HomeMy WebLinkAboutMiscellaneous - 149 MARIAN DRIVE 4/30/2018 (2) COMMONWEALTH OF MASSACHUSETTS
r
ro EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:_149 Marian Drive _
—North Andover_
Owner's Name:_David Amundsen
Owner's Address:_149 Marian Drive_
North Andover,MA 01845_
Date of Inspection 9/20/2005_
Name of Inspector: Neil J.Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address:_111 Argilla Road_
_Andover,Ma.01810_
Telephone Number:_(978)475-4786_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
I m a DEP
n site sewage disposal systems. a
training and experience in the proper function and maintenance of o s t s g p y
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: /4/1�C ,(—?)3k-l��ate: -9/20/2005—
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
is a shared system or has a design flow of 10 000
DEP)v�nthm 30 days of completing this inspection.If the system y gn ,
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments:
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:_149 Marian Drive_
_North Andover—
Owner:_Amundsen_
Date of Inspection: 9/20/2005_
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in
310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
I
Comments:
I
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,
will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"
please explain
The septic tank is metal and over 20 years old*or the septic tank(whether metal
or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will
pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the
i
distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System
i
will pass inspection if(with approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
i
ND explain:
The system required pumping more than 4 times a year due to broken or
! obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_149 Marian Drive_
_North Andover—
Owner:_Amundsen_
Date of Inspection: 9/20/2005_
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_149 Marian Drive_
_North Andover—
Owner:_Amundsen_
Date of Inspection:_9/20/2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
_ No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_No_ Liquid depth in cesspool is less than 6"below invert or available volume is''/z day flow.
_No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_No_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_No_ Any portion of a cesspool or privy is within a Zone I of a public well.
_No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described
in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to
determine what will be necessary to correct the failure
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no?'to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
Page 5 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:_149 Marian Drive_
_North Andover_
Owner:_Amundsen_
Date of Inspection: 9/20/2005
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
_Yes_ _ Pumping information was provided by the owner,occupant,or Board of Health
_ No Were any of the system components pumped out in the previous two weeks?
Yes ` Has the system received normal flows in the previous two week period?
No Have large volumes of water been introduced to the system recently or as part of this inspection?
Yes _ Were as built plans of the system obtained and examined?
_Yes_ — Was the facility or dwelling inspected for signs of sewage back up?
Yes Was the site inspected for signs of break out?
Yes Were all system components,excluding the SAS,located on site?
_Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of
scum?
_Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the
proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
_Yes_ _ Existing information.
_Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)[3 10 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_149 Marian Drive_
_North Andover–
Owner:_Amundsen_
Date of Inspection:_9/20/2005_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_
DESIGN flow based on 310 CMR 15.203_440_
Number of current residents:_2
Does residence have a garbage grinder(yes or no): Yes_
Is laundry on a separate sewage system(yes or no):_No_
Laundry system inspected(yes or no): _
Seasonal use: (yes or no): No_
Water meter reading: Yes_
Sump pump(yes or no): Yes_
Last date of occupancy:—
Current-COMMERCIAL/INDUSTRIAL
Type of establishment:__
Design flow(based on 310 CMR 15.203):__pd
Basis of design flow(seats/persons/sgft,etc.):,
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):—
Water meter readings,if available:—
Last date of occupancy/use:_
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:_Never pumped since new installation,owner_
Was system pumped as part of the inspection(yes or no): Yes_
If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank_
Reason for pumping: _Inspect tank&tees_
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool_Overflow cesspool
_Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank —Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information: 3 years old,8/16/2002,
as built plan_
Were sewage odors detected when arriving at the site(yes or no): No_
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_149 Marian Drive_
_North Andover_
Owner:_Amundsen_
Date of Inspection: 9/20/2005_
BUILDING SEWER_X_ (locate on site plan)
Depth below grade:_24"_
Materials of construction: _X_cast iron _X_40 PVC other
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.) _4"cast iron thru wall.3"PVC in house._
SEPTIC TANKS: X
Depth below grade:_12"_
Material of construction: X_concrete—metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 10'x 5'x 4'_
Sludge depth 2"_
Distance from top of sludge to bottom of outlet tee or baffle: 2511
_
Scum thickness:_3"
Distance from top of scum to top of outlet tee or baffle:_8"
Distance from bottom of scum to bottom of outlet tee or baffle:_18"_
How were dimensions determined:_Tape Measure_
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc._Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of
liquid at outlet invert.No evidence of leakage.
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):.
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_149 Marian Drive_
_North Andover—
Owner:_Amundsen_
Date of Inspection:_9/20/2005
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOXES: X
Depth of liquid level above outlet invert: —0
—
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):_D-Boz level&distribution equal.No evidence of carryover.No evidence of
leakage _
PUMP CHAMBER: X (locate on site plan)
Pump in working order(yes or no): Yes_
Alarm in working order(yes or no): Yes_
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):_Pump cycled on then
oil Alarm has both visual&audible _
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_149 Marian Drive_
_North Andover_
Owner:_Amundsen_
Date of Inspection:_9/20/2005_
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
_ leaching trenches,number,length:
X leaching field,number,dimensions:_1 field 23'x 37'_
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):_Soil ok.Vegetation ok. No sign of ponding to surface._
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:__
Depth—top of liquid to inlet invert:
Depth of sludge layer:
Depth of scum layer:_
Dimensions of cesspool:
Materials of construction: _
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_149 Marian Drive_
_North Andover—
Owner:_Amundsen
Date of Inspection: 9/20/2005
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
Septic Tank Pump
Tank
C D
House
Porch
A B
Water Meter
D-
Boz
a age
A to D-Box=36'
B to D-Box=29' Driveway--�
C to Septic Tank=16'4"
C to Pump Tank=27'5"
D to Septic Tank=2314"
D to Pump Tank=18'7"
Page 11 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_149 Marian Drive_
_North Andover—
Owner:_Amundsen_
Date of Inspection:_9/20/2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water _4'_
Please indicate(check)all methods used to determine the high ground water elevation:
_X_ Obtained from system design plans on record-If checked,date of design plan reviewed:_11/4/2000_
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:_
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:_
You must describe how you established the high ground water elevation: As per design plan_
• Summary Record Card generated on 9/22/2005 10:19:57 AM by Lisa Warren Page 1
Town of North Andover
Tax Map # 210-107.C-0051 -0000.0
149 MARIAN DRIVE
AMUNDSON, DAVID L.
149 MARIAN DRIVE
N. ANDOVER, MA
01845
Class 101 Single Family Property Type 1 Residential
Size Total 3.74 Acres
FY 2006
UB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
AMUNDSON, DAVID L. Payor
149 MARIAN DRIVE
N. ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id. 7284.0- 149 MARIAN DR Last Billing Date 8/3/2005
1090322 01 Cycle 01 Active
UB Services Maint.
Service Code Rate Charge Multiplier/Users
MISCFEE ADMIN FEE 0.63 5/8 7.82 1/
WTR WATER 01 ALL METER SIZE 47.46 /1
UB Meter Maintenance
Serial No Status Location Brand Type Size YTD Cons
16748898 a Active ERT ? w Water 0.63 0.63 0
Date Reading Code Consumption Posted Date Variance
7/20/2005 188 a Actual 14 8/10/2005 85%
4/20/2005 174 a Actual 7 5/13/2005 -10%
1/26/2005 167 a Actual 9 2/15/2005 21%
10/21/2004 158 a Actual 7 11/15/2004 -35%
7/22/2004 151 a Actual 9 8/25/2004 25%
5/7/2004 142 a Actual 9 6/8/2004 8%
2/2/2004 133 a Actual 9 2/24/2004 0%
10/22/2003 124 n New Meter 0 10/22/2003 0%
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Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTERPRISES, INC.
Excavating-Water.& Sewer Lines-Septic Systems &Pumping Service
111 Argilla Road Andover, Mass. 01810
Title 5 Inspection Report
Property Address: 149 Marian Drive, North Andover
Owner: Amundsen
Date of Inspection: 9/20/2005
My report contained herein does not constitute a guarantee of future usage and the functionality of the existing
septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further
operation of your current septic system.
PNei1J. Baeson
Bateson Enterprises, Inc.
Commonwealth of Massachusetts `� =' '��`�
.. V1.
City/Town of I 006
System Pumping Record OCT 1 2 2
Fort 4 H ANDOVER
TO','i d DF NORT
HEALTH LE ART%`—_
DEP has provided this form for use by local Boards of Health..The System Pumping Record must
be submitted to the local Board of-Health or other approving authority. .
A. Facility Information
Important:
When fining out t. System ocatio '
fomes the
computer.use
only the tab Key Address
to move your
cursor-do not l l
use the°retum Cityrrown State Zip Code
key.
2. System Owner:
Name
mnm
Address if different from,location)
City/Town State
ip^ e
Telephone Number
B. Pumping Record
1. Date.of Pumping Date 2. QuantityPumped:
Ga Ions
3. Type of system: ❑ Cesspool(s) tic
P
❑ Tight e Tank ht Tank
❑
Other(describe)-
Effluent Tee Filter present? ❑ Yes 0 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System um ed By
Name Vehicle License Number
Company --
7. Locatio ere contents ere . osed:
r�
Signature f H e Date
http://www.mass.gov/dep/ ate r p ovals/t5forms.htm#inspect
t5form4.doc•06/03 System Bumping Record•Page 1 of 1
TOWN OF
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example:left front of hoose)
Lf Iq HOAIGIAA
DATE OF PUMPING: QUANTITY PUMPED : GALLONS
CESSPOOL: NO V 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: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
i
I
I
i
Town of North Andover Of „ORT„
Office of the Conservation Department F? °°p
Community Development and Services Division t
A M�
*
William J. Scott, Division Directorrep
27 Charles Street 9SS CHus��h
Brian LaGrasse p ( )978
North Andover,Massachusetts 01845 Telephone 688-9530
Conservation Administrator Fax(978)688-9542
CONSERVATION COMMISSION DECISIONS
DATE: 2n12001
TO: S. MASSE, R.NICETTA, H. GRIFFIN, S. STARR, A. LESCARBEAU, &
W. SULLIVAN
FROM: B. LAGRASSE
The followingdecisions ec ons were approved by the Conservation Commission.
242-1051-149 Marian Dr..(D.Amundsen)(Merrimack Eny,:.Serv.)
This NOI is for a septic system replacement within the 100' Buffer Zone to a BVW. The original septic
tank and leaching area are in the rear of the house and this area is not suitable for a replacement due to
proximity to wetlands. The replacement is proposed in front of the house and is approximately 37 from
the wetland line.
242-1054-Lot 32 Bridle Path(Brookview Country Homes)(Marchionda&Assoc.)
This NOI is for the construction of a single family house,driveway,utility services and associated
grading within the 100'Buffer Zone to a BVW.
242-1056-430 Pleasant Street(Kevin Grasso)(Neve&Assoc
This NOI is the result of an Enforcement Order issued for grading performed without prior approvals.
The EO and a Cease and Desist were issued and this NOI was required to gain approvals of the work
� g PP
completed,the restoration area and any more work proposed. The applicant has added a deck proposal
to the site plans. The deck is proposed 86'from the wetland edge.
If you would like a copy of the Order of Conditions please contact the Conservation Department.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
i
i
BOARD OF HEALTH
NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date
i
A permit is requested to: drill a well install a pump
I
LOCATION• Lot #
.. f.. `4 1�'", 1 i- ! Fl:. . d ":l.1 «1".:f i i .'9,i ,-fi) f ' •i
Owner Address Tel
Well, Contrctr } ;Add. Tel
Pump,,•Co.ntrctr-. Add.., Tel
WELLS (To be completed at time of pump test. )
.. .. .y.T .�:'.. 'y. ..�o._ ,iy•.i.� i,l_ Sts '+s: ., i. '�f T�� rr.oi ; � ,
Type' of well' Use
Diameter of -well,,. Size of casing
Depth of bed rock Depth casingt into bedrock
1 .. � '�.. •�� `k• ~�.�. 4 it o.. . �. ..1' �rw')k.' y6 �'} C f'i+P,.:l 1 '..
Seal been tested? Yes (_) No (_) Date of test
Depth, of;,we'll Water-bearing, rock
Depth to ,water Delivers GPM for,, �•
(how long?)
Drawdown ,feet-:--after; pumping „--hours;-at GPM
,,►ro•, _ -
Date of completion
s Signature of well contractor
PUMPS (To be filled in before installation. )
Name & size of pump Type
Size :of tank,,.,.', !'t ' Pump,'delivers }�:' �' GPM
Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_)
Sleeve used to protect pipe? Yes (_) No (_) . Type well seal
771.
Date
Signature of pump installer
Date water analysis report submitted to Board of HHealth
' Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
' WPA Form 5 - Order of Conditions 242-1051
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
Important:
When filling `From:
out forms on North Andover
the computer, Conservation Commission
use only the
tab key to This issuance if for(check one):
move your
cursor-do ® Order of Conditions
not use the
return key. ❑ Amended Order of Conditions
w To: Applicant: Property Owner(if different from applicant):
pp ).
David L Amundsen same
Name Name
149 Marian Dr.
Mailing Address Mailing Address
North Andover MA 01845
City/Town State Zip Code City/Town State Zip Code
1. Project Location:
149 Marian Dr. North Andover, MA
Street Address CC
/Town
0 �' e
Assessors Map/Plat Number Parcel/Lot Number
2. Property recorded at the Registry of Deeds for:
-5'!�-seK
County Book
Page
Certificate(if registered land)
3. Dates:
12/27/00 2/7/01
Date Notice of Intent Filed Date Public Hearing Closed Datef Issuance
4. Final Approved Plans and Other Documents (attach additional plan references as needed):
Title
Date
Title
Date
Title
Date
5. Final Plans and Documents Signed and Stamped by:
Name
6. Total Fee:
(from Appendix B:Wetland Fee Transmittal Form)
Wpaform5.doc•rev.2/6/01
Page 1 of 7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
) WPA Form 5 - Order of Conditions 242-1051
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Findings
Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information provided in
this application and presented at the public hearing, this Commission finds that the areas in which work is
proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply:
(] Public Water Supply ❑ Land Containing Shellfish Prevention of Pollution
Private Water Supply Fisheries Protection of Wildlife Habitat
® Groundwater Supply Storm Damage Prevention [ Flood Control
Furthermore,this Commission.hereby finds the project, as proposed, is: (check one of the following boxes)
Approved subject to:
the following conditions which are necessary, in accordance with the performance standards set forth
in the wetlands.regulations, to protect those interests checked above. This Commission orders that all
work shall be performed in accordance with the Notice of Intent referenced above, the following
General Conditions, and any other special conditions attached to this Order. To the extent that the
following conditions modify or differ from the plans, specifications, or other proposals submitted with
the Notice of Intent, these conditions shall control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland
regulations to protect those interests checked above. Therefore,work on this project may not go
forward unless and until a new Notice of Intent is submitted which provides measures which are
adequate to protect these interests, and a final Order of Conditions is issued.
❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect
of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project
may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient
information-and includes measures'which are adequate to protect the Act's interests, and a final
Order of Conditions is issued. A description of the specific information which is lacking and why it is
necessary is attached to this Order as per 310 CMR 10.05(6)(c).
General Conditions (only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
Wpaform5.doc•rev.2/6101
Page 2 of 7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1051
Massachusetts Wetlands Protection Act M.G.L. c. 131, §4Q Provided by DEP
B. Findings
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years, but less
than five years, from the:date of issuance. If this Order is intended to be valid for more than three
years, the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse,
rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard,
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing.
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title
of the affected property. In the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to
be done. In the case of the registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done. The recording
information shall be submitted to this Conservation Commission on the form at theend of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection"for, WA DEP")
"File Number 242-1051 "
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance(WPA Form 8A)to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition#12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
Wpaform5.doc-rev.216101
Page 3 of 7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File"umber:
WPA Form 5 - Order of Conditions 242-1051
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Findings (cont.)
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subject to this Order and to any contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work, and if the project involves work'adjacent to a Bordering Vegetated Wetland,
the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once In place, the wetland boundary markers shall be maintained until a
Certificate of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or his/her designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
Findings as to municipal bylaw or ordinance
Furthermore, the North Andover hereby finds(check one that applies):
Conservation Commission
❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Municipal Ordinance or Bylaw Citation
Therefore, work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and.a final Order of
Conditions is issued.
® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw,
specifically:
Chapter 178 of the Code of North Andover
Municipal Ordinance or Bylaw Citation
The Commission orders that all work shall be performed in accordance with the said additional
conditions and with the Notice of Intent referenced above. To the extent that the following conditions
modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent,
the conditions shall control.
Wpaform5.doe•rev.2/6/01 Page 4 of 7
DEP FILE #242 - 1051
Therefore, the North Andover Conservation Commission(hereafter the
"NACU) hereby finds that the following conditions are necessary, in accordance
with the Performance Standards set forth in the State Regulations, the local
Bylaw and Regulations, to protect those interests noted above. The NACC
orders that all work shall be.performed in accordance with said conditions and
with the Notice of Intent referenced below. To the extent that the following
conditions modify or differ from the plans, specifications or other proposals..
submitted with the Notice of Intent the conditions shall control.
GENERAL CONDITIONS 7k
18. Failure to comply with all conditions stated herein, and with all related
statutes and other regulatory measures, shall be deemed cause to revoke or
modify this Order.
19. This Order does not grant any property rights or any exclusive privileges; it
does not authorize any.injury to private property or invasion of property
rights. However, the NACC, agent of the NACC or the Department of
Environmental Protection (DEP)reserves the right to enter and inspect the
property at all reasonable times until a Certificate of Compliance is issued, to
evaluate compliance with this Order of Conditions, the Act (310 CMR 10.00),
the North Andover Wetland ByLaw and Regulations, and may require any
information, measurements, photographs, observations, and/or materials, or
may require the submittal of any data or information deemed necessary by
the NACC for that evaluation. Further, work shall be halted on the site if the
NACC, agent or DEP determines that any of the work is not in compliance
with this Order of Conditions. Work shall not resume until the NACC is
satisfied that the work will comply and has so notified the applicant in
writing.
20. This Order does not relieve the permittee or any other person of the necessity
of complying with all other applicable federal, state or local statutes,
ordinances,by-laws or regulations.
21. The work authorized hereunder shall be completed within three years from
the date of this order.
22. This Order may be extended by the issuing authority for one or more periods
of up to one year each upon application to the issuing authority at least thirty
days (30) prior to the expiration date of the Order (Refer to Section VIII
(B)(p.33) of the North Andover Wetland Regulations).
CAWinword\000242-1051 1. NACC 2/7/2001
DEP FILE #242 - 1051
23. The NACC reserves the right to amend this Order of Conditions after a
legally advertised public hearing if plans or circumstances are changed or if
new conditions or information so warrant.
24. Where the Department of Environmental Protection (DEP) is requested to
make a determination and to issue a Superseding Order, the Conservation
Commission shall be a party to all agency proceedings and hearings before
the Department.
25. The conditions of this decision shall apply to, and be binding upon, the
applicant, owner, its employees and all successors and assigns in interest or
control. These obligations shall be expressed in covenants in all deeds to
succeeding.owners of portions of the property.
26. The term "Applicant" as used in this Order of Conditions shall refer to the
owner, any successor in interest or successor in control of the property
referenced in the Notice of Intent, supporting documents and this Order of
Conditions. The NACC shall be notified in writing within 30 days of all
transfers of title of any portion of property that takes place prior to the
issuance of a Certificate of Compliance.
.27. The proposed work includes: Construction of a replacement septics stem
within the buffer zone to a Bordering Vegetated Wetland (BVW). y
28. The work shall conform to the following(except as noted in the remainder of
this document where revisions may be required):
Notice of Intent filed by: Merrimack Engineering Services,Inc. (Representative)
66 Park Street
Andover,MA 01810
Site Plans prepared by: Merrimack Engineering Services,Inc. (Representative)
66 Park Street
Andover,MA 01810
Dated 11/4/00 REV 1/4/01
Stamped by Daniel Koravos,P.E.
29. The following wetland resource areas are affected by the proposed work:
Buffer Zone to Bordering Vegetated Wetland (BM). These resource areas
are significant to the interests of the Act and Town ByLaw as noted above and
therein. The applicant has not attempted to overcome the presumption of
significance of these resource areas to the identified interests.
u\Winword\000242-1051 2
NACC 2/7/2001
DEP FILE #242 - 1051
30. The NACC agrees with the applicant's delineation of the wetland resource
areas on the site as shown on the plans dated referenced herein.
31. The NACC finds that the intensive use of the upland areas and buffer zone
proposed on this site will cause further alteration of the wetland resource
areas. In order to prevent any alteration of wetland resource areas a twenty
five foot (25') No-Disturbance Zone and a fifty foot (50') No-Construction
Zone shall be established from the edge of the adjacent wetland resource
area. The Conservation Administrator and/or other agents of the NACC do
not have the authority to waive these setbacks as established under the local
bylaw. No disturbance of existing grade, soils or vegetation is permitted in
.the No-Disturbance zone. (See Section III(D) &Appendix G of the local
Regulations).
32. This document shall be included in all construction contracts, subcontracts,
and specifications dealing with the work proposed and shall supersede any
conflicting contract requirements. The applicant shall assure that all
contractors, subcontractors, and other personnel performing the permitting
work are fully aware of the permits terms and conditions. Thereafter, the
contractor will be held jointly liable for any violation of this Order resulting
from failure to comply with its conditions.
33. By acceptance of this Order, the owners agree to indemnify and hold
harmless to the Town and its residents for any damage attributable to
alterations undertaken on this property pursuant to the Order. Issuance of
these Conditions does not in any way imply or certify that the site or
downstream areas will not be subject to flooding, storm damage or any other
form of water damage. Maintenance of the drainage system, if accepted by
the Town as part of a public way, becomes the responsibility of the Town.
34. Issuance of these Conditions does not in any way imply or certify that the site
or downstream areas will not be subject to flooding, storm damage or any
other form of water damage.
CAWinword\000242-1051 3 NACC 2/7/2001
DEP FILE #242 - 1051
PRIOR TO CONSTRUCTION
35. No work shall be undertaken until all administrative appeal periods from this
Order have elapsed or, if such an appeal has been filed, until all proceedings
before the Department or Court have been completed.
36. This Order shall be recorded by the applicant at the Registry of Deeds
immediately after the expiration of all appeal periods. No work shall be
undertaken until the Final Order has been recorded in the Registry of Deeds
or the Land Court for the district in which the land is located,within the
chain of title of the affectedP ptY
ro er . In the case of recorded land the Final
Order shall also be noted in the Registry's Grantor Index under the name of
the owner of the land upon which the proposed work is to be done. In the
case of registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is
to be done. The recording information shall be submitted to the North
Andover Conservation Commission on the form at the end of this Order
prior to commencement of the work. Any Order not recorded by the
applicant before work commences may be recorded by the NACC at the
applicant's expense.
37. A sign shall be displayed at the site not less than two square feet or more than
three square feet in size bearing the words "Massachusetts Department of
Environmental Protection, File Number 242-1051."
38. Any changes in the submitted plans caused by the applicant, another Board's
decision or resulting from this Order of Conditions must be submitted to the
NACC for approval prior to implementation. If the NACC finds said changes
to be significant, the NACC will call for another public hearing (at the
expense of the applicant). Within 21 days of the close of said public hearing
the NACC will issue an amended or new Order of Conditions. Any errors
found in the plans or information submitted by the applicant shall be
considered as changes. The proposed project may be still under review by
other local or state boards or agencies. This may result in changes to the
project plans or wetland impacts. If any such changes occur a revised plan
and an explanation of.the revisions shall be submitted to the NACC for
review and approval prior to the start of construction. No work shall begin
on a project.until written approval has been granted by the NACC.
CAWinword\000242-1051 4 NACC 2/7/2001
DEP FILE #242 - 1051
39. It is the responsibility of the applicant, owner, and/or successor(s) to ensure
that all conditions of this Order of Conditions are complied with. The project
engineer and contractors are to be provided with a copy of this Order of
Conditions and referenced documents before commencement of.construction.
40. Prior to any work commencing on-site, the applicant shall submit to the
NACC for approval, a detailed sequence of construction, including the
construction of compensation and retention areas, installation of
sedimentation/erosion control devices and re-vegetation to be completed
before other work begins on-site.
41. Wetland flagging shall be checked prior to start of construction and shall be
re-established where missing. All wetland flagging shall remain visible and
enumerated per the approved plan(s) throughout the life of the project and
until a Certificate of Compliance is issued so that erosion control measures
can be properly placed and wetland impacts can be monitored. The proposed
limit of work shall be shall be clearly marked with stakes or flags and shall be
confirmed by the NACC. Such markers shall be checked and replaced as
necessary and shall be maintained until all construction is complete. Workers
should be informed that no use of machinery, storage of machinery or
materials,.stockpiling of soil, or construction activity is to occur beyond this
line at any time. All flags used for the above purposes shall be of a color
different from other flagging used on the site.
42. A row of staked hay bales backed by trenched siltation fence shall be placed
between all construction areas and wetlands. The erosion control barrier will
be properly installed and placed as shown on the plans approved and
referenced herein and shall be inspected and approved by the NACC prior to
the start of construction and shall remain intact until all disturbed areas have
been permanently stabilized to prevent erosion. All erosion prevention and
sedimentation protection measures found necessary during construction shall
be implemented at the direction of the NACC. The NACC reserves the right
to impose additional conditions on portions of this project to mitigate any
impacts which could result from site erosion, or any noticeable degradation
of surface water quality discharging from the site. For example, installation
of erosion control measures may be required in areas not shown on the
plan(s) referenced in this Order of Conditions. Should such installation be
required by the NACC, they shall be installed within 48 hours of the
Commission's request.
CAWinword\000242-1051 5 NACC 2/7/2001
DEP FILE #242 - 1051
43. The applicant shall have on hand at the start of any soil disturbance, removal
or stockpiling, a minimum of 15 hay bales and sufficient stakes for staking
these bales (or an equivalent amount of silt fence). Said bales shall be used
only for the control of emergency erosion problems and shall not be used for
the normal control of erosion.
44. A check payable to the Town of North Andover shall be provided in the
amount of$1,500 which shall be in all respects satisfactory to Town Counsel,
Town Treasurer, and the NACC, and shall be posted with the North Andover
Town Treasurer through the NACC before commencement of work. Said
deposit of money shall be conditioned on the completion of all conditions
hereof, shall be signed by a party or parties satisfactory to the NACC, and
Town Counsel, and shall be released after completion of the project, provided
that provisions, satisfactory to the NACC,have been made for performance
of any conditions which are of continuing nature. The applicant may propose
a monetary release schedule keyed to completion of specific portions of the
project for the NACC's review and approval. This condition is issued under
the authority of the local ByLaw.
45. The applicant shall designate a professional Wetland Scientist as an
"Erosion Control Monitor" to oversee any emergency placement of controls
and regular inspection or replacement of sedimentation control devices. The
name and phone number of the erosion control monitor must be provided to
the NACC in the event that this person has to be contacted, due to an
emergency at the site, during any 24-hour period, including weekends. This
person shall be given the authority to stop construction for erosion control
purposes. The erosion control monitor will be required to inspect all such
devices and oversee cleaning and the proper disposal of waste products.
Cleaning shall include removal of any entrapped silt. At least once during
each week in which construction activities occurs on-site, the applicant shall
submit a written report from the "Erosion Control Monitor" to the NACC
certifying that, to the best of his/her knowledge and belief based on a careful
site inspection, all work is being performed in compliance with this Order of
Conditions and that approved setbacks are being adhered to. The erosion
control monitor must visually inspect all sedimentation/erosion control
measures and assume responsibility for their maintenance on a weekly basis
and that they are functioning as intended. In addition, all wetland resource .
areas must be visually inspected for siltation, turbidity, and/or other water
quality impacts.
CAWinword\00C\242-1051 6 NACC 2/7/2001
DEP FILE #242 - 1051
46, The applicant and/or the legal owner of that portion of land upon which
these Orders of Conditions have been placed shall provide to the NACC prior
to transferring, or assigning any portion of said land to another party,
subject to said Orders of Conditions,the "Compliance Certification Form
Affidavit" attached via "Appendix A" signed under the pains and penalties
of perjury, stating that said applicant and/or owner has read these Orders of
Conditions and is in compliance with each and every condition. This
document shall apply to each of the conditions referenced herein and shall
be provided to the Conservation Department at least five (5) business days
prior to the closing of said land transaction.
47. Once these above mentioned pre-construction requirements are complete,
the applicant shall contact the Conservation Office prior to site preparation
or construction and shall arrange an on-site conference with an NACC
representative,the contractor,the engineer,wetland scientist and the
applicant to ensure that all of the Conditions of this Order are understood.
This Order shall be included in all construction contracts, subcontracts, and
specifications dealing with the work proposed and shall supersede any
conflicting contract requirements. The applicant shall assure that all
contractors, subcontractors and other personnel performing the permitted
work are fully aware of the permit's terms and conditions. Thereafter, the
contractor will be held jointly liable for any violation of this Order of
Conditions resulting from failure to comply with its conditions. The
applicant or contractor shall notify the NACC in writing of the identity of the
on-site construction supervisor hired to coordinate construction and to ensure
compliance with this Order. A reasonable period of time shall be provided as
notice of the pre-construction meeting (e.g. 72 hours).
48. The NACC shall be notified in writing of any lot line or number changes with
a copy of a plan showing these changes prior to any work on these lots.
CAWinword\00C\242-1051 7 NACC 2/7/2001
DEP FILE #242 - 1051
DURING CONSTRUCTION
49. IMPORTANT: Immediately upon completion of the system, and prior to
further construction activities associated with the site, the applicant shall
complete a plan prepared by a Registered Professional Land Surveyor of the
Commonwealth (R.P.L.S.) which accurately depicts the foundation location
and it's proximity to wetland resource areas as approved under this Order of
Conditions. Said plan shall be submitted to the Conservation Administrator
for approval.
50. Upon beginning work, the applicant shall submit written progress reports
every month detailing what work has been done in or near resource areas,
and what work is anticipated to.be done over the next period. This will
update the construction sequence.
51. Any fill used in connection with this project shall be clean fill, containing no
trash,refuse, rubbish or debris, including but not limited to lumber, bricks,
plaster, wire ,lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor
vehicles or parts on any of the foregoing.
52. No exposed area shall remain unfinished for more than thirty (30) days,
unless approved by the NACC.
53. No re-grading in the buffer zone shall have a slope steeper than 2:1
(horizontal: vertical). Slopes of steeper grade shall be rip-rapped to provide
permanent stabilization.
54. There shall be no stockpiling of soil or other materials within twenty-five (25)
feet of any resource area.
55. Washings from concrete trucks, or surplus concrete, shall not be directed to,
any drainage system, or wetland resource area.
56. All waste generated by, or associated with, the construction activity shall be
contained within the construction area, and away from any wetland resource
area. There shall be no burying of spent construction materials or disposal of
waste on the site by any other means. The applicant shall maintain
dumpsters (or other suitable means)at the site for the storage and removal of
such spent construction materials off-site. However, no trash dumpsters will
CAWinword\00C\242-1051 8 NACC 2/7/2001
DEP FILE #242 - 1051
be allowed within 50' of areas subject to protection under the Act or local
ByLaw.
57. Accepted engineering and construction standards and procedures shall be
followed in the completion of the project.
58. During and after work on this project, there shall be no discharge or spillage
of fuel, or Other pollutants into any wetland resource area. If there is a spill
or discharge of any pollutant during any phase of construction the NACC
shall be notified by the applicant within one (1) business day. No
construction vehicles are to be stored within 100 feet of wetland resource
areas, and no vehicle refueling, equipment lubrication, or maintenance is to
be done within 100 feet of a resource area.
C:\Winword\OOC\242-1051 9 NACC 2/7/2001
r
DEP FILE #242 - 1051
I
AFTER CONSTRUCTION
59. No underground storage of fuel oils shall be allowed on any lot within one-
hundred (100) feet of any wetland resource area. This condition shall survive
this Order of Conditions and shall run with the title of the property. This
condition is issued under the authority of the Town's Wetland protection
Bylaw.
60. Fertilizers utilized for landscaping and lawn care shall be slow release, low-
nitrogen types (< 5%), and shall not be used within 25 feet of a resource area.
Pesticides and herbicides shall not be used within 100 feet of a wetland
resource area. This condition shall survive this Order of Conditions and shall
run with the title of the property. This condition is issued under the
authority of the Town's Wetland Protection ByLaw and shall remain in
perpetuity.
61. Upon completion of construction and grading, all disturbed areas located
outside resource areas shall be stabilized permanently against erosion. This
shall be done either by loaming and seeding according to SCS standards. If
the latter course is chosen, stabilization will be considered complete once
vegetative cover has been achieved.
62. Upon completion of the project the applicant shall submit the following to the
Conservation Commission as part of a request for a Certificate of Compliance:
a. WPA Form 8A - "Request for a Certificate of Compliance."
b. A letter from the applicant requesting a Certificate of Compliance.
c. The name and address of the current landowner.
d. Signed statements from the individual property owners shall be
submitted with the request for a Certificate of Compliance indicating
that they read and understood the recorded Order of Conditions prior
to purchasing their property.
e. The name and address of the individual/trust or corporation to whom
the compliance is to be granted.
f. The street address and assessor's map/parcel number for the project.
g. The DEP file number.
h. A written statement from a Registered Professional Civil Engineer of
the Commonwealth certifying that the work has been conducted as
CAWinword\000242-1051 10 NACC 2/7/2001
DEP FILE #242 - 1051
shown on the plan(s) and documents referenced above, and as
conditioned by the Commission.
i. An"As-Built" plan prepared and signed and stamped by a Registered
Professional Civil Engineer of the Commonwealth,for the public
record. This plan will include:
➢ "As-Built" post-development elevations and grades of all filled
or altered wetland resource areas including the encompassing
buffer zone which is regulated as a resource area under the local
Wetland Protection Bylaw.
➢ Distances from structures to wetland resource areas. Structures
include (but are not limited to) septic systems, additions, fences,
sheds, stone walls, pools, retaining walls, subsurface utilities
and decks.
➢ A line showing the limit of work and the extent of existing
erosion control devices. "Work" includes anv disturbance of
soils or vegetation.
➢ Location of all subsurface utilities entering the property.
63. The following special conditions shall survive the issuance of a Certificate
of Compliance (COC) for this project:
➢ 25' No-Disturbance Zone and a 50' No-Construction Zone shall
be established from the edge of adjacent wetland resource areas
except in those locations approved under DEP#242-1051.
Future work within 100' of existing wetland resource areas will
require a separate filing with the NACC (refer to Section.XI
(page 18) of the Regulations for performance standards within
these zones) The Conservation Administrator and/or other
agents of the NACC do not have the authority to waive these
setbacks as established under the local ByLaw;
➢ Discharge or spillage of pollutants (Condition#58);
➢ Prohibition of underground fuels (Condition #59);
➢ Limitations on the use of fertilizers, herbicides and pesticides
(Conditions #60).
CAWinword\OOC\242-1051 11 NACC 2/7/2001
DEP FILE #242 - 1051
APPENDIX A-AFFIDAVIT
I, on oath do hereby depose ose and state:
(authorized agent applicant and/or current owner)
(PLEASE CHECK AT LEAST ONE BLOCK)
1. I am the of
(position with applicant) (applicant name or company name)
the applicant upon whom Order of Conditions
have been placed upon by (DEP or NACC number)
the North Andover Conservation Commission.
&/or
2. I am the of
(position with owner) (owner name)
the owner upon whose land Order of Conditions
have been placed up by (DEP or NACC number)
the North Andover Conservation Commission.
&
3. I hereby affirm and acknowledge that I have received said Order of Conditions
and have read the same and understand each
(DEP File#) and every condition which has been set forth
in said Order of Conditions.
&
4. I hereby affirm and acknowledge that on this day of 19
I inspected said property together with any and all improvements which have
been made to the same and hereby certify that each and every condition set
forth in Order of Conditions, are presently in compliance.
(DEP File#)
5. I hereby affirm and acknowledge that this document will be relied upon by the
North Andover Conservation Commission as well as any potential buyers of
said property which is subject to said Order of Conditions
(DEP File#)
Signed under the pains and penalties of perjury this day of 19
(Signature-authorized agent of applicant or owner)
C:\Winword\OOC\242-1051 12 NACC 2/7/2001
Massachusetts Department of Environmental Protection
- - DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions 242-1051
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
LIProvided by DEP
B. Findings cont.
9 (cont.)
Additional conditions relating to municipal ordinance or bylaw:
See Attached Conditions
This Order is valid for three years, unless otherwise specified as a special condition pursuant to General
Conditions#4, from the date of issuance.
2/7/01 -2/7/04
Date
This Order must be signed by a majority of the Conservation Commission. The Order must be mailed by
certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or
hand delivered at the same time to the appropriate Department of Environmental Protection Regional
Office (see Appendix A)and •e-gfoperty owner if different from applicant).
Signatures:
On February 7th Of 2001
Day Month and Year
before me personally appeared
Scott Masse
to me known to be the person described in and who executed the foregoing instrument and
acknowledged that he/she exxee uted the same as his/her free act and deed.
JACKI EYERLEY
L Notary Public
Notary lic My Commission Expirdby Commission Expires
July 5,2007
This Or is issued to the applicant as follows:
❑ by hand delivery on by G@RMad-mail, r , on
Date Datil
Wpaform5.doc•rev.2/6/01 Page 5 of 7
Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions 242-1051
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject
to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of
their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions.
The request must be made by certified mail or hand delivery to the Department, with the appropriate filing
fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in
310 CMR 10.03(7)within ten business days from the date of issuance of this Order. A copy of the request
shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to
the applicant, if he/she is not the appellant.
The request shall state clearly and concisely the objections to the Order which is being appealed and how
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, §40) and is inconsistent with the wetlands regulations (310 CMR 10.00).
To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts
Wetlands Protection Act or regulations, the.Department has no appellate jurisdiction.
D. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located, within the chain of title of the affected property. In the case of recorded.land, the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the.case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information
on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below.
North Andover
Conservation Commission
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