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Miscellaneous - 1925 SALEM STREET 4/30/2018 (2)
1925 SALEM STREET / 210/106.6-0013-0000.0 l 1 l� V 4 I I ` TOWN OF NORTH NDOVER " BOARD OF HEALTH Location S/V-5— � ��✓�/ `" Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing ✓ $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ / 7 6 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer 1Fj l• ?r:f,;�:i Vic,: �L'��, ` o91 p . a a �a✓i�6�r Dov .r�aJ/o✓fao,J Q j 1 O°� a p9�S ayf✓aPun koro✓ddfy � - 5� 6 s 9 -G'p, . � L G n X h'o6e�•�f/ /l7014-le%iilP 8. C'oinvXe// 34"27.07" w 69.00 77 • f �c c C . + PLAtq OF LAN � N 4b. NORTH ANDOVER M �Q % SURVEYED FdR� ff JOHN DONOHOE SCALE : I' = 40' MAY. 2 Y` •Q � DAt�iA F_ PERKiNS � S pq _ CIVIL EWGINEERS > SI .0 � Q �� lZEAbING MAS: 1-4 \ o cn •,�, LD ra 44, 639 N_ m .4,po,�oro/uwdel-1,ie Sa6d. LOT 1 �oaro/�o� not�cyuire� oQfP: � i es `e L , 160.00 70. 00 72 � 3Go 0 13� E tVL 5A L E tart: 1! O ' BUILDING PERMIT o* NORTH q 6 L 3� hLED.46 t TOWN OF NORTH ANDOVER - - APPLICATION FOR PLAN EXAMINATION Z � o ay Permit No#: Date Received �4DRAreD AC US Date Issued: IMPOCcRTANT:Applicant must,complete all items on this page a . LOCATION �7a( erm S4. A/A,&Aeuy-M. Q (8 y5 Print PROPERTY OWNER�o pS1� ���eCS yy���� Print 100 Year Structure yes no MAP PARCEL:If0/`J7" ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sew_er ESCRIPTION F WORK TO B PE FORMED: oyle c as r av\A lam:A e er ;,i S are Amo It k hAI-6-r r�lecl��4 ithbev t 9"41.6.age Identification- Please Type or Print Clearly OWNER: Name:�o 6 gh F;��e�s Phone: 97$-V9:9-5417y Address: AJr.,,, O S Contractor Name: eaa ,x1r ,<kJgr Phone: 3778 -9'W6659 Email: L-C . Address: t J5C.L JJc.rS{: /e•�� Moi. at8�/3 Supervisor's Construction License: C. e5 Iftj Exp. Date: a7 Home Improvement License: Exp. Date: a3 oZ01 -7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /c�. 9 72 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SiamtUr of Agent/Owner � �� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ TanningrmassageBody Art ❑ swi n ning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANK & DEVELOPMENT Reviewed On Signature_ CO ENT ONSERVATION Reviewed on S Si nature l" COMMENTS 4� 6�bb T41(A i v HEALTH Reviewed on Si nature COMMENTS / i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer ConnectioniSignature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Tem .)4?L mpster on site„ eyes;.__ Located}at 12,4�Mair�CqrC # Hire0epartment::signa#ure/date COMMENTS, v i North Andover MIMAP July 20, 2015 r w r i e.` . ♦ ti r =a+ _ �a :F JA 3 ,r 6. Interstates —I —SR Hodmmal Datum:MA Stateplane Coordinate System,Datum NAD83, -- Roads Meters Data Sources:The data for this map was produced by Merrimack NORTN Valley Planning Commission(MVPC)using data provided by the Town of t Easements Of t`ip q� North Andover.Additional data provided by the Executive Office of 0 MVPC Boundary ? 4�S re�s OO Environmental Affairs/MassGIS.The information depicted on this map is -'. Parcels 3 L for planning purposes only.It may not be adequate for legal boundary O to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION ,SSACl1U5�t 1"=45 ft ^�° 1 f3 A�Plr MORS 5263 �O 9 • Town of North Andover ' HEALTH DEPARTMENT ,SSACHUSt� CHECK#: DAT LOCATION: H/O NAME: J CONTRACTOR NAME: Type of Permit or License:(Check box ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑Ztitl'e Inspector $___tel Report $_-50. // ❑ Other. (Indicate) $ eaith Agent Initials White-Applicant Yellow-Health Pink-Treasurer COMM • ONWEALTH OF MASSACHUSETTS EXECUTIVE.OFFICE OF ENVIRON , AD�PAI��IVTO��ENVIRO �� ' . NNiEN1'AL:FRO.TE.CTIOh TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SySTEM FORM PART A CERTIFICATION Property Address- /FCPSf 50J64%- / ee-r Al Owner's Name: ..� JAN �-4 ZU11 Owner's Address: S.A-t TOWN � Date of Inspection: 7HM1L7 I A Name of inspector. (ple�ase�print Company Name: F Mailing.Address: tod _ L Te'lepbone Number:j 5 t�7 CQ CERTIFICATION STATEMENT J ceitify 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit a copy of this insp c on 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 l 0.000 gpd or erecter,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. Tiftt 5 tncnectinn Fnrm �/t ennnn ____ , Page 2 of 11. OF14CIAL YNSFrCTION-FORM—NOT.FOR y:OL,UNTARY ASS19S SIJBSbgFi ACE•S�(;E`DISPOSAL:SVSiiM INSPECTION FORK PART A CERTIFICATION (continued) Property Address:/ Z .c'. Lt Owner. 0-4-VU VSA-t�A Date of Inspection: Inspection Summary:. Check A,B,C,D or.E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 3,10.CMR 15.303 or.in 310 CMR 15.304 exist.Any failure criteria not,evaluatedareindicated 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,ho or not�detetntined(Y,N,ND)in the for the following statements.If"not determined"please - explain. The septic tank is me d over 20 years old* or the.septic tank' whether metal or not is structurally . eP ( ) aurally unsound, exhibits,substantial,infiliiration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a comp)y g septic tank as approved by the Board of Health. = •A metal septic tank will pass inspection it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years is available. ND explain: Observation of sewage backup or break out or hi static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven dis \reped will pass inspection if(with- approval of Board of Health): broken pipe(s)are repla obstruction is removed distribution box is level ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipc(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 I I OFFICIAL INSPECTION FORM-.NOT'FQg STAVOLV ., AR. A$SES 1l ri'I'S ..SUBIREB`SEVKAG I3ISFOA�;;ST'STE1I INSPECTION FORM A CERTIFICATION,(continued) Property Address: Owner: CAV, A A h Date of inspection: — C. Further Evaluation is Required by the Board of Health: Conditio eacut which require further evaluation by the Boatd of Health id order t is failing to protect public safetyor.the:envitoi»tttnt. ' o detemtiAe.if the systtm 1. System will pass unless Board of determines in accordance witb,310 CMR 15,303 J b that the syst4m:is not functionin$,itt amanner w will rote public tiealt (. )( P P 4 satety and the environment: _ Cesspool or privy is within SO feet of a surface r Cosspool.or privy is witliirt SO feet of a bordering ve rated wetland or a salt marsh Z Syste will fail unless the Board,of Health(and Public Water Supplier,if any)determines that system is ;fu ' ing in a manner that protects the public be9ltb,safety-and environment: the The system* tic tank-, soil abso tion surface water.supply or tP system(SAS),and the SAS is within 100 feet of a. ruPP y , to,.a surface.water supply. The system has a septic tank an S and the SAS is within a Zone 1 of a public watersupe y I , The system has a Septic tank eP and SA Sart a SAS is within SO feet of a private water supply well: The system has a septic tank and SAS and the SA * less than 100 feet but SO feet or more from a, private.water supply well••..Method.used to determine dig ce "This system passes if the well water analysis,performed at a D certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free om pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less t S ppm, provided that no.other failure criteria are triggered. A copy of the analysis must be attached to ibis 3. Other: Page 4 of I I - - J ©rte NQ-f0RVOLIJN;�ARY48ASS ITS 5fJBSU 'A E"Stw-AGE DISPOSAL SYSTEM INSPECTION FORM PART A� CEP-TMCATION(continued) Property Address: cJ Owner. MA ^A- Date of Inspection: —-6 /c> D. System Failure Criteria applicable to all:systems;. You:ilius indicate'yes"or`no"to each of the following for all inspections:. Yes No Backup of tewage into facility or system component due.to°overloaded ortlog=ed SAS"or cesspool — Discharge`or ponding ofeffluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than V2 day now Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped - Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within,.1 00,fe.et-of a surface watersupply,or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 341feet.of a private water supply well. Any portion of a cesspool or privy is,less d"n:l01feet::but,greeiterthan 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.tba4:5 ppm,provided that no other failure criteria \ are triggered.A copy of the analysis must be attached to this form.) /vU (Yes/No)The system fails. I have determinedthat 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 ' er"yes"or"no"to each of the following: (The following criteria pl to large systems in addition to the criteria above) yes no the system is within 400 feet surface drinking water supply _ the system is within 200 feet of a tribu w a surface drinking water supply — _ the system is located in a nitrogen sensitive (Interim Wellhead Protection Area– iWPA)or a mapped Zone I1 of a public water supply well If you have answered"yes"to any question in Section E the syste s considered a significant threat,or answered 'yes"in Section D above the large system has failed.The owner or rator 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 S of 1 I. ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSSS SUBSLTLtFAC9 SEWAGE-DISROSAL.SYS'FENi'INSPE'CTON'FOR M. CHECKLIST Property Address: ct v<-".:- Owner: Date of Inspection: . Z'tA k4 At-"Aztla- Check if the following have been done. You must indicate`wes"o ~ r"no as to each of the followihL,: Yes No Pumping information was provided by the owner,occupant,or Board of Health _ Were any of the system components pumped out in the previous two weeks ? _ Has the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or,as part ofthis inspection? Were as built plans of the system obtained and examined?(If they were not available note as / N A) — Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? -, Were all system components,excluding the SAS,located on site.? _ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition ofthe baffles or tees,material of construction, dimensions,depth ofliquid.p tqutd,depth of sludge and depth of scum? KI _ 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 dctermined based on: Yes no Existing information.For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)) 5 Page 6 of l t 1bWCL44,'INSPP ,` CFIOI 'FT `FOR''VO ASSESSMENTS SUBSWACE SEWAGE-,DISP0SAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: l 10 gpd x#of bedrooms): Number of current residents: �'— Does residence have a,garbage grinder-(yes or no): Is laundry on a separate sewage system(yes or no):LV [if yes separate inspection required], Laundry system inspected(yes`or no): Seasonal use:(yes or no): Water meter readings,if a tlable(last?years usage(gpd)):A1 Sump pump(yes or no): Last date of occupancy: r�i ► ,,�(� COMM ERCIAL414DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15203): Bpd Basis of design flow(seats/persons/sgft.etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of.occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: �f�` .ei�✓L Was system.pumped as pan of the inspection(yes or no): l . If yes, volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _ivy —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 Uilstalled(if known)and source of information: Were sewage odors detected when arriving at the site (yes or no): /,-J Pagt,7 of I I. OFFICIAL INSPECTION FORN1- NOT.FOR VOLUNTARY ASSESSMENTS. SUBS' 5 ;.DIS 'fsSAYr. STE1V `INSPE CTION FORM - . .P T C SYSTEM INFORMATION(continued) Property Address:/9 Z S—,S + Owner. G1 Date of Inspection: /'J—jQ �-fp BUILDING SERVER(locate on site plan) Depth below grade: _ Materials of construction:1(,.cast iron _40 PVC. other(explain): Distance from private watersi 1 pp y WCII Or SLCtlb11 iIhe: •--�. Comments(on condition,of joints,venting, evidence of lA 11 eakage. SEPTIC TANK: (�(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene —other(explain) — — If tank is metal list age:_ Is age confirmed by a Certificate of Com !lance certificate) P (yes or no):—(attach a copy of Dimensions; �x ' Sludge depth. ---- Distance'from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: r e�„e' Distance from top of scum Distance from bottom of scto top of outlet tee or baffle: um to bottom of outlet tee or baffle: / 6 How were dimensions determined: Comments(on pumping recommendations.inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet in en, evidence of,leakage,etc�r JtA .4 GREASE TRA :—(locate on site plan) Depth below grade: Material of construction;_concrete metal (explain): _fiberglass__palvethylene_other — Dimensions: Scum thickness: Distance from top of of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or-baffle condition,structural integrity, liquid levels as related to outlet invest,evidence of leakage, etc_): Page 8 of I 1 S O TC A�:INSPECTION PO N(,��'�b��OLU�TA��ASSESSMENTS SbBSiRFACEiA E DISI.O9-AI:`SY�TEM`INSpECTION FORM ''PART C SYSTEM INFORMATION(continued[' Property Address•[ 's 44'e,," S7— owner'. TOwner: DOA A4*—A fi—✓e. Date of inspection: 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: (if present must be openedxlocate on site plan) Depth of liquid level above outlet invert: d 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 .) e PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): r Page 9 of I I. OFFICFAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSI E.�,--rS S IBSVR'FACE:S1DWAG- DISFOSA�I SY `INspteTnOIy.FORM SYSTEM INFORMATION(continued). Property Address: Owner i T. Date of inspection: ��v SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number leaching chambers,number. leaching galleries,number leaching trenches,number, length: leaching fields,number,dimensions: old d overflow cesspool,number innovativeialternative system Type!name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): 6 CESSPOOLS: (cesspool must be pumped as part of inspectionVocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids laver: Depth of scum laver. 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 106f I h , .O�C;��Ix �CTI©ILEO• 'RM�i�0;,��QRr;VO�UI��t7�ASS�.fiSMEhTS `33�SZ�tFACE SEWAGE D�SFQSAL SYSTEM INSPECTION.FORM . 'AIT-C SYSTEM INFORMATION(continued) Property Address: Z 4.z,. r" e• c Owner. y�Tw�-+I-�A- . Date of inspection: J,! 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 welts within 100 feet.Locate where public water supply enters the building.' Le gy -------------- -jr L Page 11 of 1 1. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMEN"TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.ti1 PART C SYSTEM INFORMATION(continued) Property Address: A)ZSR �'e,,.. 11� _ Owner. � Date of Inspection: _ Jt lei SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: I ' Obtained from system design plans on record-If checked,date of desi6i plan reviewed:. 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 t1owyou a tabli ed the high ground water elev t' �� l 2 S iv afi ►2 4t-l* u'A� O/L C17e v 1925 SALEMSTREET p78OJ16' JS-2004-0743 Project Detail Report Printed On:Mon Feb 02,2004 Project Name: a -7 GIS#: 6910 Project No: JS-2004-0743 Owner of Record BARRY,JAMES J&SHEILA Map: 1063 Date Submitted: Jan-30-2004 1925 SALEM STREET Block: 0013 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 1925 SALEM STREET Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description Soil Testing Comments: ofWork: Department Status I GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0034 2/2/04-Request for soil test mailed to Consultant. Testing is weather dependent. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Soil Testing-Repair BHP-2004-0207 Feb-02-2004 NEEDS REVIEW JS-2004-0743 Soil Testing GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 4 ���� �� "''�� 4 �v/ Page 1 of 1 f � R DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, February 05,2004 2:26 PM To: Heidi Griffin; Brian LaGrasse; pdellechiaie@townofnorthandover.com Subject: soil testing Due to the expected continued cold snap, we have re-scheduled soil testing for 1925 Salem Street to February 19 at 10:30 a.m. Dan F1 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 in_fo(&millriverconsulting.com f� Al r 2/5/2004 Page 1 of 1 I Z DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, February 04, 2004 9:24 AM To: Heidi Griffin; Brian LaGrasse; pdellechiaie@townofnorthandover.com Subject: 1925 Salem Street Soil testing for 1925 Salem Street is scheduled for Monday 2/9 at 10:30 a.m. Dan Daniel Ottenheimer, President 0 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.millriverconsultin_.com info@mi_llriverconsulting.com 2/4/2004 -North Andover Conservation Commission Site Inspection Sheet Dep File.#242- y does-not have permit with Conservation Commission Date: q Address: Iq 2 Sa - Agent/ReprEpentative/Owner present: �irhfal� �1Pnn«�► ��rnc� flfin� Cdr /1�/ICC_ l�t• ( +'r� � Findings: a S sv r k-,>1 fA n-oo dl �f y �� e a OF f�(�,,spBO BOARD OF HEALTH NORTH ANDOVER, MASS. 0184 JAN 3 Q 20 -, 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 1 3C) MAP&PARCEL: LOCATION OF SOIL TESTS: 1;Cj �£,, OWNER: :tc�P11F s J �&2�t TEL.NO.: ADDRESS: 19 c P ENGINEERAEL,v &•y.CrL.4 D N -1 r ) f�1(i- TEL.NO.: 278•L 6 G CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision mgle Family Ho Commercial. Is This: Repair testing X _ Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes. No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests. required for each disposal area. Fee of$360.00 per lot for repairs or u - p des. _ 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 representati 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health show location of all tests(including aborted tests). 7. Within 60 days.of testing soil evaluation forms shall be subnnitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: o s G'S 0 PLAI.4 OF LAKj :b NORTH AWC)OVep M Zpg 1 O 5upvEYE� F-olz, C,� 3 3OHN DOWOHOE �• U ry SCALE . 1"- 40 MAY. 2 V bA�.14 F PE:IRKINSS M CIVIL W*%I It.IEERS jS( •� n � �` QEA�ING MAS; ��► to v o .b, Ln o a a) N 44. 639 ro a m � � Apo�ovcr/under�/�� Sa6d, 0 L OL 7 Coo�i'o/lam not rc9� A-arA . /Vor�/� .9�oovo�•�'/or»ir�y Q l 50.00 9S.72Aw, , _ I� / ► ;: Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Monday, February 23, 2004 8:43 AM To: Susan Sawyer; Brian LaGrasse; 'Pamela Dellechiaie' Subject: 1925 Salem Street Sue, Brian and Pam, Attached please find the soil and percolation test results for the property at 1925 Salem Street. Shallow depth to refusal, dense till soil and a 46 minute per inch percolation rate make this a very challenging site. Dan 0 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 info@miliriverconsulting.com 3/30/2004 Y y i 9 i � t = '(7 -11 K-J Page 1 of 1 s DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, February 05, 2004 2:26 PM To: Heidi Griffin; Brian LaGrasse; pdellechiaie@townofnorthandover.com Subject: soil testing Due to the expected continued cold snap, we have re-scheduled soil testing for 1925 Salem Street to February 19 at 10:30 a.m. Dan Q 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.millriverconsuifing.com info@_millriverconsultin-g,com 3/30/2004 Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, February 04, 2004 9:24 AM To: Heidi Griffin; Brian LaGrasse; pdellechiaie@townofnorthandover.com Subject: 1925 Salem Street Soil testing for 1925 Salem Street is scheduled for Monday 2/9 at 10:30 a.m. Dan Daniel Ottenheimer, President 0 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 info@millriverconsulting.com 3/30/2004 -7Zt;q . ��,v - Z k.Plk dp OPT 9/1 dA low -qAn wo Im r re v, nF NORlriarvi BOARD OF HEALT11 BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 t JAN 3 0 2004 978-688-9540 APPLICATION FOR SOIL TESTS DATE: i o MAP&PARCEL: LOCATION OF SOIL TESTS: Iq 05- '-o k-,E,,,,,� OWNER:_ >c,MSS Jc 2 2H TEL.NO.: ADDRESS:_L.g_ZS- sem-e ffT-1 N6 /�- ENGINEER:MM tfy k,v GL,q+� jFN -t&2 FF,21 V 6_ TEL.NO.:-2 7 8- e 6-17 t, @) CERTIFIED SOIL EVALUATOR: R kc Ftf}"Z> Tcm ClhQ 5 2 Ay 0-c-Cao fl Intended use of land: Residential SubdivisionIngle Family Ro. Commercial Is This: Repair testing _ Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 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 th( 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: