEPAPPRGVEDPORN( JUL 1 6 �no4 TOWN'Jr Nut,irir.NUL>J :.R HEAL)H DEPARTM. N > t/�7!LGY;4 L1 uC 1 ica .� x'117 IG;Nl7iaNL?t�' F'AUL U�4 f FOP.M 11 SCT. EVALUATOR FORNe Page 2 (if I Location Address or Lot i4o. -- On-site Review Deep Hole Number / . pate:��� `7" Time: Weather?/S— Location (identify on site p;en) J C�rCC� ...... ... .. Land Use � rr'�T/.� Slaps (%f Surface Stones vegetation Lendform .. '� rC/ �d Ge•�� Position on landscape Distances from; _ Open Water 3ocyfeet (drainage way ��� feet Possible Wet area 'eel Prope'ty Line feet Qrink;ng Water Well >/'!!FW feet otter DEEP OBSERVATiON'HOLE LOG r Depth from Soil Horizon Sall Texture Sorii Calor Soi!.� _ Other Surface(Inches) (U$DA) (Munsell] Marling iSiructore,Stones.Boulders, Consiste,ncv• % Cravell -� ^ Z--:5 i ,I i Parent Material(geoiogio) ,��c G +'G +� napthtoBedroO: // ....�...... DeVh to Groundw6?gr: Swnding Water in the 4o!e: Y 7 Weeping from Pit F6m 15_:•''� Estimareo Seasanaf High Grund taster: DEP AFFROM FORk,. f<t;',7193 yl 'LlU4 dl " 1.t'7'„J34k-11l4) � FA.GE ,;J • , .. FORM ii SUi] FVALL1 ATOt FORMPage 2 of z Location Address or Lot AG, 0n!siLe_B view Jeep Hole Number G ` Date: �.�i "� Time,�'`7��� Weather Location {identify on site plar) e'111v- Land Use .4k��� siup� I%) surface Stones 'Vegetation Position or. landscape D:varices from: Caen 'Vater Bo'ziy Pee? Drainege way oda feet Passib a vJet A!ea /0'e, "7 `7 Property Line ., �'�. feet Drinkir l; Nater Well feet Other . ...- .... DEEP OBSERVATIO a HOLE LOG ! p!oth: from Soil Horizcn Sod Texture Soil Cntor Soil Oi`^er I t rt ce Inches 'USDA (Munsel;l Nottlln (5vuct+.tre,Stenos.Boulders, Consiste-!cy, 9. �,� a (Inches) t i 6 I t unveil G I i a IL I Fermi Materiel{geologiCl D2p1htoBeGroek: — s De,th to Ciroundwntan S;endin;Water in the Ho!e, ". l weeping frorr Pit Face; sterroted Seasonal High Ground U6'n Arl?fit NTV F010I• 721C7193 o� :11 LUrJw 41:c+r_n 1 l J1 nJ4CJ117 tf=Naa;h:L r-Aint. t74 • 0 0 FORM 1.1 - SUIT. L• VALLIATOR FORM Page 3 of 3 Location Address or Lot No. ., %Uee~ ��. A0. Determination for Seasonal- Hi h Water Table Method Used: J Depth observed standing in observation hole ..... inches Depth weeping from side of observation, hole inches Depth to soil mottles 1-77 . inches I� ;.] Ground water adjustment ..... . . feet '+d �� . ... Index Well Number . .. Reading Date .. Index well level Adjustment factor ... Adjusted ground water level Deoth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in a;! areas observed throughout the area proposed for the soil absorption system7 if not, what is the depth of naturally occurring pervious materiel? Certification E certify that on (date) I have passed the soil evaluator examination approved by the Depsetment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.01?. Signatur Date llF:P ArPRI.l�"F1^•pr)Rhf• l2�07/45 . O O FORM 12 -PERCOLATION TEST Location Address or Lot No. 10 q 7 I �Q COMMONWEALTH OF MASSACHUSETTS /0(-vVN AlJover, Massachusetts Percolation Test` Date: ._ i� Time:. Observation Hole # Depth of Perc 37 it �aa if Start-Pre-soak End Pre-soak '� I Time at 12" 10" 13 Time at 9" 10 , L Time at Time W-61 Rate Min./Inch ' 'Mo�l1. ornc� Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed JK Site Failed ❑ ............................•---...---...........----.....................---.................:.......................................__......._....... Performed By: en ►a Mh ar. Witnessed By: r111 kver ' CcY% i Comments- DEP APPROVED FORM.12/07195 FORM 9A - Appl.ication for Eocai Upgrade Approval Commonwealth of Massachusetts VIE—.9 Massachusetts (City/Town) Application for LOCAL UPGRADE APPROVAL Title 59-310 CMR 15.000 DEP Approved Form Required by 310 CMR 15.403(1) Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance,as defined in 310 CMR 15.404(1),is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405,or in full compliance with the requirements of 310 CMR 15.000, 15.410 through 15.41.7. require a variance pursuant to 310 CMR OTE:Local upgrade approval shall not be -new design flow to a cesspool or n granted for an upgrade proposal that includes the addition of a P privy,or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. Facility Address: p.� City/Town: l � PoV T Facility/System owner: Address: 6 City/Town: Telephone: 6 State• Zip: 01 Type of Facility(check all that apply): Residential Describe facilitytngle Vil� ❑Institutional ❑Commercial ❑ School Type of existing system: ❑Privy ❑Cesspool(s) Conventional System ❑Other(describe) Type of soil absorption system(trenches,chambers,leach field,pits,etc) Design Flow per 310 CMR 15.203: Design flow of existing system O gpd Design flow of proposed upgraded system p gpd Design flow of facility gpd Proposed upgrade of system is: ❑Voluntary El Required by order,letter,etc.(attach copy) Required following inspection pursuant to 310 CMR 15.301 Provide date of inspection u UL FORM 9A - Application for Local Upgrade Approval i Department of Environmental Protection Page 1 of 3 DEP Approved Form—3/20/02 Describe the proposed upgrade to the system rra e ` A tkMA G lso -__Dl Local Upgrade Approval is requested for: Reduction in setback(s) (Describe reductions � %,� ❑ Percolation rate for 30 to 60 min/inch Percolation rate min/inch ❑ Reduction in SAS area of up to 25% (SAS size and%reduction) SAS sq ft Reduction Reduction in separation between the SAS and high groundwater Separation reduction I ft Percolation rate________min/inch Depth to groundwater$ ❑ Relocation of water supply well(Explain) Other requirements of 310 CMR 15.000 that cannot be met Describe and specify sections of the Code If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation,an Approved Soil Evaluator must determine the high groundwater elevation pursuant to.310 CMR 15.405(1)(i)(1).The soil evaluator must be a'triember or agent of the local approving authrity. High groundwater elevation determined by: ' Am b QEW m c g i2E/+R 7N �laii moo y (Print or type evaluator's Name) (Signature of evaluator) (Evaluation Date) Explain why full compliance,as defined in 310 CMR 15.404(1),is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: -HL v4ltt> >s - sr Iq L PLA acsw G —K L s s iy CQ e ca- 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: Tl1e cos- 4220 Department of Environmental Protection DEP Approved Form-3/20/02 Page 2 of 3 b FORM 9A - Application for Local Upgrade Approval 3• A shared system is not feasible: /V o ,r-�-4;-g GX�s 13 ow v;5 di"0.T/d-c C NT j 4• Connection to a public sewer is not feasible: it/-) ��w c Lo — ac- VNv�<�t( !�v The Application for.Local Upgrade Approval must be accompanied by all of the following: (Check the approprite boxes) Application for Disposal System Construction Permit ❑- Complete plans and specifications Site evaluation forms ©� A list of abutters affected b reduced duced setbacks to private water supply we lls or property erh lines.provtde proof that affected abutters ers have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List) CERTIFICATION: "I,the facility owner,certify under penalty of law that this document and all attachments,to the best Of my knowledge and belief,are true,accurate,and complete.I am aware that there may be significant consequences for submitting false information,including,but not limited to,penalties or fine and/or imprisonment for deliberate violations. I Facility owner's signature �y Print name Date �� Name ofpreparer_ ��� J�- Preparer's Address: 6' i3<<c Date �7//6/oy City/Town• 9J_ �� o) est wao 2w e-. P , ' State: .0.4 Zip: p/9 y = Pre arer s telephone: (0-70 NOTE: 310 CMR 15.40 3(4)requires the system owner to provide a approval P copy of the local upgrade pp alto the appropriate Regional Office of the Department of Environmental Protecgtion;Bureau of Resource Protection,Division of Watershed Management,men upon ' authority and before g P Issuance by the local approving � h' commencement of construction. g NU Department of Environmental Protection Page 3 of 3 DEP Approved Form—320/02 ' Page 1 of 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 23, 2004 3:59 PM To: DelleChiaie, Pamela Subject:.FW: 1094 Salem Street -----Original Message----- ' From: Dan Ottenheimer[mailto:info@miliriverconsulting.com] Sent: Tuesday, June 22, 2004 3:32 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 1094 Salem Street Sue and Pam, Attached please find the soil test results for 1094 Salem Street. Dan J Daniel Ottenheimer,President Mill River Consulting Management Se tic S Ystem Services P 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com I I,I 6/23/2004 �j Vt fj Cal Ft r -5--4 -4 1 lip till L5. qr 1 iNi 1 1- • TI i. � r - 9 ,j _ . � � ry Page 1 of 1 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, June 23, 2004 3:59 PM To: DelleChiaie, amela Subject: : 1094 Salem treet -----Original Message---- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Tuesday,June 22, 2004 3:32 PM To: Susan Sawyer; amcbrearly@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 1094 Salem Street Sue and Pam, Attached please find the soil test results for 1094 Salem Street. Dan E Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.com 6/23/2004 t. r f w � .3 I i a , III I `—+— �— + -+— + •#— y� � � � � l I I i i � o L i* - r .� � - � �� `� m ,,to ib 3� `^ BOARD OF HEALTH 120 MAIN STREET �9SSACHUSNORTH .ANDOVER, MASS. 01845 TEL. 682-6400 Oct 7 , 1985 'Mr. Charles Foster Building Inspector Re : 1094 Salem St North Andover,Mass . Dear Mr. Foster: I have been in contact with Mr. �Stringer regarding the proposed garage. If the garage is to be constructed as described to me , extending eighteen feet from the existing foundation, and supported by posts where it nears the septic system, it should present no problem. This office has no objection to its constructions under these stipulations . Very truly yours , 1 Michael Graf Inspector mg;mj cc: J.Stringer - o Town of North Andover Health Department Date: D Location: (Indicate Address,if Residential,or Name of Business) Check#: C!� Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ i ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ 1- ➢ SEPTIC�PERNIITS: �//"' fly' x:1,1 tic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) t > Health Agent Initials 087 White-Applicant Yellow-Health Pink-Treasurer 0 Q �ORTf{ TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ° 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �gs sacwus Susan Y. Sawyer,REHS7RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax FAX DanielOttenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: J 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. � Address: /9V/ Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File-Address 0 0 HP Fax K 1220xi Log for NORTH ANDOVER 9786889542 Jun 012004 4:25pm Last Transaction Date Time Type Identification Duration Pis. &salt Jun 1 4:22pm Fax Sent 819782820012 2:13 3 OK •+ 6 1. e k .. �' -. - - .. j ; SHARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 I APPLICATION FOR SOIL TESTS DATE: 5 MAP&PARCEL:_14A ap /06 A4 L,4 5-7 LOCATION OF SOIL TESTS: .OWNER: ��� h -�r,n�er TEL.NO.: 978 48a-q 163 ADDRESS: Idqy aiew I ,Acr k AjoAo oer ENGINEER:A/P.w 6j F,,o ne e r _n.1 Se rY r STEL.NO.: v CERTIFIED SOIL EVALUATOR: en to.w,iy1 C d Sa©o A -T, Intended use of land: Residential Subdivision Sing�FamilyHom Commercial Is This.- Repair his:Repair testing _ Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No 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$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 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 tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: i I o9_�ss h \' 06 ti 8 ti I �I �pO O SSS.ooS,1'ZO-3ok. ,gyp p� /s 1 h S 6o /00. Srr.Fr. '3yA 49,500. 'SaFr. 1- 07- 2 /- 07- 3 ' t SQ FT " o k? � 57, 400 z ^ Lor z � W 1 � N P)��% ,J J - Rit N /7 A tk�E�` /Ohl f X58# 5��p �, � Beet