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Miscellaneous - 139 OLYMPIC LANE 4/30/2018
139 OLYMPIC LANE / 210/106.6-0134-0000.0 - l v ' i I I r ' d Town of North Andover F NORTH Office of the Health Department Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 CHus�t Susan Y.Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE March 31,2004 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by John Soucy at 139 Olympic Lane North Andover, MA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Susan Y.Sawyer,REHS/RS Public Health Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN'OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed; ( ) repaired; by tj S Svc located at_13CJ2Tt� was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# ,plan dated ,.with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMM.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. .Bed inspection date: Engineer Representative Final inspection date: Z v 3 v Engineer Representative Installer: V% .y►� Q Lic.#: Date: 0Mqs�� Engineer: oma' RICHARD Date: 103 TANGARD h G{(/L L- 13021 Q c, FSS�ONAL Ira®F NORTH AfiJ1�G'�" / # k MAR25� � NEW ENGLAND ENGINEERING SERVICES INC . March 25, 2004 North Andover Board of Health To? ii OF NORTH AN©G I-FRj 27 Charles Street BOARD OF HEALTH North Andover, MA 01845 G MAR 2 5 ?a�n E Re: 139 Olympic Lane, As-Built Plan y iti-11T... Dear Board of Health, This letter is written to inform you we are submitting an As-Built Plan and Installation Certification for the above referenced property. Enclosed are (3) copies of the As-Built Plan and an Installation Certification. Please contact this office with any questions or concerns. io , Sincerel ,Thomas H New England Engineering Services,Inc. 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@ millriverconsulfing.com]. Sent: Monday, December 08,2003 1:36 PM To: Heidi Griffin; Brian LaGrasse; Pamela Dellechiaie Subject: 139 Olympic Lane Heidi, Brian and Pam, Attached please find the bottom of bed and final construction inspection report for the septic system built at 139 Olympic Lane by John Soucy. No problems were encountered with the septic system construction. Dan Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsultina.com 12/8/2003 a MILL RIVER CONSULTING Septic System Management Services TOWN OF NORTH ANDOVER SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 139 Olympic Lane MAP: LOT: INSTALLER: John Soucy DESIGNER: New England Engineering Services PLAN DATE: 06/24/03 BOH APPROVAL DATE ON PLAN: 11/12/03 DATE OF BED BOTTOM INSPECTION: 11/26/03 DATE OF FINAL CONSTRUCTION INSPECTION: 12/04/03 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE X GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 1,500 LOADING OF SEPTIC TANK = same tank used GALLON PUMP CHAMBER = n/a LOADING OF PUMP CHAMBER = n/a TYPE OF SAS = field DIMENSIONS AND DETAILS OF SAS: 20' x 45' field with 4 laterals SITE CONDITIONS Inspections ❑ Existing septic tank properly abandoned ❑ Internal t aplumbing.all to one building 9 sewer 0 Topography not appreciably altered Comments: Existing tank re-used. 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282.0014 info@millriverconsulting.com Page 1 of 3 MILL RIVER CONSULTING Septic System Management Services SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) Inlet tee installed, over access port Outlet tee (gas baffle or effluent filter) installed, over access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank.if effluent filter is present Hydraulic cement around inlet & outlet Comments: Existing tank re-used. Inlet and outlet tees installed. Tank appeared watertight based on holding of wastewater upon inspection. D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) O Hydraulic cement around inlet & outlets rxl Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM D Bottom of SAS excavated down to C soil layer, as provided on plan E Size of SAS excavated as per plan El Title 5 sand installed, if specified on plan 0 3/4-1 '/" double washed stone installed 0 1/8-1/2" (peastone) double washed stone installed El laterals installed and ends connected to header (and vented if impervious material above) D Orifices @ 5 & 7 o'clock positions 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.80.0.377.3044 978.282.0014 info@millriverconsulting.com Page 2 of 3 A MILL RIVER CONSULTING Septic System Management Services D Elevations of laterals installed as on approved plan ❑ Final cover as per plan Comments: Potable water supply line from street to house was not as shown on design plan. Pipe was rerouted around soil absorption system with slight modification in location of soil absorption system. Waterline location to be depicted on as-built plan. SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 3.36 Height of Instrument: 103.36 INVERT ON DESIGN PLAN ELEV A-TOP OF PIPE INVERT ELEVATION Septic Tank IN 97.39 97.84 97.51 Septic Tank OUT 97.14 97.44 97.11 Distribution Box IN 96.92 97.36 97.03 Distribution Box OUT 96.75 97.16 96.83 Lateral HIGH 96.70 97.08 96.75 Lateral LOW 96.47 96.86 96.53 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282.0014 info@millriverconsulting.com Page 3 of 3 it I CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: `�l� ��i� Name of Designer:— Plan Date: 19 T a� Revision Date: Date of Review: 71V6 Property Address: V C� //� / �_ /Vl,0/<_-: Map:,A,6 Lot: /C3 BOH Reviewer: Type of Plan(new or upgrade): Number of Bedrooms:!�L___1Ggpd) Garbage Disposal Allowed: -An General Information: IN.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK 1Problem N/A r Street number and -ma /lot 22 4 0 P O(u) Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) Legal boundaries of the facility being served-220(4)(a) t/ Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.02i Name.&address of record owner&applicant- NA 8.02k +� &address of designer-NA 8.021 l� Holder nd location of all easements-220(4)(b) a plan drawn &any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) All distances on site plan–NA 8.03a-c t� Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system incl.reserve(new const.)-220(4)(e) Limits of excavation of leach area on site plan-NA 8.02z Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) (5i ✓ Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) Existing grade elevation of each deep hole-220(4)(h) r� Elevation of percolation tests–N.A. 8.02n Name of approving authority representative-220(4)(h) &(i) Name of soil evaluator-220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines,drains,and subsurface utilities-220(4)(m) A- Observed and adjusted g.w. elevation in the vicinity of the system-220(4)(n) Complete profile of the system to scale-220(4)(o),NA 8.02c / Cross section of leaching facility-NA 8.02w (Not to scale) Sf Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) a 2 r / Original R.S./P.E. stamp, signature&date-220(1)&(2) 0 P.E.,discipline specified within stamp. MGL C. 112 s. 8 1 M sfc. supplies(w/in 400'),pub. wells(w/in 250'),pvt. wells(w/in 1.50')-220(4)( Location of watercourses,wetlands, wells,etc.w/in 150'of system—NA 8.02r � Wetland disclaimer—NA 8.02s RLS plan reference&certification required(prop line setbacks)-220(3) Plan contains designer's certification statement Use approvals/standards checked for I/A system-DEP docs., Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) Perc rate > 60 MPI-must use modified tight tank or 1/A technology-245(4) Proposed system qualifies as "shared" system-002(definitions) Flow is over 2,000 gpd-No R.S. allowed-220(1) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment-354 Leaching facility at least 1' above Base Flood elevation—NA 9.05 All piping Sch 40 minimum—NA 10.01 V Basement floor minimum 1' above groundwater elevation—NA 5.04 - Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK /Problem N/A +/ Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown,including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-01.8(2) Proper percolation test log-220(4)(i) Ample deep observation holes in primary disposal area(minimum 2)- 1.02(2) G Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) St-eVe Q--t!� UW, Ample perc testing(one in each disposal area,3 in prim.>2,000'gpd)- 104(4) U � Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: / ground elevation el. v`' � �f� 6 `���✓ • ��c%� acceptable soil el. -=c� 71 / Leach facilitv invert el. ` ��- '�� � ��71A- around � ground water el. ��� ?L W-97 refusal el. l bottom of leach facility el. � 9S,V thickness of acceptable soil before&after soil R&R �--se�424ration�togrou�ndwater r /F a2l i i separation to refusal _ a 6 -17 i soil class 2 3 perc rate j09 f1y) loading rate ''60 septic tank below g.w.table D (yes or no) pump tank below g.w. table (yes or no) l.f in fill -255(l) Setback Distances(Given in feet) 1.5.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility L/ Property line 10 10 Cellar wall 10 20 Inground pool 10 20 Slab foundation 10 10 f/ Deck,on footings,etc. 5 10 Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 t/ Wetlands 75 Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. / (in Watershed) y Trib.To Surface Water supply 325 325 Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains(wat. supply/trib.) 50 100 1/ Drains(intercept g.w.) 25 50 ✓ Foundation drains 10 20 ✓ Drains(Other) 5 10 , Drywells 20 25 1/ Downhill slope 15'to 3:1 slope 3 4 w/o barrier Building Sewer OK Problem N/A ,---"Grease trap required for certain uses(check 230 for details) e diameter listed(4" minimum)-222(1) Pipe�\on d-222(3) Pipe cast' ch 40 PVC—NA 11.02 Waterpecified-222(3)&(4) Pipe lact,fin base-222(5) Pipe laid on continuoo s6grade in straight line-222(7)@ Cleanouts precede all chahges in alignment and grade-222(8) Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment change-222(8) Invert elevation at building: Invert elevation at septic tank: �. Length of run: Slope: (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank , OK Problem N/A \Tank is accessible-228(3) No structures above tank—(228(3) \\,Tank can accommodate both primary&reserve—NA 9.04 •200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) 2-3 drop from inlet to outlet-227(5) Mimmu`m of 4'liquid depth-223(2) 3"air space,above tees/baffles(minimum)-227(4) 4i 9"airspace above flow line(minimum)-227(4) Tees are not to''be replaced by baffles-227(1) Tees extend 6" above flow line-227(1) Inlet tee extends 10�below flow line(minimum)-227(6) Outlet tee extends 14'�below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhol&,,cover above center of tank&each tee(except 2 compart) 228(2) \ 3-20"manholes-228(2) ] childproof,24"riser/manhole w i �6"of final grade if<1000gpd-228(2) Inlet and-outlet tees on center line-227(1) Soil compaction below tank specified(if soil is non-native)-221(2) 6" of<=3/4"stone beneath tank specified-22 Q2 &22 8(1) If> 1,000 gpd AND not a single fam. dwell.must,,be 2 tks or 2 comp. -223(1)(b) If plan specifies disposal must be 2 tanks in series o a2 compart. tank-223(1)(c) Buoyancy calcs.required if tank at or below water tablet221(8) Tank is watertight-221 (1) 9" of cover over tank(minimum)-228(1) H- 1 0 loading(min.)-H-20 if traffic-226(3) Top of tank<=36" below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible 4 5 Tight Tank(Check here if not present: ) OK Problem N/A 500%of design flow or 2000 gallons provided—260(2)(a) 3-20"manholes—228(2) Soil compaction below tank specified (if soil non-native)—221(2) 6"of<=3/4"stone beneath tank specified—221(2)&228(1) Buoyancy calcs.Required if tank at or below water table—221(8) Tank is watertight—221(1) 9"of cover over tank specified(minimum)—228(1) H-10 loading(min.)—H-20 if traffic—226(3) Top of tank<=36"below grade—221(7) All pumping to tank(if applies)in accordance with—229 AN alarm set at 3/5 tank capacity—260(2)(c) Min. 1-24"frame w/cover at finished grade—228(2)(f) Year round access for pumping—228(2)(g) Distribution Box(Check here if not present: ) OK Problem N/A Inlet elevation: Outlet elevation: 9L, 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6" sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b) Outlet pipes laid level for first 2 ft.-232(3)(c) Pipe Sch 40-NA 10.01 Number of outlets: Number of laterals: 7 l� Size of outlets: V " Inlet baffle/tee min. 1" over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6" of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36" below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8) Pump Chamber(Check here if not present: / ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day-220(4)(r) (also 254(1)(d)if gravity from d-box) Minimum 2" delivery line to d-box if gravity-254(1)(c) Pressure dosed Lf.if flow>=2,000 gpd-254(1)(a) &254(2)(a) Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 5 6 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH.220(4)(r) Pump can pass 1 1/4 "solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 Check valve,bleeder hole-NA 12.01 1 childproof,24" riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr.specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9" of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36" below grade-221(7) Leaching Facility(general-complete for all designs) OK/Problem N/A tf' 50%larger if garbage disposal-240(4) _ Trenches to be used whenever possible-240(6) �. No vehicle or imperv. area above l.f.unless unavoidable-240(7);NA 1.3.02 Vented if under impervious cover-241 (1) ✓/ Vented through same pipes as distribution system-241 (1)(a) V Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c) +� All lines connected to vent if bed or trenches-241(1)(d) 9" cover over peastone-240(9) Reserve area provided(new construction)-248(1) Reserve 4' from primary leach area—NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a) &(b) ✓ 4'(down to 2'with variance or I/A-upgrades only)of natural soil under l.f. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 -251(9) Require 5'removal and replacement if in fill-255(5) Top of leach facility<=36" below grade-221(7) Final grade over 11 minimum 0.02 ft/ft-240(10) Surface&subsurface drainage away from 11 -240(1 1)&245(5) Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) ,f Toe of fill slope stops 5'from property line or swale installed-255(2) Impermeable barrier if<3:1 slope or< 15 feet to—3:l slope-255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E. -255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret. wall-255(2)(g) jPere test(s)done in most restrictive layer- 104(2) Pere test 4' below leaching elevation—NA 7.06 a/ Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4" diameter except for dosed system—NA 14.04 I i 6 7 Leach lines capped, vented,or connected together-251(9) Pressure dosing guidance followed if pressure distribution-254(2)(c), .�r Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) Leaching Trenches(Check here if not present: >< ) OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff. 2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (1.1) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) In fill or reserve between trenches, 10' min.-NA 1.4.01& 14.03 Available leach area given(Min.500 s.f.)-NA 9.01(2) Bottom=L x W x# = s.f. Sidewall=L x D x# x 2= s. f. Effective leach area given Loading factor: Effective area=total area s.f. x LTAR = g/day Effective area is>=design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.-247(2) Trench depth of 3/4" to 1 1/2" double washed stone-247(1) Leaching Pits(Check here if not present: ) OK Problem N/A #of pits/pit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit.or system:,L W D Depth of pits(max eff.2'): -253(1)(a) Available leach area given Bottom=L x W x#of systems= s.f. Sidewall=L+W x D x 2 x#of systems= s.f. Total area=bottom +sidewall — s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR = g/day Effective area is>=design flow of facility being served Minimum of 2 pits at least 13'X1.6'—NA 9.01(3) Distribution for galleries/chmbrs. in trench config. -pipe every 20'-253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1 /2"2x washed peastone.-247(2) 3/4" to 1 1/2" double washed stone-247(1) Each pit has at least one 20" access cover. 24" Cl to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents,if necessary,extend under covers of pit(s)-241 (e) Leach Fields(Check here if not present: ) OK Problem N/A Number of fields: (need dosing chamber if> 1,231 (1)) 7 I 8 Length(100'max.): 252(2)(b) (/ Width: y Total area:L x Ws.f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: '66 l/ Effective area=total area 906 s.f x LTAR CJ g/dav t/ Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) f 6'line separation(max.)-252(2)(d) / 4'maximum separation from edge of field to line.-252(2)(e) ✓ 10'minimum separation between adjacent leach fields-252(2)(f) Between 6" and 12" of 3/4- 1 1/2" stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2" 2x washed peastone.-247(2) Final Grading OK/ Problem N/A Slope over leach area minimum of 0.02 feetJfoot—240(10) Grading shall divert drainage away from leach area—240(l 1) Grading slopes away from dwelling LJ A10 17 7-0 O(Ace 7O A) �P74 ��� 5/24/01 8 Commonwealth of Massachusetts Map-Block-Lot.1068-0134- ----------------------- Board Of Health Permit No North Andover -BHP-2oo3-o3sa ---------------------- FEE P.I. 4 $250.00 F.I. i Disposal Works Construction Permit ! Permission is hereby granted John_Soucy-_------------- j to(Repair)an Individual Sewage Disposal System. atNo _139 OLYMPIC-LANE-------------------------- ----------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2003-035 ated _November 10,2003 I ------------------- ---------------- - F� Issued On:Nov-10-2003 Boar Health ------------------------------------------------------------- ! ... ....._.................�.......................................................... ................................................. .... _. r e J v , APPLICATION'FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: J I D CURRENT INSTALLER'S LICENSE# LOCATION: C Lj LICENSED INSTAL R: 6 c SIGNATURE: TEL HONE# Gay CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $ 00 Fee Attached? Yes �� No Foundation As-built? Yes No Floor plans on file? Yes No Approval Date: < I Z y INSTALLER PROJECT MANAGEMENT OBLIGATIONS y As the North.Andover licensed installer for the construction of the septic system for the property at relative to the.application Of (NWated (0=O .for plans by and dated with revisions dated - I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto schedules an ins ectio project manger, or any other person not associated with my company and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicabl inspections as indicated below. I understand that requesting an inspection,. withou completion of the items in accordance with Tile 5 and the Board of Health Regulations mw result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done. first. InstalleVinust request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built o) verbal OK from engineer must be submitted to Board of Health, after which installer calls foi inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. complete.. Does not have to be com c) Final Grade—Installer must request inspection when all gradifig i's p on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to installseptic systems in North Andover can constitute reasons for denial of the- system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. 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) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. tank D-box, pipes, stone, vent, pump chamber, retaining wall and other d Installation of P P components. installation of the system as lel responsible for the install y ' S. As the installer I understand that I am so y p per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersign Licensed Septic In 11 Date: / n -.D Dispo 1 Works Constructi ermit r-9 ru 11 F Y A L a 610 14w .1 0r Postage $ uNzs ID: 0630 a 0 Certified Fee O Postmark Q Return Reciept Fee Here (Endorsement Required) 1.75 M Restricted Delivery Fee r1 (Endorsement Required) Clerk.: KK5NFG S ru Total Postage&Fees $ 4.42 08/16/03 ru O sent To e —'----------------------------- Sfreef,Apf NE - or PO Box No. J----------------------- ----------------�/ nz !C. -------------------------- City,State;ZIP+d - � n f Certified Mail Provides: assn w ao ssszo� ® A mailing receipt (esieney)Zooa ounr'pceg uuo--4Sd o A unique identifier for your maiipieoe ® A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Made or Priority Mail®. a Certified Mail is not available for any class of international mail n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. m For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811 to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. n For an additional tee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mallpiece with the endorsement"Restricted Delivery".,,. a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. (0 2UD Oru �. �S Er Postage $ UWIT IU: 0630 a 0 Certified Fee 30 O Return Reciept Fee P Herea rk (Endorsement Required) c 0 Restricted Delivery Fee r-I (Endorsement Required) Clerk: KK5NFG Total Postage&Fees $ 4.42 08/16/03 ru O Sent To (� E rr �`' Sfr'eet,Apt No.; 11 ii or PO Box No.-.l.S��!_._.. 'y� ..... ..ht................................ City,State,ZU'+4 I Certified Mail Provides: ZM-w-30-96530t o A mailing receipt (esJanea)Zoog eunr'oogg uuo:j Sd ® A unique Identifier for your mallpiece a A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail@ or Priority Mail®. o Certified Mail is not available for any class of international mail. c NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain ReturnReceipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS@ postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery. n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. M ' • ru � e �. ass E . � 13- Postage $ , a 037 UNIT IU: 0630 Q Certified Fee M 2.30 Postmark C3 Return Redept Fee Here (Endorsement Required) 1.75 O Restricted Delivery Fee r9 (Endorsement Required) Clerk:: KK5NFG ru Total Postage&Fees $ 4.42 08/16/03 ru L3 Sent To -- orPOBox No. - -AL `a"�. - --------------------------------- Crfy Slate,ZIP+4 ,1 Certified Mail Provides: z6el'w zo 56520! a A mailing receipt (esjeney)2003 eunr 0089 uuo:,Bd in A unique identifier for your mailpiece m A record of delivery kept by the Postal Service for two years Important Reminders: ® Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ® Certified Mail Is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted Delivery". o If a postmark on the Certified Mail receipt Is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt andpresent it when making an Inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SENDER COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■'Complete items 1,2,and 3.Also complete .A. Signature item 4 if Restricted Delivery is desired. X,131 � a n�0❑0,Agent ■ Print your name and address on the reverse l�! I,P Addressee so that we can return the card to you. B. Received by(Printed Name) C. Dat of Deli ery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address di erent from item 1? ❑Ye 1. Artiott Addressed to: If YES,enter delivery address below: ❑ No i 3N N IQ ID(ZTH Ati D t)vea. jo✓{ 3. Service Type VCertified Mail ❑ Express Mail 01 ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (rransfer from service label). 7002 2 410. 0001 9962 1059 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-0835' UNITED STATES POSTAL SERV _ESSa Pos aid Pm -MpS FF JIR • Sender: Please prim you mame, address, a6dZlP.f4 NEIN ENGLAND ENGINEERING 60 Beechwood Drive L-_ North Andover,MA 01845 t$YD 1111 fill 1111111411111111141111111tl 111111ifil„111111111111111 SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■'Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No • i 3. Service Type A j>I)Jvj, A Certified Mail ❑ Express Mail 10 1 t347- Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number -- - (transfer from service label) ?002 2 410 0001 9962 1080 �A PS Form 3811,August 200-1-----Domestic Return Receipt 102595-024-0835'. UNITED STATES POSTAL SERVI m.._First-Class<Mail-.,."T �•._ ���� Postage&Fees Paid " Permit No.G-10 .J s. v •. • Sender: Please print yo`Rarae, address, and ZIP+4 in this box' IJEW ENGLAND ENGINEERING 60 Beechwood Drive 6--North Andover,MA 01845 SENDER COMPLETE • N'Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. V6�Agent■ Printyour name and address on the reverse Xee SO that we Can return the Card to you. B.deceived by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑ No 3. Service Type fU� Pt ����G��r�'• f'n� P Certified Mail ❑ Express Mail of 9L(5 ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (fiansfer from service label) 7002 2410 0001 9962 1,066 PS Form 3811,August 2001 Domestic Return Receipt - 102595-02-M-0835 UNITED STATES POSTAL SERVI ;. I_ " it assdlaail . to Postage&.Fees.Paid P's'•� �1 USPS Permit No.G-10 L • Sender: Please print yobs me, address, and ZIP+4-in this box • NEIN ENGLAND ENGINEERING 60 Beechwood Drive L-North Andover,NIA ol845 .., I1G�E���1lI: l��lSII,I,I,„1!!!Il11ItItIII H,dt.,1131 MlIIf COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■'Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X i ❑Addressee so that we can return the card to you. B. Received b rinted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No r � �`CJISAN yw? 3. Service Type ,V c.,2f j{ N,,7 p,,cA ,,.AA P Certified Mail ❑Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7002_2410 0001 _9962 1073 (Transfer from service labe,-.___: �. PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-08351 , UNITED STATES POSTAL SERVIC ! "'Postage&-Pees'Pad P IM" USPS Permit No.G-10 • Sender: Please print yodr-66me, address, and ZIP+4 in this box • NEW ENGLAND ENC!11�: ^Et'^ 60 Beechwood Drive L Odh Andover,MA 01845 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete FA.,,5' natureitem 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. a eived by(Printed Name) C. D of Delivery ■ Attach this card to the back of the mailpiece, /�l or on the front if space permits. c D. Is delivery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No MATT?IEW CUNdF' UNIGS 208 SUMMER ST. NORTH ANDOVER,MA 02845 3. Service Type ❑ Certified Mail El Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 1940 0002 6846 1395 (Transfer from service label) __ � PS Form 3811,August 2001 Domestic Return Receipt 102595.02-M-0835 S ev-t)OA A'X UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • NEW ENGLAND ENGINEERING 60 Beechwood Drive North Andover,MA 01845 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. n ture item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse. X ❑"Addressee so that we can return the card to you. B. Received by(Printed Nam) C. D t of livery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No PETER IIOFFN AIN ' 236 SUMMER ST. NORTH ANDOVER,MA 02845 3. Service Type ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 1940 0002 6846 1401 (Transfer from service label) PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-0835 Sc1ym— .n UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • NEIN ENGLAND ENGINEERING 60 Be9chW00d Drive North Andover,MA 0184 5 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete ignature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Re eived by(Printed Name) C. Dat of elivery ■ Attach this card to the back of the mailpiece, /� or on the front if space permits. l 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑ No PALL rCIlt tRINSKE 39 SPRING HILL RD. 3. Service Type NORTH ANDOVER,MA 02845 ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number - - - - (Transfer from service label)1 7001 1940 0002 6846 1425 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-08351 SL) n me 2 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • NEIN ENGLAND ENGINEERING 60 Beechwood Drive North Andover, MA 01845 SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si nature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse Addressee so that we can return the card to you. B. Received by(Printed Name) C. t�Cof Delivery ■ Attach this card to the back of the mailpiece, � or on the front"Ff space permits. 1. Article Addressed to: D. Is delivery address different from item 1? 13Yes If YES,enter delivery address below: ❑ No JAMES KP.WER 30 SPRING HILL RD. NORTH ANDOVER,MA 02845 3. Service Type ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes z. Article Number 7001 1940 0002 6846 1418 (Transfer from service label« PS Form 3811,August 2001 Dyo1mestic Return Receipt 102595.02-M-0835 _4 L) ir Y't j,_{4' UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 Sender: Please print your name, address, and ZIP+4 in this box • NEW ENGLAND ENGINEERING 60 Beechwood Drive North Andover, MA 01845 COMPLETE •N COMPLETE THIS SECUONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signa re item 4 it Restricted Delivery is desired. ❑Agent s Print your name and address on the reverse Addressee so that we can return the card to you. VR, by(Printed Name) CIt of De ivery ■ Attach this card to the back of the mailpiece, J�, or on the front if space permits. ` D. Is delivery address different from item 1. Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No VERONICA 111ANDR.' 219 SUMMER ST. NORTH ANDOVER,MA 02845 3. Service Type ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise -- - - - — — - ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 1940 0002 6846 1388 (Transfer from service/at, PS Form 3811,August 2001 e�Omestic Return Receipt 102595-02-M-0835: UNITED STATES POSTAI SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • NEW ENGLAND ENGINEERING 60 Beechwood Drive Norih Andover, SIA 01(',,;5 o, pryV.lrt� _ I Ln O •. • I ,. I S Q' Postage $ UNIT ID: 0630 C3 Certified Fee EM Postmark O Return Reciept Fee Here (Endorsement Required) 1.75 M Restricted Delivery Fee r9 (EndorsementRequired) Clerk: KK5NFG rU Total Postage&Fees $ 4,42 08/16/03 ru Sent To T !!� ' b°NW Apt./J � _._.FA.__ Je_�_u:��________________________ or POBox N0.------N . - U7 + QL. fN7`r -i'= ne City,Stare,ZIP+4 0xn vo PvekR dta Z69t-W-ZO.565Z0� Certified Mail Provides: taswneal aoozeunr'000suuodSd ® A mailing receipt a A unique identifier for your mailpiece a A recons of delivery kept by the Postal Service for two years Important Reminders: ® Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. a Certified Mail is not available for any class of international mail. 0 valuables pleaasse consider Insured orPROVIDED Registered Mail. Certified Mait. For m For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt Is required. ®For an additional fee, delivery may be restricted to the addressee or addressee's authorized aant.Advise the clerk or mark the mailpiece with the endorsement"Restrictedgelivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. Ln Y bQ f A 3/... y 9 T: $. $ 9 j-n Postage $ /1� Y- Certified Fee Postmark..I ru Return Receipt Fee ��dere,. O (Endorsement Required) O Restricted Delivery Fee ^- 0 (Endsrsement Required) C] Total Postage&Fees y Q' Sent To rq PAUL L'IItJRINSIr,E •••••- r-qC3 or PO Box 1 r PAPt:' C3 39 SPRING HILL RD. or ------ C3 __N ciiy,sure,; NORTH ANDOVER,MA 02845 Certified Mail Provides: ■A mailing receipt ■A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority.Mail. ■Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Farm 3800,January 2001 (Reverse) inmag_m ni n... co ,rte I� F F I C I A L/ -n Postage $ Certified Fee " Postmark (y Return Receipt Fee Here,r (Endorsement Required) [-3 Restricted Delivery Fee M (Endorsement Required) C3 Total Postage&Fees $ S Q" Sent To r-a Street,Apt.No.; JAMES KRAXIER A C3 or po sox No. 30 SPRING HILL RD. �C3 ciiy Siete;ziP; NORTH ANDOVER,MA 02845 Certified Mail Provides: ■A mailing receipt ■A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: ®Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425 a o tr Postage $ Cc rp certified fee ru Return Receipt Fee ` Postmark 0 (Endorsement Required) --.,Here Here O Restricted Delivery Fee 0 (Endorsement Required) C3 Total Postage&Fees Er � P PETER IIOFFMI e,N o °'p 236 SUMMER ST. N airy, ........... NORTH ANDOVER,MA 02845 Certified Mail Provides: ■A mailing receipt ■A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: ■Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. mi NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. ac rgnnn i.. 9nni in..% 1n9606.M.ni.9d95 ca co 1 0 F F C _.�._. �n Postage $ � —0 Certified Fee ru Return Receipt Fee stmaricp C3 (EndorsementRequIrea) �ereO C3 Restricted Delivery Fee O (Endorsement Required) O Total Postage&Fees .$ I f IrSe rq VERONICA 1V�4NDRV a .---------------- C3 or 219 SUMA ER ST. C3 cii NORTH ANDOVER,MA 02845 ""--""----- Certified Mail Provides: s A mailing receipt ■A unique identifier for your mailpiece ■A signature upon delivery ■A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■if a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PC Fnrm SenO.January 2001 (Reverse) 102595-M-01.2425 o- m .` l': C I A L € w f trtt� -a Postage $ 1:O p Certified Fee CRstmark — ru Return Receipt Fee Here r - C3 (Endorsement Required) , C3Restricted Delivery Fee �% (Endorsement Required) O Total Postage&Fees E' Ser r—1 ra S[ie KAXTI EW CL"� b'IINOS --------------- C3 or F 208 SUMAER ST. r- ciiy; NORTH ANDOVER,MA 02845 Certified Mail Provides: a A mailing receipt ■A unique.identifier for your mailpiece s A signature upon delivery ®A record of delivery kept by the Postal Service for two years Important Reminders: s Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail Is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. ®For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. B If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425 NEW ENGLAND ENGINEERING SERVICES C S INC April 14, 2003 Sandra Starr,Administrator North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 224 Summer Street, Septic system design Dear Sandra: Enclosed are the certified mail receipts for the abutter notification of the hearing for the variances required for approval of the septic system design plan at the above referenced property. I will supply the green return cards at your meeting. If you need any additional information, or you have any questions,please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood,Jr., IT President 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 I FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ..............����.��............ ................................................. APPLICANT6aii,, PHONE ASSESSORS MAP NUMBER 1 LOT NUMBER oaq SUBDIVISION LOT NUMBER STREETC- STREET NUMBER .........rrrr ■ ■■..rrrrrrrrrrr/rrr■............................... ........ OFFICIAL USE ONLY rrrr■■errrrerrrrrrrrrrrrrrr■■rrr■■r■■rrrrrrrrr�rrrrrrr■■rrrrrrrrrrrrrrrrrrr■ ICORVATION &TRAA'fOR OF TOWN AGENTS ■ ■■ ... .. ......■rrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ ..rrrr DATE APPROVED DATE REJECTED COMMENTS v. v iV1l I M 1 j s TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED FOOD INSP CTOR-HEALTH DATE REJECTED DATE APPROVED SE SP To - DATE REJECTED COMMENTS �1' Ll T'r h r .✓ZZ / I ✓, gi Y �? 1 ►y'c�I�f'rl 1i _ , PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE ,sem COMMONWEA(a(DIA PASACTiUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION METROPOLITAN BOSTON- NORTHEAST REGIONAL OFFICE MITT ROMNEY ELLEN ROY HERZFELDER Governor Secretary KERRY HEALEY ROBERT W. GOLLEDGE,Jr. Lieutenant Governor Commissioner October 14, 2003 Philip Fer.-aguto 139 Olympia Lane North Andover,Massachusetts 01845 Re:TITLE 5 VARIANCE REQUEST Application For: BRPWP59b 139 Olympia Lane,North Andover (17-Ipswich) DEP Transmittal No.W044061 Dear Mr. Ferraguto: Your application and the correct payment for the Title 5 variance requested listed above have been received and a start date of September 30, 2003 has been established. In accordance with 310 CMR 4.04.and 310 CMR 15.412(2) the Department has 30 days to per its review and either request additional information or issue a decision to grant or deny the application. If the Department does not act on your application within these 30 days,your variance request shall be considered presumptively approved in accordance with 310 CMR 15.412(3) and work may commence. In the event your application is presumptively approved,you are not entitled to a refund of the application fee. If you have any questions regarding your application,please contact me at(617) 654-6516. Very truly yours, �12'1 Claire A. Golden Environmental Engineer Bureau of Resource Protection cc: • Board of Health,27 Charles Street,North Andover,MA 01845 • Richard C.Tangard,P.E.,New England Engineering Services,Inc.,60 Beechwood Drive,North Andover,MA 01845 This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. One Winter Street,Boston,MA 02108•Phone(617)654-6500•Fax(617)556-1049•TDD#(800)298-2207 DEP on the World Wide Web: http://www.state.ma.us/dep Z"a Printed on Recycled Paper Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street 4roo North Andover,Massachusetts 01845sawcWSt` Sandra Starr Telephone(978)688-9540 Public Health Director Fax(978)688-9542 September 22,2003 Ben Osgood,Jr. New England Engineering Services,Inc. 60 Beechwood Drive North Andover,MA 01845 RE: 139 Olympic Lane,North Andover Mr.Osgood: This letter is to inform you that the North Andover Board of Health,at their regularly scheduled meeting on August 28,2003, they unanimously voted to issue a variance to 310 CMR 15.104 to allow the use of a sieve analysis to determine the loading rate of the soil in lieu of a percolation test as required. The North Andover Board of Health soil evaluator,Sandra Starr, also indicated that the soil on site in the C layer is not compact. Should you have any questions,please do not hesitate to call the Health Department at the nu r list be ow. lVmrK LaGrasse, Health Inspector cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 _.I. NEW ENGLAND ENGINEERING SERVICES INC August 25, 2003 North Andover Health Department Town Hall Annex 27 Charles Street North Andover,MA 01845 Re: 139 Olympic Lane,North Andover, Septic system design . TOVViV C2F n!0IvFO�r�R Dear Sir or Madam: Lo�,r)C)F s 1 � Enclosed are the final soil sheets for the above referenced property AUG 21 2003 Sincerely, -�w--�- �(..�"�� Benjamin C. Osgoo r.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 I I r FORM 11 - SOIL EVALUATOR FORh1 Page 1 of 3 No. Date: Commonwealth of Massachusetts N°• , Massachusetts oil Suitability Assessment for On-site Sewage Disposal Performed By: ......... ......�.... ... .. Date: 2�/d3 Witnessed By: .................. ......... � /� / .................................-.7............. ................ .... ...... .. LA=tfon Address or / 9 cl L� �« ���� Ow Xr s Name, //uiZ_ La! A o Address,and ��L G//tll/�C� � Telephone! ew construction ❑ Repair 78 Office 2—o855— Office Review Published Soil Survey Available: No ❑ Yes 46 Year Published � .�.......... Publication Scale �4� ................. Soil Map Unit Drainage Class ` �L................... Soil Limitations � /�!�� f � ......................... ....................................... ... .. ... . ...._ .. Surficial Geologic Report Available: No © Yes ❑ a Year PublishedPublication Scale Geologic Material (Map Unit) '`�4�' .` '"� �� .... .... Landform .......................................................................................................... ...:..... .�..........G Flood Insurance Rate Map: Pu i Above 500 year flood boundary No []Yes ❑ Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) ......... ................................................ .... . Current Water Resource Conditions (USGS): Month /� Range :Above Normal ONormal ❑Belau Normal ❑ Other References Reviewed: DEP APPROVED FORM•12/07/95 R FORM. 11 - SOIL EVALUATOR h'ORm Page 2 of 3 Location Address or Lot No. ��/�2`��C C �� /�. ���� On-site Review / a Deep Hole Number Date:... Time: 1. 3� Weather t '�0� Location (identify on site plan) Land Use . ! ✓Tf4L Slope (%) . Surface Stones Vegetation . � ..,. �..:....: :. Landform Position on landscape -5rl Distances from: Open Water Bodye;�e,00 feet Drainage way,�mO feet Possible Wet Area ���. . feet Property Line -20.. feet Drinking Water Well feet Other .. .�-..,..., .,.:. ,.. . DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soll Color Soil Other Surlace (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders. Consistency. 'ro Gravel) • — // Go�� 17��j �26g8 C� � Z,iV7x,(cT �Ii¢ o o Com �a� Parent Material igeologici _(. �� CO'�� yr s`' DepthloBedrock: Dspth to(roundweter; Standing Water in the Hole: Weeping from Pit Face: Eslimaud Seasonal High Ground Water: DEP APPROVED VOW• 11/07/95 4 FORM. 11 • SOIL EVALUATOR FOWNI Page 2 of 3 Location Address or Lot No. � O�y2iC On-site Revie 0 Deep Hole Number .,. Date;.,. :� �-3 Tim e: l'�`� Weather<21W � . Location (Identify on site plan) Land Use Z�`-IZ.ON7,44- Slope M . Surface Stones Vegetation . ���'�� landform .. � �� '�� � Position on landscape Distances from: Open Water Bodyo�©mo feet Drainage way,,2o feet Possible Wet Area . 7s. feet Property Line .. d.. feet Drinking Water Well .7!� feet Other . .. .. ... .. . .... . DEEP OBSERVATION HOLE LOG' Oepth from Soil Horizon Soil Texture Soll Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consiveocy. �p Gravel) l _ Parent Material 19eolOglc! ®4"y'' sW DepthtoBedrock: Depth to 4►2yndwater: Standing Water In the Hole: �/ Weeping from Pit Face: Eslinuted Seasonal High Ground Water: UEP APPROVED FOfU t• 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No/ QGy `��� rt/�i NO•,���d� Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole........... inches ❑ Depth weeping from side of observation hole ........... ... inches i Depth to soil mottles ....t : : inches Z � ❑ Ground water adjustment ................... feet # Index Well Number .................. Reading Date .................. Index well level ......... . . . Adjustment factor ................... Adjusted ground water level ..................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in al areas observed throughout the area proposed for the soil absorption system? � If not, what is the depth of naturally occurring pervious material? Certification I certify that on �4w-(date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature G �� Date DEP APPROVED FORM•12/07/95 E ,AORT" TOWN OF NORTH ANDOVER or°��,`•':..a"� o� HEALTH DEPARTMENT y p 27 CHARLES STREET ' NORTH ANDOVER,MASSACHUSETTS 01845 ss^CHUSE Heidi Griffin Telephone(978)688-9540 Acting Health Director FAX(978)688-9542 Notice of Decision Year 2003 Property at: 139 Olympic Lane NAME: Philip&Marie Ferraguto HEARING(S): 8/28/03 ADDRESS: 139 Olympic Lane PETITION: 8.28.2003-01 North Andover,MA 01845 TYPING DATE: September 3,2003 The North Andover Health Department held a public hearing at its regular meeting on Thursday,August 28,2003 at 7:00 PM at the DPW Building,384 Osgood Street,North Andover,MA upon the application of Philip and Marie Ferraguto,139 Olympic Lane,North Andover,MA,Map 106.B,Block number 0134, requesting an approval of Variances to the i app requirements of the Title 5,the state law governing the installation of septic systems. j The request is being made to allow the installation of a septic system to replace the existing failed septic system. The following Variance is being requested TITLE 5 VARIANCE: Allow the use of a sieve analysis to determine the loading rate of the soil in lieu of a percolation test as required by Title 5 section 15.104. A notice was advertised by New England Engineering Services to the abutters of this address regarding the request of Mr.Phil Ferraguto. The following members were present: Jonathan Markey, Chairman; Cheryl Barczak, Clerk. Upon a motion by Jonathan Markey and 2"d by Cheryl Barczak,the Board voted to allow the petitioner to allow the use of a sieve analysis to determine the loading rate of the soil in lieu of a percolation test as required by Title 5,section 15.104. Voting in favor of the variance: Jonathan Markey and Cheryl Barczak. Town of North Andover Board of Health, Jona ey,Chairman Xc: Ben Osgood,New England Engineering Decision 8.28.2003-01 t%ORTy TOWN OF NORTH ANDOVER PUBLIC HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 SgCHUSE Sandra Starr Telephone(978)688-9540 Public Health Director FAX(978)688-9542 August 5, 2003 Ben Osgood, Jr. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 224 Summer Street, North Andover Dear Mr. Osgood: This letter is a re-iteration that at their regularly scheduled meeting on April 24, 2003 a duly advertised hearing was held to determine whether the North Andover Board of Health would consider a variance to 310 CMR 15.000, the State Environmental Code, to accept the results of a sieve analysis in lieu of a percolation test to determine the loading rate for a septic repair design at 224 Summer Street, North Andover. After deliberation and the assertion by the Health Director that the soils on the site were not compact, the Board voted unanimously to approve the variance request and accept the sieve analysis results. Should you have any questions, please do not hesitate to call the Health office at the above number. k FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT EfL-60r, R PHONE 7-7 -I�T--a s-7 7 ASSESSORS MAP NUMBER LOT NUMBER J SUBDIVISION LOT NUMBER STREET OL- +AAQ 1C- L A f9 STREET-- NUMBER � ............................r■■smo..amos.MMMM..sMEoo.a0Mason ......Mass..... OFFICIAL USE ONLY ...........................■.M.00a....�..s.ss.....Ma.o.ma■ ■aMosoMM■ RECOMMENDATIONS OF TOWN AGENTS �....................................................move. .................. DATE APPROVED CONSERVATION UJaa4i 41 for a, DATE REJECTED COMMENTS !ro►p�i i tea-+�'`�n s� �D N f0 s�yN DATE APPROVED TOWN PLANNER ' DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED /Srl�a S DATE APPROVED b EPTIC INSPECTOR-HEALTH rr ` DATE REJECTED CONMIENTS ����-Lc. \� t"�J+� s 6A .I 90, i-ej ienfa u PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE _ ttORTH R TOWN OF NORTH ANDOVER 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��-0OkkiEU.pR��y ss�CH Sandvi Starr Telephone (978)688-9540 PublicHealth Director FAX(978)688.9542 July 10, 2003 Ben Osgood, Jr. New England Engineering Services, Inc. North Andover, MA 01845 RE: Septic Design Plan, 139 Olympic Lane Dear Mr. Osgood: A review of the septic design plan by New England Engineering Services dated June 24, 2003 and received on July 1, 2003 has been completed. Unfortunately, the plan cannot be approved as submitted. The following items are in need of attention prior to plan approval: 1. The site plan indicates an easement on the southeast side of the property, please note its purpose and state the holder of the easement. 2. The discipline of the engineer should be indicated on the stamp. 3. Please indicate the regulatory reference for each variance requested. Please feel free to contact me with any questions you may have. Our office looks forward to working with you to obtain a replacement septic system that will comply with all regulations and ensure protection of public health and the environment of North Andover. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: homeowner �e ti Page 1 of 5 9A-APPLICATION FOR LOCAL UPGRADE APPROVAL; Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non-conforming system with a design flow of<10,000 gpd, where full compliance, as defined in 310-CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non-conforming system with a design flow of 10,000 u to 15 000 and/or for upgrade of state P of federal facility, ty, where full compliance, as defined in 310 CMF 15.404 1 is not feasible. NOTE: Local upgrade approval pg pp shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: J:�c(z-a 66-,jT� Address: 3 c 0r..yA4P(C. i-ANu-, /u� iL-)i-1 ANiDo-,2 Phone#: y?s-- 6Z39- osss' Address of facility: 2) Applicant(if different from above) Name: e Address: Phone#: 3) Type of Facility: -2 _Residential Commercial School Institutional (Specify) S iNl-L.is FANigcu ().✓� u !.y [+- Page 2 of 5 4) Type of Existing System: _privy cesspool(s) (_conventional system other(describe) Type of soil absorption system(trenches, chambers, pits, etc.) D 5) Design Flow Based on 310 CMR 15.203: a) Design,flow of existing system gpd Approved: _dyes Approval date: ? no Why: b) Design flow of proposed upgraded system y Y J Why_j t Q,)t 2 F c) Design flow of facility -ij 4 o gpd 6) Proposed upgrade of existing system is: a) Voluntary required by order, letter, etc. (attach copy) —Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) Tr C- ;> (date) b) Describe the proposed upgrade to the system: IA/3716Li.- NFw LEftCH OC r"Xs% N G– iAN/L c) Which of the following are applicable to the proposed upgrade? Reduction of setback(s)(list setbacks to be reduced with proposed setback distances) Percolation rate of 30-60 minutes per inch(state actual perc rate) Up to 25% reduction in subsurface disposal area design requirements (state required& proposed size) Relocation of water supply well(identify well, describe relocation) Reduction of required separation between bottom of SAS &high groundwater(specify proposed reduction& perc rate) t %b 3 ` Page 3 of 5 Other requirements o!f 310 CMR 15.000 that cannot be met(specify sections of the code) Feta. Woo^ Te-:;T SEC i to VN P SLrl vii' System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405,or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) If thero osed upgrade involves p p pg es a reduction in the required separation eqbetween the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the g high round water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: Ste: �;��,� ,g.(z R Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority,P pp g o ty,then such notice to abutters must be completed prior to the date of submission of the application to the department. . PP The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. Page 4 of 5 List of affected abutters: Abutter Name Date notified ' Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address __. 9) Explain why full compliance,as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgra(lded sy(s"�tem in full compliance with 310 CMR 15.000 is not feasible: - r�2 Duan i7 s b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. c) A shared system is not feasible. --ND d) Connection to a sewer is not feasible. 10)An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications,site evaluation forms), must accompany this application. Is the D SCP application attached. yes no f Page 5 of 5 I 11)Certification I I 1,the facility owner,certify under penalty of law that this document and all attachments, to the best of my knowledge and belief,are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including,but not limited to, penalties or fine and/or imprisonment for knowing violations." Facility Owner's Si ature Date Print Name n n osy s - Lal 3 Name o Preparer Date 7 10 - 8 19eec Telephone No. &Address of Preparer NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. it SEPTIC PLAN SUBMITTALS 1 � LOCATION: v? I wX Map & Parcel /®6v / 41, NEW PLANS: YES $225.00/Plan i/- Check#: REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO DATE: fa I3 ��a DATE TO CONSULTANT: DESIGN ENGINEER: 10 Telephone#: - L>1M, -17 6G When the submission is complete (including check), date stamp plans, COPY for Conservation, and place in existing file with green Design Approval form. 139 OLYMPIC LANE JS-2003-0638 Proiect Detail Report Printed On:Wed Mar 31,2004 Project Name: GIS#: 7026 Project No: JS-2003-0638 Owner of Record FERRAGUTO,PHILIP J&MARIE Map: 106.13 Date Submitted: May-05-2003 139 OLYMPIC LANE Block: 0134 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 139 OLYMPIC LANE Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Soil Testing Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0020 3/31/04-COC Issued. 3/25/04-As-Built and Installation Certifications dropped off by Tom of NEES. READY FOR FINAL GRADE INSPECTION. 11/10/03-DWC permit issued. 8/12/03-Perc test scheduled for 8/13/03. If not able to do,will still need to be at meeting for a variance.--p.d. 7/10/03-Thurs.- 1:15 p.m.Ben Osgood left msg.Re:plans. He needs to advertise variance by Friday and notify the abutters. Please call him at C:508-328-4633 asap.--p.d. 7/1/03-Wed.-Received and processed application for Design Review. No folder returned to active files,so placed application/plans in Sandy's Design inbox. 5/28/03:Soil test done today @ 1:30 p.m.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Design Approval-Plans BHP-2003-0156 Jul-02-2003 SIGNED OFF JS-2003-0638 Design Plans DWC-System Repair BHP-2003-0358 Nov-10-2003 SIGNED OFF JS-2003-0638 Repair-Complete Form U Signoff-construct BHP-2003-0257 IN PROCESS JS-2003-0638 Above ground pool in backyard Repair Soil Tests BHP-2003-0060 May-05-2003 Signed Off JS-2003-0638 Soil Testing Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Grade DWC-System Repair BHP-2003-0358 Mar-31-2004 FULL COMPLY Susan Sawyer JS-2003-0638 Final Inspection DWC-System Repair BHP-2003-0358 Dec-04-2003 FULL COMPLY Dan Ottenheimer JS-2003-0638 GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 2 139 OLYMPIC LANE JS-2003-0638 Proiect Detail Report Printed On: Wed Mar 31,2004 I Bottom of Bed Inspection DWC-System Repair BHP-2003-0358 Nov-26-2003 FULL COMPLY Dan Ottenheimer JS-2003-0638 i GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 a. Form No,z Town of North Andover, Massachusetts NORTh BOARD OF HEALTH 14, 19 p i DESIGN APPROVAL FOR ss�CHUstt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant //"Izx / Test No. Site Location Reference Plans and Specs. zls E INEER DESIGN DATE Permission is granted for an Individual soil absorption sewage disposal system to be installed `< in accordance with regulations of Board of Health. 4 CHAIRMAN,BOARD OF HEALTH Fee U�`� / Site System Permit No. ^---�-^t...^.5;:._.-..T.-:......4,---•.w.-+..-.-..._-,-..T ...-,..--.4-.,m--..x...t. _ .ss.,..,.--.-__ _....—z.--_-�.---e--.`--•-P---�.-..---..--�.-r-.,-.-.-..-------•+:_•- .--�-�---._..__,.'_-__ —Town of North Andover, Massachusetts- Form No. , pORTH BOARD OF HEALTH 0 A., 1646 OL APPLICATION FOR SITE TESTING/INSPECTION I ��SSA C H USE��y Applicant At�"f'11"'�-'z C_NAME ADDRESS TELEPHONE Site Location % . % ' Engineer NAME- ADDRESS _ TEL, PHONE Test/Inspection Date and Time /OZ 10CHAIRMAN,BOARD OF HEALTH Fee �e�of(�? _ Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 77 7 77 77 77, Town of North Andover,'Massaclhusetts Form No. 1 �%ORTH BOARD OF HEALTH ow 0 APPLICATION FOR SITE TESTING/INSPECTION ATED SSACHU5 Applicant UNAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/l nspection Date and Time 2 AIRMAN,BOARD OF HEALTH Fee— Test No. l�X7— S.S. Permit No. No. C.C. Date—Plbg.,Permit No. 1 �t BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 4 MAY — 2 as APPLICATION Y — APPLICATION F R O SOIL TESTS DATE: Z o MAP&PARCEL: LOCATION OF SOIL TESTS: c 1 tJ��i ivy �-.���i -- C�,f c�Q �. OWNER:_ 0 TEL.NO.: ADDRESS: LII vt e ENGINEER: New England Engineering TEL.NO.: 978-686-1768 CERTIFIED SOIL EVALUATOR: Richard C. Tangard and benjamiNC osgood Jr. Intended use of land: Residential Subdivision Single Family Home Commercial Is This: / Repair testing Undeveloped lot testing r In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum w P _ two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septicY Po s stem disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than 1" -100')shall be submitted to the Board of Health showing n the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write elow This Line N.A.Conservation Commission Approval: � I G �►cct t IJ Date Received: ' Check Amount: Check Date: ° Q Oz --- - - I I emmis- , " �-i�,7` i � T 01 �"" 155R�-,- , 'fif'r : -8, - ��, -, -�, �'�f, -,i�' "i -,�,---,,�-, , I "11,7 - , -�n m'�---�-". --i�-,-n--�',,�"?r 2.," ----,�.-,�---,',,�, ---,i.V,-----.-,"------,,-,"" .���,,!,,,.�-"".-.�-,-�-,�,,�"-'�-,,-,� ", �',� , `,-- - a,h-, ��,,�� ,�,t--.,%,,'z,,i,- ----:,-',',,.,, - �, !.,.e, "�-� ,`� "----�ii,,',-��*,-' T, ,,,g . � "" lg� -,,-,�,����g�z-k��.-�t�Nkt���f,�� � -, .," ,,,; - , - ``�`5'1"'-`-`��, �,'. . , . 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",I 1�, -�---� , �, . , 1 7 - , , - . - - - - - - - - -- - - - - - - - ------------- -- --- - - SOIL TEXTURAL TR ANGLE Project: 139 Olympic Lane North,lkndover, MA Sample No. : 9522 90 Based on the fraction passing the No. 10 sieve sample contains 72.8% sand, 24.0% silt, and 3.2% clay. 8 Q USDA Testural class = loamy sand ' 70 lay �� 60O 0 C 50 - C1 ,y cl �Q 30 s a n^A Ga o �o 20 10 — an 1p'a i 1 u ail 10 m CP) :lilt t ) 00 p 00 percent sand C�c G� 1 GRAIN SIZE DISTRIBUTION TEST REPORT - < Cc N C C C •- '- •- C < N 0 O O O O � O 100 N � M i l ao I ! II i 70 Z I L W 50 U I � w 4O W i II 30 I I 20 10 II 0 � f 200 100 10.0 1 .0 0. 1 0 .01 0.00 GRAIN SIZE - mm % +3" % GRAVEL % SAND % SILT % CLAY USCS LL PI • 0 . 0 22 . 5 56 . 4 18 . 6 2 . 5 SM SIEVE PERCENT FINER SIEVE PERCENT FINER Location : inches • number • •ON SITE size size 1 100.0 4 83.0 0 . 75 95 .6 10 77 .5 0. 375 88 .2 20 71 .5 Description : 40 64.3 • F-M SAND, SOME F-GRAVEL 50 58.4 LITTLE SILT, TRACE CLAY 100 42 . 1 GRAIN SIZE 200 24.5 D 0.324 3 D 1 0.0174 - Remarks : COEFFICIENTS v'i : #200 WASH SIEVE cc 1 . 70 _.�. Cu 18 . 6 UTS OF MASSACHUSETTS, INC_ Project No . : 8066 5 Richardson Lane Project : 139 Olympic Lane, North Andover Stoneham, MA 02180 Date: 6/15/03 Sample No . 9522 U01 1731 ZUUl.l. X0 I?01-.11-14ul 1 0 I MiNkaMMUM r-Hur- Ul FORM.11 - SOIL EVALUATOR FORM Page 2 of 3 Locz6on Address or Lot No: On-site Review Deco Hole Number Time: Weather Location (identify on site plan) Land Use Slope ft Surface Stones Vegetation, Landform P Position on landscape Distances from: Open Water Body eet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water 'Xiail feet Other . DEEP OBSERVATION HOLE LOG" Depth from Soil Horizon Soil Texture Soil CalorSoil Other suoae.e lInches) (USDA; (Munsell) Mottling istrucuire,stones, Boulders, Cons:sieficv, 5110 v t 4, IN MUM Zn-MUS REQUIRED AT M97 PR6P0S1tT!SPQ$AL Al'thA Parent Matedol igoologit) DepthtoSedrock: Depth ioGroundwyter! Standing Watarinthe Hole: Weeping from Pit Fate! Estimated Seaserve High Ground Water: My&PPROVEC YOKA CJrF 17!LrJCtj .'.`l.l:.L.F l ( 1�34r7111 t�ltVlafah 1)K rr�[at.: rt'L FORM. I1 - SOTS. EVALUATOR FORM Page 2 of 3 / jJt !•. I Location ,address or Lot iso, r �� ""��� Yhi v/ F A"W.",::J�'' Opt-site_Review �j ty Deep Hole Number Date:.: Time: f' . Weather/�'' r�w Location (identify on site plan) ' ` ' Land Use 7?j! r09 4,1�l Slope (or'o) 7 Surface Stones Vegetation Landform Position on landscape Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line . . .. feet Drinking Water Well feet Other DEEP OBSERVAT{ON'HOLE LOG' i i Depth from soil Horizon Soil Texture Soll Color Soil Other j Swface (Inches) (USDA) (Munselt) Mottling (Structure, Stones, Boulders, Cions stency. Oraveli 1� E (( Parent Material (geologic) DeptntoBedrock: Dewh td Groundwater: standing Water in the Hole: _ Weeping from Fit Face; Estimated Seasonal High Ground Water, DEP APPROWD F'OW,I• 12107195 t F I I Jilin f Ile 44 e4 ' l Mls4jc.Ntt9 -�- 4 �' s3• o �' tSav f143.. r.4,uk - �$r` Fouw - A.,y o 1J r , Q T i, r ti a� y: el, z t 3 usYA. 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