HomeMy WebLinkAboutMiscellaneous - 1491 TURNPIKE STREET 4/30/2018 (2),, _
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Notice of Variance/ Deed Restriction
Pursuant to 310 CMR 15.000 Title 5, and as a condition of septic plan approval by the
North Andover Board of Health, notice is hereby given that real estate located at 1491
Turnpike Street, North Andover, Massachusetts (aka Assessor's Plan #5333, Lot 5), as
described in a deed from Andover Bank to Alex V, and Diana S. Kiesel dated December
14, 1992 and recorded in the Essex County Registry of Deeds in Book 3622, Page 259 is
the subject of a variance from the Town of No. Andover Minimum Requirements for the
Subsurface Disposal of Sanitary Sewerage A1.05 and C9.01 (4). Said variance limits the
maximum number of bedrooms at this dwelling to three (3) bedrooms. This variance is
within the jurisdiction of the North Andover Board of Health.
Signed and s_cakrdltli� 13' da, 2005.
Property Owners Signatures
Commonwealth of Massachusetts
Essex,s.s.
Then personally appeared the
Date: Uw L3 2005
And acknowledged the foregoing instrument to be their free act and deed, before me.
Notary Public
414
NANCY L. BREADMORE
Notary Public
W
ommonwealth of Massachusetts
My Commission Expires
March 20 2012
ESSEX NORTH REGl9rRY OF DEED
LAWRENCE, MA96.
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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: 1491 Turnpike Street, North Andover
Owner: Kiesel
Date of Inspection: 7/27/2007
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.
Neil J. Bateson
Bateson Enterprises, Inc.
0 0
COMMONWEALTH OF MASSACHUSETTS ➢ry
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION + Ss
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
4L taIT
CERTIFICATION
Property Address: _1491 Turnpike Street'
'F _
North Andover_
Owner's Name: Diana Kiesel
_
Owner's Address: 44 Cricket LaneAUG
- 6 2007
_ North Andover, MA 01845_
Date of Inspection: _7/27/2007 TOWN OF NORTH ANDOVER
DEPARTr�ENT
HEALTH
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
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
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
ails
Inspector's Signature: Date: _7/27/2007_
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
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: _1491 Turnpike Street-
-
North Andover—
Owner: _ Kiesel_
Date of Inspection: _7/27/2007 _
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.
Comments:
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 distribution box due to broken or obstructed pipe(s) or due to a broken,
settled or uneven distribution box. System will pass inspection if (with approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
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: _1491 Turnpike Street-
-
North Andover—
Owner: _Kiesel _
Date of Inspection: _7/27/2007 _
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:
� o
Page 4 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: _1491 Turnpike Street-
-
North Andover—
Owner: _Kiesel_
Date of Inspection: _7/27/2007 _
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 `h 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 1 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 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: _1491 Turnpike Street
_ North Andover _
Owner: _Kiesel_
Date of Inspection: _7/27/2007
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 ?
No_ 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 Cis 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: _1491 Turnpike Street-
-
North Andover—
Owner: _Kiesel_
Date of Inspection: _7/27/2007_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): _R 3_ Number of bedrooms (actual): _3_
DESIGN flow based on 310 CM15.203 _330_
Number of current residents: _0
Does residence have a garbage grinder (yes or no): No_
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): _No_
Last date of occupancy: _ Vacant on June 21, 2007_
COMMERCIALIMUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): _gpd
Basis of design flow (seats/persons/sqft,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 _
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 2 Years old, 7/5/2005, 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: _1491 Turnpike Street_
_ North Andover _
Owner: _Kiesel_
Date of Inspection: 7/27/2007_
BUILDING SEWER _ X _ (locate on site plan)
Depth below grade: _27"
Materials of construction: _X cast iron 40 PVC X other
Distance from private water supply well or s_uction line:
Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" cast iron thru floor, 2" Copper in
house, no leaks visible _
SEPTIC TANK: X
Depth below grade: _18"
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: 25" _
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: 19" _
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 septic tank leaking. Outlet cover has riser 6" deep_
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 bale condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of l l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _1491 Turnpike Street-
-
North Andover—
Owner: _Kiesel_
Date of Inspection: _7/27/2007
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 BOX X ( locate on site plan )
Depth below grade 6"_
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 -boa level & distribution equal. No evidence of leakage. No evidence of
carryover._
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 ok. Cycled on
then off. Alarm has both audible & visual alarm.
Page 9 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _1491 Turnpike Street _
_ North Andover—
Owner: _Kiesel_
Date of Inspection: _727/2007_
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required)
If SAS not located explain why:
Type
_ leaching pits, number: _
X leaching chambers, number: 4 rows of eight infiltrators_
leaching galleries, number:
_ leaching trench, number, length:
_ leaching field, number, dimensions:
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. Opened up inspection ports no standing water._
CESSPOOLS:
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
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: _1491 Turnpike Street _
_ North Andover_
Owner: _Kiesel_
Date of Inspection: 7/27/2007
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
Driveway
House
Water Meter
A
#1
Port # 2
C
D
Boz
Septic
Tank
Pump
Tank
644
A to D -Boz = 43110"
•to Port #1=15'9"
• to Port # 2 = 24'10"'
B to D -Boz =15' 1"
B to Septic Tank =15'
B to Pump Tank = 816"
B to Port # 1 = 54'
B to Port # 2 = 57'6"
C to Septic Tank =13'2"
C to Pump Tank = 21'6"
•
Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _1491 Turnpike Street _
_ North Andover—
Owner: _Kiesel_
Date of Inspection: _7/27/2007 _
SITE EXAM
Slope _ No _
Surface water _ No _
Check cellar _ Dry _
Shallow wells _ No _
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: _10/28/2004_
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 Carted on 8/212007 2:42:58 PM by Lisa Warren 0
Su ry �
Town of North Andover
Tax Map # 210-107.B-0068-0000.0
1491 TURNPIKE STREET
KIESEL, ALEX V
P0BOX 1894
ANDOVER, MA
01810
Class 101 Single Family Property Type
Size Total 1.15 Acres
FY 2007
UB Mailing Index
Name/Address Type
KIESEL, ALEX V Payor
P0BOX 1894
ANDOVER, MA
01810
UB Account Maint.
Account No Cycle
Bldg Id. 13225.0 - 1491 TURNPIKE STREET
2100010 02 Cycle 02
UB Services Maint.
Loan Number Active/Inact.
Occupant Name
Last Billing Date 6/15/2007
Service Code
Rate
MISCFEE ADMIN FEE
0.63518
WTR WATER
01 ALL METER SIZE
UB Meter Maintenance
Type
Serial No Status
Location
13242631 a Active
ERT HH
Date Reading
Code
5/2/2007
265
a Actual
2/16/2007
253
a Actual
11/2/2006
237
a Actual
8/21/2006
226
a Actual
5/25/2006
194
a Actual
2/8/2006
171
a Actual
11/3/2005
155
a Actual
8/10/2005
134
a Actual
5/2/2005
91
a Actual
2/2/2005
73
a Actual
11/2/2004
61
a Actual
8/5/2004
46
a Actual
5/14/2004
27
a Actual
2/9/2004
9
c Correction
C/O 4+ERT 9=13
11/4/2003
953
n New Meter
From
Active/inactive
Active
Charge
Multiplier/Users
7.82
1/
37.56
/1
Brand
Type
METE METE
w Water
Consumption
Posted Date
12
6/22/2007
16
3/23/2007
11
12/22/2006
32
9/13/2006
23
6/20/2006
16
3/13/2006
21
12/14/2005
43
9/12/2005
18
6/8/2005
12
3/15/2005
15
12/17/2004
19
9/20/2004
18
6/14/2004
13
4/16/2004
0
11/4/2003
size
0.630-63
Page t
1 Residential
Until
YTD Cont
Variance
6°i
0°/
-590/
680/
3201
-339
-43°
113°
559
-239
-269
219
419
09
0°
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Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
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t5form4.doc• 06/03
Commonweal of Massachusetts
CitylTown of
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. Other fomes may be used, but the
information must be subsWntially the same as that provided here. Before using this form, check with your
local Board of Health to detem-dne the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1
System Location:
Address
City/Town
2. System Owner:
S\ C -A-0- c� hals-0,
114 `? Iv�'v�
Address (if different from location)
City/Town
State
Zip Code
Stye„ � � _ Zip Code
Telephone Number
B. Pumping Record
`7
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) 9'beptic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑
Yes 2'No
If yes, was it cleaned? ❑
Yes ❑ No
5. Condi 'on of S stem:
v�� e -'A
c c
v -4
6. Syst Pumped By:
77 Liz��
Name
Company
7. Location `" re nteIre ed:
Vehicle License Number
Date
System Pumping Record • Page 1 of 1
Town of North Andover
Office of the Health Department
Community Development and Services Division
400 OSGOOD STREET
North Andover, Massachusetts 01845
Susan Y. Sawyer, REHS/ RS
Public Health Director
978.688.9540 - Phone
978.688.8476 - Fax
C'EpVq77CA?m OAF' COJK�'GIA9VCE
As of:
,duly 12, 2005
rIhis is to cert that
the individual su6surface disposal system
Constructed( - � or
repaired — (X)
(By
,john Soucy
At
1491 Turnpike Street
North Andover, 9V,4.01845
Yfas 6een installed in accordance with the provisions of Title v of the State Sanitary Code and
with the North Andover Board of -7fealth regulations.
The Issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
r
Susan 7 Sawyer, RE)E
Bu6lic 5Tealth Director
BOARD OF APPEALS 688-9541 BLJILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
N
N
N
0 1 0
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( )'constructed;
(,Cfrepaired;
by SoQc Seger �ery�Ce
located at ljqL%vt Ke. SiPee--
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # , plandated 11W.)0*, , with a design flow
of -130 gallons per day. The materials used were in conformance with those specified
on the approved plan; the system was installed in accordance with the provisions of 310
CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with
the approved plan. All work is accurately represented on the As -built which has been
submitted to the Board of Health.
Bed inspection date: 0,3/or
Final inspection date: 7/1 os -
Installer:
Engineer:
S$
Engineer Representative
Engineer Representative
Date:
Date: �7_— 1 �- 0_!�__
RECEIVED
JUL _ 7 2005
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
O O Page 1 of 1
DelleChiaie, Pamela
From: Andy McBrearty [amcbrearty@millriverconsulting.com]
Sent: Monday, July 11, 2005 2:29 PM
To: Sawyer, Susan; DelleChiaie, Pamela
Subject: Emailing: 1491 Turnpike Const. Insp
Pam & Susan,
Here is the const inspection for 1491 Turnpike St. Did not have access to basement, so could not verify
separate circuits for pump and alarm. Appeared to be OK from outside. Wall was not yet installed, and
I am a little concerned about ponding of water right in front of the garage, but guess that is more of the
designer's issue than mine.
Am out in N.A. tomorrow doing soils and perc tests.
-andy
7/11/2005
TOWN OF NORTH ANDOVERt NCRTN ,
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
27 CHARLES STREET • �, .���;�.
NORTH ANDOVER, MASSACHUSETTS 01845 �'iscNUs
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
SEPTIC SYSTEM CONSTRUCTION NOTES
ADDRESS: 1491 Turnpike Street MAP:38 LOT: 42
INSTALLER: John Soucy
DESIGNER: NEES
PLAN DATE: 11/22/04
BOH APPROVAL DATE ON PLAN: 12/17/04
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTI : / 6/24/05
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
0 Topography not appreciably altered
Comments: No access to basement — verify on final grade inspection
SEPTIC TANK
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
D 1500 gallon tank has been installed .
(H-10) (2 piece)
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
D Inlet tee installed, under access port
D Outlet tee w/ gas baffle installed, under access port
0 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
0 Hydraulic cement around inlet & outlet
Comments: Hydraulic cement repaired @ S.T. outlet and PC inlet.
Page 1 of 4
0 0
TOWN OF NORTH ANDOVER
NOR7H
Office of COMMUNITY DEVELOPMENT AND SERVICES
f
3r °'`°t�
HEALTH DEPARTMENT
27 CHARLES STREET
'
NORTH ANDOVER, MASSACHUSETTS 01845
�'ss" CNS; t`g
Susan Y. Sawyer, REHS/RS
Public Health Director
PUMP CHAMBER
Comments:
CONTROL PANEL
978.688.9540 — Phone
978.688.9542 — FAX
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
® 1000 gallon Pump Chamber installed
H-10 loading
2 -Piece construction)
® Inlet tee installed, centered under access port
® Pump(s) installed on stable base
® Alarm float working
Pump On/Off float working
® Drain hole in pressure line
® 24" inch cover to within 6" of final grade installed over
pump access port
❑ Water tightness of tank has been achieved
Visual testing
® Hydraulic cement around inlet & outlet
❑ Alarm & Pump are on separate circuits
® Alarm sounds when float is tripped
® Location of control panel: Outside house
❑ Rated for exterior if placed outside
Comments:
Could not access basement to verify wiring — to be done at Final Grade Insp.
D -BOX
Comments:
❑x Installed on stable stone base
❑x Inlet tee (if pumped or >0.08'/foot)
❑x Hydraulic cement around inlet & outlets
D Observed even distribution
❑ Speed levelers provided (not required)
Page 2 of 4
0 0
TOWN OF NORTH ANDOVER t µORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
. .
27 CHARLES STREET 4
NORTH ANDOVER, MASSACHUSETTS Ol 845 CH„s
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
SOIL ABSORPTION SYSTEM
�I
Bottom of SAS excavated down to 6 in into C soil
layer, as provided on plan
D
Size of SAS excavated as per plan
Title 5 sand installed, if specified on plan
❑
3/4-1 Y2" double washed stone installed
❑
1/8-1/2" (peastone) double washed stone installed
❑
laterals installed and ends connected to header (and
vented if impervious material above)
❑
Orifices @ 5 & 7 o'clock positions
0
Gravelless disposal systems: type, number and
location
as per plan
0
Elevations of laterals installed as on approved plan
❑
40 Mil HDPE barrier installed
❑
Retaining wall (boulder / concrete / timber/ block)
❑
Final cover as per plan
Comments: Ret. Wall to be constructed.
Page 3 of 4
0 o
INVERT ON DESIGN PLAN
TOWN OF NORTH ANDOVER
NOR7a
OE
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
Building Sewer OUT
27 CHARLES STREET
C
NORTH ANDOVER, MASSACHUSETTS 01 845
�'ss„CH„5
Susan Y. Sawyer, REHS/RS
978.688.9540 - Phone
Public Health Director
978.688.9542 - FAX
SYSTEM ELEVATIONS
Benchmark: 206.96
Rod at Benchmark: 10.22
Height of Instrument: 217.18
Page 4 of 4
INVERT ON DESIGN PLAN
INVERT ELEVATION
Building Sewer OUT
96.93
Septic Tank IN
96.83
97.20
Septic Tank OUT
96.58
96.96
Pump Chamber IN
96.53
96.91
Pump Chamber OUT
96.28
96.64
Distribution Box IN
99.77
99.83
D -BOX OUT
99.60
99.64
Lateral Invert
99.50
99.67
Lateral 1 Top of
. Chamber
99.96
100.11
Lateral 2 Invert
99.50
99.62
Lateral 2 Top of
Chamber
9996
100.08
Lateral3Invert
99.50
99.61
Lateral 3 Top of
Chamber
99.96
100.07
Lateral 4 Invert
99.50
99.62
Lateral 4 Top of
Chamber
9996
100.08
Page 4 of 4
AS -BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSION
-----� SOF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
1, FROM SEPTIC TANK
b. FROM LEACH AREA
I
LOCASTIONS OF DEEP HOLES & PERCTEST
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
V/- LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER O
TANK & D -BOX F
ORIGINAL STAMP & SIGNATURE
./ IMPERVIOUS AREAS - DRIVEWAYS, YS, ETC.
Jv
NORTH ARROW
- r LOCATION
& ELEVATIONS OF BENCHMARK USED
li
"M
N°" , Commonwealth of Massachusetts T Map Black -rot
+ ; a 107 B- 0068 -
o `*„ Board of Health ...............
Perntrt No
> North Andover BHP -2005-0129
o_,,. • • P.I.
4. `••.,. «""'�h FEE
tnu`4 F.I. $250.00
Disposal Works Construction, Permit
Permission is hereby granted John Soucy
to (Repair) an Individual Sewage Disposal System.
at No 1491 TURNPIKE STREET
as shown on the application for Disposal Works Construction Permit No. BHP -2005-012 Dated May 27.2005
Issued On? . May 27 2005 Board of He th
................................. .................... s....... ....... ............ ...........................................................................................
- � r
�TOWN OF NORTH. ANDOVER f NORTlr �
Office of COMMUNITY DEVELOPMENT AND SERVICES �:.�'d"•° ,'•: $9
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 �•s•,,,,.*'
s�C
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.9542 — FAX
Public Health Director healthdept@townofnorthandover.com - e-mail
www.townofnorthandover.com - website
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE:^ ^� S
LOCATION:
LICENSED INSTALLER NAME: o ��
PLEASE PRINT
SIGNATURE:
TELEPHONE- 1
� CHECK ONE./
FULL SYSTEM REPAIR: ($250)PR
COMPONENT REPAIR (indicate what parts):
($125)
* NEW CONSTRUCTION:
* If NECONSTRUCTION, please attach the Foundation As -Built Plan.
U
$250.00 or $125 Fee Attached? Yes No
Project Manager Obligation From Attached? Yes U No
Foundation As -Built? Yes No
Floor Plans? Yes No
Approval of Health Agent Dater �l bS
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
property at r L( 1' �_ua , 00 c �.o S'f: relative to the application
A
ofS&4&P/Jk,*,w.S dated.���1/ for plans by i and
dated 9a lt5,4 with revisions dated�VM
I understand the following obligations for management of this project:
1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior
to performing any work on a site. I must have the approved plans and the permit on site
when any work is being done.
2. As the installer I must call for any and all inspections. If homeowner, contractor, project
manger, or any other person not associated with my company schedules an inspection and the
system is not ready then item three shall be applicable.
3. As the installer I am required to have the necgssary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without
completion of the items in accordance with Tile 5 and the Board of Health Regulations may
result in a $50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer must be present for this inspection. With pump system all electrical
work must be ready and able to cause pump to work and alarm to function.
c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be
on site.
4. As the installer I understand that only I may perform the work (other than simple excavation)
required to complete the installation of the system identified in the attached application for
installation. I further understand that work by others unlicensed to install septic systems in
North Andover can constitute reasons for denial of the system, and/or revocation or
suspension of my license to operate in the Town of North Andover; significant fines to all
persons involved are also possible.
5. As the Installer I understand that 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 or consultant.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6. As the installer I understand that I am solely responsible for the installation of the system as
per the approved plans. No instructions by the homeowner, general contractor, or any other
persons shall absolve me of this obligation.
Undersigne icensed Septic nstaller
Date:
Disposal iorks Construction Pe it #
6 O
NEW ENGLAND ENGINEERING SERVICES
lk . INC
July 6, 2005
Susan Sawyer
North Andover Board of Health
400 Osgood Street
North. Andover, MA 01845
Re: 1491 Turnpike Street, North Andover, MA
Septic System As -Built Plan Submittal
Dear Ms. Sawyer,
A// �2
JUL - 7 2005
TOWN CI -1 ANDOVER
HEALITIM :.LPtt RTMENT
1111-114e-10
The following Septic As -Built plans for the above referenced property are being submitted for
approval.
Enclosed are the following:
1. (3) Copies of the Septic System As -Built Plan.
2. Copy of Designer's/Installer's Certification Form.
Please contact this office with any questions or concerns.
Sincerely,
Thomas Hector
Project Engineer
cc: Homeowner
d"
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
d,
05/31/2005 12:47
9766851 �r�+
NEW ENG ENG
101
NEW ENGLAND ENGINEERING SERVICES, INC.
60 Beechwood Drive
North Andover, MA 01845
Phone 978.686.1768
ki Fax 978.685.1099
RRC-EIVED
MAY 3 1 2005
TOHEALTHDIVPARTM TER
PAGE 01
To:
Susan Sawyer
From:
Thomas Hector
Company:
North Andover Board of Health
Date:
5/31/2005
Fax:
978-688-9542
Pages:
4 Including Cover Sheet
Re: 1491 'Tumpike Street
DEP variance Approval for Sieve
O Urgent ❑ For Review ❑ Please Comment Q Please Reply ❑ Please Recycle
Dear Ms. Sawyer,
Please see the attached pages regarding the DEP Variance Approval for use of a sieve
analysis for 1491. Turnpike Street, North Andover, MA.
Pleasc contact me with any questions or concerns at (978) 686-1768.
Sincerely,
Thomas Hector
Project Engineer
�I
05/31/2005 12:47
MITT ROMNEY
Governor
KERRY HEAL MS
LeutAnant Governor
9786851() NEW ENG ENG PAGE 02
0 oE'
c?
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
METROPOLITAN BOSTON — NORTHEAST REGIONAL OFFICE
Diana Kiesel
1491 Turnpike Street
No th Andbver, MA 01845
CiEI V ED
MAY 3 1 2005
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
March 2, 2005
ELLEN ROY HERZFrLDER
secretary
ROBERT W. GO=DGE, Jr.
Cowynissioner
Re: Approval of Title 5 Variance (BRPWP59b) -Variance from Percolation Testing Requirement
1491 Turnpike Street, North Andover (17 -Ipswich)
DEP Transmittal No.: W058413
Dear Ms, Kiesel:
Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.412, the Northeast Regional Office
of the Department of Environmental Protection has completed its review of the above referenced
application for approval of a variance granted by the North Andover Board of Health.
The application contains a copy of the Board of Health's grant of a variance from the following
provision of Title 5, 310 CMR 15:000:
• 310 CMR 15.104, Percolation Testing
As part of the application, the Department received plans consisting of two (2) sheets, titled as
follows:
Title: Proposed Subsurface Sewage Disposal System
Location: 1491 Turnpike Street
Municipality: North Andover
Applicant: Diana Kiesel
Designer. Benjamin C. Osgood, Jr., P.E. No. 45891
Date: November 22, 2004
Based upon its review of the application, and in accordance with 310 CMR 15.410, the Department
has determined both of the following:
a) The applicant has established that enforcement of 310 CMR 15.104 would be manifestly unjust,
considering all of the relevant facts and circumstances of this case.
A percolation test could not be performed because of high groundwater. High groundwater was
encountered in the deep hole or holes excavated on site.
Thin wormaffon il availablo in alternate farmaf by catlins our AAA Ga.rd'matar of (617) 574-(A72.
One Winter Street. Boston, MA 02109• Phone (817) 654-6500 # Fax (51T) 558.1049 • TDD N (600) 298.2207
DEP on th* WorId Wide Web: http:/Awww.Stata.ma us/dep
0 Printed w Recycled Paper
05/31/2005 12:47 9786851 NEW ENG ENGO PAGE 03
b) The applicant has established that a level of environmental protection that is at least equivalent to
that provided
Theapplicant 3as established equivCMR 15.000 can be aeved lent environmental onmental out Strict pplication ro ect on as follows: 310 C 15.104
and
A particle -size soil analysis in conformance with the Alternative Percolation Testing Policy,
BRP/DWM/PeP-POD-4, was performed and, along with an evaluation of soil compaction, was used to
determine soil classification, the effluent loading rate, and the design of the system. The soil was
found to be sandy loam and uncompacted innature. tt n accordm is ance with that Policned with a Long y.
Rate of 0.33 gallons per day (gp ) per square foo
The Department, therefore, approves the North Andover Board of Health's grant of a variance from
310 CMR 15.104.
Additionally, the Department imposes the following conditions as part of this approval:
The Department has received a written concurrence from the North Andbver Board of Health, dated
January 21, 2005, that the soils are uncompacted. in all future applications, the lack of written
confirmation from the Board of Health as to the compaction of the soil, in the initial submittal to the
Department, will be viewed in non-compliance with the Department's Alternative Percolation Testing
Policy and a technical deficiency will be issued.
The applicant shall obtain a Disposal System Construction Permit (DSCP) from the North Andover.
Board of Health prior to commencement of construction of the system.
• The system is not designed to accommodate a garbage disposal. As such, one shall neither be used
nor installed at this facility.
• There shall be no increase in design flow to the upgraded subsurface sewage disposal system. The
design flow for the facility is 330 gpd. The facility consists of a three (3) -bedroom house.
At the time of construction, if groundwater has receded to a point where percolation testing is feasible
in the opinion of the local approving authority, then confirmatory percolation testing must be
conducted and, if necessary, the system design revised based on the actual percolation rate.
It is the responsibility of the applicant to assure that the approved plans are available at the site
during construction.
Should you have any questions regarding this matter, please contact George A. Kretas, of my staff, at
(617) 654-6602.
1. This variance determination is an action of the Department. If the applicant is aggrieved by this
determination, s/he may request an Adjudicatory Hearing in accordance with 310 CMR 1.00 and M.G.L
C.30A. A request for an Adjudicatory Hearing must be made in writing and postmarked within 30 days of
the date of issuance of this determination. Pursuant to 310 CMR 1.01(6), the request must state clearly and
concisely the facts that are grounds for the request and the mlief sought.
The hearing request, along with a valid check payable to Commonwealth of Massachusetts in the
amount of one hundred dollars ($100.00), must be mailed to.
Commonwealth of Massachusetts
Department of Environmental Protection
P.O. Box 4062
Boston, MA 02211
The hearing request will be dismissed if the filing fee is not paid, unless the appellant is exempt or
granted a waiver, as described below. The filing fee is not required if the appellant is a city or town (or
municipal agency), county, or district of the Commonwealth of Massachusetts, of a municipal housing
authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying
05/31/2005 12:47
978685]`x'
NEW ENG ENG
the fee will create an undue financial hardship. A person seeking a waiver must rile, together with the
hearing request as provided above, an affidavit setting forth the facts in support of the claim of undue
financial hardship.
very truly yours.
Madelyn Morris
Deputy Regional Director
Bureau of Resource Protection
cc: Benjamin C. Osgood, Jr., P.E., New England Engineering Services, Inc., 60 Beechwood Drive,
North Andover, MA 01645
Susan Y. Sawyer, Director, Health Department, 27 Charles Street, North Andover, MA 01945
DEP Watershed Permitting Program, Policy Section, Boston
Claire Golden, BRPNVM/NERO
PAGE 04
TOWN OF NORTH ANDOVER Of %ORTil
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 'aS;,CHU
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
January 21, 2005
Department of Environmental Protection
Northeast Regional Office
1 Winter Street
Boston, MA 02108
RE: in-situ state of Soils
Address: 1491 Turnpike Street, North Andover, MA
Soil Testing conducted on (date): 10/28/04
North Andover Board of Health Representative: Andrew McBrearty
LTA
In accordance with Title 5 Alternative to Percolation Testing Policy for System Upgrades, the soils in the
area of the proposed SAS were determined to be Uncompacted.
Sincerely,
Susan Y. Sawyer, REHS/RS
Public Health Director
0
MITT ROMNEY
Governor
KERRY HEALEY
Lieutenant Governor
Diana Kiesel
1491 Turnpike Street
North Andover, MA 01845
(0 (D
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
METROPOLITAN BOSTON — NORTHEAST REGIONAL OFFICE
jECEIVED
JAN 19 2005
TOWN Or NORTH
HEALTH DEPAf
ELLEN ROY HERZFELDER
Secretary
ROBERT W. GOLLEDGE, Jr.
Commissioner
January 13, 2005
RE: STATEMENT OF TECHNICAL DEFICIENCY
Application for BRPWP59b — DEP Approval of Variance Granted. By Board of Health
1491 Turnpike Street, North Andover (17 -Ipswich)
DEP Transmittal No. W058413
Dear Ms. Kiesel:
The Metropolitan Boston -Northeast Regional Office of the Department of Environmental Protection
has received and reviewed your application for approval of a variance pursuant to 310 CMR 15.000 with the
above transmittal number.
Accompanying the application were plans consisting of two (2) sheets, titled as follows:
Title: Proposed Subsurface Sewage Disposal System
Location: 1491 Turnpike Street
Municipality: "North Andover
Applicant: Diana Kiesel
Designer: Benjamin C. Osgood, Jr., P.E. No. 45891
Date: November 22, 2004
This application requests the Department approval for an alternative to percolation testing as
required by Title 5 of the State Environmental Code, 310 CMR 15.104.
An engineer of the Department has reviewed the plans and the accompanying data, and it is the
opinion of the Department that the request for variance to Title 5 cannot be approved as submitted for the
following reasons:
• The Department noted that Benjamin C. Osgood, Jr. had signed for the applicant. The Department
requires the signature of an applicant or a signed letter by an applicant allowing Benjamin C. Osgood,
Jr. to act as her agent.
• The written concurrence of the North Andover Board of Health for the compaction of the soil is required
by the Title 5 Alternative to Percolation Testing for System Upgrades, BRP/DWM/PeP-P00-4, dated
September 8, 2000.
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
0 Printed on Recycled Paper
C
X
In accordance with 310 CMR 4.00, you have sixty- (60) days from the postmarked date of this letter
in which to address the listed deficiency. Within the sixty- (60) day_ time frame, the applicant is advised to
allow for the appropriate Board of Health action on the revised submittal since the Department of
Environmental Protection's subsequent action may be its final action and, therefore, any further filing in this
matter would be considered a NEW application. If the applicant cannot accommodate the schedule of the
Board of Health within the sixty (60) day period, or for any other reason requires additional time, the
applicant may, by written agreement with this Department, extend this schedule in accordance with 310
CMR 4.04(2)(f). The applicant is also advised that when the Department receives the new information, it will
initiate a second technical review.
The enclosed Supplemental Transmittal Form should be completed and included as a cover sheet
with any future submittal to the Department relating to the above matter. You need only correspond to the
Northeast Regional Office at the above address.
If additional information is required, contact George A. Kretas at 617-654-6602.
Very truly yours,
Madelyn Morris
Deputy Regional Director
Bureau of Resource Protection
mm/gak
enclosure
cc: - Benjamin C. Osgood, Jr., P.E., New England Engineering Services, Inc., 60 Beechwood Drive,
North Andover, MA 01845
- Susan Y. Sawyer, Director, Health Department, 27 Charles Street, North Andover, MA 01945
- Claire Golden, BRP/WM/NERD
C
N
TOWN OF NORTH ANDOVER f NORTN
1,60
Office of COMMUNITY DEVELOPMENT AND SERVICES'60 o
r Otto .•. O
F 9
HEALTH DEPARTMENT
27 CHARLES STREET"°.• ter'
NORTH ANDOVER, MASSACHUSETTS 01845 'SSwawgtt
Susan Y. Sawyer 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
December 17, 2004
Diana Kiesel
1491 Turnpike Street
North Andover, MA 01845
RE: Subsurface Sewage Disposal System Plan for 1491 Turnpike Street, Map 107113, Parcel 68, North
Andover, Massachusetts
Dear Ms. Kiesel,
The North Andover Board of Health has completed the review of the septic system design plans, for the above
referenced property, submitted on your behalf by New England Engineering Services dated November 22, 2004.
The design has been approved for use in the construction of a replacement onsite septic system. This approval is
valid for three years from the date of this letter and during this time a licensed septic system installer must
obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer,
designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years
from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. In the
event an imminent health problem such as sewage backup into the dwelling is occurring, the time period for which
this plan is valid may be reduced by the North Andover Board of Health.
At a Board of Health meeting held on December 9, 2004 the application was approved for the following Title V
Variance:
"A Motion was made by Ms. Barczak and seconded by Dr. Trowbridge to "Allow for the use of a
sieve analysis to determine loading rate as outlined by DEP Policy #BRP/DWM/PeP-P00-4 in lieu of
percolation testing."
At a Board of Health meeting held on December 9, 2004, the application was approved for the following Local
Bylaw Variances:
"A Motion was. made by Ms. Barczak and seconded by Dr. Trowbridge to allow:"
1. Reduction in offset distance between a leach bed and a wetland from 100 feet to 29 feet.
2. Reduction in offset distance between a septic tank and pump chamber and a wetland from
75 feet to 22 feet.
At a Board of Health meeting held on December 9, 2004, the application was approved for the following Local
Upgrade Approvals:
"A Motion was mde by Ms. Barczak and seconded by Dr. Trowbridge to allow:"
1. Reduction in the offset distance between a leach bed and a wetland from 50 feet required by
Title 5 section 15.211(1) to 29 feet.
2. Reduction in the offset distance between a septic tank and a wetland from 50 feet required
by Title 5 section 15.211(1) to 22 feet.
3. Reduction in the offset distance between a pump chamber and a wetland from 50 feet
required by Title 5 section 15.211(1) to 22 feet.
O Q
4. Reduction in the offset distance between a leach bed and a foundation wall from 20 feet
required by Title 5 section 15.211(1) to 12 feet.
5. Reduction in the offset distance between aseptic tank and a foundation wall from 10 feet
required by Title 5 section 15.211(1) to 5 feet.
6. Reduction in the offset distance between a pump chamber and a foundation wall from 10 feet
required by Title 5 section 15.211(1) to 5 feet.
With the granting of the upgrades and variances, a deed restriction must be placed on the property, which limits the
maximum number of bedrooms of this dwelling to three bedrooms (or a maximum 7 room home). The applicant
must submit proof of recording, prior to the issuance of a Certificate of Compliance by the health department. This
restriction shall remain on the property until such time that the dwelling is connected to a municipal sanitary sewer
system and the soil absorption system is properly abandoned.
This approval is subject to the following conditions:
'1. The attached DEP Form 9b must be submitted to the appropriate Regional Office of the Department of
Environmental Protection at One Winter Street, Boston MA by the propei1y owner.
2. If site conditions are found in the field to be different from those indicated on the design plan and/or
soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall
stop, and the applicant shall reapply for anew Disposal Systems Construction Permit (310 CMR
15.020(l)).
3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system
installer or other representative to ensure that all other state and municipal requirements are met. These
may include review by the Conservation Commission, Zoning Board, Planning Board, Building
Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System
Construction Permit shall not construe and/or imply compliance with any of the aforementioned
requirements.
Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health
Department may be reached at 978-688-9540 with any questions you might have.
Sincere ,
u an Y. Sawyer, RE,ZiS
ublic Health Director
cc: New England Engineering Services
File
I"
O O
Commonwealth of Massachusetts
City/Town of
Form 9A - Application for Local Upgrade Approval
�M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
Iocal.Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1), is not feasible.
310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
State
Street Address ,
State
Telephone Number
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Installation of subsurface sewage disposal system.
5. Type of Existing System:
❑ Privy ❑ Cesspool(s)
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
01845
Zip Code
® Conventional ❑ Other (describe below):
Application for Local Upgrade Approval* Page 1 of 4
A. Facility Information
Important:
When filling out
1. Facility Name and Address:
forms on the
computer, use
Diana Kiesel
only the tab key
Name
to move your
1491 Turnpike -Street
cursor - do not
_
Street Address
use the return
key.
North Andover
City/Town
r�
2. Owner Name and Address (if different from above):
Same as above _
elan
Name
City/Town
Zip Code
3. Type of Facility (check all that apply):
State
Street Address ,
State
Telephone Number
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Installation of subsurface sewage disposal system.
5. Type of Existing System:
❑ Privy ❑ Cesspool(s)
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
01845
Zip Code
® Conventional ❑ Other (describe below):
Application for Local Upgrade Approval* Page 1 of 4
O O
Commonwealth of Massachusetts
C ity/Town of
Form 9A - Application for Local Upgrade Approval
G^M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach Field
7. Design Flow per 310 CMR 15.203:
Design flow of existing system:
Design flow of proposed upgraded system
Design flow of facility:
B. Proposed Upgrade of System
unknown
gpd
330 _
gpd
n/a _
gpd
1. Proposed upgrade is (check one):
❑ Voluntary ❑ Required by order, letter, etc. (attach copy)
® Required following inspection pursuant to 310 CMR 15.301:
2. Describe the proposed upgrade to the system:
3. Local Upgrade Approval is requested for (check all that apply):
® Reduction in setback(s) — describe reductions:
unknown
date of inspection
1. Reduction in offset distance between the leach bed and a wetlands from 100 feet required to 29 feet.
2. Reduction in offset distance between the septic tank and pump chamber and a wetlands from 75 feet
required to 22 feet.
❑ Reduction in SAS area of up to 25%:
SAS size, sq. ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction
Percolation rate
Depth to groundwater
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
ft.
min./inch
ft.
Application for Local Upgrade Approval* Page 2 of 4
0 0
c Commonwealth of Massachusetts
C ity/Town of
Form 9A - Application for Local Upgrade Approval
'M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Other requirements of 310 CMR 15.000 that cannot be met — describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1j. The soil evaluator must be a member
or agent of the local approving authority.
High groundwater evaluation determined by:
Andrew McBrearty
Evaluator's Name (type or print) Signature
C. Explanation
10/28/04
Date of evaluation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
No other location available on the lot for the system size reauired.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
Cost of alternative system is prohibitive.
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
Application for Local Upgrade Approval* Page 3 of 4
i
Q
Commonwealth of Massachusetts
City/Town of
W Form 9A - Application for Local Upgrade Approval
/M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
4. Connection to a public sewer is not feasible:
Town sewer is not in the area of the property.
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
❑ Complete plans and specifications
❑ Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other (List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
_ _ j 11/23/04
Facility ner's Sgnat Date
Benjamin C. Osgo d, Jr. (Agent for owner)
Print Name
New England Engineering Services
Name of Preparer
60 Beechwood Drive
Preparer's address
MA 01845
State/ZIP Code
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
11/23/04
Date
North Andover
City/Town
(978) 686-1768
Telephone
Application for Local Upgrade Approval, Page 4 of 4
i� 0
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 913
M
DEP has provided this form for use by local .Boards of Health if they choose to do so
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
A. Facility Information
1. Facility Name and Address
Diana Kiesel
Name
1491 Turnpike Street_
Street Address
North Andover
City/Town
2. Owner Name and Address (if different from above):
Same as above
Name
City/Town
Zip Code
3. Type of Facility (check all that apply):
® Residential ❑ Institutional
4. Desigri flow per 310 CMR 15.203:
5. System Designer:
60 Beechwood Drive
Address
M
State
Street Address
State
Telephone Number
❑ Commercial ❑ School
330
01845
Zip Code
gpd
Benjamin C. Os og od, Jr.__ ® PE
Name
North Andover _ _ MA 01845__
City/Town State, ZIP
B. Approval
1. Local Upgrade Approval is granted for:
® Reduction in setback(s) — specify:
❑ RS
1. Reduction in offset distance between the leach bed and a wetlands from 100 feet required to 29 feet.
2. Reduction in offset distance between the septic tank and pump chamber and a wetlands from 75 feet
required to 22 feet.
❑ Reduction in SAS area of up to 25%:
SAS size, sq. ft. % reduction
805 t5form9b 1491 Turnpike Street, North Andover • rev. 5/02 Local Upgrade Approval* Page 1 of 2
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction
Percolation rate
Depth to groundwater
❑ Relocation of water supply well (explain):
ft.
min./inch
III
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
. T--- !C. 2. tt —.
List variances granted requiring DEP approval:
Approving Authority
Print or Type Name a d Title Signa t Date
805 t5form9b 1491 Turnpike Street, North Andover • rev. 5/02 Local Upgrade Approval, Page 2 of 2
NEW ENGLAND ENGINEERING SERVICES
INC
November 24, 2004
Susan Sawyer
North Andover Board of Health
27 Charles Street
North Andover, MA 01845
Re: 1491 Turnpike Street, North Andover
Septic System Design
Dear Susan,
'IV 2 4 2004
TOWN EAT H D P RTMENVER
T
The attached document was not included in the initial design submittal on 11/23/04 for
the above referenced property. We apologize for the oversight and respectfully submit the
following document to be included with the initial design submittal for the
aforementioned property.
Attached Document:
- Sieve analysis for 1491 Turnpike Street
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
Steven E. Pouliot
Project Manager
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
A,
Town of North Andover
HEALTH DEPARTMENT
27 Charles Street
North Andover, MA 01845
978.688.9540
healthderWownofnorthandoven com
NOV 2 3 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SEPTIC PLAN SUBMITTAL FORM
DATE OF SUBMISSION: No%le-m&r a 3 , o?00`f
SITE LOCATION: T rnrn he St feel'
ENGINEER:
MCA
NEW PLANS: YES $225.00/Plan Check #:
(Includes 1 E and one Re -Review Only)
REVISED PLANS: YES
S 75.00/Plan
Check #:
SITE EVALUATION FORMS INCLUDED: YES NO
LOCAL UPGRADE FORM INCLUDED: YES NO
Telephone #:_ 679�(,$(,- �]�8 Fax #: 78)S -�
E-mail:_ _n Cam
HOMEOWNER NAME: D�ftr K t e -Se
OFFICE USE ONLY
When the submission is complete (including check):
1. 1/ Date stamp plans and letter
2. Complete and attach Receipt
3. �^ lCopy File; Forward to Consultant
4. /y Enter on Log Sheet and Database
V
s
NEW ENGLAND ENGINEERING SERVICES
INC
November 23, 2004
Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845
Re: 1491 Turnpike Street, North Andover
Local Bylaw Variance Request
Dear Susan:
Fiz2CEIVED
NOV 2 3 2004
TO��h! Or tIORTH ANDOVER
HEALTH DEPART
The purpose of this letter is to request that the above referenced property be included in
the upcoming Board of Health meeting agenda to discuss the following variances.
Local Bylaw Variances Required:
Reduction in offset distance between the leach bed and a wetland from 100 feet
required to 29 feet.
Reduction in offset distance between the septic tank and pump chamber to a wetland
frons 75 feet required to 22 feet.
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
Thomas K.ector
Project Engineer
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
a o
NEW ENGLAND ENGINEERING SERVICES
INC
November 23, 2004
Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845
Re: 1491 Turnpike Street, North Andover
Septic System Design Submittal
Dear Susan:
NOV 2 3 2004
TOWN
HEAOF LTH ORTH TER
The following plans and enclosures for the above referenced property are being submitted
for approval.
1. (3) Copies of the Septic System Design Plans.
2. (1) Copy of Form 11 -Soil Evaluation Sheets.
3. (1) Copy of Septic Plan Submittal Form.
4. (1) Check for payment of the Town approval fee.
5. (1) Copy of Local Bylaw Variance Request.
6. (1) Copy of Local Upgrade Approval Form 9-A
7. (1) Copy of Local Approval Form 9-13
If you have any comments or questions please do not hesitate to contact this office.
Sincerely,
—/—z' 141 --
Thomas K. Hector
Project Engineer
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
NEW ENGLAND ENGINEERING SERVICES
INC
December 1, 2004
Susan Sawyer
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845
Re: 1491 Turnpike Street, North Andover
Septic System repair design
Dear Susan:
VECjNIED
DEC 0 12004
TOREH
N T,DE -f NT ANDOVERORTH
Please accept this letter as a request to be included on the December 9, 2004 Board of
Health agenda to consider variances and local upgrade approvals required for the above
referenced septic system repair design. The specific variances and local upgrade
approvals are as follows.
LOCAL UPGRADE APPROVALS REQUIRED
1. Reduction in the offset distance between a leach bed and a wetland from 50 feet
required by Title 5 section 15.211(1) to 29 feet.
2. Reduction in the offset distance between a septic tank and a wetland from 50 feet
required by Title 5 section 15.211(1) to 22 feet
3. Reduction in the offset distance between a pump chamber and a wetland from 50
feet required by Title 5 section 15.211(1) to 22 feet
4. Reduction in the offset distance between a leach bed and a foundation wall from
20 feet required by Title 5 section 15.211(1) to 12 feet
5. Reduction in the offset distance between a septic tank and a foundation wall from
10 feet required by Title 5 section 15.211(1) to 5 feet
6. Reduction in the offset distance between a pump chamber and a foundation wall
from 10 feet required by Title 5 section 15.211(1) to 5 feet
LOCAL BYLAW VARIANCES REQUIRED
1. Reduction in offset distance between a leach bed and a wetland from 100 feet to
29 feet.
2. Reduction in offset distance between a septic tank and a wetland from 75 feet to
22 feet.
3. Reduction in offset distance between a pump chamber and a wetland from 75 feet
to 22 feet.
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
TITLE 5 VARIANCES REQUIRED
1. Allow the use of a laboratory textural analysis (sieve analysis) as outlined by DEP
policy # BRP/DWM/PeP-P00-4 in lieu of a percolation test to determine the
loading rate of the soil.
Pursuant to our conversation the abutter notification has already been sent. A copy of the
notice and the certified mail receipts are attached herewith.
If you have any questions, or need additional information, please do not hesitate to
contact this office.
Sincerely,
b-2 C 0��L
Benjamin C. Osgood, Jr., P.E.
President
PUBLIC NOTICE
PUBLIC HEARING
Public notice is hereby being given to the abutters of 1491 Turnpike Street, North
Andover, MA regarding the request of Diane Kiesel for approval of Variances to the
requirements of Title 5, the state law governing the installation of septic systems. The
following Variance is being requested:
TITLE 5 VARIANCES
1. Allow the use laboratory textural analysis (sieve analysis) as outlined by DEP
Policy #BRP/DWM/PeP-P00-4 in lieu of a percolation test to determine the
loading rate of the soil.
LOCAL BYLAW VARIANCES
1. Reduction in offset distance between a leach bed and a wetland from 100 feet to
29 feet.
2. Reduction in offset distance between a septic tank and pump chamber and a
wetland from 75 feet to 22 feet.
LOCAL UPGRADE APPROVAL
1. Reduction in offset distance between a leach bed and a foundation wall from 20
feet required by Title 5, Section 15.211 (1) to 12 feet.
2. Reduction in offset distance between a septic tank and pump chamber and a
foundation wall from 10 feet required by Title 5, Section 15.211 (1) to 5 feet.
3. Reduction in offset distance between a leach bed and a wetland from 50 feet
required by Title 5, Section 15.211 (1) to 29 feet.
4. Reduction in offset distance between a septic tank and pump chamber and a
wetland from 25 feet required by Title 5, Section 15.211 (1) to 22 feet.
The North Andover Board of Health will hold a public hearing regarding this request in
Thursday, December 9, 2004 at 7:00 PM at the Department of Community Development
building conference room located at 400 Osgood Street, North Andover, MA. If you
have questions regarding this hearing, you may contact the North Andover Board of
Health at (978) 688-9540, or contact New England Engineering Services, Inc. at (978)
686-1768.
Ln
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rq Postage $ 0.37 UNIT IN 0630
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C3Return Reciept Fee Postmark
(Endorsement Required) 1.75
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M
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C3 JOHN JACOBSON
vrPc 30 EAST PASTURE CIRCLE
NORTH ANDOVER, MA 01845 �------�-=
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Postage $ 0.
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0 (Endorsement R R t Fee
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r-1,Clerk: KKSWG
Total Postage &Fees �
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MA 01844
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Sent Tc WILLIAM PICKETT, JR
t� sveeti' 90 BOSTON STREET--
orPol NORTH ANDOVER, MA 01845
City, Si -
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Sent Tc WILLIAM PICKETT, JR
t� sveeti' 90 BOSTON STREET--
orPol NORTH ANDOVER, MA 01845
City, Si -
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BENJAMIN FARNUM
r-
397 FARNUM STREET
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NORTH ANDOVER, MA 01845 '"`-----------
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11/30/04
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106 BOSTON STREET
ANDOVER, MA 01845
.................
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ARLENE COLLINS
N
----------------
1515 TURNPIKE STREET
NORTH ANDOVER, MA 01845 ---
t
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
tab
O
Commonwealth of Massachusetts
City/Town of
Form 9A - Application for Local
C
Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1), is not feasible.
310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
1. Facility Name and Address:
Diana Kies_el _
Name
1491 Turnpike Street
Street Address
North Andover
City/Town
2. Owner Name and Address (if different from above):
Same as above _
Name
City/Town
Zip Code
3. Type of Facility (check all that apply):
MA
State
Street Address
State
Telephone Number
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Installation of subsurface sewage disposal system.
5. Type of Existing System:
01845
Zip Code
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below):
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
Application for Local Upgrade Approval* Page 1 of 4
FA
o 0
Commonwealth of Massachusetts
City/Town of
W Form 9A - Application for Local Upgrade Approval
LSM
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach Field
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: unknown
gpd
Design flow of proposed upgraded system 330
gpd
Design flow of facility: n/agpd —
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
❑ Voluntary ❑ Required by order, letter, etc. (attach copy)
® Required following inspection pursuant to 310 CMR 15.301
2. Describe the proposed upgrade to the system:
3. Local Upgrade Approval is requested for (check all that apply):
® Reduction in setback(s) — describe reductions.-
1.
eductions:
unknown
date of inspection
1. Reduction in offset distance between the leach bed and a wetlands from 100 feet required to 29 feet.
2. Reduction in offset distance between the septic tank and pump chamber and a wetlands from 75 feet
required to 22 feet.
❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction
Percolation rate
Depth to groundwater
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
10
min./inch
ft.
Application for Local Upgrade Approval* Page 2 of 4
O
Commonwealth of Massachusetts
City/Town of
w Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Other requirements of 310 CMR 15.000 that cannot be met — describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member
or agent of the local approving authority.
High groundwater evaluation determined by:
Andrew McBrearty
Evaluator's Name (type or print) Signature
C. Explanation
10/28/04
Date of evaluation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
No other location available on the lot for the system size reauired.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
Cost of alternative system is prohibitive.
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
Application for Local Upgrade Approval* Page 3 of 4
A�
d
Commonwealth of Massachusetts
City/Town of
Form 9A - Application for Local
E6
Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
4. Connection to a public sewer is not feasible:
Town sewer is not in the area of the grooe
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
❑ Complete plans and specifications
❑ Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other (List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
Facility ner's Signat
Benjamin C. Osgo d, Jr. (Agent for owner)
Print Name
New England Engineering Services
Name of Preparer
60 Beechwood Drive
Preparer's address
MA 01845
State/ZIP Code
805 t5form9a-Application for Local Upgrade Approval 1491 Turnpike
Street • rev. 5/02
11/23/04
Date
11/23/04
Date
North Andover
City/Town
(978) 686-1768
Telephone
Application for Local Upgrade Approval* Page 4 of 4
R
DATE: 9 - 2°t - OL{
LOCATION OF SOIL TESTS:
BOARD OF HEAL -I a)
NORTH ANDOVER, MASS. 01845
978-688-9540
APPLICATION FOR SOIL TESTS
MAP & PARCEL: 10 -1 R ---- .G 8
OWNER: AL -e-& F -DiAmA KiEsEL TEL. NO.: cf76- C,65'- 3629
ADDRESS: /y`9/ 7-UAVp,(4- Srm�e-T'
ENGINEER: 11IEVj EW --A (hcWf'L(FTEL. NO.: 979 - 6SCo-17(ba
CERTIFIED SOIL EVALUATOR: &NTAK K G or'c?wp 7e! Riamim
Intended use of land: Residential Subdivision Single Family Home Commercial`
Is This:
Repair testing ✓ Undeveloped lot testing
In the Lake Cochichewick Watershed? Yes
Upgrade for addition
No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests)
2. Plot plan
3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests
required for each disposal area. Fee of $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing 0
location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval:
Date Received: Check Amount: Check Date:
Ise
At/p, JV
0 0
N
Wpm
�34131�-I!Z���
1 1491 TURNPIKE STREET
ASSESSORS MAP 107B, PARCEL 68
139 50,200 SQ FT
0
0
Wpp/Oq
WFN
0
Soil and Plant Nutrient Testing Lab
West Experiment Station
University of Massachusetts
Amherst, MA 01003
413.545.2311
http://www.umass.edu/plsoils/soiltest
TEXTURAL ANALYSIS RESULTS
Customer Name: New England Engineering Services
11/09/04
RECEIVED
NOV 2 4 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
COMMENTS:
Ben Osgood
60 Beechwood Dr
North Andover, MA 01845
Sample ID:
60321
Customer Designation:
1491 Turnpike St
N. Andover
` USDA SIZE FRACTIONS
PERCENT OF
WHOLE -SAMPLE
PASSING
Main Fractions
Size (mm) Percent
Size (mm)
Sieve #
Sand
0.05-2.0 66.5
Silt
0.002-0.05 30.6
Clay
< 0.002 2.9
Total
< 2.0 100.0
2.00
#10
74.7
Sand Fractions
Size (mm) Percent
1.00
#18
69.7
0.50
#35
63.1
Very Coarse
1.0-2.0 6.7
Coarse
0.5-1.0 8.8
0.25
#60
53.7
Medium
0.25-0.5 12.6
Fine
0.10-0.25 21.3
0.10
#140
37.8
Very Fine
0.05-0.10 17.2
0.05
#270
25.0
66.5
0.02
20 um
13.2
}.
0.005
5 um
5.3
Silt Fractions
Size (mm) Percent
0.002
2 um
2.2
F,. Coarse
0.02-0.05 15.8
Medium
0.005-0.02 10.6
Fine
0.002-0.005 4.2
30.6
COMMENTS:
OPage 1 of 1
Dellechiaie, Pamela
From: Dan Ottenheimer [info@millriverconsulting.com]
Sent: Tuesday, October 12, 2004 12:45 PM
To: amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; Susan Sawyer
Cc: 'Lisa LaVasseur'
Subject: soils
Sue and Pam,
We are set for soil testing on 10/27 at 1101 Turnpike and 80 Patton Lane, ad 10/2=1491Tumpike:.)
Dan --
>Alfll Rivier,,--1
consuItin \
Daniel Ottenheimer, President
Mill River Consulting
Septic System Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting.com
danomillriverconsulting com
10/12/2004
Location Address or Lot No. -7vrr 12�ke Stre.0-i
Determination Lor Seasonal High -W ater Table
Method Used:
El Depth observed standing in observation hole ................. inches
❑ Depth weeping from side of observation hole ................... inches
Dep.th.to soil mottles V,*A" inches TPa4TP3
El Ground -water adjustment ................... feet
Index Well Number .................. Reading Date ................... Index well level ..................
............. Adjusted ground water level ................................
Adjustment factor ...... ........................
Depth of Naturally Occurring Pervious Material.
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? &.5
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on A], Mb (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 Date
DEP APPROVED FORM - 112/07195
No.
Date: 11
IRS
64
Commonwealth of Massachusetts
46A AJ.mo-r Massachusetts
-
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: .............. Date:
Witnessed By: ...
................................... ................
Location Address or 'ke- 6*ee+ 'e 6
wo If q I TorA I Owner's Num, j)iAA0- K el
A)OrVA lave-riA4A Address, and
Telephone I M I. Turq\lKe Street
Norte AjAdDver) ),Ak oigqs-
�ew Construction ❑ Repair
"I"LAZ X%rvlfzw
Published Soil Survey Available: No F! Yes
Year Published ....1.9 81. Publication Scale
Driainage Class WWI...... Soil Limitations ... . .................
.Surficial Geologic Report Available: No 4 Yes R
Year Published Publication Scale
Geologic Material (Map Unit) .......................................................................
Landform
..................................... ..................................................... .............. ..................
Flood Insurance Rate Map:
Above 500 year flood boundary No E]Yes k
Within 500 year flood boundary No E]Yes M
Within 100 year flood boundary No E]Yes El
Welland Area: . .
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Soil Map Unit
Current Water Resource Conditions (USGS): Month Oc4abar q00
rNZ6
Range :Above Normal PNormal E]Belc-iNormal EJ
Other References Reviewed:
aDEP APPROVED FORM - 12/07/95
;FORM 11 -S IL E�ALUA
TOR FORM
Page 2 of 3
Location Address or Lot No. l �}9/ /yrAp,}-
On-site Review
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (Triches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Gravel)
-1
�
►oyQ3/a
ala
ao'=air' ..
►by���8
6%b
v F lS
)OYR
67YRS s
Parent Material (geologic)-2%Depthto8edrock:
Depth to Groundwater: StandingWater in the Hole: �) `I
7 % Weeping from Pit Face: �$
Estimated Seasonal High Ground Water:___al/�
DEP APPROVED FORM - 12/07/95
0
Y; 4 ,FORM
IQ EVALU
ATOR I'ORM
Page 2 of 3
Location Address or Lot i4o. ! y9% lyr►1 nr k
On-site Review
P io i) UU °
Dee Hole Number ..::,,.:.::..:::: Date:...._:..,):...::: ,� Time:.::.%�Q Weather �F f._ .
Location (identify on site plan) ....:.: Cn1! '
:..::.:: :..:..:,::.::............:.::.v.. .
op ::
Land Use ,:..:..S.t . >!l.s.�:::.,:..::.......::. Slope Surface St ones....,�5 ::..:::....
. :.....::......:
Vegetation
Landform
Position on landscape (sketch on the back)....ac.`c.e..:,,..::.:...::...:..::::::.:::..:...:.::.....:.:..:.:..:.::.::::.:.::...:.:.:,,....:..;:.:...::.:..
Distances from:
Open Water Body J#49..0....., feet Drainage way.95P0--. feet
Po5sible'.Wet'Area•:::.3$........ feet Property Line .:: 75... feet
Deinking Water Well .: 1a:,.: -v . feet Other ..... , ......� .w k..
DEEP OBSERVATION HOLE LOG`
Depth from
Surface.(lriches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Gravel)
®�_ r�
F; ! 1
SL
JOYR aia
F
OyR31a
13w
1 :
10YR
Cl
18
5y61
t RY
5yb/a
Parent Material (geologic) _ A6144;;cn T; W; DepthtoBedrock:
Doth to Groundwater:'Standing Water in the Hole:� I
Weeping from Pit Face:
Estimated Seasonal High Ground Water:_, �l
DEP APPROVED FORM - 12/07/95
On-site Review
Deep Hole Number ..:: ::..::.: Date:...4m/o4 Time:. 549.10::. Weather r
Location (identify on site plan)
Land Use ..: !:.::.:,e...%1::::....:........:: Slope m , 37o... Surface Stones
Vegetation
Landform,.::.2�rle,:.:.....::.:._..:::.:.:..:..:.:..:...:::.....:....,::.::..........:.::.:::,::..:....:..:::::::::..:::::..:::::::.,.::::..:.::::.,.:.,.:................: .
Position on landscape (sketch on the back) .... �5.�c.,..::.::.......:::::::.:.::::::......:::....::
Distances from: ,
Open Water Body :1. :.::., feet Drainage way.c?Jr 0_— feet
Possible:We> Area :.:7.a.:......: feet Property Line .:.:biz.;..:.:., feet -
Dirinking Water Well:W feet Other
DEEP OBSERVATION HOLE LOG`
Depth from
Surface. (Inches) .
Soil Horizon
Soil Texture
(USDA) _
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, °k
Gravel)
SL
lom
:.SL
Io YR i
10 Y9
I
y8 9� -
a
SL
5Y
n..... nC\1uinru Hi cvcmT rnuruitu ulJ1'u,ALAKLA
Parent Material (geologic)Ad4+ m Ti I I DepthtoSedrock: �-
Depth to Groundwater: 'Standing Water in the Hole: Weeping from Pit Face:
' N
Estimated Seasonal High Ground Water.__ 3y.
DEP APPROVED FORM - 12/07/95
Town of North Andover, Massa( setts Form No.
NORTH BOARD OF HEALTH fJ%
q�0
r
�oAei?Eµ>Pa �0 APPLICATION FOR SITE TESTING/INSPECTION
Applicant_ I n aP-A
NAME ADDRESS TELEPHONE
Site Location % / a Cr
Engineer
NAME / ADDRESS J TELEPHONE
Test/Inspection Date and Time 1 . Cz,�l C� r ��J i 6� .
CHAIRMAN, BOARD OF HEALTH
,
Fees' Test N o. 7C�
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
I
BOARD OF HEALTH
0 0
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: Cl 11Q8 199 MAP & PARCEL:
LOCATION OF SOIL TESTS:
563
`�•I(5 4-74 O�9 CEJ
OWNER: �1.� 9, ()1 AN/-\ K t ��- TEL. NO.: 9-1 (3 - (08 J 3(y20 C 14
ADDRESS: J4q I iiJt2.N Pi t�G 5 i 61l® . 6� 00k-YZ
M��I NV�t,IL
ENGINEER: Pa,ia . ®rJltit�9-7,6-4-715-515,55-
1��,�1 • TEL.NO.:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision 'X gle Family Home Commercial
Repair Testing: V---" Undeveloped lot testing:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
Proof of land ownership Tax bill, or letter from owner permitting test)
2. Plot plan
3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or
Lipgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal
area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of
the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing: Yevv pFOR ANDOVER/
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted tort OR OF HEALTH
Board of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted. SEP 2 8 1999
Please Do Not Write Below This Line
N.A. Conservation Commission Approval:
Date Received: Check Amount: Check Date:
�717 IR
Town of North Andover,
BOARD (}FHEALTH
ED V6 // 6-
19��^�_
APPLICATION FOR SITE TESTING/INSPECTION
SS Arm
CHUS
NAME ADDRESS TELEPHONE
Engineer—
INAME ADDRESS TELEPHONE
_AIRMAN, BO-A-RDOF .^~^..
Fee Test No. �
S.S. PormitNo`--______]D.VY.0 No`__—_—__C]C. DatoP|bo' Permit No.
y73
„ ? Q
RECEIVED BOARD OF HEALTH TEL. 688-9540
MAY 1, 91999 NORTH ANDOVER, MASS. 01845
NORTH ANDOVER APPLICATION FOR SOIL TESTS
CONSERVATION CO SSION
DATE: 'v I4\1 0 q Cl
LOCATION OF SOIL TESTS:�� ��-1P11 SST
Assessors map & parcel number. rgP )Q2. t�! L T (v&
p�A1.1A► ��D
OWNER: TEL. NO.: 97S . (oBS, Sh29
ADDRESS:_ MMI TOWFI1C
ENGINEER: SCo(A� TEL. NO.: 075' 415' �5S x \Z
CERTIFIED SOIL EVALUATOR:
Intended use of land: residential subdivision, �Aes
commercial
Repair testing X Unde7;
N. A. Conservation Commission Approval: � Y ll'( /�
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 275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of $75.00 per lot for
repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to
the Board of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
91 -91 1TV 61 W4 6661 c� T('.tR'iJ iiF t1C)R "H �rs�oi Ri
MAY 19 1999
l
1616 /�V
Li
G �-,),, / ,2-
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,s-
G �-,),, / ,2-
7--� /
1
/•
T�
�-
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�N
�
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E
el XY
LOCATION: _ ` C�- j
ENGINEEF .:
BOH WITNESS:
sad„ _sem_
P✓�C0L"T10N TE ST
EO— OM DEF I OF PERC TEES -7
in OF G�
T iN1E SGr.K: _ %-(At I��s inuics Icrc)
l iiv'lE T _ 6
r
F
TIME
IME o7
C`'E=NICHT S01 -"K
ilivEE ST PI=u_
NIL
TME ,17
TIME AT
I
ToQI TP 5�
bg ids gopyp,3iC
DAIJV
'p -e
rcti a� 200. o