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Miscellaneous - 119 LIBERTY STREET 4/30/2018
j 119 LIBERTY STREET t _ fJ � 210/090.B-0060-0000.0 i APPLICANT: RICHARDSON � 1 t, l 1 i i FINAL GRADE INSPECTION Date: ll Address: LOAMED? SEEDED? COVER PER PLAN? Other: North Andover Board of Assessors Public Access Page 1 of 1 tORrh North Andover Board of Assessors i IRBIL * i 'SSACHUset roperty Record Card Click Seal To Return Parcel ID :210/090.B-0060-0000.0 FY:2009 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales ,r Summary Residence Detached Structure Condo 119 LIBERTY STREET i Commercial Location: 119 LIBERTY STREET Owner Name: PAVLIK TRUST,SCOTT PATRICIA PAVLIK TRUST Owner Address: 119 LIBERTY STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 3.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2518 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 522,000 538,300 Building Value: 309,500 325,800 Land Value: 212,500 212,500 Market Land Value: 212,500 Chapter Land Value: LATEST SALE Sale Price: 1 Sale 05/08/2000 Date: Arms Length Sale F-NO-CONVNIENT Grantor: SCOTT&PAT k ode: PAVLIK ert Doc: ALSO 229 Book: 05744 Page: 0228 i http://csc-ma.us/PROPAPP/display.do?linkId=1462949&town=NandoverPubAcc 4/23/2009 R' r f MAR . _ LOT #t Lk__..._ - ....._...Lt.............. ..... ......... PARCEL it STREET CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE SEEN PAID? YES NO PLAN APPROVAL: DATE^__—�_D O _—.---- APP. BY .. DESIGNER: — PLAN DFl I'E..__ .._ CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMITS DRILLER._ WELL TESTS: CHEMICAL DA I E (11.1—RUVED.C/a BAC I ERIA I Dfl1 E (IPPRUVED BACTERIA II UA1E (V'PRUVEll COMMENTS: FORM U APPROVAL: APPROVAL TO 15�3U- YES NO DATE ISSUED— ----- BY —__._`.... �J%L/..... _._...... CONDITIONS: FINIAL APPROVAL: ALL PERMITS PAID YES h,ID WELL CONSTRUCTION APPROVALYES NO SYSTEM CONSTRUCTION APPROVAL `' NO OTHER YES NO ANY VARIANCE NEEDED YES U.----, F?NAL BOARD OF HEALTH APPROVAL: llfalE: I:+Y : SEPTI.G._E.Y_SZEM__[..NSjl.3L .RTI-QN IS THE INSTALLER LICENSED? NO TYPE OF CONSTRUCTION: NLW REPfAIR NEW CONSTRUCTION: CERTIFIED PLOT PLnN REVIEW YES 1,10 CONDITIONS OF APPROVAL YES NU (FROM FORM U) ISSUANCE 'OF ''DWC PERMIT -YE NO �c�r�-r-� DWC PERMIT N0. 9�' INSTALLER:�r_ . BEGIN .INSPECTION EXCAVATION . INSPECTION: NEEDED: PASSED �a9� BY �` -- CONSTRUCTION INSPECTION: NEEDEDa N6 TD TAAIK --- -- AS BUILT PLAN SATISFACTORY: YE5: APPROVAL TO BACKFILL: DATE: X2FINAL GRADING APPROVAL: DATE : FINAL CONSTRUCTION APPROVAL: DATE: /_Zh L_©Y_�-- _ _ —. ssachusetts Commonwealth of Ma Z City/Town of DECEIVE® V. System Pumping-Record C�; C 2014 Form 4 TOWN Uh NUK I M ANDOVER DEP has provided this form for use-by local Boards of Health. Other fonns�`r a" "b usedT ut�"f ie 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/ i h rear of hous , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Rio rear of building, Under deck Address City/Town State Trp Code 2. System Owner. P Name' Address(if different from location) City/Town State ��� �'7 Zi Code Ll/c � 7 Telephone Number i B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) 0-septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ®'Yei; ❑ No If yes,was it cleaned? ED-Yes M No: ' 5. Condition of stem: 6.- System Pumped By: Neil.Bateson F5821 Name Vehicle license Number Bateson Enterprises Inc- dompany 7. Locatim-wbere=ntents were disposed: ... C� Lowell Waste Water Sig Hauls Date t5fomm4.doc-06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record yF Form 4 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 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, Le Ri ht rear of ho , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Cityrrown if �U State Zip Code 2. System Owner. Name Address(if different cations - - RECEIVED City/rown State Z' de Co MAY 2 8 2013 ���_�0��7 M Telephone Number -MWNOF NOM MMVER _ iOTH CE B. Pumping Record 5 3 , 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system:- ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes, was it cleaned? es ❑ No. 5. Condition of Systerr.K 6. System Pumped By: Neil.Bateson F5821 b Name Vehicle License Number Bateson Enterprises Inc Company 7. Location here contents were disposed: G.L S. Lowell Waste Water SignAtufe I Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Paine& -vee& "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pages/index-Website Notes: If copied to BOH Members-Reference Copy Only-no response requested at this time i i From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Thursday, May 20, 2010 3:18 PM To: DelleChiaie, Pamela; Sawyer, Susan Subject: I'm leaving early today, but can we schedule todd bateson's final inspection. @ liberty street; we can do it at 9:00 a.m. tomorrow but I just wanted to confirm that it's okay with you that we go ahead w/it. todd said the engineer's on his way right now and should be there by 4:00. thanks. Mill river coins It i ng< Civil Engireerin,g tt 1nviv(i1M#f1tti1 PI'MM ifig Muninipatl rnvironf a itai Ftealtn Consulting Marianne Peters Office Manager 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 Fax: 978-282-1318 www.miliriverconsulting.com mpeters(@,millriverconsulting.com i 2 r' DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Monday, May 24, 2010 12:42 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 119 Liberty St Attachments: Construction Inspection 119 Liberty.doc Please find attached the construction inspection for 119 Liberty St. The system was designed by Bill Dufrense and installed by Todd Bateson and was installed per plan. Feel free to contact me with any questions. i I Randy Burley Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsultiniz.com rburleygmillriverconsulting com I 1 I pORTH q G e.ti �f►l P40 ea yy� T .CO[NKHa wKw v1 T ��SSAC HUS���y PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 119 Liberty St MAP: 90B LOT: 60 INSTALLER: Todd Bateson DESIGNER: Merimack Eng PLAN DATE: 5/6/09 BOH APPROVAL DATE ON PLAN:5/21/10 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 5/21/10 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 2000 gallon tank has been installed H-10 loading monolithic construction ® Watertightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8416 Web www.townofnorthandover.rom Inspection Form lune 2008 j pORTff oF.4 ,6 6 11? e`,�` �' 6 OL O ti A-OCO-C I-K y7 7.9 AoAAreo ►.PP,`(y SSACHUS� PUBLIC HEALTH DEPARTMENT fommunity Development Division ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet DISTRIBUTION-BOX ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets Y ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved Ian pp p ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 p►ORTty q 6 OL O y� ;t T + O 1• A_ COCMIc".CNIWKM V 7.q 40AATE 0 I•Pa�I(5 SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 10 ® Number of rows (trenches): 4 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT ELEV DESIGN INVERT ELEV Building Sewer OUT 135.45 135.40 Septic Tank IN 134.23 134.20 Septic Tank OUT 133.94 133.95 Distribution Box IN 133.87 133.87 Distribution Box OUT 133.69 133.70 Lateral 1 INVERT 133.67 133.67 Lateral 2 INVERT 133.68 133.67 Lateral 3 INV ERT 133.67 133.67 SKETCH PLAN 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 I NORTiq O A� � O�q coc.o wewKw`�1� �9SSACHUS���� PUBLIC HEALTH DEPARTMENT Community Development Division II CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTH Q�tt�eo �6q 1O � L - T � q0LOL—... 1 T Pay �9SSACHUS���y PUBLIC HEALTH DEPARTMENT Community Development Division ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 I Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 i DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, May 19, 2010 4:48 PM To: Grant, Michele Cc: DelleChiaie, Pamela Subject: FW: Septic- 119 Liberty Street- Bed Bottom Inspection Request I set up an 9AM appointment with Todd Thursday AM. He is going to make it as pretty as possible. He may need to get some sand in to get to the far end that needs the most attention from the rain. He is pretty confident that he is at the correct elevation. I told him one of us would be there and it was ok to go ahead and get to that far end even if he puts a little sand in before we get there. I would rather see him taking care of the puddle end,then worry about seeing all parts of the bottom. It is so far out there, I would hate to have to go back more than once am available if you have an appointment. Be in after Rotary. I think you had a final grade to do too? Thx S From: DelleChiaie, Pamela Sent: Wednesday, May 19, 2010 10:43 AM To: Grant, Michele; Sawyer, Susan Subject: FW: Septic- 119 Liberty Street- Bed Bottom Inspection Request Just a reminder................. From: DelleChiaie, Pamela Sent: Tuesday, May 18, 2010 2:40 PM To: Grant, Michele; Sawyer, Susan Subject: Septic - 119 Liberty Street.- Bed Bottom Inspection Request Todd Bateson called with a BB request. Whoever can do it,I will leave the file on the file cabinet next to the counter. I told him most likely not today due to the time constraint,but would let him know either way, so let me know. Thank you. got W 4 L�,cace "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail 1 119 Liberty Street—Homeowner,presented on behalf of himself asking for a variance from the local septic regulations for a septic soil absorption area to be located 68 feet from the wetland area instead of the 100 feet. The packet had a smaller version of the 68 feet. We will expect the revised plans to be received from Bill Dufresne at a later time. We want to get this moved forward. Liberty Street is off of Sharpners Pond Road. There is a well and wetlands, so septic had to be in the center. They thought it was an old wetland line,but it is closer. This is a replacement. The newer system is closer to the house, and further away from the wetland. We are trying to help them move forward. They are in front of Conservation for an RDA. The Board of Health will be re-writing the regulations, so that the variance. Motion Dr. MacMillan made a motion to accept the variance. Joe McCarthy seconded the motion. Homeowner will be before Conservation on August 1201 . I � y � DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Thursday, May 20, 2010 4:05 PM To: DelleChiaie, Pamela; 'Daniel Ottenheimer'; 'Isaac Rowe'; 'Randy Burley' Cc: Sawyer, Susan Subject: RE: Septic- 119 Liberty Street- Final Const. Insp. Request-Todd Bateson/Bill Dufresne This inspection is scheduled for 10:00 a.m. tomorrow/Friday with Randy Burley. Thanks. From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Thursday, May 20, 2010 3:44 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: Septic- 119 Liberty Street Final Const.Insp. Request-Todd Bateson/ Bill Dufresne Okay to go ahead and schedule= =Bill Dufresne just called. I will call the office to be sure you got this as well. Todd's number is: 978.815.2708. Thank you. Seal Wya14, dame& �e�e "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pages/index-Website Notes.- If otes.If copied to BOH Members-Reference Copy Only-no response requested at this time From: DelleChiaie, Pamela Sent: Thursday, May 20, 2010 3:36 PM To: 'Marianne Peters' Cc: Sawyer, Susan Subject: RE: I'm leaving early today, but can we schedule todd bateson's final inspection We have to hear from Bill Dufresne first before it can be scheduled. The installers should call the Health Dept.to schedule inspections as well, not Mill River directly. Thank you for following up. Fea W"14, 1 NORTFr O� LED 1 OL O !- 70 D�4 COCMIC IWKK`y1 ED 9SSACHU`��� PUBLIC HEALTH DEPARTMENT Community Development Division CERTI-IFICA rr(F OF COMP jrVCE As of: June 17, 2010 This is to cert that the individuaCsu6surface disposatrsystem received a SATISTACTORT IM(PECTIOX of the: Tuff Vspair1TjV&cement of an On Site Sewage Disposa[System (13y• ToddBateson At: 119 Li& Street 9Yap-109.B; Parcef-60 9 Forth Andover, X4 01845 The Issuance of this certificate shaCC not 6e construed as a guarantee that the system wiCr function satis toriCy. Sus `Y.Sawyer, 1R 1� 10011 (Pu6CicYlealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com %AORTF1 0��,��.eu ibgti0 OL O F- 70 y ~ yy* T � eb T O C0004 ED NIC IWKK 1' �OO P♦� SSAC HUS��,`� PUBLIC HEALTH DEPARTMENT Community Development Division CERVFIC4 rr(F O F COJVI<1'.GI./��VCE As of: June 17, 2010 This is to cert that the individuafsu6surface disposafsystem received a SA`W IFA CTORT IYS(PECTr05V'of the: ('ulrftair/W?pCacement of an On Site Sewage OiTosa[System Oy: ToddBateson At: 119 Gi6erty Street Map-109.B; �1'arcel—60 North Andover, ,AVIA 0184.5 The Issuance of this certificate shad not be construed as a guarantee that the system wiCC funZsatistoriry- Sauyer, REQ �._... Public YLeafth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com pORTH xr O 4t`ao p••40 t • �SSACHUs�< PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM-INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed;( )rep — R9d By: -rOL)D f' (Print Name) JUN 9 Located at:- I _ - 181rrLf''� lrYLk�E"r TOWN OF NORTH ANDOVER (Installation Address) HEALTH DEPARTMENT Was installed in conformance with the North Andover Board of Health approved plan,originally dated �—& — O and last revised on &-L4 ^04 ,with a design flow of "I gallons per day. The materials used were in conformance with those specified on the .approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative(Signature) No, Vurn.l,yK)a✓ And—Print Name Final Construction Inspection Date: Engineer Represents ive(Signature) 1I�I.I� I7l,�HJ.t �j►.� And—Print Name Installer: ignature) Date: X 7rVO2 RknZgg a,. Q And—Print Name Enginer: 1114 114tf� /1M,(4W ignature) Date: �l LA 2L�-i� I�I�1-IG►� F,�.�� And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com 4 SUMMARY OF INVERTS BUILDING TIES SEWER ® FDTN. 135.44 BLDG. CORNER A B C NO THIS THIS PLAN & CERTIFICATION IS NOT a SEPTIC TANK IN 134.23 SEPTIC TANK IN 46.8 52.0 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 133.93 SEPTIC TANK OUT 52.5 49.7 SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 133.86 DIST. BOX 58.0 49.7 AND ELEVATION OF THE EXISTING SYSTEM j DIST. BOX OUT 133.69 COMPONENTS. INV. IN CRAM.__4 133.64 BOTT. CHAM. 132.99 N ROOIFU M .tea:.,..._... as ._ tt:a t f VENT ' MBP. 83' PGRT 79' 0-801f 65' 2.000 GAL LE40 MF1LiAOM YRAMW TO� BEPi1C TAW OHAMBW tV CC � b 17 ' Z R:' BM.Tir/10.1 j yy -F t LOLA t t ; i a i l � f lj ul n 1 STREET NEMCHISN!'OK 'k a'k ,, ry AS BUILT PLAN �` .�`f ry OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS. AS PREPARED FOR SCOTT PAVLIK TM: 90B DATE: 5-21-10 TL: 60 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Monday, May 24, 2010 12:42 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 119 Liberty St Attachments: Construction Inspection 119 Liberty.doc Please find attached the construction inspection for 119 Liberty St. The system was designed by Bill Dufrense and installed by Todd Bateson and was installed per plan. Feel free to contact me with any questions. Randy Burley Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsulting.com rburley millriverconsulting com i NORTH q O �t�eo 16 ti Z. to KLAKIco,J . c.��• 0 11 ��SSAc►+u5y PUBLIC HEALTH DEPARTMENT fommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 119 Liberty St MAP: 90B LOT: 60 INSTALLER: Todd Bateson DESIGNER: Merimack Eng PLAN DATE: 5/6/09 BOH APPROVAL DATE ON PLAN:5/21/10 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 5/21/10 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan Bottom of tank hole has 6 stone base ® Weep hole plugged ® 2000 gallon tank has been installed H-10 loading monolithic construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 pORTi4 O��t►eo 16q�� 6 OL O s A Co'O CO[MI<lWKM�1' 044TED PPP` �Cl % SACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet DISTRIBUTION-BOX ® Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution Z Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed Z Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTi4 O F- A IL e~ ° COCMIC NlWKIt y1` Z1,4 A°RAno SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 10 ® Number of rows (trenches): 4 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT ELEV DESIGN INVERT ELEV Building Sewer OUT 135.45 135.40 Septic Tank IN 134.23 134.20 Septic Tank OUT 133.94 133.95 Distribution Box IN 133.87 133.87 Distribution Box OUT 133.69 133.70 Lateral 1 INVERT 133.67 133.67 Lateral 2 INVERT 133.68 133.67 Lateral 31NVERT 133.67 133.67 SKETCH PLAN 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 D* pORT11 Sts.sD 16 - t c• 0 tL n ey O coc.iawiwaw 1' TED ��SSACHUS���� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 tAORTPI 6,1 r4 O t 1r � n h fc S ACHU5 PUBLIC HEALTH DEPARTMENT Community Development Division ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.lownofnorthandover.com Inspection Form lune 2008 TOWN OF NORTH ANDOVER 4 NORrN q Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT A 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 MCNUSF Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION 'L ADDRESS: ��® C7• MAP: �y�, LOT: INSTALLER: � � ®�� DESIGNER. PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: / /ve -DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTROCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: 2>4 SEPTIC TANK Voe�Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ AZO -gallon tank has been installed 2� � H-10 loading Monolithic construction �'^`" ❑ Water tightness of tank has s 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 inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent 5 Z" , filter is present �- v v ❑ Hydraulic cement around inlet & outlet v e v Wastewater System Documentation—Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER ONORTH A Office of COMMUNITY DEVELOPMENT AND SERVICES O HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 ACHUS Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER Bottom of tank hole has 6" stone base eep hole plugged ❑ Co bo Tank installed. Size: ❑ 1000 lion Pump Chamber installed H-1010 ing Monolithic nstruction) ❑ Inlet tee insta , centered under access port ❑ Pump(s) installed stable base F-1AlarmAlarm float work ❑ Pump On/Off floats works ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final de installed over pump access port ❑ Water tightness of tank has been achieve Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TE HNOLOGY ❑ pe of treatment device: ❑ Insta d per manufacturers requirements ❑ All comp nents workin in accordance with 9 manufactu 's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER a4 NORTk H Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 1600 OSGOOD STREET;Building 2-36 o M NORTH ANDOVER,MASSACHUSETTS 01845 '''+S""c'°''s�y - - sNCHUSe Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476 FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.087foot) El Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: 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 ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less 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: Wastewater System Documentation—Feb 2006 Page 3 of 6 t TOWN OF NORTH ANDOVER of NaRTk q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT o • p 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 ��ss gcC NusE Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals El size inch as per plan Comments: 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: Wastewater System Documentation—Feb 2006 Page 4 of 6 I TOWN OF NORTH ANDOVER < NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 0 ro4tiz�.. 0� HEALTH DEPARTMENT « : 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER MASSACHUSETTS 01845 ''9S""`° � SacHuse Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 ❑ Inground pool- 10 20 -- ❑ Slab foundation 10 10 -- ❑ . Deck, on footings, etc 5 10 -- ❑ Waterline 10 . 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot.Area ❑ Reservoirs 400 400 ❑ Drains(wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains(Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 i 1 Suction line 222(2) y 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 I u. TOWN OF NORTH ANDOVER F NoRTF! Office of COMMUNITY DEVELOPMENT AND SERVICES 3rOtRTao etioG HEALTH DEPARTMENT 0 .p 1600 OSGOOD STREET; Building 2-36 " t NORTH ANDOVER,MASSACHUSETTS 01845s% +\GNUS Susan Y.Sawyer,REHS/RS 978.688.9540 Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT 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 Wastewater System Documentation—Feb 2006 Page 6 of 6 Commonwealth of Massachusetts Map-Block-Lot t�ti1q `'Sao 090.B0060 ----------------- Board of Health Permit No North Andover BHP-2010-0566 x a .... .` • ----------------- P.I. FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd_B-ateson --------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 119 LIBERTY STREET ------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2010-056 Dated—May-04,20-10 rnDV Issued On:May-04-2010 a f ea &ORTH Map-Block-Lot of Commonwealth of Massachusetts 090.Bo060 3 4� Board of Health ----------------------- North --- ------------------North Andover �°�•-��`� "� CERTIFICATE OF COMPLIANCE �ssAcaais�s THIS IS TO CERTIFY,,That the Individual Sewage Disposal System (Repair) by .... B Todd-- -------------------ateson------------------------------------------------------------------- ------------------------------------ -- -- - Installer at No 119 LIBERTY 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-2010-056 Dated M -04,-2010 ----------------------- --- ay ---- -------- ----------------------------------------------------------------- Printed On:May-04-2010 Board of Health ` 4 . 6 0 Of NORTy . . O9 _ * Town of North Andover '�'•�,,,,,�. ' HEALTH DEPARTMENT ,SSACMUS CHECK#: DA E: LOCATION: H/O NAME: ` CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ k ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ f ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ' ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septi Design Approval $ C '`Septic Disposal Works Construction(DWC) $ GV f ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ C Cg",-Other. (Indicate)-x $ F l Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer r Application for Septic Disposal System io ° ` •• -�' 0Xonstruction Permit —TOWN O TODAYS DATE �' •� ORTH ANDOVER, MA 01845 $250.00—Full Repair sAC $125.00-Component Important: Application is hereby made for a permit to: When filling out * ., forms on the ❑Construct a new onsite sewage disposal system computer,use ®Repair or replace an existing on-site sewage disposal system MAY only,the tab key to move your ❑Repair or replace an existing system component—What? cursor-do not use the return A. FacilityInformation STH 0SpAR'rMENT key. ICI Address or Lot# Cityrrown 2.-*-TYPE OF SEPTIC SYSTEM*: ❑Pump ravity(choose one) ***If pump system,attach copy of electrical permit to application*** ❑Conventional System(pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑Pressure Distribution S.A.S.(No D=Box)(Attach Draft Maintenance Agreement) ❑Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information Name Address(if different from above) N City/Town - 'r 42 t a- state Zip Code Telephone Number 3. Installer Information) Name Name ofCompa ENTERPRISES,INC. 111 ARGILIA ROAD � Address Clty/rown state Zip Code Telephone Number(Cell Phone#gpossible please) 4. Designer Information /Wrl` �v�,q�fl div. � A.j* Name � Name of Company Address MIA CitylI own State Zip Code ! Telephone Numbe est#to Reach) Apprication for Disposal System Construction Permit•Page 7 of 2 M°RTN Application for Septic Disposal System 'iy t 4t�.° .1tio pConstruction Permit - TOWN. OF TODAY'S DATE ORTH ANDOVER' MA 01845 $.250.00-Full Repair +CH�S t� $125.00 -Component PAGE 2OF2 A. Facility Information continued j 5. Type of Building: esidential Dwelling or❑Commercial I B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued N this Board of Health. Name Date Application Approve yJ Board of Health Representative .s Name Date Application Disapproved for the following reasons: For Office Use Only: y 1. Fee Attached. ✓ Yes No 2. Project Manager Obligation Form Attached. Yes No 3. Pump System.? If so,Attach copy of Electrical Permit Yes No 4. Foundation As-Built. new construction struction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only). Yes_ No I Application for Disposal System Construction Permit•Page 2 of 2 I ` SEPTIC SYSTEM INSTA L-,ER PROJECT MANAGEMENT'OBLIGATIONS As the North Andover licensed installer for the,construction'for the septic system for the property at: (Address of septic system) For plans by (Engineer) Relative to theapplication of4' ,e$d�1 t (Installer's name) ; And dated _— Ce_p ngina date). Dated Say's ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am.obligated to obtainall permits and Board of Healthapproved plans prior to performing any work on a site. I must have the approved plans and the perinit'on site when any work is being done. 2. As the installer,.I.must call forany and allinspections. If homeowner,contractor,.pro' other or any other,person not associated with my company schedules an inspection and the system is not ready, then item threeshall..be. applicable. 3.'` As the installer,:l atzi required to.have the necess work com feted prior aIT p. to thea licable ' p . pp ms .ections as indicated below .I.understaricl that regdesda an insyection without completion of the items in.accordance with Tide 5 and the$oard of Health Re frons ma resulrin a 50:00'fine.bein levied'a ainst ine And/or my eoiripan�: a Bottom of ted-L Generally, this:is the firsinspection unless..there is a retaining wall,which should be donefirst. The installer must request the inspection but does not have to be present. b. Final.Co..nstractiori Inspection—Engineer must first:'do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to:healtlide t townofnorthaindover com)from the engineer must p�� be submitted to the Board of.Health,after which installer.calls for an inspection time. Installer must be present for this.inspection.. With a pump system,all electrical work must be ready an d. to cause pump o work and alarm.to function. c. :i;ve tbe--—Installer must request inspection.when all grading-is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work (other than simple excavation)and I am re aired to complete the installation of the system identified in the attached application for installation: :I further understand:that work done b' others unlicensed fo'install se tics stems..in North.Andover can eonstttute reasons for denial of the s stem and or.revocanon or sus ension o MV license.to o este in 4'.'r—w! .of North Andover si ficant fines to.all ersons'involved.are also ossilile. 5.. As the.installer; I understand thatI must'be'on-site during the.performa'nce of the following construction steps: a. Detthat.the proper elevation ofthe excavation has been reached b. Inspection Of the sand and stone to be used. c. Final mspection by Board ofHealth staffor consultant. d. Installation.oftank D-Box,pipes,stone, vent,pump chamber,retaining and other wll components a . 6. As the installer I understand that I.am solel responsible for the in of the s stem as a roved dans. No instructions b the homeowner er the eneral.conttaetar or an '.other: ersons shall-absolve me of this obligation. Undersigned I:icensed Septic Installer: (Today's Date) A1 J Jr o ame— :suit p e,h is TOWN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACHUSETTS 01845 i �aR*„ Date Issued Expiration Date ssac►wst Jackie's Law — Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant— �� e5v�/ Phone Cell Street Address 4r7,-11"- Pd• —L '}a 3 City1rown MA ZIP Name of Excavator(if different from applicant) Phone Cell Street Address City/Town MA ZIP Name of Owner(s)of Property Phone Cell Street Address .5 [f i�.4 vac CfWrown MA �p Alo, ✓ o[ g'r�rf Other Contact Permit Fee Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable fines etc..)Please use reverse side if additional space is needed. Insurance Certificate#: j r Name and Contact Information of Insurer- Policy Expiration Date: _ Dig Safe#: Name of Competent Person(as defined by 520 CMR 7.02): Massachusetts Hoisting License# t-!.C-7 033 License Grade: a,4 Expiration Date:BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L.c. $2A,520 CMR 7.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY -THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLIC SIGNATURE , DATE 7'c $—lU EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OWN SIGNA (IF IFFERENT) DATE: –4,1-i o 2 1 P a g e ------------- - ._____—___..__----__._.......... I v, ........... Ow somm ............ NOW 014WEM 02-- CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the,application,the applicant understands and agrees to comply with the following: i. No trench may.be excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as ii, said system is defined in section 76D of chapter 164(DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section I of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CFR 1926.650 et.seq.,entitled Subpart P"Excavations". iv. Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,acceptingand signing this permit,the applicant hereby attests to the following-,(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2)that he has.read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 026.650 etseq.,entitled Subpart P I T� xcavaflonr as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application,complied with the requirements of sections 40- 40D of chapter 82A. vi. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at ikMy s �d 3 Page Y Summary of ftavation and Trench SafW Regulation 020 CMR 14.00 et seq.) This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L,c.82A and does not include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.0.82A,go to www/mass.gov/dps Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety,jointly with the Division.of Occupational Safety, drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a trench made for a construction-related purpose on public or private land or rights-of-way. All municipalities must establish a local permitting authority for the purpose of issuing permits for trenches within their municipality, Trenches on land owned or controlled by a public(state)agency requires a permit to be issued by that public agency unless otherwise designated. In addition to the permitting requirements mandated by statute, the trench safety regulations require that all excavators,.whether public or private,take specific precautions to protect the general public andprevent unauthorised access to unattended trenches. Accordingly,unattended trenches must be covered, barricaded or backfilled, Covers must be road plates at least'/,"thick or equivalent;barricades must be fences at least 6'high with no openings greater than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators may choose to attend trenches at all times,for instance by hiring a police detail,security guard or other attendant who will be present during times when the trench.will be unattended by the excavator. The regulations further provide that local permitting authorities,the Department of public Safety,or the Division of Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury;the failure to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The trench shall remain shutdown until re-inspected and authorized to re-open provided, however,.the excavators shall have the right to appeal an immediate shutdown. Permitting authorities are fbriher authorized to suspend permit following a hearing. Excavators may also be subject to administrative fines issued by theeDepartm revoke k o Public Safety for identified violations. Summary of 1926 CFR Subpart p_OSHA Excavation Standard This is a worker protection standard,and is designed to protect employees who are working inside a trench. This summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational Purposes only and does not constitute an official aspects of the standard. interpretation by OSHA of their regulations,and may not include all For further information or a full copy Of the standard go to www.osha. ov. Trench Definition per the OSHA standard: o An excavation made below the surface of the ground,narrow in relation to its length. o In general,the depth is greater than the width;but the width of the trench is not greater than fifteen feet. • Protective Systems to prevent soil wall collapse are always required in trenches deeper than 51,and are also required in trenches less than 5'deep when the competent person determines that a hazard exists. protection options include: o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices,the equipment manufacturer's tabulated data,or designed by a registered professional engineer. o Shielding(Trench Boxes). Trench boxes must be used in accordance with the eq manufacturer's tabulated data,or a registered professional engineer. uipment o Sloping or.Benchin . In g Type C soils(what is most typically encountered)the excavation must extend horizontally 1 %feet for every foot of trench d and%foot for Type A soils. epth on both sides, 1 foot for Type$soils, o A registered professional engineer must design protective systems for all excavations greater than 20'in depth. continued I V a� ' a r • Ladders must be used in trenches deeper than 4'. o Ladders must be inside the trench with workers at all times,and located within 25'of unobstructed lateral travel for every worker in the trench. o Ladders must extend 3'above the top of the trench so workers can safely get onto and off of the ladder. • Inspections of every trench worksite are required: o Prior to the start of each shift,and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person(see below). • Competent Person(s)is: o C able(i.e.,trained and knowledgeable)in identifying existing and predictable hazards in the trench,and other working conditions which may pose a hazard to workers,and o Authorized by management to take necessary corrective action to eliminate the hazards. Employees must be removed from hazardous areas until the hazard has been corrected. • Underground Utilities must be: o Identified prior to opening the excavation(e.g.,contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected,supported,or removed once exposed. • Spoils must be kept back a minimum of 2'from the edge of the trench. • Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. • Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by creation of the trench,they must be underpinned,braced,or otherwise supported. o Sidewalks,pavements,etc.shall not be undermined unless a support system or other method of protection is provided. • Protection from water accumulation hazards: o It is not allow able for employees p yees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulation,this must be monitored by the competent person. o If the trench interrupts natural drainage of surface water,ditches,dikes or other means must be used to prevent this water from entering the excavation. • Additional Requirements: o For mobile equipment operated near the edge of the trench,a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath loads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high-visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4'if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist(e.g.,02<19.5%or>23.5%,20% LEL,specific chemical hazard),adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with guardrails must be provided for crossing over trenches>6'deep. o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. S�Page DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, May 18, 2010 2:40 PM To: Grant, Michele; Sawyer, Susan Subject: Septic- 119 Liberty Street-Bed Bottom Inspection Request Todd Bateson called with a BB request. Whoever can do it, I will leave the file on the file cabinet next to the counter. I told him most likely not today due to the time constraint, but would let him know either way, so let me know. Thank you. "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pages/index-Website Notes: ff copied to BOH Members-Reference Copy Only-no response requested at this time Tracking: 1 Recipient Delivery Grant,Michele Delivered:5/18/2010 2:40 PM Sawyer,Susan Delivered:5/18/2010 2:40 PM 2 NORTII . ��fit►8D ,6 0 � S. w b L cOcmnuwa• 1• 7�404ATYD ACM1l15�� PUBLIC HEALTH DEPARTMENT Community Development Division October 29,2009 Scott Pavlik 119 Liberty Street North Andover, MA 01845 RE: Septic System Design, 119 Liberty St,North Andover May 90B Lot 60 Dear Mr.Pavlik, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated May 6,2009,last revised October 9,2009 received on October 20,2009.This plan has been approved.The approval includes a Local Variance to allow the Soil Absorption System to be 68 feet from a wetland where 100 feet as required by NA 8.02.Please keep a copy of the attached document for your records.This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of an onsite septic system for a 4- bedroom house(maximum 9-room).During this time,a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance be endorsed by the installer,designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 fax 978.688.8416 Web www.townofnorthandover.com Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sinc , usan Y.- awy HS/RS Public Health Director Encl: list of licensed septic system installers Cc: Merrimack Engineering Services 1640 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnoribandover.com NORTN q I61b�O0 i A 0 cxwiiriwcw �• SACHUS���y PUBLIC HEALTH DEPARTMENT Community Development Division July 24,2009-PENDING RECEIPTOF REVISED PLANS FROM BILL DUFRESNE Scott&Patricia Pavlik Trust c/o: Scott Pavlik 119 Liberty Street North Andover, MA 01845 RE: Septic System Design, 119 Liberty Street,North Andover Map 090.11 Lot 60 Dear Mr. Pavlik: The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated May 6, 2009, and last revised on 2009. This plan has been approved. The approval incli-Aae a unriance from the local septic regulations for the request to allow the setback from the we- from the local requirement of 100 feet. This plan is N r � � wal. The design has been approved for use in the coi bedroom house(maximum 9-room).During thi t obtain a permit and complete this work, and a( �- installer, designer and the Town of North Andc such as sewage backup into the dwelling is occ iay reduce the time period for which this plan is va This approval is subject to the following condii 1. If site conditions are found in the field to bi i plan and/or soil evaluation,the originally issued installation shall stop, and the applicant shy Construction Permit. G 2. It is the responsibility of the applicant and/ot-tne-appircani s-scp«c 0,V aLWI. system installer or other representative to ensure that all other state and municipal requirements are met. These may include review b the Conservation Commission Zoning q Y Y � g Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ttoRT1h q OL W, 0 , y ArEo 0, OSA cocwiiHe wcw`y1• � ��Ssgc►+us���y PUBLIC HEALTH DEPARTMENT (ommunity Development Division July 24,2009—PENDING RECEIPT OF REVISED PLANS FROM BILL DUFRESNE Scott& Patricia Pavlik Trust c/o: Scott Pavlik 119 Liberty Street North Andover; MA 01845 RE: Septic System Design, 119 Liberty Street,North Andover System Design, 119 Liberty Street,North Andover Ma�090.B Lot 60Lot 60 Dear Mr. Pavlik: The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated May 6, 2009, and last revised on 2009. This plan has been approved..The approval includes a variance from the local septic regulations for the request to allow the setback from the wetland to the soil absorption system to 68 feet from the local requirement of 100 feet. This plan is valid for two years from the date of this approval. The design has been approved for use in the construction of an onsite septic system for a 4- bedroom house (maximum 9-room).During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director Encl: list of licensed septic system installers Cc: Merrimack Engineering Services 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com DelleChiaie, Pamela From: Sawyer, Susan Sent: Thursday, October 29, 2009 9:18 AM To: DelleChiaie, Pamela Subject: 119 Liberty Attachments: 119 Liberty St app 10.26.09.doc I will put the file n your box PIs print this app letter Call owner Scott Pavlik 781937-1895 And installer Mike Reilley 978 375-4811 Tell them it is approved and Mike may come pick up the permit and plan anytime. Thx Susan i i 39bo Of NORTH 1h t Town of North Andover HEALTH DEPARTMENT ,SSACow CHECK#: ATE. / LOCATION: H/O NAME: CONTRACTOR NAME: 9,�6v / . 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 $ C� Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $� rJ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector' $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Iffekthl A en Initials White-Applicant Yellow-Health Pink-Treasurer M pajOQTk'71,p Application for Septic Disposal System jo J69 op Construction Permit - TOWN OF TODAY'S DATE $250.00—Full Repair ORTH ANDOVER NU 01845 $12 , 0-Component Important: Application is hereby made for a permit to: When filling out ❑ onstruct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site se a disposal system* only the tab key to move your ❑ Repair or replace an existing system compone —What? cursor-do not use the return key. A. Facility Information 1 I—I b ✓ S�i'GP rab Address or Lot# No r-�h hhd oW City/Town 2 -*TYPE QF31EPTIC SYSTEM*: El Pump Gravity(choose one) ***If pump system,attach copy of electi- ❑Conventional System(pipe and stone s! / ❑ Infiltrator or Biodiffuser(Gravel-Less)(F stem. ❑ Pressure Distribution S.A.S.(No D-Box) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name Ab rrje�s�ss(if different fryo �tabove) J City/Town — — - 3. Installer Information M)('ha'0_[ &IN - r.p. Pen71y + Stns Name Name of Company Address ---- ----- ---- --- �9nd DIY 1 D City/Town State Zip Code 97T- 37s-L/g// Telephone Number(Cell Phone#if possible please) 4. Designer Information �, 1/f ----- -----— - _/fie✓rirngG� �Y19/�►��s� Name Game of Company oP Address &'I'h rail- N911d City/Town St toZip Code :355 Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 i µORTp Application for Septic Disposal System pConstruction Permit — TOWN OF TODAY'S DATE ORTH ANDOVERMA 01845 $250.00—Full Repair , �SSACNUSEta $12 . 0-Component Important: Application is hereby made for a permit to: When filling out forms on the Elonstruct a new on-site sewage disposal system computer,use Repair or replace an existing on-site se a disposal system* only the tab key to move your ❑ Repair or replace an existing system compone —What? cursor-do not use the return key. A. Facility Information Address or Lot# A/Or-�h AMOW City/Town 2.-*TYPE OF EPTIC SYSTEM*: ❑ Pump Gravity(choose one) ***If pump system,attach copy of electrical permit to application*** ❑ Conventional System(pipe and stone system) /f ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Scoff 1b v I k- Name A dress(if different fropi above) /torr _ v1fzlr City/Town State Zip Code Telephone Number 3. Installer Information M ioyil-t ge(11 u Fp. k9ell/u + 5bns Name a Name of Company Cuto evil Laho' a, Il Address �93gd[2 Uw- mH- Dl Y v City/Town State Zip Code 9 7ff-,.37s-Ljg/i Telephone Number(Cell Phone#if possible please) a. Designer Information �1e✓rime C�tg/r� � Name Dame of Company up t 'r_ Sh-ee- - Address all- ar/D of /Town St to Zip Code I7�--Ll75�-311�91�_ Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 c N°RTS Application for Septic Disposal System d TODAY'S DATE pConstruction Permit - TOWN OF ORTH ANDOVER, MA 01845 $250.00-Full Repair i S�GNUSES4 $125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: 24sidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. (Dbf Name --- --- -- Date Applica ' Inn Approved By' oard of Health Representative) Na a Date Ap kation Dipproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes No 2. Project Manager Obligation Form Attached. Yes No 3. Pump Svstem? If so,Attach copy ofElectrical Permit Yes_ No 4. Foundation As Built. new construction ronly : Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 .11/20/2006 12:18 9786888476 HEALTH PAGE 02/02 SEP'T`IC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the consttuctaon for the septic systcm for the property at: I 1 q L, `der Sere (Address of septi gsten� For plans by �1 1 f l n�t1ECS) Uatitvc to the application ofM I(il -e (Installer's nawc) And dated Dated !OL, kAQ"rg a� With revisions dated //r- �.L L Pot revised date) I understand the following obligations for management of thins project: 1. As the installer,I am obligated to obtain all permits and Hoard of Health approved plans Prior to performing any work on a site. I must have the aMmm;-d plans-mdlhe_oestniLm Sim-whet1_=work is being done.- 2. As the installer,I must call for any and afi inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work couapkted prior to the applicable inspections as indicated below. I understand that reclueatiAgnection av1 out_comgletion of the items in accordance avith_T'Itle5 and the Board of Heakh Rm"tiotis may result is a ESQ 00 fine being levied against me and/or M92-Many. a. Bottom of Bed-Generally,this is the first(1')inspection unless there is a retaining wall,which should be dome first. The installer must request the inspection but does not have to be present. b. Final Comtommoninspecu --Engineer must first do their inspection for elevations,ties,etc.. As-built of verbal,OK for e-mail to:h;Wdjftj1&LWjofnorthandover.com)£roan the engineer must be submitted to the Board of Health,after Which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade-Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work(other than.r pVk excavation)and I unrequited to complete the installation of the system identified in the attached application for installation. I further undesstagd that work aorta by others unliceaced to install septic�ystems in liTorth Andover can constitute reasons£or denial of the Wtem.and/or revocation or suapgp„>on of my license to overate is the Tag of North.ApAmer,ignifiRMLfines to all,persons involved are also pos=able S. As the installer,I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached b. Ah9pecdon of the sand sad stone to he used. c, .Final inspection by Bowl ofHeahh ewffor consultant. d Iastsllatioa oftanly D-,fox,pW8,stone, vent,pump eharnrber,raetginix wall and other componeat& 6. As_the installer.I understand that I am aolal4 zaamsible for the inag allation of he sy t� em as,pet the WZxoved p ms. No instructions the hameo%imer,gene�tal_contractox,,,or ang other cssonc s a]l absolve me of dais obligagation. Undersigned Zitcensed Septic Installer: (Today's Date) �v h M .��/lu (iName- tint (Name ign F.P.REILLY&SONS,INC. 6457 R ' TOWN OF NORTH ANDOVER 10/1/2009 119 Liberty Street 250.00 I New Northmark Chec 119 Liberty Street 250.00 F.P.REILLY&SONS,INC. 6457 TOWN OF NORTH ANDOVER 10/1/2009 119 Liberty Street 250.00 New Northmark Chec 119 Liberty Street 250.00 PRODUCT DLT104 USE WITH 91663 ENVELOPE NEBS To Reorder:1-800-225-6380 or www.nobs.com PRINTED IN U.S.A. A A 0 0 13 g,,.,.�. ,...,,,,,..q,,,r...,�+.:'+4��.�krc7.a.,rrrr.r.;,,;...;.:.r.:,..:,ti,:...:�+..,tl,...,._...•r.:+..:' ,.-.,._-..,_,r .,-...,...... ... . �I } t NORTH ,.. 3967 c �O F Town of North Andover HEALTH DEPARTMENT SS US ��. CHECK#: DATE: /f LOCATION: �. ��i ��s H/O NAME: c��e�X �X1� .: CONTRACTOR NAME: /�/�/�% /'Os/ f•' F x'.. TYye of Permit or License: (Check box) r O Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ S ❑ Food Service-Type: $ ❑ Funeral Directors $ r' ❑ Massage Establishment $ F' ❑ Massage Practice $ �s ❑ Offal(Septic)Hauler $ ❑ Recreational Camp ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC St stems: eptic-Soil Testing $ �O d� ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ' ❑ Septic Disposal Works Installers(DWI) $ ` ❑ Title 5 Inspector $ ❑ Title 5 Report $ 13 Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer M TOWN OF NORTH ANDOVER aF NflRp" Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT m 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �4Ss�cm t`h Susan V.Sawyer,RENS,RS 978.688.9540-Phone Public Health Director 978.688.8476-FAX ECIVED heaithde t townofnorthan vers m www.townofiiorthandover.c m APR 2 1 2009 APPLICATION FOR SOIL TESTS TOWN.OF NORTH ANDOVER DATE: �j- O� MAP&PARCEL: {'1j HEALTH DEPARTMENT LOCATION OF SOIL TESTS: Tyl-fF`l' OWNER: P6, Li)C Contact#: APPLICANT: 91,14 Contact#: ADDRESS: I I°I I.I�i E�'r` lj2tiT ENGINEER:I i u,(2 ftk?,- /Ur-,YZ IL-1 I�JAC K Contact#:__67 oj) CERTIFIED SOIL EVALUATOR: t V 17i t Fl7 GSA Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: ,Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No ✓ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x II"Plot plan A Location of Testiar(please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Dates Signature of Conservation Agent: Date back to Health Department:(stamp in): /r a I Nj m �n, -a 1 N - 1 TbP OF PIVD et.: 132,14 R1POF EL.132.41 0 'NV `L l� L IV IN 2.14 INV IN a 82.57 INV ouT- 132,04 . INV OIfr. 63 137 2p , INV M•ISl.I� � .. �1 4tq Fic17T,TIC, . bi:1�p - , 24•%3. 0-00 __-scale r 40'—.. "� PTI L ��{"•;.:'�E M AS - ea�;�.T DEEDGOOK PA1Ge � I� anon PL" .. . LI,�>✓grY DTpT assEss011 wr BLOCK Leel sc, LOT 4 .. IC3 I 6:S LPA4,JQ Ft]tZ G F—QctwISE 21t"r.- x oc t 17 I X00 M dl hl S'[��6"`, � '�'i£ • L1 dvGiZHIU. I MN�S. +ass North Andover Board of Health MEETING AGENDA THURSDAY,July 23,2009 .7:00 p.m. 120 Main Street,2"d Floor Selectmen's Meeting Room North Andover,MA 01845 I. CALL TO ORDER II. PUBLIC HEARINGS—7:15 PM A. Septic Regulations for review—Continued from June 25,2009 meeting....... The North Andover Board of Health,pursuant to Chapter 111, Section 31 of the Massachusetts General Laws, will hold a public hearing on Thursday,April 16, 2009 for purpose of making revisions to the existing regulations regarding the minimum requirements for subsurface disposal of sanitary sewage. II. APPROVAL OF MINUTES A. Meeting Minutes from May 28,2009 to be presented for signature III. OLD BUSINESS . IV. NEW BUSINESS A. 545 Winter Street—Septic Issues at the request of homeowner,David Hengl—Continued from June . 25,2009 meeting B. 119 Liberty Street—Request for a variance from the local septic regulations for a septic soil absorption area to be located 68 feet from the wetland area instead of the 100 feet. - V. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION A. Presentation regarding The Effects of Food Safety Training on Producer Incentives to Reduce Inspection Violations and Improve Food Safety Efforts:Local Policy Implications by Brian F.Goodhue,BS,RN,NREMT-P VII CO. RRESPONDENCE/NEWSLETTERS VIII. ADJOURNMENT JuCy 23,2009 North Andover Board of Health Meeting—Meeting Agenda Page 1 of 1 Note: The Board of Health reserves the right to take items out of order and to discuss and/or vote on items that are not listed on the agenda. Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman,Larry Fixler,Member/Clerk,Anne Brennan,Member, Joseph McCarthy, Member,Francis P.MacMillan,Jr.,M.D.,Health Department Staff:Susan Sawyer,Health Director; Debra Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Pamela DelleChiaie,Health Department Assistant � it Sawyer, Susan From: brdufresne@comcast.net Sent: Wednesday, July 15, 2009 3:54 PM To: Sawyer, Susan Subject: 119 Liberty Street Susan, We have revised the upgrade design for the above referenced site. The revisions involved field delineating the wetlands and adding them to the plan. Based on the revised delineation, the soil absorption system is 68 ft. from a wetland which meets the state requirement of 50 ft. but not the local requirement of 100 ft. On behalf of our client, we respectfully request that this matter be placed on your earliest availble meeting for consideration of a variance from your local requirement from 100 ft. to 68 ft. We appreciate your prompt attention to this matter. Thank you, Bill Dufresne Merrimack Engineering services i � d t NOTES 1.) ALL FILL BENEATH THE SOIL ABSORPTION SYSTEM SHALL BE IN CONFORMANCE WITH 310 CMR 15.255 (3). 2.) THIS SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. 3.) REMOVE ALL TOPSOIL., ROOTS AND SUBSOIL AND REPLACE WITH SPECIFIED FILL WITHIN 5 FEET OF SYSTEM. FILL SHALL BE IN CONFORMANCE WITH CMR 15.255 (3). 4.) COVER MATERIAL OVER THE SYSTEM SHALL BE FREE OF CLAY, STONES, MASONRY, V STUMPS, OR WASTE CONSTRUCTION MATERIAL. THE TOP 3" SHALL BE LOAMED AND SURFACE SEEDED. MACHINERY WHICH MAY CRUSH OR DISTURB THE ALIGNMENT OF THE PIPES IN THE DISPOSAL AREA SHALL NOT BE ALLOWED. 5.) FOUNDATION DRAINS ARE NOT TO BE INSTALLED WITHIN NA FT. OF THE SEPTIC TANK NOR WITHIN NA FT. OF THE SOIL ABSORPTION SYSTEM.— 6.) ALL PIPING SHALL BE LAID STRAIGHT ON CONTINUOUS GRADE AND SHALL HAVE WATERTIGHT JOINTS 7.) PROPERTY LINES SHOWN WERE TAKEN FROM EXISTING PLANS AND RECORDS. 8.) THE LOCATION OF EXISTING UNDERGROUND UTILITIES WAS TAKEN FROM EXISTING PLANS AND RECORDS OR FROM FIELD OBSERVATIONS AND MARKINGS AND ARE APPROXIMATE. THE CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE EXACT LOCATION OF ALL EXISTING UTILITIES BEFORE CONSTRUCTION BEGINS. THE DESIGN ENGINEER SHALL BE NOTIFIED IMMEDIATELY OF ANY DISCREPANCIES SO THAT REMEDIAL ACTION CAN BE TAKEN. 9.) THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER 48 HRS. IN ADVANCE OF BED EXCAVATION AND COMPLETION SO THAT REQUIRED INSPECTIONS CAN OCCUR. 10.) THE CONTRACTOR SHALL BE FINANCIALLY RESPONSIBLE FOR THE AS—BUILT INSPECTIONS AND PLAN. THIS SERVICE SHALL BE INCLUDED AS PART OF THE CONSTRUCTION CONTRACT. 11.) FOR THE REPAIR (OR UPGRADE) OF SYSTEMS, THE EXISTING S.A.S. AND SURROUNDING AND UNDERLYING SPOILED SOIL SHALL BE EXCAVATED AND REMOVED WHEREVER IT IS WITHIN 5 FT. OF THE PROPOSED SYSTEM. 12.). FOR THE REPAIR (OR UPGRADE) OF SYSTEMS, THE EXISTING SEPTIC TANK SHALL BE PUMPED AND EITHER PUNCTURED AT THE BOTTOM AND FILLED WITH CLEAN SAND OR COLLAPSED AND REMOVED FROM SITE. 13.) NO PRIVATE WELLS EXIST. WITHIN 100 FT. NOR ANY PUBLIC WELLS OR DRINKING WATER SUPPLIES WITHIN 400 FT, OF THE SYSTEM, 14.) NO WETLANDS EXIST WITHIN 100 FT. OF THE PROPOSED SYSTEM. 15.) THIS SYSTEM DESIGN, ALL MATERIALS AND COMPONENTS AND ALL INSTALLATION PROCEDURES SHALL BE AND ARE ALL TO.BE IN FULL CONFORMANCE WITH TITLE 5, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, 310 CMR 15.001 THROUGH 15.505. UNLESS OTHERWISE NOTED. DESIGN CALCULATIONS DESIGN FLOW = 4 BEDROOMS- x 110 CAL./DAY.= 440 GPD DESIGN PERC RATE: 3 M,P.1. SOIL CLASS: T LEACHING AREA REQUIRED = 440 GAL. x 1/6 GPD/S.F. = 733 S.F. USE QUICK 4 STD. INFILTRATOR.CHAMBER 4.72 S.F./L.F. 733 S-F/ 4.72 S.F./L.F.= 156 L.F. (39 CHAMBERS) USE 40 INFILTRATOR CHAMBERS IN A 4 x 1 O CONFIGURATION= 160 L.F. EFFECTIVE AREA PROVIDED: 4.72S.F./L.F, x 160 L.F. 755 S.F. I CERTIFY THAT ON MAY 9, 1996, 1 PASSED THE 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. SIGNATUREc(r- 1 ti--�. DATE �IpcQAnr DI AA/ nom` WETLAND BY NORSE ,. ENVIRONMEN'At.. SERVICES INC, � . 2 A4 15,_12;_ 09 fl �6A OP* f t f ✓ c Eri6T / ✓ �i RROP. r 13315. VENT PROP./44AY BALE BARRIER (130 L.F.f) ' - 87' a PRI 1 1 PROR. D,,BO`k " c . INS 1515 E,aST. -Rol TANK 1 PRO F Won / 40 INFILTRATOR LO 000 GAL. CHAMBERS IN A 1 PROP.,2, 4x1 g.✓CONFIGURATION r K i ff: 1 OX2 f I // � Ot i (A 00 1 11 �• f ( \ zo a) PROP. LOAM ., � STOCKPILE AREA r j EXIST, EXIST 1 I I i E::f'�T. GARAGE �y F f 1 i L i14Uv, / I T'--7' �T-- I if f / i f L GiE•1.15.15• =142.1 ( 1 E:Xit,�i. 4' EGF:"rd. 1512 DIVrULING gf119 ! 4 / - 'EYIST. PORCH DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, May 27, 2009 12:08 PM To: Isaac Rowe Cc: DelleChiaie, Pamela Subject: RE: 119 Liberty Street It has been so long that we have had a plan reviewed, I forgot what one looked like O Thx Susan From: Isaac Rowe [mailto:irowe@millriverconsulting.com] Sent: Wednesday, May 27, 2009 9:27 AM To: 'Daniel Ottenheimer'; Grant, Michele;irowe@miliriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 119 Liberty Street Susan, Please find attached a plan review disapproval letter for the above referenced property. Overall the plan looks good, both test pits within the proposed field! You may want to require the edge of the wetland resource area to be flagged because he is using a buffer zone from "record septic plan". There is a good chance the wetland edge has changed since the original system was built. I would show this to Jennifer as well. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting 2 Blackburn Center i i 1 s NOTES 1.) ALL FILL BENEATH THE SOIL ABSORPTION SYSTEM SHALL BE IN CONFORMANCE WITH 310 � CMR 15.255 (3). 2.) THIS SYSTEM IS NOT. DESIGNED FOR USE WITH A GARBAGE GRINDER. 3.) REMOVE ALL TOPSOILr ROOTS AND SUBSOIL AND REPLACE WITH SPECIFIED FILL WITHIN - 5 FEET OF SYSTEM. hLL SHALL BE IN CONFORMANCE WITH CMR 15.255 (3). 4.) . COVER MATERIALOVEN THE SYSTEM SHALL BE FREE OF CLAY, STONES, MASONRY i STUMPS, OR WASTE CONSTRUCTION MATERIAL. THE TOP 3" SHALL BE LOAMED AND SURFACE SEEDED. MACHINERY WHICH MAY CRUSH OR DISTURB THE ALIGNMENT OF THE PIPES IN THE DISPOSAL AREA SHALL NOT BE ALLOWED. 5.) FOUNDATION DRAINS ARE NOT TO BE INSTALLED WITHIN NA FT. OF THE SEPTIC TANK NOR WITHIN NA FT. OF THE SOIL ABSORPTION SYSTEM. 6.) ALL PIPING SHALL BE LAID STRAIGHT ON CONTINUOUS GRADE AND SHALL HAVE WATERTIGHT JOINTS 7.) PROPERTY LINES SHOWN WERE TAKEN FROM EXISTING PLANS AND RECORDS. 8.) THE LOCATION OF EXISTING UNDERGROUND UTILITIES WAS TAKEN FROM EXISTING PLANS AND RECORDS OR FROM FIELD OBSERVATIONS AND MARKINGS AND ARE APPROXIMATE. THE CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE EXACT LOCATION OF ALL EXISTING UTILITIES BEFORE CONSTRUCTION BEGINS. THE DESIGN ENGINEER SHALL BE NOTIFIED IMMEDIATELY OF ANY DISCREPANCIES SO THAT REMEDIAL ACTION CAN BE TAKEN. 9.) THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER 48 HRS. IN ADVANCE OF BED EXCAVATION AND COMPLETION SO THAT REQUIRED INSPECTIONS CAN OCCUR. 10.) THE CONTRACTOR SHALL BE FINANCIALLY RESPONSIBLE FOR THE AS-BUILT. INSPECTIONS AND PLAN. THIS SERVICE SHALL BE INCLUDED AS PART OF THE CONSTRUCTION CONTRACT. 11..) FOR THE REPAIR (OR UPGRADE) OF SYSTEMS, THE EXISTING S.A.S. AND SURROUNDING AND UNDERLYING SPOILED SOIL SHALL BE EXCAVATED AND REMOVED WHEREVER IT IS WITHIN 5 FT. OF THE PROPOSED SYSTEM. 12.) . FOR THE REPAIR (OR UPGRADE) OF SYSTEMS, THE EXISTING SEPTIC TANK SHALL BE PUMPED AND EITHER PUNCTURED AT THE BOTTOM AND FILLED WITH CLEAN SAND OR COLLAPSED AND REMOVED FROM SITE. 13.) NO PRIVATE WELLS EXIST. WITHIN 100 FT. NOR ANY PUBLIC WELLS OR DRINKING WATER SUPPLIES WITHIN 400 FT. OF THE SYSTEM. 14.) NO WETLANDS EXIST WITHIN 100 FT. OF THE PROPOSED SYSTEM. 15.) 'THIS SYSTEM DESIGN, ALL MATERIALS AND COMPONENTS AND ALL INSTALLATION PROCEDURES SHALL BE AND ARE INTENDED TO BE IN FULL CONFORMANCE WITH TITLE 5, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL 15.001 THROUGH 15.505. UNLESS OTHERWISE NOTED. ANITARY SEWAGE, 310 CMR DESIGN CALCULATIONS DESIGN FLOW = 4 BEDROOMS x 110 GAL./DAY. = 440 GPD DESIGN PERC RATE: 3 M.P.I. SOIL CLASS: 1T LEACHING AREA REQUIRED = 440 GAL. x 1/•6 GPD/S.F. - 733 S.F. USE QUICK 4 STD. INFILTRATOR.CHAMBER 4.72 S.F./L.F. 733 S.F./ 4.72 S.F./L.F.= 156 L.F. (39 CHAMBERS) IIS USE 40 INFILTRATOR CHAMBERS IN A _4 x 10 CONFIGURATION= 160 L.F. EFFECTIVE AREA PROVIDED: 4.72 S.F./L.F, x 160 L.F= 755 S.F. I CERTIFY THAT ON MAY 9, 1996, 1 PASSED THE 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( ,, /tom DATE I/Pt^-DA nC' ®1 A At Ac ,- WETLAND BY NORSE • � ENVIRCiNMEN•rAi.. SERVICES INC, 9 f i A 1iC A 4A '.mss f/r 13 X8 `� ? n 10 ki PROP. LIMIT OF EXCAVATION `- ES 5' ALL AROUND RROP. VENT (SEE NOTE 3) - PROP.,NAY BALE BARRIER (130 L.F.t) 73' I PROR � � �"" PROP. \ � . ` b`B O`X ns . —PORT _ 70' " TANK ' Fii F`rt< GcA i PRO / 40 INFILTRATOR (3 PROPLrt . 2"000 GA . CHAMBERS IN A f 4x1 Q:CONFIGURATION I 0 iiiK ,^ t ILLJ PRQP. LOAM 'I 14cSTOA CKPILARE ' Xi ST GARAGE I \• XIS 1 ftafEi 1 —r PORCH 1 / BM. i.f.-142.1' / 1 C:deLLING #119 / t EXIST. PORCH� f � I I • }' i; 11 4 LOT 4 (130,680 S.F. ) EXIST, WELL • 29.63 r STREEI 5a•6� - 105 67.00' PLAN . y � 3 Sawyer, Susan From: brdufresne@comcast.net Sent: Wednesday, July 15, 2009 3:54 PM To: Sawyer, Susan Subject: 119 Liberty Street Susan, We have revised the upgrade design for the above referenced site. The revisions involved field delineating the wetlands and adding them to the plan. Based on the revised delineation, the soil absorption system is 68 ft. from a wetland which meets the state requirement of 50 ft. but not the local requirement of 100 ft. On behalf of our client, we respectfully request that this matter be placed on your earliest availble meeting for consideration of a variance from your local requirement from 100 ft. to 68 ft. We appreciate your prompt attention to this matter. Thank you, Bill Dufresne Merrimack Engineering services 1 r NOTES 1.) ALL FILL BENEATH THE SOIL ABSORPTION SYSTEM SHALL BE IN CONFORMANCE WITH 310 CMR 15.255 (3). G 2.) THIS SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. i 3.) REMOVE ALL TOPSOIL,.ROOTS AND SUBSOIL AND REPLACE WITH SPECIFIED FILL WITHIN 5 FEET OF SYSTEM. FILL SHALL BE IN CONFORMANCE WITH CMR 15.255 (3). 4.) COVER MATERIAL OVER THE SYSTEM SHALL BE FREE OF CLAY, STONES, MASONRY, 1 STUMPS, OR WASTE CONSTRUCTION MATERIAL. THE TOP 3" SHALL BE LOAMED AND SURFACE SEEDED. MACHINERY WHICH MAY CRUSH OR DISTURB THE ALIGNMENT OF THE PIPES IN THE DISPOSAL AREA SHALL NOT BE ALLOWED. 5.) FOUNDATION DRAINS ARE NOT TO BE INSTALLED WITHIN NA FT. OF THE SEPTIC TANK NOR WITHIN NA FT. OF THE SOIL ABSORPTION SYSTEM. 6.) ALL PIPING SHALL BE LAID STRAIGHT ON CONTINUOUS GRADE AND SHALL HAVE WATERTIGHT JOINTS 7.) PROPERTY LINES SHOWN WERE TAKEN FROM EXISTING PLANS AND RECORDS. 8.) THE LOCATION OF EXISTING UNDERGROUND UTILITIES WAS TAKEN FROM EXISTING PLANS AND RECORDS OR FROM FIELD OBSERVATIONS AND MARKINGS AND ARE APPROXIMATE. THE CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE EXACT LOCATION OF ALL EXISTING UTILITIES BEFORE CONSTRUCTION BEGINS. THE DESIGN ENGINEER SHALL BE NOTIFIED IMMEDIATELY OF ANY DISCREPANCIES SO THAT REMEDIAL ACTION CAN BE TAKEN, 9.) THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER 48 HRS. IN ADVANCE OF BED EXCAVATION AND COMPLETION SO THAT REQUIRED INSPECTIONS CAN OCCUR. 10.) THE CONTRACTOR SHALL BE FINANCIALLY RESPONSIBLE FOR THE AS-BUILT INSPECTIONS AND PLAN. THIS SERVICE SHALL BE INCLUDED AS PART OF THE CONSTRUCTION CONTRACT. 11.) FOR THE REPAIR (OR UPGRADE) OF SYSTEMS, THE EXISTING S.A.S. AND-SURROUNDING AND UNDERLYING SPOILED SOIL SHALL BE EXCAVATED AND REMOVED WHEREVER IT IS WITHIN 5 FT. OF THE PROPOSED SYSTEM. 12.) FOR THE REPAIR (OR UPGRADE) OF SYSTEMS, THE EXISTING SEPTIC TANK SHALL BE PUMPED AND EITHER PUNCTURED AT THE BOTTOM AND FILLED WITH CLEAN SAND OR COLLAPSED AND REMOVED FROM SITE. 13.) NO PRIVATE WELLS EXIST. WITHIN 100 'FT. NOR ANY PUBLIC WELLS OR DRINKING WATER SUPPLIES WITHIN 400 FT. OF THE SYSTEM. 14.) NO WETLANDS EXIST WITHIN 100 FT. OF THE PROPOSED SYSTEM. 15.) THIS SYSTEM DESIGN, ALL MATERIALS AND COMPONENTS AND ALL INSTALLATION PROCEDURES SHALL BE AND ARE ALL TO.BE IN FULL CONFORMANCE WITH TITLE 5, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, 310 CMR 15.001 THROUGH 15.505. UNLESS OTHERWISE NOTED. DESIGN CALCULATIONS DESIGN FLOW = 4 BEDROOMS x 110 CAL./DAY c 440 GPD DESIGN PERC RATE: 3 M.P.I. SOIL CLASS: Il LEACHING AREA REQUIRED = 440 . GAL. x 1/6 GPD/S.F. 733 S.F. USE QUICK 4 STD. INFILTRATOR.CHAMBER 4.72 S.F.A.F. 733 s.r.1 4.72 S.F./L.F- 156 L.F. (39 CHAMBERS) USE 40 INFILTRATOR CHAMBERS IN A 4 x 1 O CONFIGURATION= 160 L.F. EFFECTIVE AREA PROVIDED: 4.72 S.F./L.F. x 160 L F= 755 S.F. I CERTIFY THAT ON MAY 9, 1996, 1 PASSED THE EXAM1NATION APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL AND THAT ABOVE ANALYSIS WAS PERFORMED BY ME CONSISTENT EWITH NTHE REQUIRED ETRAINING, EXPERTISE AND EXPERIENCE DESCRIBED IN 310 CMR 15.017, SIGNATURE E�- —' T% DATE 5-5f //PI--DAnr- O/ AA/ nc - WETLAND BY NORSE ENVIRC111MEN'rAl- SERVICES, INC. L� 1 5P 13 \ \_3p ! ov- ,fr ES\ PROP. i .\ tss, VENT r PROP. FLAY BALE BARRIER (130 L.F.t) 87+ PRS f \ PROR. y N. f D7BOX , INS TANK PROP,, j A- 1 40 INFILTRATOR O Ln PROP. _2000 _6 kAL. CHAMBERS IN A C K 4x1Q:CONFIGURATION f: � / 1 L�L00 to Z w ( i �\ I PR8P. LOAM t % ! ST fCKPIL� AREA 14e '�_.. �(� -^ , GARAGE 1 PORCH i 1 t i140v„ 7 7 '#-*Bkl T.F.r142A EXI+T. 4 BGRh.I. ' DV�tLu?dG g}19 y` EXIST. PORCH 1 ... E pORTIy 3a°�T,..D ,61go p ^� y 1 D w Ar 9SSACMU`��� Health Department May 26, 2009 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Plan review for 119 Liberty Street(Map 90B, Lot 60) Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated May 6, 2009 and received on May 8, 2009 has been reviewed. Unfortunately,the plan cannot be approved until the following item is addressed. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. The plan depicts the 100'.buffer zone from record septic plans. Please confirm the buffer zone is accurately shown as it appears on site. a. Confirm wetland line by meeting with Jennifer Hughes, Conservation Administrator(978 688-9530) or b. Confirm wetland line by delineation by a wetlands scientist 2. Please show the edge of the wetland resource area if found to be different than the proposed plan(NA 8.02r). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and.assure protection of public health and the environment of North Andover. Since y, usan Y. Sawyer, /R Public Health Director cc: Scott Pavlik 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 V/ TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD'T OCT 2 6 2001 DATE: _j( � Oda SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) Com, DATE OF PUMPING: QUANTITY PUMPED 1 50C� GALLONS CESSPOOL: NO YES 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: P5 _7 COMMENTS: CONTENTS TRANSFERRED TO: f NORTIi Oe��`ao 161ti0 �a e...0_ r•.'e O O L I- T �1SSACHUS t� Health Department May 26, 2009 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Plan review for 119 Liberty Street(Map 90B, Lot 60) Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated May 6, 2009 and received on May 8, 2009 has been reviewed. Unfortunately,the plan cannot be approved until the following item is addressed. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. The plan depicts the 100' buffer zone from record septic plans. Please confirm the buffer zone is accurately shown as it appears on site. a. Confirm wetland line by meeting with Jennifer Hughes, Conservation Administrator(978 688-9530) or b. Confirm wetland line by delineation by a wetlands scientist 2. Please show the edge of the wetland resource area if found to be different than the proposed plan(NA 8.02r). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Since y, us an Y. Sawyer, /R Public Health Director cc: Scott Pavlik 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building20•Suite 2-36 � E-Mail. heatthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 lil 4106 Of NORTp@f,M Town of North Andover HEALTH DEPARTMENT s�C U CHECK#: DATE: );P/10f r LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) i ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ I ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ 0 Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval 2— ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ",❑ Other. (Indicate) $ / Healt Agent Initials White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER F NORTH Office of COMMUNITY DEVELOPMENT AND SERV dCES HEALTH DEPARTMENT � a 4 µ 1600 OSGOOD STREET; BUILDING 20• SUITE 2-36 NORTH ANDOVER MASSACHUSETTS 1845 > T S 0 sa�Hus 978.688.9540—Phone Susan V.Sawyer,REI-�S/ISS 978.688.8476—FAX Public Health Director E-MAIL:heaithdept(cDtownofnorthandover com WEBSITE:http://www.town - SEPTIC PLAN SUBMITTAL FORM MAY Date of Submission: �5 —Avq TOS ,wuvvER Site Location: N L A � -r 1 �� 70J - Engineer: s ,L"New Plans? Yes ✓ $225/Plan Check# Z'�7((includes 1S`submission andHOVERT review only) � �� Revised Pla ns.Yes $75/Plan Check# 5 Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? 6-4Yes No Telephone#: (°�7y)`�RSA�i�il'�`� Fax#: (1.7&), 47 `57— t4 Lt l E-mail:_[lj Iz1�!>=►ZE�i_��i (iUM Com ; J�I'y� Homeowner Name: U Y� OFFICE USE ONLY When th=Date submission is complete (including check): stamp plans and letter Complete and attach Receipt opy File; Forward to Consultant Enter on Log Sheet and Database t l Location: �e br :,. Owner's Name:__ ,�!�► z — Addres�, P �° Installer. Tel NnrL_ prlr Date: WeQandsZone II °- Soil Srtu6ol Son Rhme1 t 50�Cl.. Deep Obsuw ipn Role Logs Ele1•ntl6a Dcpth Soil H" Soil Testnce Solt Color Soil l4iotttia9. %Gravel,Stoner,etc: or ,, 117, tom, fir „ Pr L4 Mft!5 Y rarail 1►Lte" h.o.m F.a, ctlr -T, � Pareat A�iataial ,�,: .^p�Fy��a� �Yda•!n llca Bila�`�..r Neepin=[tom ltc Face��ESAGtiYe `�� " Dare Percolation Tests Observidan Aolef Depth of Pere 4 -r " SuitPit-soil; Time at 124 Time at r" Time at 6" Time -Rate nn&cb-. ' Performed B�: �. �.�c.► �'' �'"��� Witnessed DelleChiaie Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Thursday, April 30, 2009 8:45 AM To: DelleChiaie, Pamela Cc: Sawyer, Susan Subject: Soil Eval:119 Liberty Street&then to 66 Cedar Street This has been scheduled for next Wednesday, May 6th @ 9:30. 1 offered Bill Monday the 4th, but he said he had other testing. Cedar Street will be done immediately after this. From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Wednesday, April 29, 2009 3:13 PM To: Daniel Ottenheimer; Isaac Rowe; Marianne Peters; Randy Burley Cc: Sawyer, Susan Subject: FW: Septic 119 Liberty Street- Soil Testing Application Hi Marianne, I received a call from the homeowner, Scott Pavlik re: this address. The soil test application was dated 4/15/09 and received here on 4/21/09 from Bill Dufresne. Jennifer was away on vacation that week. I received back her input yesterday, and forwarded on to MR to schedule. H/o states that the test date was scheduled for May 12th, and it is costing him money to keep his system going, and he does not want to wait that long. I advised him to call his engineer (Bill) and see why there is a late scheduling. I told him it has to do with the availability of all the people involved. If you can possibly schedule anything earlier, please coordinate with Bill, and let me know the final date. I told the h/o we would assist him if possible, and with what is reasonable for all. Thank you. Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 1 r a} 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com-Website Notes: If copied to BOH Members -Reference Copy Only-no response requested at this time From: DelleChiaie, Pamela Sent: Tuesday, April 28, 2009 1:28 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Marianne Peters; 'Randy Burley' Cc: Sawyer,Susan Subject: Task Status Report: Septic- 119 Liberty Street- Soil Testing Application -----Original Task----- Subject: Septic- 119_ Liberty Street- Soil Testing Application Priority: Normal Start date: Thu 4/23/2009 Due date: Wed 4/29/2009 Status: In Progress Complete: 0% Actual work: 0 hours Requested by: DelleChiaie, Pamela <<Septic- 119 Liberty Street-Soil Testing Application>> 4/28/09— Site /28/09—Site checked by Jennifer Hughes in Conservation today. Wetland is to the rear of the test pit area about 60 feet plus out, so is all set to setup an appt. I i 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 29, 2009 3:13 PM To: 'Daniel Ottenheimer; 'Isaac Rowe'; Marianne Peters; 'Randy Burley' Cc: Sawyer, Susan- Subject: FW: Septic- 119 Liberty Street-Soil Testing Application Hi Marianne, I received a call from the homeowner,Scott Pavlik re:this address. The soil test application was dated 4/15/09 and received here on 4/2.1/09 from Bill Dufresne. Jennifer was away on vacation that week. I received back her input yesterday, and forwarded on to MR to schedule. H/o states that the test date was scheduled for May 12th, and it is costing him money to keep his system going, and he wait that long. advised him to call his engineer Bill and see why there is a late scheduling. I told him does not want to g (Bill) Y i g it has to do with the availability of all the people le involved. . : If you can possibly schedule anything earlier,please coordinate with Bill, and let me know the final date. I told the h/o we would assist him if possible,and with what is reasonable for all. Thank you. PameQa Vele Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com-Website Notes: If copied to BOH Members-Reference Copy,Only-no response requested at this time From: DelleChiaie, Pamela Sent:Tuesday, April 28, 20091:28 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe';Marianne Peters; 'Randy Burley' Cc: Sawyer, Susan Subject: Task Status Report: Septic- 119 Liberty Street- Soil Testing Application j -----Original Task----- Subject: Septic- 119 Liberty Street- Soil Testing Application Priority: Normal 1 Start date: Thu 4/23/2009 Due date: Wed 4/29/2009 Status: In Progress Complete: 0% Actual work: 0 hours Requested by: DelleChiaie, Pamela Septic-119 Liberty Street-... 4/28/09— Site /28/09—Site checked by Jennifer Hughes in Conservation today. Wetland is to the rear of the test pit area about 60 feet plus out, so is all set to setup an appt. i i I 2 a DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, April 23, 2009 12:25 PM To: Hughes, Jennifer Cc: Sawyer, Susan Subject: Septic- 119 Liberty Street-Soil Testing Application Attachments: SKMBT_60009042312100.pdf; image001.gif Please review the attached application and let me know if there are any concerns from Conservation before I forward an appointment request with Mill River Consulting for soil testing. Thank you. Pame& Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com-Website From: noreply@yourcopier.com [mailto:noreply@yourcopier.com] Sent:Thursday, April 23, 2009 1:11 PM To: DelleChiaie, Pamela Subject: Septic- 119 Liberty Street Soil Testing Application 1 1_1 2)L''o -2 4 7 C, HEALTH PA6E 02, COMI-nonwealth of Massachusetts RECEIVED Massachusetts RECEIVED City/Town of NORTH ANDOVER M OF U 7NP T A !z Syste M SSAC M Pumping Record FOrm 4 F NORTH ANDOVER TOWN OF N T of LTH DE kR MENT HEALTH T 8 em Pumping Dep has Provided this form for use by local Boards rds of Health. The ern Pumping Record must be submitted to the local Board of Health or other approving authority, ty, A, ikat-lfity Information I Iniporta nt: 1AIrlen filling out I Systurn Location: forms on the computer;use Only the rib key to move your Cursor-10'lot UZO the return c1tv,I owrl key. 2. SY$'LeM C)Wne -4 Code __-7-7 Name Address cif different rrerri locdli�n) ------ — State 70 C!e Pui;wing Record • Date of PUMP1119 Pumped: I I /2uar,,ti 6ate- ty eptic Type of system,- -)I($) Gallons 0 cesspo' ng ❑ Tight TanK ❑ Other(dC-$Cribe): Effluent'Tee Filter-present? Ej yes ❑ No COndition of SysteM, If yeS, was it cleaned? Yes El No 5.6. system PuflIped By. bun n Name ROOTER-MAN Veeicle License Numper -- 12 EAST DRACUTROAD Z*0 I I�Ip.1 f I-y- METHUEN,MA 01844 7. LocatiOl WIlLare.Con/tents were disposed: -0 U"'dLP/water/aPPrO.VaIS/t-Sfortlis.htM#1jjSpect 15f0rYn4.o(;,c&06103 System PUMP;,19 Record Page 1 of 1 i Commonwealth of Massachusetts City/Town of Al- Rr-_CEIV i System Pumping Record Form 4 DEC 2 0 2005 7M F N,RTH ANDOVER DEP has provided this form for use by local Boards of Health. Other forms may Z�� obit tt#ite,RTMENT information must be substantially the same as that provided here. Before using i rm, ec 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 Important: When filling out 1. System Location: forms on the computer,use i only the tab key Ad ress to move your .�� f f f cursor-do not dz- use the return City/Town State Zip Code key. 2. System Owner: ame 'BR0! Address(if different from location) /Town Ci Code ry State Zip i Telephone Number B. Pumping Record 1. Date of PumpingDat d 2. Quantity Pumped: G'a 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ( No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: `x Name Vehicle License Number Company 7. Location where contents were disposed: ignature of Hauler I Da t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Comm nwe lth of Massachusetts "-if.4 Massachusetts System Pumping Record System Owner System Location C � Date of Pumping: C® � Quantity Pumped: eons Cesspool:p No [}- Yes [] Septic Tank: No [] Yes � System Pumped by: 044m" License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: TC` 27 9 q 1, f T ra, i 4 Y14, J ry 1�f IJ 1 V„ i 132,,41 tToo � INV INv o�tT 3 1:32,128 f I N V W 133.12 F I �c t ST 1,.�F� D'4 E L L4 r r F.x.l��r►N� i f o - —1 L:7 -- me.a,rrek_a y SCALE i 40 A i• DEED BOOK PA%re AREA PLAN ASSESSOR MAri± I BLOCK LOT - 6.5� Oeclk1ki F"OfZ C U' / I(0 0 MGI 1 ALAN ; 1 I•-1 a�/G�•H i 1s1. ;���-'aS SYS f FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ******************Applicant lfills out this section***************** .✓APPLICANT: f rIU Q t�t�71 TOW 1 Phone LOCATION: Assessor' s Map Number Parcel Subdivision Lot(s) c/�treet I �(�I Lilt- st Lb . Ue, St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected ,— -S�A l J l > Date Approved Septic Inspector-Health Date Rejected Comments C G Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, April 28, 2009 1:28 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Marianne Peters; 'Randy Burley' Cc: Sawyer, Susan Subject: Task Status Report: Septic- 119 Liberty Street-Soil Testing Application -----Original Task----- Subject: Septic- 119 Liberty Street- Soil Testing Application Priority: Normal Start date: Thu 4/23/2009 Due date:Wed 4/29/2009 Status: In Progress Complete: 0% Actual work: 0 hours Requested by: DelleChiaie, Pamela Septic-119 Liberty Street-.:. 4/28/09—. Site /28/09— Site checked by Jennifer Hughes in Conservation today. Wetland is to the rear of the test pit area about 60 feet plus out, so is all set to setup an appt. 3 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, April 23, 2009 12:25 PM. To: Hughes, Jennifer Cc: Sawyer, Susan Subject: Septic- 119 Liberty Street-Soil Testing Application Attachments: SKMBT_60009042312100.pdf; image001.gif Please review the attached application and let me know if there are any concerns from Conservation before I forward an appointment request with Mill River Consulting for soil testing. Thank you. �a�azeea �eP�e Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com—Website From: noreply@yourcopier.com [mailto:noreply@yourcopier.com] Sent:Thursday, April 23, 2009 1:11 PM To: DelleChiaie, Pamela Subject: Septic- 119 Liberty Street- Soil Testing Application 1 • v a . I TOWN OF NORTH ANDOVERgoRYp Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT I600 OSS®Ol}STREET; BUILDING 26, SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 QSsacHusFt�u i Susan V.Sawyer,RENS,RS 978.688.4540-Phone Public Health Director 978.688.8476-FAX RECEIVED heaSthdelaq@townofnorthan ver.c m wWw.townofhorthandQver.o im APR 2 12009 APPLICATION FOR SOIL TESTS TOWN OF NORTH ANDOVER DATE: MAI'8c PARCEL: g HEALTH DEPARTMENT LOCATION OF SOIL TESTS: L 102 E V- 1' LJ Tv?-- 0F1- Contact#: APPLICANT:-_ <�- , 9 L4K= Contact#: ADDRESS: ENGINEER Pr1tt fJUJ% `yk' /L4612 1✓J Contact#:-� '70) t!j CERTIFIED SOIL EVALUATOR Intended Use of Land: Residential Subdivision Single Family Home Commercial LS-This: Repair T'esting:__Z Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes Ngo, ✓ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x II"Plot plan&Location of Testing(please indicate test pit sites on the Plan), ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for reaairs or npg�rades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design-septic plans: ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and.at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing, ➢ Within 45 days of testing,a scaled plan(no smaller than t"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Comnpission Approval Date_. Signature of Conservation Agent: Date back to Health Department:(stamp in): LZHEALTHE ARTANDOVER TER w 91 y�6 - 'S�Jv'W t X1'11 hrd�V F! S�i�d�tr, f �.�' 1VW YOfSisSp N%nd (73 pitlY Nr iOVd NOOa.O?7a ��G- �'•1;C1 Q r7 b /'7,y.., J 71115 Y''�•gSj.`;alr,a '���.rte". .< ._-__r�-''V t bo�tE1. ¢szu o 141 sj) _ t - �y i� � 9tlld yo dqj tee' ry r r N TOWN OF NORTH ANDOVER BOARD OF HEALTH Location Lur 4 Permit #2j -!-� Food Service $ Retail Food RECEIVIED PA $ Limited Retail OCTY4f6�jr Seasonal �B S NNnn Disposal WoYTCs� s $ Disposal Works Constructi8fOr$ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ i 0293 CiAO He 1 Agent White - Applicant Yellow - Dept. Pink - Treasurer i I Town of North Andover, Massachusetts Form No.3 NOR7M BOARD OF HEALTH 1 Ot tt�ao a^1ti0 � [ 19 ' H p 1 . "^•;..o��^"� DISPOSAL WORKS CONSTRUCTION PERMIT 9SSAC14 SES Applicant 'et /T� NAME ADDRESS TELEPHONE i ' Site Location LO LL k-LAA::;,,- 4 I • Permission is hereby granted to Construct ( r Repair ( ) an Individual Soil Absorption I • I Sewage Disposal System as shown on the Design Approval S.S. No. I ; ' CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. i NORTH Town ' -A) of � .. ,, 6 � Andover No.. LL® 4 d4 «IJi "*nIVFMIAY FNTRY PERMIT - --. - � C I EI er, Mass. 19% QOQ Pa\� I > BOARD OF HEALTH PERMIT LD /It9� THIS CERTIFIES THAT. ' �u.T.T ,/qui '.l..epoloy.41.x0 .......... BUILDIN'G,w INSPECTOR has permission to erect ......................... ..h0a1A.0-Ap�A411—.44114E Rough J11...�.I.. .• n•.. .. Chimneyto be occupied as.. . ... r.............................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in C� PLU BIN 1 SPECTO this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of ou O/�P y Buildings in the Town of North Andover. =Fawn - /) �` Final VIOLATION of the Zoning or Building Regulations Voids this Permit. `I+�e� IL PERMIT EXPIK.S . IN 6 MONT FPMftM ELECTRICAL INSPECTOR �1Rough � ^, , SS CONSTRUCT ONS ARTS Service I Final DATE.L r WILDING INSPECTOR EEE LAID •• GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on thepFffijAME/BUILDING Do Not Remove DATE: FEE PAID/e; Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector i Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH NORTH Ot 19(� +,9•�,...... DISPOSAL WORKS CONSTRUCTION PERMIT SgACHuSE Applicant /� � t A�NA ��e��M NAME ' v ADDRESS TELEPHONE Site Location : Permission is hereby granted to Construct ( r Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH OF HEALTH Fee Go D.W.C. No. i AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation House -1,33 , 1 _'Z� Tank IN Tank OUT ;112 D-box IN D-box OUT 132,02 O g Trench Inverts Line 1 /, 75 /,3,;? Line 2 Line 3 Line 4 Bottom of Exc. Stone OK?_1G D-box checked? Pipes cemented? i i } G. R. STEAD BUILDERS INC. - RESIDENTIAL DESIGN - BUILD GARY STEAD FRES. GEORGETOWN, MA 508-352-7332 f 1 - I i 1 - _ 6 �r BOARD OF HI'ALTH Town of North Andover ,11ass . Date ermit — APPLICATION FOR WELL & PUMP PERMIT ;.4Nppi'ircation .is hereby made for permit to drilla well (_) . Application i,.S nade to install (_) a pump system' - L . . Lot ## • . . . . `•-.ocation : Address �• ;)w n e r l %/('7 Sft�7/�( �t�U�ll/6f Tel . f�. I1ddr ss '.ae11 Contractor�� Address �� %G Cl . Address Tel . . Dump Contractor P,4ELL CONTRACTOR (To be completed at Cirne of pump Lest ) T e of Well �� Well used for yr jDiameter of Well � Size of Casing; I - f Depth of Bed Rock ZQ Depth casing; into Bed Rock .,Was Seal Tested? Yes 04 ) No (_) Date. of Testing; /l What –!�1ell Well Ended in What- Material ' , Deliv�°rs dL? Gals . Per Min . for 4 hour: Depth to Water- Drawdown feet after pumping __hours' a e Date of Completion (� % -� _�� ignaCure Jell Contractor e J t ion ) ,f01 , cd i n. b c .. PUMP INSTALLER (To be fill ,• AC'?�SLt1I Purnp Type Used. oks6 Size & Name Pump //-1, l cJG� Y ---- --- —-— Wafer Pump Deii��ers /p GPM Size of Tank- X rfo �O� Pipe I`iaterial Used in Well : Cast Iron ( _) rnl v.�ni zed ( ) Plastic (_� Well Pit (_) or Pitless Adapter (✓ Was sleeve used to protect pipe? Ycs (_) NO( �) l.ypc or Name Well Seal Date (94q- g2� _ l N4NY NYNk *)Mt4�44r�'t�'r�'t,4�4i4�'t�'r�rtir�r�r�r�r,. .: .. ..,r,r„�,,,,, ,:,:�: Date Water analysis . repor-t 'submitted to Board of Health Do _e .release given tD owner of record & IM19 Insp Health Inspector 4 I i I .. .. . .... . . .... ... ................. . ............. i r r 7houtenden .Calorator sac, 66 LITTLETON ROAD WESTFORD, MA 01866 (508) 6928395 FAX (508) 692-0023 1.800.642-TEST Reiput•t Numtrut•; C—wpb-6002 Report Date; June 22, 1992 Client: Sample Taken At: W1luuzigl-nil PsurIp Supply Inc. G-R. Stead tlldrs. P.O. Box 517 Lot 4 Libertv St. Wilulington, MA 01887 N. Andover MA. Sample Taken By: wp$ Staff Un: June 19, 1992 CERTIFICATE OF ANALYSIS TEST PARAMETER: EPA Malt RESULTS UN1'1'9 Total Coliform- (P) 0 *0 per 100mi CGaIui,um No Limit: 32.1 mg/L Copper (S) 1.3 0.01 m�/L Is,uss (a) 0.3 0.04 mg/I, Magnesium No Limit 6.9 n/L Manganese (S) 0.05 0.05 Sodium " 20 1.1.7 Po6abbium (S) No Limit 1.7 Alkalinity (S) No Limit 97.5 mg/L Aiinnuziiu No Limit <0.03 mg/1, Chloride (S) 250 3.4.7 mg/L Chlorine (total) 0.7 0.02 mg/L Culex• (S) 15 5 CPU Conductivity I No Limit 275 umhos/cm Hardne6t* No Limit 109 mg/L Nitrates(as N)(P) 'l 10 0.04 marl, Nitrites(as N) 1 <0.01 mg/L 7.3 SU Odor (S) 3 0 TON Sulphates (3) 250 11.9 mg/1, Turbidity t.y 5 1.17 NTLr G6diment pow/zsels ne B N'TvNot Tested, Pt Value Exceeds EPA STD, TNTC=Too Numerous to count *_Background Bacteria Noted. "=EPA Advisory Limit f_Exceeds EPA Advisory Limit (P)'=Primary EPA Standard, (S)aSecondary EPA Standard (may affect aesthetics of drinking water i..e. taste, color, etc:.) This watax. s ansplw, nrs GebLad, meets or exceeds EPA health standards for the parameters listed above. The quality of this water is accepted as POTABLE according to EPA Standards. �st✓at�y� Massachusetts StaLe Certified Michael P. Carlson, for TvwLing Lmborator Y #MA 048 Thorsr.Qns;en Laboratory Inc. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applic nt fills out this section***************** APPLICANT: i Phone L LOCATION: Assessor's Map Numbe Parcel Subdivision / .� Lot(s) zi Street � � y�© St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: �1 /-1-1 Date Approved Conservation Administrator Date Rejected Comments Date Approved 6e I l '�`Z To Pla er Date Rejected Comments A, 2� Date Approved Heal h Agent Date Rejected Comments Public Works - sewer/water connection L 6 f driveway permitQ� Fire Department ` Received by Building Inspector Date swl Vy - 0 wo��> U rm U MP . 52� 733z 9 NUMLtFR FEE 3 3c� THE COMMONWEALTH OF MASSACHUSETTS .....TOWN..... of ......NORTH._ANDOVER.............. This is to Certify that .....V-iera...Well...Cmmpany............................................................... NAME 253 Andover Street, Georgetown, MA --------------------------------------- ------ ----------------------------------------••---------........------------•-------...------..................-----------....... ADDRESS IS HEREBY GRANTED A LICENSE For .......................Well Drillers License — Lot #4 Liberty Street .------------------------•-------•---------........------.......--- --------------------•---............------------------------------.......................--------------- --------------- ------------------------------------------------------------------------•----------......---................................................... -------- This license is granted in conformity with the Statutes and ordinances relating thereto, and expires.December--.3.1......1.9-9.2...............--e' imi sooner sus 6car ' rev d. .... .. .... ... .. ........ ------ -•---------- ------------ ........ .. ....... .................... -----June---2.................................19.---..- 92 ------------------ --- --•-.-- . ------••---- rrc --- -- -- ------- -------------- FORM 433 HOBBS $ WARREN, INC. BOARD OF HEALTH North Andover , Date , ..._... Town of Date .'ermi t r'# PERMIT FOR WELL & PUMP ermit to drilla well (_) • Application :1ppii-cation is hereby mune for nade to install ( ) a pump y — - j Lot #1 . . . . .ocation : Address .- r 1 ddress caner .) l� :��'r' l^•SrE�7l�[`�d�CU��ll , - (70(70Address n� Gell Contractor r/ek� ,,/;, Tel . .aump Contractor A d d r e s s—____.__-- 'aELL CONTRACTOR (To be completed at tirne of pump test ) Type of Well Well used for Size of Casing Diameter of Well Depth of Bed Rock Depth casing into L'ect hock Date. of Testing '-.Was Seal Tested? Yes (—) No (—) Well Endcd in Wha-t. Material 'Depth of-- – Delivrrs Gals . Per Depth Co Water- a Min . for 4 hour' _ > > � C ctr Drawdown feet after pumping fours — Date of• Completion _ Signature We Contractor • V.• .J. .�'::::%�,'�i:.if�l'i.•. •. .. n .. .. •. .. •. .. .. .. .. .. .. •. .. .. .. .:is.. .. •. .. .. .. n n n .. .f X In. t ion ) PUMP INSTALLER (To be' filled i..n bcforc > nit, • �e Used Pump Type Size & Name Pump --:- ------ --` --- Size of Tank Water Pump Delivers GPM — asCic Cast Iron ( ) ca ] v,���i zed ( ) I'l (—� Pipe Material Used in Well : — Well Pit (_) or Pitless •Adapter (_) to - Pr pipe? Ycs (—) NO( _) Type or Namc Well Seal Was sleeve used p , Date �4 7:SScf,,�;a C���C•,•�)•'ti:UC��; Date Wateranalysis . report submitted to I�oard of lfealth Do _e release given tD owner of record & 131(19 • Insp Inspector ` TODA 2( TIME A+ FROM AFicx I'ODE Ni16E r� W OF j.y E'7EAt5.'�<r LU c _ W � W SIGNED air spa. _ '.............T.,- ,..........,..—. ._ .} q „•�^ 11:! ALL %VAIs Uqs Uri) AMPAD NO.23-176-400 SETS NO.23-376-200 SETS �� _q tREAf � Ni,PA�BER i XTCar"i�Awl A �'U U) LU PfMGElt€( GAL � BACKC AGY SEE YOU a El AMPAD NO.23-176-400 SETS NO.23-376-200 SETS DATE 07 7 Sheet of I BOARD OF HEALTH TOWN OF NORTH ANDOVER / SUBSURFACE DISPOSAL DESIGN REVIEW FEE l9 D. PERMIT # DATE RECEIVED APPLICANT /)vY)ASSESSOR'S MAP ADDRESS �ePrly PARCEL # LOT # J STREET ENGINEER ADDRESS J PLAN DATET / /��' REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED ` AlOr w PLAN REVIEW CHECKLIST ADDRESS-/, _: ENGINEER GENERAL 3 COPIES Li STAMP t/ LOCUS SCALE CONTOURS !/ PROFILE SECTION ;l/ BENCHMARK I—` ELEVATIONS L,-- SOIL �j & PERC INFO WETS. DISCLAIMER WELLS & WETLANDS c/ d WATERSHED DISTRICT DRIVEWAY WATER LINE DRAINS RESERVE AREA (x SCH40 [/ SLOPE SEPTIC TANK MIN 1500G. . 17 INVERT DROP L GARB. GRINDER/j/6 (+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOX # OUTLETS - FIRST 2' LEVEL STATEMENT INLET 1 ova 8- OUTLET,13 = 2" OR . 17 FT) LEACHING 100' TO WETLANDS 100' TO WELLS &,-' 325' TO SURFACE H2O SUPP 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW 2% SLOPE - 4' PERM. SOIL BELOW FACILITY z/ MIN 12" COVER t/ FILL? �(25'' if above natural elevation; 101if below) . TRENCHES MIN 660 FT2 SLOPE (min . 005 or 611/1001 ) >3 ' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D .(MI N 61 ) '4--___ IS RESERVE BETWEEN TRENCHES? iZ IN FILL?`" MUST BE/ 10MIN. BOT X LDNG + SIDE til X LDNG 3�0 = TOT y C� (L x W x #) (G/ft2) (DxLx2x#) 2 �� 7k 21 �11 Lzr 1,-7- Xp S S SCPI I c Sy ST -- EM vEsl6� 13 D15APPRL�VEp COnJpIT�d�JS -. ��QSoNS = ' 7FXAVWf cow rc Q i�JSS ❑ 1= F� I tiSPF�rlon� F(PE F-Pt),-A He)066 i v T/Ji-)r (,1 Pry S5 �0 F/0)L DIS,I�P� ovED D,arC R�Sa NS , FINAL APPI�()VAL DA�� Commonwealth ol Massac usetts City/Town of 6,4T Qdv pEp 0 6 2004 System Pumping Record Form 4 HEALTH DLr DEP has provided this form for use by local B ar s of Health. Other forms may be used, but the information must be substantially the same as h t provided here. Before using this form, check with your local Board of Health to determine the form the use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System.Location: forms on the computer,use only the tab key AddreY to move your cursor-do notCly-oW��- S� Zio Code use the return key. 2 System Owner: Y P',g- ,Ll/< Name c Address(d different from location) I City/To M State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping p 2. Quantity Pumped: Gallo 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank [I Other(describe): 4. Effluent Tee Filter present? ❑ Yes �� If yes,was it cleaned? E] Yes ❑ No 5. Condition of System: 6. System Pumped By: Na Vehicle Uoense Number 4orhiany' 7. Location where contents were disposed: Signa ure ofilKier Date t5fornA.docc 06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED Civ/Town ofNO'S lh r l�{? JAN 0 5 2008 i S ste m Pumping Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Facility Information: System Location: Address � Y --- City./Town State Zip Code System Owner- Name. Adress (if different from location of pumrnp) City/Town State Zip Code j � 7� Telephone ?Number Put-tiping Record - — --. Date of Pumping I I1 U U ����, \\� II Quantity Pumped � OJV gallons Type of System Septic Tank Grease Trap other __-o what) System Pumped by:_ Company: ROOTER-MAN 12 East Dracut Rd., Methuen, MA 01844 Location where contents were disposed: Signature of Hauler Date I sus: dk M6(4h Y1 N4c6ver 2-6- 4-, STEWARTIS SEPTIC TANK SERVICE )ZG Main -Cl. 47 RAILRQAD STREET A/a/�h A/1na/�� BRADFORD, MA 01835 978-372-7471 MOM of Oc-f'd bp-r- c�p�o MMW REPW FOR TawN of LOA n Nye( D= ADDRM - - GA=NS aoMEns p_ 10 d 5�9 lem :5 /oc)o fo-3 /a )cky tOroe i2d Isem® /C„e— doo f76 7b-cke,,f�rm 1� '1D-6' Y66 win -k laaa o-` bE e is-ire gl7 � �t 7!56 7 rpt) erS 0hde '. 10-1 ( 14 tc�co/� 16ao Moo HEALTH Cal City/ToW11 QF foassachu�i;5tts RECEIVED Re Ful' �arou,dLd this iQrm for use milCad to ih tby local aQards Of aI �Uclrra Cf t1 alai,..The NOV 2 0 2007 H�ahh or a%her aA(�ravin Ykam R 'c3.Ct]ty Info( --.___� au[hrariiy; umpin9 TOWN OF NORTH ANDOVER out I. ys1k�� ETH DEPARTMENT `Ul l RkN4 Yf iiVYC •• �Yst�,m ��v ,_,.. stag -------- //�� // �/� ! Aad (ii�iiT fromiu aat,an) pu Record i'Yp SeRtic Tonic Gil hk --- �] Tight Tank 4. �Nluent'Te�Fiit�rpr�s�rtt? � �`�s EJ No w [] yes ROOTER MAN Zp ly'_ 12 EAST QRAGUT ROAD Veh ci la 1i- 7• NIITHUEN�NIA 0184 >^u =lricln Wi1�j•e �� GQ,(1It?f1kS Wl('� SIS •yuv/d�pl,�aC�r,'ap�;t•pti,�l�/I�IQrrns. � �at�'--/ V T- "• hcm#ins � k �-�sr�m r'ump,n�Recara •Pa�� .� 41 t Commonwealth of Massachusetts City/Town of a a° System Pumping Record Form 4 MAY 510 M DEP has provided this form for use by local Boards of Health. Othe fo� e Y information must be substantially the same as that provided here. ma;56 k with our local Board of Health to determine the form they use. The System bmitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Lefts se, Right side of house, Left front of house, Right front of house, Left rear of hott!�e, Right rear of housgs Left rear of building. Right rear of building. Address [ t. I L—) 'b� CityrrownState Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record S_ /7-lv 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) E3--Sep-fic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes E5–Iqo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: I 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: LAS.D Lowell Waste Water l6 g to a of Haul r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts W City/Town of a System Pumping Record Form.4 JUN 14 e o l' �M Tr� � DEP has provided this form for use by local Boards f W t¢ yi 1" a be used, but the information must be substantially the same as that prov �'1reie this form, check with your l�b 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: Le house, right front of house, left side of house, right side of house, Left rear of hous Cright rear of h u , left side of building, right rear of building, under deck. City/Town State Zip Code 2. System Owner: Name CEJ �i Address(if different from location) City/Town State Zip Code 3'7 Telephone Number B. Pumping Record 1. Date of Pumping Date _ 2. Quantity Pumped: _ Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes, was it cleaned? es ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location wit _ere contents were disposed: C;I. .S.Q. owell ste ter Signau of auler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1