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HomeMy WebLinkAboutMiscellaneous - 1135 SALEM STREET 4/30/2018 (4) a (VI RE �Q� � -C-\ Commonwealth of Massachusetts City/Town of OCT 1 "Q 2012 System Pumping Record TOWN OF MWO H ANDOVER 7_ Form 4 HEALTH OF—PARTMEN7. DEP has provided this form for use by local Boards of Health. Other forms maybe used, but the information.must be substantially the same as that provided here. Before Lusing 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 within 14 days from.the pumping date„in .accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab 113S- C S 36 le m S4- key to move your Address cursor-do not ,Q, _ Yio/ m� use the return City/Towr` N tato- Zi code key.. 2. System Owner: II He"deCSori Name Isom Address(if different from location) City/Town State Zip Code i 7(? (-Fo Telephone Number —� B. Pumping Record 1. Date of Pumping Date! 2. Quantity Pumped:” Gallons a IMP 3. Type of system: ElCesspool(s) 2.42 Tank ❑ Tight Tank ❑ Crease Trap ❑ Other(describe): — 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: zo re,Cz z° h� ' sem Name Vehicle License Number Company 7. Location where contents were disposed: Geo !;;,a Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 �°eaH o�tt,..m ,e�tio N i v Cow Health Department March 5, 2007 Richard Adams 114 Stonecleave Road North Andover, MA 01845 RE: Wastewater System Plan for 1135 Salem Street,Map 106A,Lot 44 Dear Mr. Adams, The North Andover Board of Health has completed review of the onsite wastewater treatment and dispersal system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated November 6, 2006,with a final revision date of March 2, 2007. The design has been approved for use in the construction of an onsite wastewater system. The proval included a local variance to allow a dwelling be constructed with a cellar floor elevation below the estimated seasonal high groundwater elevation. At a regularly scheduled Board of Health meeting, held on January 18, 2007, the Board of Health members unanimously approved this variance. 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. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(310 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's designer, 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, 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com North Andover,MA 01846 Phone:978.688.9540 Fax:978.688.8476 .Your effort to provide a properly functioning onsite wastewater treatment and dispersal system for your property is greatly appreciated. The Health Department may be reached at 978-688- 9540 with any questions you might have. S7Y.ce SS er, REHS/R Public Health Director encl: List of licensed installers cc: New England Engineering Services file TRANSMISSION VERIFICATION REPORT TIME 03106/2007 11:53 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE,TIME 03106 11:52 FAX NO./NAME 819783276138 DURATION 00:00:56 PAGE{S} 03 RESULT OK MODE STANDARD ECM North Andover Health de r10RTF/ artment o� TMLQ '�q, 1600 Osgood Street � { 'nbrt a oo Building 20, Suite 2-36 Le��Qrorp1s1i��pl. 0 North Andover, MA 01845 4L � � F 978.688.9540 - Phone Page�- of �°kTM `� 978.688.8476— Fax ssaewus�� healthdept@townofnorthandoyer.com-E-mail www.tow of orthandover.com-Website TO; BENJAMIN C. OSGOOD,JR.,P.E. DATE: &A/ � COMPANY: NEW ENGLAND ENGINEERING SERVICES,INC. FROM: Pamela elle .iaie,Health Department Assistant Re: J ) Phone; 978.686.1768 Fax: 978.321,6138 We are sending you. Man review Letter ® RaVA 0 D NOT APPROVED O System Construction follow-Up V Other These are transmitted as checked below.- 13 As elow:❑As Required 13 As Requested []For your File REMARKS: COPY TO: Homeowner Fax## I GNorth Andover Health Department NORTH q p oti 1600 Osgood Street Letter ®� rq �1 I '�'tq 3? �e�t °�� -Building 20, Suite 2-36 ° North Andover, MA 01845 978.688.9540 - Phone Page of 4*Eo 978.688.8476 — Fax SSgcHus� healthdept(cb-townofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: BENJAMIN C. OSGOOD,JR., P.E. DATE: COMPANY: NEW ENGLAND ENGINEERING SERVICES, INC. FROM: Pamela DelleChiaie,Health Department Assistant Re: J ) Phone: 978.686.1768 ���J //lrr� Q Fax: 978.327.6138 We are sending you. N-Pla�n__Revie w Letter ROVED O NOT APPROVED O System Construction fo/%w-Up O Other These are transmitted as checked below: []As Required 0 A Requested []For your File REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY TO: Fax# Or Mailed COPY TO: Fax# Or Mailed *� earcrH ,� OQ tt�eO e A,1,O N A ��SSAC Wu6 1'C`, Health Department March 5, 2007 Richard Adams 114 Stonecleave Road North Andover, MA 01845 RE: Wastewater System Plan for 1135 Salem Street,Map 106A, Lot 44 Dear Mr. Adams, I The North Andover Board of Health has completed review of the onsite wastewater treatment and dispersal system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated November 6, 2006, with a final revision date of March 2, 2007. The design has been approved for use in the construction of an onsite wastewater system. The proval included a local variance to allow a dwelling be constructed with a cellar floor elevation below the estimated seasonal high groundwater elevation. At a regularly scheduled Board of Health meeting, held on January 18, 2007, the Board of Health members unanimously approved this variance. 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. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's designer, 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, 1600 Osgood Street HEALTH(DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com North Andover,MA 01846 Phone:978.688.9640 Fax:978.688.8476 't Your effort to provide a properly functioning onsite wastewater treatment and dispersal system for your property is greatly appreciated. The Health Department may be reached at 978-688- 9540 with any questions you might have. S7er SSer, R.EHS/R7 __... Public Health Director encl: List of licensed installers cc: New England Engineering Services file Page 1 of 1 a► r " DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Thursday, September 28, 2006 1:35 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Results, 0 Salem St(106A/44)-Sept. 20th Attached are the soil results done on 9/20 for 0 Salem Street. n Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 N www.millriverconsulting.com 7 9/28/2006 1 w + ----- ---kil_,s__ �9 t „-.. _ _ - �, ,.. _......s -E..._a...»._...�._ ..., i.•w..1r. .....,.5 ..... r e.+ =fi:��•�,t.e. .•f: �»..i .... _, ... .,. 9 s.. .-::i.. T. _..--a-..{.-...-- a I R�-si 41t. '$ -cs s; ' r r z•'* , x {, t� �t / � ,.• '1. f.' � UJ�� '� a K. -�_CC'rJ�!�� j � _.--_� , •� � � ._._.. � ,,.,,, i * '7 4r...4 r .Fx;i`�._tXL i;'�s'f. ��.- �- � _ ,�,�. �n r.d •. M r� c 1 i �`�N*• w � :� � - � _ .E. .. _tom,-- i-- ---7-____._._ ----- ------ _, :__-__ t1 i` � �•� ,<wQ r ..,t.7 pro sy v� iT �'\. � � � ._..�' _._-_... I ....._ �i ��p _ � ....f» wZviri sy- 27Y . .... WIWI �y�t '�^H ztax " app. ., �— s + '._ !',•�- t._4_`i` 7''�} - t� � �r T..�--�__'^ R 98/06/2010 12:81 HUDSON STOP & SHOP 201 4 919784759075 NO.096 Doti Mr. Douglas Ahern P.0. Box 802 Andover. MA. 01810 Aug Dear Mr.Ahern Asper your request I visited the building under constru ion on 1135 Salem Street, North Andover, Massachusetts where we met on the 5 h of August, You were kind enough to point out the two multiple [qu Ie beams over the first and second floor Living-room►and bedrooms respecti•,oely. Upon my inquiry as to what the problems, if any,with these beams were, you handed me a printout of the computer beam analyses performed by Jackson Lumber and Millwork in Lawrence, MA. I indicated that I shall give them a more detailed scrutiny at home buf you informed me that the concem about them was not the adequacy but the coherence of the beam-assembly. More particularly, the lack of therm tieing bolted together. [All 4 of them together.] Also, that you have taken care of this 'neglect' by adding the bolts into the beams in-situ. My scrutiny of the analyses revealed that the beams ore grossly over- designed, anyways, to put it in other words: "more than adequate", You then pointed to some of the bolts sfill visible in the beams. I have taken photographs of them of which I am enclosing two herewith. As to the location of the bolts in the beams they are evidently within the Inner 113-rd zone of the beams as recommended by the design manuals. I hove no scruples whatsoever in connection with these beams. In case of any other questions please do not hesitate to call. [As always.] Very truly yours, Gabor Stava-Xovats, o� Processor Emeritus.aV11 Eng.(MuniCIP04 Intra-OUcrures. SV jiW dallies) Registered PE.MASS.#23384 A•KpYAr5 rn ,A Na 43986 . 4`�18Trp RAL�� NEw ENGLAND ENGINE EAG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 Benjamin C. Osgood, Jr., P.E. March 5 President , 2007 Susan Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 CES " , MAR 0 5 2007 Re: 1135 Salem Street,North Andover °r;�aTH DaPARTM�T�R Dear Susan: Enclosed are 5 copies of revised plans for the above referenced property. These plans contain the change in foundation drain outlet requested by the Board of Health. If you have any questions, or need additional information,please do not hesitate to contact this office. Sincerely, Ben'" in C. Osgood, Jr., P.E. President NEw ENGLANDENGI E EMG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 November 2, 2006 Project# 1250 Ms. Sue Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 1135 Salem Street North Andover Local Health Bylaw Variance Request Dear Ms. Sawyer, The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following variance: Local Health Bylaw Variance Request Allow a dwelling be construction with a cellar floor elevation below the ESHGW elevation. If you have any comments or questions please do not hesitate to contact this office. Sincerely, z 6 �/k' ' in C. Osgood, r. P.E. President Commonwealth of Massachusetts RECEIVED City/Town of . 4&C.0' r f NOV - 7 2006 Percolation Test Forel 12 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer,use Richard Adams only the tab key Owner Name to move your 114 Stonecleave Road cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code tab Contact Person(if different from Owner) Telephone Number m B. Test Results 9/20/06 10:06 9/20/06 10:18 Date Time Date Time Observation Hole# PT1 PT2 Depth of Perc 30"/15" 36'715" Start Pre-Soak 10:06 10:18 End Pre-Soak 10:21 10:33 Time at 12" 10:21 10:33 Time at 9" 11:01 11:05 Time at 6" 11:45 12:03 Time (9"-6") 44 Min 58 Min Rate(Min./Inch) 15 Min/Inch 20 Min/Inch Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ Thomas Hector Test Performed By: Leslie Whelan Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, December 28, 2006 8:06 AM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 1135 Salem Street Plan Review The plan for 1135 Salem Street is acceptable and an approval letter is attached for you. Best, Dan Mi :ver oonsuIting Daniel Ottenheimer,President Mill River Consulting,Inc. On-Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com dano a�millriverconsulting com 1/2/2007 Commonwealth of Massachusetts C ity/Town of A/o lk" A*JDo v E Q Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information 7NOV7 2006 �c_KAR D A D�4M S Owr,ap game p 6 4 /y t�/ TOWN OF NORTH ANDOVER <� .5 SAL J,✓t � Map/Lot HEALTH DEPARTMENT Street Address A10 RTW AND Dy E I- State Zip Code City/Town B. Site Information 1. (Check one) New Construction [!� Upgrade ❑ Repair ❑ oe 2. Published Soil Survey available? Yes [X No ❑ If yes: (q V I ' Jy Year Published Publication Scale Soil Map Unit bDc w TA 3t V D 0H6"T5 kjATS 7 � Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ❑ If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ❑ No ❑ Within the 100 year flood boundary? Yes ❑ No ❑ Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No ❑ 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 7 Commonwealth of Massachusetts City/Town of /V o RM AN DOVE(Z a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal G'M 6. Current Water Resource Conditions (USGS) -%Pr Z006 Range: Above Normal'j Normal L9 Below Normal ❑ MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) rp I O — 06 -10, 00 5u.c�y�4 74P ' Deep Observation Hole Number: a- Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) R eAK MT Of Co tJG 4ETF S Lit- [3 2. Land Use: UACA4X' L o\ 6 (e.g.woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) 6RASS 6R0U'VD I' OgAt� f;,4 CA Se-oPCE Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 3 c'00 Drainage Way 2 COC-) Possible Wet Area Zero feet feet Property Line 1 Drinking Water Well Z00't- Other feet feet 4. Parent Material: 4 wS(,,4T-i aA) - i `-L- Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No Da If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: Z�•�R 156.q$ DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 2 of 7 Commonwealth of Massachusetts City/Town of A/o R7W A ND o v E CL u ' Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal a <C�M inches elevation Deep Observation Hole Number: T P Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0 -0 A �lZ 5� $' Z8 L2> t o yp 5L- W SL 2.sy 6 08 118 GCJ 2- 5-yiZ 618 Additional Notes NO wf.EPw( :ST-Au DA-;(- E� Rt_FvSAL, 09560VE0 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 Commonwealth of Massachusetts City/Town of N oZT-1 A.04d V tZ a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M C. On-Site Review (Cont.) Deep Observation Hole Number: TPS `l-36- oG SvN,vy 7c) Date Time Weather 1. Location Ground Elevation at Surface of Hole 1�• I Location (Identify on Plan ) 1+f aAT, iR t 6 H 1 S s DE O F �oUG 2 ETA S wl�S 2. Land Use: VAGAL L-OT- (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) B A SS (;JZ0 U I) t-t O 1 I A./k 9,4-C PC— Vegetation Landform Position on landscape(attach sheet) 3000 Drains Way ��a r 3. Distances from: Open Water Body g Y�— Possible Wet Area Z co feet feet feet Property Line Z 5- Drinking Water Well ZdN�I_t_ Other feet feet 4. Parent Material: O N 7-1 (--LUnsuitable Materials Present: Yes ❑ No S If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No El If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: Zcr UDo I,77 .( 0 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of N o RTW A ND o v 9.R, N Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number. "r Z Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil o Consistence Other Horizon/ Color-Moist (mottles) Texture /o by Volume Depth Layer (Munsell) (USDA) (Moist) (In_) Depth Color Percent Gravel Cobbles &Stones Z- 0 a Zy 0 31 Z•�y 6�1s� Sl t0 b Z�-Y& Gd z.syR 5/6 Z`I" syIZ 6/6 Additional Notes ND W EJ: PINL, ST_AAJ D'&,,G o R R 9 Fy S,-lE i— 09.59 i?v E 0 - DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 e Commonwealth of Massachusetts City/Town of V0 R--.-VA AA.)Dou CR_ a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: TP3 30- �� ( e o0 '20" �titiY Daatete Time Weather 1. Location Ground Elevation at Surface of Hole 60.$c) Location (Identify on Plan ) 'R.EA R� 6 G F 1-0 f C'o<,C&971—: s $ IZEA�, L 1�TOF �ouGR �(Z SLA ,moo Land Use. sloe °i° 2 R Surface Stones p ( ) (e.g.woodland,agricultural field,vacant lot,etc.) SL0P� G f�AC-S. S w R� 4- Pwa�' (o k'o��u o wlc�tL.4�.v� RA c/t Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body '?*ocO Drainage Way 2 G 00 Possible Wet Area 2 ppr feet feet feet Property Line Z 0 Drinking Water Well -ZOO-" Other feet feet 4. Parent Material: A 8C.AricW) T(L–L-- Unsuitable Materials Present: Yes ❑ No [41 If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock[:] 5. Groundwater Observed: Yes ❑ No [l] If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 33ltwojr 1S78.0 S inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 4 of 7 Commonwealth of Massachusetts C ity/Town of Aj o R W A nip o v l;tZ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number: TP� Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Volume Consistence Other Horizon/ Color-Moist (mottles) Texture %by (Moist) Depth Layer (Munsell) (USDA) (in.) Depth Color Percent Gravel Cobbles &Stones 3- D of �- 6 A IoYR�Z Ste. IoY�Z3/ 2•sy 6�1 s� Sl (o/ 33 9 6 9 Gc� z.syR s/� 33 • syr sls Additional Notes NO w Pt-u(dS-17A vD,&yG W4T CtZ o R SAAt- 09.56 ZvE (l DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7 Commonwealth of Massachusetts City/Town of A/v R" ApJDoV4,: K a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) I® : ©o 5�.�•v y ?6Q Deep Observation Hole Number: -T-a,r C1-'so -off Date Time Weather 1. Location Ground Elevation at Surface of Hole 160 Location (Identify on Plan ) KCA( LC FOf CctiCR� S�-r4 8 . v.4CAtiT God'" 0 2. Land Use. (/o) (e.g.woodland,agricultural field,vacant lot,etc.) Surfa-,e Stones Slope ��ASS SH��� a QoA.vTS 6k0UA.)D r-10,R 41,c.J: Ve etation Landform Position on landscape(attach sheet) 9 3. Distances from: Open Water Body 3� Drainage Way 20cIcD Possible Wet Area Zit feet feet feet Property Line Z O Drinking Water Well ZOO"' Other feet feet 4. Parent Material: A aGA rt 0/%JT1 L-1-- Unsuitable Materials Present: Yes ❑ No [� If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole 157 Estimated Depth to High Groundwater: in RE�b K - Y`� inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 4 of 7 w Commonwealth of Massachusetts C ity/Town of AJ o f{r w A"D o v b CZ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number: TP 14 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 3/ SL. 2•sy Ell sL s� l o b 33-96 5/6 33 Additional Notes NO WE9_ Pt,vL, ST-AtiD,NG W417ce oR &£FvS,¢L, 09,50evE- (1 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7 u A . Commonwealth of Massachusetts City/Town of N o AV Dov 9 fZ u Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal a M D. Determination of High Groundwater Elevation I 1. Method used: ❑ Depth observed standing water in observation hole A. inches B inches ❑ Depth weeping from side of observation hole A. B. inches inches 3 Depth to soil redoximorphic features (mottles) A. Z B. _Z'-1 33 inches inches ❑ Groundwater adjustment(USGS methodology) A.inches B inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes ❑ No❑ t,Z$ j 3� >'<<8 -S) 9 `f b. If yes, at what depth was it observed? Upper boundary:Z Zy y 33 Lower boundary:r.)_1(. y) inches inches F. Certification I certify that 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 the required training, expertise and experience described in 310 CMR 15.017. Signature of Soil Evaluator Date TK0MAS H LECT0 R_ I1- 9 - .1L00V Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 6 of 7 Commonwealth of Massachusetts City/Town of N o 12-.,-Vi A U DoV'E IZ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M Use this sheet for field diagrams: See PLAN DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7 yyr iI� ^ MORTIS �.: Of ccvo 1 � p r Town of North Andover HEALTH DEPARTMENT •,/fir r`g i' SgCNUSt I/�/ N� CHECK#: / LOCATION: / H/O NAME: �c d� � CONTRACTOR NAME: Type of Permit or License:(Check box) ❑_ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ' ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ _ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ pss ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ 1950 Health Agen11 t Initials White-Applicant Yellow.-Health Pink Treasurer k' TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1.600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER.MA.SSAC:IIUSETTS 0:1.845 C,,,��` 978,688.9540-.Phone Susan Y.Sawyer,REHS/RS 978.688.8476-FAX Public Health.Director E-MAIL:healthdegt�i).to,�vqiofnorthandover.com WEBSITE:I1tt:p: /www.townofnorthandover.eom SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: Engineer: New Plans? Yes $225/Plan Check# (includes I"submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes (/ No Local Upgrade Form Included? Yes No _,'� � Telephone#; Fax#: E-mail: Homeowner Name: 11/L OFFICE USE ONLY ------------- When the submission is complete (including check): RECEIVED ➢ a.� Date stamp plans and letter ➢ �/ Complete and attach Receipt NOV - 7 2006 ➢ / Copy File; Forward to Consultant TOWOE NORTH ANDOVER HEALTH DEPARTMENT ➢ Enter on Log Sheet and Database Page 1 of 1 DelleChiaie, Pamela From: Kimberly Brown [kbrown@neengineeringinc.com] Sent: Thursday, January 11, 2007 3:50 PM To: DelleChiaie, Pamela Subject:BOH Hearing Hi Pam, Can you include us in the next Board of Health Meeting on January 18, 2006 to discuss a Local Bylaw Variance for 1135 Salem Street No Andover-Adams. This has been postponed since the November 2006 hearing. Also, as a favor, can you see if Ben can be put first, he has another hearing that night in Chelmsford. I appreciate it. Thanks, Kim 1/17/2007